‘Day staff will be here soon. And Hamish is coming back when he’s had a few hours’ sleep. I’ll get my head down for an hour or two then.’
‘In that case, how ’bout a coffee?’
‘Hmm.’ The small staff kitchen and sitting room was only a few steps away. Another swift survey of all the monitors showed that nothing had changed in the last ten minutes, and Megan’s nurse nodded encouragingly.
‘Go on,’ she said. ‘I’ll call you if anything changes.’ ‘OK.’ Emily rubbed at her eyes, which felt as though they were full of grit, and then she gave Mike a weary smile. ‘It’s a good idea. Might even be essential.’
Mike made the coffee. Hot and strong and sweet. He put the steaming mug in front of Emily as she sat down at one end of a small Formica-topped table.
‘I know you don’t normally have sugar in your coffee but I thought you might need a bit of a boost.’
‘Thanks, Mike.’ Emily watched as he took the chair on the side of the table closest to her. ‘You’re wonderful, you know that?’
‘You’re pretty amazing yourself, Dr Morgan. I’ve been watching you work ever since we found Megan. If anybody’s going to pull her through this, it’ll be you.’
‘I have to pull her through.’ Emily sighed. ‘There’s a baby not very far from here that needs his mother.’
‘Don’t push yourself too hard. You’re a human, not a machine.’
Emily pulled a face. ‘I know. And I should apologise. I’ve made my weaknesses fairly obvious tonight, haven’t I?’
‘What are you talking about?’
‘I’ve been a mess. I’ve lost count of the number of times I’ve been crying on your shoulder since you came to find out why I wasn’t at the party.’
‘Twice,’ Mike said with a smile. ‘But you were only really crying once.’
‘You’ve hugged me more than twice.’
‘Have I?’ Mike sounded cautious. ‘Is that a problem?’
Emily felt suddenly shy and dropped her gaze to her mug of coffee. ‘No, of course not. You’re the best friend I’ve got, Mike, and I really appreciate your support.’
‘It’s always there for you, Em.’
‘Thanks. And ditto, you know? For when you might need it.’ Emily raised her gaze and smiled. ‘We should really have thrown some dice, shouldn’t we? To see who went first in the “ego-boosting after being dumped” game.’
‘I needed the practice,’ Mike said. ‘I get dumped a lot more than you do.’
‘Only because you keep trying. I’m not brave enough to risk it very often.’ Exhaustion was loosening Emily’s tongue. ‘I think I might be a once-in-a-decade kind of girl.’
‘You mean it’s been ten years since you were last in a serious relationship?’
‘Yeah. How sad is that?’
‘You would have still been in medical school. How old were you?’
‘Twenty-two.’
‘A baby,’ Mike stated. ‘That’s only practising for the real thing.’
‘It didn’t feel like a practice run. We were engaged. I’d picked out my wedding dress and everything.’
‘What happened?’
‘Too much,’ Emily said evasively. Her tongue hadn’t been loosened to the extent of burdening Mike with all the sorry details. How galling would it be to have to admit that her planned marriage had simply been an obligation her fiancé had felt he couldn’t dodge? ‘Bottom line was that he left me for someone else.’ She snorted wryly. And who says history doesn’t repeat itself?’
‘Who was he?’
‘A house surgeon on one of the runs I was doing. Cameron, his name was.’
‘He was another bloody idiot,’ Mike said calmly. ‘For God’s sake, Em—you’ve got to learn to choose more carefully.’
‘I don’t want to,’ Emily said decisively. ‘I think I’ll just accept my lack of ability in that department. I think I’ll stay single.’
‘What? For ever?’ Mike sounded so horrified that Emily had to smile.
‘It’s not a curse, Mike. There are plenty of very happy, fulfilled women out there that are single by choice.’
‘But…what if someone turns up who’s wearing that badge? And it starts glowing?’
‘I don’t think that’s likely to happen. Maybe I’m sick of looking. Maybe I’ll just take my badge off and throw it up on top of my wardrobe.’
‘You can’t do that.’ Mike shook his head firmly. ‘Besides, it wouldn’t make any difference.’
