Читать книгу A Consultant's Special Care - Joanna Neil - Страница 7

CHAPTER ONE

‘HELP… Oh, please, help me, someone. I think he’s hurt badly…he can’t breathe…’

Abby heard the distressed cry from where she was sitting, on a sun-warmed golden stretch of sand in the lee of an outcrop of rocks. She had been watching the holidaymakers swimming in the sea, enjoying the rare peace of a summer’s afternoon while she listened to the snatches of laughter and sounds of children playing nearby.

Now, though, the tranquillity of the day was abruptly shattered. Abby lifted a hand to shield her eyes from the sun and looked over to where the appeal had come from, further along the cove, where a craggy promontory jutted out into the sea, its rock-strewn base dashed by increasingly powerful waves. A fair-haired young woman was kneeling on the beach, and she appeared to be cradling a man in her arms.

Instinct took over, and Abby scrambled to her feet as quickly as she could, snatching up her sandals and canvas bag. The skirt of her cotton dress flapped against her bare legs as she went, creating a faint breeze that cooled her hot skin as she hurried along the shoreline towards the couple.

Reaching them, she saw that the man wasn’t moving, but was simply lying there as though he had collapsed. He was in his early twenties, she guessed, on the thin side, his body still damp from swimming in the sea, and there were fresh grazes on his chest. Looking at them, Abby frowned.

‘I heard you call. What happened? What’s wrong?’ she asked, sinking down on to the sand beside the pair. The mass of her honey gold curls fell across her cheek with the movement, clouding her vision, and she swept them away with the palm of her hand, tucking the silky strands behind her ear.

‘He was swimming, and I think he was beginning to get tired,’ the girl said shakily. ‘He’s been ill recently—a kind of flu virus, I think…I knew he was overdoing it and I told him he should stop, but he wouldn’t listen…I don’t know what he was trying to prove. The waves were getting fiercer and I said we should be going.’ Her mouth was trembling, her voice breaking in panic.

‘Then all of a sudden a huge wave came and took him by surprise and toppled him over and he was too close to the rocks. I knew he was too close. I think he stumbled and he must have fallen onto them. He was winded—I could see that. It was all he could do to get back to me, and then he collapsed…’ She looked up at Abby, her blue eyes troubled, on the verge of tears. ‘I don’t know what to do. I need to get help, but I can’t leave him like this.’

‘I’m a doctor,’ Abby said, her gaze busily moving over the ashen-faced man. ‘I’ll have a look at him, shall I?’

She said it confidently enough, but if the truth were known, she had not long ago finished a stint as a house officer, and she was still feeling a little unsure of herself. Her next post as senior house officer wasn’t due to start until tomorrow and even that threatened to be a nerve-racking experience.

She hadn’t met her new boss yet, but Mr Blakesley’s reputation had gone before him. He was known to be sometimes curt, blunt and demanding, and as the consultant in charge of Accident and Emergency at the Roseland Hospital, he was the one who would be supervising her experience of emergency medicine for the next six months.

Pushing those awkward thoughts aside, she concentrated her attention on the injured man. He was still conscious, but he appeared to be in pain and wasn’t paying either of them very much attention just then. ‘What’s his name?’

‘Kieran. I’m Vicky. We just came down here for the weekend. We thought Cornwall would be so romantic…’ Her voice trailed off in despair.

Abby tried to reassure her patient. ‘Kieran,’ she murmured gently, ‘I’m Dr Curtis—Abby. I’m going to take care of you, but I just need to examine you for a moment. Is that all right with you?’

Kieran nodded, almost imperceptibly, as though the effort was too great, and Abby quickly checked his pulse. His breathing was laboured, and she looked carefully down at the grazed area of his chest. She watched as he tried to breathe and discovered that there was a part of his rib cage that wasn’t rising and falling as it should. Instead of expanding as he breathed in, that section moved inwards, and when he tried to expel the air from his chest, it shifted outwards.

‘I think you have what we call a flail chest,’ Abby explained to him quietly. ‘It means that you’ve probably broken several of your ribs in a couple of places, so that part of the rib cage is moving independently and interfering with your breathing. I’ll do what I can to make you feel more comfortable, and then we’ll get you moved to hospital for a proper check-up.’

