Читать книгу His Honourable Surgeon - Kate Hardy - Страница 9

‘I WONDER if Jake’s single?’ Gemma, the ward sister, asked.

Vicky shrugged. ‘I’m more interested in whether he’s good at his job.’

Gemma gave Vicky a searching look, which Vicky ignored. Honestly. When would her colleagues understand? She wasn’t interested in having a relationship until she’d got where she wanted to be in her career. And she really wasn’t interested in Jake Lewis, their new consultant. She was still annoyed with him about yesterday—she’d tried to make him feel welcome, and he’d made her feel as if she were slacking.

He’d find out his mistake soon enough. Victoria Charlotte Radley was far from being a slacker. And although part of her wanted to see him eat humble pie, the sensible part of her knew it was best to just ignore it and get on with her job. Emotions of any sort—except where her brothers and new niece were concerned—just weren’t part of her life.

‘He seems nice. And you have to admit, he’s good-looking,’ Gemma continued. ‘Tall, dark and handsome to a T! And those eyes—they’re really come-to-bed. Like melted chocolate.’

Vicky sighed inwardly. Either Gemma hadn’t got the message or she didn’t want to. Before Vicky had a chance to explain—firmly but politely—that she really couldn’t care less if every other woman in the hospital thought Jake Lewis was sex on legs, because it really wasn’t relevant, her pager bleeped.

She glanced at the display. ‘I’m needed in ED. I’ll finish the ward round later and I’ll ring down when I know which theatre I’m in.’

‘OK. I’ll fill the board in for you,’ Gemma said.

‘Thank you.’ Vicky smiled at her and headed for the emergency department.

‘Dr Radley—you paged me,’ she said to the receptionist.

‘Yes—it’s one of Hugh’s patients. I’ll just get him for you.’ She returned with a doctor in tow.

‘Hugh Francis, SHO. Thanks for coming, Dr Radley,’ he said, smiling at her. ‘I’ve got a ten-year-old with a suspected subdural haematoma.’

‘Did he fall?’ Vicky asked.

‘Tripped up and hit his head on a skateboard ramp.’

Vicky frowned. ‘Wasn’t he wearing a helmet?’

‘I couldn’t get much out of him,’ Hugh admitted. ‘He was pretty scared. But he told Ruth—one of our staff nurses—that he’s been having some problems with bullies. A gang of them waylaid him in the park this morning on the way to school, kept on and on about how useless he was and how he couldn’t do some move or other on the skateboard ramp. They goaded him into trying it—but, of course, he didn’t have a helmet with him and they said he was a coward if he didn’t do it without.’

Vicky groaned. ‘And he thought they’d lay off if he did what they wanted.’

‘Something like that.’

But bullies never let up. If you proved yourself and did what they said you couldn’t do, they’d find something else. On and on. Nag, nag, nag—until you finally snapped. And girls were probably worse than boys, because they went for mental torture. Being clever and being an Hon. had marked Vicky as a major target at school. She hadn’t said a word to her mother, knowing that Mara had been too self-absorbed to do anything about it. But Charlie had found Vicky crying one afternoon after school and had made her tell him what was wrong. He and Seb had taught their younger sister the rudiments of judo so she could defend herself—and Vicky had practised on them enough to make sure that when she finally gave in to the demands for a cat-fight on the playing field, she’d left the bullies flat on their backs and crying. She’d had detention every lunch-time for half a term afterwards, but it had been worth it. The bullying had stopped.

‘Poor kid,’ she said feelingly. ‘Was he knocked out, do you know?’

‘He says not. But he was late for school, and the teacher picked up that he seemed a bit confused and drowsy. She wondered if he’d been sniffing glue or something and sent him to the first-aid room. He said he had a headache but wouldn’t tell anyone anything.’

Of course not. If you told, it just drove the bullying underground. They were sweetness and light in front of the teachers, and when you were on your own you were really in for it. No more nasty letters, because they could be traced back—but there would be name-calling, deliberately breaking your things, accidentally-on-purpose tripping you up, or taking something precious and playing ‘catch’ with it until you were running frantically around like a hamster on a wheel, desperate to get it back.

She forced the memories back and stiffened her backbone. ‘Lucky the first-aider sent him to us, then,’ she said.

‘She couldn’t smell any substances. So she called his parents and told them to get him here, stat.’

‘Good. What have you done so far?’

‘GCS 11, pupils equal and reactive, ears OK.’ Hugh frowned. ‘But I’m not happy with his blood pressure, pulse or respirations.’

‘Checked the eyes with an ophthalmoscope?’ she asked.

‘Yep. I think the intracranial pressure’s rising, but I want a specialist’s opinion.’

