Emergency--A Marriage Worth Keeping

by Carol Marinelli

  She sat clutching her handbag firmly over her chest, the vivid smear of pink lipstick out of place with her rather wild grey hair. Each scrawny finger was decorated with a massive, loose ring and a yellow silk scarf was tied around her neck.

  ‘How’s your pain?’ Isla asked.

  ‘Fine. How’s yours?’ came the cheeky reply.

  ‘I’m going to need to take your rings and scarf off, Mrs Dullard,’ Isla said, her lips twitching as she smothered a smile. ‘You can’t wear them in Theatre.’

  ‘They can be taped up—that’s what they do on the television.’

  Isla shook her head. ‘A wedding band perhaps, but you’ve got rings on every finger! They’ll be perfectly safe. I’ll lock them up in the safe.’

  ‘They’re not real, you know!’ Ivy declared, pulling them off one by one and popping them into her bag. ‘They’re not even worth ten cents.’

  ‘They look nice.’

  ‘Anything else?’ Ivy demanded, and Isla gave an apologetic wince.

  ‘I need the scarf as well.’

  ‘You’ll want me knickers next,’ Mrs Dullard huffed, but as Isla nodded the old lady started to laugh. ‘Lucky I didn’t have any on, then, isn’t it?

  ‘Still, I’m not taking my lipstick off until I get there, and I’m certainly not going to take my teeth out till the last moment. I’ve got some pride, and you can tell that to the anaesthetist!’

  ‘Good for you.’ Isla winked. ‘I’ll get you a container for your teeth—you can pop them out once you’re up there.’

  Those suspicious eyes finally softened slightly as she eyed Isla. ‘How long do you think I’ll be in here?’ Ivy asked as Isla wrote down her obs. ‘The doctor said they’d have me up out of bed by tomorrow!’

  ‘If you’re well enough,’ Isla responded. ‘A lot depends on your stomach injury, but on the whole it’s been found that in the long term the quicker a patient is mobilized the fewer side effects are suffered. But it will all be done gently. The physio will be the one who gets you up and we won’t expect you to be racing around the ward.’

  ‘That wasn’t what I asked—when will I get out?’ Pursing her lips, Ivy ran her hand again through her shock of grey hair, and Isla noticed it was anything but steady, her slightly jerky movements increasing.

  ‘We’ll know a lot more when you’ve been to Theatre, Mrs Dullard. Is there anything troubling you?’

  ‘Apart from a broken hip, you mean?’

  Smiling inwardly at the old lady’s sharp tongue, Isla pushed on.

  ‘Yes, apart from your broken hip, Mrs Dullard.’

  ‘I’ve got a cat, Treacle.’ Rummaging through her bag, she pulled out her purse and held out a photo, but Isla’s eyes were drawn more to the contents inside her bag, though she didn’t let on straightaway.

  ‘She’s gorgeous.’

  ‘It’s a he,’ Mrs Dullard corrected. ‘And he’s twenty years old, which is about my age in cat years. We’ve never been apart.’

  ‘Is there someone who could feed him?’ Isla asked, which only served to incense the old lady.

  ‘Oh, wouldn’t Amy just love that?’

  ‘Amy’s the neighbour who called the ambulance?’ Isla checked.

  ‘Busybody,’ Mrs Dullard sniffed.

  ‘Sometimes even busybodies serve their purpose. If she hadn’t come around when she did, you could still be lying on the floor.’

  ‘Perhaps, but now she’s got my front door key, and no doubt she’s poking around in all my things as we speak.’

  ‘Do you want me to arrange a social worker to come and talk to you?’ As Ivy opened her mouth to argue, Isla carried on talking. ‘She could collect your key from the neighbour, if that’s what you want, and she can help you work out what to do with Treacle while you’re in here.

  ‘Now…’ Keeping her voice deliberately light, Isla moved on to a rather more difficult subject. ‘Do you have any valuables that need to be locked in the safe?’

  ‘I’ve done that,’ Ivy snapped. ‘They’ve already taken my money out of my purse and my bus pass.’

  ‘Good.’ Isla’s eyes drifted pointedly to the open bag. ‘Mrs Dullard, you know that you’re nil by mouth?’ When the old lady didn’t answer, Isla pushed on. ‘That means you can’t have anything at all to eat or drink.’

  ‘I’m not stupid.’

