by Sarah Morgan
‘Gladys?’ Logan’s frown changed to a look of concern and Kyla thrust a piece of paper into his hands.
‘You see? You care really, you know you do. You just hide it well. This isn’t going to wait, Logan. She needs to be seen right away.’
‘I have surgery—I can’t be in two places at once.’
‘Well, I think the place you need to be is with Mrs Taylor. Janet thinks she’s broken her leg. You go. I’ll keep the patients happy. Evanna and I will see the ones that we can and the others will just have to wait.’ Kyla waved a hand towards the door. ‘Go forth and heal, oh great one. I can sing and dance and generally entertain them while you swan off like a knight in shining armour.’
‘I’ll start your surgery.’ Ethan stepped forward, cool and unflustered, watching the exchange between them with puzzled curiosity. ‘Why not?’
Logan ran a hand over the back of his neck. ‘Because you’ve been travelling all night? Because you must need a shower and a rest? Because you don’t know the patients or the island? How many more reasons do you need?’
Ethan gave a faint smile. ‘I’m used to travelling and the shower and the rest can wait. As for not knowing the patients or the island…’ he gave a dismissive shrug of his broad shoulders ‘…I don’t see why that should that be a problem. Presumably Kyla’s on hand if I need help. Keep your mobile on. If I have any questions, I’ll call you.’
‘All right, then. If you’re sure.’ Without further argument Logan reached for his bag. ‘If she’s fractured her hip, I’m going to need the air ambulance, Kyla. I’ll call you.’
‘You do that.’ Kyla watched her brother stride through the door and then picked up a set of keys. ‘All right, Dr Walker. Looks like you’re on duty. I’ll show you your room then I’ll fetch you a cup of coffee. Hopefully that will see you through until we have time for something more—’ She didn’t finish her sentence because the surgery door crashed open and a large man staggered in. His face was pale and shone with sweat, his hand pressed against his chest.
‘Doug!’ Kyla was by his side in a flash, her arm sliding around him in an instinctive offer of support. ‘What’s happened? Are you ill?’
‘Pain.’ His face was contorted in agony and tiny drops of sweat clung to his forehead. ‘Terrible pain in my chest. I was down in the basement, shifting crates of beer, when I started to feel funny. A bit sick, to be honest. Then it hit me all of a sudden. It’s like an elephant on my chest.’
‘Can we lay him down somewhere?’
‘In the consulting room.’
Ethan took the man’s arm and he and Kyla guided him down the corridor into the room. ‘Let’s get you up on the couch, Mr…?’
‘McDonald,’ Kyla said quickly, raising the back of the couch and helping the patient to lie down. ‘Doug McDonald. Fifty-six years of age, been treated for hypertension for the past three years. He’s taking beta blockers, an ace inhibitor and a statin.’
Ethan lifted a brow as he took Doug’s pulse and reached for a stethoscope. ‘You know every patient’s history by heart?’
‘Small community, Dr Walker. What do you need?’
‘Start with oxygen?’
‘There’s a cylinder to your right with a mask already attached, and I expect you’ll want to put a line in. I’ll fetch you the tray.’ Brisk and efficient, she reached into the cupboard, removed the tray and placed it on the trolley next to him. ‘Just breathe normally through that mask, Doug. That’s great. I’ll squeeze while you find a vein, Dr Walker.’ She put her hands around Doug’s arm, watching while Ethan stroked the back of his hand, searching for a vein.
‘Do we have the facility to start an IV?’
‘Of course. I’ll run a bag of fluid through for you.’
‘You have good veins, Doug.’ He cleaned the skin, inserted the cannula with the ease of someone who had performed the same procedure successfully a million times before. Kyla gave a faint nod of approval and released her grip on Doug’s arm.
‘You’re doing fine, Doug. Dr Walker will soon have you feeling better. I’ll get the notes up on the screen for you,’ she said to Ethan. ‘That way you’ll be able to see what Logan has been doing.’ She moved over to the desk, flicked on the computer, crossed the room and grabbed the ECG machine from the corner. ‘That computer will just take a minute to wake up.’