‘Why not?’ For some inexplicable reason, Emily felt her heart rate quicken. The extra oxygen in her system had to be responsible for that weird tingling in her feet and hands. Mike had that unshuttered look again. As though he wanted Emily to see something genuine. Or that he was about to say something very personal. And he did.
‘Because I’d know it was there. I’d still be able to see it.’
There was no chance Emily could break the eye contact they had right now. No chance at all. It hadn’t been her imagination that had conjured up the signals she’d received over the course of this long, tense night.
Given the emotional climate of both the events surrounding Megan and their current personal situations, could she put any faith in what she guessed Mike was about to tell her?
Mike was just as tired as she was and when you got this exhausted it was a bit like being drunk. You could think things and even say things that would seem just plain ridiculous by the cold sober light of the next day. She could avoid any embarrassment for them both here. Pretend she hadn’t picked up any signals and brush them away.
If Mike was serious, he’d try again.
But maybe he wouldn’t. Maybe they had both needed to be pushed over the edge in an emotional arena to see what had been there all along. What was a little embarrassment to risk if that wasn’t the case?
Emily barely moved her lips and she spoke very, very softly.
‘Is it…glowing?’
Mike opened his mouth to answer. The door to the staff-room opened at precisely the same moment. The faint sound of an electronic alarm could be heard beeping from behind Megan’s nurse.
‘Emily? Sorry, but we need you.’
CHAPTER FIVE
MONDAY-ITIS struck with a vengeance.
Catching more than just a few hours’ sleep would have helped but Emily knew there was no point trying. Her time as an ICU registrar in a big city hospital had given her the ability to switch off the instant her head hit the pillow, but she had also learned that if she woke up and was immediately focused completely on a particular patient, there was no way she could turn over and go back to sleep.
Not that Dr Morgan would have the chance for more than a flying visit to the intensive care unit, despite a delayed start time for the usual Monday morning theatre list. Her position as an anaesthetist meant juggling her duties in Theatre with those in the unit—a system that normally worked very well. But, then, Emily did not normally feel such an involvement with her patients. The case of Megan and the baby she didn’t know she still had was pushing everything else well into the background and making the routine business of elective surgery seem almost a chore.
Not quite everything else was being pushed into the background, however. Emily was well aware, as she inhaled the wonderful scent from the frangipani on her way through the Agnes Wetherby memorial garden, that she would be feeling a great deal worse right now if she wasn’t being energised by a rather delicious level of anticipation.
Mike had gone by the time the problem triggering one of Megan’s alarms had been dealt with. Emily had heard the rescue helicopter taking off as she’d adjusted, yet again, the settings on the ventilator and had run off a new barrage of checks. She hadn’t heard it return, presumably because she had been asleep by then.
Crocodile Creek Base Hospital’s theatre suite was on the same level as the intensive care unit, so Emily made the theatre admissions area her first stop. A plump, fair woman in her mid-forties was the only patient present and a nurse w
as holding her hand. There was evidence of recent tears in the collection of scrunched-up tissues on the bed.
‘Hey, Sonia.’ Emily smiled at the patient. ‘How are you feeling?’
‘Scared stiff.’
‘You’re going to be fine.’ Sonia was first on the list for the day and about to have her gall bladder removed after years of suffering the pain of chronic cholecystitis. ‘We’re going to take very good care of you.’
Emily caught the gaze of the senior theatre nurse on duty and moved to speak to her. ‘Has Sonia had her pre-med?’
She checked the chart and nodded. ‘Temazepam. Thirty milligrams.’
‘How long ago?’
‘Thirty minutes.’
‘Should kick in pretty soon, then.’ Emily had spent some time with Sonia the previous day, doing a pre-anaesthetic check and doling out a large amount of reassurance. ‘She has been very anxious. Let me know if she’s not a lot happier in the next fifteen minutes and I’ll give her something more, IV. I’m just going to duck into ICU for a couple of minutes.’
The nurse nodded. ‘How’s the girl from last night doing?’
‘That’s what I want to find out.’
