‘Neither of you are restrained if I have an accident,’ he pointed out, and Anna, who was tucking the edges of the blanket around her patient, glanced his way.
‘Then don’t have an accident!’ she said, and turned her attention back to Dani.
Tom hurried around to the driver’s side. Both the way Dani looked and Anna’s reaction told him something was seriously wrong. Toxaemia of pregnancy? Animals could suffer the same thing. He took off carefully, then drove swiftly but cautiously back towards town. Behind him, he could hear Anna murmuring to Dani, assuring her everything would be all right.
But would it?
Damn it all! He knew how much Dani and Brian wanted this baby—how excited they’d been. This South African doctor had better know what she was talking about!
And what she was doing!
Though she seemed caring enough, he’d give her that.
‘Do you have a mobile? Can you call ahead to the hospital? Let them know we’re coming in—tell them pre-eclampsia. I’ll need magnesium sulphate and whatever anti-hypertensive drug they use.’
He slowed his speed slightly and reached out to activate his hands-free, voice-activated mobile, speaking the number he knew by heart, not because he’d had reason to use the hospital but because the sequence of digits was so close to his own he often received misdialled calls.
‘Emergency entrance will be best, they’ll meet us there,’ Anna said, when he finally turned into the hospital entrance.
She was right. As he pulled into the covered bay, the emergency doors slid open and a young nurse came out to meet them.
Anna helped Tom lift Dani out and settle her onto the gurney the nurse had wheeled into position beside the car, then she helped push her patient into the small emergency room.
‘I’ve rung for help,’ the nurse said. ‘Dr Drouin’s not available, and Dr Carter, who’s on call, is sick, but I called Jessica—she’s a senior—and she has midwifery experience.’
‘Let’s pray it’s not needed,’ Anna said, her eyes going quickly to the nurse’s ID where she read the name Elena. ‘I’m Anna Talbot—I take over from Dr Drouin on Monday. I don’t think I met you when Elizabeth showed me over the hospital.’
Elena introduced herself, and Anna, satisfied the nurse had accepted her as a person with authority, asked if the hospital had a file on Dani.
‘I’ll check,’ Elena said, ‘but I doubt it. She’s probably Dr Carter’s patient, and the records would be at his surgery. But neither of the doctors here do more than occasional checks on pregnant women, they don’t do deliveries. Pregnant women go across to a bigger hospital on the coast to have their babies. They’re usually under a specialist over there.’
‘She intended going across to Rocky to have the baby,’ Tom put in, using the locals name for Rockhampton, a regional city Anna vaguely knew was on the coast some hundreds of kilometres away.
‘It would have helped to have a record of her normal blood pressure,’ Anna said to Tom, as Elena disappeared. ‘We diagnose pre-eclampsia with a systolic pressure of 140 or a rise of 30 mm over the patient’s normal systolic reading, and 90 mm or a rise of 15 mm diastolic above her normal diastolic.’
She was taking Dani’s blood pressure as she explained, and had to swallow a small gasp when she saw the mercury rise and rise. Elena returned with a file that proved to be an admission form, not a record, and she was followed by a youngish woman in paint-spattered shorts and a checked shirt.
‘The shirt’s clean,’ she said, ‘but Elena said it was an emergency, so I didn’t stop to shower or change. You’re Dr Talbot, aren’t you?’ she added, moving over to take Dani’s hand, then addressing the patient before Anna had a chance to answer. ‘And what have you been up to, idiot?’
Her voice was too softly affectionate for the question to be rude, and Dani responded with a wan smile.
‘Feel awful, Jess,’ she said, confirming Anna’s guess that this was the midwife Elena had called.
‘You look awful, too,’ Jessica said heartlessly. ‘Doesn’t she, Tom?’
‘Aw, I’ve seen her look worse,’ he drawled. ‘Remember when Bert Campion’s sow stopped halfway through delivering her piglets and I was out on Westaway? She came home from that little adventure pretty sick-looking.’
