Marriage Miracle in Emergency
Autor:in
Scarlet Wilson
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CHAPTER ONE
IRIS CONWAY PUSHED her blonde hair back from her face and yanked at her ponytail band, trying to push it all back into something more reasonable. The stained scrubs were tossed into the nearest laundry basket as she pulled a new set from the trolley in the corner of the changing room. This was the third set she’d worn on this shift so far. Things were not going well.
She shoved her feet into her shoes and elbowed her way back out the door into the noise and bedlam of the A&E department.
St Mary’s University Hospital in Dublin was currently in chaos and she hated it. They were four doctors down. Two were on maternity leave, her Spanish colleague had just returned home due to some bad news and a fourth had been involved in an accident on a rugby pitch which had resulted in some emergency surgery. She strode down the corridor and glanced at the board. Every time a space appeared, it was immediately filled. They’d long since breached their four-hour waiting time.
‘Rena,’ she said sharply, ‘I need an update.’
Rena—the charge nurse on duty—appeared at her side, her face pinched. ‘X-ray is still backed up, we have six patients waiting for a medical review, three at Surgical, the paediatrician has just appeared—she’s got four to review—and there’s four patients waiting for casts.’ Iris didn’t get a chance to talk. ‘The two in Resus need your attention again. I have a woman requiring an ultrasound—apparently Obstetrics are just too busy to get here. And Harry’s back again. I’ve just made him a cup of tea and some toast. Oh, and the new doc? She’s not coming any more. We’re getting some guy—can’t even remember his name—instead.’
Iris swallowed down her frustration. Rena looked ready to snap at the next person to say a word to her—not good news for anyone in this department. After a few days of storms, the hospital was full to bursting. There were absolutely no beds left, which was why each speciality was having trouble getting to A&E to review their patients.
Harry was one of their frequent flyers. An elderly man who’d slept in Dublin doorways for years. He never accepted any offer of accommodation, but frequented their department at least twice a week. He would likely be the only individual today that wouldn’t hear the sharp end of Rena’s tongue. ‘Also,’ she added, ‘one of our new medical students is crying in the staff room, and the other needs to be gagged and handcuffed—thinks he’s already qualified and can make decisions.’
Iris sighed. Just what she needed. As a university hospital, St Mary’s had more than the average share of student doctors, all at varying stages of their careers. Proper supervision was difficult when she was four doctors down. ‘What’s she crying about?’
‘No idea,’ said Rena. ‘I haven’t had time to find out.’
Iris pressed her lips together. Comforting and investigating why a medical student was in tears would take time she simply didn’t have right now—not when the department was like this—and she absolutely hated herself for it. ‘Put Joan on our over-ambitious medical student. Tell him he can’t do anything without her say-so.’
Joan was one of their fiercest nurse practitioners. Iris didn’t usually assign students to her—mainly because they didn’t seem to come out of the experience unscathed. But the last thing she needed right now was someone making a mistake. Joan would ensure that wouldn’t happen.
Rena raised one eyebrow. ‘You’ll pay for that,’ she said knowingly. Joan was the only other member of staff in here that could give Rena a run for her money.
Iris nodded. ‘Oh, I know. And ask Fergus to deal with the other student.’ At least he was a safe choice. Fergus, an experienced staff nurse, practically had the word nice hanging above his head. He could deal with any upset member of staff in an instant.
That was one of things she loved about this place. She knew the people here like family. In fact, for the last six years they had been her family. Some A&E departments were notorious for their transient staff. It was a high-stress, high-paced environment and people frequently moved on. Many doctors spent a few years in A&E for their CVs, then quickly moved on to other places. Only a few stayed the distance, and Iris was one of them. When she’d been promoted to head of department here, her surrounding colleagues had been quick to congratulate her. She’d fitted in well. Loved the city and loved the people since her arrival six years previously. When she’d adopted her daughter, Holly, on her own, they’d all had her back whenever she’d needed help at short notice. In turn, Holly loved them all, and had tough-nosed Rena and Joan, and soft-hearted Fergus, all dancing to whatever tune she played. These people were worth their weight in gold, and Iris valued every one of them. Her own adoption experience as a child hadn’t been good, so she was even more determined to be the best parent she could be to her daughter.
The phone rang next to them and Iris picked it up. Her skin chilled as she listened quietly. She said a few words in acknowledgement, then replaced the phone. Rena knew instantly that something was wrong. Iris pressed the alert on her pager. ‘Incoming sea rescue. Four casualties,’ she said.
‘We need to clear Resus,’ said Rena instantly. Iris took a quick glance around the room, hearing the sounding of pagers all around her as staff received the alert.
She strode down the corridor, shouting instructions to faces that appeared from behind curtained cubicles. No one argued. All just giving a nod in agreement and disappearing again.
