The Pregnant Intern

by Carol Marinelli

  'Poor Josh,' Alice whispered, almost to herself. 'And poor Dianne,' she added. Although she had never met Dianne, her heart went out to this woman and the pain she must be feeling.

  'Obviously Josh will be taking some time off, which is going to mean more work for you, Alice.'

  'I'll be fine,' she said, her grey eyes brimming with tears. 'It kind of puts things into perspective, doesn't it?'

  Jeremy gave a brief nod. He wasn't going to be drawn into a deep discussion, but she could tell from his eyes that this news had shaken him, too.

  It was a rather subdued group that made their way quietly out of the office. Linda was breaking the news rather less tactfully to the anaesthetic registrar.

  'Which is just great. We've got the consultant just back from sick leave, the reg on annual leave, the resident on paternity leave and the intern about to go on maternity leave. I'm carrying the lot of them.'

  'That's what I like about you, Linda,' Jeremy said dryly, as the anaesthetic reg signalled a desperate look at Linda to stop. 'Your sense of team spirit.' And without a backward glance he made his way across to Lachlan Scott, leaving Linda spluttering her excuses to his departing back.

  Blinking back tears, Alice made her way down to A and E. How could it all have gone so terribly wrong? She remembered Josh's excited face just this morning. Oh, she knew things went wrong, that there were no guarantees of a perfect healthy baby, but why did it have to happen? And why to Josh and Dianne? It just wasn't fair.

  A and E was busy, but wasn't it always?

  'Hi, Alice.' Fay, the Unit Manager greeted her.

  'Hi, Fay. I didn't expect to see you. How come you're on nights?'

  'Don't ask.' Fay rolled her eyes. 'Given the fact that it's me who does the roster, I guess I've only got myself to blame. Anyway, it might be chaotic down here, but from a surgical point of view it's not too bad. There's just two for you to clerk in. Linda's seen them and ordered a few tests, but most can wait for the morning. As soon as you're done I can shift them up to the ward and free up a couple of trolleys.'

  Which was an extremely nice way of saying 'get on with it'.

  So she did, or at least she tried to, but no sooner had she clerked the first patient and was about to start with the second one than the sound of her pager signalled the end of her introduction to the patient.

  'I'm sorry, Mr West, I'll just have to answer this. I'll be back to clerk you, hopefully soon.'

  'No worries, love.'

  Dialing the number as she flicked through Mr West's medical history, she was surprised when Fi answered. Normally Fi held off from paging when she knew Alice was coming back. Something must be up.

  'I haven't forgotten the bloods, Fi. I've just got one more patient to clerk then I'll be up.'

  But that wasn't why Fi was ringing. 'I've already done your bloods, so don't worry about that. Look, Alice, I'm a bit worried about Lachlan Scott. Would you mind coming and having a look?'

  Alice didn't need to be asked twice. Ignoring the pained look from Fay, she made her way straight up to the ward.

  'Thanks,' Fi said when Alice arrived. 'Hopefully I'm worrying about nothing, but he just doesn't seem right to me.'

  'What are his obs doing?' Alice asked as they made the way to his bedside.

  'Nothing remarkable. His temp's normal and his blood pressure's a tiny bit low, but I guess that could be put down to his analgesia.'

  Lachlan Scott looked pretty much the same as when Alice had last seen him, maybe a little paler but nothing that would cause Alice too much concern. 'Lachlan, I'm just going to have a look at you,' Alice informed him, as Fi and Kate, the student nurse, helped her with the bedclothes. Lachlan gave a small nod.

  'How are you feeling, Lachlan?' Alice asked.

  'Tired.'

  'Are you in any pain?'

  Not bothering to open his eyes, Lachlan shook his head as Alice gently palpated his abdomen. Again there was no real change since the last time she'd seen him. Listening to his chest, she found the story was the same—nothing remarkable.

  But Fi was worried and Alice wasn't going to ignore the fact.

  Suddenly Lachlan opened his eyes. 'I should be in the library. I've got an exam in the morning.'

  Alice gave Fi a worried glance.

  'Lachlan, do you know where you are?' Fi asked urgently.

  Closing his eyes, Lachlan nodded.

  'Where, Lachlan?'

  'Melbourne City.' Which, of course, was the right answer, but his moment of confusion prompted Alice into action.

  'Do another set of obs and I'll ring Linda.'

