The Doctor's Unexpected Proposal

by Alison Roberts

  And Jim, Emily thought as she moved after them. She wasn’t surprised he’d ‘run out of puff’ if he’d gone looking for his wife. He looked as though he could well be in some degree of heart failure or respiratory distress from other causes. There was a nasty grey tinge to his skin and Emily did not need a stethoscope to hear the harsh sounds his breathing was making.

  The girl in the bed looked even more taken aback to see the AMS crew arrive than her mother had, and it seemed to be more than an unwelcome surprise. It verged on being a last straw. There was no sense of the strength her parents gained from each other. Megan looked as though she didn’t have any desire to fight anything and Emily was struck by the air of hopelessness. She was, what, nineteen years old? It was far too young to have given up.

  Megan turned her face away from the strangers invading her bedroom. ‘I’m fine,’ she said tonelessly. ‘Go away. I told Dad not to call any doctors.’

  ‘You weren’t fine when I called,’ Jim reminded her. ‘You fainted, remember? And you’ve been shivering fit to bust on and off ever since, even in your sleep.’

  Mike crouched beside the girl. He reached out and touched his fingers to her cheek.

  ‘Hey.’

  The tone was so gentle, and the following silence so patient, that Megan slowly turned her head inch by inch until she could see the man who had spoken. Then she received one of his most charming smiles.

  ‘I’m Mike,’ he introduced himself. ‘You’re Megan, right? And you’re not feeling so flash at the moment, are you, sweetheart?’

  Emily could see that Megan was caught by Mike’s smile and the concerned expression that she would have to be seeing in those dark eyes. And who wouldn’t respond to that? What female on earth wouldn’t want to be made to feel special by having a man like Mike concerned about them?

  Megan nodded reluctantly.

  ‘Do you remember what happened when you got out of bed before?’

  ‘I…got a bit dizzy, that’s all.’

  ‘She hasn’t eaten anything for days,’ Honey put in. ‘I don’t think she even ate a hot dog at the rodeo and that was last Thursday.’ She was clutching Jim’s hand and they were both staring anxiously at their daughter.

  Mike laid his hand on Megan’s forehead and Emily knew exactly why the young girl closed her eyes as though the touch was comforting.

  ‘You’re running a bit of a temperature. What else is going on for you, Megan?’

  Emily unzipped the pack to locate a stethoscope and a blood-pressure cuff. ‘Is it OK if I take your blood pressure, Megan?’

  ‘I guess.’ The assent was grudging.

  Emily moved to the other side of the bed. She was happy to play a supporting role here. Mike was just as capable as she was of doing a patient assessment and he had already established far more rapport with Megan than she herself was likely to achieve. The teenager was still watching Mike as Emily wrapped the cuff around her upper arm.

  Megan was overweight and the cuff didn’t have much of an overlap so Emily had to hope the Velcro would stay fastened as she pumped up the pressure. Other impressions were also crowding in. The girl’s breathing was faster than it should be and so was her heart rate. Not surprising given her fever and not unexpected if this was a viral illness, but something was triggering a faint alarm bell for Emily.

  And for Mike, it appeared. He was frowning.

  ‘What about these stomach pains your dad said you were getting?’

  Emily could swear she heard a faint gasp from Honey but when she looked up her attention was caught by what she saw Jim holding in his free hand. A small red canister with a white pump nozzle on the top.

  ‘Do you get angina?’ she asked Jim. ‘Have you needed your spray tonight?’

  ‘I used it a while back.’

  ‘Do you have any chest pain at the moment?’

  ‘No. I’m fine. It’s Megan you need to worry about.’

  Emily turned back. ‘BP’s 95 on 50, Mike.’

  ‘Mmm.’ Mike had coaxed Megan into letting him examine her abdomen. Emily could see that even gentle pressure was causing considerable pain. The glance she caught from Mike made that alarm bell ring more clearly.

  ‘I’ll set up an IV,’ Emily said quietly. ‘We don’t want that blood pressure getting any lower.’

  ‘Tell me about these stomach pains.’ Mike encouraged Megan again. ‘When did they start?’

  ‘A few days ago.’

  ‘And have you had anything like this before?’

