by Anne Fraser
‘IT WAS good to see Millie looking so much better, wasn’t it?’ Louise made a swift check of the list of patients waiting to be seen and then glanced across to where Jenny was collecting fresh dressings from a cupboard. ‘The surgeon discovered a twisting in her intestines as well as the diaphragmatic hernia, so the operation was a little more complicated than we might have expected. I thought it would take longer than a few days for her to recover.’
Jenny smiled. ‘I was so pleased when Mrs Watson brought her in. I didn’t know whether you would get the chance to see her. I know that you’ve been busy in the treatment rooms all day.’
‘Her mother waited until I was free,’ Louise explained, noting down which patients were to be allocated to each of the doctors on duty. ‘She said she wanted to thank us for looking after her little girl. It was so lovely to see the child looking well and happy.’
‘That’s one of the delights of the job, isn’t it…seeing the little ones back up on their feet again, ready to cause mayhem.’
Louise chuckled. ‘It is, definitely.’
A moment or two later, the phone at the central desk started to ring. It was the line that warned them of incoming patients and Jenny hurried away to answer it, just as James Ashleigh walked into the department. He was dressed immaculately, as ever, in a grey suit and a crisp pale shirt.
Louise paused briefly in writing up her allocations on the board and half turned towards him, sending him a swift glance before straightening up to face him properly. Why was it that he always managed to make such an impact on her? He had an undeniable presence, a way of grabbing her attention and stopping her in her tracks.
What was he doing here? She braced herself. He was management, and that probably meant trouble.
‘I wasn’t expecting to see you around here,’ she murmured. ‘Is there something you wanted?’
He hesitated momentarily, his gaze flicking over her, and from the slightly arrested look in his eyes, it gradually dawned on Louise that her stretch cotton top had shifted a fraction as she had reached up to the board. She quickly smoothed it back into place, ensuring that her midriff was adequately covered and that her pencil-slim skirt was tidy.
He had obviously gathered himself together during that small space of time, because he smiled faintly and there was a glint of humour in the depths of his grey glance. ‘Now there’s an interesting question,’ he said in a husky drawl, his gaze coming to settle on the gentle curve of her hip. ‘But, given that we haven’t started off our relationship in a particularly good way, I think I’d better forgo the answer that springs to mind.’
Her eyes widened and her knees went weak. Was he actually saying what she thought hewas saying? Was he making a pass at her? She felt a surge of heat flow through her entire body as the after-shock of awareness rocked her. The way he looked at her was purely male…discreetly disguised, but full of masculine appreciation, all the same, and she didn’t know how she felt about that. After all, he was the enemy. Why was she even contemplating howit might feel to get to know him better?
Covering her confusion, she said shortly, ‘I believe we have a patient coming in by ambulance, as well as a waiting room full of children needing to be seen. If you’re here to pass the time of day, I’m afraid we’re rather busy.’
He inclined his head a fraction. ‘I had anticipated that. Until we devise foolproof preventative measures where traffic and accidents are concerned, A&E is always going to be a hectic place.’
He glanced around the central area. ‘I must say, this is one of the more cheerful departments I’ve seen. It’s colourful and child-friendly, with all the jungle scenes painted on the walls. I noticed that you have toys in the waiting areas too, and tables set aside for activities.’
‘I’m glad that you approve,’ she said in a calm manner. ‘I was thinking of adding a couple of pictures to the treatment rooms that still look a bit bare… With all the worry about closure, I had put it on hold, but I think I’ll go ahead anyway. I don’t see why the children should miss out just because the adults are squabbling.’
‘I can understand why you would want to do that.’ He took another look around the central area, noting the rooms that led off all around. They were glass fronted to allow for easy viewing. There was an uncluttered appearance about the place, and Louise had done her best to make it pleasant for parents who had to wait for news of their sick children, as well as for the youngsters themselves.
‘We also have a play leader, to make sure that the little ones are occupied and diverted through what might be a difficult time.’ Her gaze narrowed on him. ‘You seem to be quite interested in the layout of the place. Is that why you’re here? To look around?’
‘I’d like to do that. Would it be all right with you?’
She frowned. ‘I suppose so.’ He obviously had time on his hands if he was able to hang about here, taking note of the surroundings and the general atmosphere. Or was there a hidden agenda to his presence in her department? He was one of the executives, after all, and it went with the territory that they were always on the lookout for any changes that could be made.
Just then, Jenny hurried over to them, saying urgently, ‘It looks as though we have an incoming emergency on our hands. He’s a three-year-old who’s having seizures—apparently he swallowed some of his mum’s antihistamine tablets.’
Louise was immediately on the alert. ‘Do we know what kind of tablets and how many?’
‘Yes. It was dimenhydrinate. The paramedics have taken full note of everything. They’re not sure quite how many he took, but they guess it was a substantial amount and it was some time before the mother realised what had happened.’
‘Okay—let’s get him into the resuscitation room as soon as he arrives. We’ll need to hook him up to an ECG monitor and start him on benzodiazepines to control the seizures.’
‘I’ll go and start making preparations,’ Jenny said, hurrying away.
