The Elusive Consultant

by Carol Marinelli

  Emily never looked ruffled. The woman had probably spent the morning pulling dislocated hips and shoulders into place and yet her blonde hair was pulled back into a perfectly neat ponytail, her theatre blues looked tailor-made and her clear, china blue eyes never wandered as she listened intently to the brief history given by a suddenly nervous Jane.

  Emily had that effect on women.

  On men, too.

  Come to think of it, Tessa grumbled to herself as she assembled equipment, even three-year-olds quaked when Emily approached.

  She might look like a tiny fragile porcelain doll, but two minutes in her company soon put paid to that. Emily Elves hadn’t made it to orthopaedic registrar courtesy of her good looks, and the fact her father was the top obstetrician in the hospital wouldn’t count for anything when she went for the consultant’s position at the end of the month. No, Emily had made it this far in a man’s world through steely determination, a brilliant medical mind and an utter disregard for emotion.

  ‘So the jet-skier wasn’t wearing a life jacket.’ Her blue eyes finally swivelled to Max when the history was completed and a wry smile appeared on her smooth face. ‘Did you hear that, Max?’

  ‘No doubt it’s all I’m going to hear for the next few days,’ Max responded with a slight edge to his voice that instantly had the room enthralled.

  ‘You see,’ Emily explained, still smiling as she started to pull up some drugs from the trolley, ‘Max Slater, your, oh, so responsible emergency consultant, the lynchpin of the department, the one we’re supposed to look to for guidance, well, he thought he might try his hand at jet-skiing last weekend.’

  Everyone laughed. It was the type of conversation that often took place as the adrenaline kicked in while they waited for the arrival of patients, but even though Tessa joined in the laughter a small frown puckered her brow. As commonplace as this type of conversation might be amongst the staff in Emergency, it was a revelation to hear Emily opening up. Emily Elves was eternally private. In fact, normally she went out of her way to keep her professional and personal lives completely separate, yet here she was for the first time in memory telling anyone who was interested about her weekend with Max. There was definitely something strange going on.

  But Tessa had no choice but to listen and laugh along with the rest of the rabble and it hurt.

  Really hurt.

  ‘Of course,’ Emily continued, ‘I knew nothing about it. There I was, having a doze on the beach, half listening as some hoon came in way too close to the shore, laughing his head off, whooping with enjoyment and generally making a nuisance of himself, you get the picture. It was only when the yob in question started calling my name did I sit up and take notice...’

  ‘I was only on the jet-ski for ten minutes,’ Max argued. ‘If that. Mind you...’ he grinned ‘...it was the best ten minutes of my life.’

  ‘And it could very well have been the last ten minutes,’ Emily said pointedly, cocking her head as the sound of the chopper got louder. ‘Need I say more?’

  Thankfully she didn’t. The last thing Tessa needed this morning was cosy little images of Emily and Max at the beach, no doubt with Emily skinny and gorgeous, some tiny little bikini accentuating her smooth brown skin, good-naturedly bickering about Max’s casual attitude to the world at large, Max’s take-it-or-leave-it slant on things.

  It was a relief when the patients arrived and Tessa could concentrate on work.

  The first victim to arrive was the unfortunate jet-skier. Though no longer in full arrest, he was still dangerously close to it.

  ‘OK, Kim, just listen to Max, he’s supporting the neck so he’s the team leader.’ Tessa hovered in the background, watching closely as Kim worked intently. As important as it was to give the staff experience, it could never be at the expense of patient care, and in this instance any hesitation could prove fatal. The lift over to the trolley was swift but very controlled, given the likelihood of spinal injuries, and Tessa tried not to interfere too much as she watched Kim’s shaking hands change over the equipment from the rescue team’s to the unit’s own. Already the young man was intubated. The paramedics had put a tube in place in his throat, thus securing the airway, and intravenous access had been established.

  ‘Right, Kim, look at the cardiac monitor. What do you see?’

  Kim swallowed hard, her cheeks colouring as she stared at the machine. ‘His heart rate’s slow.’

  ‘Yep, he’s in sinus bradycardia, so what drugs do you think he’ll need?’

  ‘Atropine?’ The answer was right but Tessa could hear the question in the Kim’s voice.

