'More swabs.' Fergus was concentrating and Ailee slid them across from the scrub sister, who looked pale under her eye shield as she hurried to do what she was told.
'And can I have a swab on a stick as well, please?' Ailee's gentle voice seemed to dissipate the tension in the room. Ailee swabbed the area she'd just suctioned and for a brief instant a welling of blood could be isolated from the rest before it disappeared under a tide of red that filled the cavity again.
'Good work, Ailee.' Fergus had seen it, too, and now that he knew where the problem lay, he set to isolating the vessel as fast as he could.
'Blood pressure's going through the floor.' Andrew's voice drifted laconically to the surgeons as he set about increasing the amount of fluid he was infusing. 'I'm on the last packed cells now.'
'I can see the bleeder.' Fergus acknowledged he'd heard the warning. 'I won't be long and we'll stop wasting the stuff.'
The alarms sounded from the anaesthetic equipment and Ailee spared a brief thought for Peter and Emma's baby girls if Emma's lack of blood caused her to go into cardiac arrest on the table. It was a horrific scenario to contemplate. She forced away the thought. The situation was grim but she didn't doubt that Fergus would gain control. He had almost finished repairing the vessel, and Ailee had never seen one ligated so well under such circumstances. 'That was quick, but there's still too much blood.'
'Then find where it's coming from, fast.' Fergus finished his knot and held his hand out for another suture.
Ailee spoke to the registrar. 'Can you pull from a more lateral angle? I want to see under the bladder.'
For the briefest moment, after suctioning and a quick swipe with the swab at the end of the long forceps, Ailee spotted another mini-fountain of blood. That explained it and she knew they'd win the battle now.
'I saw it and I've got it.' Fergus pressed his finger on the spot and collected another swab from the scrub sister. 'You little bastard,' he said softly.
Ailee raised her eyebrows. 'Language.'
The registrar looked doubtfully at Ailee taking on the boss, especially after the morning he'd had.
Fergus glanced up in time to see her censure and his eyes crinkled as he relaxed. 'Smack me later.'
Andrew looked up and then adjusted another gauge on his machine as he coughed to hide his amusement. 'So are you people going to be long?'
Fergus had tied off the last of the rogue vessels. 'Closing now.'
Over the next ten minutes Emma's blood pressure crept up and the abdominal layers were closed without further setbacks. Ailee stepped back as the final closure began and stripped off her gloves.
'Thank you, Dr Green.' Fergus didn't take his eyes off the patient but his voice raised the awareness between them.
'My pleasure, Mr McVicker.'
She smiled at the registrar. 'Well done, Tom. It's all good experience afterwards, isn't it?' Ailee stripped off her outer gown to leave the bloodstained clothing in the theatre. She waved at Andrew and smiled at each person in the room except Fergus before she pushed open the door. 'Bye, everybody.'
Ailee didn't go back to the ward. She sat in her office and pretended to do paperwork as her mind kept going over the crisis in Theatre.
To lose Emma would have been a tragedy, and it had been close. Fergus had been exceptional, very talented. The bleeder had been no one's fault and the spotting of it before closure would have made the difference to trying to retrieve an irretrievable situation if they'd missed it.
When William's transplant was over she would be able to go back to what she loved doing. Surgery was something she was skilled at and there would always be hospitals to take her. Dr Harry had already offered her tenure, working with an eye to a consultancy in the not- too-distant future.
The problem was now that she'd worked with Fergus, it would seem flat. From only that brief window she'd seen skills that she hoped to emulate one day.
She picked up the phone. There was work to do before the round.
Fergus knew the moment Ailee arrived on the ward. He tried not to glance her way but it was hard, especially after yesterday's kiss.
He'd been amazed at her quiet confidence and skill in Theatre and attributed a lot of the retrieval of Emma's haemorrhage to Ailee's help. He had to admit Ailee was a good woman to have by his side in a crisis.
Before coming to Theatre she'd already had a tough morning, being there to support Eva's grieving parents again.
It was funny how he might not think much of her sensitivity in Singapore, but he had no doubt she'd give everything in her work.
