The Pregnant Intern

by Carol Marinelli

  Josh was right. Two hours into the day Alice felt as if she'd never been away. The ward round had been mercifully quick, with mostly discharges which meant heaps of empty beds and therefore heaps of admissions, but as they weren't the team on call that day hopefully she was in a for a fairly smooth first day back.

  Famous last words. 'Alice, could I borrow you a moment?'

  Alice looked up from the IV charts she was writing, glad of the diversion. She was desperate to ring Mavis and check on little Maisy but she had already rung once this morning. 'Sure, Fi, what's the problem?'

  'It's Mrs Dalton.'

  Alice nodded. Mrs Dalton had been Alice's last patient before she had gone off sick. During that time she had been discharged, only to return last week with the same problem. However, this time her ulcer was far worse and her circulation was deteriorating markedly. She was booked for an angiogram that morning to assess the severity of the blockage, and it was looking as if bypass surgery was becoming the only option.

  'Her foot seemed fine on the ward round—well, no worse anyway. But she just buzzed and is saying it's agony. It feels pretty cold. I think you'd better take a look.'

  Alice made her way straight over and as Fi pulled the curtains Alice slipped the bedsock off the offending foot.

  'It's very painful, is it, Mrs Dalton?'

  'Yes, dear. I'm sorry to make such a fuss; I know you're all busy.'

  Alice looked up from the foot to her patient. 'Let's have none of that. Now, when did the pain start?'

  'Just after Mr Foster left. I tried to ignore it...'

  Alice knew from her previous conversations with Mrs Dalton that for her to be this distressed meant that she was in severe pain. Mrs Dalton had put up with more than enough in her life without complaint. The foot was definitely cold, not just cool, and there was some mottling around the toes and on the dorsal surface. Gently she tried to palpate the pedal pulse but after a few moments of effort and quiet concentration she took her fingers away. 'Did you have any luck, Fi?'

  'No.'

  Fi handed her the Doppler, and Alice squeezed some gel onto the cold foot. Gently placing the probe, she tried to find a pulse. The speaker made some whooshing noises as Alice slowly and patiently moved it around, but despite all her efforts there was definitely no pulse to be heard.

  'Shall I page Jeremy for you?'

  Alice chewed her lip. 'Better not. Can you try Linda first?'

  The attempt at friendliness on Linda's part obviously only extended to out of hours. Her sour voice on the end of die phone was back to its usual condescending tones and when she marched into the ward she didn't even bother to address Alice, instead directing all her questions at Fi.

  'How long has it been like this?' she barked.

  'Mrs Dalton said the pain started after the ward round.'

  'But that was over an hour ago. Why was it left so long before calling someone? Were you waiting for it to turn blue?'

  'I only just let the staff know,' Mrs Dalton said apologetically, and Alice choked back her own rage at Linda's unprofessional attitude.

  'Should I page Mr Foster?' Fi ventured.

  'He's already coming,' Linda barked. 'It was obvious to me this was an emergency.'

  Which it was, of course, but, as Alice had done, Jeremy took his time examining the foot, carefully trying to palpate a pulse, listening with the Doppler and arranging a strong injection for pain while he waited for the ultrasound machine to arrive.

  'It doesn't look too good, does it, Doctor—I mean Mister?'

  Jeremy looked up from the ultrasound monitor. 'There's a blood clot blocking off the blood supply,' Jeremy informed her, his voice friendly but entirely professional. 'Now, we could start a heparin infusion, that would thin the blood and disperse the clot, but the down side is that may take too long. Realistically I think we ought to take you straight to Theatre and perform what we call an embolectomy. While we're there we'll also perform the bypass surgery to hopefully improve the circulation to your foot.'

  'And if it doesn't work?'

  Alice found herself staring at her own feet as she awaited Jeremy's answer.

  'Well, I'm going to do everything I can to make sure that it does work but, yes, there is a chance, and a fair one, that it mightn't work.' He paused, allowing his words to sink in.

  'You'd have to amputate?'

  'Worst-case scenario, yes.' He waited a couple of moments as Mrs Dalton sobbed quietly into her handkerchief before he continued. 'Mrs Dalton, I don't like to speculate too much, and I don't like to raise false hope, but certainly that is really a last resort. My intention is to save your foot.'

