CONSULTANT IN CRISIS

by Alison Roberts

  And she still had the present to deal with.

  CHAPTER EIGHT

  SHE hadn’t made any mistakes this time.

  The patient was intubated. Kelly was close to the head of the stretcher, moving with it, squeezing the ventilation bag with practised regularity as she handed the patient over to the waiting emergency trauma team.

  ‘His name is John Woodbury. He’s twenty-five years old. He was the driver in a high-speed, head-on car v. car.’

  They were through the doors of the resus room now. Kelly pushed an IV stand out of her way. ‘GCS was 9 on arrival. Breathing deteriorated rapidly due to a tension pneumothorax.’

  Fletch could see the chest decompression cannula taped into place. The oxygen saturation recording was sitting at a perfectly acceptable ninety-five per cent now so the procedure had clearly been successful.

  ‘He’s been intubated with a size 7 tube without complications. Cardiac function was also compromised with a period of VT that resolved spontaneously on decompression.’

  Staff had positioned themselves to move the patient to the trauma bed.

  ‘On your count, Kelly.’ Fletch reached for a handle of the backboard.

  ‘On three,’ Kelly instructed. ‘One, two…three.’

  The young man was now on the bed. A nurse began cutting away remnants of clothing. Another was hanging up two bags of saline.

  ‘He’s got two 14-gauge cannulae in situ,’ Kelly informed Fletch. ‘Both patent. He’s had three litres of saline so far.’

  ‘What was the blood pressure on arrival?’

  ‘Eighty over 40.’

  It was now 95 over 60. The fluid replacement had also been a potentially life-saving procedure. Now Fletch had to direct his team to finding the source of internal haemorrhage and stopping it.

  ‘There’s no sign of any obvious cervical or head injury. Trachea was midline.’

  Fletch nodded. The collar was now preventing his own assessment of the cervical spine and neck but he trusted Kelly’s judgement.

  ‘He has multiple left-sided rib fractures and subcutaneous emphysema. There’s also left-sided abdominal distension.’

  Probably a ruptured spleen. As long as the control of the patient’s airway and respiration was secure, they could get this young man up to Theatre quickly. Thanks to Kelly’s management they did not need to take any extra time to intubate and gain venous access.

  ‘He has bilateral open fractures of his tib and fib.’ A nurse lifted the dressings on both John’s legs and Fletch nodded grimly.

  ‘Give Orthopaedics a call. And get a surgical registrar down here, stat. We’ll do a log roll and check his back and then I want X-rays of the C-spine, chest and pelvis. Type and cross-match for blood.’ Fletch continued his list of instructions as Kelly and her crew partner began to collect their gear. The portable oxygen cylinder and cardiac monitor were put on top of the bloodstained sheet covering the stretcher. Kelly positioned herself to help with the log roll and then she slid the backboard clear of the bed. Callum took it into the adjacent decontamination shower room. Kelly pushed the stretcher clear of the working area around the bed and then moved to a corner behind the nurse documenting the resuscitation. She clearly had not had a chance to complete any of her own paperwork en route.

  Fletch found himself watching Kelly as he moved behind the shield when the overhead X-ray equipment came into use. He should tell her what a good job she had done here but he had barely spoken to her since the aftermath of that case of hypoglycaemia and he recognised how unfair it had been to accuse her of any incompetency over that patient. It had been a classic stroke presentation and it wasn’t as if the oversight hadn’t been picked up and corrected before any lasting damage had occurred.

  Everybody made mistakes. Fletch had made a few of his own over the years. He turned his gaze deliberately away from the sight of Kelly’s bent head with the long, dark plait hanging over one shoulder and the look of concentration on those well-remembered features. Fletch’s mistakes had been more concerned with women than patient management and he wasn’t stupid enough to make the same mistake twice. He had been reminding himself of that for the last three weeks.

