CHAPTER TWO
‘WELCOME to chest pain city!’
Acutely uncomfortable in her very new uniform, supremely conscious that at least one of her police colleagues was hovering out in the waiting room, Bella did her best to blend into the throng of nurses standing at the nurses’ station as the night sister smiled up at them, no doubt anxious to get the handover started and finished as quickly as possible. But even though she’d been away from nursing a long time, Bella knew this was one handover that was going to take a while. One look around the chaotic department, one look at the weary faces of the night staff and Bella knew it had been a very busy night. Several doctors were around, writing notes, making calls, working in Resus, the waiting room lined with people still waiting to be seen. Trolleys lay abandoned and unmade in the corridor, some still with rumpled blankets on top, a sure sign the night had been hell.
‘How was your holiday, Jayne?’ the night sister asked, and Bella looked over as a middle-aged woman rolled her smiling blue eyes, giving a dry laugh as she accepted the hands-free phone from the ward clerk and chatted for a moment before turning it off and placing it in her pocket.
‘Great, Hannah—only now it doesn’t feel as if I’ve been away. That was South Ward,’ she added. ‘They want to know if we can keep the patient they’re expecting down in the department till after seven-thirty. They can’t take him now because they’re busy with handover.’
‘Oh, the poor guy,’ Hannah groaned, shaking her head as a porter pushed a trolley out of a cubicle. ‘He’s been here since ten last night.’
‘Which is why I told South Ward that they were too late and he’s already on his way up. They’ll just have to tear someone away from their half-hour sit-down and mug of coffee. Go on, Jim,’ she called to the porter. ‘Take him up.’
Normal, Bella decided on the spot, peering at the name badge pinned to the woman’s crisply ironed blouse and confirming that it was indeed Jayne Davies. Her short, practical light brown hair was still damp from the shower, a slick of lipstick the only make-up she wore, and clearly, from the way a couple of doctors had already waylaid her to ask a question, the way she’d dealt with a ward’s rather annoying request, even before handover had started, Bella knew that this was a woman very much in control.
But Hannah!
Bella’s eyes worked the woman, taking in the rather jumpy appearance and wild hair, remembering the briefing she’d had from Detective Miller. A night sister, Hannah was working overtime to support her ailing husband, and apparently it was common knowledge around the department she had massive financial problems. But the weary smile she gave as she caught Bella staring, the tiny wink she imparted in a show of support for a nurse on her first day, had Bella shuffling her mental cards somewhat, discarding Detective Miller’s observations a tad and deciding to form her own opinions. Right here, right now Hannah was way down on her list.
‘I’ve let Bethany, the grad nurse, go home early,’ Hannah said to Jayne. ‘She’s got her driving test at lunchtime and obviously wanted to have a sleep first, so we’re a bit short on the floor at the moment. I haven’t even had time to check the drugs.’
‘OK, Trish.’ Turning to a nurse standing next to Bella, Jayne gave out her orders. ‘If you wouldn’t mind, you can go and check the drugs with one of the night staff. I’ll fill you in on the handover later. Something tells me that if Hannah wants to get off before lunchtime then we’d better get started now!’
Chest pain city was certainly an apt description, Bella thought as they made their way around the department. For various reasons, some obvious and some completely obscure, certain symptoms seemed to present themselves en masse. Christmas and New Year were notorious for fights, the dangerous combination of alcohol and distant relatives in close proximity enough of a reason, hips and wrists were top of the list on a frosty morning, and on a wet night you could rest assured a higher proportion of road accidents would be present. And as to the obscure: any night nurse would testify that the slightly mad were barking on a full moon, but chest pains? Why did they all seem to arrive at once?