She lifted her gaze to Vicky. ‘I’ll need to go and get my medical bag from my car,’ she said softly. ‘I’ll be just a couple of minutes…it isn’t too far away. Will you watch him carefully while I’m gone? Don’t move him at all, just make sure that he’s comfortable and try to keep him warm. If he should stop breathing, tilt his head back slightly and blow into his mouth. Do you think you can do that?’

Vicky looked at her with frightened eyes, but she nodded all the same.

‘OK, then.’ Abby looked around and saw that there was a beach towel spread out on the sand nearby. ‘We’ll cover him with this, shall we?’

She carefully tucked the towel around Kieran, and then got to her feet, reaching into her bag for her phone to call for an ambulance as she headed towards the cliff. Her car was parked on a standing space on the clifftop, and she was thankful that she was strong and healthy and could manage the climb at a reasonable pace. She wasn’t so sure that the ambulance crew would cope as well in this terrain with a patient on a stretcher, though, and when the operator suggested sending the rescue helicopter, Abby agreed readily enough.

Going back down to the beach was more difficult when she was carrying her medical kit, but she made as much haste as was possible, knowing that Kieran’s condition could deteriorate at any moment. He was already having problems with his breathing, and if he had punctured a lung or a blood vessel, he could be in deep trouble.

‘He’s getting worse.’ Vicky’s agitated words greeted Abby as she came to kneel down beside her patient once more. ‘What’s the matter with him? Can you help him?’

By now Kieran was showing clear signs that something was very wrong with him. His breathing was rapid and his lips were beginning to show a bluish tinge. ‘He needs oxygen,’ Abby murmured.

Quickly, she slid a Guedel airway into place, and then covered his mouth and nose with a face mask and began to squeeze the attached ventilation bag. ‘Do you think you could manage to do this?’ she asked Vicky. ‘I need to examine him again.’ As she spoke, she heard the gratifying drone of the rescue helicopter in the distance. At least help wasn’t far away.

‘Yes, I can do that.’

‘Good.’ Abby ran her stethoscope over Kieran’s chest. There were no breath sounds on his injured side and he was becoming increasingly distressed. His pulse was rapid, and the veins in his neck were becoming distended, and all that was very bad news. It meant that pressure was building up dangerously, and if she didn’t act soon, he could go into cardiac arrest.

‘Kieran,’ she said gently, ‘the injury has caused a tear in the pleural cavity around your lungs, and air is building up in there because it can’t escape. That’s why you’re having difficulty breathing. It’s caused your lung to collapse, and I need to relieve the pressure by putting in a tube. I’m going to give you an anaesthetic so that it won’t hurt as I do that.’

His situation was desperate, and she worked as fast as she could, sliding a cannula between his ribs and withdrawing the needle. There was a reassuring hiss of air as the gas escaped, and she taped the cannula in place and inserted a chest drain. In the background, she could hear the whir of the helicopter blades as it approached.

A paramedic came to stand beside her a few minutes later. ‘What’s the situation here?’

She looked up and greeted him with a feeling of relief. Briefly, Abby outlined the patient’s condition.

‘OK,’ he said when she had finished. ‘My partner and I will get him aboard the helicopter and then I’ll let the hospital know that we’re coming in.’

His partner was already preparing the stretcher. ‘I’d like to go with him,’ Abby said quickly. ‘His condition could worsen, and I want to do what I can for him. I feel responsible for monitoring him, since I’ve already been giving him treatment.’

‘That’s all right.’ The paramedic smiled and glanced at Vicky, waiting anxiously by Kieran’s side. ‘We’ve room enough for two more.’ He helped secure their patient on the stretcher. ‘It’ll take us about ten minutes to get there, but Dr Blakesley and his team will be ready for us.’

Abby felt a quiver of alarm run through her. It was beginning to look as though she was going to meet her new boss sooner than she had expected. She could only hope that the meeting would go well.

She looked on while the paramedics transferred Kieran by stretcher to the helicopter, which was waiting some distance away. When he was safely installed, the paramedic in charge helped Vicky climb in alongside Kieran, and Abby followed.

