Chapter 2
2
I’ve known I wanted to be a nurse since I was a teenager, but I never expected to end up working in A&E. I always imagined myself on a ward, chatting jovially with patients as I adjusted their drips or helped them with their medication. However, we were expected to work in a variety of roles as part of the training and I found myself drawn to the cut and thrust of A&E, even though the schedule of twelve-hour day and night shifts is punishing. The other surprise is that Natasha, my younger sister, ended up following me into nursing and works in the Paediatric department of the same hospital in Tunbridge Wells. Neither of our parents have any connection to the medical world and my father is positively hospital-phobic, so they find it particularly strange that both their children are nurses.
As predicted, the Maurice Minor story made its way around the entire department by the end of my shift, and there are still a few giggles as we prepare for our briefing the following morning. Five minutes into the briefing, a man bursts in, looking rattled.
‘Ah, Dr Milne,’ Dr Patel says dryly. ‘Nice of you to join us. We start at eight, for future information.’
‘I’m so sorry I’m late,’ he tells her. ‘I couldn’t find anywhere to park.’
Uh-oh, I think to myself. One of the many things you learn quickly about Dr Patel is that she has no time for excuses.
‘That must have been very trying for you,’ she tells him, the note of sarcasm in her voice as big a warning signal as a rattlesnake shaking its tail. ‘Parking is always a challenge at any hospital, and yet we all seem to have managed it. Might I suggest you allow more time in future?’
He opens his mouth to speak, but the expression on her face evidently makes him think better of it, and he ends up nodding mutely.
‘Right,’ Dr Patel says, having made sure that the new arrival has got the message. ‘Please continue, Dr Kozlov.’
‘As I was saying,’ Dr Kozlov, the consultant from the previous night shift, says with a heavy sigh, looking pointedly at a blushing Dr Milne, ‘bay five has Mr Jones, who has complex fractures of the femur, having been involved in a road traffic accident in which his motorbike collided with a car just after midnight last night. He’s stable, and we’re keeping him comfortable until theatre are ready for him. No obvious complications, he’s a lucky man, but we’re keeping him under close observation just in case. No evidence of concussion or other head injury. He does have considerable bruising of the torso and two fractured ribs, but these are to be expected. Any questions before we move on?’
The meeting continues in much the same vein as Dr Kozlov takes us through each patient currently in Majors. Once he’s finished, he stands aside to let Dr Patel finish the briefing. Unusually, we haven’t been interrupted by any urgent new arrivals this morning.
‘Everyone, this is Dr Milne,’ she tells us at the end. ‘He’s a junior doctor and it’s his first day with us. Tilly, I’d like you to take him under your wing to begin with, please.’ She turns to Dr Milne. ‘Tilly is one of our senior nurses, so she’ll show you the ropes and get you up to speed. Remember, all medical interventions need to be agreed with me or one of the other duty consultants. I don’t know what it was like where you came from, Dr Milne, but we operate a tight ship. Any questions from anyone?’ She looks around the room. ‘Good. Why are you all still here then?’
As the others file out to begin their shift, I take a moment to study our new arrival, and I’ll admit to liking what I see very much. He’s dressed in the standard uniform for junior doctors, but I can’t help noticing his strong-looking forearms. His dark wavy hair is shiny, making me suspect there’s some kind of product in it, and his brown eyes sparkle with humour. Having him under my wing for the day is going to be very pleasant.
‘Welcome to the department, Dr Milne,’ I tell him, holding out my hand. ‘I’m Tilly.’
‘Delighted to meet you, Tilly,’ he replies, gripping my hand with just the right amount of strength. ‘Please call me Luke.’
I smile. ‘I can call you Luke in here, but Dr Patel will haul me over the coals if she hears anything so informal in front of the patients.’
‘Is she always that terrifying?’
‘I wouldn’t call her terrifying, exactly. If you do everything she says and don’t upset her, she’s a pussycat.’
‘Hmm. I’ll take your word for it.’
‘Shall we go and see some patients then?’
* * *
One of the things that I love about my job is that you never find yourself clock-watching. From the moment the shift starts, you’re fully immersed and you never know what’s going to come through the door next. Peak adrenaline is when the red phone rings with a trauma call. This is how the paramedics alert us to an incoming case so serious that the trauma team needs to assemble. If you’ve ever seen one of the hundreds of hospital dramas on TV, you’ll have seen people running alongside stretchers as they try to hook up drips and yell medical terms such as ‘intubate’ at each other. Thankfully, the reality is a little less dramatic. Everybody is in position before the ambulance arrives, and we work quickly and quietly to try to stabilise the patient as swiftly as we can. Of course, we don’t always succeed, and that’s tough, particularly when the patient is young, but you don’t generally get time to dwell on it because the next emergency is usually just around the corner.
Today is no different. No sooner has the motorcycle accident victim gone down to surgery than his place is taken by an elderly woman who has fractured her hip as a result of a fall at home. She looks pale and frightened, and seems confused about where she is and what’s happening to her.
‘I don’t rate her chances,’ Luke mutters to me conspiratorially as I do her observations.
‘One thing I’ve learned from my time here is that you can never predict a patient’s journey,’ I tell him equally quietly.
‘Yeah, but hip fractures are usually the beginning of the end for old people, aren’t they?’
‘What area were you working in before?’ I ask as I study the screen. The woman’s blood oxygen levels are lower than they ought to be. ‘Mrs Corrigan?’ I raise my voice and two cloudy blue eyes lock on to mine. ‘Can you take some deep breaths for me, please?’
‘I was in geriatric care,’ Luke whispers as I watch Mrs Corrigan’s fragile chest rising and falling. ‘Hip fractures and pneumonia were the two biggest signs that a patient was starting their final decline.’