The handover did take for ever, the world didn’t stop in Emergency as it did on the wards. Ambulances still arrived, unstable patients still demanded vigilant attention, and one by one the entourage of nurses was trimmed down as Jayne allocated them tasks. Finally the rather depleted group, comprising Jayne, Bella, a couple of students and Hannah, were at the end of the resus list. ‘Charles Adams, seventy-four years of age, previous history of hypertension and angina.’ Hannah suppressed a yawn as Bella peered over at the patient lying exhausted on the gurney and attached to various monitors. A woman by his side, dressed in a massive trench coat, held his hand. Bella assumed it must be his wife, watching anxiously as a very tall blond doctor took some blood from the patient’s other arm, chatting away to both of them as he did so. Bella’s interest upped a considerable notch and it had nothing to do with the fact that the doctor was completely and utterly stunning. It was because from the description she’d been given, she realised this must surely be Heath Jameson, the consultant she was investigating.
She was investigating!
Every now and then Bella felt as if everyone must surely know, as if surely there was some massive sign above her head telling everyone the real reason she was here, but for a moment or two Bella realized it had seemed as if the clock had turned back, as if she really was just another nurse on a busy Monday morning listening to handover.
Heath Jameson.
Summoning details to mind, Bella stared apparently nonchalantly as Hannah gave the handover.
Recently divorced, massive custody issues with his ex-wife over the children and a hint of partying rather too hard since being reluctantly made single, though apparently in recent weeks that had all calmed down. With the promotion to Acting Consultant, it would appear that Heath had settled down and decided to concentrate firmly on his patients and career. Certainly, from the way he was chatting to Mrs Adams, he was doing a good job, taking some time to reassure the anxious woman instead of merely rushing off.
‘Charles woke this morning at five a.m. with central chest pain, radiating down his left arm. His wife Celia decided it would be quicker to drive him in than wait for the ambulance!’ Hannah’s raised eyebrows told everyone the unfortunate lack of wisdom behind that decision. Patients with chest pain could collapse very quickly and with no warning—and this, it seemed, had happened to Charles en route to the emergency department. ‘Now, I should warn you at this point, just so that you’re prepared, that there’s no telling Celia what to do. She’s read every article on the internet about her husband’s condition and as I speak is no doubt suggesting to Heath what blood tests he runs. I tried to tell her that next time her husband gets chest pain, assuming that her husband survives this event, she should call an ambulance because next time there might not be a police car travelling behind her. Thankfully, on this occasion the police officers realized she was in trouble and forced her to pull over so they could assist. He went into VF just as the paramedics arrived.’
‘Lucky,’ one of the student nurses commented, and Hannah nodded.
‘Very lucky! The paramedics shocked him once and he reverted to sinus rhythm.’ She gave a small grin. ‘And gave him some IV lignocaine as ordered by Celia! They basically got an IV bung in and scooped and ran, then brought him in, where he’s carried on misbehaving! He was just about to be given some morphine and promptly suffered another VF episode. Heath’s in with him now…’
‘Why aren’t Cardiology in with him?’ Jayne asked. ‘The man’s had two cardiac arrests after all. Surely they should be down here.’
‘Because they’ve had as bad a night as we have,’ Hannah sighed. ‘They’re stuck on ICU with another chest pain who’s had a full, extended arrest and a teenager who took every last one of her grandfather’s heart tablets. Heath is looking after him till they can get here.
‘Problem,’ Hannah said as a rather anxious-looking Trish returned.
>
‘There’s an ampoule of morphine missing!’
If Bella had felt conspicuous before, she felt as if she were glowing now, scarcely able to believe that after only half an hour in the department drugs were already missing. But her internal excitement was somewhat dampened by Hannah’s response.
‘Damn!’ she cursed, instantly putting her hand up. ‘That was my fault! We wasted the morphine Mr Adams was supposed to have prior to his arrest. Bethany and I signed for it but the patient got restless again as soon as he came round and Heath decided to go ahead and give the morphine but we’d already thrown it out. Bethany and I got a fresh ampoule but we were so busy we didn’t have time to sign for it at the time. She’s off duty now; I can ask Heath—’
‘Who checked the drug?’ Jayne broke in.
‘Bethany and I.’
‘So why would you get Heath to sign for something he didn’t check?’ Jayne’s voice was crisp, her stare direct. ‘Hell, Hannah, you know the trouble the department’s been in with drugs going missing, you know we have to do things by the letter. You’ll have to ring Bethany at home and tell her to come in and sign for it.’
