Читать книгу Her Celebrity Surgeon - Kate Hardy - Страница 10

OVER the next few days, Charlie settled in with the rest of the team. Sophie even worked with him a couple of times without her hackles rising, although she still avoided Charlie’s drinks night on the Thursday. Being off duty was a good enough excuse, as far as she was concerned. Although he gave her a quizzical look when they were next on the ward together, at least he didn’t take her to task for it.

Then she got a call from Paul, the registrar in the emergency department. ‘Twelve years old, fell from a horse which then stood on her. Admitted with bruising over her lower ribs and tachychardia. I think she’s ruptured her spleen. Any chance of doing a laparotomy?’

‘I’ll organize Theatre,’ Sophie said. ‘Have you done a CT scan?’

‘Too long a wait. I did a peritoneal lavage,’ Paul said. ‘We had blood staining.’

Blood staining indicated an internal injury to the abdomen, and bruising over the lower ribs was often associated with damage to the spleen, liver or kidney.

‘One other thing,’ Paul added, lowering his voice. ‘The mum’s a Jehovah’s Witness. So is the girl.’

‘Ah.’ That was a possible sticking point. If the girl needed to have her spleen removed, she might need a blood transfusion—which was unacceptable on religious grounds to most Jehovah’s Witnesses, who interpreted blood transfusion as the ‘eating of blood’. Autologous transfusion, where the patient’s own blood was salvaged during an operation and filtered, ready for reuse, was a possible solution, but some patients would find that unacceptable if the blood had left the blood vessels rather than being in continual contact with the patient’s own circulation.

There were alternatives, such as the use of recombinant human erythropoietin, a hormone that helped red blood cells to reproduce. This helped to avoid anaemia around the time of the operation. But it really depended on what happened during the operation.

Sophie bit her lip. She hated cases like this. Ethically, she was bound to defer to the patient’s wishes, but it was a grey area in the case of children. Children under the age of sixteen could consent to blood transfusions but couldn’t refuse one. But if the parents were staunch believers, the surgeon had to either abide by their wishes or apply to the courts. In an emergency Sophie knew she could give a child blood without legal consent—if she let the child bleed to death, apart from being against her personal ethics, it could leave her open to legal prosecution for negligence. But if she did give the transfusion, that would leave an emotional minefield.

It would have to happen on Andy’s day off. Guy was in Theatre. Maybe she could buzz through and get a lead from him. ‘I’m on my way,’ she said grimly, and replaced the receiver.

She pushed through the doors to leave the department, and almost walked straight into Charlie.

‘You OK?’ he asked.

She nodded. ‘ED called. There’s a twelve-year-old girl with a possible ruptured spleen and they want me to take a look.’

‘Complications?’

How had he guessed? Or did he respect her skill enough to think she could do a splenectomy without problems? ‘Mum’s religious beliefs. If I have to do a splenectomy, it’ll have to be without a transfusion.’

‘Ah. Just the mum, or the dad as well?’

‘I don’t know right now,’ she said honestly. ‘I’m guessing it’s both of them.’ If the girl’s father was of a different religion—one that didn’t have the same issues with blood transfusion—she might be able to get his consent. Which would be enough. She only needed the consent of one parent.

‘Want some back-up?’

She was tempted to say no, she could cope on her own; her pride said she shouldn’t accept help from him. Her common sense gave her pride a swift upper-cut. She would have asked Andy or Guy for help. Charlie was here, and he was senior to both Andy and Guy. So what was the difference? ‘Yes. Please,’ she added.

‘What are your plans?’ he asked as they headed towards ED.

‘I’m going to examine the girl and explain the situation to her parents—that I’ll do my best to do the operation without any transfusions, respecting their wishes, but if there’s a complication a transfusion might be unavoidable.’ She sighed. ‘It’s not my place to judge, but I just don’t understand how a parent could stand by and watch her child bleed to death.’

‘Most parents find it acceptable if you say you’ll do your best not to use a transfusion, but you won’t allow the child to die for want of a transfusion,’ Charlie said softly. ‘Besides, all treatment is confidential.’