With another reassuring smile and word for Sonia, Emily moved briskly down the corridor. Her heart sank when she saw that Hamish was not alone. Cal was there as well. And Gina. The young doctors were all staring at a set of chest X-rays illuminated on the wall of the central station and they were all looking decidedly grim.
‘What’s up?’
But one glance at the X-rays told Emily exactly what the concern was. Widespread, diffuse opacification made the film look cloudy. Both Megan’s lungs were filling with fluid. ARDS. Adult respiratory distress syndrome—‘shock lung’. Whatever you called it, it was a disappointing if hardly unexpected development.
Emily raised her eyebrows at her colleagues. ‘Pulmonary function parameters?’
All deteriorating.’
‘Damn.’ Emily leaned over the desk and rapidly scanned printouts. She checked her patient swiftly, listening to the fine crackly noises over both lung fields, and she took another blood-gas sample to get an accurate current reading. Then she set about adjusting what she could to try and improve the situation in consultation with the other doctors.
‘We’ll increase the frusemide dose and try and get rid of some of that extravascular lung water.’
Cal charted the new dosage.
‘Make sure you do frequent postural changes for Megan,’ she reminded the nursing staff. ‘And keep right on top of any suction required.’
‘We’ll need to start physiotherapy, too,’ Hamish put in. ‘For secretion management.’
Emily nodded but she was already concentrating on the ventilator machine and wanted to discuss settings. ‘We’ll increase the tidal volume,’ she decided eventually. ‘And the PEEP level.’
‘Do you want to increase the level of oxygen?’
‘Not yet.’ Emily shook her head warily. ‘I really don’t want to go over 60 per cent unless we have to. It would be good to avoid the complications of oxygen toxicity on top of everything else we have going on here.’ She turned to Gina. ‘Are you happy with her rhythm at the moment? She’s throwing off the odd ectopic, isn’t she?’
‘I’m happy,’ Gina said. ‘But I’ll be keeping a close eye on her today.’
‘Great.’
Cal was signalling Emily. ‘Time we got started next door, Em.’
‘OK.’ Emily scribbled some final orders on Megan’s chart. ‘I’ll be back between patients,’ she told the nursing staff.
‘I’ll be here,’ Hamish said. ‘Don’t fret.’
‘I’m not…It’s just…’ Emily turned back for one more look at Megan.
A white face against a white pillow, with the intrusion of tubes in her mouth and nose. Arms and hands that lay limp on a white sheet with more fine tubes in situ.
Could they win this battle?
They had to. And, as Mike had pointed out, they’d got her this far. As long as they—
‘Emily!’
‘Coming, Cal.’ She skipped a step or two to catch up the surgeon. ‘Sorry.’
‘Bit full on today, isn’t it?’
‘Mmm. I’d like to clone myself at times like this. One of me could do the routine stuff in Theatre and the other one could stay in ICU.’ Emily looked back over her shoulder and frowned as a new thought occurred to her. ‘There’s no new patients. Do you know what Mike flew off to in the middle of the night?’
Cal nodded. ‘Hamish said he popped back up to ICU when he got back.’ The look Cal gave Emily was almost amused. ‘He thought you might still be up.’
‘Oh?’ Emily tried to sound casual but it was difficult. Had Mike come looking for her with the intention of continuing their interrupted conversation? She ignored the erratic thump of her pulse. ‘That was nice of him.’
‘Mmm.’ Cal sounded curious but didn’t pursue the topic. ‘Anyway, the call turned out to be a false alarm. Someone had spotted a car upside down in the river down south a bit. Turned out that it was a wreck someone had dumped but they were searching for hours before they traced the owner and got the full story.’
‘Poor Mike. He must have been annoyed about that.’
‘I think he was too tired to be bothered. With the regulations on flying hours he has to stand down till about 6 p.m. so I imagine he’ll be out for the count until then.’
A whole day to wait, then. Hours and hours. That odd prickle of anticipation was strong enough to be uncomfortable as well as exhilarating, so Emily was going to notice every passing minute of what promised to be a long day.
