The hospital intercom suddenly blared out in a tinny voice, ‘Code Blue, Surgical Ward,’ repeating it several times.
‘Got to go, Louise,’ Allegra said, heading for the lift. ‘I’m on the crash team this morning.’
The surgical ward was on the sixth floor, but when Allegra got to the bank of lifts none of them seemed to be moving. She shifted from foot to foot impatiently, before turning and heading for the fire exit. She started running up the stairs two at a time, glad she’d resumed her fitness programme now that Christmas had passed.
When she arrived on the ward the curtains were drawn around one of the beds in room two, the crash trolley, two nurses and the intern already doing cardiac massage on the patient.
‘What’s the story?’ she asked, as she pushed aside the curtains.
‘Sixty-five-year-old male, two days post right hemicolectomy,’ the intern answered. ‘The nurses were getting him out of bed for a wash and he collapsed. Looks like a PE, maybe an infarct.’
‘Is the floor anaesthetist on the way?’ Allegra asked.
‘He might not be coming,’ one of the nurses answered. ‘There’s some sort of complicated case going on in Theatre that’s tied up a lot of staff.’
‘I’ll intubate him,’ Allegra said, moving to the head of the bed and picking up the sucker from the emergency trolley. ‘You’ll need to help me,’ she said to the nurse on her left.
‘But I’m just out of grad school,’ the young and rather nervous-looking nurse said. ‘I’m not sure what I’m doing. I’ve never been to an arrest before.’
‘Just do what I say, you’ll be fine. Turn on wall suction,’ she said, as she suctioned the patient’s mouth and reapplied the oxygen mask. Allegra picked an endotracheal tube and checked the laryngoscope battery. ‘OK,’ she said to the intern who was bagging the patient between cardiac compressions from the surgical ward nurse, ‘I’ll tube now. Put on cricoid pressure, will you?’
The intern stepped aside and applied cricoid pressure while Allegra removed the mask from the bag and oxygen. She rapidly intubated the patient and connected the oxygen, handing the bag back to the intern to continue ventilation while she secured the tube. The medical registrar, Peter Newton, had by now arrived and was looking at the ECG trace.
‘He’s got a rhythm,’ he said. ‘Looks like VT. We’ll need to cardiovert. I’ll do it.’ He took the paddles from the defibrillator and dialled up 100, applied the paddles to the patient’s chest and called, ‘Clear.’ All staff removed their hands from the patient while the intern continued to ventilate. With a jerk the patient’s back arched and then fell back as the current was applied.
‘He’s in sinus rhythm,’ Allegra noted, looking at the monitor. ‘What drugs do you want up?’ she asked the registrar.
‘He’s had an infarct is my guess. There’s a few VEBs. I’ll start a lignocaine infusion, but we need to get him round to ICTU and keep him well oxygenated. I’ll contact my boss and bring him round to ICTU for a consult.’
‘You look as if you could do with a bit of oxygen yourself,’ Allegra said, taking in Peter’s flushed features. ‘Are you OK?’
He gave her sheepish look. ‘The lifts were busy. I had to run up two flights of stairs. I guess I’m not as fit as I thought.’
‘Lucky you,’ she said as she moved aside for the trolley men who had come to do the transfer. ‘I had to run up six.’ She gave him a smile and added, ‘Go and have a glass of water. I’m going back to ICTU anyway so I’ll hand the patient over.’
Allegra accompanied the patient, Gareth Fisher, to ICTU and had not long informed the surgeon, Bruce Crickton, of his patient’s condition when the ICTU registrar Danielle Capper approached.
‘Dr Tallis, can you help me on bed five?’ she asked. ‘It’s Mr Munsfield, the Whipple procedure. He was extubated yesterday and was doing OK, but his sats have gone down in the last hour and he’s on 60 per cent oxygen. He’s become febrile and has abdo pain.’
‘Sure.’ Allegra began walking with Danielle to the far end of ICTU, where bed five was situated. ‘Have you had any bloods done?’
‘They should be on the fax now in the office. I’ll grab them and see you there,’ Danielle said.
Allegra reached bed five and after greeting Fiona Clark, the nurse in charge of beds four and five, took a look at the patient, who was pale, slightly cyanosed and very breathless. His sats monitor showed 80 per cent, BP 100 and pulse 110.