  Linda was particularly unhelpful. 'So let me get this straight. His obs are fine, and you can't find anything wrong on examination. Exactly why are you calling me, Alice?'

  'Because the nursing staff are concerned—I'm concerned,' she said trying to sound confident. 'And, as I said, he's confused.'

  'Momentarily,' Linda pointed out, 'He's had major surgery, he's on a high dose of pethidine and you've just woken him up in the middle of the night. You said yourself he's orientated now. Look, Alice, I just had A and E on the telephone complaining there's still a patient waiting to be clerked. I'm stuck on Intensive Care with a sick patient and I've still got a list of patients to see on the wards. Now you're ringing to tell me a patient I reviewed an hour ago is in the exact same condition as when I left.'

  'I'd just like you to review him,' Alice said as evenly as she could. 'I'd really value your opinion,' she added tactfully.

  'When I get a moment,' was all Linda could offer.

  'Is she coming?' Fi asked as Alice replaced the receiver.

  'When she gets time.' Alice shrugged. 'What are his obs doing now?'

  'Not much change. His temp's down a bit further—it's 35.0 now.' Which was low. Not dangerously low, but low enough to set an alarm bell ringing in Alice's head.

  'He could be septic.'

  'But wouldn't his temperature be high then?' Kate asked.

  Alice shook her head. 'Not necessarily. Sometimes when the body's overwhelmed with infection a patient can actually become hypothermic.'

  Alice wasn't a brilliant doctor, she was the first to admit that. She had got into and through medical school by sheer hard work and diligence. But she was a good doctor, and she knew that, too. And part of being a good doctor involved listening. Fi, with her years of knowledge and experience, had called on her because she was worried, and now Alice was worried as well. She wrung her hands anxiously. 'I'd better ring Jeremy.' She looked at Fi for her reaction.

  'Good. I'll share the flak if it's nothing.'

  She had obviously woken him when she'd rung, and Jeremy listened without interruption as she relayed her findings.

  'What did Linda say?'

  'She's a bit busy at the moment. His temperature wasn't quite so low, though, when I spoke to her,' Alice said hesitantly. 'Maybe I should have called her back...'

  'Doesn't matter now. Look, take some gases and bloods, do some cultures as well, and I'll be straight in.'

  Alice, unsure whether her concern for the patient was entirely merited, was somewhat taken aback by how amenable he was being. 'I could ring Linda again,' she offered. 'Or call you back with the blood results. It could be nothing.'

  'Let's hope it is,' Jeremy said darkly. 'I'm on my way.'

  Linda wasn't all bad, and in fairness she did come over almost immediately. But Alice's relief at seeing her senior quickly vanished when Linda heard she had already contacted Jeremy.

  'You what? You just went ahead and called him? How dare you, without running it by me first?'

  Alice was trying to concentrate on finding a vein and didn't look up as she answered. 'I did run it by you first. I felt. Lachlan needed to be seen, and urgently. I knew how busy you were.'

  'So you went straight over my head?'

  Alice didn't reply; she was becoming increasingly worried about Lachlan now. His veins were proving extremely difficult to find, again a rather ominous sign in a young h
ealthy man.

  'It's not your responsibility to ring the consultant. You ring me and then / decide. It's not your concern...'

  Alice had heard enough. Rowing at a sick patient's bedside really wasn't her style. 'I'm paid to be concerned, Linda, and right now I'd appreciate your help in finding a vein. You can bawl me out later.'

  'Let's concentrate on the patient, shall we?' Jeremy's rich tones filled the room, and Linda immediately snapped to attention.

  'You got here quickly,' Fi said appreciatively.

  'I'm sleeping at the hospital tonight.'

  Alice's eyebrows shot up in surprise but she didn't say anything.

  In the short space of time it had taken Jeremy and Linda to arrive, it had become obvious that Lachlan was extremely unwell. He kept pulling off his oxygen mask, confused rantings coming from his mouth.

  'Linda, run over to ICU and get the gases done,' Jeremy said quickly. 'Fi, call a MET.'

  Fi nodded and turned to Kate. 'You do it. Tell them the room number and bring back the resusc trolley with you.'