Doug gave a grunt of pain, his hand on the mask. ‘I was always afraid that this might happen. It’s why I tried to lose weight. I managed to stop smoking but I just ate more.’ He grimaced and leaned back against the pillow as Ethan connected a bag of fluid. ‘I’ve been trying, really I have. But it’s so hard.’
‘You’ve been doing brilliantly, Doug, you know that. Don’t worry about it now,’ Kyla said quickly, wrapping the blood-pressure cuff around his other arm. ‘We just need to find out what’s happening.’ She checked his BP, showed Ethan the result and he gave her a nod.
‘Can we do a 12-lead ECG?’
‘Already on it.’ Kyla quickly stuck the pads onto the patient and applied the chest leads and limb leads. ‘Just hang in there, Douglas, you’re going to be fine. Dr Walker is a real whiz kid from the mainland. People usually pay a fortune to see him, but you’re getting him free so this is your lucky day.’
She was aware of the sardonic lift of Ethan’s dark brows but chose to ignore him. This was her territory, she reminded herself. There was no way she was going to allow herself to be intimidated by a locum doctor, no matter how slick and handsome.
Doug closed his eyes and gave a wan smile. ‘It doesn’t feel like my lucky day, hen.’
Kyla felt her heart twist at the endearment. She’d known Doug since she’d been a child. ‘Of course it’s lucky because I’m on duty,’ she said lightly, switching on the machine. ‘If you had to be ill then you’ve done it in the right place. You’re going to be OK, Doug.’ She chatted away in a steady, reassuring voice and then looked up as the door opened and a dark-haired girl in a blue uniform hurried into the room.
‘I just drove past Logan breaking the speed limit on the coast road and, judging from the look on his face, I thought you might need some help here.’ Her eyes were gentle and concerned and her ponytail swung as she moved her head. ‘Doug? What have you been doing to yourself?’
‘This is Ethan Walker, the new GP. Ethan, this is Evanna, the other island nurse. Logan’s gone to see Janet’s mother who’s had a fall and our Doug here is having nasty chest pains. Can you call the air ambulance?’ Kyla glanced up at her friend and colleague and used her eyes to transmit the message that the request was urgent. ‘Whatever happens, we’re going to need to transfer Doug to the mainland. Doug, I need to call your wife and let her know what’s happening. Is she home?’
Evanna slid out of the room without argument and Kyla felt a flicker of relief. She knew she could trust her friend to get the air ambulance to the island as quickly as possible.
‘No.’ Douglas turned his head, his face pale and sweaty and his voice urgent. ‘You’re not to worry Leslie. She’s got enough on her mind at the moment with our Andrea going through a rebellious phase. She doesn’t need this. I’m having a heart attack, I know I am. It’ll be too much for her.’
‘She loves you, Doug,’ Kyla said firmly, starting the machine and watching the trace. She didn’t like what she saw but she was careful not to let her worry show on her face. But she was definitely calling his wife. ‘You’re a partnership. A team. What do you think she’d say when she discovers that you’ve flown off on a mini-break to the mainland and left her here?’
ST elevation, she thought to herself, studying the pattern. She’d seen it often enough in her short time in A and E.
Doug gave a wan smile and shook his head. ‘She’s always on at me to leave the island for a break.’
‘Well, there you are, then.’ Kyla stood to one side so that Ethan could watch the trace. ‘There’s ST segment elevation in two leads. I expect you’ll want to give him heparin and reteplase. I’ll get it ready.�
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Ethan looked at her and she saw approval and a flicker of surprise in his eyes. ‘Do we have morphine and GTN spray?’
‘Of course.’ The question amused her. So he thought he was working in a backwater, did he? She unlocked the drug cupboard, found what she needed and prepared it, listening as he talked to Doug.
‘I’m afraid the ECG shows that you’re right about the heart attack, Doug. Probably caused by a blood clot in one of the vessels leading to your heart.’ His tone was calm and steady. ‘I’m going to give you a drug that will break it down.’
‘One of those clot-busters I’ve been reading about?’
‘That’s right. We need to get the blood flowing back through that artery for you. Before I give it, I need to ask you a few questions.’
Doug winced, his face pale behind the mask. ‘I ought to warn you that I hate quiz night at the pub. I never go. If you’re about to start on capital cities, you can forget it. I left school at sixteen and went out on my father’s boat.’
