AWARE that the situation was urgent, Rory drove to the hospital. He set his mind firmly on the problem ahead of him, refusing to consider what the big blond man had been doing at Alana’s flat all this time.
Though his subconscious refused the ban on conjectures and kept right on working.
Not that it was hard to guess, the way she’d been dressed.
Not that it was any of his business.
Hypovolaemic shock! That’s what he had to think about.
It was a sign of poor tissue perfusion—not enough fluids in the tissues, including brain tissue. The patient presented with low blood pressure, clammy skin, feeble pulse, accelerated heartbeats and rapid breathing. Usually it went along with massive blood loss, but there was no evidence of that in the patient, while scans showed no internal bleeding.
At the level the resident had mentioned, it was lethal, and while staff were already pumping fluids into the man, if they didn’t find a cause for his sudden collapse, they wouldn’t know what to add to the fluids to rebalance the patient’s system.
His blood test showed hypoglycaemia, a low level of glucose in the blood, and this was being addressed by the addition of five per cent dextrose in the saline. According to his wife, he’d been tested recently for diabetes, after complaining of tiredness to his GP.
‘I’m glad you’re here. He’s stabilised slightly but there’s obviously something very wrong.’
Doug Weaver was the junior resident on duty and, though Rory had only met him briefly, he’d heard good reports of the younger man.
‘Let’s take a look,’ he said, and saw Doug relax. He remembered the feeling from his early days in hospitals, where calling in a specialist could result in appreciation or a tirade of abuse for not being able to handle things himself.
The patient, Albert Cross, still looked extremely ill, but as Rory examined him, small red marks like tiny burst blood vessels on the man’s skin suggested a possible cause.
‘See these,’ he said to Doug, pointing to them.
‘Petechial haemorrhages. I associate them with drowning or suffocation—hanging and the like.’
‘They can also occur as the result of fever and for a variety of other reasons, but look at his hands.’
The skin, particularly in the knuckle wrinkles, seemed dark for a man who was ginger-haired.
‘Some kind of adrenal insufficiency?’ Doug guessed. ‘Addison’s disease?’
‘Not necessarily Addison’s disease, but you’re right about adrenal insufficiency. We’ll ask the lab to check levels of cortisol in his blood and if it’s low we’ll add cortisol, hydrocortisone phosphate, to the drip, six-hourly doses until the acute symptoms subside.’
Doug turned to the nurse to explain what they wanted, while Rory flipped through the patient’s chart, seeking the results of the preliminary blood tests. They were good as far as they went, but failed to show the more complex values of either an increase or decrease in ACTH, the adrenocorticotrophic hormone produced by the pituitary gland to stimulate the adrenal gland into producing corticosteroids.
He ordered further blood tests, asking specifically for what he needed, which should tell him if the problem started in the pituitary gland—with it not producing enough ACTH to start the process in the adrenal gland—or in the adrenal gland, with some glitch in the production of cortisol.
He checked the monitor screen, which showed the heartbeat had stabilised and the oxygen saturation in the patient’s blood had improved. Looked at the patient, who was somnolent now rather than comatose.
‘Keep him here with a nurse, if there’s one available, to monitor him, until you’re satisfied he’s stable, then admit him, but with half-hourly obs and total bed rest. You know to watch for excessive saline in his blood as a result of the infusion, make sure his airway’s kept clear and give him oxygen if he seems to be having any respiratory distress. I’ll call in and see him in the morning, and we’ll start further investigations on Monday if he’s well enough. The point is to stabilise him now and to keep him calm.’
Doug laughed.
‘Maybe you’d better see his wife. She’s outside and she’s the one you’re going to have to keep calm.’
Rory glanced at his watch. Facing an anxious spouse wasn’t his favourite occupation at four in the morning, but as Albert Cross was likely to be his patient for some years to come, he’d better introduce himself now.
‘But why?’ Mrs Cross demanded, when he’d explained as best he could and, mindful of Alana’s derogatory remarks about ‘specialist speak’, tried to do it in layman’s terms. ‘And why now?’
