‘I’ll be there in a moment,’ Ruby said, torn with indecision, because she had told Jamelia her concerns yet Jamelia didn’t seem worried.
But Ruby was.
She went back in to Bill, saw the fear in his eyes and held his hand for a moment.
‘Not,’ he said once, blowing out air and trying to gather the strength to say it again, spittle at the sides of his mouth and just too ill and too exhausted to state his case further. Ruby knew she had to do it for him.
It was the most nerve-racking thing she had done. Sheila was clearly busy, Connor was in with a patient, so reluctantly Ruby went to Siobhan and explained her concerns, but unfortunately Jamelia came over just as Ruby said that she wasn’t sure Bill was manic.
‘I’ve seen him during two acute episodes,’ Ruby explained. ‘And I really think that there’s more to it.’
‘Of course he’s manic,’ Jamelia snapped. ‘He’s climbing off the gurney, he thinks he’s a doctor, he’s clanging…’
‘He’s not clanging,’ Ruby responded. ‘And he is a doctor.’
Jamelia gave an eye roll and went back into Resus, having clearly decided that Ruby had no idea what she was talking about, and Ruby waited for a shrug from Siobhan as Jamelia headed off. Instead, Siobhan was reading through his obs and calling Reception to ask them to hurry up with Bill’s history.
‘What’s clanging?’ Siobhan asked, and saw Ruby blink. ‘I don’t claim to know everything,’ Siobhan said, and maybe Ruby was seeing things, but for a second there she thought Siobhan smiled. ‘Just most things.’
‘When they’re manic, sometimes they do things with words, and it makes no real sense—like not, hot, cot, dot, or…just vague association. He’s not doing that now, he just can’t get his words out, but they’re lucid words. He’s trying to tell us that there’s something very wrong.’
‘Well, bring him over if you’re worried,’ Siobhan said, and she gave a sigh when Ruby just stood there. ‘Ruby? Do you want to bring a patient over to Resus?’
‘Yes,’ Ruby finally said.
‘Then I’ll give you a hand.’
And Ruby got it a little bit then. It was indecision that was the enemy in this place, because even if she wasn’t sure if it was the right one, as soon as she made the call, whether she turned out to be right or wrong, Siobhan, it would seem, supported her.
So they took off the brakes and wheeled Bill over. Cort was probing an abdominal wound and looked up as they came in.
‘Ruby’s worried about this patient,’ Siobhan explained. ‘He’s waiting on Psych, but she’s looked after him before and says this presentation is unusual for him.’ Which was a far more efficient way than Ruby would have described it!
‘I’ll take a look in a moment,’ Cort said, and frowned as he glanced at Bill, who was breathing more rapidly and was much more sweaty now. As Ruby attached him to the monitors the alarm went off loudly as the cuff inflated and blew up higher to get an accurate reading.
‘Has he had bloods taken?’ Cort checked, and Siobhan nodded.
‘He’s hypertensive. Jamelia gave him some diazepam earlier as well.’
‘I’m not, not, not, not…’ Bill begged, and Ruby tried to reassure him.
‘We know you’re not well, Bill. The doctors are sorting out what’s wrong.’
‘Ring the lab,’ Cort called, ‘and ask them to push his bloods as urgent.’
Ruby did so, only to find out that they hadn’t got them yet. She looked and there they were, still sitting in the chute basket, so Ruby hurriedly sent them.
‘Get Jamelia to come and take another look,’ Cort called, but just as Ruby was about to, Bill let out a strange cry and before it had properly registered, she knew, just knew, that he was going to start seizing. Ruby moved quickly, lowering the head of the bed and pulling out the pillow, while Siobhan put oxygen on him as Sheila came speeding over with the cart and a worried Jamelia running in too.
‘He’s stopped,’ Sheila said, but within seconds, even as she pulled up some medication, he was seizing again, and Cort finished up what he was doing, ripped off his gloves and came over.
‘He was fine…’ Jamelia said, but Cort just ignored her, giving Bill some sedatives. When he continued to seize, he told Sheila to urgently page the medical team.
Bill’s blood pressure was becoming elevated and each seizure was running into the next. All Ruby could think was that he didn’t deserve this.
‘He said this wasn’t normal for him.’ Ruby heard her own voice, but apparently from the lack of response, she was the only one who did.
