The Doctor's Outback Baby

by Carol Marinelli

  ‘When is he going?’ Clara asked, expecting a fortnight, a month even, but nothing prepared her for Ross’s answer.

  ‘At the end of the week. But we had a long talk about things yesterday and the upshot is that Kell’s finished working at the clinic as of now. He’s going to spend the rest of the week packing and sorting out his paperwork.’

  ‘Doesn’t he have to serve his notice?’ Timothy asked, his practical questions such a contrast to the emotions that were coursing through Clara.

  ‘He offered to,’ Ross sighed. ‘The thing is, Timothy, that’s not how we run things here. Over the years Kell’s put in way above what his contract dictates. Everyone chips in here, and at the end of the day that’s how somehow we manage to run a clinic with limited staff and resources that’s stuck in the middle of nowhere. It’s time to pay Kell back for all he’s given to Tennengarrah. He wants to go after Abby and I think we owe it to him to support his decision. He’s going to move into a flat and find work before he looks her up, so he’s got a lot to sort out before he leaves…’ He gave a small shrug. ‘People have to want to be here.’ Ross stood up and seeing Clara’s shocked expression mercifully misinterpreted it. ‘Shelly said she’ll help out as much as she can. She didn’t want to come back to work so soon after having Kate.’ He gave a wry laugh. ‘Actually, she didn’t want to come back to nursing, full stop, but it’s not as if there’s much choice at the moment. I’m sorry, Clara. I can see you’re upset. I really will try and get more help.’

  ‘It’s not that.’ Clara forced a smile. ‘I don’t mind the extra work. I’ll just miss him, that’s all.’

  ‘We all will.’ Ross agreed. ‘You more than most, no doubt. You’ve been friends and colleagues for ages.’

  Clara nodded, the lump in her throat not really permitting much else, but thankfully Timothy managed to fill the awful gap that followed.

  ‘I don’t mind pitching in. I know I’m not a nurse, but when I was a medical student I worked nights as a nurse aide, so I’m more than happy to wear two caps—not literally of course.’ He laughed. ‘We can’t have Clara running herself ragged.’

  ‘Thanks,’ Ross said warmly. ‘It’s just as well you turned up early. How do you fancy being thrown in at the deep end?’

  Timothy grinned. ‘It’s my favourite pastime. Mind you, I normally have an air tank.’

  ‘Timothy dives,’ Clara explained, finally managing to resume the conversation, but her heart really wasn’t in it.

  ‘Well, Kell was supposed to be doing a mobile clinic this morning…’

  ‘I don’t mind,’ Clara volunteered, more than happy to be out on the road, but Ross shook his head. ‘Kell finally persuaded Jim to have that testicular lump looked at, and it’s probably not very politically correct but, given that this is the bush, I think it would be better if a guy went along.’

  ‘I’d need a map,’ Timothy said hesitantly, ‘and a quick read up on testicular lumps before I head off.’

  ‘We’re not that cruel.’ Ross laughed. ‘I wouldn’t send you out on your own on your first day here! You can go to a mobile clinic with Clara later in the week—they take a bit of getting used to so it’s best if you just watch the first few times. I’ll do the mobile clinic today if you don’t mind staying here and running the morning surgery. Normally Monday mornings are pretty much routine, sore throat and ears, a few stitches perhaps. If you don’t know how anything works, just ask Clara.’

  Oh, she tried, she really tried not to roll her eyes, but as both men turned to her she did exactly that. ‘We’ll be fine, Ross,’ Clara sighed. ‘You go on ahead.’

  ‘How are you doing?’

  It was the emptiest the clinic had been all morning. The second Ross had driven off, the floodgates had opened and every ailment that had been put on hold in preparation for the ball had chosen today to surface. Given Timothy’s relative inexperience, Clara braced herself for endless questions, but apart from the occasional prompt as to where things were kept Timothy had pretty much rolled his sleeves up and got on with the job. The older locals had been fine, chatting easily to the new doctor, offering to ‘shout’ him a beer even, but some of the younger guys hadn’t been overly friendly with Timothy, taking it upon themselves to act like a collective group of protective older brothers and returning his attempts at small talk with the most suspicious stares and surly remarks. Not that Timothy seemed bothered. He just got right on with the job in hand, happy to ask Clara’s opinion every now and then or to advise the patient to come back for a follow-up visit when Ross returned when he felt a more experienced physician’s opinion might be called for. To Clara’s pleasant surprise, the morning clinic passed smoothly.

