Doctors at Risk

by Alison Roberts

  Wendy could feel the heat of that desire now, and the pain of Ross pushing her away surfaced again, undiminished even by an agonising night of trying to deal with it. Tears prickled yet again but this time Wendy scrubbed them away with an impatient hand. She didn’t cry. And she never moped. Feeling like this was alien enough to frighten her. OK, so she’d never been in love with someone before—not like this—but surely it couldn’t be enough to undermine a lifetime of standing up for herself and taking positive action over anything that stood in her way? This was simply another challenge to meet and Wendy had never let herself be defeated.

  The phone ringing seemed like an exclamation to congratulate her on a new resolution. Wendy snatched up the receiver.

  ‘Hello?’

  ‘Hi, Wendy.’

  ‘Oh…’ For some reason, the call was a surprise. ‘Hi, Kelly.’

  There was laughter on the line, now. ‘You sound disappointed. Were you expecting Ross to ring?’

  ‘Not really,’ Wendy said honestly. The hope that it might have been him was undeniable, however. ‘Sorry, Kelly. It’s great to hear from you. How are you?’

  ‘Fine. Busy working. It all seems very routine these days. Our USAR time seems like ages ago.’

  ‘I know,’ Wendy agreed. ‘But it’s only been three weeks. It’s a bit scary, the way you can just fall back into old routines.’

  ‘Some of us don’t. I was just talking to Jessica and she’s broken out of hers in a big way.’

  ‘How’s Ricky doing at that special school?’

  ‘Really well, but that’s not the most exciting thing that’s going on. Seems like Jess is a lot more than a house guest as far as Joe’s concerned now.’

  ‘Really?’ Wendy was taken aback by the pang of envy that struck her. Was Jessica experiencing the same euphoria of falling in love that she had found with Ross? Kelly was right, it did seem like ages ago. Another lifetime almost.

  ‘I knew she’d fallen for Joe,’ Kelly confided. ‘She told me as much when I went down to her mum’s funeral with her. And I have to say I encouraged her to go for it.’

  ‘And she did?’

  ‘Apparently so.’ Kelly’s tone had a grin in it. ‘The best bit is that Joe seems to feel the same way.’

  ‘That always helps.’ Wendy managed to keep her tone light. If only Ross could feel the same way she did now. The way he had so quickly when they had fallen in love. Wendy tried to dismiss the envy she still felt. She was glad for Jessica, of course she was. Her friend deserved the joy of finding love. After all, she had coped with far more in her life than Wendy ever had. ‘I’m so pleased,’ she added with genuine warmth. ‘I hope it works out for them.’

  ‘I have a feeling it will.’ Kelly chuckled. ‘Maybe the applications for the next USAR training course should have something in the fine print about its advantages as a matchmaking service. You and Ross. Now Joe and Jess.’

  ‘Your turn next, then.’ Wendy summoned a sound that could pass for amusement. ‘Who did you fancy in the class? That fire officer, Roger, seemed keen. And I have to confess to having the odd moment of wondering about you and Fletch.’

  ‘Did you?’ Kelly sounded astonished. There was a tiny silence and then Kelly laughed again. ‘I’m happy the way I am, thanks. Now, listen. Joe’s offered to babysit Ricky tonight so Jess can go out. We’re planning to go to a bistro for a drink or two by way of celebration. That’s why I’m ringing, to see if you could come with us. Are you working tonight?’

  ‘No, I’ve got two days off.’

  ‘Could Ross do without a visit from you just this once, do you think?’

  ‘I reckon.’ Wendy wondered what Kelly would say if she knew that Ross had effectively issued instructions to bar her from visiting him. She wouldn’t want to put a dampener on spending time with her friends, however. It was just what she needed to brighten her own mood and she certainly wasn’t about to spoil any of Jessica’s happiness. ‘I’d love to come,’ she told Kelly. ‘Just tell me where and when.’

  Wendy hung up the phone feeling far more like her usual self. She moved purposefully towards her desk and opened a drawer to find her chequebook. She would pay for the new harness, the state-of-the-art climbing rope and the set of new straight gate carabiners. What’s more, she wouldn’t let them gather dust out in the garage. If she wasn’t welcome to visit Ross in the next two days she would do what she’d always done with her time off. When her chores at home were finished, she’d treat herself to a session at the indoor wall in the gym. She’d go for a decent run up the Cashmere hills and tonight she’d go out and have a good time with her female friends. And tomorrow she’d see if she could round up a mate or two from the climbing club who wanted a session at Castle Rock, tackling the most difficult rockface they could find.

