‘What the hell are you doing?’ Mr Anderson roared as Leah missed at her first attempt to get a needle in. ‘Will you get someone in here who knows what to do?’
Taping a wad of cotton wool in place, Leah moved the tourniquet down and slapped at Jessica’s hand before talking, trying to keep her voice as calm as possible. ‘Mr Anderson, Jessica is very dehydrated, that’s why her veins are so difficult to find. Once we get a needle in we can give her some fluid.’ A thin blue vein was coming up now. Rubbing it with alcohol, Leah tried to keep her hand from shaking as Mr Anderson stood over her, watching her every move. Leah knew if she missed this time he was likely to explode, but his threatening stance wasn’t exactly helping matters!
‘Mr Anderson.’ Sweat was beading on her brow now and, casting an anxious look up, she willed someone to appear at the door, but knew deep down she was on her own. ‘I know how worried you are, Jessica is sick. Now, I need you to go around the other side of the bed.’
‘I’m not going anywhere,’ he roared, and Leah fixed him with a firm stare.
‘Go around the other side of the bed,’ she repeated measuredly, ‘and hold onto your daughter so that if she jumps when I put the needle in, you can steady her. I don’t want to get an IV line into her only to have her move and pull it out. I need your help here, Mr Anderson.’
Finally and to Leah’s infinite relief he gave a brief, very short nod and Leah let out a small sigh as he moved around the other side and cradled his daughter.
‘It’s in,’ Leah said, breathing a sigh of relief as she taped it firmly in place and flushed the line. ‘Right, I’m going to run some IV fluids through a line and as soon as the doctor comes we can get…’ Her voice trailed off as Tara arrived minus a doctor, and Leah knew with a sinking feeling that the relative stand-off she had engineered with Mr Anderson would vanish in a second if there was going to be another delay. ‘Someone will be here in a few minutes,’ Tara whispered, taking over priming the IV fluids. ‘It’s hell out there.’
Theoretically Leah needed a doctor to start the fluids, she also needed another registered nurse to check the solution she was about to administer, but in her old department she would have barely given it a thought. She would have started the drip and faced the consequences later, knowing she had the back-up of the consultant. Her timing may have been off, but for the first time in more than a year Leah felt a wave of homesickness for her old department, for the team she had so effortlessly run, for the comradeship she had fought so hard to nurture.
But rules were different here, Leah reminded herself, and more to the point she wasn’t in charge. The buck didn’t stop with Leah—Fay would possibly be in trouble also if Leah went ahead and broke with convention.
‘Fill the paediatric burette to two hundred mils,’ Leah ordered, ‘and set the pump to give a stat bolus dose. By the time you’ve done that I’ll be back.’
Running across the department, she slid open the resus doors. The sight that greeted her not a particularly pretty one and she could see in a glance the reason no one had responded to Tara’s pleas for a doctor. Every bed was full, a three-, maybe four-year-old was fitting as the paediatricians fought desperately to stop the convulsions that racked his body, a young man was having his fractured leg reduced, his screams filling the room as the trauma team performed cardiac massage on the end bed.
‘I need a doctor in Paed Resus.’ Leah spoke above the noise, her eyes meeting Cole’s as he looked up briefly. ‘Now!’ she said firmly, ‘or we’re going to have a paediatric arrest on top of everything else.’
‘I’ve got this, Cole, you go,’ one of the orthopods said, taking the unfortunate young man’s leg and carrying on with the reduction as Cole hurried out after Leah.
She relayed the story as best she could as they raced through the department. ‘Have you started a drip?’
‘I can’t do that without a doctor’s order,’ Leah said, not missing the quizzical look Cole shot at her as they entered the room.
He nodded as soon as he was at the bedside and Tara passed the bung which Leah connected as Cole examined the infant.
‘Has she had any wet nappies today?’
‘I don’t know,’ Mr Anderson answered, clearly agitated as Cole listened to her chest. ‘She’s had lots of dirty ones, but I don’t know if she’s been wet.’
‘Blood pressure?’ Cole asked, his voice clipped, and even though he looked calm Leah could see the lines of tension around his mouth.
‘Sixty on thirty.’
‘Elevate the foot of the bed and get an NG tube into her while she’s still flat. Did you take any blood when you put the IV in?’
