Crisis at Katoomba Hospital

by Lucy Clark

  ‘Usually two—three if they’re pushed. Depends on how much Stephanie can twist my arm.’

  ‘Something she’s well qualified at, believe me.’ His blue eyes were expressive as he spoke but he didn’t smile. ‘And how was your clinic today? Fairly busy?’

  ‘No. Actually, this afternoon was quite slow.’ She leant back against the desk, smoothing her hand down her brown skirt.

  ‘Is it generally frantic?’

  ‘Worried the patient base you’re taking over could dwindle to nothing?’

  ‘It’s a consideration.’

  Nicolette was once again struck with a sense of déjà vu as she looked at him, her mind trying to place where she’d seen him.

  ‘We haven’t met, Nicolette,’ Stephen drawled, reading her mind.

  ‘What?’

  ‘You’re mind is working at a frantic pace, trying to figure out where you’ve seen me before.’ He shrugged nonchalantly. ‘Trust me. I’d remember.’

  ‘It’s driving me nuts. I know I’ve seen you somewhere before. I have a clear picture of you in my mind.’

  ‘There are plenty of places we could have crossed paths. Medical conferences, mutual friends or even just wandering around Portabello Market.’

  ‘You liked to go there?’

  ‘Yes.’

  Sophie returned and looked at them both. ‘Have either of you seen Stephanie?’

  ‘No,’ Nicolette answered for them both. ‘Is she around?’

  ‘She was about to leave when I saw her about half an hour ago, but I’m not sure whether she’s actually managed to get out of here.’

  ‘I hope she’s gone. She worked an early shift,’ Stephen said. Both women looked at him and he shrugged. ‘She spent the night at my place and left very early this morning.’

  ‘There was a lot of fog last night,’ Sophie said.

  ‘I’m amazed at how quickly it rolls in. I wouldn’t let her go, even though she said she was used to driving in it.’

  ‘The over-protective big brother?’ Nicolette smiled at the thought, thinking of her own over-protective big brothers.

  ‘Yes.’ He paused for a moment, then a small smirk twitched at his lips. ‘Drives her crazy.’

  Sophie laughed. ‘So naturally you do it. All right. Let me give you the run-down on what’s happening here.’ She preceded to tell them about their current patients and hand over the casenotes of the few patients still in the waiting room. ‘Here’s a file for you.’ She held one out to Nicolette. ‘And one for you.’ She held the other out to Stephen. ‘Welcome to Katoomba hospital.’

  Stephen nodded his thanks and began reading the casenotes. He’d been quite happy to simply stand there all night and chat with Nicolette so actually doing some work was probably a good thing. As they were about to go call patients through, two of the nurses finished with their patients and walked wearily to the nurses’ station.

  ‘Let the night roll on,’ one of them sighed and then straightened a little when she looked at Stephen, devouring him instantly with her gaze. ‘Hello. I’m Lauren.’ She held out her hand to him and Stephen shook it firmly.

  ‘Stephen,’ was all he said. He knew the bubbly brunette was flirting with him but he tried to ignore it. He was, for some reason, also highly conscious of the way Nicolette was watching him interact with the nurse. The urge to tell her the perky nurse wasn’t his type surprised him. He didn’t have to explain himself to anyone.

  ‘And I’m Jade.’ The other nurse smiled politely but continued with her work. ‘Who’s got Louise Briggs?’ she asked them, pointing to the casenotes they held.

  ‘I do,’ Nicolette answered.

  ‘She’s in Examination Cubicle 2. Stephen, that means you have Mr Cole who’s in EC-9.’

  ‘I’ll go with Stephen,’ Lauren said quickly, and smiled brightly at him.

  Stephen nodded briskly and headed off, Lauren trailing behind him.

  ‘I hope he can cope,’ Jade mumbled.

  ‘I hear he’s quite a brilliant doctor,’ Nicolette responded as the two of them headed to EC-2.

  ‘I don’t mean medically. Lauren’s like a piranha.’

  Nicolette smiled. ‘I think he can cope.’ At least, she hoped he could. Did he fancy the young brunette? He hadn’t shown any outward signs of accepting her attempts at flirting, but from the little she knew of him he was a man who gave nothing away with his facial expressions. She shook her head and sighed, shoving thoughts of him roughly aside as she pushed open the curtain of EC-2.