‘It was before we had the goats,’ Dani protested. ‘I’d only ever watched you do stuff like that! I had to go and throw up when I finished.’ Though Dani’s voice was weak, Anna realised Jessica and Tom had goaded the patient deliberately, bringing her back out of the black cloud her sudden illness had closed around her.
Anna checked the tray Elena had readied at Tom’s phoned-in request, and was pleased to see the antihypertensive, which would reduce the dangerously high blood pressure, was one she knew and had used before. With that and magnesium sulphate, to ward off the possibility of seizures, injected into her, Dani and the baby she carried should be safe for a while.
‘I’ll need a urine sample,’ she said to the two nurses when both drugs had been administered. Jessica stepped away from the bed.
‘I’ll do the catheter,’ she said. ‘Get a little of my own back on this woman who’s had me doing unmentionable things to goats.’
Anna looked at Tom who was slouched by the top of the gurney, one of Dani’s small hands enveloped in his capacious ones.
‘Are you going to go out and give her some privacy?’ she asked, and all three women laughed, though Dani’s effort was weak.
‘Tom worry about a woman’s privacy?’ Elena said. ‘He’s been in town long enough for us to get to know him and, believe me, he’s more likely to poke his head under the sheet and have a good look. He’s got about as much sensitivity as a block of wood.’
‘Less, I’m sure,’ Jessica said, returning from the basin where she’d scrubbed and dried her hands then pulled on disposable gloves. ‘After all, blocks of wood probably care about their little splinters.’
Again the women laughed, and Anna shook her head in amazement at the casual camaraderie between them all. True, this was her first experience of working in a really small hospital, but surely they weren’t all so informal.
She glanced up and saw Tom watching her, and felt a shiver of presentiment run down her spine.
He couldn’t possibly know what she was thinking, and be watching for her reaction! Watching closely, as if her behaviour in this crisis was a test of some kind.
‘Should we ring the fog?’
Elena’s question, meaningless though it might be to Anna, snagged her attention away from tests and Tom’s scrutiny.
‘Ring the fog?’ she repeated, when she realised it had been directed at her.
Jessica smiled.
‘Flying obstetrician and gynaecologist—initials F.O.G. or FOG.’
‘Oh, I remember reading about him. He’s based south of here, isn’t he? With a plane, so he can be anywhere in western Queensland within a couple of hours?’
‘That’s the man. He’s purely a consultant, meaning a doctor has to refer the patient to him, but he does emergency work in any hospital in his area, which covers a large part of the state.’
Jessica explained all this as she busied herself with Dani’s catheter, then she passed a small sample of urine to Anna.
‘Test kits are in the scrub room just through that door over there,’ she told Anna, indicating a closed door towards the back of the emergency room.
Anna took the sample, and Dani’s chart, but she knew more was expected of her.
‘I’ll think about the FOG…’ Her voice faltered over the acronym. ‘But in the meantime, can you admit Dani and put her into a single room? I want someone with her all the time, with half-hourly obs. Do you have the nursing staff to handle specialling a patient?’
‘They’ll organise it somehow.’ It was Tom, not one of the nurses, who delivered this statement, and though Anna assumed he had no authority at all within the hospital, he was so definite about it she took the assurance as gospel.
; She walked into the small room Jessica had indicated. Once there, she remembered Elizabeth showing it to her on the tour and pointing out the cupboard where various test kits were kept.
‘What’s wrong? Is this pre-eclampsia you’re talking about some kind of toxaemia?’
Tom’s voice startled Anna so much she almost dropped the small box she’d pulled from the cupboard, but he’d appeared and disappeared so often since she’d met him, she shouldn’t have been surprised to find he’d followed her into the room.
‘Yes. And you can probably guess it precedes a far more dangerous condition—eclampsia. Pre-eclampsia can usually be managed with the drugs I’ve given her, one to reduce the blood pressure and the other to prevent seizures, together with complete bed rest. The condition causes various metabolic imbalances and subsequent kidney problems, but the symptoms disappear after the baby is born and the condition rights itself.’