  ‘No,’ Isla said slowly, ‘but you’ve had a lot of powerful drugs that can make you a little bit confused. Now, on a ward, we generally clear the patient’s locker and table of any food or drink…’

  ‘I haven’t got anything.’

  ‘You’ve got a half bottle of vodka in your bag, Mrs Dullard,’ Isla said evenly. ‘And as I’ve said, it’s very easy to forget that you’re nil by mouth sometimes.’

  ‘Do you really think I’m likely to have a drink of vodka at eight in the morning?’

  ‘I don’t know,’ Isla admitted. ‘But if you did, it could have some very serious consequences. It’s imperative that your stomach is empty for the anaesthetic. I’d feel a lot happier if you let me put the drink along with your other belongings.’

  ‘It might get taken.’

  ‘Well, I can lock it up in the safe with your valuables, then.’

  For a second the old lady bristled and Isla braced herself for a rather curt few words, but surprisingly she fished in her bag and handed over the bottle without more protest.

  ‘I suppose you think I’ve got a problem.’

  ‘I didn’t say that…’

  ‘I didn’t say that,’ Ivy mimicked. ‘Standing there all haughty and judging me.’

  ‘Nobody’s judging you, Mrs Dullard. If it was a can of cola in your bag, I’d have asked the same thing. Now, I’ll go and lock this up in the safe for you and then I’ll come back and see how you’re doing.’

  ‘Please, don’t.’ Gripping Isla’s hand, the elderly lady struggled to sit up, wincing as the pain gripped her. ‘Please, don’t leave me.’

  ‘Mrs Dullard—’

  ‘Ivy.’

  ‘Ivy,’ Isla soothed. ‘Have you got more pain?’

  ‘I just want to know where you’ve put Treacle. I just want someone to come and tell me what’s happening.’ Tears started then, but angry, frustrated tears. She let go of Isla’s hand and rattled the side of the hospital gurney in a futile attempt to get down.

  ‘Mrs Dullard—Ivy—you need to stay still. You need to lie back and calm down and tell me what’s wrong.’ Pushing the button on the automatic blood-pressure machine, Isla tried to calm the elderly woman as Heath came over with Jayne.

  ‘What’s the problem?’

  ‘Eighty-two-year-old…’ Jayne started, then paused, nodding for Isla to carry on. ‘I’ll leave you to it. Call if you need a hand.’

  Alone, Isla faced her first handover.

  ‘Ivy Dullard, fell at home last night and sustained fractured neck of femur and a splenic haematoma. She’s waiting to go to Theatre for a dynamic hip screw, but has just become increasingly agitated and confused. Her obs have been stable, but her blood pressure’s dropped slightly to 110 over 60 and her pulse is now 100, up from 80.’

  ‘Any head injury?’ Heath asked.

  ‘None noted.’

  ‘What are they doing about her spleen?’ Heath asked, pulling back the blanket and probing Ivy’s abdomen, much to her indignation.

  ‘The surgeons have reviewed the CT and want to treat it conservatively at this stage. Do you want me to page them for a review?’

  ‘What’s with the vodka?’ Heath asked, ignoring Isla’s question and nodding to the bottle she was holding.

  ‘She had a blood alcohol of nought point three on arrival. I found this in her bag. I was just about to lock it up.’

  Heath gave a knowing nod and scribbled on the casualty card. ‘OK, give her 5 milligrams of diazepam and I’ll give the orthos and anaesthetist a call. She’ll need to be reviewed again before she goes to the Theatre.’

  ‘Do you want me to page the surgeons?’ Isla a
sked as he walked off, holding her breath as Heath turned on his heel and faced her. ‘I mean, it could be her abdomen…’ Isla swallowed hard. Her first patient, her first day and here she was questioning a registrar.

  It really was just like old times.

  ‘Her blood pressure’s down, her heart rate’s up, she’s confused…’

  ‘Which are the symptoms of alcohol withdrawal,’ Heath said tartly. ‘I’ve just examined her abdomen and there’s no increased tenderness.’

  ‘But she’s had morphine,’ Isla pointed out. Maybe it wasn’t just like old times, maybe things had changed after all, because at twenty-three years of age she’d have been blushing to her roots and mentally berating herself for causing a scene. But seven years on and it was a tougher, more confident woman that faced this rather difficult situation, and she didn’t even waver as Jayne came over to find out what was going on. ‘The fact Mrs Dullard’s had morphine means she isn’t going to be feeling pain.’

  ‘Are you questioning my judgment, Sister?’