  ‘Louise, I’m Dr Nicolette Bourgeois.’ She smiled politely at her patient, who was lying on the examination bed with her right foot bandaged. ‘It looks as though you’ve been having some fun. Jade, would you mind removing the bandage for me, please?’ Nicolette scanned the notes. ‘It says here you have some glass in your foot. How did that happen?’

  ‘Dropped a glass and thought I’d vacuumed it all up but apparently not. I stood on a piece and managed to pull it out, but there was a lot of blood and I get kind of queasy…’

  ‘You can say that again,’ her husband, who was standing beside her holding her hand, chimed in. ‘She almost passed out when she saw the blood. Luckily, I’d just got home from work but I wasn’t taking any chances so insisted she come here.’

  ‘Good thinking.’ Jade had finished removing the bandage. ‘Well, let’s take a look.’ Nicolette put the notes down, washed her hands and pulled on a pair of gloves as Jade manoeuvred a freestanding lamp into position. She elbowed a chair around the examination bed and sat down at the foot to examine the injury more closely.

  ‘How is it?’ Louise’s tone was shaky. ‘Has it stopped bleeding?’

  ‘Yes. We’ll just clean the area a little more so I can get a better look.’ Jade handed Nicolette the things she needed. ‘I’ll need a magnifier headset,’ she said softly to the nurse, before saying more clearly, ‘I just want to be sure there are no other little bits around, otherwise we risk infection.’ As she cleaned the wound, Louise flinched several times. Peering closely at it through the magnifier, Nicolette could see several particles of glass.

  ‘OK.’ She sat up and took off her gloves. ‘There’s still some glass in your foot so what we need to do is thoroughly flush out the area, which will hopefully remove the particles.’

  ‘Will…will that hurt?’ Tears formed in Louise’s eyes.

  Nicolette smiled reassuringly. ‘I’m going to give you a local anaesthetic so you won’t feel a thing.’

  ‘Except the anaesthetic needle,’ she whimpered.

  ‘She’s not good with needles either,’ her husband ventured.

  ‘That’s all right. We’ll get through it. Are you allergic to any medications?’ Nicolette quickly checked Louise’s notes.

  ‘No. Not that I know of.’

  Nicolette flicked back a few pages. ‘It says here you had a local anaesthetic when you were fifteen.’

  ‘My brother and I were arguing and we both fell down an embankment. We needed stitches.’

  Nicolette nodded and showed Jade the notes so she knew what local anaesthetic to prepare. ‘We’ll give you the same anaesthetic you had back then as you didn’t have a reaction to it.’

  Jade quickly opened cupboard doors, getting things ready. ‘OK. I want you to look at your husband, hold his hands and squeeze them as hard as you can.’

  Jade held Louise’s leg still, ensuring the woman didn’t flinch as Nicolette administered the local.

  ‘Louise? Louise?’ her husband called.

  ‘She’s going,’ Jade said calmly just as Nicolette was finishing. Sure enough, Louise had fainted. Jade attended to her, taking her vitals, calling to her.

  ‘What’s wrong?’ her husband asked anxiously.

  ‘She’s fainted,’ Jade replied, and a moment later Louise came around. Jade continued to monitor her. ‘How are you feeling?’

  ‘Is it over?’

  ‘The injection part? Yes.’ Nicolette smiled at her. ‘It’ll take about ten minutes for the a
rea to be numb enough so I’ll be back to check on you then. Jade will stay with you.’ As she walked out, Sophie came up.

  ‘Stephen needs you in Trauma Room 1. Emergency brought in by ambulance. Teenage boy complaining of arm, neck and shoulder pain.’

  ‘OK.’ Nicolette and Sophie went into TR-1 and headed to the sink. They both washed their hands before pulling on gloves and protective gowns.

  ‘IV line, Sophie. Nicolette,’ Stephen’s voice was smooth. ‘Meet Cecil.’

  ‘Hi, there. Not been feeling too good?’ Nicolette looked down into the scared face of the sixteen-year-old boy.

  ‘My arms and shoulders are really sore,’ he complained.

  ‘Cecil’s been burning the midnight oil for the past few days, studying hard.’

  ‘I have mock exams.’ No sooner were the words out of his mouth than he began to turn pale again.

