‘BP?’ Elliot demanded, raising the young man’s legs to try to improve the flow of blood to his heart and brain.
‘Eighty and dropping,’ Jane answered, and heard Elliot swear.
The adrenaline and corticosteroid should have acted almost immediately but the young man was still fighting for breath and his circulation was collapsing. He was slowly but surely suffocating.
‘Come on, come on!’ Elliot exclaimed, checking the young man’s pulse again. ‘You are not going to die on me. I am not going to allow you to die on me!’
‘BP 85,’ Jane announced.
It was up a little, but not enough. Keith’s heart was thundering like a train, and if the adrenaline and corticosteroid didn’t work soon he’d have a lot more than anaphylactic shock to worry about.
‘I want more fluids,’ Elliot ordered. ‘Up the adrenaline, too, Jane, and get ready in case we have to perform CPR.’
She nodded. If he had a heart attack on top of everything else…
She didn’t want to think about the consequences and determinedly she concentrated on inserting another IV line while keeping her eyes on the BP gauge.
90…95…100. They’d got him!
‘That was a close one,’ she murmured.
‘Too damn close if you ask me.’ Elliot grinned. ‘Well done.’
‘Well done, you, too.’ She smiled back, then noticed that Keith had opened his eyes and was staring up at them in confusion. ‘How do you feel, Mr Fuller?’
‘Terrible,’ he croaked, licking his lips gingerly. ‘Where am I?’
‘St Stephen’s Accident and Emergency unit,’ Elliot replied, relieved to see that the puffiness around the young man’s face was finally beginning to lessen, the welts on his body fading. ‘Giving Sister Halden and myself the fright of our lives.’
‘Was it almonds again?’ the young man asked.
Elliot nodded. ‘Any idea how you managed to eat some?’
Keith Fuller hadn’t, but his girlfriend supplied the answer. She’d had muesli for breakfast and a tiny fragment of almond must have become lodged in her teeth. When they’d kissed he’d been exposed to the almond and, hey presto, full anaphylactic shock.
‘Almost quite literally the kiss of death, in fact,’ Elliot observed after the young man had been transferred to IC for observation.
Jane nodded and laughed, but as she did so Elliot suddenly realised that Charlie Gordon had been right about something else, too. Her face did light up when she smiled.
Funny how he’d never noticed it before. Neither had he noticed that she had a small dusting of golden freckles on her nose and cheeks. She was quite small, too. Five feet one, he reckoned, and built on generous lines, with wide, curvaceous hips and full, high breasts.
And he knew something that Charlie didn’t. She wore plain white cotton bras and briefs. He knew it because he’d seen them draped over the shower rail in the bathroom alongside Nicole’s little tights and underwear.
Gussie wore skimpy, transparent bras and briefs. The kind guaranteed to have any red-blooded male wanting nothing more than to tear them straight off her. Jane’s underwear was sensible. Sensible, plain white briefs, sensible, plain white bras.
Actually, no. Now he came to think of it, the bras weren’t plain. They had tiny little flowers embroidered on them, and some lace on the bits which would cover her breasts. The breasts that were high, and full, and…
And it was obviously time he made a date with Gussie, he decided, feeling a slow crawl of heat edging up the back of his neck. Jane…Well, good grief, she was a very nice girl and everything, but if he was starting to think about her breasts, he definitely needed to make a date with Gussie.
‘Something troubling you, Elliot?’ Jane asked, her face concerned.
Too damn right there was, he thought, tugging at his collar, but to his relief he was saved from answering.
‘I think Richard wants your help,’ he said, noticing the junior doctor waving to them from outside cubicle 7. But as she turned to go he put out his hand to stay her for a second. ‘Has he come to his senses yet—manners-wise, I mean?’
‘Oh, he’s been much better lately,’ she replied brightly. Actually, he’d taken to virtually totally ignoring her ever since the incident with the gallstones, but frankly she much preferred it to his previous behaviour. ‘I think he’s finally beginning to settle in at last.’
Elliot hoped he was. Staff friction was bad for morale, and love affairs between members of staff were even worse, he thought with a deep frown, seeing Charlie beaming at Jane as she passed him.