  It was unfortunate that removing the chequebook from the drawer revealed the sealed, addressed envelopes that had been ready to post the day the USAR course had ended. One gave notice for her current position at Coronation Hospital. Another was a letter of enquiry about positions that might be upcoming at the hospital on the West Coast and the third had been a month’s notice to her landlord. The envelopes had represented such confidence in the plans she and Ross had made for their immediate future and now all they meant was a waste of paper and evaporated dreams. Even if she and Ross managed to sort their way through this obstacle in their relationship, those plans would need major readjustment.

  Wendy shoved the envelopes into the bag of rubbish, ready to be put out for collection that morning. No threat of tears this time. She wasn’t admitting defeat here, merely acknowledging that a change of direction was needed. A different approach. It was like facing the most difficult climb she had ever done, really. The thought of what she stood to lose—her life—was terrifying, but the goal made the attempt worthwhile, and choosing the right equipment and path was crucial to success.

  She was actually smiling as she tied the top of the rubbish bag with a firm knot. Wendy liked that analogy. She could do this…and succeed. After all, she had overcome her weight problem as an adolescent, hadn’t she? She had also shown people she wasn’t too small to play netball at a nationally competitive level and she knew, with all modesty, that she was regarded as the gutsiest and one of the most popular members of the various sporting clubs she had joined over the years. Everybody seemed to love her ‘go for it’ attitude and determination to succeed.

  Ross wasn’t going to discover just how determined she was to succeed this time, however. Instinct warned Wendy that he could be just as stubborn as she was if he thought he needed to be. Her approach needed subtlety, and giving him a day or two to think that he had been successful in convincing her it was all over was not a bad place to start her campaign. With a bit of luck he might realise what a gap she was going to leave in his life. He might start missing her with the same painful sense of loss that she herself was experiencing, and when he’d had enough time to think about it he might be ready to talk to her. Really talk and not simply erect a verbal brick wall.

  Wendy picked up a pen and the chequebook. She would post these accounts on her run up to the hills. What’s more, she wasn’t going to waste any emotional energy feeling annoyed at the ten per cent penalty she now had to add to the power bill. She had far more important matters to put that energy towards.

  Ross had to clamp down on the annoyance he was feeling. He pressed the bell beside his pillow for the second time and a nurse hurried into Room 2 thirty seconds later.

  ‘Sorry, Ross. It’s bedlam out there. Mrs Skinner got stuck in the toilet and was too upset to cope with the lock. There’s been two arrivals in ICU and I got held up waiting to help with a log roll. I hope it wasn’t anything urgent.’

  ‘I’m itchy,’ Ross complained. ‘It’s driving me nuts.’

  ‘Oh.’ The nurse eased her hand under his back. ‘I thought I’d found all those chips of plaster last time you were turned.’

  ‘It’s further in,’ Ross directed. ‘Up a bit
. Go left. Ah…That’s better.’ He looked at the tiny shred of dried plaster bandage in her hand. ‘Amazing something that small can make you feel so uncomfortable.’

  ‘I’ll have another check and make sure there’s no more bits lurking. We’ll give you a good scrub when you go on your side again. That should fix it.’

  ‘You’d think they would have found a more high-tech method of taking measurements for a back brace.’ Ross could feel the hand wriggling carefully down the length of his spine.

  ‘Maybe you can keep the plaster shell of your torso and take it home for a souvenir.’

  ‘I’ll pass on that, thanks.’ Ross let his breath out in a weary sigh.

  ‘You sound tired.’ His nurse straightened and her gaze rested on the thick metal spring with handles on each end which was lying abandoned on the side of the bed. ‘Have you been overdoing those upper-body strengthening exercises?’

  ‘No.’ Ross managed a half-hearted smile. ‘I’ll be in trouble when Sally turns up. She gave me a lecture on that subject yesterday. If I don’t regain my upper body tone, how can I expect to cope with being independent in a wheelchair?’