‘Ring the lab,’ Cort said. ‘Tell them we need those bloods.’ Ruby did so, waiting on the line as they ran some rapid blood tests and delivered the news that Bill’s sodium was dangerously low.
‘At least we know what we’re dealing with.’
They hung some saline, and the medical team worked on him till finally his seizures were halted. But Bill was clearly very sick, and instead of the psychiatric ward he was transferred to ICU. Ruby even went with Siobhan to take him up and hand him over.
‘Nice call,’ Siobhan said, and gave a compliment in her own backhanded way. ‘You have to go with your gut sometimes, even if you have no idea what you’re basing it on…’
Though it was nice of Siobhan to say so, Ruby was incensed on her patient’s behalf, annoyed at how he had been dismissed, and that anger simmered inside her all night, especially when Jamelia carried on as if nothing had happened.
It was just a horrible, busy, chaotic night, though there was order to the chaos and, Ruby realised, even if she didn’t like the bubbling anger inside her, even if resentment didn’t generally suit her, it helped to be carrying some in a place like this. When a group of revellers noisily crossed all boundaries and spilled into Resus, where behind a curtain Ruby had just finished inserting a catheter, to demand when they’d be seen, it was actually Ruby who dealt with them—all five and a bit feet of her. She covered her patient, the poor woman clearly distressed by the intrusion, and Ruby ripped off her gloves and strode over to the three angry men and shooed them out. Sheila, who had been about to summon Security from the waiting room, smothered a smile and replaced the phone.
‘You do not come in here!’ Ruby was enraged. ‘Go back down to the waiting room and when it’s your turn you’ll be called.’
‘Ah, come on, darling…’ They made a few comments about her temper and her hair and Ruby just stood her ground, told them that if they took one step further, she’d have them removed, and she meant it. Absolutely, she meant it.
‘They’re gone.’ She went back in and reassured her patient. ‘I’ll go and get you some water. The doctor wants you to drink a lot.’
‘You did well,’ Cort said as he made himself a drink, while Ruby banged about in the kitchen where she was getting a jug of water for her patient. For a second there she thought she was about to get to say her piece, that finally the way Bill had been treated was about to be acknowledged, except Cort was talking about something else. With the drunks bursting into Resus.
‘It’s good to assert yourself,’ Cort pushed, but still she said nothing, this mini red tornado in the kitchen, and he wanted her to talk to him, to open up to him, to treat him as she did others, so he pushed a little further. ‘You’re angry?’
‘Yes,’ Ruby said. ‘I’m angry.’
‘Which is fine—’
‘Well, I don’t like it,’ Ruby said. ‘I prefer enjoying my work to walking around…’ She couldn’t say it, couldn’t let rip without criticising Jamelia and she didn’t want to do that, so she just ignored him, because they’d used up all the free tokens that had come with their first night together. But Cort wouldn’t let it slide, Cort wanted the ten minutes of Ruby that her friends and colleagues seemed to get.
‘Walking around?’ Cort continued. ‘Walking around, what?’
‘Angry,’ Ruby said. ‘Is that what it takes to survive this place?’
‘For some,’ Cort admitte
d. ‘Ruby, it’s okay to be angry.’
‘That’s a joke, coming from you.’ She blasted a jug of ice with water. ‘I got hurt and the one time I was angry, the one time I let it show…’ She turned off the tap. ‘Look what it cost me.’ She turned on a smile because that was all anyone really wanted from her. ‘You carry on with crabby Cort. As soon as I’m out of here, I’ll get back to being happy.’
Except she couldn’t quite get there.
The place incensed her, especially when it turned out that no one had bothered to ring Psych and let them know what had happened with Bill. Imran, a psych doctor Ruby knew quite well, came down at two a.m. to admit him.
‘Oh, he had a seizure,’ Jamelia said. ‘Hyponatraemic. He’s under ICU for now.’
‘Well, thanks so much for advising me,’ Imran said. ‘I’ll get back to bed, then.’ But his sarcasm was wasted on Jamelia who just moved on to her next patient.
‘Busy?’ Ruby asked.
‘Full moon,’ Imran answered, and Cort, who was on the phone, felt his jaw snap down. ‘Have you got time for a drink before I head back up there?’