Which reminded him, considering her undoubted skill in surgery, it was even more ludicrous she was temping as a co-ordinator.
Maybe she was temporary at everything? He had to ask Rita, the unit manager, when he had a chance.
Peter was back from his operation, still groggy from the anaesthetic and pain relief.
He opened his eyes and squinted up at Fergus. 'How's Emma, Doc?'
'Emma's doing well. She lost more blood than we anticipated but she's fine now. She'll stay in Intensive Care tonight and High Dependency tomorrow. It all looks good so far. How are you feeling?'
Peter almost smiled. 'Sore. Glad it's over.' His eyelids drooped and his voice faded. Then he forced his eyes open again. 'You're sure Emma's OK?'
'She's fine. Rest and recover. She'll be just as anxious about you when she comes back to the ward.'
Fergus rubbed his eyes. They felt scratchy with lack of sleep and twelve hours of surgery. He'd head home for the rest of the morning and catch a couple of hours' shut-eye before the afternoon surgery.
When Fergus opened his eyes, Ailee had come up to the group and her concerned look tore at the fabric of his control. He'd love to rest his head on her. 'Yes, Ailee?' His voice came out much sharper than he'd intended in a knee-jerk reaction to his own weakness.
He watched her recoil from the harshness in his tone and he winced. 'I'm sorry.' Now he just sounded gruff.
Lord, what this woman was doing to his emotions. 'Did you want something?'
'There's a call for you. Rita asked me to pass the message on.'
An excuse to leave! Fergus grabbed at the chance. 'I'll come now. After the round, if you have to contact me, I'll be at home. Ring me there.'
Ailee nodded and turned away to answer a question from Maurice about a new patient who'd just arrived.
Ailee was glad of the distraction because she was becoming more annoyed all the time about Fergus and the way he reacted to her. In fact, she'd skip the rest of the round because there was no further need for her here today.
Anyone would think she had done something wrong when all she could be accused of was being attracted to a man she'd met on a plane. What gave him the right to pass judgement on her?
He was treating her like a scarlet woman, even after their brief affinity in Theatre.
Well, it took two to tango and Fergus McVicker had been just as abandoned in Singapore before his daughter had phoned. And he'd initiated that kiss yesterday, not her.
Ailee bit her lip and closed her eyes briefly. This was not the place to recall those memories. Her cheeks warmed and she felt the tears prick the backs of her eyes. This was ridiculous. And to think she'd considered chasing the man up after William was well again.
She drew a deep breath and lifted her head. There were a hundred things to do and she'd better get started.
The patient Maurice wanted her to see was an elderly lady who was almost but not quite at the dialysis stage.
'I wondered if you had time to explain haemodialysis again to Agnes, please, Ailee. I came to explain her medications but she doesn't understand dialysis and I know how good you are at explanations.'
Maurice turned to a seventy-ish white-haired woman whose lined face mapped years of laughter.
'This is Dr Green, Agnes.'
Ailee warmed to her immediately and held out her hand.
'Hello, Agnes. I'm Ailee. Maurice says you have some questions
about haemodialysis.'
'Haemo-whatever.' The old lady snorted. 'I suppose it would help if I could remember what to call the darned thing, but what I really want to know is how my blood can go into some machine dirty and come out clean without killing me.'
Ailee grinned. 'If it was my blood, I'd want to know, too.' She sat down beside Agnes.
'You know, Agnes, with your increasing renal failure, the amount of water you are passing is getting less and less.'
'Hmmph,' said Agnes. 'And that's a good thing as I don't have to get up at night to pee, finally.'
Ailee shook her head. 'It will keep getting less until you might only pass an eggcup full of urine in twenty- four hours. That's not good.'
'Why not?' Agnes was concentrating.
'Because any extra fluids you swallow can't leave your body until the next three-times-a-week dialysis can remove it.'
Ailee went on. 'Too much extra fluid causes oedema, or water in your tissues, like swollen ankles, which puts a load on your heart. Your heart will blow up like a balloon to cope with the extra fluid and then deflate when they take the fluid off. All that stretching and deflating weakens your heart as well.'