Louise glanced at James. ‘I need to head over to the ambulance bay. You’ll have to come along with me if you want to talk.’
‘That’s fine by me.’ He walked alongside her as she headed for the main doors.
‘Is this visit part and parcel of you wanting to check out the viability of the unit?’ She decided that it was better for her to come out with what was on her mind rather than fudge the issue.
‘That’s a rather harsh way of putting it, don’t you think?’ His mouth flattened.
Louise gave a faint shrug. ‘I don’t see any reason not to be blunt,’ she murmured. ‘That way we both know where we’re coming from.’
He acknowledged that with a faint twist to his mouth. ‘Let’s say that I prefer to see things firsthand. I really need to know what I’m talking about if I’m asked to give an opinion on the various proposals. It’s one thing to look at facts and figures that are laid down in reports, and quite another to get a feel for the place and see the way it actually runs.’
‘If I were to take that the way it sounds, I might be encouraged to believe there was some hope that you might change your mind about the move to the Royal Forest Hospital.’ She made a face. ‘On the other hand, I’ve seen the way these things work at other hospitals, and I suspect that in reality you could be looking into ways you might reorganise the facilities when we’re no longer around.’
He laughed. ‘You’re a cynic through and through, aren’t you, Louise?’
Her green eyes flashed. ‘Tell me I don’t need to be.’ It was a definite challenge but, as she expected, he wasn’t about to take it up. Perhaps her vehemence startled him, but this department meant everything to her. It was more than a place of work, and she felt an urgent need to defend it and the patients it served. In a way, they were like the family she never had, and she would protect them in any way she could.
She turned away from him as an ambulance siren sounded close by. ‘I have to concentrate on the job in hand,’ she said. ‘If you’re going to observe, I hope you’ll keep out of the way and let us get on with our
work.’ It occurred to her that she was perhaps being too dismissive of him, but her priority was with her patients and if he didn’t like it that was too bad.
She hurried out to the ambulance bay and observed the small child who was being wheeled in through the main doors of the hospital.
He was in a bad way. He was still having seizures despite the attentions of the paramedics, and his skin was hot and dry. She listened to what the paramedic had to say, and then glanced at the chart he handed her.
‘Okay, take him into Resus Two, Andy,’ she told him. The young man nodded and did as she suggested. Then he stood back, out of the way, clearly unwilling to leave just then.
Once the child was safely in the room, Louise quickly obtained intravenous access and then administered the drugs that would help stop the seizures.
‘Is he going to be all right?’ the toddler’s mother asked in a shaky voice.
‘We’re doing everything we can for him,’ Louise told her. ‘If you’d like to stay by his side and hold his hand and let him know that you’re here, I’m sure that will help.’
‘Let’s get him on oxygen,’ she said, glancing at Jenny, ‘and we’ll do a blood glucose test.’
She worked with the child for several minutes, anxiously watching the monitors and infusing him with various medications as she tried to stabilize his condition.
The Specialist Registrar came to assist. ‘The ECG reading is showing a widening QRS complex,’ he told her.
She acknowledged him, saying, ‘Okay, Tim, we’ll start bicarbonate therapy and see if that will settle things down.’ Louise glanced anxiously at the monitors once more. ‘You had better notify the intensive care unit,’ she told Jenny. ‘He’ll need to be admitted. In the meantime, I’ll put in a nasogastric tube so that we can give him activated charcoal and then, as soon as we’re able, we’ll do a gastric lavage.’
Louise stayed with the child until she had done everything that was possible for him.
‘What’s going to happen to him?’ the boy’s mother asked. ‘Matthew’s so little and he looks dreadfully ill. I just never realised it could get this bad.’
She was naturally distressed, and Louise wished that she could reassure her in some way. ‘We’ll keep him in our observation bay until ICU can find a bed for him,’ Louise told her. ‘We’ve washed out his stomach in case there was any antihistamine still in there, and we’re doing what we can to minimise the effects of any of the drug that’s in his system. Other than that, it’s too soon to tell how things will turn out. We’ll know better in a few hours if we’ve managed to counteract the worst consequences.’
The paramedic was still waiting to see if there were any results. He was a fair-haired young man in his thirties, and Louise knew that he was dedicated to his job.
He was frowning, and Louise went over and spoke to him as she left the child in Jenny’s care. She didn’t want to leave him at all, but there were other patients who needed her, and all she could do for him now was to wait. ‘I’m sorry there isn’t any better news for you, Andy,’ she told him. ‘I suppose you have to get back to work now, don’t you?’
Andy nodded. ‘I stayed as long as I could.’
‘I’ll let you know as soon as there is any change,’ she promised. ‘It’s heartbreaking, isn’t it, seeing a child in that situation.’ She gave a soft sigh. ‘He looks so tiny and vulnerable.’
Andy’s expression was bleak. ‘All I know is that he’s in the best hands, with you looking after him. I expect I’ll see you later on, Louise.’ He lightly touched her arm in a gesture of support before he made his way back to the ambulance bay.
Louise started back towards the central desk and saw that James Ashleigh was waiting for her, his gaze following the paramedic as he left the reception area.