‘Deep breaths, Mr Munsfield,’ Fiona instructed the patient. ‘I’ve just given you some IV morphine for the pain.’
‘What was the last temperature, Fiona?’ Allegra asked.
‘Thirty-nine. It’s been up all morning,’ Fiona answered.
‘Where’s the pain, Mr Munsfield?’ Allegra addressed the patient gently.
‘In…my stomach, and in my back…’he gasped and puffed. ‘In the middle of my back…like a knife…’
Danielle arrived with the printouts, accompanied by Joel Addison, who had been collecting pathology reports from the printer. ‘Hb is 80, white cell count 25 with neutrophilia, and his amylase and lipase are through the roof, Dr Tallis,’ he said, looking intently through the sheath of figures before he met her eyes briefly. ‘What do you feel is the problem?’
‘Looks like we’ve got pancreatitis, maybe pancreatic sepsis. Could have an anastomotic leak,’ Allegra said.
‘I agree. We should also consider an anastomotic leak as the precipitating problem,’ he suggested.
‘Danielle, get the surgeon down here now. We need an urgent surgical review, and get X-ray up here, too—we need a chest X-ray. Those sats are worse. My guess is adult respiratory distress syndrome.’
‘ARDS is almost certain, Dr Tallis. We’ll need to intubate pretty much straight away but it’s your call,’ Joel said, giving her an unreadable look.
Allegra explained to the patient that there was a problem in his abdomen and that it was affecting his lungs, making it hard for him to breathe. She explained the procedure of intubation to him before instructing Fiona to obtain drugs and airway equipment.
‘His Hb has dropped too, Dr Tallis,’ Joel said, when she’d turned back from the patient. ‘There are a couple of cross-matched units left over from surgery.’ He turned to address Danielle. ‘Can you retrieve those from the blood fridge while I help Dr Tallis here?’
After pre-oxygenating as much as possible, Allegra got Joel to inject 10mg suxamethonium and 10mg diazepam and applied a mask and bag.
‘He’s hard to inflate. His lungs are stiff with pulmonary oedema,’ she said. ‘I’ll have to intubate him—he’s too hard to keep bagging. Hand me the laryngoscope and tube, Dr Addison.’
Allegra introduced the laryngoscope and attempted intubation but the patient had only been extubated forty-eight hours before and the larynx was red and swollen. To make matters worse, he had a short, bullish neck. She couldn’t see the cords and reverted to bag and mask, but could hardly keep a seal on the face with the mask because the insufflation pressure needed was so high.
She muttered a curse under her breath, conscious of Joel watching her every move. ‘I’ll have to try again. We’re in real trouble here.’
‘I can see that, but you’re the most skilled here at airway management,’ Joel said calmly. ‘Just tell me how you want me to assist.’
Allegra threw him a quick grateful glance and tried the laryngoscope again but still could not intubate the patient. Mr Munsfield’s sats were now 70 per cent and he was looking deeply cyanosed.
‘We need to get an airway, Dr Tallis. He’s badly hypoxic and throwing off VEBs,’ Joel said.
‘I can’t get a tube in,’ she said, her brow beading with perspiration. ‘I’ll have to do a surgical airway. Open the tray, Dr Addison, stat.’
Joel opened the surgical airway pack on the top of the trolley. Allegra put on sterile gloves and made a transverse incision over the cricothyroid membrane with a disposable scalpel. Taking a pair of artery forceps, she widened the hole, a
nd passed in a cuffed tracheostomy tube and inflated the cuff, then connected the tube to the oxygen bag. The chest rose and fell with each pump on the bag, though the insufflation pressure was high.
Allegra flicked her gaze to the sats monitor, which showed the patient’s sats coming up into the 90s. She connected the ventilator and set the dials to cope with the high pressure and poor oxygen exchange.
‘Well done, Dr Tallis,’ Joel said, briefly placing a hand on her shoulder to steady her. ‘That was a top-notch surgical airway under pressure. Things look back under control here. I’ll leave you to fill Harry in—he’s just arrived.’
He moved off towards the A and E area before Allegra could thank him for his help. She frowned as he went through the swing doors, her feelings towards him undergoing a confusing change which she couldn’t quite explain.
