‘That’s little boys for you,’ Maddy agreed. ‘You just have to be there with them all the time.’ She turned and said to Ed, ‘This is Mrs Cowley and her son Robbie. I’ve seen quite a bit of young Robbie.’ She twinkled at the little boy. ‘He’s been a regular customer—that devil on his T-shirt says it all.’
‘I’m a pirate now, not a devil,’ Robbie shouted. ‘What nasty stuff on you? I’ll hit it with my cutlass.’
Ed stopped a cutlass swing with his arm, and crouched down to face Robbie. ‘That’s a fine weapon you have there, Captain,’ he said, ‘and a fine hat, too. What’s the name of your ship?’
‘The Hisp…the Hisp thingy,’ Robbie said. ‘After Nurse Maddy had bandaged up my arm she read me a bit about it. It was good!’
‘She’s a good reader. I’ll get her to read to me. Now, you will be careful with that deadly weapon, won’t you?’
Maddy watched curiously. Ed had work to do but from his body language it was obvious that he was clearly taken with the little boy. There was regret in the way he straightened himself, became a doctor again.
‘I’m going to capture a ship,’ Robbie told him. ‘One of those white ones on the top deck.’
‘I wish you luck. A pirate’s life is a hard one.’
There was time for a few polite words with Mrs Cowley and then they moved back to the medical centre. ‘You seemed to quite take to Robbie,’ Maddy suggested.
‘Typical little boy. I like them.’ A clipped reply. ‘Is his father on board?’
‘There is no father. And Mrs Cowley has just been diagnosed with adult-onset diabetes. She has the pills, she knows—or she should know—how to control her diet. But she relapses. I’ve kept an eye on her, tried to get her to discipline herself. But if you like eating then a cruise ship is the last thing you want to be on.’
‘So Mrs Cowley has spent quite some time resting in her cabin? And Robbie has been allowed to run riot?’
‘There are two big children’s play grounds and staff always on duty. But no way can they keep track of every child. Robbie was trying to climb onto a lifeboat but he fell and gashed his arm. Before that he tumbled down some stairs and trapped his fingers in a door.’
‘But a cheerful child?’
‘He’s lovely,’ Maddy agreed.
There was a message from the captain waiting for them when they got back to the medical centre. The storm had got worse and the forecast was that over the next twelve hours it would get worse still. It would be extremely difficult, probably impossible, to try to move ill people from the ship to land. A helicopter landing was out of the question, a boat trip would be highly dangerous.
‘I don’t think we want to start moving old sick people anyway,’ Nick said, ‘but we’ll have to decide if it’s necessary. What do you think, Maddy, Ed?’
Maddy was pleased that she was included in the decision-making. But she decided to remain silent for a while. Perhaps she was too close to the problem.
‘It’s gastroenteritis all right,’ Ed said, ‘but it’s a very nasty strain. I still suspect it’s bacterial in origin.’
Nick shook his head. ‘We can’t be certain until I’ve done tests,’ he said. ‘I’ve collected samples, and we’ll know more when I’ve been inside the lab for a while.’
He looked at his son, a glance half compassionate, half assessing, Maddy thought. There was something here that she didn’t know about. And she wanted to know what.
‘We’re agreed that Maddy needs help—that one of us should stay aboard?’
‘We’re agreed. There’s just too much work for one person. And I’m the obvious one to stay.’
‘Are you sure you’ll be all right?’ Nick asked.
‘I’ll be fine.’
Another silence. Maddy wondered what was happening. There seemed to be some silent exchange of messages between the two men. She could read it in their body language. Nick was relaxed, trying to be helpful. Ed had the taut look of a man who was expecting an argument. Finally Nick said, ‘Right, then. Still, remember, a good doctor will ask for help if he needs it. Now I’m going to see the captain, explain the situation and tell him what we think it’s best to do. Then the final decision will be his. But unless he objects, Ed, you stay, do what you can, and remember that the next twelve to twenty-four hours will be the hardest.’
‘I’ve dealt with that before,’ Ed said.