‘OK. I’ll take a look. I think a CT scan’s a good idea—can you organise one?’

‘Already booked.’

Vicky smiled. Just what she liked to see: a junior doctor who knew what he was doing and who had the confidence to act on his own initiative. If this was the way Hugh Francis usually worked, he’d be in the running for the next registrar’s post in ED. ‘Well done.’ She walked with him to the cubicles. A pale, gangling boy was lying on the bed, and a worried-looking woman was sitting next to him.

‘Mrs Foster, this is Dr Radley. She’s a neurology specialist,’ Hugh introduced her. ‘Dr Radley, this is Declan.’

‘Hello, Declan—Mrs Foster.’ Vicky sat down on the side of Declan’s bed and held the boy’s hand. ‘My name’s Vicky, and I’m going to be looking after you for a bit. I hear you’ve had a bit of an argument with a skateboard ramp. I’m just going to have a look in your eyes, if that’s all right with you, and then we’re going to send you for a scan to see if there’s anything making you feel rough.’

‘I’m sorry,’ he mumbled. ‘Don’t want to be any trouble.’

‘Hey, that’s what I’m here for.’ She squeezed his hand. ‘We’ll sort it out, sweetheart.’

Hugh handed her the ophthalmoscope. She checked in Declan’s eyes, and nodded. ‘Yes, I definitely want to see a scan. Do you know what a CT scan is, Declan?’

‘No.’

‘It’s a special sort of X-ray that takes pictures of your head from lots of different angles—it pictures slices inside your head. I’ll show you them later on a computer, if you like—not many people get to see inside their own heads. And I might be able to arrange a film to be printed for you so you can show your mates later.’

‘Haven’t got any mates.’

It was said without any emotion, as if he didn’t care, but Vicky would bet otherwise. She remembered that feeling herself, only too well. Being an outsider, the last person picked for a team, and trying to pretend to everyone else that it didn’t matter…when it did. ‘Do you go to an all-boys school?’ she asked.

‘No.’

Half her problems had stemmed from going to a single-sex school where she just hadn’t fitted in. If she’d gone to a co-ed school, things might have been very different. ‘Let me give you a little bit of advice,’ she said softly. ‘Try chatting to the girls.’ Ten was an awkward age: boys still thought that girls were silly, and it was uncool to be seen talking to them. But what did Declan have to lose? Nothing but his loneliness. ‘You might find some of them like the same things you do.’

‘Girls don’t like Game Boys,’ Declan said. ‘Or the Romans.’

‘I liked computers when I was your age,’ Vicky told him. ‘So I reckon you might be in for a nice surprise. Give it a try. What have you got to lose?’ She smiled at him. ‘Now, Hugh here’s going to take you off for a scan, and I’m going to have a chat with your mum.’

‘Don’t tell school,’ Declan said. ‘Don’t tell them.’ He nearly choked. ‘Don’t say what I told you. Please, don’t.’

‘It’s OK,’ Vicky soothed. ‘There’s nothing to worry about, I promise.’

Mrs Foster had clearly only just been holding it together, because a tear leaked down her face when Hugh wheeled Declan out. ‘I’m sorry,’ she said, wiping a hand across her face. ‘I just feel so useless. I had no idea he was being bullied—what kind of parent does that make me?’

‘A normal one,’ Vicky reassured you. ‘Believe me, it can be very hard to tell if kids are being bullied. Sometimes they go a bit quiet, sometimes they go the other way. But until they’re ready to tell you, you won’t know.’ She’d done that herself. Kept it in, because she’d believed it was her fault and if anyone knew they’d despise her and treat her like dirt, too.

‘Oh, God. I don’t know what those little bastards have done to him. Or how long it’s been going on—he won’t say.’

‘When you’re bullied, you try to hide it—you don’t want anyone knowing, in case the bullies get in trouble, because you’re scared that then it’ll get worse,’ Vicky said gently. ‘Or that somehow it’s your fault, because you’re different in some way—whether it’s the way you talk, the colour of your hair, or you’ve got freckles. Whatever distinguishes you. But at least you know now, so you can help him. Keep his self-esteem high by praising him and making it specific so he knows you mean it and you’re not just being nice, and maybe get him some martial arts lessons.’

‘So he can hit back, you mean?’

‘So he can defend himself against physical stuff,’ Vicky corrected her dryly. ‘Mrs Foster, I need to know a few things about Declan before I can do anything to treat him. Would you mind answering a few questions for me, please?’

Mrs Foster nodded. ‘If I can.’

‘Has he had any previous head injuries?’

‘Not that I know of.’

Good. ‘Is there any family history of easy bruising, or bleeding that doesn’t stop?’

‘No.’