‘I doubt we’ll be getting breaks tonight.’
‘I don’t know how you stand the place,’ Imran said, and then he saw a flash of tears in Ruby’s eyes. She muttered something about not knowing how she stood it either.
‘Can I steal Ruby for a drink?’ Imran clearly knew Sheila. ‘To compensate for my wasted journey?’
‘Ten minutes,’ Sheila called over, because no one would be getting a proper break tonight and Ruby clearly needed a short one. Her cheeks were burning with colour, she was tense and angry, and Sheila didn’t blame her a bit—she just didn’t have time to address it.
As Ruby and Imran headed off to the staffroom, Cort found something out about himself—occasionally he ground his teeth.
Ruby did feel a bit better for talking to Imran. ‘What if he’d been still stuck in a cubicle when he’d had the seizure?’ Ruby asked as they broke open a bar of chocolate.
‘They’d have heard him,’ Imran said. ‘Bill’s going to be fine. They’ll sort him out and then he’ll be back with us.’
‘He’s not manic.’
‘Of course he’s manic.’ Imran laughed. ‘He does this all the time.’
She closed her eyes, because it was almost impossible. There was just so much to learn, so much to take in, and three years just didn’t cut it.
‘You’ll get there,’ Imran said as they headed out to the unit. ‘This sort of thing happens all the time.’
‘Well, it shouldn’t.’
‘You’ll be back with us soon,’ Imran said as they walked passed Cort.
‘Thank God,’ Ruby muttered, and Cort rather agreed. He needed his mind to get back to work.
CHAPTER SIXTEEN
THERE was a lull about five.
The suture room had a list of patients waiting and there were some still waiting to be taken to the ward, but for a moment they sat at the nurses’ station, because a break, Sheila said, was vital. Ruby glanced at the clock. Two and a half hours and her time in Emergency would be over—it couldn’t come soon enough for her. Sheila had even said that given she hadn’t had her dinner break, if the place was quiet, she could shower and change and be out by seven-thirty.
‘Here.’ Siobhan waddled in with a laden tray and though Ruby had fully intended to have a strong black coffee with three sugars, she was so touched that Siobhan had filled her little white teapot, it seemed churlish not to drink it, so though she yearned for a hit of caffeine, Ruby sipped on dandelion leaves and chamomile instead.
‘He’s doing better.’ Jamelia came off the phone and smiled over at Ruby, who had no idea who she was talking about. ‘Bill,’ Jamelia said. ‘They’re transferring him to a medical ward now.’ Then Ruby blinked as Jamelia continued. ‘It’s good you knew him. I listened too much to his family,’ Jamelia admitted. ‘They said this is how he got when he came off his medication…’
‘He still needed a proper work-up before he was referred to Psych,’ Cort broke in, neither judgmental nor angry, just matter-of-fact. ‘When a patient’s manic, they don’t always think to eat and drink properly,’ Cort said, ‘or they get grandiose and think they can survive on nothing, or, like Bill, start training for a marathon. You don’t just label someone as psych till you’ve done a full work-up.’
He didn’t labour the point, in fact no one did, they just spoke about it for a little while, and Sheila regaled them with a few stories from the past. For Ruby it was a revelation and she started to get the place a bit better. Saw that no one was blaming—instead they were teaching and learning.
‘Have you heard of clanging, Sheila?’ Siobhan said, adding about four sugars to her coffee. Ruby would have killed for a taste. It turned out Sheila hadn’t heard the term and they had a bit of fun explaining. Ruby started to see that you were allowed to not know things, you just had to be honest enough to admit it, and it wasn’t about scoring points or pulling rank, it was about a group of minds that, when pooled, were formidable.
And finally, when the emergency phone shrilled, whether it was the chamomile or she was just numb from the experience of Emergency, Ruby didn’t jolt on her stool when it went off.
If anyone seemed stressed, it was Sheila.
‘Yuk!’ Sheila put down the phone and pulled a face. ‘We’ve got a penetrating eye injury coming in…’ She gave a shudder. ‘Siobhan, you’ll have to deal with it.’ She glanced at Ruby, who couldn’t hide her surprise at Sheila’s reaction. ‘We’ve all got our things—even me,’ Sheila said. ‘Mine’s eyes. Can’t go near them.’
