Chapter 7 #2
The toddler was still screaming near the desk and an odd-looking man sat bolt upright on a stretcher beside the triage desk. A police officer stood beside the ambulance crew.
‘Hey… Jennifer!’
‘Hi, Matt. What’s brought you down here?’ The orthopaedic consultant was not a frequent visitor to the emergency department.
‘Overload. You’ve used up all my registrars. There’s a nasty open femur and a fractured pelvis among the MVA patients that have just come in. I’m just waiting for the X-rays to come through.’
‘Oh.’ Jennifer caught the eye of the triage nurse. ‘Is the trauma room covered, Mel?’
‘Yep. We’ve got a status two asthmatic coming in now, though. ETA two minutes. Can you cover that one?’
‘Sure.’ Jennifer’s attention was again caught by the man on the stretcher, who was staring at Mel with an increasingly disgusted expression.
‘Are you going to come out with us tonight?’ Matt’s voice was persuasive. ‘You’ve been having early nights ever since you got back to work, and that’s weeks ago now.’
‘It’s been tiring.’ Jennifer turned her gaze to the overfull whiteboard listing the department’s current patient load. No wonder beds were beginning to line up in the corridors. ‘Maybe I should have taken more than a week to recover in the first place.’
‘How’s the arm?’
‘No problem now. I just put a central line in and hardly noticed it.’
‘And the feet?’
‘Almost back to normal.’ Jennifer was keeping one eye on the doors to the ambulance bay and another on a patient being moved from one of the resus areas. She would need that bed for the asthmatic patient coming in. ‘I’m walking to work now but they’re not up to dancing quite yet.’
‘So just come to the drinks session and on to dinner. If you don’t want to do the club thing after that, we’ll let you go home.’
‘I’ll think about it,’ Jennifer said evasively.
Matt’s face fell. ‘This isn’t like you, Jen. The crowd’s just not the same without you.’
Jennifer smiled. Why was the invitation so unappealing anyway? She had always worked hard and played hard, and a night on the town with a group of congenial people with exactly the same agenda had always been the perfect way to wind down after a stressful shift. Right now, however, it came across as being an empty way to spend an evening. Shallow, even.
What would she rather be doing? Sitting in a hut in the middle of nowhere with a man who would have preferred that she’d never set foot on his planet?
‘ Bitch! ’
The vehement accusation was startling, but it wasn’t directed at Jennifer. She whirled around to see the man on the stretcher still staring at Mel and making a vigorous attempt to get up. Fortunately, the safety belt was restraining his hips and the police and ambulance officers were quick enough to put pressure on his shoulders and force him back against the pillow.
‘You’re all the same,’ the man shouted. ‘You need to be wiped off the face of the bloody planet!’
Jennifer’s eyes widened, but Matt grinned. ‘I don’t think he’s too happy with the fairer sex at the moment, do you?’
Mel stepped hurriedly back behind the central counter.
Jennifer stepped forward. ‘What’s going on?’
‘Midazolam’s wearing off,’ the paramedic told her.
‘History?’
‘Police were called to a department store where he was slicing up women’s clothing with a carving knife.’ The paramedic raised an eyebrow. ‘He was cross enough to be rather uncooperative. Seems that his girlfriend doesn’t find his company too appealing anymore so she left… in the company of his best mate.’
The man on the stretcher spat on the floor near Jennifer’s feet and struggled against the restraining hands. An IV pole crashed to the floor.
‘ Bitch! ’ he screamed again. ‘It’s your turn next!’
‘Call security,’ Jennifer ordered. She caught the eye of a junior registrar emerging from a cubicle to see what the commotion was. ‘Michelle, could you draw me up some more midazolam, please? Matt, can you give us a hand? Mel, call Psych and tell them we need an urgent consult.’
The ambulance bay doors were sliding open and a young girl could be seen struggling for breath.
‘Resus 3,’ Jennifer called.
She pulled Doug from Resus 2 to help, leaving Matt and a very nervous registrar to deal with the psych patient.