  ‘It is important,’ the nurse said gently. ‘Being able to transfer independently from a bed to chair or chair to toilet makes a huge difference.’ She brushed the small pieces of debris she had collected into her hand. ‘You must be getting pretty sick of having to depend on other people to deal with the kind of things we all prefer to keep private.’

  ‘Yeah.’ The incessant itching was gone but Ross still felt irritated. ‘My indwelling catheter’s due to come out in the next couple of days. I guess I’ll have the fun of learning to use collection devices then.’

  ‘You may not need them. When are you due to get your bladder function checked by cystometry again?’

  ‘Tomorrow morning. Seems like my spinal shock is wearing off so they should get some accurate pressure readings. The verdict so far is flaccid.’

  ‘That’s easier to manage. You can learn to empty the bladder by compression or using abdominal muscles. You might not have any incontinence hassles.’

  ‘True.’ Ross picked up his exercise equipment. Dealing with bladder management was not something he wanted to spend too much time thinking about. A lot of techniques involved the use of condoms, and how depressing would that be, knowing that it was probably the only use he’d ever have for such items any more? He stretched the spring, pulling his arms wide, and could feel the protest of muscles that had weakened with alarming rapidity over the last three weeks.

  ‘Anything else you need while I’m here?’ The nurse was looking undecided, as though she was wondering whether Ross needed a chance to discuss the more personal aspects of his rehabilitation. ‘Only I’ve got a dressing change to do for a pressure sore. I could come back later.’

  Ross shook his head with a wry smile. ‘My social calendar’s pretty full for the rest of the day. Sally’s due to come and give me a workout and then it’ll be time for dinner. Then it’s visiting hours.’

  Not that he was particularly looking forward to visiting hours. Wendy had stayed away yesterday and there was no reason for her to come in today either, when she wasn’t working. His level of niggling annoyance increased and Ross put more effort into pulling the heavy spring apart. He held it for as long as his protesting muscles could manage and then added a few more seconds. He hadn’t expected Wendy to come in, had he? He’d told her it was over. He’d even left a message with Debbie to tell her that he didn’t want to see her. Maybe it hadn’t been so difficult for Wendy to accept after all. Maybe she had even been relieved.

  The burning in his shoulders and upper arms was real pain now. Ross slowly allowed the spring to shrink in length. He gave himself a few seconds’ rest and then pulled again. Even harder.

  His young physiotherapist arrived, and was impressed. ‘Don’t break that spring,’ she joked. ‘We’re short of them. We’ll have to get you into the gym in the next day or two and then you’ll be able to thrash some decent gear.’

  The sweat was beading on his face as Ross released the tension in the spring yet again. He felt ridiculously short of breath. ‘I’m too unfit…for that.’

  ‘You’ll get it back,’ Sally promised. ‘You were so fit when you arrived it shouldn’t take too long at all.’

  Ross was still trying to slow his breathing. A twinge beneath his ribs was painful enough to make him blink. Surely he hadn’t diverted so much of his frustration and grief into the exercise that he pulled a muscle? The pain wouldn’t go away. He hadn’t stopped sweating either. Ross felt the chill of premonition.

  ‘Can you check my feet…for any peripheral…oedema?’ The fact that he’d needed more than one breath to finish his sentence made Sally frown.

  ‘Are you OK, Ross?’

  ‘I’m not sure,’ Ross said tersely. He could feel his heart rate increasing and his breathing wasn’t getting any easier. ‘I think I might…have a PE.’

  ‘Pulmonary embolism?’ Sally’s eyes widened in shock. ‘But you’ve been on anticoagulation since you were admitted and you’re wearing anti-embolism stockings and…’ She had uncovered his feet as she’d been speaking and her hands were now on his feet and ankles. ‘And there’s no sign of any swelling.’ Her gaze lifted briefly to meet Ross’s. ‘I’ll get a doctor,’ she said calmly.

  Ross watched the speed with which Sally left the room and his level of alarm rose. Textbook gems carefully learned for long-ago examinations flashed into his head.

  ‘Newly injured tetraplegic or paraplegic patients are at high risk of developing thromboembolic complications.’

  ‘Peak incidence is in the third week following injury.’

  Ross swallowed with difficulty and tried not to listen to his rapid rate of respiration. He was nearing the end of his third week.