‘But she’s got her driving test,’ Hannah protested.
‘And I’ve got a department to run,’ Jayne clipped back. ‘Now, I’m sorry to do this, Hannah, I know you’ve got the kids to get to school, but before you go off duty I need you to fill out an incident report.’
‘What?” Hannah’s voice was incredulous. ‘It’s a non-event, Jayne. You’re completely overreacting. I really can’t stay. I need to have a couple of hours’ sleep before I bring Ken back here for his outpatients appointment at eleven…’
‘Sorry to interrupt, but could I have a hand in here, ladies?’ A rather snobbish, very deep, very laid-back drawl halted the bickering, and Bella’s eyes widened as she turned around. The reading on the heart monitor that had been blipping along slowly but regularly had reverted to the wiggly line of VF and Heath was laying Charles Adams down before he even passed out, before his wife had even registered that there was something really wrong. As Trish dashed over and led her away, Heath was applying fresh pads to the patient’s chest as Jayne quickly pressed a button to charge up the defibrillator. The machine whirring into action was a sound Bella hadn’t heard for ages, but as instantly memorable as a dentist’s drill.
Heath was supremely calm, an utter contrast to Bella who could feel her heart fluttering almost as much as the patient’s—watching in awe as Heath pulled the paddles out of their trays.
‘Everybody back.’
Another memorable noise, listening as 200 joules were delivered to the patient, watching as his body spasmed, then turning to the monitor.
‘Still VF. Charge to 360 and could someone put out a code?’
On the wards a code would have been called immediately, but events like this were more commonplace in emergency and they had the equipment and expertise to deal with it. Once Charles’s heart had failed to respond, however, it was time to call for the team.
Heath’s hands were on his patient’s chest now, commencing cardiac massage as he called for drugs that would hopefully work on the irritable heart before they shocked him again.
‘Bag him, please, Bella.’ Jayne’s order was sharp and to the point.
Hell, she hadn’t even been shown around the department, but Bella knew that with the RN badge dangling from the cord around her neck she was responsible now, not an undercover cop but an emergency nurse, and a life was on the line.
An ambu-bag was already connected to the oxygen, lying on the head of the trolley beside the patient thanks to his previous episode. Bella checked the man’s airway to make sure it was clear before extending the neck and placing the mask firmly over his face, delivering oxygen as the machine charged and Heath pumped on.
‘OK. Everyone back,’ Heath ordered, then addressed his patient. ‘Come on, Charles. I’ve just finally managed to arrange a bed up on CCU for you. Don’t let’s waste it.’
As soon as Jayne delivered the shock, Bella took her position again, holding the bag tightly over Charles’s airway, ready to commence immediately. Suddenly she felt resistance, the uplifting sound of the monitor bleeping, the unmistakable feel of the quiet tension that had been present seeping out of the room as Charles started thrashing his head around. Bella replaced the ambu-bag with an oxygen mask, letting out the breath she had been holding before finally looking up.
‘It’s OK, Charles.’ Heath’s voice was still calm, and he lowered his head and spoke into his patient’s ear. ‘You’re back with us now. You just had another small turn.’
Which was one way of describing it, Bella thought, blowing skywards the hair that had escaped as she let out another deep breath.
‘Fun’s over, guys!’ Heath grinned as the crash team started skidding into the room. ‘This is Charles Adams, the patient I’ve been babysitting for you. He’s just had his third episode of VF in the last three hours and this time he had to be shocked twice before he reverted. Can we get him out of here now please and onto CCU?’
‘Good job, everyone.’ Heath nodded to the staff, then addressed Bella. ‘I assume from the way you reacted, you’ve done emergency before.’
‘Not for a long while,’ Bella admitted.
‘Well, you did great.’ He held out a hand. ‘I’m Heath Jameson, the very new acting consultant.’
‘Bella Gray.’ Bella smiled. ‘And I’m the very new nurse.’
