'You've got everything happening to stabilise him,' Gabi said, moving back towards the curtain so she could speak to Alex without upsetting the patient. 'What's worrying you?'
'The cause. He came in because he'd been knocked out—hit his head against the windscreen in spite of his seat belt. That means his chest must have struck the steering-wheel. Heaven knows, we see it often enough to be aware that kind of injury can result in a tear in the aorta or in some other vessel and internal bleeding would explain the shock, but there's no sign of blood loss in his BP. I've booked him for a CT scan just in case but, in the meantime, have you any suggestions?'
'Delayed shock isn't that uncommon,' Gabi said, fighting the deja vu of working A and E again with Alex. The pregnant woman had obviously awoken a lot of buried memories. 'Have you talked to him? I realise you must have when you asked him where it hurt—but have you really talked to him? Perhaps he had a child in the car and is only now realising just how close they came to being seriously injured.'
Alex nodded.
'I guess it's possible, but you'd think there'd have to be a physical reason as well.'
'Not necessarily,' Gabi told him. 'I show all the symptoms of shock every time I think about going up in a plane—and that's not physical. Well, the symptoms are but the reason isn't.'
Gabi left him to it, moving on to the next patient, but the plane part of her conversation had reminded her about the rescue course. Was it too late to back out?
Did she need that much change in her life?
Especially now Alex was back and, should she want to, she could discuss what had gone on with their marriage without ever setting foot in an aircraft.
We're not talking Alex here, she berated herself. We're talking change and whether she needed it.
Simple answer? Yes!
More complex answer? Still yes, because, if nothing else, keeping busy for the next six months would stop her brooding over that faint possibility of HIV. After all, no matter how low the odds, someone had to contract HIV from needle-stick injuries to make up the statistical point five of one per cent.
The day fell into its normal routine. The accident victims who'd been kept in were shifted to the corridor, still being observed but releasing curtained cubicles for new patients. Gabi was switched to the walking wounded, people who'd come by themselves or with relatives, needing attention ranging from suturing of minor wounds to hospitalisation for acute appendicitis.
She snatched a cup of tea at one stage and caught a glimpse of Alex disappearing behind a green curtain but, as she'd guessed, their paths rarely crossed. Until a young girl who'd slashed her wrists was brought in, with such serious blood loss the ambulance attendants had bound her wrists to stop further blood loss and started fluid replacement.
'We need blood-typing for a full blood transfusion,' Alex said as she came in answer to his call for help to stabilise the woman. He was switching a bag of fluid over, replacing an empty isotonic solution aimed at boosting the fluid levels with another. 'Then another catheter inserted. Try the anticubital fossa in her other arm first and if you can't get a 16-gauge in there so we can pump fluid in faster, you'll have to try to get one in her leg.'
Gabi found herself praying she'd have success with inserting another catheter in the girl's arm. Although she'd inserted hundreds of catheters into the femoral vein in a patient's leg, the technique, using a flexible wire to guide the needle, was slower and more likely to cause complications for the patient later.
She was lucky, and, with some blood removed and a second access open, more fluid could be fed into the patient's depleted vascular system. Once two to three litres had been infused Alex would assess the girl's response, then decide whether or not whole blood would be necessary.
'If she was in the ICU she'd have a central venous catheter inserted to monitor the venous pressure,' Alex said, looking worriedly at the girl's colourless lips.
'As soon as you feel she's OK to move again, that's where she'll go,' Gabi reminded him. 'And they've the facilities to do a cut-down far more easily and effectively up there than we have down here.'
She didn't add that although all students learnt to do 'cut-downs'—the technique of cutting into a vein in the neck or upper chest to insert a catheter for either infusion of fluids or to monitor central venous pressure—under normal circumstances they weren't encouraged to do it in A and E, where conditions made it more possible for an infection to develop in the wound.
There were also any number of complications that could ensue, including pneumothorax if the needle should puncture the lung, or internal bleeding if the cut did too much damage to the blood vessel.
Thinking of work as she checked the girl's blood pressure stopped her considering the terrible despair the youngster must have been suffering that she'd taken such drastic measures. And to have lost as much blood as she had she'd either opened her veins in the correct manner, along them rather than across them, or she'd not been found for a long time after doing it.
And I'm afraid of going up in a plane! Gabi thought, and probably shuddered because Alex touched her shoulder, as if to comfort her, though he couldn't possibly have known her thoughts.
'The second lot of fluid's working,' he said, nodding at the oxygen saturation monitor. 'Thanks.'
Gabi left the cubicle and was making her way back to the main station to find out who was next when she passed the man Alex had treated for shock earlier. He was sitting on a gurney, drinking a cup of tea.
'Feeling better?' she asked, and he nodded, but the depressed look on his face suggested that 'better' was a relative term.
'You're still worried. Did you have someone else in the car with you? Someone who was more seriously injured?'
He shook his head then said, 'No, that's wrong. I did have someone in the car. My wife. Have you been pregnant?'
The question was so unexpected it startled Gabi, then she put two and two together.