‘We need two secure IV lines,’ she instructed Doug. ‘Continuous nebulised salbutamol and some adrenaline, IV. What’s the oxygen saturation?’
‘Less than 90 per cent,’ the paramedic reported.
‘We’ve got one patent IV. Sixteen gauge.’
‘Good. Let’s get her off the stretcher. Doug, get someone down from Anaesthetics. We may well need to intubate.’
‘On the count of three,’ someone said. ‘One, two… three !’
‘Sit her up,’ Jennifer ordered. ‘It’s okay, sweetheart,’ she told their patient. ‘We’ll get on top of this really soon.’ She had her stethoscope in position, noting with dismay an almost silent chest and increasing panic in the girl. They were on the verge of a respiratory arrest. It was no problem to tune out the scream from behind the curtains.
‘ Bitches! You’re all the same! Don’t touch me! Ahh! ’
Twenty minutes later, Jennifer’s young asthmatic patient was on the way to the intensive care unit. Colin, the man with the septic shock from his urinary tract infection, had also gone to Intensive Care. The car accident victims were under control, two having gone to Theatre and one having a CT scan. The disturbed psychiatric patient was well sedated and had two burly security officers in attendance pending his transfer to a secure ward. Peter, the young man with the spontaneous pneumothorax, was still stable but the chance to grab a cup of coffee remained elusive.
‘How long has the nosebleed been going on for?’
The epistaxis patient in Cubicle 7, Mrs Bennett, had presented enough of a challenge for a junior registrar to go in search of assistance. ‘Over an hour,’ she told Jennifer. ‘And there’s no response to direct pressure.’
‘Spontaneous bleed?’
‘Started after she sneezed.’
‘Any past history?’
‘Not of nosebleeds. She has hypertension and angina and she’s on a high dose of aspirin daily.’
‘That won’t be helping. Is the bleeding anterior or posterior?’
The registrar looked disconcerted. ‘I’m not sure. Presumably posterior, if direct pressure isn’t enough to control it.’
‘Get a Y suction catheter,’ Jennifer instructed. ‘And find out where the site of bleeding is. When the catheter is passed beyond the bleeding site you’ll get blood appearing at the nostrils again.’
The registrar nodded.
‘Take bloods for haemoglobin, blood group and a coagulation profile. What’s the blood pressure?’
‘One-ten over sixty.’
‘And she’s normally hypertensive?’
‘Yes. She’s on a beta-blocker for that.’
‘Keep a close eye on her then. With beta blockade, she won’t be showing a rise in heart rate to warn you of hypovolaemia. Get IV access and put fluids up.’
‘Will it need packing?’
‘Get back to me when you’ve decided on the bleeding point. If it’s posterior and still severe, we might need to use a Foley’s catheter in combination with anterior packing. She’ll probably need some sedation to cope with that. She’ll also need antibiotics if it’s packed, and we’ll have to admit her.’
A nurse hurried up, holding a cardboard container. ‘Mrs Bennett’s just vomited.’ She held out the bowl, which appeared to contain a large volume of fresh blood.
Jennifer started moving rapidly towards Cubicle 7.
‘Mel? Could you get someone from ENT to come down, please?’
Staff from the ear, nose and throat department were not readily available, which would have been a nuisance for Jennifer a few weeks ago, keeping her tied to the treatment of a single patient and unavailable for the next critical case to come through the doors. The satisfaction to be gained from focusing on one patient was a new phenomenon, but the change in the way Professor Allen worked had not gone unnoticed.
‘Are you going visiting this afternoon?’ Mel held up a pair of spectacles. ‘Only these are Mr Smith’s glasses and if you’re going up to ICU, I won’t have to find an orderly to deliver them.’
Jennifer took the spectacles. ‘I’ll pop up and see how he’s getting on after my shift finishes.’ She glanced at the wall clock. ‘Which should be in about ten minutes.’