The surgical registrar arrived with the consultant, Harry Upton, and was briefed by Allegra.
‘He needs to be opened, I agree. The pancreatic anastomosis has probably leaked, and on top of that he’s got pancreatitis. Thanks for salvaging the situation, Allegra.’
Danielle filled Harry in on the rest of the patient’s details before he turned back to speak to Allegra. ‘You look like you could do with a break.’
Allegra blew a wisp of damp hair off her face. ‘I’m off for a break right now. It’s been one of those mornings.’
‘So you’ve finally met our new director,’ Harry said with a twinkle in his eyes. ‘I didn’t see you at his welcome function last week.’
‘I was on nights,’ she explained, her mouth tightening a fraction.
Harry grinned at her sour expression. ‘So what gives, Allegra? You don’t like his…er…aura?’
She gave him a mock reproving look. ‘Don’t you start, Harry. He totally rubbished my project as if it was a load of pseudoscience. “Can’t afford alternative therapies in his science-based unit”, I think was how he put it.’
‘Yeah, well, I guess he’s under a lot of pressure to make this place work,’ he said. ‘There’s a lot of cash been poured into it, and there are a few irate unit directors who think they should have got the funds instead. If it doesn’t shape up fast, his head will roll.’ He grimaced as his pager went off. ‘I’m due in Theatre. I’ll see you around. Good work on Mr Munsfield, by the way. You and Joel Addison make quite an impressive team.’
She gave him another mock reproving glance but a small smile softened it. ‘Thanks, Harry.’
Allegra was using the staff restroom to freshen up when Kellie Wilton, one of her colleagues, came in.
‘I was hoping I’d run into you,’ Kellie said as she washed her hands at the basin. ‘I heard about your meeting with Dr Addison.’
Allegra frowned as she twisted her light brown hair back into its clip. ‘The hospital grapevine is running rampant again, I see,’ she said, turning to look at her friend. ‘Who told you about it?’
‘Louise mentioned it at morning tea,’ Kellie said, leaning back against the basin. ‘It certainly sounds as if you got off on the wrong foot. What’s his problem with your project? I thought Patrick Naylor was touting it as a unique study.’
‘He did, but apparently Dr Addison is under the impression that his decisions bear more weight than those of the chief executive officer. I hate men with overblown egos and closed minds.’
‘How is your relationship going with Patrick, by the way?’
Allegra put her hands on her hips and gave her friend a frustrated grimace. ‘Listen, Kellie, I had dinner with him—once. It wasn’t even in a posh restaurant and I ended up paying because his credit card wouldn’t swipe. We had pizza and a bottle of awful red wine, which I was still paying for with a headache the next morning. He spent the whole time complaining about his soon-to-be-ex-wife. Hardly what I’d call a date.’
‘Yeah, I’d heard his separation had hit him hard,’ Kellie reflected. ‘You do need to get out more, Allegra, with some fresh talent. Have you ever thought about using a dating service? My sister did and got a real honey.’
‘I don’t believe what I’m hearing, Kellie. What do you think—I’m desperate or something?’ Allegra gaped at her. ‘I can find my own dates without the help of a computer, thanks very much.’
‘One bad dinner in two years is not a good track record,’ Kellie pointed out.
‘Eighteen months,’ Allegra corrected her swiftly.
‘Look, Allegra, you’re twenty-eight years old. We’ve known each other a while now, and as far as I can tell the only fun you’ve had lately is sharing tubs of chocolate-chip ice cream with me while watching soppy movies at my place.’
Allegra sucked in her stomach and groaned. ‘Don’t remind me. It’s taken me four weeks to get my jeans to do up again after the last time.’
Kellie smiled. ‘Some of us are going to go out for drinks this evening after work. Why don’t you join us?’
‘Where are you going?’
‘Just down to the pub on Elgin Street. It won’t be a late night. You’re not on call, are you?’
Allegra shook her head in relief. ‘No, thank God.’
‘So will you come?’ Kellie urged. ‘You never know, you might pick up.’
‘What? A cold sore or a strep throat?’
Kellie laughed. ‘You are a sad case, Allegra. You’ve been hanging around unconscious people way too long.’