Ethan smiled. ‘You don’t suffer from any bleeding disorders? Haven’t had surgery lately?’ He asked a series of rapid questions and then took the drugs from Kyla. ‘How long does the air ambulance usually take to arrive and where do they land? I’m not sure he’s stable enough to travel.’
‘The paramedics are skilled and you can go with him. They carry a defibrillator, along with all the other gear you’re likely to need.’
Ethan administered the drug carefully. ‘And they can fly here?’
‘Oh, yes, providing the weather is all right, and today it should be fine.’ Kyla took the empty syringe from him and disposed of it with swift efficiency. ‘We need to call the hospital and fill out details for the transfer.’
‘If I go with him, that will leave you with no doctor.’
Kyla smiled. ‘Logan’s still on the island and he won’t be long, I’m sure. Don’t make the mistake of thinking that you’re indispensable, Dr Walker,’ she said cheerfully, her eyes sliding to Doug’s taut features. ‘We nurses are extremely versatile.’
His gaze followed hers and he frowned and checked Doug’s pulse. ‘How’s the pain now? Any improvement?’
Doug nodded. ‘Better,’ he rasped, just as Evanna came back into the room.
‘Air ambulance will be here in fifteen minutes,’ she said in her calm, gentle voice. ‘I’ve explained to the patients in the waiting room that there will be a delay until Logan gets back.’
Kyla looked up. ‘Did you call him?’
‘Yes. Mrs Taylor has a nasty laceration of her leg and she’s very shaken up but nothing’s broken. He’s going to bring her back here to be sutured and I’ve said that one of us will spend some time in the home with her, discussing how to avoid falls.’
Kyla frowned as she reached for the phone. ‘She ought to join your exercise class, Evanna. Did she trip over something?’
‘Not sure. Janet just found her at the bottom of the stairs. It was fortunate that she didn’t break anything or we’d be keeping the ambulance busy today.’ Evanna glanced at her watch. ‘If you don’t need me here, I’ll get started. I’m going to filter Logan’s patients and see as many as I can for him.’
She left the room and Kyla handed Ethan the phone. ‘You’ll want to speak to the head of the coronary care unit at the Infirmary. His name’s Angus Marsh. He’s a nice guy.’ She walked over to Douglas. ‘It’s time we let your wife know what’s going on. This is an Island, Doug. She’ll see the air ambulance and pretty soon someone is going to tell her who the patient was. The first thing she’ll do is worry and what will be going on in her head is going to be worse than the real thing. The second thing she’ll do is kill me.’
As if to prove her point, the door flew open at that moment and Leslie hurried into the room.
‘Who needs phones when there’s the island grapevine?’ Kyla breathed, stepping back from the couch and watching as Leslie lifted her hands to her cheeks.
‘What have you been doing to yourself, Douglas Rory Fraser McDonald?’
Doug gave a feeble groan but there was no missing the affection in his eyes. ‘What are you doing here, woman?’
‘I was buying fish from Geoff on the quay and he told me he’d seen you looking really off colour and heading up this way.’ Leslie stared at the ECG machine in horror and then turned to Kyla. ‘Nurse MacNeil? What’s going on?’
Kyla’s gaze flickered to Ethan but he was on the phone, talking to the consultant at the hospital, arranging the transfer. ‘Douglas has had some chest pain and it looks as though he might have had a heart attack,’ she said gently. ‘He’s doing very well and there’s certainly no need to panic. We’re going to transfer him to the mainland just until they’re happy with his condition. Just a precaution. The helicopter is going to be here in a minute.’
Leslie gave a soft gasp. ‘You’re going to the mainland? You’ve had a heart attack? And just when were you planning on telling me this, Doug? Next Christmas?’
‘Stop fussing. Kyla was just about to ring you but they’ve been working flat out since I arrived.’ Doug kept his eyes closed and his voice was thready. ‘Go back and check on our Andrea. I’ll call you from the hospital.’
‘Andrea is fine. She’s thirteen now. She can get herself to school.’ Leslie looked at Kyla, her face grey with shock and worry. ‘Can I go with him?’