She continued working as she explained, checking the test strip to confirm an excess of protein in Dani’s urine. She frowned at the result, although she’d guessed what it would be.
‘The problem is, any single one of the signs—oedema, proteinuria or a rise in blood pressure—can lead to a diagnosis of pre-eclampsia, but Dani has all three.’
She was speaking her thoughts aloud—nothing more—and though Tom didn’t say anything, she felt his presence made it easier to think through the problem.
‘We can watch her closely. If her blood pressure rises again within the next six hours, then it’s time to do something.’
‘Like what?’
‘Either induce the baby or take it by Caesarean section before she moves into the more dangerous eclampsia. As I said, once the child’s delivered, the symptoms go away.’
She looked at Tom, and saw concern in his blue eyes.
‘I’ll ring this FOG person if Dani wants me to, or if the nurses think it’s advisable,’ she said, hoping to reassure him. ‘Tell him the position we’re in and see what he says.’
Tom nodded but didn’t leave the room—well, not until he’d frowned at her for what seemed like ages but in reality had probably only been seconds. And when he did leave, he again poked his head back around the door, but whatever he intended to say remained unsaid as he merely shook his head, then disappeared once more.
Following Dani as she was wheeled from the emergency room to a ward—he wondered idly if single-bed rooms were called wards—Tom’s mind was on the new doctor, while his shoulders were tight with a tension he hadn’t felt since he’d arrived in Merriwee. He might have whinged about the letters, but they hadn’t really upset him, and he’d been thrown by the arrival of the women who’d tracked him down, but he’d got over that.
No, this was something new.
Something different.
Something that had started back inside the little room. He’d gone in to ask about Dani’s condition, then had intended thanking Anna for her kindness to his friend, but the words had stuck in his throat, blocked by the weirdest feeling of déjà vu—only déjà vu was the sensation of having been there before, while this feeling was more a presentiment of the future, a sense that the two of them…
What?
He shook his head in frustration.
He had no idea!
And he wasn’t a fanciful man—in fact, he was about the most down-to-earth bloke he knew.
Maybe he was going mad.
Or sickening for the flu that seemed to be doing the rounds.
Tom closed his eyes then opened them again. The two nurses were shifting Dani from the gurney to a bed.
‘You rest now, you hear?’ he said sternly to her, then, to give himself something practical to do, he wheeled the gurney back to the emergency room and let himself out the door.
Satisfied with the test, Anna wrote a note on Dani’s chart, then made her way to the nurses’ station where she learned Dani was now in Room Six—three doors down the corridor.
The young woman was sleeping and Jessica, who’d been sitting beside her, stood up and moved quietly towards the door.
‘I’m off duty but I’ll stay with her overnight. We’ve been friends since we started school,’ she explained to Anna.
Anna nodded.
‘I’ll be over at the doctor’s residence if you need me, and if you don’t call, I’ll come back in an hour to see how she is.’ She hesitated. Nursing staff in country hospitals at home often had to make life-or-death decisions without the benefit of a doctor being present and she guessed it was the same here. Jessica would have practical experience in these situations a newcomer like herself might never gain. Would never gain, given she only had six months.
She moved closer to Jessica, so she could speak without waking Dani.
‘What do you think about calling in the specialist?’
Jessica didn’t hesitate.
‘Not yet,’ she said firmly. ‘He’ll have to fly in and once he arrives, well…’
Now the hesitation and a frown, before she continued, ‘Well, he’d be here on the spot and, rather than just take a look at Dani and fly out again, he might decide to take the baby—either by induction or a Caesar—just in case. Then, because it’s premi, it and Dani will have to be flown to a maternity unit on the coast, which, with Brian away, Dani would hate. But if we can control this stage of things, the little one will have a better chance of remaining right where it is until it’s far safer for it to emerge into the world.’
She stood up and moved away from the bed, steering Anna towards the door.