  So what if Kelly hadn’t dumped him because he’d been sick? That she’d never come to see him in hospital because she’d had no knowledge of his admission? It made no difference. In fact, maybe it made things worse. She had broken their engagement on the strength of one bad night out and on the assumption that he’d lost control because he’d had too much to drink. To be prepared to break off what was supposed to be the most significant relationship in her life and to cut off any contact without explanation was a pretty damning indication that the available love would never have lasted into marriage. He was lucky to have escaped. Stray thoughts that Kelly might have had some justification for her actions had been occurring to Fletch with disturbing frequency since that session in his office but her story wasn’t enough to convince him.

  Or was it?

  Callum emerged from the shower room with the clean backboard and Kelly smiled her thanks just as the X-rays were completed and Fletch moved back to his patient. He had seen that smile so often in the past. A recognition for even the smallest act of caring—a cup of coffee maybe, or a word of encouragement. It had always made the service worthwhile. Made Fletch want to do more to show how much he cared.

  ‘That was a good job, Kelly.’ Fletch’s tone was more brusque than he had intended. Surely he didn’t feel jealous that it was Callum who had received that smile? ‘Well done.’

  ‘Thanks.’ Kelly’s smile had begun to fade the instant Fletch had spoken. The fact that she didn’t even make eye contact was a put-down. Fletch moved past briskly. He had been right all along. Her story made no difference and he wasn’t going to set himself up to get slapped down by this woman again.

  So why did he continue to notice her every time she came into the department? It wasn’t as if he was directly involved in the care of any of her patients over the next week or so, yet he could virtually list them—an old lady with a fractured hip, a toddler with an epileptic seizure, chest pains and heart attacks, abdominal pains and an amputated finger.

  Then there was the case of hypoglycaemia that Kelly had treated with IV glucose but transported to hospital because she’d been unhappy with the response. He eavesdropped on that particular handover.

  ‘Mrs Seule is an insulin-dependent diabetic who’s having trouble controlling her BGL. This is the third episode of hypoglycaemia she’s experienced this week despite lowering her insulin dose. Her husband tried to get her to take oral glucose but she vomited and was unresponsive on our arrival.’

  Fletch tended to vomit when his BGL dropped low enough. That was why he used glucagon when he knew his symptoms were becoming critical. Not that he used it often. Most of the time he was perfectly normal—just as he had been when he knew Kelly. No wonder she’d been so shocked when he’d told her he was diabetic. And no wonder she’d been puzzled. Strictly speaking, he wasn’t diabetic. He’d only needed IV dextrose treatment once in the last year and his insulin levels very rarely created any problems at all.

  Kelly finished her handover and was about to transfer her patient to a bed. The woman reached up and took the paramedic’s hand.

  ‘Thank you so much, my dear. You’ve been so kind. Don gets so worried when I have one of my little turns.’

  Fletch wondered if Mrs Seule had any clear idea of what her behaviour was like during a hypoglycaemic episode. He doubted that she became combative or unpleasant. Mr Seule was beside his wife, holding her hand. He added his thanks and won a smile from Kelly.

  ‘You’re very welcome.’ The words were sincere. And warm.

  Fletch knew perfectly well that Kelly wasn’t coldhearted or ruthless. He had been unfair and he didn’t like the prickles of guilt that continued to make their presence felt as one busy day followed another. He knew what Kelly’s real character was like. She was determined. And courageous. She would go through
whatever she had to in order to achieve what she knew had to be done, but she wouldn’t do it unless she’d weighed up the pros and cons. For whatever reason, Kelly had believed she had been justified in taking the action she had against Fletch and that explained why she had considered an apology from him appropriate.

  Was there any justification? Just how obnoxious had he been that night at the restaurant? Had he been more than argumentative and uncoordinated? Fletch tried to concentrate on the X-ray in front of him but he wasn’t calculating the degree of pulmonary oedema his patient had with any degree of accuracy. It had been unpleasant but dismissible to have a period of time, however brief, of which he had absolutely no memory. It was a lot less easy to dismiss now that he knew he had behaved so appallingly. And so completely out of character. It sounded as though he’d been a loudmouthed hoon with no regard at all for public decency.