  ‘Good,’ Tessa said encouragingly. ‘Max is checking his airway now—that’s the first priority—but once he looks at the monitor no doubt he’ll be calling for atropine or adrenaline so if you can try to preempt what he’ll need, you’ll have a head start. You may well be wrong but at least it’s easier to pull up the drugs and have them ready to hand over to him before he starts calling for them.’

  ‘Atropine.’ Max’s word was clipped, not even looking up he placed an impatient hand out, and thankfully Kim was able to pass him the drug immediately.

  ‘Get the chest-tube pack out,’ Tessa whispered, watching Max frown as he palpated the young man’s ribcage and run through a flask of mannitol. As the resus doors slid open and Tessa’s patient arrived, she gave her colleague’s shoulder a quick squeeze. ‘Don’t mind Max if he shouts. It’s not aimed at you personally, it’s just his way.’

  It was just his way, Tessa thought as she started to work on her own patient, ignoring a rather loud expletive coming from Max’s general direction. Max, passionate about every patient, would be working on the young jet-skier as if it were his own family member lying near to death on the resus trolley. And if he lost his temper, if he shouted because the equipment he’d only just asked for wasn’t in his hand now, it was easily forgiven. Everyone knew they were watching a genius at work, and a genius was surely allowed the odd eccentricity.

  Unlike Emily, Tessa thought to herself as she set to work on the latest admission. Not that Emily wasn’t a diligent and talented doctor, but her work technique and bedside manner didn’t even begin to compare to Max’s. The young man before them was flailing around on the gurney, distressed, in pain, terrified and, Tessa thought, confused, which was more ominous than the rest of his symptoms put together. And with little reassurance to her patient, Emily commenced her examination as Tessa struggled to hold the young man down and reassure him.

  ‘Stay still for me.’ That was the sum total of Emily’s communication with her patient as her hands worked their way down his body, leaving it to Tessa to attempt an explanation. But explanations were hard to give in the absence of information and Emily, as usual, was giving nothing away.

  Emily worked in a completely different manner to Max. Emotions were kept strictly in check as she thought things through in her own time, and from a nursing perspective she wasn’t the easiest doctor to work with. There was no pre-empting her, no little clues along the way, nothing in her calm exterior to indicate what was going in that clever head of hers.

  ‘What’s his blood pressure?’ Emily’s voice was completely calm, as if she were asking if there was any milk in the fridge or if anyone had thought to buy a newspaper this morning. The coffee-room or the resus ward was all dealt with in the same unflappable manner. Her meticulous, very neat little hands methodically examined the restless body.

  ‘It’s up,’ Tessa said, glancing over at the machine. ‘One hundred and ninety on a hundred.’

  There was no reaction from Emily as she carried on working her way down the patient. ‘Do we have a name?’

  ‘Phil’s all we’ve got at the moment,’ a voice called from the back of the room, and Tessa nodded her thanks to the paramedic who was writing up his notes in the corner.

  ‘Phil, try and stay still for me while I examine you.’

  Which didn’t exactly calm the agitated man down.

  ‘You’ve
been in an accident, Phil,’ Tessa added as diplomatically as she could, keeping her voice calm and even as she orientated her patient. ‘You’re at Peninsula Hospital. Dr Elves here is just going have a look at you.’

  ‘His shoulder’s dislocated,’ Emily said, more to herself than anyone.

  ‘His oxygen sats are low,’ Tessa said grimly, ‘even though he’s on ten litres of oxygen.’

  ‘Hmm, he’s got a few fractured ribs as well.’

  Sometimes Tessa wanted to shake Emily. An excellent doctor she might be, but she was a lousy team player. Nothing in her calm expression, her clear blue eyes let the staff know what she was thinking—unlike Max, who wore his heart on the sleeve. Right now Tessa was worried about the head injury. By all accounts, Phil had been unconscious for some time, his agitated ramblings and high blood pressure all indicative of a serious head injury, but Emily, though aware of the facts, seemed more concerned about his shoulder.

  ‘Let’s get his shoulder back in place then we’ll see where we are.’

  ‘Do you need anything?’ Tessa ventured, hoping against hope Emily wasn’t going to do the procedure without anaesthetic but knowing the call was Emily’s.

  ‘Some traction, please,’ Emily said without looking up. ‘And make sure the brakes are on the trolley.’