‘What’s yours, Siobhan?’ Sheila asked.
‘Dunno.’ Siobhan shrugged. ‘I guess old people.’
‘What?’ Sheila grinned. ‘You can’t go near them?’
‘No, they just get to me. Like that woman the other day, moaning about her child not being seen while I was sitting eating—she moaned loudly enough and got straight to the top of the queue and there was poor old Tom who’d been waiting to be stitched since we came on duty and because he’s old…’ She gave a shrug. ‘It just gets to me, I guess.’
Ruby blinked because, even if it had been handled, in Ruby’s eyes, poorly, there was a reason—a side to the hard-nosed Siobhan she had never seen. Even Cort looked up in surprise.
‘What about you, Cort?’ Siobhan asked. ‘And don’t say kids, because everyone has a thing when a sick kid’s brought in.’
He was about to shrug, to say nothing, to get up and walk outside and get some fresh air while they awaited the arrival of the ambulance, but then Cort realised that was what he always did. He closed up and walked off and just dealt with it in his own way, and it wasn’t perhaps the best way. He wanted to be part of the solution, wanted more of a team, and he realised that meant taking part on a level that he never had.
‘Prolonged resuscitations,’ he said. ‘I can’t stand them!’
‘You can’t, can you?’ Sheila did a double-take as realisation hit. ‘You get all worked up…comejack booting in and taking over.’
‘Yeah, well, I’m working on it,’ Cort said. ‘My wife was in a car accident, they worked on her for way too long, and she was left with an acquired brain injury…’
‘Your wife?’ Sheila’s face paled and Ruby just sat there quietly and could not have been more proud of him.
‘My late wife,’ Cort said, and then stood. ‘So, yes, I get a bit tense around them, but now you know why.’ He saw the flash of blue light come in through the dark window and although he’d missed his chance for fresh air, he was quietly relieved that he’d cleared the air inside a touch, ‘Let’s see how this guy is.’
It turned out eyes weren’t one of Ruby’s things.
Which meant she didn’t mind them.
She was able to talk to the patient and reassure him as Cort carefully assessed, and it was a too serious injury for a general hospital so Ruby sat and monitored him, because he was heavily sedated, as they
waited for an ambulance to transfer him to the eye hospital. ‘Where did you slip off to?’ Ruby grinned, walking back from the ambulance foyer as Sheila returned from taking the last patient to the ward. Connor had agreed to do the escort as Ruby had to get away on time and, anyway, as a student she wasn’t able to provide escort.
‘Has he gone?’ Sheila asked, and Ruby nodded.
‘Why don’t you go now?’ Sheila said. ‘It’s nearly seven—have your shower and you can be out of here on time.’
‘Are you sure?’
‘I think you’ve earned it.’
She smiled all the way to the locker rooms and chatted for a moment to some of the day staff that were dribbling in, but only when she tucked her hair into a shower cap and turned on the taps full blast did she let the tears flow, because that, Ruby had realised, was what this place did to her. It brought every carefully checked emotion right up to the surface, made her confront things, think of things, see things she’d really rather not—and even if the staff did annoy her, even if they were cliquey and rude, now she understood why. And she loved them, every bitchy, horrible one of them.
And now she had to go out there and say goodbye to them, and say goodbye to Cort too—so she cried, where no one could hear her, because it was certainly better out than in, especially as she had to go now and see her family, and heaven forbid she go there all knotty and tense.
Because then she might just say something, speak a little of her mind.
And, as she’d recently found out, that didn’t go down well.
Ruby dried and dressed in neutral clothes and brushed her hair till it was straight and shiny. She put on some neutral make-up and instead of putting on bangles and earrings she put her smile back on and headed back out there.
‘Where are you off to all dolled up?’ Sheila asked, and then looked again. ‘Or rather all dolled down?’
‘Church.’
Cort glanced up and though, of course, it was Ruby, it wasn’t.
She was in a neat brown skirt, with flat brown closed-toe sandals and a neat cream top. Her hair was down and brushed and she was neither prim nor plain. In fact, she looked gorgeous. The only way he could explain it was as if she’d been de-Ruby’d. And he could tell too, just as he had on the first night, that she’d been crying. It was almost indecipherable, she’d put on make-up and her glassy eyes could be from exhaustion, but he knew there was more to it than that.
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