She wasn’t at all happy with her patient’s pallor, and as the helicopter took off and the journey progressed, she realised that he was showing increasing signs of distress. That was very worrying.

Vicky held his hand and murmured soothing words, while Abby inwardly fretted. If anything, he should be showing signs of his condition improving, but instead he was experiencing increased breathlessness and his pulse rate was rising. She glanced at the chest drain, and doubts crept into her mind.

If only she knew more about emergency medicine. Although she had followed what she believed was correct procedure, it wasn’t beyond the realms of possibility that she had made a mistake somewhere along the way.

‘He’s still breathless,’ the paramedic observed, and Abby nodded. Could she have pushed the tube in too far?

The paramedic quietly relayed the developments back to the hospital via his radio and listened to the response. ‘Dr Blakesley is going to meet us as soon as we land,’ he told Abby. ‘His team will be standing by.’

His words were meant to be reassuring, but Abby had mixed feelings about that. What would Mr Blakesley think of her if she had messed things up? With her patient in poor condition there was the distinct possibility that she could find herself starting off on the wrong foot with her new boss.

She glanced back at her patient. If blood was building up in his pleural cavity, he was in imminent danger…She found herself praying that they would get to the hospital very soon. It was more than likely that Kieran would need surgery to repair the wound in his chest.

‘We’ll need to send blood for cross-matching,’ she said. ‘I’ll organise that now…and we’ll start intravenous fluids.’ That should compensate in part for what Kieran was losing.

They landed a few minutes later, and Mr Blakesley was taking charge even before Abby had stepped down from the helicopter. While the paramedics were giving their report, Abby stood back and had time to observe the consultant momentarily.

Somehow, he wasn’t at all what she had expected. He was relatively young, for a start, in his mid-thirties, she guessed, long-limbed, and full of vital energy, his jet-black hair tousled by the wind from the whirling rotor blades of the helicopter. He was wearing an expensively tailored grey suit, the jacket open to reveal a dark blue shirt.

Within seconds Kieran had been transferred to a trolley and then he was being whisked off through the wide doors of the hospital and along a corridor towards A and E.

Abby hurried to keep up. ‘He’s losing too much blood,’ she said worriedly, coming alongside Mr Blakesley. ‘He must have lost two litres already.’

The consultant was giving instructions to his team as they went, ordering X-rays and tests and calling for a cardiothoracic surgeon, but he paused long enough to throw her a quick glance.

Close up, his features were even more impressive than she had at first noticed, and she was thrown completely off guard for a moment or two. He was incredibly good-looking, his face angular, strong-jawed, his compelling eyes a satisfying mixture of blue and grey. His mouth was firmly moulded…attractively masculine, she thought distractedly, and immediately berated herself. How could she allow such an irrelevant observation to creep into her thoughts at a time like this?

‘I know you must be concerned,’ he said briefly, ‘but I can assure you that we’ll take very good care of him.’ His voice was deep and resonant, his tone reassuring. His gaze shifted to take in Vicky, who had paused uncertainly alongside Abby and was looking anxious and tearful. ‘For the moment,’ he added, ‘it would probably be for the best if you let the nurse show you both to a waiting room while we look after him. We’ll let you know how he is as soon as we can.’

Unsure of herself and bewildered by events, Vicky allowed the nurse to gently lead her away, and Abby heard her asking what was happening to Kieran, and what his chances of recovery were. Abby stayed where she was, following Mr Blakesley into the emergency room. ‘You don’t understand,’ she began, and he lifted a querying brow.

‘Are you a relative?’ he asked, and she realised with a small frown of dismay that he must believe that the doctor who had treated Kieran had stayed behind at the beach. He went on, ‘I know that Miss Baxter is his girlfriend, but perhaps you would like to tell me who you are?’

He looked her over fleetingly, and she was suddenly conscious of the flimsy summer dress she was wearing, a sunny yellow cotton creation, splashed here and there with a pattern of tiny pale flowers. The bodice clung to her curves and emphasised her slender waist, leaving her shoulders bare except for two narrow straps, and the skirt draped itself around her legs, falling in gentle folds to her knees.

His glance flicked to the shimmering cloud of wayward curls that tumbled around her face and lightly brushed her shoulders. Abby’s cheeks flushed with hot colour. She must look like a dishevelled tourist when, more than anything else, she needed to appear calm and professional.