  It was hardly surprising that Kelly might have been shocked into second thoughts about the man she’d been planning to marry. It wasn’t as though they had really known each other that well. It had been a whirlwind romance with the engagement coming little more than two months after their first date. Fletch had never felt, and never could feel, that strongly about any other woman. And he had been so sure that Kelly had felt the same way. Maybe she had. And maybe he had been abusive enough that night to scare her into running. Maybe she had waited for an apology and reassurance that had never come. Kelly had admitted she’d made a mistake. She had apologised.

  Did she deserve another chance? Fletch pulled the X-ray from the viewing screen with a decisive snap as he turned to scan the department for Kelly’s whereabouts. Perhaps he could arrange some time they could spend together. A coffee or a meal. Enough time to explore the possibility that there might still be a spark somewhere amongst the embers of their relationship. But what Fletch saw were the taillights of the ambulance as it pulled away from the loading bay. Kelly had gone.

  Fletch strode towards Resus 4 where his patient in heart failure awaited his opinion. It was just as well Kelly had left the department. The moment of personal indecision would pass swiftly, just like the flashes of attraction that he’d been experiencing ever since she’d stepped back into his professional orbit. His body might still have memories of his overwhelming attraction to Kelly, and it was possible that his heart still had the capacity for emotional involvement, but his brain had matured a lot in the last couple of years. It was more than capable of counteracting and overriding any signals that might make reawakening even a friendship with Kelly Drummond seem like a good idea.

  Reawakening friendships was not always a good idea. Kelly stood a little to one side of the group of people gathered at a local winery on this warm spring evening. She sipped her orange juice with little enjoyment. Why had it seemed like a good idea to accept the invitation when Dave Stewart had rung last week? She had known Fletch would probably attend this reunion of their USAR course class. She had even convinced herself that it would be good to see him socially. It was becoming routine for them to avoid each other when they met professionally. Almost easy, in fact. If she could handle the distance in a social setting, maybe it would provide some kind of closure. She could accept that she had ruined her chance with Fletch, put a stop to any forlorn hopes of putting things right and move on.

  There were plenty of people here that Kelly had been looking forward to seeing. It had been too simple to focus on the situation at home and withdraw from involvement anywhere else outside work. The busier she had kept herself, the better able she had been to feel optimistic about getting through this particular patch of her life, but regrets about how out of touch she had become were now undermining that optimism. Kelly moved towards Wendy who had just broken away from a conversation with Joe.

  ‘I’m sorry I haven’t been out to visit Ross for a while.’

  ‘That’s OK. He knows how busy you are.’

  ‘It’s the height of the season for the daffodils. When I’m not at work I’m helping my mother get the blooms picked and packed for the market. She can’t afford to hire extra help at the moment.’ Kelly knew her excuse was lame. Her mother had coped alone with the small flower farm while she had been in Australia. ‘How are things going at the moment?’

  ‘Not great. I wanted Ross to come tonight. He’s quite independent in his wheelchair now and getting out for the first time would have been a major hurdle to get through, but he refused to even discuss it.’

  ‘I guess being out with us might be too much of a reminder of the accident and everything he’s lost.’

  ‘It’s been nearly two months. He’s got to face up to it some time.’ Wendy looked tired and sounded uncharacteristically dispirited. ‘We all have to accept things that can’t be changed and move on.’

  Kelly nodded with heartfelt agreement. That was precisely what she was doing, wasn’t it? She could see Fletch talking to Roger and Owen and she wasn’t experiencing any overwhelming feelings of loss. Or even attraction. If anything, Kelly just felt a little sad. Maybe Wendy’s mood was contagious. She looked away from Fletch.

  ‘How’s Jessica, do you know? She still sounded pretty upset when I spoke to her last week.’ Kelly’s gaze was searching the gathering. ‘Joe hasn’t said anything much about the break-up. In fact, I hardly seem to see him around headquarters these days.’

  ‘She’s gone back to her old job. She told me she’s determined to pick up the pieces and get on with her life.’

  ‘Good for her.’ Kelly was looking at Joe now. It was simply a coincidence that he happened to be standing next to Fletch. ‘Such a shame, though. I really thought those two were made for each other.’

  ‘Like me and Ross?’ Wendy murmured. She looked ready to cry.