  ‘She’s always had painful periods,’ Honey offered quickly, with a swift, almost apologetic glance at her husband. ‘But they don’t usually make her sick. She’s just caught a bug at a bad time of the month, hasn’t she?’

  Mike’s attention was fixed on Megan. ‘So you’ve got your period at the moment?’

  A face that had already been flushed from fever seemed to lose colour and then go astonishingly red. Megan shot an agonised glance in her father’s direction and it was only when Jim muttered something about putting the kettle on and left the bedroom that she finally nodded with extreme reluctance.

  ‘Sorry, sweets, I know this is a bit personal but it could be important. Would you rather just talk to Emily?’

  Megan shook her head emphatically but Emily wasn’t offended. Given the choice, Mike would win as far as she was concerned as well.

  ‘OK. Do you use tampons?’

  Emily almost nodded at the line she could see Mike following. Septic shock from ill-advised tampon use was a real possibility here. Appendicitis was also amongst a raft of conditions that could produce severe abdominal symptoms. A ruptured ectopic pregnancy was unlikely to cause the fever but Emily was running through every possibility she could think of. She had a strong impression that they were missing something important.

  ‘Sharp scratch, Megan, I’m sorry.’ The cannula slid into a vein on the back of the girl’s hand and Emily secured the line and attached a bag of saline as Mike continued his examination and assessment.

  Emily held the bag of saline towards Honey. ‘Would you mind holding that for the moment, please?’

  ‘She’s really sick, isn’t she?’ They could all see that another shivering spell was gripping Megan. She had to stop answering Mike’s questions because her teeth were chattering hard enough to make speech impossible.

  ‘She’s certainly going to need to go into hospital,’ Emily said carefully. The anxiety levels around this place were quite high enough, without her adding too much. ‘Would you like to come in with her?’

  Honey opened her mouth, closed it again and then shook her head in distress. ‘I can’t! We can’t afford to have the cattle loose again.’ With a quick glance at her daughter she lowered her voice. ‘Jim can’t manage by himself and there’s been enough trouble…’

  Emily remembered Wetherby Downs’ station manager’s disgust at the state of the shared fence line between the properties. And she remembered something else. A comment about ‘one of the lads’. She also threw a quick glance in Megan’s direction. Wayne had implied that the ‘trouble’ had been some time ago. Around Christmas, which was eight months ago now. Too long for a ruptured ectopic pregnancy to cause the current symptoms. But what about a miscarriage? Maybe Megan’s relationship was ongoing. The girl’s weight was certainly enough to easily conceal a pregnancy for some time.

  If her parents were unaware of the possibility then perhaps Megan had reason to want it kept confidential. Perhaps taking her to the hospital unaccompanied by any family members would actually be preferable.

  Except that Jim clearly needed some kind of evaluation himself. Mike had had the same thought. He approached Megan’s father after she was settled on the stretcher in the back of the helicopter, having been carried there, single-handedly and rather heroically in Emily’s opinion, by Mike.

  ‘When did you last see a doctor, Jim?’ he queried casually.

  ‘He won’t.’ Honey ignored the warning look from her husband. ‘It’s too far for us
to try and get into town and the only clinic in the area is held at Gunyamurra.’

  That was very close to Wetherby Downs and the station’s population would provide the majority of any patients. The short silence spoke volumes about bad blood between neighbours. Emily broke the uncomfortable pause.

  ‘Maybe you’ll be able to get in to bring Megan home,’ she suggested. ‘It would be easy to set up an appointment to suit. We’ve got a really good cardiologist who’s just joined the staff and I could help by—’

  ‘We don’t need your help,’ Jim interrupted gruffly. ‘I’m fine. We can manage by ourselves, thanks. Just look after Megan for us, eh?’

  Monitoring the sick teenager kept Emily too occupied to worry about being airborne again in a craft that lacked wings. Her faith in Mike’s ability to get them all back to base safely was absolute, and working with a patient in a helicopter was not so different to being in a fixed-wing aircraft. She still had to deal with engine noise while trying to talk to her patient or listen to breath sounds or get a blood-pressure reading, and to cope with unexpected fluctuations in her balance while reaching for equipment or trying to record observations on the patient record chart.