‘Good. Oh, the patients I’ve just seen, there’s one, a Mr Simmonds. He’s got gastroenteritis all right and I’ve given him a thorough examination—he’s an old man but there’s nothing seriously wrong with him. Nothing physical, that is.’
‘But mentally?’ Ed asked.
‘Well, I noticed he’s on antidepressants—mild ones. When I asked him about them he said they did little good, he’d stopped taking them and he felt better. But… I’ve got a feeling about the man.’
Ed shook his head. ‘I’ll keep an eye on him,’ he said, ‘but I suspect there’ll be nothing we can do. We just have to hope.’
‘Sometimes that’s all a doctor can do,’ his father said. Then he turned to Maddy. ‘Been good to see you, Maddy. Hope you and Ed get on well together. I’ve every confidence in the pair of you.’ And then he was gone.
Maddy and Ed looked at each other. ‘This morning we didn’t even know the other one existed,’ Maddy said hesitantly, ‘and now we’re thrown together like this.’
‘Strange, how things happen. But I’m looking forward to working with you. Getting to know you better.’
That was a statement that could be taken more than one way, Maddy thought. But as they looked at each other he didn’t say anything more. There seemed to be some kind of understanding flowing between them that, just for the moment, didn’t need words. His blue eyes stared at her. She could see puzzlement there, as if he didn’t really know what he was feeling. But finally he jerked them back into the present.
‘Let’s get started,’ he said. ‘Now, are there any scrubs I could borrow?’
She pointed to a cupboard. ‘One thing about being on a cruise ship, the laundry is done fast and well.’
‘It’s going to need to be that way,’ Ed said. ‘During a gastroenteritis outbreak, cleanliness is all important. Now we need to see what resources we—’
The phone rang. Maddy picked up the receiver, listened for a moment. ‘Cabin B52? We’ll be right there.’ She looked at Ed. ‘Another case. It’s going to be like this non-stop now, isn’t it?’
‘It is. And there’s your regular work, too.’ He smiled again. ‘But we’ll manage together.’
He decided to change into scrubs before they set off. When he came back in the green shapeless garments she noticed the muscles on his forearms. And she noticed something else. He was wearing a wedding ring.
For some reason she was disappointed, which was silly. She should have known. A good-looking man like Ed would obviously be married. He would have been snapped up years ago. What was she thinking of? Anyway, she was off men. It was foolish on her part, harbouring even the smallest feeling for him. They were just colleagues for a while.
They went to Cabin B52 and examined the patient—a man this time. There was the usual initial assessment. A high temperature suggested bacterial infection rather than viral. Hypotension—low blood pressure—was another indicator. There would be tachycardia—a fast pulse, and often it would be thready. The most obvious signs were of dehydration. A dry mouth, no tears, skin that tented when it was pinched, poor capillary return, tested by pinching the fingernails. There would be mild discomfort to the abdomen—but it didn’t get worse when palpated. Either she or Ed would take a blood sample and test it in the medical centre.
And there was always the chance that it could be some other condition. It would be foolish to assume that any illness was automatically gastroenteritis.
To avoid dehydration each patient had to be given a saline and dextrose IV line. The amount given depended on physical state, body weight and the blood count. Since Ed had deci
ded that this was a bacterial infection, not a viral one, antibiotics could be used. But the kind and the amount and the frequency depended on the patient’s state. And the seriousness of the attack. Some people were more susceptible than others.
As before, after this assessment Ed spoke to the man’s partner and told her what to expect, what to do. Again, as before, Maddy was impressed by the clear way he spoke, by the manner in which he made it clear that he expected his suggestions to be carried out. The passengers certainly seemed calmed by him.
But Maddy still felt a little unsettled. Working with Ed was not as satisfying as it had been before.
As they walked back to the medical centre she asked, as casually as she could, ‘Ed, will your wife mind you being away for a while?’
‘Why do you think I have a wife?’ The question was abrupt, hostile even.
‘Well, it’s just that I saw you were wearing a wedding ring. I’m sorry if I upset you.’
‘You didn’t upset me.’ But his tone contradicted his words. ‘My wife is dead.’