‘I…I’m Abby Curtis,’ she explained awkwardly. ‘Dr Curtis. I’m the one who treated him at the beach.’ Hesitantly, she added, ‘He was suffering from a tension pneumothorax and I had to act quickly. I’m…I’m just afraid I may have pushed the drain in a little too far.’

His blue-grey eyes widened a fraction and held her gaze for a second or two. ‘Abby Curtis,’ he echoed thoughtfully, adding in an enquiring undertone, ‘So…are you the one who’s about to become a new member of my team?’

Abby nodded in response. ‘That’s right. I am.’

His mouth made a faint, ironic twist. ‘And you think you could be responsible for the fact that our patient is bleeding to death? That’s quite an afternoon’s work, Dr Curtis.’

He paused momentarily, then flicked a glance at Kieran, adding, ‘I believe my patient needs me right now. As I said, perhaps you had better take some time out while we take a look at him and see what needs to be done. You’ve done your bit, and from the looks of him it will take some time to put right whatever has gone wrong. I need to find out what exactly is causing the bleeding, and I suggest that you leave me to get on with it.’

Abby felt the colour drain from her face. She was sure her mouth must have dropped open at his words, and her only consolation was that at least he was no longer there to witness her humiliation. He was striding purposefully across the room towards a treatment bay and she was left standing there, suffering from an acute attack of dismay.

One of the male doctors on his team threw her a quick glance and winced in sympathy, before turning to the patient.

Slowly, Abby pulled herself together. What was it that she had expected from the consultant—a few words of comfort, perhaps, for him to say that Kieran was safe now that they had him in hospital? And maybe an explanation of how these things came about and what could be done to avoid them happening again? A teaching insight, maybe…was that what she had been hoping for, among other things? After all, she was due to start her posting at this hospital tomorrow, under Mr Blakesley’s guidance, and surely, at the least, she could have looked forward to some measure of support from him.

It didn’t seem as though she was going to get any of that, though, did it? Unhappily, she absorbed that fact, and then slowly stiffened her back, cementing her resolve. She had acted in good faith when she had gone to help Kieran, had done everything she could to keep him alive. No one, not even the all-powerful consultant, Mr Blakesley, was going to put her down for long. She was here to learn, and she would do everything in her power to become a good doctor, in spite of his abrupt dismissal of her.

For the time being, she went to find Vicky in the waiting room.

‘Is there any news?’ Vicky asked, but Abby shook her head.

‘Not yet, I’m afraid. It will take a while. They’ll do scans to find out the extent of his injuries, and then the surgeon will most likely take over. I’m sure Mr Blakesley will do everything for him that can be done—he’s a very-well respected consultant.’

No matter what her immediate opinion of him was, she had to give him that. Abby had heard about Jordan Blakesley from a number of different sources, and though his manner might leave something to be desired, they had all spoken well of his medical expertise. That was why she had applied for this new posting.

In truth, she had ignored the fact that some people commented that he sometimes had an abrasive manner and that he could be difficult at times, because she had imagined that was just hearsay. She wanted to learn alongside the very best, and she was prepared to accept a few foibles.

She had interpreted their comments to mean that he probably didn’t suffer fools gladly, but she certainly hadn’t imagined that she might find herself in that awkward position from the outset. It was only now that she was beginning to have doubts about the wisdom of her choice.

Eventually a nurse came to tell them about Kieran’s condition. She spoke gently to Vicky, telling her that she could go and see him in the intensive care unit.

Abby didn’t want to intrude on their privacy. Instead, she decided to go and get herself a cup of coffee from the machine in the corridor. Perhaps she would get to hear what had happened to him if she hung around for a bit longer.

What she wasn’t expecting was that Jordan Blakesley would come along and find her burning her fingers on the hot coffee that spilled as she lifted the plastic cup. She licked her fingers to help ease the sting and immediately felt embarrassed to be caught that way.

‘So you’re still here, Dr Curtis,’ he murmured. ‘Worried about what you might have done to that young man, are you?’