It’s none of your business if Charlie is interested in Jane, he thought after he’d reassured the woman with a stiff neck and fever in cubicle 3 that she didn’t have meningitis as she’d feared, but simply a bad cold and a strained shoulder muscle.
The guy’s not married, and Jane’s single, so it’s none of your business. And it wasn’t, but that didn’t mean he wasn’t going to keep his eye on the situation, he decided as he heard the high-pitched wail of an approaching ambulance. Both eyes if necessary, he told himself as the doors of the treatment room opened and the paramedics appeared.
‘His name’s Vic Imrie, and he’s fifty-two,’ one of the paramedics announced as he and his colleague wheeled their casualty in. ‘His son found him collapsed on the floor by the side of his bed. There were two empty pill bottles and a half-full bottle of whisky beside him, and the son thinks he’s taken an overdose.’
‘Any idea what he’s taken?’ Elliot asked, beckoning to Jane and Kelly as the paramedics transferred Mr Imrie from his stretcher onto the trolley.
‘Tetrabenazine and Valium. He’s being treated by his GP for Huntington’s chorea. Unfortunately the son doesn’t know how many pills he took, or when. It could be a couple of hours, maybe more.’
In which case none of the drugs would still be in Mr Imrie’s stomach. They would already be on their way to the intestines.
‘You said his son telephoned you,’ Elliot said. ‘Is he a widower, then?’
The paramedic shook his head. ‘Apparently, his wife went to the opening of a new art gallery in town. The police are trying to contact her, but…’
The condemnation in the paramedic’s voice was clear. Any wife who went off to the opening of a new art gallery, leaving a clearly very ill man at home, wasn’t up to much.
‘Huntington’s is an inherited disease, isn’t it?’ Kelly asked when the paramedics had gone and she was helping Jane to insert a cannula into Vic Imrie’s nose to aid his breathing. ‘Causing a gradual degeneration of the brain?’
Jane nodded grimly. It was, and the disease was one of the most devastating imaginable. Not only did it cause random, jerky, involuntary movements and grimaces, there were also personality changes as the disease progressed, changes that led to memory loss, and eventually dementia.
And if that wasn’t catastrophic enough, symptoms of the disease didn’t usually appear until a sufferer was between the ages of 35 and 50, by which time they’d probably already had children. Children who each had a fifty per cent chance of inheriting the disease.
‘Mr Imrie—Mr Imrie, can you tell me where you are, and what day of the week it is?’ Elliot demanded, putting his head down close to the man’s lips, but nothing the man said was even remotely coherent, and he turned to Jane quickly. ‘OK, I want a blood sample for a blood-alcohol level, and a toxic screen to find out exactly what he’s taken. Just because we’ve got two empty pill bottles doesn’t mean that’s all—or even what—he’s ingested.’
‘An ECG and chest X-ray, too?’ she queried as she began removing Vic Imrie’s clothing.
‘Absolutely.’ He nodded.
But they all knew that they couldn’t wait for the results of any of these tests. The most important thing at the moment was to prevent the digestion and absorption of as much of the drugs that Mr Imrie had taken as possible, and as most of the pills were probably in the intestine, that meant a stomach pump.
�
��BP, Jane?’
‘One-thirty over ninety.’
A bit high, but normal in the circumstances.
‘OK, let’s get his stomach emptied,’ Elliot said.
It was easier said than done. Mr Imrie might be frail because of his Huntington’s chorea, and almost comatose, but he still fought Jane all the way as she pushed the tube up into his nose, then down through his oesophagus and into his stomach.
‘Is it in?’ Elliot asked when she finally straightened up.
‘You bet it is,’ she replied.
‘ECG?’
She glanced across at the monitor. ‘Still normal.’
With the tube in place it was a simple matter to flush Mr Imrie’s stomach out with clear water, before passing a slush of charcoal and a cathartic down the tube which would hopefully absorb any remaining medication. A simple job, but a messy and an unpleasant one.