  Tessa bit her tongue. Giving the patient pain control now would mask any symptoms of his head injury, but to do it without anaesthetic would be agony. She watched as Emily slipped off her shoes and realised Phil was going to need all the sweet-talking Tessa could manage.

  ‘It will only take a second,’ Emily said assuredly. ‘Are you going to provide the traction?’

  It was more an order than a request. Reluctantly, and trying hard not to show it, Tessa held onto the unfortunate man’s shoulder, watching as Emily placed the ball of her foot in his armpit. For someone so tiny she was incredibly strong, which was an absolute prerequisite in orthopaedics. Leaning back, Emily pulled as Tessa took the head end and utilised every last bit of her strength to hold the trolley steady and provide the necessary traction that would enable Emily to slip the shoulder back into place. Engaged in their own tug of war for a moment, just as Emily had predicted, the shoulder slipped back easily into place and instantly Tessa felt Phil relax under her hands.

  Emily was good, Tessa admitted grudgingly.

  Very good.

  ‘Better?’ Tessa asked gently, smiling as her patient nodded, responding appropriately for the first time since his arrival. His eyes were closed, though, only opening when Tessa spoke.

  ‘It was killing me.’

  ‘Do you know where you are?’

  Phil didn’t answer immediately, his eyes closing between sentences, and Tessa had to prompt him to stay awake. ‘Phil, do you know where you are?’

  His battered, sunburnt face turned and stared at the badge hanging around Tessa’s neck. ‘Hospital?’

  Tessa smiled. ‘Is that an educated guess?’

  ‘I’m afraid so,’ he answered, drifting off again until Tessa none too gently tweaked his ear, which roused him enough for a slightly longer conversation.

  ‘Do you remember anything that happened?’ Ticking off Phil’s responses in the observation chart, Tessa tried to keep the assessment as light as possible. She could see the effort in Phil’s face as he attempted to recall the morning’s events, see the fear in his eyes, the slight note of panic in his voice, and knew it was only a matter of time before the full impact of what had happened took hold.

  ‘We were just out, doing some waterskiing, having a laugh...’ He frowned as loud rhythmic banging came from behind the curtain, and Tessa felt her heart sink as she realised that the other young man had obviously slipped back into cardiac arrest, the rhythmic banging a desperate attempt to massage the stilled heart into action. ‘Some kid on a jet-ski, he’d have only been about nineteen... He just came from nowhere.’

  Max’s orders were coming thick and fast now, and as she heard his call for two hundred joules Tessa forced her eyes to stay on her patient, listening to the defibrillator charging up behind her. She could hear Jane’s voice, so there was no need for her to go and help, but it didn’t mean her heart wasn’t on the other side of the curtain, willing the young man to pull through.

  ‘Do you remember anything else?’ Tessa asked gently, but as Phil went to answer again Max’s voice broke in.

  ‘Everybody back.’

  Phil lay in agonised silence as the click of the shock being delivered filled the resuscitation room. ‘Is that him?’

  Technically Tessa didn’t need to answer. Discussing other patients was taboo at the best of times but, given that only a thin curtain separated the two patients, it seemed cruel and pointless to dismiss Phil’s heavy question with a dismissive shrug, so instead she gave a small nod, watching as Phil’s face dropped, placing a gentle hand on his good arm.

  ‘They’re doing everything they can.’

  ‘How’s it going?’ Jane’s grim face popped around the curtain.

  ‘Emily’s just popped his shoulder back, he’s a lot more comfortable.’

  ‘Do you want to move him over to one of the cubicles?’ Jane’s wide eyes left Tessa in no doubt that the news was only going to get worse for the young jet-skier. And it would probably be kinder to move Phil, less traumatic for him to be in his own space with his own thoughts, rather than listening to the terrible events unfolding a few steps away. Now was a time for one of nursings tough calls. Despite the reduction of his shoulder dislocation, Phil’s blood pressure was still dangerously high, and Tessa still wasn’t satisfied with his consciousness level. The ease at which he drifted off when she wasn’t prompting him worried Tessa, and the thought of him unobserved in a cubicle couldn’t be justified because of the traumatic events taking place in the resuscitation room.