Even better. ‘Has Declan ever had a cerebral shunt?’

‘What’s one of those?’ Mrs Foster asked.

‘If he’d had hydrocephalus as a child, we would have operated to put a special valve in his head to drain off excess fluid—and it would have been replaced several times before now as he grew bigger,’ Vicky explained. And Mrs Foster would definitely have known what a cerebral shunt was—the fact she’d asked meant it was highly unlikely Declan had had one.

Mrs Foster shook her head. ‘No, nothing like that.’

‘Does he have any allergies—penicillin or anything like that?’

‘No. He’s always been so healthy.’

Even so, Vicky needed to ask the last question. ‘Is he taking any medication?’

‘No. What’s wrong with him?’

‘I’ll know more when I see the results of his scan, but I think he’s got a subdural haematoma. That’s a blood clot between the tissue of his brain and the membrane called the dura mater, which goes between his brain and his skull. It sometimes happens after someone bangs their head hard—the bridging veins between the brain and the membrane stretch and tear, a bit of blood leaks out and forms a clot.’

Mrs Foster’s face turned a shade paler. ‘Does that mean you’ll have to operate?’

‘I won’t know until I see the scan,’ Vicky answered honestly. ‘Sometimes we can treat it without operating—just by careful monitoring—because smaller ones tend to go away on their own, but sometimes we need to operate before it puts too much pressure on the brain.’

‘Oh, my baby,’ Mrs Foster whispered.

‘Is there anyone we can call for you?’

‘M-my husband’s on his way.’

‘Good. If you want me to run through anything with you again, or you’ve got any questions, just let me know. That’s what I’m here for.’

Mr Foster had arrived by the time Declan had had his scan. Vicky reviewed the files and pointed out one area to Hugh. ‘I’m really not happy about this. I’m going to have to take him to Theatre.’ She went back in to see Declan and his parents.

‘Was the scan all right?’ Mr Foster asked.

‘I’m afraid not,’ Vicky said gently. ‘It showed me there’s a clot forming between Declan’s brain and the membrane covering it. It’s pressing down on the brain and causing pressure, which makes the brain swell and not enough oxygen gets to it—that’s why Declan’s finding it a bit difficult to see and why he’s sounding a bit confused. The good news is that I can operate—he’ll have a general anaesthetic, and I’ll cut a tiny lid into his skull so I can get the clot out. He’ll need to be in here for about a week so we can keep an eye on him, but he should be fine.’

‘Is he going to die?’ Mrs Foster mouthed, turning her face away so Declan wouldn’t see the question.

‘There are risks, yes, but it’s much safer to do the operation than to leave it,’ Vicky said quietly. ‘He’ll have a headache afterwards, but he won’t be in any real pain.’

‘I’ll kill them,’ Mr Foster said between gritted teeth. ‘I’ll kill them for what they’ve done to our Declan. Just leave me on my own with them with a cricket bat.’

‘Neil, no,’ Mrs Foster said. ‘You can’t do that. That makes you as bad as they are.’

‘Well, they’re not going to get away with it,’ Mr Foster declared.

‘There are things you can do,’ Vicky said quietly. ‘But, right now, let’s concentrate on getting Declan sorted.’

While Declan was being prepped for Theatre, Vicky rang up to the ward. ‘I’m going to be in Theatre Five.’ And this was the bit she’d been dreading and looking forward to at the same time. ‘Could you page Mr Lewis?’ It didn’t really matter whether she led or assisted: this was where she’d see what he was made of, and whether he was better with patients than he was with the staff. Or, at least, than he was with her.

She’d just scrubbed up when he came into the room. ‘What have we got?’

‘Craniotomy, to remove a subdural haematoma. The files are there, if you want to take a look.’

Jake reviewed the files swiftly. ‘Good call. Have you done a craniotomy before?’

She nodded. ‘I’d use a linear incision rather than the standard reverse question-mark incision in this case. We’ve pinpointed exactly where the haematoma is—and a linear incision will mean we spend less time controlling bleeding and it reduces surgery time.’

Jake’s dark, dark eyes appraised her—and she thought she saw the glimmering of respect. But luckily she was prepared for his next comment. ‘Good call. I’ll lead, you assist.’

She’d told herself it didn’t matter: but it did. ‘How about I lead,’ she said, ‘and if you don’t like the way I do it, you can take over?’

He finished scrubbing up before he answered her. ‘All right. But you talk me through exactly what you’re doing and why.’

Her mouth tightened behind her mask. ‘Like a junior?’

‘Like any other senior registrar on their first operation with a new consultant. It’s a quick way of getting to know how we both work.’