‘Why now? It could be he had an underlying problem which was suddenly exacerbated by tiredness or stress.’
‘Tiredness or stress—we’ve got plenty of both,’ Mrs Cross told him, her voice rising with a modicum of hysteria. ‘My son’s girlfriend has just announced she’s pregnant, and she’s got so many bits of metal studding her body the baby’ll come out with holes in it. And my daughter finally decided she wasn’t putting up with her husband fooling around so she belted him—hit him with a frying-pan—and walked out, bringing her three kids, all under four, home to Mum and Dad. Now she’s probably going to gaol and we’ll be stuck with the kids. And you talk about stress!’
Rory shook his head with disbelief.
‘I can’t imagine how you cope.’ He didn’t add that he wasn’t sure how Mr Cross would survive with such stress, once released.
‘But in the meantime, we’ll find out what caused the sudden collapse, and once we do, we’ll know how to treat your husband. What to give him to stop it happening again.’ Along with the advice given to all adrenal patients to avoid stress as much as possible! Rory had never fully realised just how futile that advice could be.
He thought again of Alana, with her fingers crossed behind her back, but, like her, he knew when reassurance was more useful than blunt facts.
‘Look, we’re going to keep Mr Cross here. Would you like to see him, just so you know he’s being looked after? Then you should go home and get some sleep. It’s hard having someone close to you in hospital, so you’ll need to look after yourself as well.’
Mrs Cross seemed to crumple, as if what he’d said had brought home the realisation that her husband wouldn’t be leaving with her. Or perhaps it was because she’d have to face, alone now for a while, the chaos in her family’s life.
‘All right,’ she said, ‘but I don’t need to see him. I’m very tired and I think seeing him might make me cry. If you promise me you’ll take good care of him, I’ll just go home and come back in the morning.’
‘I promise,’ Rory said, and was pleased when Mrs Cross seemed to relax.
‘How are you getting home?’ he asked, aware that hospital environs often had unsavoury characters hanging around.
‘I’ve got the car. The ambulancemen who came to the house said to bring the car. They knew he wouldn’t be coming home with me, didn’t they?’
‘I suppose they did,’ Rory agreed, then he walked her out to the main door and was relieved to see she’d parked—illegally but at four in the morning it didn’t matter—almost right outside the door.
When she’d driven away he went back inside, where a nurse was standing by Mr Cross’s bed.
‘It’s quiet enough for me to stay here,’ she said to Rory. ‘But he’s ever so much better than when he came in, isn’t he? I said to Dr Weaver at the time, I didn’t think he’d make it.’
Mr Cross did indeed look a lot better than even when Rory had first seen him. Which was good, considering his promise to Mrs Cross.
He drove home, the streets still dark, though he could see the sky lightening in the east. But arriving at Near West gave him no joy whatsoever. After Jason had retired, doubtless to play computer games rather than go straight to bed, Drusilla had insisted she and Rory have a talk.
And though it wasn’t easy to hear capital letters in spoken words, he knew she’d imbued the word ‘talk’ with capitals.
‘It’s about Paul,’ she’d begun, and Rory’s heart sank. He knew from friends in the finance industry that Paul’s business was in trouble, and guessed that was why Jason’s father was suddenly showing interest in the son he’d abandoned. Jason had a very healthy inheritance tucked away and, though it was reasonably secure, Paul was a shifty wheeler-dealer and could doubtless get access to at least some of it should he gain control of Jason’s life.
‘You know he wants Jason. He’s already made an application for custody to the court.’
‘I’ve been notified,’ Rory had responded, wondering just where this ‘talk’ would lead. There’d never been any love lost between Drusilla and Paul.
‘Well, my lawyer said you’d have a better chance of keeping Jason if you were married. With your working hours, and having to be on call, Paul’s lawyers will argue it’s hardly a stable environment for the boy. But if you had a wife…’
Oh, please, tell me she’s not going to propose, Rory pleaded silently, hoping some understanding—and preferably powerful—entity might be listening.