It was actually more like an hour. What should have been a swift final consult to finish her day, as she saw the toddler who’d been screaming intermittently for half the afternoon and prescribed antibiotics for an angry ear infection, was hijacked by the distraught mother of a fourteen-year-old girl.
There were no staff members immediately available to talk to the quietly sobbing woman, so Jennifer took her into the relatives’ room herself and closed the door.
‘You’re Courtney’s mother, aren’t you?’
She nodded. ‘I’m Jane. They’ve just taken Courtney to the operating theatre.’
‘She needs a D and C,’ Jennifer explained gently. ‘The miscarriage wasn’t complete.’
‘I didn’t even know she was pregnant. I had no idea! I should have known.’ Tears flowed afresh. ‘And she’d been raped at a party. Why didn’t she tell me?’
‘Sometimes, when something terrible happens, it’s easier to try and pretend it didn’t happen than to have to go over and over it in your head. Telling someone forces you to confront the reality, and that’s a hard thing to do.’
Jennifer hadn’t spoken to her colleagues or even close friends in any detail about her experience of the plane crash. Maybe that was why it was proving so difficult to stop thinking about it all. About the narrow brush with death. About losing a patient she had desperately wanted to save. About the ordeal of the long trek to safety.
About Guy Knight.
‘I should have known something had happened. I just thought she’d fallen out with her friends at school or she was worried about exams or something. She’s been so quiet for the last few weeks. Not eating or sleeping properly. Not going out with her mates.’
It sounded remarkably familiar to Jennifer. She hadn’t been raped, of course – quite the opposite – but the terror of the crash and its aftermath had to rank fairly highly in any list of traumatic events.
‘You’ll get through this,’ Jennifer said reassuringly. ‘It’ll take time and it might not be easy, but your daughter needs your support now more than ever.’
Jane sniffed and then nodded. ‘I would have been there for her, even if she’d ended up having the baby. Except… how could you love the child if the father had done that ? This is probably the best thing that could have happened. That’s an awful thing to say, isn’t it?’
‘It’s a perfectly understandable reaction,’ Jennifer assured her. ‘And now Courtney’s got the chance to put it behind her and move on with her life. With your support.’
It was just as well Jennifer hadn’t ended up with any kind of reminder more tangible than memories. It hadn’t even occurred to her at the time that she was risking pregnancy… or worse. Jennifer never took risks like that. She must have been out of her mind. She had been lucky, but it had been stupid, and Jennifer didn’t try to push back the anger her stupidity generated even now.
‘I’d like to be there when she wakes up.’
‘They’ll let you into the recovery room. It’s a fairly quick procedure so you won’t have to wait much longer.’
‘Can I go there now?’
‘I don’t see why not.’ Jennifer stood up. Her flash of anger was fading into a vague irritation, and movement seemed like a good way to completely dispel what could become a negative mood. ‘I’m on my way to the intensive care unit so I go past Recovery. I’ll show you the way and have a word with the nursing staff.’
Their progress along the corridor was temporarily blocked by a patient being moved with a large entourage of medical attendants. They were manoeuvring the bed with extreme care and Jennifer could see that they had an unstable spinal injury patient, probably on the way to Theatre or Intensive Care. The young male had his head secured in halo traction and was on a ventilator.
‘Motorbikes,’ the accompanying consultant muttered as he passed Jennifer. ‘Don’t you love them? C4-5 fracture.’ He turned his head again a moment later. ‘Only two weeks to go, Jennifer. Still confident?’
‘As always, John.’ Jennifer’s smile felt forced.
John’s looked smug. ‘May the best man win and all that.’
The journey with Courtney’s mother continued in silence. John was the main competition Jennifer faced in the upcoming decision regarding a new head of department for Auckland Central’s emergency department. A few years older than Jennifer, he was amused by her bid for the top job and rarely missed any opportunity to put her in what he considered to be her place.
Common dislike of John’s arrogance might well work in her favour, she decided a little later, having finally left the hospital after confirming that Colin was responding to treatment and his condition improving. Her chin rose unconsciously as she started the short walk to her apartment. The nagging irritation that the talk with Courtney’s mother had generated now had new fuel.