What if Mike regretted even starting that conversation? Maybe Emily had just been in the right place at the right time when Mike had been feeling the lack of significant female companionship and his ego had been a bit bruised. There she had been—available. And looking pathetically eager.
Emily cringed inwardly at the very thought as she pushed open the double doors into the theatre’s anteroom, where her patient was waiting. She would have looked like that, wouldn’t she, when she had asked if her ‘badge’ was glowing?
Thank goodness the next few hours would keep her far too busy to dwell on anything personal. That background buzz of nervous anticipation would just have to stay where it was and simmer quietly without being stirred. It was a shame she couldn’t catch a little of her patient’s now very relaxed demeanour.
The sedation had worked wonders for Sonia who smiled happily as Emily slipped a tourniquet onto her arm.
‘I’m just going to pop a little needle into the back of your hand,’ Emily said. ‘For giving you the anaesthetic.’
Sonia was still smiling when the IV line was in place and Cal poked his head through the door to say hello before he scrubbed up. She actually giggled at her surgeon.
‘Do you reckon you could take a bit of flab out at the same time as my gall bladder?’
Cal winked at Emily. ‘Nice to see you keeping our patients so happy.’ Then he smiled at Sonia. ‘Sleep well.’
It was a routine protocol that went smoothly for Emily. She double-checked her equipment and the array of drugs, already drawn up into syringes and carefully labelled.
‘Count down backwards from ten for me, Sonia,’ she instructed as she began injecting the induction agent.
Sonia only got as far as six and Emily had already picked up the syringe full of muscle relaxant which would enable endotracheal intubation. Despite this being another overweight patient, the controlled environment of Theatre and the ability to position her patient perfectly made the procedure easy, and Emily spared only a brief thought to how fraught doing the same thing on Megan last night had been. And how difficult the later anaesthetic had proved.
Maintaining Sonia’s anaesthesia was routine enough to be almost boring in comparison. Her ECG stayed steady, pulse oximeter readings were excellent, and the changes in her blood pressure simple to manage by adjusting the flow of IV fluids.<
br />
Cal was performing the surgery with a full laparotomy rather than keyhole surgery due to the very small possibility of a colorectal malignancy, which fortunately proved to be non-existent, but it was an hour or so before Emily could begin the reversal phase of the anaesthetic and another thirty minutes before she could leave her patient in the care of the recovery room staff.
Cal and others disappeared into a staffroom for a coffee-break before the next patient but Emily dashed back to Intensive Care to check on Megan.
The adjustments made to her ventilation had not led to any improvement in her status but the fact that she hadn’t deteriorated further was some comfort. Emily eased up the level of oxygen being administered, reviewed a now extensive drug chart and ordered another set of chest films.
Then she returned to Theatre, still well before the scheduled surgery for Mr Gibbons, who was to undergo a partial gastrectomy for a benign tumour. She started her protocol to check all the machinery and draw up a fresh line of labelled syringes.
Marcia, one of the theatre nurses, was positioning another set of sterile trolleys.
‘Have you had a coffee, Emily?’
‘No, I’m good, thanks. You should go and grab one, though, while you’ve got the chance. We’ve got two minors after this so it’s busy morning.’
‘I hear you were up all night as well.’
‘I got a bit of sleep.’ Emily smiled at the young nurse. ‘I’m used to it. I actually prefer to be really busy sometimes.’
‘It’s not good,’ Marcia said doubtfully. ‘Not if it goes on for too long. They’re going to have to sort out the staff shortage problems we’ve got here.’
‘Things will settle down. People leaving without working out any notice is bound to throw everyone for a while.’
‘Mmm.’ Marcia looked as though she wanted to offer some sympathetic comment about one of those people who had left but then she gave Emily a somewhat embarrassed smile, muttered something about being desperate for caffeine and took off.
Emily didn’t mind. A minute or two by herself was exactly what she needed. Funnily enough, it wasn’t until Marcia had disappeared through the double doors that she clicked about the reason for that embarrassment. The observation that Emily used her involvement in her career as a coping mechanism for personal problems must be more widespread than she’d realised.
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