‘Maybe,’ Allegra said with a wry smile. ‘But they don’t break your hearts and they’re not unfaithful.’
Kellie’s expression softened. ‘And they don’t always live, no matter how hard you try.’ She placed a gentle hand on her friend’s arm. ‘Alice Greeson didn’t have a chance, Allegra. You did your best.’
‘I know…’ Her shoulders slumped a little. ‘But telling the family is always so hard. She was just twenty-one. I thought she was responding…’
‘She was brain dead, Allegra,’ Kellie said. ‘It was hopeless right from the start. You did what you could but the brain injury she sustained in that car accident was beyond anything medical science could repair.’
Allegra gave a long sigh. ‘I know, but I guess I was hoping for a miracle. They happen occasionally, I just so wanted one for Alice and her family.’
‘You’ll get your miracle one day,’ Kellie said. ‘We all do. It’s what keeps us going. Why else would we work the hours we do if there were no miracles?’
Allegra smiled. ‘You’re right. Thanks, Kel. What time did you say drinks are on?’
‘Just come when you’ve finished your shift. The place will be rocking by the time you get there so come no matter what time you finish. You need some chill-out time.’
‘You sound like my mother.’
‘Yes, well, mothers often know best, although I’m not sure mine would approve of the date I have lined up for the weekend.’
‘Don’t tell me you’re doing that internet dating thing, like your sister?’
Kellie grinned. ‘Why not? Look at her, six months on and she’s married and pregnant to a gorgeous guy. It could happen to any of us.’
Allegra rolled her eyes. ‘My mother would have a coronary if I told her I was dating someone I’d met on-line. My father would be even worse. They’d be doing a personality inventory and an astrology and numerology profile on the guy, and checking out his background with a private investigator. I think I’ll have to do it the old-fashioned way, you know, boy meets girl, that sort of thing.’
‘That sort of thing usually ends in divorce,’ Kellie pointed out. ‘Physical attraction is one thing but finding someone you can relate to is the stuff that really counts. You need to be friends first, lovers second.’
‘Yeah…I guess you’re right, but with the sort of hours I work, how am I going to find the time to make friends with anyone halfway decent? Most men expect you to sleep with them on the second or third date these days. They’re not interested in friendship, they’re interested in getting laid as soon as they can.’
‘That’s why the dating service is so
useful,’ Kellie said. ‘It cuts corners for you by weeding out the weirdos and the ones who have no interests in common with you. Think about it. I can get Jessica to do a preliminary printout for you to show you how it works.’
‘I’ll think about it,’ Allegra said, as she shouldered open the door. ‘I’ll see you tonight.’
The door swung shut behind her but halfway along the corridor she came face to face with Patrick.
‘Hello, gorgeous,’ he said, planting a moist kiss to her mouth before she could turn her head away in time.
‘Patrick…I…’ She tried to push herself away but his hands were heavy on her shoulders.
‘Have dinner with me tonight?’ he asked, his tone pleading.
She opened her mouth to respond when just past his right shoulder she caught sight of Joel, coming out of one of the smaller meeting rooms used for conferencing with the relatives of patients. His dark eyes were cynical and there was a hint of something that looked very much like a smirk at the corners of his mouth.
‘Sorry, Patrick, but I promised Kellie I’d join some of the others for drinks later this evening,’ she said. ‘Maybe some other time.’
‘I’ll hold you to it,’ he said, and, pressing another quick kiss to her mouth before she could avoid it, went on his way in the opposite direction.
Joel stepped away from the doorjamb he’d been leaning against and walked towards her, his eyes very dark as they held hers. ‘Dr Tallis, no doubt you will disagree with me on principle, but perhaps it might be prudent to refrain from fraternising with members of staff in the corridors of the unit. I wouldn’t want any of our patients’ relatives to think that you’re acting unprofessionally.’
‘I wasn’t acting unprofessionally, I was just—’
‘Dr Tallis.’ His low deep tone brooked no resistance as he pointed to the room he had left a short time ago. ‘In that conference room are the parents of a young man who was admitted to ICTU a short time ago. He fell from a building site and has suspected spinal injuries. I do not think that they need to see right now two members of staff going for it in the corridor.’
In Her Boss's Special Care Page 2