Agnes nodded slowly. 'So it's the fluid that's the problem?'
Ailee smiled. Agnes was catching on fast. 'Not just the fluid. Your kidneys are like a filter in a coffee-machine. They collect the impurities from your blood and send the wastes out in the urine. If your kidneys don't work, they won't do that and your body fills up with toxins.'
Agnes nodded and Ailee went on. 'The haemodialysis is your artificial kidney. You weigh yourself before being connected to the machine and your weight determines how much extra fluid needs to be removed while your blood is being cleaned.'
Agnes frowned. 'And if I don't have this haemo- whatever, I just die from the poisons and fluid that build up in my body that I can't get rid of on my own.'
'Dialysis saves people's lives,' Ailee agreed, 'but still at best only provides fifteen per cent of what is called "normal" kidney function.'
'So I have to stay on the piddly amount of fluid I'm allowed to drink. Four cups or so only?'
'I'm afraid so. It can cause cramps if you drink too much and the machine has to take the extra out of your blood.'
'So how does the blood go in and out? Do they put a tap in or something?'
'Something like that,' Ailee said. 'Before you start treatment, one of our doctors will put a shunt in your arm...' Ailee pointed to a spot halfway between Agnes's hand and her elbow '...where they will connect you to the machine with a needle each time.'
Agnes rubbed her wrist at the thought. 'So how does this coffee-machine clean my blood, or have you told me that bit and I didn't get it?'
'No, I'm slow but I'll get there.' The two women smiled at each other and Ailee went on. 'Dialysis is a lot to take in at one time and we'll go over it again at each stage.'
'Give me the good news,' Agnes snorted.
'Your blood is pumped through a plastic cylinder that contains thousands of very fine tubes. Each tube has tiny holes that let the waste and extra fluid pass through but not the blood cells or protein. A special fluid washes around the outside of the tubes so that your blood can be returned to you with the toxins removed.'
'So how long do I have to stay tied to the machine with a needle in my arm?'
'It takes about four hours for all your blood to pass through the machine about six times.'
'Blimey. And to think I never appreciated my kidneys.'
Ailee grinned. 'That's what I learnt when I came to work here.'
Agnes scratched her chin and the hair poking out under her lip wobbled. 'OK, dearie. I'd say my old brain's done as well as it can.'
'It's a pretty heavy topic,' Ailee agreed, 'but each time you come, ask more questions. Everyone is happy to help you understand what is happening. Good luck.'
Agnes had restored Ailee's sense of humour and she headed back to'her own office happier and without glancing at Fergus as he completed the round. Unfortunately, she could still feel his gaze on the back of her neck all the way up the corridor.
By Friday Fergus was losing his battle to remain aloof with Ailee. Since that time in Theatre she'd never been far from his thoughts.
He woke in the morning dreaming of her back in his arms and at work he felt every smile she gave so freely to all except him. This was crazy. He'd have to do something soon or he'd crack.
'Dr Green? Ailee?' Fergus caught up just as Ailee came to the entrance of the renal ward. She jumped and put her hand to her chest as if he'd leapt out in front of her.
Fergus frowned. 'I'm sorry. I didn't mean to startle you.'
He watched her take a deep, calming breath and unconsciously his hand lifted to lie on her arm in reassurance.
When she looked down at his fingers on her skin he felt his own gaze drawn as well. It was as if they were both back in Singapore and finally he had an inkling she was just as affected by his proximity as he was by hers.
'We need to talk.' His words came out with more overtones than he'd intended, but it was a measure of his relief that he had no control over his voice.
Why hadn't he noticed this before? He wanted to back her into a corner of the ward, put his arms on either side of her head—trap her so she couldn't escape—and find out then and there why she had really run away that morning.
Slowly her head came up and she met his look with a fierce one of her own. 'Is it about a patient?'
'No!'
'Then I'm busy.' She glared at him but he didn't believe her this time.