  For the next fifteen minutes Mrs Dalton's bedside was a hive of activity. The anaesthetist came in to do a pre-op assessment. Thankfully, as she had been due for an investigation later that morning, Mrs Dalton was already fasting, which made emergency surgery a lot safer as her stomach was empty, thus reducing the risk of aspiration. Fi, quietly efficient, performed an ECG without waiting to be asked, and by the time Mr Dalton had arrived, red in the face and dressed in the grubby jeans and an old T-shirt, Mrs Dalton was ready to be taken to Theatre.

  'Fancy coming to the hospital in your gardening clothes,' Mrs Dalton chided, groggy from the analgesia. 'What will people think?'

  'Never satisfied, these women, no matter what you do,' Mr Dalton tried to joke as his eyes filled with tears.

  'I quite agree,' Jeremy quipped, and Alice was positive that little comment was aimed at her.

  But there was none of that once they got to Theatre. The only objective here was to save Mrs Dalton the trauma of losing her foot and Jeremy worked exhaustively, first evacuating a huge clot before the painstaking task of bypass surgery. Finally, when it was over, Alice could only again marvel at his skill. Mrs Dalton's foot, right down to the tips of her toes, was now a healthy pink.

  'I want strict fifteen-minute vascular obs for the first two hours, then hourly for six hours and two-hourly overnight. Actually, make it hourly overnight.'

  'The ward staff won't be too pleased,' Carrie warned.

  'Do I look as if I care?' snapped Jeremy, peeling off his gloves and hurling them into the metal bin beside Mrs Dalton's gurney before stalking out of the recovery room.

  Carrie raised a well-plucked eyebrow. 'Someone's unhappy in love. I wish I knew who she was—I'd like to buy her a drink. It's about time that bastard got his comeuppance.'

  The venom in Carrie's voice was pure poison, and as she listened Alice felt the hackles on her neck rise. 'I'd like to remind you, Sister, that Mr Foster happens to be my boss and a consultant surgeon. If you can't show any respect for that fact then at least show it for your patient. Mrs Dalton may be unconscious but there can be no excuse for that kind of talk.'

  'I'm sorry,' Carrie spluttered, the colour in her cheeks mounting. 'It won't happen again.'

  'It had better not,' Alice warned. 'Let's leave it there, shall we?'

  Making her way to the changing rooms, Alice realised she was shaking. Useless at confrontation, she normally avoided it. But hearing Jeremy so unfairly being jeered at, she had felt anger flame within her. Sitting herself down on the small wooden bench, she put her head into her hands. Who was she trying to kid? She loved him, she always had, she had never stopped. It was just so impossible. Even if she wanted to ignore his past, everywhere in this hospital there were constant reminders. Maybe it was for the best. Maybe that would serve to keep her strong and focussed and remember why she could never be with him again. Letting him go once had been agony, to do it again would be sheer hell.

  CHAPTER NINE

  If there was some tension at work between them, it was almost bearable. Jeremy was aloof and distant, but the demands of their busy schedules and the vast difference in their status meant there was, more often than not, a reason to rush off if things got too close for comfort. But on the home front the tension was palpable. Jeremy did his utmost not to be there and, given the fact that Alice was a mere intern, it invaria
bly meant her days were punishingly long. But there were the inevitable times when they met in the hallway on their way to the bathroom or had to make small talk over the vast three-course meals that Mavis insisted on cooking.

  The one saving grace was Maisy. Her angelic presence always lightened the mood, and some evenings, when Alice was positive she would spontaneously combust if she had to sit there staring at the television with Jeremy achingly close as Mavis knitted quietly, she would jump with relief when Maisy let out her wakening cry.

  He was wonderful with Maisy—there was no argument there. Though he was careful not to appear too keen when Alice was there, several times when she came home she hid a smile as she walked in to find Jeremy singing the latest pop songs to his devoted audience, or practising his lecture technique on the finer points of vascular surgery to his most affable student.

  'Finally, a female who doesn't answer back.' He would shrug, blushing as Alice walked in. 'How could I resist?'

  'Give her time, Jeremy. She'll learn.'