Kyla nodded. ‘You should be able to but I’ll have to check with the crew. Leslie, you look very pale. Sit down.’ She quickly dragged a chair across the room and the other woman plopped onto it gratefully.
‘I’ll be fine in a minute,’ she muttered, rubbing her hand across her forehead. ‘It’s just a bit of a shock, that’s all.’
Ethan replaced the phone just as Evanna popped her head round the door again. ‘The helicopter is here. The paramedics are bringing a stretcher in for you.’
‘I’ve spoken to the hospital and they’re expecting him.’ Ethan checked Doug’s observations again and then helped the paramedics move him onto the stretcher.
They loaded Doug into the helicopter, helped Leslie on board and then Ethan sprang up beside him in a lithe, athletic movement. ‘How do I get back?’
Kyla grinned. ‘If you’re lucky, they bring you back. If you’re unlucky, you swim. Don’t worry, the water’s quite warm at this time of the year. See you later, Dr Walker.’
She ducked out of range of the helicopter’s blades and made her way back into the surgery. Walking into the crowded waiting room, she explained what had happened and quickly assessed who could see her instead of a doctor.
‘Is Doug going to be all right?’ Paula Stiles, who worked in the gift shop, asked the question that was on everyone’s mind.
Patient confidentiality was a total nightmare, Kyla reflected as she gave as little information as possible while still providing the necessary reassurance.
Then she opened the door of her own room and switched on the computer. Interesting start to the day, she mused as she tapped a few keys and brought up her list for the morning. Not even nine o’clock and already she felt as though she’d done a day’s work.
And she didn’t want to think about how Ethan must feel. He’d travelled for most of the night to catch the first ferry and now she’d had to send him back to the mainland, and she knew from experience that he’d be lucky to make it back before lunch.
She hoped the new doctor had stamina because he was going to need it.
CHAPTER THREE
HER first patient was the headmistress from the local primary school, who had been hoping to see Logan and be back in time for the start of the school day.
‘I’m sorry you’ve had a wait, Mrs Carne,’ Kyla said, her tone apologetic as she reached for a pen. ‘If it’s your asthma that’s bothering you, I could discuss it with you and then we could talk to Logan later.’
‘It is my asthma.’ Ann Carne put her bag on the floor and sat on the chair. ‘I’ve been having problems on the sports field. Can you imagine that? I’m dea
ling with six-year-olds and I’m getting out of breath.’
‘Six-year-olds are extremely energetic,’ Kyla said dryly. ‘Don’t underestimate the impact that can have on your breathing. I went to sports day last year and I was exhausted just watching. So what’s happening? Are you using an inhaler before you exercise?’
‘Sometimes.’ Ann looked uncomfortable. ‘I try to sneak off to the staffroom but it isn’t always possible.’
‘Why would you need to sneak?’
‘I don’t want the children knowing I have an inhaler.’
Kyla looked at her, trying to work out what the problem was so that she could tackle it in a sensitive way. ‘Are you worried about them or you?’
‘Both?’ Ann gave a rueful smile. ‘I hate admitting I’m ill and I don’t want the children worrying that I’m going to collapse in front of them.’
‘Would they think that?’ Kyla frowned and tapped her pen on the desk. ‘There are a couple of asthmatics in your school, as you well know. The children are used to seeing inhalers and spacers.’
‘But not in their teachers.’
Judging that the situation was more about Ann than the pupils, Kyla sat back in her chair. ‘It’s nearly a year since you were diagnosed, Ann. How do you feel about it all now?’
There was a long silence and then Ann breathed out heavily. ‘I still can’t believe it’s me,’ she said finally. ‘I mean, I’m fifty-two years of age. It’s ridiculous! How can I suddenly develop asthma out of nowhere?’
‘People do. It isn’t about age. There are many other factors involved.’
‘Well, I can’t get used to the idea.’
‘Is that why you don’t use the inhaler?’ Kyla’s voice was gentle. ‘If you don’t use the drugs then you can’t be ill?’
‘How did you come to be so wise?’ Ann gave a faint smile. ‘I remember you when you were six years old, Kyla MacNeil. You brought a frog into my class and hid it in your desk.’