  ‘We’ll keep him here for now.’ Tessa made a small gesture to the monitors and Jane nodded her understanding, moving aside as Luke appeared with the portable X-ray machine and handed Tessa a lead gown.

  ‘I think Max wants a quick C-spine in the next cubicle,’ Tessa said in businesslike tones, ignoring the rather eager smile Luke was wearing. Six weeks ago they had shared one very questionable date, and for Luke, at least, it wasn’t over yet. ‘Then, no doubt, there’ll be a pile of films for you to do here. I’ll take a lead gown for the doctors, and Kim next door as well.’

  ‘Tessa.’ Kim’s call from the next cubicle merited more than a ‘yes’ and, nodding to Emily, Tessa ducked round the curtain, attempting to slip a very heavy lead coat over Max’s head as he examined the patient, tying it up at the sides she tried, and failed, not to notice the musky scent of him, the light hairs on his arms, the quiet strength of his lean body.

  He didn’t acknowledge her and neither did Tessa expect him to.

  ‘Sorry to be a pain,’ Kim started, as Tessa offered to slip a protective coat gown on her, her face red from the exertion of giving cardiac massage. ‘It’s just...I’d rather not be here while they do the X-rays.’

  Her already red face was almost beetroot now and Tessa felt sorry for her. That was the trouble with nursing: nothing was sacred. The fact Kim didn’t want to stay while the films were being done could only mean she was either pregnant or hoping to be, and while most of the general population were able to sit on their secrets, emergency nurses didn’t have that luxury. Though Tessa’s curiosity was naturally aroused, she didn’t show it.

  ‘Sure,’ Tessa said lightly. ‘You take over Phil next door and duck outside while the X-rays are being done.’

  ‘I’m sorry,’ Kim said again, needlessly. ‘I should have said something earlier.’

  ‘That’s the trouble with this place,’ Max said dryly, ‘it’s never early enough. Go,’ he said with a small wink. ‘Tessa and I know now, that’s enough to be going on with, and don’t worry about Fred here.’ He gestured to the anaesthetist who looked up at the mention of his name. ‘We’ll cover for you till you’re ready for the world at large. I
sn’t that right, Fred?’

  ‘Sure,’ Fred mumbled, obviously bemused at what he was agreeing to.

  ‘Thanks, guys.’

  Taking over the massage, Tessa called Kim back. ‘Phil’s upset about this one,’ she said in low tones, ‘but I don’t think he’s well enough to be moved. I know that he looks pretty good on paper, but I’m not happy with him.’

  ‘What does Emily say about him?’ Max asked, not even bothering to look up from the array of monitors he was watching like a hawk.

  ‘Not much,’ Tessa said tactfully. ‘She’s reduced his shoulder, so he’s a lot more settled. She’ll probably do another neurological assessment now that he’s calmer.’

  ‘Well, keep a close eye on his neuro obs, and if you’re worried, I’m only here,’ he offered, which was the closest to an acknowledgment of Emily’s poor communication skills they were going to get.

  ‘Sure.’

  Fred spoke with an air of weary resignation. ‘Max, we’ve been going for fifteen minutes with no response—there’s been nothing since he arrested in the ambulance.’

  ‘He had a pulse when they pulled him out of the water, and a pulse when he first arrived here,’ Max snapped, but the anaesthetist shook his head.

  ‘Yes, but he wasn’t breathing, heaven only knows for how long. His neck’s broken, he’s got multiple injuries—’

  ‘Let’s just wait for the X-ray, shall we.’ It wasn’t a question, it was a statement, and Fred shrugged and raised his eyebrows at Tessa who, in an attempt at diplomacy, said nothing. There was nothing unkind in Fred’s words or actions, just the awful deliverance of the truth.

  But Max didn’t want to hear it.

  Fred held the X-ray film against the patient’s neck as Luke lined up the machine for his shot.

  ‘What time do you finish, Tessa? I thought we might hit that new wine bar that’s opened.’ Luke’s apparent casualness belied his slightly nervous stance.

  ‘I don’t think so,’ Tessa said abruptly, annoyed with Luke not only for embarrassing her but also for his blatant disregard for the patient. Unconscious he might be, but attempting to arrange a date when a young man lay desperately ill was pushing the boundaries of decency in Tessa’s book.