  ‘I’ll just finish these stitches and then we should be able to grab a coffee.’

  ‘Sounds good to me.’ Timothy peered over her shoulder, smiling at the young man who eyed him suspiciously. ‘Make sure you take all the antibiotics, Mitch, and come back if there are any problems.’ Lowering his voice for Clara’s ears only, Timothy moved in over her shoulder. ‘I’m sorry if I’ve been a real pain this morning.’

  ‘You haven’t,’ Clara conceded, feeling guilty for her eye-rolling earlier. ‘You’ve done really well. Before you put the kettle on, could you put your head into Mary’s room? Tell her I’ll be along soon. I just gave her some pethidine before I started this, so hopefully it will be taking effect.’

  ‘Done.’ He turned to go then changed his mind. ‘Can I watch—I mean when Mary has the baby? If it causes her any embarrassment then, of course, I won’t…’

  ‘That’ll be fine,’ Clara smiled warmly. ‘Hopefully it won’t be too much longer now.’

  ‘I’ll see about that coffee.’

  Famous last words!

  Settling back to work, Clara snipped the last of the stitches then placed a wad of Melanin and a neat bandage over Mitch’s hand, but just as she was sure a well-earned break was finally imminent a commotion brewing outside forced a low sigh to escape from behind her mask.

  ‘Sounds like Hamo’s not at his sunniest,’ Mitch volunteered, as a few loud expletives winged their way into Theatre. ‘Do you need a hand? I can usually calm him down.’

  ‘Better not,’ Clara sighed. ‘He’s usually pretty good for me.’ Securing the bandage with tape, she handed Mitch the antibiotics, hating to rush her patient but knowing she was needed elsewhere. ‘Make sure you do as Timothy says, and if there’s any problems come straight back.’

  Jumping off her stool, she discarded all the sharps then followed the noise to the nurse’s desk, hoping Hamo wasn’t going to take his obvious bad mood out on Timothy. Aggression in the workplace was unfortunately par for the course these days, whatever part of the world you lived in, but as trained as the staff were to deal with it, it was hardly a great first day welcome for Timothy. Hamo occasionally turned up at the clinic the worst for wear, needing stitches or whatever, but one look at him and Clara knew that in this instance more was going to be called for. His face was tinged grey and he was clutching his stomach with one fist, the other dividing its time between holding onto the desk at the nurses’ station and punching in the air as he cursed the world at large and Timothy in particular.

  ‘Hamo, what’s wrong?’ Clara asked, making sure she didn’t get too close.

  ‘I need some painkillers and the so-called doctor here won’t give them to me.’

  ‘I didn’t say that, Hamo.’ Timothy’s voice was calm, laid back even, much to Clara’s relief. With Hamo in this volatile mood even the slightest hint of confrontation could turn things ugly, but Timothy seemed to know exactly what he was doing. His stance, though confident, was non-confrontational and Clara listened as he carried on talking, all the time watching Hamo. ‘I can see that you’re in a great deal of pain, but before I can give you anything I need to examine you.’

  ‘I just need an injection,’ Hamo snarled through gritted teeth, staggering towards them, and Clara realised with a surge of nervousness that his short fuse h
ad really snapped this time. But Timothy had obviously read the situation the same way and in one swift motion he pulled Clara out of the way and moved himself forward, effectively standing between her and the patient.

  ‘Why don’t you go and check on Mary?’ Timothy suggested, as Hamo doubled over again. And though Timothy’s voice was calm, friendly even, Clara knew it was an order and not a request, though she had no intention of following it. Hamo was a tricky customer at the best of times but Clara had always been positive he would never lift a finger to her.

  She wasn’t so sure that courtesy would be extended to Timothy.

  ‘I’d rather stay here,’ Clara said firmly, but Timothy shook his head.

  ‘We’ll be fine, won’t we, Hamo?’ For the first time he looked at Clara. ‘Once I’ve explained to him that we’ve a young woman here about to give birth, he’ll settle down. He’s hardly going to knock out the only doctor for miles and put a woman and her baby’s life at risk.’ Turning back to the patient, he gave him a smile. ‘Right, let’s have a look at you, then,’ he said. Deliberately ignoring Hamo’s reluctance and taking his elbow, he guided him to the trolley. ‘That’s the man,’ Timothy said matter-of-factly. ‘Up on the trolley so I can have a look at you and then we’ll see about pain control.’