CHAPTER SIX
Under her bravado Fergus could feel Ailee's indecision and he stepped closer. 'Give me a time and we'll talk then.'
Fergus suspected if he didn't pin her down now he would have trouble cornering her again. She hesitated and he pounced. 'No is not an option,' he said quietly.
She didn't answer so he solved it for her. 'Then we will make it this afternoon when you finish.'
Ailee shook her head. 'I have a family dinner at seven.'
'No problem. I'll pick you up at five from here and we'll find somewhere private then I'll drop you back.'
'Not too private.' Her voice was dry and she looked composed but he had the feeling she wasn't as cool as she seemed.
'As you wish,' he said, and watched her nod and turn to walk away from him. He just hoped he hadn't been mistaken about his instinct or he was going to look even more of a fool.
Ailee sensed Fergus behind her shoulder, even though he wasn't touching her, and they entered the ward together. Rita raised her eyebrows at the tension between them but thankfully the unit manager didn't make one of her usual teasing comments.
The ward had a new patient today and soon all attention centred on Lawrence Roper.
Lawrence had needed a kidney transplant after going into renal failure a year ago and, because he was an orphan and a single man, and the average waiting time in Australia for a donated kidney was four years, sometimes longer, he had decided not to wait.
With commercial transplantation prohibited in Australia, the United Kingdom and the United States, he'd sold his house and used the money to go overseas and purchase a black-market kidney from a country with a commercial programme giving donors monetary compensation.
This alternative to waiting had proved to be a sometimes dangerous option for those who chose it, and it certainly seemed so for Lawrence.
Fergus shook the patient's hand. 'Good morning, Lawrence.'
The man was in his late twenties, dark-haired and unwell-looking. 'Hello again, Doc. Bet you didn't expect to see me again.'
'No. I'm sorry you're not well, old son.' Fergus turned to the team with a wry smile. 'Lawrence was over at Sydney West and decided to not wait for the donor programme. He went for broke—literally.'
He smiled at the young man and Ailee admired Fergus's non-judgemental attitude of Lawrence's choices.
Fergus went on. 'Lawrence travelled to another country six month
s ago and when he returned to Australia post-transplant he was well. Now he's become concerned that his condition has deteriorated.'
He glanced down at the report in his hand. 'We've brought him in to fine-tune his medication regime, stabilise any damage if we can, and follow up a few of his concerns.'
He lowered his voice. 'I've got your blood tests back and I'm afraid it is what you suspected. You contracted a blood-borne disease from your donor or the equipment during the procedure.'
Lawrence closed his eyes and sank back in the bed. 'You warned me.'
Fergus turned to Ailee. 'Lawrence's condition has been complicated by contracting hepatitis B, despite his surgeon's assurance his donor had been screened. He'll need help with information and support so he can come to terms with that.'
'I suppose I can be glad it's not AIDS, but hepatitis B can be pretty rotten, too, can't it?' Lawrence managed to smile whimsically at Ailee.
Ailee was impressed with how philosophical the young man appeared. She leaned towards him and touched his shoulder. 'I'll have the communicable disease sister come and see you, Lawrence. Trudy can answer any questions and concerns that you have, as well as connect you to some support so you don't feel as isolated as you do now.'
Fergus nodded. 'When we sort out your medications, you'll feel better as well. Give yourself a few days to get over the shock and we'll have you as well as you can be before you leave.'
'Thanks, Doc.' Lawrence held out his hand. Fergus shook it and then rested his hand on the young man's shoulder for a moment before moving on.
Ailee could tell that Fergus was affected by Lawrence's plight.
'It's a sad twist for him,' she said. Personal issues were forgotten for the moment.
Fergus met Ailee's eyes. 'It's a tragedy. Five of the last sixteen patients that I know of who have gone overseas have died within twelve months. Contracting a blood-borne disease because of inadequate screening is one of the major causes of complications following commercial transplants.'
He compressed his lips. 'The tragedy is that if we could lift our national donor rate to where it is in progressive places like South Australia, Lawrence wouldn't have been driven to take the risks he had.'
Fiona McArthur Page 6