Fair enough. He was still a bit abrupt for her liking, but maybe he’d discovered that she was the daughter of a baron and thought she was just playing at being a doctor. This was her chance to prove to him that she was serious—and she wasn’t going to blow that chance.

As part of the preparation, Declan’s head had been completely shaved. Instead of making him look like a thug, the haircut made him look like a defenceless little boy. Which was exactly what he was.

But there was no room for sentiment or emotion here in Theatre. Vicky had a job to do. And she was going to do it well.

‘This is where I’m going to cut,’ she said, indicating the area on Declan’s head.

‘OK,’ Jake said.

Deftly, she cut through the layers of skin, muscle and membrane at the site. ‘Burr-holes next,’ she said, drilling a series of tiny holes. ‘The bone’s not too thick at this point, so I don’t need to drill them very, very close together.’

She talked him through the rest of the operation—using a Gigli’s saw, passed between the burr-holes using a malleable saw guide, then lifting the lid of bone back on a hinge of muscle so she could open the dura mater to reveal the inner membranes. ‘Here’s the clot. Suction and irrigation,’ she said, working carefully to remove the clot. ‘Here’s the ruptured blood vessel. I’m going to clip it here.’

When she’d finished and was sure the blood vessel had stopped leaking, she gently replaced the bone, ready to sew the membranes, muscles and skin back into position.

‘Want me to close?’ Jake asked.

It wasn’t really a question. He’d assessed her; now it was time for her to see how he worked. She nodded and stood back.

He was good. Fast, thorough and very deft. She’d never seen such neat stitching—and said so.

‘Thank you.’ He inclined his head slightly at the compliment, but didn’t allow anything to detract from his focus.

That, Vicky thought, was impressive. She had a feeling she was going to enjoy working with Jake Lewis. A like mind, focused on his job. He really didn’t care what people thought about him—the patient came first. Refreshing.

When they’d finished, he walked back to the ward with her. ‘Do you want me to talk to his parents?’

She shook her head. ‘I’ll do it. They know me from the emergency department, and it’s better that they have continuity of care as far as possible.’

‘I agree. You know where I am if you need me.’

Meaning that he trusted her. Quite why that should make her feel enveloped in a warm glow, she had no idea. She already knew she did her job properly, so it shouldn’t matter what he thought.

She went into the relatives’ room, where the Fosters were waiting anxiously. ‘I’m pleased to say the operation was a success. Declan should be coming round in a few minutes and you’ll be able to see him straight away. We’ll need to keep him flat for the next day or two so his brain can settle down again, and gradually we’ll raise the head of the bed. We’ll be assessing him very, very frequently and he’ll have more CT scans over the next few days, so we can keep an eye on how he is and pick up on any little niggles before they turn into problems.’ She decided not to mention the fact that the CT scan would pick up extra fluid; it was perfectly routine, but would sound scary to the Fosters and they were already upset enough.

‘So he’s going to be all right?’ Mrs Foster asked.

‘He should be,’ Vicky said with a smile.

‘Oh, thank God. Thank you.’

‘And my consultant. If you have any questions, please, ask for me or Mr Lewis and we’ll do our best to reassure you.’

‘So that’s everyone—oh, except Vicky, but you were with her in Theatre,’ Gemma said.

‘Dr Radley.’

Gemma grinned. ‘Don’t stand on ceremony. She doesn’t even use her title around here.’

‘Title?’ That was news to Jake. What title?

‘She’s an Hon.—the Honourable Victoria Radley,’ Gemma explained. ‘Though she’s always made it very clear she’s a doctor first.’ She smiled. ‘You’ve probably heard of her brother, Charlie. Baron Radley.’

The name rang a bell, though Jake wasn’t sure why. He never bothered with celebrity magazines or gossip pages in the paper.

‘But don’t go thinking she’s a snob or anything like that. I mean, she doesn’t tend to go on ward nights out, but it’s not because she thinks she’s too good for us. It’s because she’s writing a paper or she’s got the chance to shadow someone on a particularly interesting case.’ Gemma sighed. ‘She works too hard.’

‘Nothing wrong with being dedicated,’ Jake said. He’d had that accusation thrown at him a few times, too. And if Vicky was dedicated, that explained why she’d been so confident during the craniotomy.

But an Hon….

It was only then that Jake realised he had been thinking about acting on his attraction to Vicky. Asking her out for a drink, perhaps. He already knew she wasn’t married so he didn’t think he’d be treading on anyone’s toes. But being an Honourable put her miles out of his league socially. Someone who was used to mixing with the likes of royalty wouldn’t want to go out with a boy who’d grown up on a council estate.

Better to know now before he made a fool of himself. And that would teach him for thinking about breaking his personal rules. Vicky was a colleague, so she was off limits. For good.