  But there was too much left unsaid, too many questions unanswered for there not to be some sort of confrontation, and three weeks was a long time when your heart was bleeding.

  One night during the second week she was there Maisy was particularly fretful. Nothing Alice tried seemed to placate her. She tried more milk, boiled water, rocking her face down, as June Wicks, the maternal and child health nurse, had showed her, but nothing, it seemed, was going to silence her. Almost at her wits' end, Alice was tempted to knock on Mavis's door and ask for some welcome advice. But just when Alice had exhausted all possibilities and was about to beg the older woman's guidance Maisy, for no apparent reason, suddenly gave Alice the most delicious smile and drifted off into a deep sleep.

  Wide awake now, Alice padded out to the kitchen with a pile of half-empty bottles and nappies. The sight of Jeremy sitting hunched at the kitchen table, nursing a glass, stopped her in her tracks. Suddenly she was back where it had all started, catching him unawares, glimpsing the Jeremy behind the cool facade. She was truly horrified by how he seemed to have aged—the blond stubble on his chin and the lines etched around his eyes. He didn't look up, but as she stood there, not knowing quite what to do, he spoke, his voice thick and husky.

  'Is she all right?'

  'She's just gone off. I'm sorry, Jeremy, I tried to keep her quiet. Are you in pain again?' she asked, knowing it was now none of her business but concerned just the same.

  'Agony,' he replied. Jeremy took a sip of his drink and with a long sigh he placed the glass down on the table. 'Have you any idea the hell it is for me, listening to her crying?'

  Alice was straight on the defensive. 'I said I tried to keep her quiet. Surely you must have known it might be like this sometimes with such a young baby. If it's too much we'll be out—'

  He stopped her flood as he banged the glass down on the table. 'I meant listening to her crying and not being able to do anything, sitting here not being able to help because you've erected a damned "do not enter" sign around your heart. I'm sorry,' he said wearily, looking up at her stunned face. 'You don't need this. We're on call tomorrow. I'd better get to bed.'

  'Can I fetch you a painkiller or anything?' she asked, not wanting to let him go like this.

  A wry smile tugged at the edge of his lips. 'A painkiller wouldn't touch it.'

  It was only when he had left the kitchen that Alice realised with a start that the agony he was in wasn't from his back. With a moan she realised it was she, Alice, that was causing his pain. The cool persona, the icy contempt, it was all an act—he really did love her.

  Back in the sanctuary of her bedroom, gazing at Maisy asleep, one hand held high above her head as if she were doing some strange version on the Irish jig, Alice ached to go to him, to hold and comfort him—but what then? Her old fears were sniping at her heels again—Linda's painful predictions, Carrie's wrath, Olivia's pain. How could she risk Maisy and her security by throwing it away to chase a dream, delectable as it was? It took a massive effort to climb into bed, pull the sheets up tightly and will herself to sleep—anything rather than weaken now. She had come so achingly close to achieving her goals that it would be foolhardy to wreck it now.

  After a night spent trying and failing not to think of Jeremy, the last thing Alice needed was the prospect of twenty-four hours on call. But Mavis, insisting she had slept like a log and hadn't heard a peep all night, fussed about seemingly oblivious to the tension, piling mountains of bacon and toast onto Alice's plate and refilling her cup with sweet, strong coffee.

  'Come on. Jeremy,' she scolded gently as he appeared unshaven at the table. Obviously Jeremy wasn't relishing the prospect of being on call either. They studiously avoided each other's eyes as Mavis rabbited on. 'So if you get home before two tomorrow, fine, but if not I'll take Maisy to the child health nurse for her weigh-in. Is there anything you want me to ask for you?'

  Alice had a list as long as her arm, but instead she shook her head. 'Just mention that she seems unsettled at night. I think she might even be teething, although it seems a bit soon.'

  Mavis clucked happily. 'Some are born with teeth.'

  'Anyway, I should be back in plenty of time to take her myself. I usually finish around midday after being on call.' She stood up, smoothing some crumbs from her smart navy skirt. 'I'd better be off.'

  'But why not wait for Jeremy?' Mavis protested. 'He won't be too much longer, will you, pet?' she asked, turning to the newspaper now blocking Jeremy's face. 'It seems silly, you taking a bus or tram when Jeremy will be driving there anyway.'