  The first litre of fluid had run through with no improvement in blood pressure. Emily started another bag of normal saline and took another set of vital sign measurements. Megan’s heart and respiration rates were way above normal and her temperature was 39.6 degrees Centigrade, which was worryingly high.

  Conversation proved difficult and not just because of the engine noise. Megan seemed even more miserable and withdrawn, possibly because Mike was no longer there to coax or charm. Emily did her best to keep her comfortable and maintained a cheerful, reassuring manner, but trying to win the girl’s confidence and talk to her properly might have to wait until she didn’t have to shout. And when they had more diagnostic tools and tests for assistance.

  Charles was waiting in the emergency department of Crocodile Creek Base Hospital as Mike and Emily rolled the stretcher through the doors. Jill Shaw, their director of nursing, stood beside his chair.

  ‘I’ve set up the resuscitation area,’ she told Emily. ‘Charles offered to stay so I’ve held off calling any other staff in, but they’re only over at the house.’ She smiled. ‘Apart from Cal and Gina, that is. I think they’re still sitting on the beach somewhere.’

  ‘I’ll stick around,’ Mike offered. ‘I could be useful.’ Mike’s strength was vital, in fact, as they transferred Megan from the stretcher to the bed. The girl’s level of consciousness appeared to have dropped and she groaned loudly and rolled her head from side to side but said nothing in response to Jill’s greeting as the nurse readjusted her oxygen mask and started to remove clothing to change her into a hospital gown.

  Charles raised an eyebrow questioningly at Emily.

  ‘I think we can rule out meningitis,’ Emily told him, ‘and her chest is clear. It’s more than a viral illness, though. Something’s going on abdominally and I’m worried about sepsis. We need to rule out peritonitis or maybe pyelonephritis or pancreatitis. Or possibly an incomplete miscarriage.’

  Both of the rather bushy eyebrows that topped Charles’s craggy features rose at the last suggestion.

  ‘Plan of action?’

  ‘I’ll get bloods for chemistries. A complete count and coagulation studies from two separate sites. We’ll get a catheter in, get an analysis, do a pregnancy test and start monitoring urine output. I’ll do a pelvic exam and an ultrasound.’ She glanced at the monitor above Megan’s bed which was settling to give continuous readings of her ECG, blood pressure and pulse oximetry. ‘I want to get her blood pressure up a bit as well. I’ll start a dopamine infusion. And we’ll get her on full antibiotic cover as soon as we’ve taken the first bloods.’

  ‘I can take care of the samples,’ Charles offered. ‘I know my way round a few of those machines in the lab and I’m sure Alix won’t mind if we don’t haul her in at this time of night.’

  Megan muttered incoherently and groaned frequently as Mike helped Emily collect the blood samples required. Jill was charting a new set of vital signs and looked up as the tympanic thermometer beeped.

  ‘Temp’s up to 40.2.’

  Emily nodded. ‘We’ll need to cool her down.’ The blood pressure showing on the monitor was also a concern, having dropped a little to 90 over 45. ‘I’ll get that dopamine infusion started.’

  Within twenty minutes the medical care Megan was receiving seemed to be helping. Her level of consciousness improved with a drug-induced rise in blood pressure and reduction in her body temperature, and by the time Emily was ready to do a pelvic examination Megan was alert and orientated. She understood Emily’s explanation of what she was about to do.

  And she was not happy about it.

  ‘Why do you want to do that?’

  ‘I’m concerned about your bleeding,’ Emily said carefully. ‘It doesn’t seem quite like a normal period.’ Which was an understatement. The pad Jill removed in preparation for the necessary urinary catheter looked, and smelt, very abnormal.

  Megan stared at her doctor. ‘What if I refuse? I can refuse, can’t I?’

  ‘I’m only trying to help you, Megan.’ Emily hesitated then took a steadying breath. She really needed some answers here. ‘Is there something worrying you, Megan?’ she asked gently. She took hold of her patient’s hand. ‘Are you—or have you been—pregnant?’

  ‘No!’

  Emily stayed still for a moment, maintaining eye contact. Offering what she hoped was a sympathetic and nonjudgmental ear. Jill was quietly busy, noting observations on the chart in a corner of the room. Mike had taken the blood samples to the lab where Charles was getting set up to do the analyses.