She’d show her fellow consultant. She’d win this position, and when she did, she’d do something about the way John interacted with both his colleagues and his patients.
It was a Friday evening, and the cafés and bars in the trendy commercial area of Jennifer’s apartment were all buzzing. She walked past people sitting at tables on the pavement, and a wave of nausea swept over her at the rich aroma of roasted meat. Ducking down her alley, she punched in the security code for the gate and ran upstairs to let herself into her apartment and get to the bathroom just in time.
With a facecloth soaked in cold water and pressed to the back of her neck, Jennifer stared at her pale reflection in the mirror. What on earth was wrong with her? She was probably hypoglycaemic, she decided. It had been a physically stressful day and she hadn’t eaten anything other than a biscuit with a cup of tea at some point late in the morning. She often got through a hard day without a meal, but she hadn’t had her usual breakfast this morning, had she? The thought of food had made her feel queasy even then.
Jennifer hoped she wasn’t coming down with some kind of virus. She needed to be on top of her game in the runup to this job interview, and she was already at a disadvantage with her broken arm and the general tiredness she couldn’t quite shake off. It was just as well she had declined the invitation for a night out on the town. What she needed was a hot bath, some good food and an early night before another 6a.m. start tomorrow.
Soaking in scented water, Jennifer started mentally ticking off the day’s cases. Often only a couple stood out and the rest became an easily forgotten blur unless her memory was jogged. For some reason, not being able to remember the details of all of them, or put a name or face to a case, had become disheartening over the last couple of weeks.
Peter was easy to remember because he’d reminded her of Guy. Colin had made her think of Digger. The psych patient with his desire for revenge against all women was certainly memorable, and that toddler with the ear infection had been called something a little unusual. India? No, Africa. The name of an elderly woman with a fractured femur had vanished completely, however, and Jennifer sighed, giving up the game.
Maybe she was just pushing herself too hard at the moment in her determination to slot back into the routine of her normal life and create the kind of impression that would help her win the coveted position of head of department.
Keeping her cast dry while bathing had become part of the daily routine, but Jennifer was looking forward to having it removed. She was due for another X-ray on Monday, which would be four weeks since the fracture. At least it wasn’t painful any longer. Just irritating.
Like not being able to remember the name of that old woman. The one who’d slipped while mopping her kitchen floor. Gloria? Gladys? When the hairbrush slipped from her hand a moment later, Jennifer actually swore aloud. Then she shook her head and laughed at herself. Being irritable and snappy denoted a lack of control that had never been a fault of hers, and she wasn’t going to tolerate it now. What she needed was a glass of wine to wash away the nagging sense of unease that seemed to be plaguing her.
John wasn’t worth wasting emotional energy on. Except that this mood had started before that meeting in the corridor, hadn’t it? She’d been angered by the reminder of what she’d risked by that night with Guy.
Nearly a month ago.
Let it go , she told herself. It’s over .
Except that it wasn’t, was it?
Jennifer stared at her glass of wine, but she didn’t raise it to her lips. The irritation left in the wake of the conversation with Courtney’s mother had had nothing to do with her own stupidity regarding that night. She had been stupid all right, but it was the continuance of that state providing the irritation now. She had been a perfect example of the kind of denial she had described to Courtney’s mother, but the awareness of what had been provoked was only just surfacing now.
She’d taken a risk and maybe she hadn’t been so lucky. It was four weeks ago now. The stress of the whole experience might not be enough to explain why her period was a little late. And two weeks couldn’t be considered a little late either.
‘Oh, my God,’ Jennifer breathed.
Was it possible she was pregnant ? With Guy Knight’s baby?
It was easy enough to find out. A quick trip to the staff toilet with a testing kit at 6a.m. the next day confirmed the suspicion that had kept Jennifer awake for most of the night.