‘Welcome aboard.’ Very green eyes smiled momentarily at her, but his face grew more serious as he looked away, nodding to the group to step outside Resus and addressing Hannah and Jayne.
‘If you have to argue, could you do it well away from Resus next time?’
‘I’m sorry, Heath.’ Jayne blushed darkly. ‘But you know the problems we’ve been having with drugs.’
‘So does half the department now,’ Heath retorted sharply. ‘Is Bethany on duty tonight?’
Hannah nodded.
‘Well, she can sign for the drug then and do an incident report when she comes in. I don’t want my nurses half-asleep on the job, which is what she will be tonight if we drag her back here now to fill in a blessed incident report just to appease the powers that be. That’s when real mistakes start to happen.’ He turned to Hannah. ‘If you can come in fifteen minutes early tonight, you can fill yours out then.’
Hannah gave a grateful nod but Jayne was far from appeased.
‘Heath, this is a nursing-related issue and given that I’m the most senior nurse in the department…’
‘This is a staff-related issue,’ Heath corrected. ‘And I’m the consultant. Sorry,’ he added before Jayne could. ‘Acting consultant.’
‘So you’re pulling rank now, Heath? According to the records there are drugs missing…’
‘There’s a single vial of morphine that hasn’t been signed for,’ Heath broke in, instantly diluting Jayne’s accusation. ‘And if anyone has a problem with the incident reports being filled in tonight instead of this morning, they can discuss it with me. I am not having a simple mistake turning into a drama, and if it means pulling rank then I’m up for it. I am not going to walk around panicking about things and feeling guilty when I’m not, and neither do I expect the rest of the staff to. Now, can I have a nurse to come in to speak to Charles’s wife with me?’
And turning on his heel he stalked off, leaving everyone, especially Bella, standing blushing and open-mouthed.
Jayne because she’d been put down.
Hannah because she’d been backed up.
And for the rest of the nurses standing there, including Bella, it was entirely due to the fact that they were female.
CHAPTER THREE
CELIA was inconsolable.
Sobbing in a chair, a massive overcoat over a fluorescent nylon nightdress, pulling tissues out of a box, she stood up and let out a wail of terror as Heath and Bella walked in.
‘Please, don’t tell me…’
‘He’s not d
ead,’ Heath said quickly, taking her elbows and lowering her back into the chair. Bella could only admire him. Instantly he’d quelled Celia’s greatest fear without giving false hope. How many other doctors would have walked in and quickly said that Charles was OK, that the drama was over when, in fact, it had barely started.
‘This is all my fault.’
‘It’s no one’s fault.’ Heath attempted to soothe her. ‘Charles has had a heart attack, and unfortunately these types of events often occur afterwards. He suffered another cardiac arrhythmia,’ Heath explained. ‘His heart effectively stopped again. However, we got it started.’
‘And he’s OK?’ Celia begged, but Heath held back.
‘He’s critically ill, Celia, but we’re moving him up to the coronary care ward and we’ve given him some drugs which we hope will calm his heart down. The next forty-eight hours will be—’
‘Critical,’ Celia whispered through chattering teeth. ‘I’ve read all about heart attacks on the internet.’
‘Quite.’ Heath flashed a brief smile, clearly not impressed with her cyber-knowledge. ‘For now, though, I need you to tell me what happened.’
‘It’s all my fault,’ Celia said again. ‘I should have listened to him when he said he wasn’t well enough—’
‘Did Charles have chest pain last night?’ Heath asked, but Celia shook her head.
‘He was fine last night. I made him a special dinner. I told him to forget his diet for a night, we had a bottle of nice red wine and everything was fine until this morning. Oh, God, what have I done?’
‘This isn’t your fault,’ Heath said firmly, then softened it with a smile. ‘Some doctors actually recommend red wine for cardiac patients and I can assure you, Celia, nothing in last night’s meal would have caused this…’ Clearly he’d said the wrong thing as her sobbing grew louder. Bella pulled out another wad of tissues as Heath struggled to say the right thing, his eyes meeting hers over the woman’s heaving shoulders in a silent plea for help.
Undercover at City Hospital Page 2