Her green eyes sparked fitfully and then narrowed on him. ‘Of course I’m concerned about how he is. Isn’t that only natural?’ There was a hint of tension in her voice as she went on, ‘I did what I could for him. I did my best, but if I made a mistake, I feel really badly about that.’

‘Do you? And have you been waiting here, all this time, going over everything that might have gone wrong?’

Abby bit her lip and put her coffee cup down. ‘I don’t know why you’re giving me such a hard time over this,’ she said, her chin lifting. ‘I was looking for support from you, since you’re about to become my mentor. I hadn’t bargained for outright condemnation.’

He lifted a dark brow. ‘You think I was harsh in my judgement of you?’

She had probably already burned her boats, so she went for the truth. ‘I do.’

His mouth quirked momentarily, and she thought she saw a glint of humour in his eyes, but it passed so suddenly that she decided she must have imagined it. ‘Well, at least you speak your mind,’ he said abruptly, frowning at her. ‘That’s something, I suppose.’

Had she gone too far? Doubts suddenly crowded in on her. ‘I’ve not had a lot of experience in emergency medicine,’ she said, backing down a little. ‘And some of what I did was what I had only learned in theory. I didn’t know that I would be thrown into things at the deep end, so to speak. I was rather hoping that my next few months as a senior house officer would help me to improve my skills. ‘

‘Being thrown in at the deep end is what happens in A and E,’ he remarked brusquely. ‘None of us can know every type of incident that will come our way, but we have to learn how to deal with it.’ He sent her a hard blue stare. ‘If you’re going to be part of my team, you’re going to have to learn to be a lot more confident about the decisions you make, and not be forever looking back on yourself to see where you went wrong.’

‘I realise that…I thought—I hoped that would come with time.’

‘I hope so, too, Dr Curtis. For all our sakes.’ His glance seared her. ‘In fact, you should know that you saved the man’s life. His injuries caused a haemothorax, which led to him losing a lot of blood, and you did what you could to compensate for that. The surgeon has dealt with the tear and managed to stem the bleeding. He’ll be all right.’

A surge of relief flooded through her. ‘Oh, I’m so glad about that.’

‘Of course. We all are.’ His glance ran fleetingly over her, making her conscious all over again of her beach clothes. ‘Are you expected somewhere, or do you have time to take a look at him?’

‘I don’t have to rush back just yet. I’ve a few things that I must see to at home, and I’ll need to go and pick up my car fairly soon—I left it on the clifftop—but, yes, I’d like to go and see him, if that’s all right.’

He nodded. ‘You had better come with me, then, and take a look at the results of your handiwork.’ Without any more preamble, he moved briskly away.

Abby blinked, feeling somehow as though she had just been in collision with a juggernaut. Then, seeing his tall figure rapidly disappearing along the corridor, she got a grip on herself and hurried after him.

She had never before come across anyone who was such a peculiar mixture of abrasiveness and compelling vigour…except perhaps for her ex-boyfriend, Richard. He had certainly been one to make decisions and sweep her along with him, hadn’t he?

He hadn’t started out that way, though. To begin with, he had simply been kind and considerate, wanting only to please her. It had only been later that his strength of will had emerged and eventually turned to something infinitely more disquieting.

Catching up with the consultant, Abby went with him into the intensive-care unit. Kieran was asleep, his body needing rest after the trauma he had gone through. His vital signs were being monitored, and there were tubes and drips of various sorts attached to him to support his recovery. Vicky sat beside his bed, and she looked up and smiled as the two of them came into the room.

‘The nurses said they think he’s going to be all right.’

‘I know,’ Abby said softly. ‘I’m glad.’

‘He’s still drowsy from the anaesthetic,’ Jordan put in, ‘but his vital signs have improved, and he seems to be doing well enough. The tubes can probably come out in a day or so.’

They stayed by his bedside for a moment or two, while Jordan explained to Vicky about Kieran’s condition and told her what was likely to happen next. Then he signalled to Abby that it was time to leave, and they said goodbye and quietly left the room.

Out in the corridor, Jordan looked down at the gold watch on his wrist. ‘I have to go. That’s my stint finished for the day, and I’m due at a charity function within the hour.’ He threw her a quick look. ‘You said you have to pick up your car—where is it?’

‘By Blue Ridge Cove. I was spending the afternoon there, taking some time out to get to know the area.’