  As the overhead chimes relayed their urgent message, Alice felt her adrenaline kick into overdrive. A medical emergency team was called when a patient was suffering a life-threatening incident. It was a relatively new innovation, and not practised at many hospitals, but it had on many occasions proved to be more than effective. Once the call was put out, the ICU anaesthetist, along with an ICU nurse and the on-call physicians, would make their way urgently to the patient's bedside to implement urgent intervention before the patient arrested. And though it was becoming increasingly obvious to Alice that Lachlan really was very sick, she was somewhat surprised at the dramatic measure Jeremy had taken.

  From then on Alice felt she was somewhat supernumerary as a multitude of staff and equipment appeared, all far more skilled and experienced at coping with emergencies than she was. Jeremy relayed the findings to the MET team as IV fluids were pumped into Lachlan's system and his oxygen concentration was turned up. The head of the bed had been removed by Fi to allow the anaesthetist more access to Lachlan's airway, and the patient was now attached to a cardiac monitor with a probe clipped onto his earlobe to continually measure his oxygen saturation.

  'Ring the lab, Alice, and ask them to step on his bloods,' Jeremy ordered, just as Linda returned breathlessly with his blood gas results.

  'We'll get him over to ICU,' the anaesthetist addressed Jeremy. 'We'll need to put in a central line and do the works, but hopefully the antibiotics will kick in soon. It's lucky we got to him in time. That was a good pick-up, Jeremy. Glad to have you back on board.'

  By the time Lachlan had been wheeled over to ICU it was a white, shaking Alice that stood in the empty room as Fi started to clear up the large mess that had been created. ICU wasn't Alice's domain. It was up to her to cover the rest of the wards.

  'That was close,' Fi said.

  'Very,' agreed Alice. 'He just seemed to go downhill so quickly.'

  Fi nodded. 'Young, fit ones often do that. They hold their vital signs stable until the last minute. By the time a young guy like that drops his BP you're often too late. I'm sure there's a far more technical way of explaining it, but I'll leave that for Jeremy to explain.'

  'Thanks, Fi, if it hadn't been for you...'

  'Don't sell yourself short. It took a lot of guts to ring Jeremy.'

  They both looked up simultaneously as Jeremy coughed, making his presence known.

  'I agree.'

  Alice didn't answer.

  'How's Lachlan?' Fi asked. 'Will he be going back to Theatre?'

  Jeremy shook his head. 'Not at this stage. He's had an ultrasound and it doesn't look as if there's a collection in his abdomen. He's septic from the infection, we think. Hopefully we can keep him going until the antibiotics kick in. His parents have arrived. I was wondering if you could come in with me, Fi?'

  Fi nodded. 'I'll take them down to the day room.'

  'You might as well head off to bed, Alice,' Jeremy said, without meeting her eyes.

  'I've still got a patient in A and E to clerk.'

  'Don't worry about that,' Jeremy said, rather too lightly. 'I've rung A and E and they're going to send him straight up—he can be clerked later. Linda's going to be up all night with me, anyway. I can tell her to head over here and do it when there's time. Is there anything else outstanding?'

  'Just some two a.m. bloods.' She glanced at her watch. 'Which are just about due.'

  'I'm sure Fi can help with that. If not, I'll come and do them.'

  'You?' Alice said rather ungraciously. Since when did a consultant offer to do an intern's two a.m. bloods? 'Are you sure?'

  'I'm sure I can handle it,' Jeremy said in his superior way, and then his tones softened. 'Let's say I owe you one.

  Linda, too, for that matter,' he added darkly. A ghost of a smile touched his lips. 'Go on, get some rest. You might even cram in a couple of hours' sleep.'

  It was then that Alice noticed how pale Jeremy looked. The night's events had obviously shaken him up as well.

  'Thanks, then,' she said gratefully. 'But call if you need me.'

  As she made her way out of the room Jeremy called her back.

  'Likewise, Alice. You call if you need me as well. I'll always listen.'