  Isla took a deep breath, wondering how best to play this, deciding that Heath’s rather inflamed ego wouldn’t take the response that was on the tip of her tongue. ‘I’m just concerned that Mrs Dullard has gone downhill so quickly…’

  ‘Since you tried to take away her alcohol…’

  ‘Morning!’

  She had sensed Sav before she had heard him, had smelt the delicious tangy aftershave that had filled her nostrils this morning, heard the confident footsteps as they approached. But what wasn’t familiar, what was surprisingly different, was the light-heartedness in his voice, the cheery note to the single word.

  ‘A bit early in the career comeback to be hitting the bottle, Isla.’ Sav grinned and Isla clutched the vodka, staring utterly bemused at the man smiling back at her. A man she hadn’t seen in fourteen months, the haughty yet smiling face of the man that she used to know.

  ‘What’s going on?’

  ‘Nothing,’ Heath snarled.

  ‘Nothing?’ Sav checked, clearly picking up on the tension. ‘It doesn’t sound like nothing.’

  ‘I asked the new nurse to get some Valium that I prescribed for a patient.’

  ‘And?’ Sav’s eyes swung between the two.

  ‘I’m still waiting.’

  There was the longest pause, which Isla finally filled. ‘I’m concerned that perhaps I didn’t give Dr Jameson a relevant enough handover. I have an elderly lady with a fractured neck of femur and abdominal injuries—’

  ‘Who has alcohol withdrawal,’ Heath snapped. ‘Now, are you going to get the drug I ordered or not, Sister?’

  ‘I’ll get the Valium.’ Jayne stepped in. ‘Isla, you stay with Mrs Dullard. Here, give me the vodka. I’ll lock it up for you.’

  Only Sav would have registered the angry set of Isla’s lips, the glint in her eye as she handed over the bottle without a word. Clearly, in his eyes at least, she was annoyed that Jayne had overridden her in an effort to keep the peace.

  ‘I’ll come in and have a look,’ Sav said as Isla slipped back into the cubicle.

  ‘Fiery little thing, isn’t she?’ Heath smirked as the two men were left alone. ‘I’ll guarantee there’s a flash of red under that gorgeous blonde hair.’

  ‘Can we get back to discussing the patient?’ Sav snapped, but Heath wasn’t listening.

  ‘Nice figure, too,’ he mused. ‘You know, I can’t help thinking I’ve seen her before…’

  ‘You have,’ Sav said in a clipped voice, fixing Heath with a warning glare. ‘At last year’s Christmas party. Isla’s my wife.’

  Heath didn’t even blush, just gave a vaguely apologetic grin, the smile only wiped off his face when Isla’s summons came from inside the cubicle, the loud but controlled call for assistance which had everyone suddenly running.

  ‘Can I have some help in here? Now!’

  CHAPTER FOUR

  FOR a second Isla froze.

  Less than a second, probably.

  Pulling back the curtain, seeing Ivy lying pale and unresponsive on the trolley, her vibrant pink mouth horribly slack now, Isla assessed the scene, processed a hundred thoughts almost immediately.

  Reflexes she had worried might not know how to respond snapped to attention as she crossed the short distance to the gurney, calling her patient’s name and attempting to rouse her while simultaneously lowering the head of the gurney so her patient lay flat.

  ‘Can I have…?’ Isla’s voice was barely a croak and the background noise of the hospital was too loud for her colleagues to hear her anxious plea, but the emergency bell was on the other side. Clearing her throat, Isla gave another shout as she pulled on gloves and checked Ivy’s airway, noting it was patent. She watched the rapid but shallow rise and fall of Ivy’s chest as her own fingers probed the flickering pulse in Ivy’s neck, while with her free hand she punched the button on the blood-pressure cuff.

  ‘What have we got?’

  Sav was beside her, taking control in an instant, grabbing the oxygen mask from Isla and placing it over Ivy’s mouth as she turned the oxygen on to ten litres.

  ‘I found her collapsed and unresponsive, her resps are rapid and shallow, pulse over a hundred and weak…’

  ‘Blood pressure?’

  On cue the monitor delivered its reading. ‘Eighty on forty. It was a hundred on sixty ten minutes ago.’

  ‘OK. Open the IV full bore.’

  ‘I have.’