‘The results are back from the lab, Elliot,’ Kelly announced. ‘Tetrabenazine, Valium and whisky.’
He nodded. ‘We’ll just have to hope we’ve got most of it out. Jane—’
‘He’s arrested,’ she yelled as the alarm on the ECG monitor suddenly went off. ‘V-fib!’
Ventricular fibrillation. Vic Imrie’s heart had gone into total chaotic activity, with no co-ordinated pumping action.
Without a word having been said, Jane and Kelly were already beginning to perform cardiopulmonary resuscitation, and swiftly Elliot whacked Vic Imrie in the centre of his chest, hoping to provoke a electrical current across his chest to the heart to induce his heart rhythm back to normal.
It didn’t work.
‘Defibrillator, Jane!’ he demanded.
Quickly she handed the two paddles to him. He set the machine at 200, rubbed the paddles together with electrical conducting gel to prevent the patient’s skin from burning, then called, ‘Everybody stand clear!’
Obediently Jane and Kelly stepped back from the trolley, and Elliot placed the paddles on Vic Imrie’s chest. A surge of electricity coursed through his body. He convulsed briefly, then lay still.
‘Nothing,’ Jane reported, glancing at the monitor.
‘OK, stand clear again, everybody,’ Elliot announced, only to pause with a frown as he heard the sound of angry, raised voices coming from outside the cubicle curtains. ‘What the hell’s going on out there?’
‘Kelly, go and find out,’ Jane ordered.
The student nurse nodded but suddenly the curtains round the cubicle were pulled open and a middle-aged woman appeared.
‘Don’t—oh, please, don’t do that!’ the woman insisted, tears streaming down her face as Elliot placed the paddles on Vic Imrie’s chest and he convulsed again. ‘Hasn’t he gone through enough already? Hasn’t he suffered enough already? Why can’t you just leave him alone?’
‘Get her out of here,’ Elliot ordered as two security guards piled into the cubicle behind the woman.
‘But I’m his wife,’ she protested as the guards took her firmly by the arms. ‘And I don’t want you to do that. He wouldn’t want you to do that!’
Did Mrs Imrie know what she was saying, what she was suggesting? Elliot wondered, and decided she did. Sufferers of Huntingdon’s chorea could live for as long as thirty years after the disease was first diagnosed. Thirty years of physical and mental degeneration. Would he want anyone he loved to go through that?
He wouldn’t, but it wasn’t his decision to make. He was a doctor, trained to do everything in his power to save life, not to end it, and determinedly he motioned to the security guards.
‘Take her out.’
Sobbing bitterly, Mrs Imrie allowed the security guards to lead her away, and Elliot upped the charge on the defibrillator to 300. Still there was no change, but when he increased the power to 360 the ECG machine suddenly blipped into life.
‘OK, now we’re rolling,’ he declared. ‘Pulse, Jane?’
‘Very weak and slow.’
‘Right. Give him atropine in the IV line. With luck it should make his heart beat faster.’
It did.
‘BP now, Jane?’
‘One hundred over sixty.’
That meant they’d stabilised him enough to go up to IC, and normally such a result would have brought beaming smiles of relief from everybody, but not this time.
This time no one said a word as Elliot mechanically replaced the Ambu-bag the paramedics had inserted with an endotracheal tube, and quickly checked Vic Imrie’s BP and pulse rate again.
‘You did a good job, Elliot,’ Jane said as he stood watching the staff from Intensive Care wheeling Vic Imrie away.
‘Maybe,’ he replied, his voice tired, defeated, ‘but the real question is, was it the right one?’
What could she say to him? she wondered, remembering how devastated Mrs Imrie had looked, how much her husband had struggled against the stomach pump. Nothing but the truth.
‘I don’t know. I honestly don’t know. All you can do—all any of us can do—is the job we’ve been trained for.’
‘Even if it’s not what the patient wants?’ he asked, his eyes bleak. ‘Jane, did you get a look at the size of the lids on those pill bottles?’
‘The size of the lids?’ she echoed in confusion.
‘They’re tiny, awkward, and the top of a bottle of whisky isn’t much bigger. And Vic Imrie has Huntington’s chorea.’