  ‘Does it hurt to look into the light, Cecil?’

  ‘No.’

  ‘Good.’

  ‘Temperature is up,’ a nurse reported.

  ‘Abdomen?’ Nicolette asked Stephen.

  Stephen nodded and began to palpate Cecil’s stomach. He pushed a little and received a groan from the patient. As he eased off on the pressure, Cecil groaned again.

  ‘Does it hurt more after I finish pressing?’ Stephen asked.

  ‘Yes.’

  Nicolette turned to look at Cecil’s mother, who was standing at one side of the room. ‘Has he had any painkillers?’

  ‘Two ibuprofen tablets but that’s all.’

  ‘Thank you. Urine analysis, full blood work,’ Nicolette ordered.

  ‘Are you allergic to any medications, Cecil?’ Stephen asked.

  ‘Not really. Sometimes I get stomach cramps from regular painkillers. I don’t know what they’re called.’

  She looked down at the patient. ‘Have you had bad stomach pain before?’

  ‘A few times, but it’s the cramps in my arms, neck and shoulders that are really sore.’

  ‘A heat pack might give you some comfort.’

  ‘Why do you care about his stomachaches?’ Cecil’s mother asked.

  ‘Because that could be where the real problem lies,’ Stephen responded. ‘Sometimes when there’s an infection around the abdomen, gases can form and they produce pain in the shoulders and neck.’ He turned to look at Sophie. ‘Contact the general surgical registrar and get him down here, stat.’

  ‘Yes, Doctor.’

  ‘BP’s dropped slightly.’

  ‘Get that fluid infused quickly. What’s the result on the urine analysis?’ Nicolette asked.

  ‘Definite infection.’

  ‘Right. IV ampicillin and morphine for the pain.’ Stephen wrote up the notes. ‘Nicolette, feel his abdomen,’ he said softly.

  ‘Appendicitis?’

  ‘I don’t think so. Something’s not right.’

  ‘Ulcer?’

  ‘Can’t be sure.’

  Nicolette moved closer to Cecil. ‘I’m sorry, Cecil,’ she said as she touched his stomach. ‘I just need to have a feel.’ She did as Stephen had suggested but couldn’t directly feel anything. ‘Sorry,’ she said after Cecil had groaned again.

  ‘Temperature’s going up.’

  ‘Get that morphine into him.’ No sooner had Nicolette spoken than Cecil started to retch. She managed to get a bowl to him in time and he vomited, the contents looking like coffee grounds with a trace of blood.

  Stephen and Nicolette looked at each other. ‘Tell the surgical registrar to book a theatre,’ Stephen advised. ‘Call the anaesthetists, too.’

  ‘What’s happening?’ his mother asked in shock.

  ‘I’ve got it,’ Nicolette replied, and took off her gloves and gown. She took Cecil’s mother into the waiting room and sat down beside her. ‘Cecil has an infection somewhere and we believe it’s in his stomach. As Dr Brooks mentioned before, the pain Cecil feels in his shoulders, arms and neck is more than likely due to a gas build-up inside.’

  ‘But what causes that?’

  ‘There could be several things but until the surgeons have had a look, we won’t know for sure.’

  ‘What will they do?’

  ‘They’ll do an exploratory laparoscopy, which is where they make a few tiny incisions—one just below the belly button and the other to the side. Next, they’ll put a small camera into the area to see what’s going on. What they find dictates what happens next.’

  ‘But he just had some neck pain. That was it. That’s why we came here. Not for this. Not to be told he needs morphine and then surgery.’

  ‘I know it’s not what you want to hear and I’m extremely glad you did bring him in. Cecil needs urgent medical attention and he’s going to receive it. The surgical registrar will see him next but—’

  ‘Why can’t you or that other doctor operate?’

  ‘We’re not surgeons. I’ll just check to see when we can expect the surgical registrar. Why don’t you come and stay with Cecil?’

  ‘Uh…all right. I guess so.’

  They headed back to Cecil and Nicolette was pleased when the surgical registrar appeared a few minutes later.

  ‘I need to check on a patient before her local anaesthetic wears off,’ she told Stephen, before heading off.

  ‘Louise,’ she said as she breezed back into EC-2, ‘how’s the foot? Nice and numb?’ Nicolette washed her hands again and pulled on a fresh pair of gloves.