His gaze moved over her and she tried not to let his careful scrutiny throw her. He noticed too much, and it threw her to know that he, of all people, could unsettle her with a mere glance.
‘You seem to get on very well with everyone around here,’ he commented.
‘I find it helps to have a good working atmosphere,’ she said lightly. ‘We’re with each other for many hours in the day and sometimes through the night, and it makes for a much better outcome if everyone gets on well together. That way we work as a team.’
She glanced at him. ‘How do you run your department? I take it that you do have a department to oversee, now that you’re back in the UK, or are you spending all your time adding up figures and moving papers about?’
He laughed. ‘You have a way with words, don’t you?’ Sobering, he said, ‘It’s true that I do oversee a department, but I only actually take a couple of morning clinics and do a ward round in the middle of the week. The rest of the time I’m involved with management duties.’
‘Such as you are this afternoon?’ She let the statement hang in the air. ‘I don’t see how you can possibly advise your committee on whether my unit is a success or whether it should suffer the axe, when you’ve been out of touch with the cut and thrust of hands-on medicine for such a long time. I don’t see that a couple of mornings here and there give you much of an edge on the rest of us. But then, that’s what you management people are all about, isn’t it? You don’t see the day-to-day work that goes on. You see costing and services, and a series of numbers to be crunched and targets to be achieved.’
‘Some of us have to look at the workings of the hospital from an overall viewpoint, and make decisions about the structure of things. Reorganisation could be the answer to the problems in this region. It isn’t a cost-cutting exercise, as you called it, but resources are not infinite.’
She scowled. ‘And if one little paediatric A&E unit folds as a result, that’s fine, isn’t it? Who’s going to count the cost of one little boy who swallowed his mother’s tablets and might have to travel through rush-hour traffic to get to the Royal Forest Hospital? I don’t know whether we’ve managed to reverse the damage that was done to him, but I do know that he probably wouldn’t have stood any chance of making it if he’d been forced to travel to the Royal Forest.’
‘You can’t say that for certain. Who’s to say that the local GP might not have been around to intervene where necessary?’
‘I might have known you’d find a way to wriggle around the situation. That’s the whole trouble, isn’t it? All your ideas are pure theory. You spout all this so-called wisdom, while I have to cope with the day-to-day problems of holding together an overstretched department. You should be pouring resources into it, not closing us down. We need more staff here, but your proposals have put paid to that, haven’t they? Who’s going to come here and risk being out of a job in a few months’ time?’
‘Whoa there, steady on.’ He put up his hands, palms flat in front of him, as though to stop the onslaught. ‘Perhaps it isn’t as bad as you think.’ He lowered his hands and moved closer to her so that she was disturbingly aware of his long, lean body and the way that he moved, with a suppleness that spoke of lithe energy and keen vitality. ‘There’s nothing to stop me from coming and working here, is there—for a few months, at any rate?’
He said it in such a casual manner that it took a moment or two for it to sink in. She stared at him. ‘I’m not sure that I heard that right. Did I just hear you offer to come and work in my department?’
‘Well, I know that you’re looking for a Senior House Officer, and I may be a touch overqualified for that, but I can spare a couple of mornings and maybe a couple of afternoons a week in order to lend a hand. I’m sure we could work something out between us.’
She blinked, and struggling to take in what he was saying. ‘I’m actually looking for someone who has paediatric experience,’ she managed after a while. ‘That’s on top of being able to cope with accident and emergency. From what I’ve heard, you’re working in the renal unit, so I’m not quite sure whether you would be the right candidate for the job.’
Even to her own ears it sounded shocking that she should be ta
king one of the executives to task about his qualifications. Why was it that she felt the need to constantly have a go at this man? It wasn’t enough to argue that he was threatening her position here, or even that he didn’t take proper care of his grandfather. It was something more than that.
On a basic, primitive level, she felt that she needed to defend herself against him, although she couldn’t put into words exactly what it was that she feared. It was enough to put her into attack mode.
‘By all means check my credentials,’ he said and, to be fair to him, he didn’t look at all put out by her misgivings. ‘I think you’ll find that I have enough experience in both departments to fulfil the criteria. As to my reasons for doing it, let’s just say that I can see that you’re understaffed, and I’m in a position where I’ve been away for a while and I haven’t yet eased back into my full-time role. I’m in the fortunate position of being able to pick and choose what I want to do.’
‘You’re highly fortunate, I would say.’ Louise recovered her equilibrium and found that she was more than a little sceptical of his motives. He made it sound as though he was doing her a favour, but she had her doubts about that. ‘I expect that working in the department will make life far easier for you when it comes to writing up your report, won’t it? You’ll have all the information you need at your fingertips.’
‘Are you afraid to accept my offer?’ Again, there was that faint hint of amusement that played around his mouth. It was unsettling, as though he could read her like a book, whereas Louise would be hard put to say what it was that was bothering her.
If his plan was to work with her in order to check up on the day-to-day running of the unit, then shewas pretty certain that she could deal with that well enough. She suspected her unease was caused by something entirely different, and it was enough to make her hesitate.
How would she cope with having him in close proximity on a regular basis? He exuded masculinity without even trying, and just knowing that he was around seemed to throw her nervous system into chaos.