'The pregnant woman was your wife? But surely someone's told you? She's fine. Her specialist has seen her and, although he advised her to rest when she got there, he said she could go home.'
'Exactly,' the man said bitterly. 'Which, according to the nurses, is just what she did. It's why I asked if you'd been pregnant.'
Totally confused, Gabi nodded.
'Did it take over your life?' the man demanded. 'Did it consume you to the extent that no one and nothing else mattered?'
Had it? Gabi wondered.
Certainly Alex's reaction had made her draw in on herself, but...
'Your wife had a shock, and I guess her first concern was for the baby.' Even as she said them, she knew the words weren't going to offer any comfort whatsoever to this poor man.
'So was mine!' he snapped, right on cue. 'But I thought of her as well, of both of them. But did she care about me? Obviously not, or I wouldn't be sitting here on my own while she's swanned off home in a cab.'
Gabi sighed, but only inwardly. She'd seen more domestic arguments in her years of working in A and E than most people saw in a lifetime.
'You were probably still being treated. You went into shock, you know.'
'She didn't even ask about me. I asked the nurses and the woman on the desk. She doesn't care. All she cares about is the baby.'
'Dr Gabi Graham to Room Five.'
The message, repeated twice, as all pages were, reminded Gabi of the backlog of patients the accident would have caused, but she was reluctant to simply walk away from this man.
'Have you talked to her about this? Told her how you feel?'
The man laughed, but so harshly it made Gabi's skin prickle.
'Of course I have. Or I've tried to. But from her view I'm being childish and behaving badly because I'm no longer the sole focus of her attention.'
That 'focus' word had sure been getting a workout lately, Gabi thought, while another bit of her brain sought for some advice or comfort she could offer this man.
But, short of suggesting he feign a relapse a
nd be hospitalised for further tests in order to grab his wife's attention, she couldn't think of anything, and the overworked staff, including Alana up in the admissions ward, mightn't be impressed if she suggested that option.
'You might both need some counselling. In fact, I'll see if I can get someone from Patient Services to come down and talk to you now. He or she might be able to suggest something that would help, or at least put you in touch with someone who might have some ideas.'
As her name was called again she excused herself, but paused on her way to Room Five to ask Roz to get someone down to talk to the man.
'Mr Hargreaves? Oh! I was just going to see him. His wife phoned in tears because she'd forgotten him. She'd been so concerned about the baby—'
Gabi held up her hand.
'Don't tell me, tell him,' she pleaded. Then she grinned and added, 'And lay it on thick about how upset she was. That'll do him more good than all the counsellors in the world.'
But the incident—or the ramifications of it—stayed with her. So much so it was still on her mind much later when, work finished for the day, she went up to the oncology ward to visit Jane.
Pushing open the door into the room, and seeing her ex-mother-in-law alone, she asked the question that had been bugging her since that morning.
'Did I get totally self-absorbed when I was pregnant? To the extent I shut Alex out?'
Jane's furiously wiggling eyebrows and contorted facial expressions told her it was the wrong thing to be asking, and, with the sick feeling that goes along with putting one's foot in it, Gabi turned to see Alex leaning against the wall on the far side of the room.
'Well, did I?' she demanded, asking the question of him now—not sure if it was him or herself with whom she was angry.
'Not overly so,' he said quietly, his dark eyes meeting hers but not telling her a damn thing. 'You're thinking of Mr Hargreaves? I heard he'd been talking to you.'
Gabi was about to question the 'not overly so' remark when an almost imperceptible shake of Alex's head warned her off the subject, and he stepped forward, making sure she didn't pursue it but explaining to his mother about the morning's accident.
Conversation turned to more general matters, but as they walked home together—well, it would have been stupid not to—she searched for a way to bring up the subject again and, not finding any subtle way of putting it, asked outright.
'Did you answer my question for your mother's sake— is that why you said, "Not overly so."?'
They'd stopped to wait for a break in the traffic so they could cross the road, and Alex turned to Gabi, his eyes searching her face as if to read some hidden subtext to the question.
Then the break came, and he took her arm and held it while they crossed.
'We were at odds with each other before you became pregnant—over going to Scotland. Then you felt it was sufficient reason for us to change our plans. I guess it was natural that I wondered if you'd done it deliberately, so that skewed my view of it—and everything that happened after it.'
He was talking so calmly it would be easy to believe that none of it had touched him deeply, but Gabi knew him well enough to guess that the words he was offering were being weighed and measured then dusted of emotion before he let them pass from his lips to her ears.
She wanted to argue over his 'our plans' statement, but that would have been petty. Besides, she remembered her own impression, when she'd lain in bed this morning, that she'd have to go a long way back—well before the pregnancy—to find their happy times.
'Can you remember where it started, the being at odds?' she asked, as she tried to remember what it had been like. 'Did it have an actual beginning or was it just niggly stuff that grew?'
Alex glanced her way and she glimpsed a slight frown before it was wiped away and he asked, 'Does it matter now?'
No, of course it doesn't, she should have said, but it would have been a lie because it did matter—at least to her.
'I suppose knowing why ours fell apart might make a difference in another relationship. Might save it foundering.'