Perhaps mistaking his silence for interest, Drusilla had continued.
‘Now, if you’d still been with Rosemary, I wouldn’t have suggested this, but according to Jason you haven’t seen her for ages. He says you haven’t gone out with her since Alison got sick. Not that she’d have been much good as far as being a mother to Jason was concerned. Most lawyers work longer hours than you do.’
Rory had been aware of the need to say something—anything—but his mind had closed up for the night. Possibly for ever, given the blankness between his ears.
‘It could just be a marriage in name only—you know, like the marriages of convenience in the old days. Unless, of course, you wanted more. I’ve always found you most attractive, and at times thought you might be interested in me.’
Thinking of the situation now, as he rode up in the lift, he just hoped none of the horror he’d felt had been reflected on his face. Drusilla was certainly an attractive woman, but she didn’t attract him.
The lift spilled him out on the third floor and he unlocked the door, though the knowledge that he hadn’t been firm with Drusilla about this marriage thing lurked like a nauseous lump in his gut.
He’d said no—well, he was pretty sure he’d said no, but perhaps not in so many words, definitely not that bluntly, trying not to hurt her as he knew Jason should have contact with his father’s family.
He tried to recall that part of the conversation, but though every word Drusilla had spoken remained crystal clear in his head, he couldn’t remember quite how he’d phrased his refusal.
If he’d…
No, he was sure he had…
But though he knew he needed more sleep, when he crashed back onto the sofa bed, it eluded him until the sun was well and truly up, and Jason was tiptoeing past him to the kitchen.
Rory pretended he was asleep, and eventually pretence must have turned to reality for he next woke to the smell of coffee and something sweetly delicious being cooked in his kitchen.
‘Muffins!’ Drusilla said gaily, when he opened his eyes and peered blearily towards his kitchen. ‘I bought some blueberries yesterday. Jason said they were your favourite.’
The dazzling smile she was directing his way suggested his ‘no’ hadn’t been firm enough. Or perhaps it had been non-existent.
Panic gripped his chest with the ferocity of a heart seizure.
Which reminded him…
He looked at his watch—ten after ten. He should have been back at the hospital before now.
Reached for the phone and pressed the recorded number.
When he asked about Mr Cross, he was put through to Eight B.
‘Yes, he’s here. Apparently he was supposed to go to Eight C, but there were no beds. We put him into a single-bed room and he’s resting comfortably. Do you want blood values from the most recent test?’
‘No, I’ll come up within an hour and see him myself,’ Rory said, and, because he happened to be looking towards the kitchen, saw the disappointment that etched itself on Drusilla’s face.
‘He’s a patient I was called out to in the night,’ he said, trying to make it up to her. ‘But I’ve time to eat first. I’ll just use the bathroom and be right out.’
From the bathroom, he could hear the sound of tennis balls being hit on the court below, and remembered Jason’s match. He tried to squint out through the small bathroom window, but could only see the top of the netting.
Reminding himself that sorting Drusilla out was his first priority, he slipped into his bedroom for clean clothes, then headed for the kitchen.
‘You are coming shopping with us later?’ Drusilla asked, anxiety making her brown eyes look darker.
‘Of course,’ Rory assured her. ‘Left to his own devices, Jason’s choice of footwear could give my credit card a heart attack. He also has some strange ideas of what’s essential equipment for a thirteen-year-old. Last time we went shopping, I had to drag him away from a pair of boom boxes he wanted to connect to his CD so his already loud music could be enjoyed by the entire building, and probably half the neighbourhood as well.’
He could hear the tennis game from here, too, and though he knew he could see the court from the kitchen window, he wasn’t sure he wanted to look out. Women tended to have extra-sensory perception where other women were concerned, and Drusilla might imagine he was looking at Alana rather than at Jason.
A mental sigh sifted through his brain, then his lips tightened when he remembered his last sighting of the blonde from the floor below. Even if he had wanted to ask Alana out socially, that now seemed to have been stymied by the arrival on the scene of the body builder.