The shock would have been numbing except that it didn’t have much of a chance to set in. Jennifer was still washing her hands when a nurse burst into the rest room.
‘Oh, there you are, Dr Allen. We’ve got an arrest in Resus 2 and there’s a multi-victim MVA arriving any minute.’
‘On my way.’ The crumpled paper towels fell into the rubbish bin and covered an equally crumpled pregnancy test kit.
Jennifer almost stopped in her tracks on entering Resus 2. Why, of all days, did she have to face a case like this right now?
‘Apparently found non-breathing fifteen minutes ago,’ Doug informed her. ‘CPR started by the ambulance crew.’
The small paediatric defibrillator pads looked far too large for this tiny chest and the plastic tube securing the airway obscenely out of place.
‘How old is she?’
‘Ten weeks.’
It was sadly clearly too late for this baby, but they had to go through the motions.
‘Shocking again. Everybody clear?’
‘Clear.’
‘Where are the parents?’ Jennifer had taken over the bag mask ventilation. It took only a gentle squeeze to inflate tiny lungs. The main reason for going through a distressing process like this was to reassure distraught parents that everything possible was being done for their child, but there were no stricken bystanders in Resus 2.
‘The mother’s in a cubicle.’ Doug sounded disgusted as he drew up new drugs. ‘Too drunk to stand up. The father’s being interviewed by the police.’ He watched the compressions on the tiny chest in front of him. ‘She’s seventeen. He’s just out of prison. There was a party going on and apparently the baby was making too much noise. Mother says she put her in their bed and didn’t notice she wasn’t breathing until she woke up this morning.’
Had the infant been inadvertently suffocated, sleeping with an intoxicated adult, or had something more sinister happened earlier in the night? It would be up to the pathologist and police to determine the cause of death, but this was, possibly, an escape from a bleak future for this child. Jennifer glanced at the clock.
‘How long has CPR been in progress?’
‘Forty-five minutes, including pre-hospital time.’
‘I’m calling it, then, if we’re all in agreement,’ Jennifer said heavily. ‘Doug?’
‘Yeah.’ The registrar shook his head, his face grim.
‘Michelle?’
The young registrar just gave a single nod.
‘Suzy?’
The nurse also nodded mutely, her eyes filling with tears.
‘Okay. Time of death 6.47a.m.’ Jennifer’s gaze returned to the infant, a tiny still shape on the bed. She reached to disconnect the ECG electrodes, her heart breaking as her fingers brushed the soft skin. It would be nice to remove the ET tube, but the pathologist would need to confirm its correct placement, and maybe there wouldn’t be a parent wanting to hold this baby immediately anyway.
She had what she knew was a very inappropriate urge to pick the baby up and hold it herself. Just for a minute or two…
‘Dr Allen?’ A head came through the gap in the curtains. ‘They need you in the trauma room.’
‘Be there in a second.’ Jennifer stripped off her gloves. It was better that she had to focus on something else right now. Otherwise the overwhelming sadness would be too much, and she might totally ruin her chances of becoming the head of this department by being seen weeping in a corner somewhere.
She flicked the curtain back to screen the area as she emerged into an already humming department. Straightening her spine, Jennifer set off to deal with the rest of her shift.
She could cope.
She had to.
She was in control of the destiny of more than one person now. Her baby was never going to lie abandoned on some hospital bed. It would be loved and cared for to the very best of her ability. It was a complete shock to be facing motherhood like this, but the urge to protect the baby that was just starting to grow in her womb was, suddenly, astonishingly fierce.
This was her baby.
She might not have chosen to get pregnant, but there was something else that was vying with the urge to protect this baby. Something she’d never expected to feel – the longing to hold her own child in her arms.
To be a mother.
As the days passed over the next week, tentative ideas became plans.
She would have to leave her apartment, of course. A child needed a real home, with a garden, preferably close to a good school. She wouldn’t be able to manage alone, but that wasn’t an insurmountable problem either. She would be able to afford the best available nannies, especially if she became the head of department.