‘I got enough to do some U and Es and an FBC.’
Handing him the blood forms, Cole scrawled his orders and signature and Leah handed the blood tubes and forms to Tara.
‘Get a porter to rush these up and ring the lab and tell them to get straight onto them.’
Cole was examining the little girl gently, pushing her chin down to her chest to check for any neck stiffness, which could be a sign of meningitis, and then carefully examining her ears and throat. As he gently probed her mouth with the lolly stick, Jessica grimaced, feebly trying to push Cole’s hand away, which was a good sign indeed as only a few short minutes ago she had barely flinched as Leah had twice stuck needles into her. Looking up, Cole gave Mr Anderson a steadying smile. ‘The fluids we’re giving her are already starting to have an effect. Hopefully now she’ll pick up quickly. I’m still with another patient but I’ll write up some IV orders for Jessica and I’ll be back very shortly and do a more thorough examination. I know you would have gone through this last night but I’m going to need to get a history from you again.’
Mr Anderson nodded, positively docile now. ‘Look, I’m sorry about before.’ He gave an embarrassed cough as Cole, who clearly had no idea what had gone on, gave a bemused frown. ‘I had a bit of a go at the nurses when I got here. It’s just we seemed to be waiting for so long and I was so worried.’
For an instant Leah could have sworn Cole’s grip tightened on the pen he was holding, could have sworn his eyes narrowed slightly as he looked up, but even as she registered the fact, Cole righted himself, giving Mr Anderson a brief nod.
‘Don’t worry about it for now. We’re used to agitated patients here.’
Leah had heard it all before, had probably said the exact thing herself on numerous occasions, but today, with her heart rate still topping a hundred, with Mr Anderson’s angry shouts still ringing in her ears, Cole’s laid-back words incensed Leah. It was all very well for Cole to graciously accept an apology, all very well for Cole to shrug it off as a non-event when it hadn’t even touched him, and she didn’t return Cole’s smile when he looked over at her.
‘I’ll be back shortly, then,’ Cole said, writing on the IV chart before beating a hasty retreat back to a still steaming resus.
Jessica was picking up now and Mr Anderson swallowed back his tears as he cradled his daughter.
‘Later on we can give her some fluids down the tube in her nose,’ Leah explained as she checked Jessica’s obs again, pleased to see they were picking up. ‘For now, though, she’s getting everything she needs through the drip.’
‘Will she still have the diarrhoea?’
‘That has to run its course, I’m afraid. We don’t give any medication to stop it, but they took a specimen last night so we should get the results through soon and then we’ll know what bug’s causing it so we’ll be better able to tell you how likely it’s going to last.’
‘Can she have a drink? If she asks for one, I mean.’
Leah nodded. ‘She may well vomit it up, but drinking’s good.’
A tiny blush crept over Mr Anderson’s face. ‘Sister, about before, I really am sorry.’
Leah didn’t say anything, just fiddled with the blood-pressure monitor, setting the cycle for fifteen minute obs before writing down her findings.
‘I was just blowing off a bit of hot ai
r,’ Mr Anderson mumbled. ‘I would never have hit you, you know?’
Eighteen months ago she would have shrugged it off, accepted his apology and carried right on, only she couldn’t do it any more. Couldn’t pretend that it didn’t matter, that bully-boy tactics didn’t hurt. Taking a deep breath, Leah looked up from the chart on which she was writing. ‘No, Mr Anderson,’ she said softly, as he shifted uncomfortably in his seat. ‘I didn’t know.’
It took for ever for the department to settle, but finally order was restored and even though the department was still full with a massive backlog in the waiting room at least things seemed manageable. Glancing up at the clock, Leah gave an internal sigh. There was still another hour of her shift to go and all she really wanted to do was go home to sink into a bath and hopefully quell the knot of tension that seemed to be stuck like a fist in her stomach since the confrontation with Mr Anderson.
‘How are you doing?’ Cole looked over her shoulder as she wrote up some notes.
‘Fine,’ Leah sighed, ‘or at least I will be in an hour or so.’
‘It’s been a bit like that today, hasn’t it?’ Cole agreed. As she made to go he called her back. ‘Hey, Leah?’ He was tapping his pen on the nurses’ station in front of him, clearly not quite comfortable with what he was about to say. ‘How come you didn’t start the drip?’