‘That’s looking much better,’ I tell Mrs Corrigan brightly as the oxygen levels on the screen come up to normal levels. ‘Make sure you breathe deeply every so often, OK?’
‘That’s all lovely,’ I tell Luke quietly, so Mrs Corrigan can’t hear, ‘but irrelevant in this role. For all I know, Mrs Corrigan might make a full recovery and spend many years waltzing round a ballroom with her surprisingly ardent lover. Our job is to assess her and, in conjunction with the consultants, decide what treatment path is going to be best for her. Whatever happens, she won’t be staying here. So, what are your thoughts, doctor?’
He stares intently into my eyes, and I can feel my skin prickling under his gaze. The last time someone looked at me with that level of intensity, it was my last boyfriend, I was naked and underneath him. To my horror, my mind starts to imagine Dr Luke Milne in that position. Thankfully, he breaks the spell by speaking.
‘It’s unlikely that anything could be done for her surgically,’ he murmurs. ‘But she can’t be discharged without an appropriate care package in place, so I guess I’d admit her on to a ward and keep her under observation while social services sort out the relevant bits and pieces.’
I smile at him. ‘Good plan. Given that she’s broadly stable, shall we go and see if Dr Patel agrees with you?’ I raise my voice again as I carefully remove the blood pressure cuff from her arm and ease her finger out of the oxygen monitor. ‘Mrs Corrigan, are you in any pain at the moment?’ I ask.
‘No, dear,’ she replies in a wavering voice. ‘If you’re finished, I’ll be on my way.’ She starts to try to sit up and winces.
‘Try not to move, Mrs Corrigan,’ I tell her firmly. ‘You’ve broken your pelvis, so you need to stay in bed for now, OK?’
‘I can’t stay in bed, dear,’ she says, her eyes filling with tears as she sinks back onto the pillow in defeat. ‘I’ve got to feed my cat.’
‘We need to keep you here for a while. Is there someone we can call to feed your cat? What’s his name?’
‘She’s called Sheba, and I suppose my neighbour would pop in if I asked nicely. I do hate being a nuisance though. Are you sure you can’t just give me some painkillers and send me on my way?’
‘Quite sure,’ I tell her with a smile. ‘But let’s see if we can get hold of your neighbour, hey?’
* * *
‘You were brilliant with Mrs Corrigan,’ Luke tells me a while later when we’re taking our first break. He’s staring at me intently again and it’s making me feel slightly hot. I hope I’m not blushing. ‘I think there’s a real difference between how you treat the elderly in A&E and how we used to treat them.’
I think about it for a moment. ‘I guess,’ I begin carefully, ‘it’s probably because most of the elderly patients we get in are still living independently, and they expect to return home once we’ve fixed them. Of course, that isn’t true for everyone, and it might not be true for her, but they need that hope to sustain them. Does that make sense?’
‘Yes, I think so.’ The intensity of his gaze has somehow ramped up a notch. ‘Do you mind me asking how you became an A&E nurse?’
I laugh, trying to break the tension and dispel the rather steamy thoughts about Dr Milne and me that are starting to circle in my head. ‘The usual way. Nursing degree, falling in love with A&E during my training placements, applying and getting the job. You?’
‘I decided I wanted to become a doctor when my granddad first fell ill. I was only ten, so I had no concept of terminal illness and couldn’t understand why they weren’t just making him better. I was angry when he died, wrongly assuming that the doctors were stupid and hadn’t given him the right treatment, so I decided to become one myself so I could do better.’
‘And how did that work out for you?’
He grins. ‘I’m here, aren’t I? I realised long before I started my training that my original assumption was wrong. They’d obviously done everything they could for him, but he’d spent most of his working life around asbestos, so it was bound to get him one way or another. But by then, the concept was ingrained.’
‘And why transfer from geriatrics to A&E?’
‘I moved house,’ he says simply. ‘I was in Milton Keynes before, and commuting from here wasn’t really practical.’
‘Long way to move,’ I observe.
A strange look crosses his face, as if he’s trying to decide whether to tell me something or not, and it occurs to me that this move might not have been his choice.
‘Sorry,’ I continue. ‘None of my business. Right, shall we get back?’
‘We’ve got a couple of minutes still,’ he says, checking the clock on the wall. ‘I didn’t mean to be odd just then. It’s just my mother. She lives on her own in a flat on Monson Road and, well, she’s not coping so well any more. I’ve moved back down here to help her out a bit.’
‘What a lovely thing to do. I bet she’s glad to have you around. So, did you grow up here?’
‘I did. Moving to Milton Keynes was supposed to be my big gesture of independence, but…’ He tails off.
I touch his arm lightly, savouring the sensation. ‘I’m sure she appreciates it.’
He smiles. ‘I’m not so sure.’ Another unidentifiable look crosses his face before he speaks again. ‘Look, don’t take this the wrong way but most of my friends from back in the day have nine-to-five jobs, so it’s not always easy to meet up with them. I’d like to get to know a few people from the hospital and you seem friendly. Do you fancy going for a quick drink after work?’
If I wasn’t flushed before, I definitely am now. Does he mean drink as in drink drink? Just the two of us, talking quietly in a dimly lit booth in a pub? Is he coming on to me? I slap myself mentally. Of course he doesn’t mean that. He’s just said he’s keen to get to know people, so he obviously means me and the rest of the team, irritatingly. I’ll admit that the idea of it just being the two of us was rather appealing.
I force a bright smile on to my face. ‘That sounds fun. I’ll ask around and see who else is free.’
‘Thanks.’ He smiles but there’s something behind it. Is it disappointment?