She wondered if he was going to say any more, then wondered if she ought to say she was sorry again. But he said nothing, pacing more quickly down the corridor so she had to hurry to keep up with him.
Obviously she had upset him. She wondered if all relationships had to result in pain.
When they got back to the medical centre Ed became his normal efficient self again. ‘We know the situation is going to deteriorate,’ he said, ‘and we need to get on top of it now. I’d like to check on all supplies. If necessary, we might have to get in some more. Somehow.’
‘I’ll write out an inventory of the most needed drugs,’ Maddy said, ‘we can mark them off as we use them, so we know when we’re getting low.’
‘Good idea. And shall we have a list of the stewards we can call on and work out a rota? If you want to pencil in any personal comments, I’ll see them but they’ll go no further.’
‘You’ve done this kind of thing before, haven’t you?’ she asked.
‘I have.’
She noticed he didn’t give her any details. For a moment there was a hunted look on his face, as if there was a painful memory. But when he spoke he was as clear and forceful as ever. ‘What’s very useful is to have a wall chart, marking off each patient we have, the stage of development of the illness, the treatment. It’s important that we can see at a glance just what the situation is. A set of patient’s notes that you have to page through just isn’t good enough.’ He thought for a moment. ‘In fact, could we have a steward or someone in here to act as ward secretary?’
‘I’ll phone the captain, see if he can find someone for us. I’m sure he will.’
‘Good. Is there anything special that you—?’
The phone rang again. This tine it was Ed who answered it, who took the number of the cabin and then said, ‘I’ll be right there.’
He looked at Maddy. ‘Looks like another case. I’ll take this one on my own—you’ve got plenty to do here organising the logistics of this operation. I’ll be back to liaise as soon as I can.’
Back to liaise? Maddy thought as soon as he had gone. Had she joined the army without knowing it? Then she realised. Everything Ed had done made perfect sense. This was an emergency and he was treating it as such. He was concerned about the welfare of his patients. Then she remembered something else. There had been a set expression on his face as he’d talked about the organisation necessary. As if this was—or had been—painful. What was he hiding?
She had finished the paperwork when he returned and told him that the captain was sending them down a purser’s assistant to act as ward clerk. He nodded approvingly. ‘I hate paperwork,’ he said, ‘but I know it’s vital to keep it up. Now we can concentrate on the important work. Maddy, did you tell me that you thought that one of your patients had a TIA this morning?’
She nodded. ‘Mr Bryce. I got a steward to keep an eye on him, but I’d like to go and see him myself.’
‘Let’s go together. Are the case notes handy?’
He scanned the notes and she saw him frown. ‘If we were on shore, I’d send this man to hospital,’ he said.
‘So would I. But this morning I thought that shipping him ashore might be more of a risk than keeping him in his bed. That was when I thought that we’d dock tomorrow. And now, with the disease and the storm, it’s impossible.’
‘You still made the right decision. Let’s go and look at him.’
So they went. And it was obvious that Mr Bryce was a very sick man indeed. Now his speech was slurred, he was much weaker. Maddy watched helplessly as Ed listened to Mr Bryce’s heart, took his blood pressure, talked gently to him.
‘You’ve enjoyed the cruise, then, Mr Bryce? Thinking of coming back on another one?’
‘If I’m alive, yes.’ Maddy saw a tiny smile on her friend’s face. ‘And if Maddy there is on the ship.’
‘Maddy is a star. I’ve only just met her but I can tell that.’
‘That’s a nice thing to say. Yes, Maddy is a star.’ Mr Bryce’s eyes closed.
Ed changed Maddy’s prescription of aspirin for war-farin—a much more effective anti-coagulant. Then he shook Mr Bryce’s hand and told him that they’d be back to see him.
‘How is he?’ Maddy asked, knowing and dreading what the answer would be.
‘He’s an old man and I think there’s a danger of a stroke,’ Ed said. ‘But, Maddy, no one can tell. He has a fighting chance and he looks like a fighter. Was he a particular friend of yours?’
‘Sort of,’ Maddy said. ‘I’ve seen a lot of him. Ed, you were kind to him.’