  ‘Thromboembolic complications are the commonest cause of death in spinal patients who survive the period immediately following their injury.’

  The pain was still there, a sharp stab every time he took an inward breath. Patrick arrived with a registrar, John Bradley. Debbie was following and she whisked the curtains closed around Ross.

  ‘What’s happening?’ Patrick looked concerned.

  Ross couldn’t answer because of the coughing that had just started. Then he had to concentrate hard on his breathing. John had his hand on Ross’s wrist.

  ‘He’s tachycardic,’ the registrar reported. ‘Rate of 120.’ He was also counting the rate at which his patient’s chest was heaving. ‘And he’s tachypnoeic. Respiration rate of 36.’

  Patrick had his stethoscope in position. ‘I can hear a right-sided crackle.’ His mention of the abnormal lung sound was calm. ‘Any pleuritic pain?’

  Ross nodded.

  ‘Peripheral oedema?’

  ‘No.’ Ross coughed again and this time he had to reach for a tissue. The streak of blood he wiped from his lips was all the evidence the medical staff needed of the blood clot that had reached his lungs.

  ‘Let’s get him back to ICU,’ Patrick directed. ‘We’ll get a chest X-ray, arterial blood gas and ECG.’ He turned to John. ‘Get him on some high-flow oxygen and start a heparin infusion,’ he ordered. ‘Five thousand units IV and then a continuous infusion of 800 units an hour.’

  ‘What about streptokinase?’ Ross queried. ‘Or TPA?’

  ‘Let’s just see how much of a problem we’re dealing with first.’ Patrick smiled at Ross. ‘There’s one good thing about having a medic as a patient. We’re not likely to forget anything, are we?’

  Ross concurred with the general opinion formed an hour or so later that standard treatment with heparin would probably be all that was needed.

  ‘You’ve got a pleural effusion on X-ray but no wedge-shaped infarcts that might suggest a massive PE.’ Patrick held the chest X-ray so that Ross could see it, then handed him the 12-lead ECG.

  ‘There’s signs of right heart strain but they’re not enough to worry me,’ the consultant said. ‘S
ubtle ST-T wave changes here and a mild right axis deviation.’

  ‘They should be temporary.’ Ross was breathing much more easily now. He didn’t feel like he needed the oxygen mask. Being tilted on his bed to a more upright position was probably all that was necessary now.

  ‘Coughing stopped?’

  ‘Pretty much.’

  ‘Pleuritic pain?’

  ‘Better than it was.’

  ‘Good.’ Patrick nodded. ‘Your arterial blood gas wasn’t so hot so we’ll repeat that in a few hours and we’ll keep you in ICU until you’re not hypoxic and the ECG changes have resolved.’

  ‘OK.’ Ross was happy enough to have the extra monitoring even if the embolism was not large enough to be life-threatening.

  ‘Don’t let this seem like too much of a setback, will you, Ross? You’re over the worst of it now.’ His gaze was sympathetic. ‘Would you like me to ring Wendy and let her know what’s happened?’

  Oh, Lord. Ross would like that so much. He would like to see the concern for himself that would show so clearly in Wendy’s face. He wanted to see the relief that he was all right and the love that would make those emotions so intense. He wanted to feel Wendy’s touch and cling to the protection her love could offer him from what life was continuing to throw in his direction. And he couldn’t allow himself to do that.

  He wouldn’t allow himself to do that.

  ‘No,’ was all he said to Patrick. He shook his head decisively, more to convince himself than the hospital’s medical director. ‘I don’t want to worry her and I’ll see her soon enough. She’ll be working in here tomorrow.’

  Patrick raised an eloquent eyebrow but clearly decided against debating his patient’s motivation. ‘Tomorrow’s soon enough, I guess. Try and get a good rest.’

  ICU was not the best place to rest. Four of the six beds were occupied and the staff were kept busy. Ross dozed intermittently between turns and having his vital signs measured and recorded, but he felt very tired still the next morning. Tired and weakened by the fatigue and the scare of this feared complication. His spirits rose a little at 7 a.m. with the staff change. Perhaps Wendy would be assigned as his nurse for the day. His resolve to free her from their relationship seemed to have weakened overnight, along with his general physical condition. Maybe there was some way they could keep things together somehow. Maybe, this time, it was too much of a challenge to face alone.