The upcoming interview had provided several days of anxious focus and had interfered more than a little with her concentration levels, but it, too, settled into the shape of a plan. As long as nobody found out about her condition before the interview, it shouldn’t make any difference. She could always plead ignorance later and blame it on something like an irregular cycle or a lighter than normal period.
Sure, she might need some time off, but if it all went well, she could work right up until she was due, and if she saved up all her paid leave she could probably take a month off before coming back to work full time.
But what about Guy?
The issue had been there from the moment she’d seen the colour appear on the test strip, but it kept getting pushed to the bottom of the list as she sorted through all the other worries. There was no avoiding it now, although Jennifer managed to put it aside for just a little longer while she made a quick trip to a medical ward to finish her day.
Colin Smith reminded her even more of Digger today, with his tufty hair in disarray but a cheeky smile on his face.
‘It’s my angel back again.’
‘You’re looking so much better.’ Jennifer’s delight was obvious. ‘Are they letting you go home soon?’
‘Tomorrow.’
‘That’s wonderful.’
Jennifer headed for home feeling very satisfied. She had to weave her way through a very busy street, with people enjoying a sunny Saturday evening at the cafés and boutique shops. Traffic was snarled up at one point, with drivers hooting in irritation. A teenage girl, texting on her cell phone without looking up, bumped Jennifer’s shoulder as she passed. Collecting her balance, she spotted a dark head at one of the footpath tables. For a split second, Jennifer was convinced it was Guy.
Turning into the alleyway leading to her apartment block, Jennifer saw the man’s profile and realised it wasn’t Guy. A curious mixture of relief and disappointment stayed with her as she climbed the stairs, and an image of the real man was uppermost in her mind.
Opening a window to air the apartment, all the sounds and smells of the street below came inside and Jennifer suddenly felt more than disappointed. She felt… trapped.
Lost.
She would rather be sitting beside a picture-perfect mountain lake, she realised with something like desperation. Absorbing the stillness. Waiting for Guy to return.
Sitting down, she tried to pull herself together, but nothing worked. The plans she had been formulating all week were no longer the answer to any problems. They all felt suddenly wrong. The satisfaction in following up one of her patients today to find him due for discharge evaporated. Could she even remember half the cases she had seen today? Would she have the time or inclination to follow any of them up?
She was tired. Bone-achingly weary. Closing her eyes and dropping her head onto the back of the couch, Jennifer allowed herself to focus on the only thing that really mattered right now.
She was going to have a baby.
Would it be a girl with blonde hair and blue eyes like her? Maybe it would be a boy with dark eyes and a flop of even darker hair.
Like his father.
And, with that thought, Jennifer sighed. There was no way around this. A telephone call or a letter to inform Guy of his impending fatherhood wasn’t good enough. He wouldn’t welcome Jennifer coming into his life again, but she had the perfect excuse now, didn’t she? Telling someone news like this could only decently be done face to face.
A knot of something like excitement coalesced amidst the emotional turmoil. All the half-formed fantasies and even the crazy idea she could be in love with the man of the mountains – that Jennifer had attributed to post-traumatic stress syndrome – edged back into her mind. If she saw him again, she would know exactly how she really felt, wouldn’t she?
She wouldn’t tell him she was coming. She wouldn’t even need to tell anyone at the hospital where she was going. The mission could be accomplished on her next couple of days off. And maybe, just maybe, Guy might be happy to see her again. He might even welcome the idea of becoming a father if it was forced on him. Never mind those emphatic statements he had made about not planning on having kids and having no space in his life for them. It was another remembered comment that seemed of far greater significance at this moment.
What had that woman said in the eavesdropped conversation?
Oh, yes…
If anyone needs a family, that young man does.
Jennifer was unaware of the tears trickling down her face. She needed a family, too. A complete family. Something she hadn’t had since she was eight years old. Was that what the appeal of having a baby was all about? That she would have someone to love who would love her back?
But it wasn’t just the baby she wanted, was it?
Jennifer wanted Guy as well.