‘A lot of GPs won’t do deliveries these days, because of the cost of insurance. Insurance companies fear something may go wrong and they’ll have to pay out liability claims later, so insurance costs have sky-rocketed, and local GPs just can’t pay for obstetric cover.’
Anna nodded. ‘I’ve heard all of this, but what’s your point?’
Jessica studied her for a moment, brown eyes searching Anna’s face.
‘Would you be happy to deliver the baby if it became necessary? Would you feel confident doing a Caesar if Dani’s condition suddenly worsened and she needed it done urgently—before the FOG could arrive?’
‘Of course!’ Anna replied without hesitation because she knew Jessica, anxious about her friend’s safety, needed this reassurance. ‘As well as the big obstetrics component in my medical training, I’ve done an obstetrics short course, and performed, I suppose, a hundred Caesarean operations. I believe the private doctor in town is willing to do anaesthetic work, so between us we should manage.’
She’d just finished this positive and, she hoped, comforting explanation when she realised she wasn’t—yet—officially on the staff at Merriwee Hospital. But she wouldn’t bother Jessica with that minor consideration.
‘Yes, Peter Carter often helps out with minor ops,’ Jess said, then she gave a satisfied nod. ‘So that’s settled, and as long as we have that back-up position in case things turn bad, I’d say don’t call the FOG.’
Anna walked away but a sense of responsibility rested heavily on her shoulders and in the end she made her way to the main hospital office where she studied the list of phone numbers Elizabeth had shown her during the ‘tour’. The office clock reminded her it was getting late, but she should at least let the official on-call doctor know what was happening—as a back-up position, as Jessica had said.
Just in case…
The woman who answered the phone sounded harassed, but her abrupt ‘Jackie Carter speaking’ told Anna she’d reached the right place.
Quickly she explained the situation, adding, ‘I became involved because I was at the vet’s place when Dani rang Tom to say she felt ill. Tom knew Paul Drouin was away, and your husband was sick so he took me along, but as Dr Carter is officially on call, I thought I should let him know.’
‘Do you absolutely need him there?’ Jackie asked, and Anna hastened to assure her that Dani was now resting comfortably and would be monitored all night.
‘Well, Peter’s asleep right n
ow, and he’s been so restless and fidgety all day I’d hate to wake him just to tell him all of this, but if you do need to talk to him, ring me again.’
‘Some back-up!’ Anna muttered to herself, then she shook her head. In another two days this would be ‘her’ hospital, and there’d be no back-up then. This was the challenge she’d wanted—and in the place she’d heard and read so much about—the vast Australian outback.
She walked back to Room Six to check on Dani, and was relieved by Jessica’s report that the patient’s blood pressure had already dropped back to within normal range.
‘Phone me if you have the slightest concern,’ Anna told Jessica, ‘and I’ll come right back. If I don’t hear from you, I’ll check her again in an hour or so.’
The nurse nodded as Anna repeated this promise, then returned to sit beside her friend.
With only a couple of wrong turns in the hospital corridors—building the place around an open central courtyard made navigation complicated—Anna finally reached the rear staff entrance and crossed the parched earth towards her little cottage.
A light was on in her living room, but she was too tired to wonder why she’d had one on when she’d left the place in broad daylight. She dug in the pocket of her shorts for the key and, finding nothing, remembered the shorts belonged to someone else. And her clothes were in a plastic bag at Tom Fleming’s place.
She’d left all the windows open, and though they were all screened against insects, maybe she could remove one of the screens and climb in. She moved to the closest window and was about to test this theory when she realised that not only was a light on in her house but the place was occupied. Tom Fleming was lying full length on her living-room floor, and after an initial shock—wondering if he had broken into her house then died in there—she noticed movement. And realised what he was doing!
He was talking softly to the cat, which was nuzzling lovingly around his head, then, as Anna watched, the wretched animal leapt lightly up onto his chest, curled her tail around her legs and sat there, for all the world as if she’d never had a moment’s doubt about life in Merriwee.
Outback Doctors/Outback Engagement/Outback Marriage/Outback Encounter Page 5