  ‘I think so.’

  Jade helped Nicolette put the magnifier on and positioned the light. Nicolette tested that Louise’s foot was indeed numb before debriding the wound. A few more particles came out but there was still one stubborn piece that refused to. Nicolette tried several times to grab it with the tweezers but it wouldn’t budge.

  ‘Locking forceps, please, Jade.’

  Jade opened a drawer, pulled out what Nicolette needed and handed it over. Again, the piece of glass proved to be too slippery and after debriding one more time and making a very small incision to give her a bit more room to manoeuvre, Nicolette finally managed to remove it, breathing a sigh of relief as she did so.

  ‘Hooray. It’s all out,’ she told Louise. ‘I’m just going to check again to make sure there are no other sneaky pieces there and then we’ll stitch you up.’

  ‘Stitches?’ Louise went pale again.

  ‘Here she goes again,’ he husband muttered, but his wife hit his arm, proving she was feeling better than he’d anticipated. Nicolette smiled but continued with her work.

  Once she’d finished, she wrapped Louise’s foot in a bandage and filled in a requisition form for crutches.

  ‘Thank you so much, Nicolette.’ Louise’s husband pumped Nicolette’s hand. ‘You’ve been great.’

  ‘Next time—’ Nicolette said, smiling at Louise, but her patient held up her hand.

  ‘I know, I know, don’t walk around in bare feet.’

  They all smiled and Nicolette left to write up the notes.

  Later, near the end of their shift, she bumped into Stephen at the nurses’ station.

  ‘How’s Cecil?’ she asked.

  ‘I’ve just had Sophie ring through to Theatre and it’s not good. After the initial incision for the laparoscope, gas escaped.’

  ‘As you suspected.’

  ‘So they’re doing a full check exploratory to see what they can find.’

  Nicolette shook her head. ‘What’s your bet?’

  ‘Ulcer.’

  ‘Optimistic.’

  ‘That’s me. You think it’s cancer?’

  ‘I sincerely hope for Cecil’s sake it isn’t.’

  ‘You and me both.’ He shut the casenotes he’d just completed. ‘Are you all done?’

  ‘Yes. I was just going to get my jacket and think about heading home.’

  ‘I was thinking that, too.’

  She smiled at him. ‘Great minds think alike.’ He didn’t return the smile but nodded. When he didn’t say anything else, she forced herself to move away, head
ing to the changing rooms to get her things.

  Nicolette pulled on her jacket, knowing it would be freezing outside…and foggy. She wondered how Stephen was going to cope, driving in the fog, especially after his earlier comments about not wanting Stephanie to drive home last night. The road between Katoomba and Blackheath was well lit but visibility could be down to a few feet and if you didn’t know the curves in the road, it could be treacherous.

  She decided to wait for Stephen and when he appeared in the main corridor, jacket on, briefcase in hand, she called out to him.

  ‘I thought you might appreciate a guide on the drive back to Blackheath.’

  ‘Thank you. That’s very thoughtful.’

  He came to stand before her and she saw he’d removed his tie and undone his top shirt button. Raking a hand through his hair, ruffling it slightly, she had an instant sense of déjà vu as a photograph of him flashed into her mind. Photograph. She watched him and concentrated hard before realisation hit.

  ‘Simone.’ She whispered the name and saw his eyes narrow slightly.

  ‘Pardon?’

  ‘Simone.’ Nicolette nodded. ‘I knew I’d seen you before. You used to date Simone.’

  The colour drained from his face in a guilty admission.

  CHAPTER TWO

  ‘YOU’RE a friend of hers?’ Stephen asked after a moment, his voice sounding slightly strangled, even though he did his best to hide it.

  ‘Yes.’

  ‘A friend who’s interested in the truth or just what Simone told you?’

  Nicolette couldn’t believe him. Men! They were all the same. His comments, his facial expressions and the tone of his voice brought back memories of the way her own previous boyfriends had spoken to her near the end of the relationships. Just like Stephen, they’d always tried to dodge the blame. ‘She almost had a nervous breakdown when you broke up with her, Stephen.’

  His grip tightened on his briefcase as he made an effort to hold onto his temper. From the tone of her voice, he could see it would be pointless to discuss anything now. It was late, they’d both had a busy night and the last thing they needed was to argue before driving home on the foggy roads.