He’d missed out by one night.
Missed out on what, you idiot?
In a change from sighing, his brain was now arguing with itself, so it took him a moment to realise Drusilla was speaking.
‘So when Madeleine said one of the one-bedroom units in the building would be available next month, I told her to put my name down for it. I have to give references, of course, and I suppose I’ll have to get a job just to pay for it while I’m there, but I can usually get temporary work quite easily.’
Madeleine? Madeleine Frost, top floor, kind of building manager for her father who owned Near West.
His brain stopped arguing with itself long enough to offer this information, which was useful in its own way but did nothing to stem the horror of his suppositions.
Was Drusilla saying she was staying on in Westside—that she was staying on in this very building?
Why?
As an aunt-type gesture towards Jason? Or because Rory had given her reason to hope her proposal—proposition, whatever—was of interest to him?
Damn all women to hell!
He broke his muffin and shoved enough of it into his mouth to make speech—well, polite speech—impossible.
He chewed, swallowed, sipped coffee and ate more muffin, hopefully giving the impression of a man in such a hurry he had no time to talk. Not a man in such a panic he had no idea what to say!
‘I won’t be long at the hospital,’ he managed, then amended it. ‘Well, I shouldn’t be long, but you never know. If I’m not back by two, could you take Jason yourself? He has a list of what he still needs, so don’t buy anything that isn’t on the list. He has a supplementary card for my credit card and can put his purchases on that.’
‘Oh, Rory, is that wise? He’s far too young for that responsibility surely.’
Rory finally met her eyes.
‘That kid helped me nurse his mother through her final illness. If he’s old enough for that kind of responsibility, he sure as hell can use my credit card.’
He stood up, then, realising he’d been close to rude, thanked her for the breakfast and praised the muffins.
‘In fact, I’ll take another one to eat on the way to the hospital. I’ll walk up there so at least I get some exercise today. I keep promising myself I’ll alway
s use the stairs—great cardiovascular workout, climbing stairs—but more often than not, when I’m coming home, I weaken and take the lift.’
He was rattling on and knew it, but his level of uncertainty—not to mention anxiety—about Drusilla’s motives in moving to Westside was so high it was a wonder he wasn’t hysterical.
Not a pretty sight, a hysterical middle-aged male, he thought as he opened the door then bit into his muffin.
He walked down the stairs, because a muffin-eating male strolling the streets wasn’t that good a sight either. Though tempted to slink around the back of the building to check on the progress of the tennis game, he directed his feet to head for the hospital instead.
The late night had taken its toll on Alana, and Jason beat her easily.
She collapsed onto the garden seat in the gazebo beside the court, lying full length along it and propping her legs over the back.
‘You should be stretching to warm down,’ Jason told her, bending over to stretch his hamstrings.
‘I am,’ Alana replied. ‘See, my legs are stretched up and my spine is stretched straight. You nearly killed me, you little wretch.’
She opened one eye and peered at him.
‘Are you organised with a coach yet? You should be getting more practice than an occasional game with me.’
‘Rory was going to ask you about that,’ Jason replied. ‘What I’d really like is to go to one of the tennis schools in America, where I can do school and tennis at the same time. If I leave it until after I finish school here, I’ll be too old to really be good.’
‘Rubbish!’ Alana retorted. ‘Plenty of good players started later.’ She saw his face tighten and guessed he’d seen her as an ally in this argument. ‘On top of that, mightn’t going away right now be a bit like leaving Rory in the lurch? I know you lost your mother, but he lost his sister, too. If they were close, he’s feeling it.’
She glanced sideways in time to see Jason’s infinitesimal nod, and hurried on.
‘Besides, you’re very young to be so far from home. Why don’t you set some goals for yourself? If you were to do well in the Australian Junior Championship by the time you’re fifteen, then I’m sure Rory would see the sense in sending you to the best possible coaches. And being a bit older, you’d find it easier to settle in over there.’
The Doctor's Destiny Page 11