  Suitably impressed, Clara undressed Hamo and tried to take a set of obs as Timothy slipped an oxygen mask over his face and attempted to get a history. ‘What’s been happening, Hamo?’

  ‘I just want an injection.’

  ‘Not until I know what’s wrong with you. How about you tell me when this pain started?’

  ‘How about you give me a needle?’ Hamo was getting agitated again and Clara took over.

  ‘Hamo, enough. Let the doctor have a look at you and answer his questions. And I need you to stay still so that I can run a set of obs on you.’

  But Hamo was having none of it. Pulling off his mask, he tried to lever himself off the trolley, which wasn’t a good move as the brakes weren’t on and the trolley lurched forward, unfortunately clipping Clara none too gently on the hip.

  ‘Hamo.’ Pushing on the brakes with his foot, Timothy’s voice for the first time wasn’t quite so laid back. ‘Lie down. You’re not going anywhere because you’re not well enough. Now the quicker you answer my questions the quicker I can make a diagnosis, but I cannot give you an injection until I’m sure what’s going on.’ His eyes met Clara’s but the annoyance in his voice didn’t abate. ‘Now, Clara, can you, please, check on Mary?’

  ‘Can I have a quick word, Timothy?’ Widening her eyes for Timothy’s benefit, Clara kept her voice even. ‘About Mary.’

  He gave a brief nod then turned his attention back to his patient.

  ‘I’m not going to fight you, Hamo. If you want my help you can have it, but that has to be your call. Now, lie there for a moment and decide whether or not you’re prepared to co-operate. I’ll be back shortly.’

  Only when they were out of earshot did they speak.

  ‘I assume this isn’t about Mary?’

  Clara nodded. ‘I know Hamo’s being obnoxious, but the truth is, Timothy, in all the time I’ve known him he’s never been aggressive towards me. I just wanted you to be clear on that. And he’s never once asked for an injection—it normally takes a supreme effort to get him to take even the mildest painkiller. It isn’t drugs that he’s after, I’m sure of that. He must be in a lot of pain to be acting this way.’

  ‘I don’t doubt that he is,’ Timothy said thoughtfully. ‘Thanks, Clara, I’ll take it on board. I’m actually seriously concerned about him. I’ll have to examine him, of course, but I’m pretty sure he’s going to need more care than we can offer here.’

  ‘Do you want me to get the Flying Doctors on the line?’ Clara offered.

  ‘I’ll just have a look first—hopefully he’s calmed down a bit by now. Oh, and, Clara.’ Turning, she paused, expecting a quick question, but from the look on Timothy’s face she realised he wasn’t best pleased. ‘Next time there’s a violent situation and I ask you to leave, please, don’t argue the point.’

  ‘I wasn’t arguing.’ Clara flushed. ‘Like I said, I’ve known Hamo all my life. I’m sure he’d never hurt me.’

  ‘Sure’s not good enough,’ Timothy said grimly. ‘Suppose he’d lashed out in pain or tried to hit me and missed, suppose he’d ended up blacking your eye.’

  ‘I’d have been all right,’ Clara answered quickly, but from the look on his face it was clearly the wrong answer.

  ‘Maybe you would have been, but how do you think Hamo would have felt afterwards and how would the rest of the town have dealt with him when word got out? You come with a lot of surrogate brothers, Clara, I saw that for myself on Saturday night. And while I’m not excusing violence, sometimes the lines get blurred when a patient’s in pain. Sometimes we have to save them from themselves.’

  She’d never thought of it like that and, suitably chastised, Clara turned away. ‘I’ll just check on Mary,’ she murmured, but only as she walked off did she realise the full horror of the situation Timothy had just averted and her hands were shaking slightly as she knocked on the door of the side room and walked in.

  ‘How are things?’

  ‘Better.’ Louanna looked up from her daughter. ‘What was all the noise about outside?’

  ‘One of the patients got a bit upset,’ Clara said tactfully, ‘but it’s all sorted now. I’m sorry if it upset Mary.’

  ‘She didn’t hear a thing,’ Louanna said softly. ‘That injection really helped. She’s even managed to doze off. Things seem to be slowing down—the labour won’t just stop, will it?’