  'Perhaps she needs some fresh air,' Jeremy suggested curtly, not bothering to move the paper.

  Planting a lingering kiss on Maisy's cheek as the baby gurgled happily in Mavis's arms, it was a positive relief to escape the unbearable tension of the apartment and step out into the warm morning sun. It was only just over a week until her internship was completed but it seemed interminable. Admitting to herself that she had never stopped loving Jeremy only made things harder, and the fact he obviously loved or at least thought he loved her made it downright impossible.

  Even as she stepped on the tram, purchased her ticket and made her way to her seat, her muddled mind never once left Jeremy. Resting her head against the cool window, she allowed her mind to wander. Suppose, and it was a big suppose, she did relent, did reveal the depth of her feeling to him and—almost more impossible—suppose he did forgive her, what then? Mavis wasn't going to be around for ever. Jeremy was hardly going to move to the country. Jeremy—with all his ego, all his immaculate, chauvinist, carefree ways—suddenly thrust into the role of a parent as she struggled to juggle work and child-raising—it could never last, and she was a fool to even hypothesise.

  The wailing of a siren broke into her daydream. The tram halted at the lights, giving way as an ambulance sped past. As they waited, unmoving, through several light changes the air was filled with ever-increasing wails. Looking out, Alice saw a couple more ambulances tearing towards the hospital. Making her way to the head of the tram, she spoke to the conductor.

  'What's the delay?'

  'Police told us to sit tight, love. Apparently there's been a big accident. They're trying to keep the entrance clear.'

  'Could you let me off?' Alice asked urgently. 'I'm a doctor, I'd better get there.'

  'No worries, Doc.'

  As the doors slid opened her mobile phone trilled loudly. Answering it as she ran, her heart came into her mouth as she heard the chilling message.

  'Dr Masters, there's a major incident in progress. Can you please come directly to Accident and Emergency?' The switchboard operator's voice was cool and efficient but Alice could detect the tremor in it. She would have been given a list of all personnel to work through and would know exactly what to do after the endless rehearsals, but this was no mock set up. Alice knew for sure it was real.

  'I'm on my way. I'll be two minutes,' she gasped as ambulance after ambulance sped by. Something huge
was going on.

  The impeccable mechanism of the accident and emergency department had swung into action by the time Alice arrived, breathless, at the doors. Fay, the unit manager, donning a red hard hat to show she was in charge, was directing the traffic. 'Dr Masters, straight through to Resusc, please. Mr Donovan will direct you.'

  'What happened?'

  'Two buses versus a truck' came the grim reply. The casualty list would be huge.

  What went up had to come down—it was a simple law of physics. On the up side, if there was to be a major incident, seven forty-five was probably the best time for it to happen. At that time the nurses were still in hand over, meaning there was double the staff. Most doctors were already there or, like Alice, on their way, while the night cover was still on site. The down side to the scenario was that if a truck lost control and collided with two buses, seven forty-five a.m. meant they would both be packed with commuters and school children.

  Alice steeled herself as she entered the department in an attempt to prepare herself for what lay ahead. But despite lectures, videos and simulations of a major incident, nothing but nothing could have prepared her for the sight that greeted her. It was truly appalling. Bodies were everywhere as Samuel Donovan, the accident and emergency consultant, directed the staff while simultaneously working on patients.

  Jeremy had obviously beaten her to it. He'd clearly not even had time to remove his jacket, and his immaculate grey suit was already splattered in blood as he worked on a lifeless body on the trolley in front of him. She watched as he shook his head and looked up at the clock, calling the time that this life had ended. For a second he caught her eye, and not for the first time Alice couldn't interpret the look that flashed over his face.

  'Take this one into a cubicle, Alice,' Samuel ordered as the paramedics rushed a trolley in.

  The young woman that met Alice's eyes as she looked down at the ambulance stretcher had a look of absolute terror on her face and Alice's heart went out to her for what she must have been through. Her face was as pale as the sheet that covered her, and Alice was certain that under normal circumstances she would have been placed straight into Resusc—but, then, there was nothing normal about today.