Turning, Leah gave a small shrug, but her casual gesture belied the sudden glint of tears in her eyes. ‘Like I said, I needed a doctor—’
‘Oh, come on, Leah.’ Cole shook his head. ‘You’re a charge nurse, for heaven’s sake. The kid had been in the night before with gastro and don’t hide behind the fact you’re a just a nurse. You know damn well with your qualifications you would have shut down any argument from Admin in a second. You’re paid to make decisions in an emergency. Are you trying to tell me that in England—?’
‘But we’re not in England.’ Her words came out harsh—too harsh, Leah realised, but tears were threatening now. Cole was right. Theoretically he was wrong, but in practice he was right. Any emergency nurse worth her salt would have started that drip and her hesitation truly scared her. ‘And I’m not a charge nurse here, Cole, I’m an RN and a bank nurse to boot. If you don’t like the rules, if you want nurses starting drips without a doctor’s say-so, then you, better than anyone, are in a position to change things. I was just doing my job.’
It was a cop-out and they both knew it, and Cole gave a tight shrug as Leah made to go. Again she didn’t get very far, only this time Cole calling her back had nothing to do with it. This time it was Leah making waves.
‘In England,’ she added, with a defiant note to her voice, ‘a grad nurse wouldn’t have to beg twice for a doctor to come to the cots.’
‘Tara didn’t say it was an emergency.’
‘Oh, so do you think I sent her in to ask you to come and strap an ankle? And while we’re on the subject, in England, or at least in the department I used to work in,’ Leah added, with a slight tremble to her voice but not bothering to lower it as Fay came over and shot them both a questioning look, ‘if a patient was abusive to a member of staff, the doctor wouldn’t just dismiss it out of hand.’
She should have stayed, should have seen it through, but the emergency corridor was hardly the best of locations and, biting on her lip to hold back her tears, Leah made her way to the coffee-room, half expecting Cole to follow her. But it was Fay instead who came in and busied herself pouring a coffee without saying a word.
‘I’m sorry, Fay,’ Leah said as Fay handed her a steaming cup, ‘but despite what you’re thinking, that had absolutely nothing to do with the fact Cole and I are seeing each other.’
‘I know that,’ Fay said shrewdly, ‘or this conversation would have been taking place in my office. Mr Anderson really upset you, didn’t he?’
Leah gave a small reluctant nod, running a trembling hand through her hair. ‘I just got a bit of fright,’ Leah said finally. ‘And Cole’s dismissal infuriated me, though in fairness Cole wasn’t there when it all happened. By the time the emergency was over Mr Anderson was as docile as a teddy bear. Cole probably thought he’d just snapped a bit, when in actual fact he was extremely threatening to both Tara and myself.’
‘He was probably scared,’ Fay said wisely. ‘And as for Cole…’ Kind, knowing eyes met Leah’s. ‘I made no secret of my reservations about you two working together, not only to you, Leah, to Cole as well. Happily I’ve been proved wrong, but the simple fact of the matter is, impartiality might come at a high price sometimes.’ Registering Leah’s frown, Fay pushed on gently. ‘Sometimes when you’re trying not to show favouritism you can go too far the other way, and if he came across as impassive it was probably to mask what he was really feeling.’
Leah nodded, remembering Cole’s expression when Mr Anderson had attempted to excuse his actions.
‘You can’t have it both ways, Leah,’ Fay said a touch more firmly. ‘You can’t expect Cole to treat you as a colleague one minute and a defensive lover the next.’
‘I know,’ Leah admitted, grateful for Fay’s insight and embarrassed at the same time. ‘I’m more cross with myself really than Cole. That little girl needed a drip, was on the verge of collapse. Normally I would have…’ Her voice trailed off as Leah squeezed her eyelids closed on a fresh crop of tears.
‘In your other life?’ Fay said.
Leah nodded, wiping a stray tear angrily with the back of her hand, determined not to break down completely.
‘It must be hard,’ Fay said gently. ‘Was it busy where you worked?’
Leah nodded, surprisingly grateful for the chance to talk about her old job. ‘Pretty much like this. I did nights,’ she added, and Fay gave a knowing nod.