'Have you another relationship in danger of foundering?' he asked, and Gabi realised they'd stopped walking and Alex was frowning at her, only this time it wasn't just an eyebrow twitch of a frown—this time it was the real thing, a full-blown, full-on scowl of a frown.
She turned away, moving on, climbing the steps into the apartment building.
Perhaps the 'our plans' had helped, because she'd suddenly remembered the birth of their problems. In fact, the expression on Alex's face as he'd asked about relationships had been just the same as when he'd announced that he'd made enquiries about specialising overseas, and she'd argued that, although she'd like to work overseas at some stage of her career, she didn't know that they should go right then. His mother was still grieving and needed them, and because of the length of time specialty studies took, Gabi had explained, she'd prefer it if he did them at home.
You'd have thought his shoe had bitten him, he'd been so shocked. And shocked on two counts—firstly that she hadn't automatically agreed with him, and secondly by her decision not to specialise but rather to stick with A and E, with heading that department in the children's hospital as her ultimate goal.
His reaction had made Gabi wonder if she'd lost all her identity—and, in Alex's eyes at least, had become nothing more than an extension of himself. At the time it had infuriated her so much she'd probably said some very rash things.
But no matter what she'd said, even pointing out that for him to enquire about studying overseas without discussing it with her was an indication of the way he was thinking about her position in his life, he hadn't listened. He'd shut himself off from any discussion because, in his view, no matter how she wrapped it up in reasons and excuses, she was letting her fear of flying dictate the terms of both their lives.
And though in the end she'd given in, reluctantly agreeing to go. to Edinburgh with him, the argument had caused such divisions that it had only been natural it had flared again when she'd become pregnant.
And had wanted to stay in Australia until she'd had the baby.
Naturally, he'd accused her of doing it deliberately!
'I would never have done something like that!' she muttered as he followed her into the foyer, then, realising she'd spoken aloud, she turned to him to find him nodding, as if he'd followed every strand of her tortuous thought processes.
And agreed with her?
Hardly likely.
Gabi stepped into the lift and pressed the '2' button. When the lift stopped she got out, offering 'I have to see Alana' as an excuse. She did have to see Alana but, in truth, Alex's company—and probably the conversation they'd been having—was causing so much tension she needed to unwind a bit before facing him again.
Or not facing him! Though she'd have to see him briefly as she shifted her things from her flat to Alana's.
CHAPTER FIVE
'You re doing what?' Alex roared, when he caught Gabi, laden with bags, trying to get out of the flat while he was still in the shower.
'Shifting down to Alana's.'
'Oh, for Pete's sake, Gabi, aren't you overreacting just a little here? Can't we behave like civilised people and share a flat for a couple of weeks without any drama?' His eyes narrowed. 'Or is it that you can't trust yourself to be in the same flat with me?'
He was so close to the mark that Gabi had to force a scoffing laugh from her throat.
'Don't kid yourself, buster!'
She was about to explain when he turned away, striding across the living room then back again to hold out his arms in a supplicating pose.
'And how do you think this is supposed to make me feel? I come back, thinking I might stay a while, and now I find I'm forcing you out of your own home? Are you finding ways to torment me? Is it a punishment thing?'
'Tormenting you? Punishment? What on earth are you going on about?'
'That dragon, for a start,' he fumed. 'Seeing you slink around with
that animal sinuously curved around your body. Isn't that a deliberate tease? And the hair? I come home, you look like Gabi, then before the day is done you've changed. Gabi's gone and some new fashion plate is in her place.'
'Judging a book by its cover now, are you?' Gabi snapped. 'I'm still the same me, and I'll have you know the hair had nothing whatsoever to do with your return. And for your information you are not forcing me out of my home—and I repeat, my home—I'm merely doing Alana a favour. She's going away tomorrow and needs someone to mind her pets, and as all my clothes are still in carry bags it's easier for me to shift down there than to be running back and forth between the two flats.'
But she might as well have kept her mouth shut for all the good that explanation did. Alex did at least wait until she stopped talking, but the rational part of the explanation had obviously passed him by.
'And that's another thing. Why are all your clothes in carry bags? Was the flat broken into? Were all your clothes taken? Have you done something about better security since it happened?'
Gabi sighed, and dropped the bags she was still holding onto a chair.
'I need a cup of coffee,' she muttered, heading for the kitchen.
She also needed to get away, but she couldn't just walk away, leaving Alex in a welter of guilt over her departure. Neither could she admit that she was moving out because of him. After all, she'd fed Alana's pets before without shifting into her apartment.
But in spite of all that had happened between them—the bitterness and pain, the arguments and recrimination, the twelve months' separation—her body still responded to Alex's presence with a neediness that frightened her, while her heart, which had been well behaved for a year, now did scrunching and fluttering things whenever she caught sight of him or sensed he was near.
He'd followed her into the kitchen, so it was happening now, the uncontrollable organ pumping so wildly she suspected she was glowing pinkly all over. She was certainly hot enough to be aglow.
Dr Graham's Marriage Page 7