‘That’s more or less on my way home. I’ll give you a lift.’

The unexpected offer threw her off balance. ‘I don’t want to put you out…’

‘You won’t. Let’s go, shall we?’ Briskly, without giving her any more chance to discuss the matter, he led the way down to the car park and across to a gleaming midnight blue saloon.

He appeared to be in a hurry, and as soon as she was settled in the luxuriously upholstered seat beside him, he started the engine and drove smoothly out onto the main highway.

‘You said that you were getting to know the area…you’re new to Cornwall, then?’ he queried as they left the town and headed towards the cove. He glanced at her obliquely, and when she nodded, he asked, ‘Where have you come from?’

‘London. I’ve lived there for a number of years, because that’s where I did most of my medical training, but I decided that I wanted a change, the chance to come and live by the coast for a while and breathe in some fresh sea air.’

Abby wasn’t going to tell him that part of her reasoning in coming here was that she had hoped to escape from her ex-boyfriend. She was determined to make a new start, free from the worries of Richard’s persistent refusal to accept that the relationship was over.

‘That’s a big change,’ he murmured. ‘Have you left your family behind? Friends?’

‘Friends, yes—I shall miss them. My brother lives down here, though, and my mother lives fairly nearby, in Devon, so I shall be able to see more of her than I did before.’

‘And your father?’

She might have known that he would pick up on that omission. She was saddened, thinking about her father. ‘He died some years ago,’ she said quietly.

‘I’m sorry.’ He flicked her another brief glance. ‘At least you’ll have your brother close by.’

She shook her head. ‘Unfortunately, I won’t. He’s working abroad for a few months, but he’s letting me stay at his house in the meantime. It makes things easier for me, and Daniel will feel happier knowing that the house is being looked after while he’s away.’

‘Even so, you’re taking a huge step, moving away from everything you’ve been used to. Choosing a coastal area when you’ve been used to city life is an immense change. You can’t have come to that decision lightly.’

‘I didn’t, of course. I wanted to study emergency medicine, and the Roseland has a good reputation as a teaching hospital.’

His blue-grey eyes searched her face. ‘So do a lot of others.’

She sensed that he was still doubtful of her logic, and that he was expecting her to say more, but she didn’t want to go into her real reasons for moving down here. She wasn’t ready to talk to anyone about the worries she had back in London, least of all to Jordan Blakesley.

If he knew that she was afraid of a man who had become too possessive, too demanding, his opinion of her would take a nosedive. He would probably dismiss her as incredibly weak and lacking in backbone. How could he possibly comprehend the way that Richard had begun to exert an insidious hold on her, refusing to let her live her life as a free agent? She could barely understand it herself.

By now, they had arrived at the clifftop where her car was parked. Drawing up alongside it, Jordan cut the engine and let his gaze narrow on her. ‘Life down here is vastly different from that in the City, but if you’re expecting it to be easier, you’re in for a disappointment. In the summer months we’re inundated with visitors to the area and the hospital takes the strain.’

‘Yes, I guessed that.’

‘Are you sure? You’ll be under pressure a lot of the time.’

‘I appreciate that. I’m not afraid of hard work.’

‘There will be no time for indecision and wallowing in uncertainty.’

Her mouth quirked in a wry grimace. ‘I’ll try to bear that in mind,’ she murmured. She guessed his opinion of her wasn’t great. No matter that she had managed to save a man’s life this afternoon, he believed that she had been uncertain and anxious, and he wasn’t a man to tolerate shortcomings in his colleagues.

‘Good. I’ll expect to see you tomorrow, bright and early, then. Just remember,’ he added on a warning note, ‘that if you do make any mistakes, I want to know about them straight away, so that they can be put right.’

‘I understand that.’

‘I hope that you do.’

She hunted for her car keys in her bag, and then slid out of the passenger seat. ‘I must go. Thanks for the lift.’

‘You’re welcome.’ He watched her walk to her car, waiting until she had unlocked it and started up the engine. Then he drove away.

Abby’s glance followed him, her emotions a chaotic jumble of uncertainty and apprehension. The man was an enigma and, not for the first time that day, she wondered just what she was letting herself in for.