‘I just hope they see it that way,’ Sophie said feelingly. ‘I’d move mountains for my child.’

For her child? Charlie’s heart missed a beat. Sophie was married? But he’d been so sure she wasn’t. He hadn’t heard anyone talk about her partner or children. He glanced surreptitiously at her left hand. A surgeon never wore rings to work, but maybe Sophie wore a wedding ring on a chain around her neck or something. He couldn’t see any band of pale skin on her ring finger, so maybe she was divorced. Single mum?

‘Boy or girl?’ he asked, trying to sound relatively cool.

‘Pardon?’

‘You said you’d move mountains for your child. I just wondered if you had a boy or a girl.’ Now he was beginning to wish he’d never asked. She’d think he was being nosy. And just why was he asking anyway? It was none of his business.

She shrugged. ‘I don’t have any children. I was speaking figuratively. My parents moved mountains for me—we couldn’t really afford for me to go to med school, despite the student grants and hardship funds, but they both took on extra jobs in the evenings to raise the cash. Mum cleaned and Dad did a few shifts behind the bar at the local pub, and I did bar work in the holidays and at weekends.’

Ouch. No wonder she’d been a bit hostile towards him. A lot of the medical students he remembered had come from rich backgrounds. But he couldn’t think of many whose parents would have made the extra sacrifices that Sophie’s parents had made. His mother certainly wouldn’t have. He, Seb and Vicky had had to fight all the way, too, to get to med school.

Not that he was going to share that with Sophie. He didn’t think she’d believe him somehow.

Her parents’ lack of wealth also explained why Sophie Harrison was so ambitious, so focused on her job. Clearly she wanted to show her parents that their sacrifices had been worth it. Again, he wasn’t going to tell her he’d worked that out. It would sound too patronising, even though he wouldn’t mean it that way. ‘I’d imagine they’re very proud of you,’ he said lightly.

‘I’m proud of them,’ Sophie responded crisply.

Family meant a lot to her. And he envied her for it. He was close to Seb and Vicky, though even that was a complicated mixture of sibling rivalry and watching each other’s backs. But his mother…They hadn’t been close for years and years. Since his father’s death. Maybe even before that, if he thought about it.

Not that he was going to. He preferred to keep that shut well away. Where it was safe.

‘Are you an only child?’ he asked.

‘Why?’

‘Just making conversation.’ Trying to find out more about her. Stupid, really. They’d never be anything more than colleagues. Probably not even friends. He’d noticed that she’d avoided his drinks night, when other colleagues who’d been off duty had turned up.

‘Yes. I think my parents wanted more, but they just weren’t lucky. You?’

She actually wanted to know something about him? He suppressed a flare of pleasure. She was probably just being polite. Making conversation. ‘I’m the oldest of three. My brother’s in emergency medicine, and our baby sister’s the clever one. She’s a brain surgeon.’

She looked at him, then, though he couldn’t tell her thoughts from her expression. ‘A brain surgeon.’

‘Yep. We tease her a bit—you know, “our sister, the brain surgeon”—but Seb and I are really proud of her. Vicky’s a brilliant neurologist.’

‘The gossip rags never talk about them.’

Then she looked horrified, as if she’d given too much away.

Charlie’s heartbeat quickened. Had she read them, looking for him?

No, of course not. Don’t be so arrogant, he told himself sharply. Sophie was much too serious to read gossip rags. Anyway, she’d been talking about his siblings. ‘They don’t. Probably because Vicky would break the fingers of any paparazzi who dared to take a picture of her, and Seb’s got the mouth of a lawyer.’ He sighed. ‘And they’re not the ones stuck with—’ He clammed up. Sophie definitely wouldn’t be interested in what it was really like to be a baron. How everyone wanted to be your friend, just so they could say they were friends with the nobility. How the estate was an albatross around his neck—a place he hardly ever went nowadays, although he’d loved it as a child. It hadn’t been his home for well over a decade, but he wasn’t about to throw his mother out or expect her to deal with the upkeep. It was his responsibility. And also the reason why, on a consultant surgeon’s salary, he had less money to spare than a house officer.