‘Which means fewer doctors and more pressure?’
‘I loved it,’ Leah admitted. ‘And Cole’s right in what he said. I wouldn’t have thought twice about starting that drip back home.’
‘You would have thought twice,’ Fay said perceptively. ‘Three times even. You’d have examined the child, known it was gravely ill, and when you’d realised the doctors were stuck, and that no help was forthcoming, you’d have acted. That’s what we do each day, Leah, that’s what being an emergency nurse is all about—dealing with emergencies. And despite what Cole might say, despite your qualifications, I’m glad that you did hesitate today. I don’t want an RN, no matter how well qualified she thinks she is, saying to hell with protocol.’
‘I know that,’ Leah agreed. ‘Even when I was thinking about starting it, I knew that if I did, if things went wrong then it wouldn’t just land on my shoulders but yours as well. But I still feel guilty…’
‘Because you’re over-qualified,’ Fay suggested. ‘Over-qualified to be just a number. Would it help if I told you there’s a clinical nurse specialist position coming up? I know it’s not up to the level you were but at least it’s a step in the right direction, and if you were on the permanent staff things could surely only be easier?’
Leah looked up sharply, a tremulous smile wobbling on the edge of her lips. ‘I thought I was about to get a dressing-down, not offered a promotion.’
‘I’m not handing it to you on a plate,’ Fay said sternly, but her eyes were kind. ‘But I guess, with me as a recent reference, they’d be pretty stupid to say no. It’s on nights. I know that’s not ideal for a young woman,’ Fay added, misinterpreting the frown that flickered on Leah’s face, ‘but at least you’d have a shoe in, and the way the roster is at the moment there’s no doubt that we’d soon be needing you back on days.’
‘I’m only on a holiday visa,’ Leah said, doubts flowing into her mind with a horrible dousing effect.
Nights!
Nowhere was really safe in Emergency, Mr Anderson had proved that. Tempers could flare at any given moment, but the thought of permanent nights had Leah in a spin. ‘I’m only here until I’m well enough to fly home.’
‘Are you, though?’ Fay said, standing up as her pager sprang i
nto life. ‘This could be home too, Leah. It’s up to you.’
‘About before,’ Leah started as she walked in the door. They hadn’t seen each other since her dummy spit in the corridor and, bracing herself for a confrontation, Leah headed up the hall.
‘Work’s work.’ Leaning up against the living-room door, never had Cole looked more divine and never had she loved him more as he came over and kissed her deeply, dismissing her worries in an instant. ‘If we’re going to work together, we’re going to row, but we have to leave it where it belongs—at work,’ Cole said softly. ‘This is home, we leave the arguments at the door.’ He gave a low laugh as Leah pulled her scrunchy out and ran a troubled hand through her hair. ‘Mind you, had you came home an hour ago it might have been a different story. I was still smarting.’ His eyes narrowed thoughtfully, staring at her for an age before he carried on talking. ‘Knowing what you’ve been through, knowing how hard it is for you, when that guy—’
‘I understand, Cole.’ Taking a deep breath, Leah carried on talking. ‘And what I said before was unfair. The last thing I really wanted was you jumping to my defence. I just didn’t realise it at the time.’
‘I spoke to him later.’ As Leah’s eyes widened Cole gave her a slow, measured smile. ‘Don’t worry, I was so restrained you’d have been proud of me, but I’m pretty sure the nurses on the children’s ward don’t have anything to worry about.’ He took her hands, staring at them for ever before he carried on. ‘I’m a doctor there, Leah. I can’t let emotion get in the way and if I’d gone with my initial reaction, if I’d told him what I really thought, well, suffice to say I don’t think you’d have been particularly pleased.’
‘I wouldn’t have,’ Leah admitted. ‘And I understand that at work you’re a doctor and I’m just another nurse, it’s just…’
He heard the hesitant note in her voice and his hands gripped hers tighter. ‘Say what’s on your mind, Leah. It’s just what?’
Looking up, she took a deep breath. ‘I don’t want to be just another nurse.’ When Cole didn’t respond Leah carried on talking. ‘Which seems so strange when until a few weeks ago I didn’t even know if I wanted to work in Emergency any more…’
The Consultant's Accidental Bride Page 10