  But Megan looked away. ‘I’m not pregnant,’ she told Emily. ‘And I don’t need any internal examination. I’ve just got the flu.’

  ‘Having flu wouldn’t be giving you such a sore tummy,’ Emily said patiently. ‘We need to find out what’s making you this sick, Megan. If it’s something like your appendix, then it’s possible you may need an operation.’

  ‘Is that what you think it is?’ Megan sounded almost hopeful. ‘My appendix?’

  ‘We won’t know unless you let me do what I need to do. I know it’s not pleasant, Megan, but I’ll be as quick and as gentle as I can be.’

  This time Megan nodded and she stayed co-operative as Emily put gloves on and got Jill to assist in positioning Megan. The older nurse moved to hold Megan’s hand reassuringly.

  Emily was careful. And thorough. And very surprised. She caught Jill’s gaze and the older nurse blinked. Megan stared at Jill. Then her gaze flicked to Emily who tried to keep both her face and tone very calm.

  ‘Jill, can you take these swabs through to Charles and see what’s happening with the blood samples?’

  Jill eyed her curiously but nodded. ‘Of course.’

  ‘I’m feeling better now,’ Megan announced as Jill left the room.

  ‘That’s great.’ Emily smiled. ‘We’ll have to make sure you keep getting better.’

  ‘I’m really thirsty.’ Megan was staring at Emily with unnerving intensity. Had she guessed what Emily was thinking?

  ‘We can’t give you anything to drink just yet, I’m sorry—just in case you need to go to Theatre. Not until we’re sure of our diagnosis.’ Emily was sure now. All she needed was a minute to collect her thoughts and decide how to handle the new information she had.

  ‘I need to go to the toilet.’

  ‘I’ll find you a bedpan.’

  ‘Ew!’ Megan looked disgusted. ‘But I feel fine. Why can’t I use a proper toilet?’

  ‘You might not feel so good if you try standing up. And we need to do some tests on your urine in any case. Can’t you wait just a minute or two? I don’t want to leave you alone to go and get a pan.’

  ‘No. I’m busting.’

  Emily scanned the monitors. Everything was stable, and looking better than it had. She nodded reluct
antly. ‘OK. Just rest there, Megan,’ she instructed. ‘I’ll be back in just a second.’

  ‘Where are you going?’

  ‘To the sluice room.’ Emily hesitated. ‘Do you want me to wait until Jill comes back? Or find another nurse to sit with you?’

  ‘No, I told you—I’m busting!’

  Emily’s path back from the sluice room intersected with that of Mike as he came back into the department.

  ‘Results will be through in another few minutes,’ he told her. Then he peered at Emily’s face. ‘What’s up, Em? Is it Megan?’

  She nodded. ‘I’ve just done a pelvic exam. I know what’s wrong with her.’

  Mike was still studying Emily’s expression. ‘She’s had a miscarriage?’

  ‘No.’ Emily had used the last minute or so to assimilate the most recent information she had gathered on her patient. ‘I think she’s given birth. Very recently.’

  Mike whistled silently. ‘Like…in the last few days?’

  Emily nodded again. Very slowly. ‘She’s got a perineal tear that’s just starting to heal. The only likely explanation for that is giving birth—to at least a close to full-term baby.’

  ‘And Megan was at the rodeo on Thursday. Her mother said she hadn’t eaten any hot dogs.’

  Emily’s nod was excited this time.

  ‘Which would make it entirely possible that Megan is—’

  ‘Lucky’s mother,’ Emily breathed. ‘Oh, Mike!’ She held onto Mike’s gaze. ‘Do you know what this means?’

  ‘That she might be septic from a fragment of retained placenta?’

  ‘Yes, but…’ It was almost too much to get her head around. Emily could so easily imagine what it would have been like if she’d been told her baby wasn’t dead after all. Megan must think she’d lost her infant. Gina—the doctor who had discovered Lucky behind the bushes at the rodeo—had been convinced that the mother would have believed it to be a stillbirth.

  ‘Should we tell her now?’

  ‘Has she said anything about being pregnant?’