‘Stuck with what?’ she asked.

‘Nothing,’ he muttered. ‘Just stuff. And we’ve got a patient to see.’

Well, her patient.

In the ED, Paul introduced them to Katrina, who was white with pain.

‘Katrina, may I examine you?’ Sophie asked.

The girl nodded. Sophie examined her as gently as she could, noting that the girl’s ribs were discoloured, there was localised tenderness and guarding in her abdomen and pain in the upper left quadrant.

‘Does it hurt anywhere else?’ Sophie asked.

‘My shoulder. The left one.’

Kehr’s sign, meaning that there was definitely a problem with Sophie’s spleen, In addition to that, Katrina’s abdomen was distended and Sophie already knew there was an internal bleed, thanks to Paul’s lavage.

‘Mr and Mrs Jackson, I think your daughter has a ruptured spleen,’ Sophie explained to Katrina’s parents. ‘She’s going to need an operation.’

‘She can’t have a transfusion,’ Mrs Jackson said immediately. ‘We’re Jehovah’s Witnesses. It’s against our religion.’

‘I’ll do my best to respect your wishes,’ Sophie said. ‘I need to take a closer look—I’ll do a procedure called a laparotomy. It’s a small incision in her stomach, and it will show me how bad the damage is. I may be able to glue it back together if the damage isn’t too bad, but I might need to remove her spleen.’

‘She can’t have a transfusion,’ Mrs Jackson repeated.

‘As I said, I’ll respect your wishes as far as I can,’ Sophie replied.

‘If there are complications during surgery and she needs blood, she could die without a transfusion,’ Charlie warned quietly.

Mrs Jackson’s face was set. ‘I know my rights. You can’t give her a transfusion without my permission, and I won’t give it.’

‘I know. But I have responsibilities to my patient, too. In an emergency, my priority will be to save your daughter’s life,’ Sophie explained.

‘If it’s willed…’ Mrs Jackson shook her head. ‘No.’

‘All right, Mrs Jackson. If you’ll excuse me, I just need a word with my consultant.’ Sophie looked at Charlie and slid her eyes sideways, indicating that she wanted a word away from the Jacksons.

‘What?’ he asked softly.

‘I’ve got a hunch that Katrina’s dad doesn’t feel the same way as his wife. Can you do me a favour and keep Mrs Jackson talking while I have a quick word with Mr Jackson?’

‘Sophie, you’re opening a can of worms here,’ Charlie warned.

‘What’s the choice? A row between the parents or the unnecessary death of a child. I know where my vote goes. We haven’t got time to fight. Please. Just keep her talking.’

He nodded. ‘I’ll explain autologous transfusion and see what her views are on that. But if you get the slightest indication from Katrina’s father that you’re going the wrong way, stop. We’ll get a co-ordinator in to do the talking for us.’

‘But—’

‘No arguments, Sophie.’

His accent was suddenly cut-glass, and it raised her hackles—particularly as she knew he was right. ‘OK. I’ll tread carefully,’ she promised.

While Charlie talked to Mrs Jackson, Sophie drew Katrina’s father to one side. ‘Mr Jackson, you know that the treatment we give people is confidential, don’t you? The only people who will know anything about Sophie’s treatment are you and your wife.’

He nodded. ‘My wife’s a Jehovah’s Witness.’

Meaning that he wasn’t? ‘Do you share your wife’s beliefs?’ Sophie asked carefully.

He closed his eyes. ‘No. She was converted by some friends. She was depressed after Katrina was born, but going to meetings made her happy again, so I went along with it.’ He opened his eyes again and looked at Sophie. ‘Could Katrina die if she doesn’t have a transfusion?’

She had to be honest with him. ‘I won’t know until she’s in Theatre. But it’s a possibility, yes. If she needs a transfusion and I can’t give it to her…’ She spread her hands. ‘That’s the worst-case scenario. Hopefully it won’t come to that.’

He shuddered. ‘I don’t want her to die.’

‘This isn’t about a battle of wills or judging your wife. But I want to give Katrina the best treatment available. We only need one parent to agree,’ Sophie said softly. ‘I know it could make things difficult between you and your wife.’