‘I try to be kind to all my patients,’ he said. ‘When it’s possible.’
After that cases came in with predictable regularity. Ed saw each one first, made an initial diagnosis—which was usually not difficult. More difficult was assessing the seriousness of the attack and deciding on the medication. This was a task Maddy was pleased to hand over. After Ed’s initial visit, Maddy took over the nursing duties.
Here again, things weren’t as normal. Ed had to warn her. ‘Maddy, this is an emergency, you can’t give each patient the time you would in a normal nursing situation. You’re a specialist and you must learn to delegate. Whatever a steward can do, get him or her to do it. You’re needed for the special nursing jobs.’
She didn’t like what she had to do, leaving patients who needed and wanted her skills. Needed her care. But she knew that Ed’s apparent ruthlessness made sense.
As the day wore on the situation got worse. More and more people were falling ill. The captain came down to see them. He said, ‘I’m not going to stay, not going to interfere. Whatever you need, just ask for it. If it’s available, you can have it.’ And he was gone.
‘Good man, the captain,’ was Ed’s remark.
They were coping—just. But they knew that they’d have to be up all night. ‘Don’t worry,’ Ed told her, ‘whatever happens, we’ll manage. We’ll manage because we’re a team, we’re working together.’
She liked him for this. She wasn’t exactly enjoying herself—but Ed made her feel as if her work was worthwhile, he gave her a sense of purpose. She liked working with him.
They worked together until the evening. Maddy was sitting in the medical centre, checking over the supplies. Ed had gone what he called wandering. ‘Just ambling about, dropping in here and there,’ he said. ‘Getting the feel of things.’
Then after fifteen minutes, she was buzzed. ‘Hi, Maddy, Ed here.’ It had only been ten minutes since she had seen him. But she was surprised at how welcome his voice was. What was happening to her? Then she recognised the tone of his voice, quiet, regretful. This wasn’t good news.
‘Who is it, Ed?’
‘It’s Mr Bryce. He’s…very ill but he’s asking for you.’
‘Mr Bryce?’ An old man but the one true friend she had made on the voyage. ‘How is he, Ed?’
There was a hesitation, then the usual careful doctor-speak. �
��He’s very ill, very weak. There’s nothing more we can do for him. But he’s lucid—now.’
Maddy got the message. Her friend Malcolm Bryce was dying. She had managed to visit him twice that day, though if she had not been so busy she would have stayed with him much longer. But she just hadn’t had time! And now he was dying. Maddy bit her lip, trying to stop the tears squeezing from beneath her lids. Why did it have to happen to her friend?
‘All right if I come to see him?’
Ed understood what she was asking. ‘Of course. If you’d like to stay with him a while, I have other things to do.’
‘I’m on my way.’
She only needed one glance at Malcolm to know that he didn’t have very long. To a trained nurse the signs were obvious. But he was still awake, he recognised her and smiled when she took his hand.
‘Something to say to you, Maddy,’ he managed to whisper. ‘I don’t think I’ll have the chance again. When I asked you to marry me—I know it was a joke, but I half meant it.’
She smiled sadly at the old man. ‘I told you, Malcolm, just now I don’t want to get married. But if I did, you’d be the man I’d pick.’
‘I don’t think I can wait. But if I’d been forty years younger then I would have waited. But, Maddy, you’ll make some other man very happy.’
‘Perhaps,’ she replied, and squeezed his hand. Then she watched as his eyes closed and he lapsed into unconsciousness. She knew he wouldn’t open them again.
She was tired, she needed to go to bed. But Malcolm had been her friend, she did not want him to die alone. So she sat in a chair and listened to his laboured breathing. The nicest man she had met in a long time—and he was going to die. She couldn’t help it. Silently, the tears came.
It didn’t come as a shock when there was a quiet tap on the door, and Ed came in. He said nothing, glanced at Mr Bryce then raised his eyebrows at her. She shook her head. Nothing could be done. But he was still a doctor, he made a quick but gentle examination—and apparently agreed with her.
Nurse Bride, Bayside Wedding Page 4