  Never had the thin, hard, on-call bed looked more tempting. Aching and exhausted, Alice slipped off her shoes and slowly lowered herself onto the mattress. Normally she slept on her stomach, but her ever-increasing size had meant that for the last few weeks she had been forced to sleep on her back or side, which inevitably meant most of the night was spent tossing and turning, trying to get comfortable. With a groan she placed her pager on the bedside table and flicked off the lamp, tucking a plastic-covered hospital pillow under her bump she rolled onto her side. A couple of hours sounded good from here. There was still a full day's work tomorrow to get through. Fancy Jeremy telling her to go to bed. Under normal circumstances she would have insisted she was fine, but Brett Halliday's warnings had hit home and she wasn't going to do anything to risk her health—too much depended on it. Anyway, given how the night's events had panned out, Linda probably did owe her one, Alice mused. Still, it had been extremely nice of Jeremy to pull rank and, in his own way, to thank her. But, then, that was how Jeremy had been all the time she had worked for him—extremely nice. Low as her expectations had been about his demeanour, he had surprised her. Drifting off into a deep sleep, her last conscious thoughts were of Jeremy, and as her subconscious kicked in, her dreams for once were not filled with Marcus and unborn babies, but a certain consultant with blond hair and a smile that set her heart racing.

  CHAPTER THREE

  'Good morning, Dr Masters, your six a.m. alarm call.'

  'But I didn't book one,' Alice replied, fuddled and confused. Flicking on the light, she reached for her watch, trying to orientate herself to her surroundings. With a jolt of panic she reached for her pager. 'Has anyone been trying to get hold of me?'

  'Not as far as I know,' the switchboard operator answered cheerfully. Replacing the receiver, Alice sat up slowly.

  'Good morning to you, too,' she said, as the baby let out a huge kick.

  Standing under the shower jets, Alice closed her eyes as the warm water slowly brought her around. Four solid hours' sleep on an on-call night was a luxury she hadn't even dared dream about. Thank goodness the switchboard operator had called, Alice thought. She was so tired she might have slept in until midday. Pulling on some fresh greens, she made her way down to the canteen, but the bleeping of her pager foiled any thought of lingering over a cooked breakfast. After purchasing a muesli bar and a coffee from the machine, she made her way over to the surgical unit.

  'Morning, Fi, how has it been?'

  Fi rolled her eyes. 'Let's just say I'm glad it's morning. Nothing for you to worry about, though,' Fi said quickly as Alice gave a concerned look. 'Just a couple of the old dears decided to go a-wandering. It must be a full moon. Anyway...' She grinned. 'You certainly
look a lot better. Did you have a good sleep?'

  'Marvellous. Luckily, switchboard gave me a wake-up call or I'd still be there now. You didn't book it by any chance?' Alice asked, but Fi shook her head.

  'Maybe Linda was having an attack of the guilts. She looked positively sheepish when she came over to do some bloods. I was going to page you to resite an IV and Linda even said that she'd do it—I nearly fainted with surprise. Who knows? Lachlan Scott going off like that might be just the jolt Linda needed to bring her back down to earth.'

  'Maybe,' Alice said, but she was far from convinced. Linda McFarlane might have had a bit of a jolt, but Alice was quite sure it would take more than that to soften the edges. Though not a vindictive person, Alice had a sharp memory, and Linda would need to do more than take a few bloods and book a wake-up call to earn Alice's respect. 'How's Lachlan doing—have you heard?'

  'Stable. Jeremy's been in with him all night. Apparently his cultures already show a massive infection. It's lucky we got him over to ICU when we did. I wouldn't have fancied his chances otherwise.'

  'Unbelievable.' Alice let out a small sigh. 'People are so sure an appendectomy is just a minor operation these days, which, of course, it would have been if Lachlan had come in earlier.'

  Fi nodded and added in a subdued voice, 'Like having twins. With IVF and everything, twins are so much more common but people just don't realise the dangers of multiple births. I remember when I did my midwifery, everyone was on standby when twins were about to be delivered. It seems almost a non-event these days—until it all goes wrong, that is.'

  'Have you heard anything?'

  'I rang just before. Obviously they wouldn't tell me much, but apparently there's not much change. We'll just have to wait for more detail. I'm sure Josh will let us know more when he can.'

  But Josh didn't ring. And by five o'clock, when the euphoria of four hours' sleep had long since worn off and Alice sat exhausted as the tram clattered along, the sight of the Women's and Children's was something she just couldn't go past. Despite the fact she had only known Josh two weeks, and had never met his wife, Josh had shown her so much kindness. She wouldn't be nosy, wouldn't ask to see the babies or anything like that. She simply wanted to let them know they were in her thoughts. If the roles had been reversed—and, please, God, they wouldn't be, Alice thought, instinctively placing a protective hand over her stomach—she just knew Josh would do the same. Jeremy, despite his obvious sadness as he'd broken the news, hadn't mentioned Josh all day. Babies were obviously way down on his list of priorities.