Her eyes widened. ‘Elliot, do you know what you’re suggesting?’
He nodded. ‘That he couldn’t have opened them himself, not with those tremors in his hands. I think his wife gave them to him with his consent.’
Elliot was saying he thought it was a case of assisted euthanasia. That Vic Imrie had decided he didn’t want to go on living any more, and had asked his wife to help him die.
‘What are you going to do?’ she asked, and he shrugged wearily.
‘Nothing. We both know euthanasia’s illegal in this country, but do we really want that couple taken to court?’
She didn’t. It wouldn’t achieve anything. It wouldn’t miraculously cure Vic Imrie. OK, so if Mrs Imrie was sent to prison she wouldn’t be able to help him to kill himself, but that didn’t mean he wouldn’t try again. And the next time it could be something infinitely more messy and painful than an overdose.
And Elliot wondered, too. Wondered at the strength of Mrs Imrie’s love. A love which had been so great she’d been prepared to help her husband to die even if it meant she was left devastated and guilt-ridden for the rest of her life.
He’d thought he’d loved Donna that much once, he remembered as Jane hurried away to speak to one of their receptionists who had appeared at the treatment-room door, her face grim. In fact, it had been he who had insisted on the church wedding, the white dress, the morning suits, because he’d been so sure it would last for ever.
But it hadn’t lasted. Within a year, he and Donna had been arguing, and within two years…
Never again, he’d told himself when the divorce papers had come through. Never again would he ever fall in love, and he’d kept that vow—intended to go on keeping it. To feel the kind of pain Mrs Imrie must have been going through, was still going through…No, he didn’t want that. He didn’t think he could handle that.
‘What is it—what’s wrong?’ Elliot asked as Jane came running back to him.
‘We’ve got a three-month-old baby girl on the way. She’s not breathing and she has no pulse. Sounds like a SIDS.’
Elliot groaned inwardly. He didn’t need this. A case of sudden infant death syndrome was bad enough at the best of times, but he really didn’t need this right now.
They tried their best. They always did try their best, but Elliot knew the moment he saw the baby that it was hopeless. She was mottled, cool and lifeless, and after forty-five minutes he gave the order to stop trying to resuscitate.
“It’s every parent’s worst nightmare,’ Floella sighed, her eyes full of pity, as Jane gently wrapped the baby in a shawl. ‘And it’s always the same story. The
baby was fine when I put her into her cot. No, she wasn’t ill, apart from a slight cold.’
‘I just hope somebody finds out what causes it soon,’ Jane murmured. ‘There have been so many suggestions. Like it’s caused by putting a baby to sleep face down, or it’s because of prematurity, or cold weather, or the parents smoking in the same room. And yet we still don’t know anything for sure other than it’s slightly more common in boys than in girls, and more deaths occur in the winter.’
‘Look, I’ll take the baby down to Pathology,’ Floella said quickly, seeing Jane gently stroke the wisps of golden hair on the little girl’s head. ‘You get off home. Your shift’s over—’
‘I’ll wait for Elliot,’ Jane interrupted. ‘I’ve a feeling he might need some company.’
And he did. Never had she seen him look so defeated as when he came out of their private waiting room, having spoken to the baby’s parents. Oh, she’d seen him upset when they’d lost a patient they’d fought hard to save, but never had she seen him look so drained, so haggard.
‘Want to talk about it?’ she asked as they walked together out of the hospital.
For a moment she didn’t think he was going to answer, and when he spoke his voice was ragged.
‘It’s the irony of it, Jane. We saved Vic Imrie, though both he and his wife wanted him to die, but we couldn’t save that baby and she had everything to live for. It’s the irony—the irony!’
What could she say to him? What could anybody say? Nothing that would really help, and gently she linked her arm in his and said through a throat so tight it hurt, ‘Let’s go home, Elliot.’
And they did, both of them lost in their own private worlds. Both of them hurting, but both equally reluctant for their own private reasons to reach out to one another for comfort.
And there was little comfort for Elliot when they did get home and Nicole returned from her friend’s house.
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