  ‘I’ll just have a little look. I’ll try and not disturb her,’ Clara said, moving quietly and checking the baby’s heart rate with the foetal monitor then standing with her hand on Mary’s stomach for a few moments. ‘The baby’s heart rate is good and strong. I’m not going to wake her and do an internal. I’m sure things are moving on just as they should.’

  ‘So why have the pains stopped?’

  ‘That’s mother nature giving Mary a chance to catch her breath before the real hard work of pushing starts,’ Clara said assuredly. ‘Just let her rest and when she wakes, or if you need anything at all, just come and let me know.’

  Timothy had been busy while she had been away. IV fluids had been run through a line and were hung beside the gurney on a pole as he inserted an IV bung. Hamo was still in obvious pain, but the aggression of previously seemed to have subsided. He was even keeping on his oxygen mask.

  ‘How is she?’ Timothy asked, without looking up, taking a large syringe of blood from the IV bung as Clara hovered with the IV line.

  ‘Resting. How’s Hamo?’

  ‘Still in pain, but more compliant now. He let me take a set of obs.’ The worried grimace Timothy pulled was for Clara’s eyes only and he nodded appreciatively as he pulled out the syringe and Clara immediately connected the IV fluids, securing the access with tape while Timothy filled various vials with the blood he had collected. ‘Give him a two-hundred-millilitre bolus of fluid, then run the flask over four hours,’ Timothy instructed Clara, then turned to Hamo. ‘I’m just going to have a word with Clara, Hamo, and then I’ll be back with that injection.’

  ‘What do you think is going on?’ Clara asked, once they were out of earshot.

  ‘He’s got an acute abdomen,’ Timothy replied. ‘He’s in a lot of pain and he’s been vomiting since the early hours of the morning.’

  ‘Any blood in it?’ Clara asked, but Timothy shook his head.

  ‘None. I’ve asked him about his alcohol intake…’

  ‘I bet that went down well.’ Clara grimaced.

  ‘Actually, when I explained to him why I need to know, he was quite open. He drinks regularly, but even Hamo admits that he excelled himself at the ball on Saturday night. I think he’s got acute pancreatitis, and if that’s the case he’s going to need to be transferred.’

  Clara nodded. Pancreatitis
was sometimes caused by excessive alcohol consumption and although the treatment was fairly conservative—careful monitoring of IV fluid intake and urine output, along with strict pain control—there were many possible complications, some of which could be life-threatening.

  ‘We haven’t got the facilities to do the blood tests for pancreatitis here, but they can be sent of with him when the Flying Doctors come,’ Clara said, gesturing to the tubes in the kidney dish Timothy was holding. ‘But we’ve got the urinary test strips that’ll do the job. I’ll see if he can give us a specimen.’

  ‘I’ve already asked,’ Timothy said grimly. ‘And he flatly refused.’

  ‘Well, if it is pancreatitis, he’s going to need a catheter. We could get a specimen that way.’

  But Timothy shook his head. ‘Again, he refuses. Until I give him some pain control I don’t think we’re going to get much further with him.’ He glanced at his watch. ‘How much longer do you think Ross will be?’

  ‘An hour, maybe two. Do you want me to try and contact him? Mind you, if he’s running the clinic he mightn’t hear the radio, and there’s no satellite coverage where Ross is so I can’t even get him on his mobile.’

  Timothy shook his head. ‘I might as well talk to the Flying Doctors. It’s obvious he needs to be transferred and the quicker we get things moving the better. If you can get the Flying Doctors on the line for me that would be great.’

  ‘What about pain control?’ Clara asked, knowing her question wasn’t an easy one to answer. Acute abdomens were notoriously difficult to diagnose, and woe betide any junior doctor who gave analgesia without a concrete diagnosis. Once the symptoms were masked by analgesia it would make the surgeon’s job of an accurate diagnosis that much harder and could, in fact, prove life-threatening.

  ‘I’ll talk to the Flying Doctors first, but the truth is I can’t leave him in pain till they arrive.’ For a second or two he chewed on his bottom lip then he gave a brief shake of his head, his slightly hesitant stance changing. ‘No, I’m confident of my diagnosis. He’s got upper abdominal pain after a large drinking episode, he’s tachycardic with low blood pressure and his temperature’s up, frequent vomiting and he’s got a positive Cullen’s sign.’