‘Katrina comes first. I’ll sign the consent form,’ he said.

‘Thank you,’ she said quietly. ‘I won’t say anything to your wife. It might not even come to this. But if it does—it’s good to know there’s a safety net there.’

But Mrs Jackson had clearly anticipated Sophie’s move. ‘If you sign that form, Derek, I’ll make sure you never see Katrina again.’

Mr Jackson paled. ‘Alice, be reasonable. Katrina’s life could be at stake.’

‘If it’s a bad rupture, she could bleed to death,’ Sophie said quietly. ‘And I need to take her to Theatre now.’

Charlie stepped in. ‘Maybe we can do the autologous transfusion we talked about.’

Alice Jackson’s face set. ‘Maybe.’

‘Mrs Jackson, I will do my best to abide by your wishes,’ Sophie said, ‘but as a surgeon I cannot allow your daughter to die due to the lack of a transfusion.’

‘BP’s dropping,’ Charlie said quietly. ‘Mrs Jackson, we have to go to Theatre now.’

‘You’re doing the operation? I’ve seen you in the papers. Out with all those women.’ She shook her head. ‘No. I don’t want you touching my daughter.’

‘Katrina is my patient. I’ll be doing the operation,’ Sophie said. ‘But if Charlie did it, she’d be in excellent hands. He’s the director of surgery. He got the post because he’s an excellent surgeon. And the papers whip up all that stuff about him to sell copies, so don’t believe what you read. I’ll come and see you immediately after the operation,’ she said, and started moving the trolley out of the emergency department.

‘Thank you for the vote of confidence,’ Charlie said as they went into Theatre.

‘It’s the official line, isn’t it?’

So she hadn’t meant it. Not personally. ‘Yeah,’ he said, trying to ignore the sinking disappointment in the pit of his stomach. Why should it matter what she thought of him?

Though it did.

‘It stopped the discussion. That’s the main thing. Where’s Sammy?’ she asked the scrub nurse, wanting to know where her senior house officer was.

‘Held up.’

‘I’ll assist,’ Charlie said as Sophie started to scrub up. ‘I was planning to observe all the surgeons anyway, so I may as well kill two birds with one stone.’

‘Observe?’ Sophie asked coolly.

‘I need to know my team’s capabilities. Where your strengths are, how you do things, where we can learn from each other.’

‘So, despite what you said to me, you are planning new-broom stuff.’

‘No.’ He kept his temper under wraps. Just. Hadn’t they agreed on a truce last week? And he’d thought they’d been getting on all right, before they’d seen the Jacksons. Obviously he’d been wrong. ‘But I believe in keeping my team motivated. To do that, I need to know where you are now and where you want to be. And it’s my job to get you the extra experience you need to move your career onwards.’

As soon as Sophie had opened Katrina’s abdomen and suctioned out the blood, she groaned. ‘Her spleen’s split completely in two. Gluing isn’t an option.’ She nodded at the screen where Katrina’s spleen was visible.

‘Agreed. It’s going to have to come out,’ Charlie said.

‘Her BP’s dropping,’ the anaesthetist said.

‘OK. I want four units of O-negative on standby, please. In the meantime, we need to filter and reuse her blood,’ Sophie said. ‘I’m doing an open operation, not laparoscopic,’ she added to Charlie. ‘Do I need to explain my decisions to you?’

‘Later. Just do it,’ Charlie said.

Sophie increased the size of her incision so she could perform the operation. To her relief, there were no further complications and the rest of the operation was textbook—grasping the splenic pedicle between the fingers of one hand, ligating the splenic artery, splenic vein and short gastric arteries, then removing the spleen, while trying not to damage the tail of the pancreas or the splenic flexure of the colon.

‘Would you like to close?’ she asked Charlie.

‘As I’m assisting?’

‘As your suturing is neater than mine,’ she corrected.

Was that the ghost of a smile in her eyes? Or her idea of an olive branch? Whatever. He nodded and stitched the wound.

‘How is she?’ Derek asked, as soon as Sophie came out of Theatre.