  ‘You and Ross are going to be fine. You’ll get through this.’ Kelly’s gaze was still caught by Joe and Fletch. They both had tall glasses of beer in their hands and Kelly was suddenly conscious of the drink she was holding. She was sick to death of drinking orange juice. No wonder it came across as a holier than thou attitude about alcohol. She eyed the glass in Wendy’s hand.

  ‘I think I’d like a glass of wine.’

  Wendy finished her drink and smiled. ‘You’re right, Kelly. I’m not about to give up on Ross. Let’s both find a glass of wine and drink to the future. Preferably on the other side of this vineyard. I’m getting really fed up with the way Kyle keeps staring at me.’

  Wendy’s planned escape didn’t quite eventuate. The two women had to pause when Dave wanted an update on Ross. They were joined by Owen and Roger and then Kyle managed to tag onto the amalgamation that saw Fletch and Joe join the conversation. Kelly stepped back a little as a waiter came past bearing a tray of wine. She swapped her orange juice for one of the long-stemmed glasses. Pleasantly surprised by the taste of the sparkling white wine, Kelly took several sips before tuning back in to the conversation around her.

  ‘It was a trial by fire, wasn’t it?’

  ‘Let’s hope you don’t lay on the kind of practical follow-up we had for your next USAR course.’

  ‘You guys are the best trained team we’ve got now.’ Dave sounded proud of the class.

  ‘I keep my kit packed. It sits right beside my bedroom door.’ Kyle was as enthusiastic as ever. ‘I’m ready for the next call-out. How ’bout you, Wendy?’

  ‘I can’t say I’ve thought about it.’ Wendy edged sideways to get further away from Kyle. ‘It’s not something that’s very likely to happen, is it?’

  ‘You never know.’ Joe seemed as subdued as Wendy was. ‘We thought that before the last call-out, I seem to remember.’

  ‘Have they got any closer to finding out who planted that bomb?’

  ‘They’re not likely to, in my opinion.’ Kyle sounded knowledgeable enough to make Wendy roll her eyes at Kelly. The almost imperceptible jerk of her head was a plea for escape. Kyle was still speaking as they slipped away from the group. ‘I heard that the video surveillance tapes were destroyed—and anyway, how could they trace
someone who could have left a bomb programmed to go off days later?’

  ‘This wine is nice,’ Kelly told Wendy.

  ‘I’ll have another one,’ Wendy decided. ‘And then I’m going home. I don’t really feel like being sociable. Especially with Kyle being here. Do you know, I don’t think he feels any responsibility over Ross’s accident at all? If he hadn’t been stupid enough to get that spike through his leg it would never have happened.’

  ‘The injury wasn’t serious enough to slow him down much, was it?’ Kelly glanced over her shoulder. Kyle was still standing near Fletch. ‘I don’t really feel like being sociable either. I think another wine is an excellent idea.’

  The general consensus a short time later that the group should move on to a nightclub gave Wendy the excuse to leave. Kelly intended to do likewise.

  ‘I need to go home,’ she told Joe. ‘It’s getting late.’

  ‘Oh, come on.’ Joe put his arm around Kelly. ‘It might cheer you up.’ He peered at his colleague more closely. ‘You look about as bad as I feel. What’s up?’

  Kelly almost laughed. Where should she start? With the fact that her father had been released from prison a few days ago and her mother was too nervous to answer the phone? With the offer of her old job in Melbourne, an option Kelly was very tempted to consider? With the knowledge that, however hard she tried to move on, she would never quite come to terms with the low opinion Fletch now had of her?

  ‘Do you know,’ she said seriously to Joe, ‘that some people think I’m shellfise?’

  ‘Sorry?’ Joe looked confused.

  Kelly concentrated on her enunciation. ‘I meant selfish.’ Heavens, nobody got drunk on two glasses of bubbly wine, did they? ‘Selfish and cold-hearted,’ Kelly expanded. She felt ridiculously close to tears. ‘Some people really hate me.’

  ‘Oh, rot!’ Joe was grinning now. ‘Stay here. I’m going to see if there’s a taxi left that we can fit into.’