  ‘Let’s get her over to Resus. Get some O-negative blood ready…’

  ‘She’s already been cross-matched.’ Isla’s voice was slightly breathless as she kicked off the brakes and pushed the gurney over the polished tiles, Heath running ahead to wait for them in Resus.

  ‘Right, ring the lab, tell Len, the porter, to run up and fetch two units and page the surgeons…’

  ‘Done!’ Jayne was back, with the Valium in the kidney dish. She gave Isla a tiny wink that, frankly, Isla was too busy to interpret.

  ‘Good,’ Sav barked, skidding the trolley into Resus and swinging it around so that the head of the trolley was against the wall. ‘Page Theatre as well and let them know to expect her soon.’ Picking up the wall phone, Isla punched in the number for the switchboard, grateful it was written in red on the telephone, and told the operator the urgent pages she wanted put out.

  Then it hit her.

  Hit her in a way she’d never anticipated when she’d first considered coming back, and she realized that she hadn’t been lying at all when she’d spoken to Jayne that morning.

  Watching as the crash cart was opened, Kerry wheeling over the ultrasound machine, the well-polished wheels of Emergency rolling into action, Isla realized there and then how much she’d missed this.

  Missed this.

  That pit-of-the-stomach flutter of nerves kicking in as the adrenaline started flowing, the frantic race against the large ticking stopwatch mounted on the wall to save a life. And it was, for Isla, like watching a much-loved movie, one you hadn’t seen for ages, had somehow forgotten the frantic twists that made you gasp, the drama, the tension that had you on the edge of your seat.

  ‘Theatre’s standing by.’ Isla spoke over the low urgent tones as the surgeons flew in. She took the blood from a breathless Len and, almost as naturally as breathing, picked up Ivy’s limp hand and proceeded to check the details on her name band against the precious life force she held in her other hand.

  ‘We’ll need the blood warmer,’ Jayne called, but Kerry was already setting it up, a far more sophisticated model than Isla was used to.

  Isla focused for now on what she knew, connecting the giving set to the bag of blood and feeding the precious fluid down the long line that would coil inside the machine and warm the refrigerated blood to body temperature, a necessary requisite when rapid infusion was needed.

  ‘I need that blood,’ Sav called, as he inserted another wide-bore IV, his hand absolutely steady as Isla handed the end of the giving set over while Kerry punched the buttons
, telling Isla what she was doing as she did so.

  ‘Punch in the desired temp—it’s generally already set—then snap the lever into place and press the go button. I’ve set it at a stat rate.’

  ‘And that’s it?’ Isla asked, impressed, recalling the rather large trays of water they had filled just a few short years ago to warm the blood as it coiled through the giving set.

  ‘That’s it.’ Kerry nodded.

  ‘Was this Valium given?’ The astute eyes of the anaesthetist scanned Ivy’s notes as he pulled up drugs and laid them by the head of the trolley for easy access. Even though she was still breathing, her respiratory effort wasn’t allowing for adequate oxygenation and everyone present knew it was only a matter of time before she stopped breathing or went into cardiac arrest unless a full and effective resuscitation with fluids commenced.

  ‘Thankfully, no.’ Sav’s voice was bland but the withering stare he shot Heath could have melted ice at a hundred paces. ‘We initially thought her confusion was because she was suffering from alcohol withdrawal.’

  ‘That was my call,’ Heath volunteered, and Isla’s rather low opinion of Heath nudged up a small fraction. Everyone made mistakes, and in fairness Heath hadn’t technically made one, just jumped the gun a touch. ‘Given her blood alcohol reading on arrival and the fact the sister had just found a bottle of vodka in her bag, I wrongly assumed that was what her problem was.’

  ‘You’re not necessarily wrong.’ The surgeon looked up from where he was examining Ivy’s abdomen. ‘Her agitation may well have been a contributory factor in her laceration extending, but right now her main problem is the fact she’s bleeding out. Let’s get her straight up to Theatre.’

  And that was it.

  Or almost.

  ‘Ivy?’ Leaning over the elderly lady, Isla called her name. Holding the pale hand, Isla squeezed it tightly, noting with quiet relief that the pressure was returned. Ivy’s pale eyelashes flickered slightly, the blood and oxygen and aggressive resuscitation clearly taking effect. ‘You’re going to be OK.’

  For a second Isla struggled with what to say, how much Ivy would comprehend. Her signature on a consent form was out of the question when she couldn’t even open her eyes. ‘We’re taking you to Theatre now and afterwards you’ll be on a ward. We’re looking after you.’