Part of their earlier conversation struck a chord in her head. ‘What happened to our new doc—Claire somebody? Why isn’t she coming?’
Rena shrugged. ‘She got a better offer apparently. Some hospital in Rio de Janeiro.’ She gave Iris a rueful smile. ‘Don’t think we can put up a fight against their weather, can we?’
Iris shook her head. ‘This storm isn’t helping anyway. Three days of relentless rain and gale force winds. Why does no one listen to the weather warnings and stay inside? Feels like half of Dublin is currently in our waiting room.’
‘Yeah,’ agreed Rena, glancing towards the packed room, with steamy windows. Every seat was taken, with plenty of others standing around inside. ‘And virtually no doctors to treat them.’ The irony dripped from her voice.
It seemed that no doctor on the entire Planet Earth wanted a short-term contract in their A&E department right now. Ridiculous. This was a marvellous place—or at least, it normally was.
She spent the next few minutes stabilising both patients in Resus, and getting them sent on to the A&E combined assessment unit. It was literally only supposed to be used to keep patients overnight while they awaited more tests. Both of these patients should be in beds in the wards upstairs—but Iris didn’t have time to wait for that to be sorted. She picked up the nearest phone, paging the doctor on call for the medical wards.
She didn’t waste any time when he answered. ‘You have six patients in my department—all of whom have breached their waiting time. Get down here, review them and make a clinical decision. I have four fishermen being winched from the Irish Sea and I don’t have space for them all.’ She put the receiver down before he had a chance to speak.
Iris glanced at the board again and gave a quick look at her watch, making an instant decision. ‘Can you get me a foetal monitor?’ she asked Rena. ‘That poor woman’s waited long enough.’
Rena nodded and appeared a few moments later passing over the handheld monitor. Iris sucked in a deep breath and took a quick glance at the chart, then disappeared behind the curtains.
The middle-aged woman was pale-faced, with streaked mascara around her eyes. Her hair was plastered to her head. She’d come in a few hours ago reporting reduced foetal movement. She was on her own, and Iris was immediately concerned about the potential for delivering bad news to someone with no support. She knew immediately that no woman this far on in her pregnancy would have come out in this weather unless she was really worried.
She started washing her hands. ‘Hi, Carrie, I’m Iris, one of the A&E consultants. I’m sorry you’ve had a bit of a wait, but it seems our obstetricians are caught up today. Would you mind if I looked after you instead?’
Carrie gave a quick shake of her head, her hands placed protectively over her stomach. ‘I just want someone to tell me if everything is all right.’
Iris nodded and sat down next to the bed. ‘I get that. Okay, I see you reported reduced movement. Can you tell me what’s been happening?’
Carrie sniffed. ‘I feel terrible. I hadn’t even realised at first. It was just when I was walking around the supermarket earlier—when the wind dropped for a bit—and I saw someone else with a newborn strapped to their chest, and I realised I hadn’t felt any movement today.’
Tears started to flow again. ‘I know I felt her last night. Because she woke me up. Kicking like anything when the rain was battering off the windows. But I usually feel her most of the time. And it wasn’t until then I realised I hadn’t felt anything since then. And I’m an older first-time mum, and I know I’m at higher risk of everything. But all of my tests have been fine; in fact, everything’s been fine, up to now.’ Her words had just seemed to spill out, and they came to an abrupt halt.
There were lots of things she could say right now. But Iris knew there was only one thing this woman wanted to know.
She held up the Doppler. She spoke slowly and clearly. ‘Okay, I’m going to use this to see if we can hear baby’s heartbeat. You’ll have had this done before?’
Carrie nodded. ‘My midwife has used it before. I phoned her today. But she was stuck out on some country road where the storms had made a tree fall. She couldn’t get to me and told me to come into hospital and get checked out.’
Which was exactly the advice Iris would have expected her to give her patient. She already knew that the community midwife had phoned in to see how Carrie was, and she made a mental note to try and check up later that the midwife had got back to her base safely. ‘This is the one I have immediate access to, so we’ll use it first. I want to reassure you, if we don’t pick up a heartbeat straight away, not to panic. Sometimes babies lie in an awkward position. Is someone with you?’
Iris knew at this stage she should always be able to pick up a heartbeat, but wanted to hedge her bets for a few more moments.
Carrie shook her head. ‘It’s just me. Me and Ruthie. That’s what I’m going to call her.’ She smiled at her belly as she stroked it. ‘I never thought I could have children. Tried for years. My husband left me, then I met someone else for a while, and that didn’t work out either. Then, out of the blue—’ she gave a little smile ‘—this. But the father didn’t want to know. I knew straight away this was my last chance to be a mum and I didn’t care about anything else. I don’t need a man to do this. I have a good enough job and my own place. My mum and sister-in-law will help out. They were both delighted for me. But I didn’t want to tell them about this. I didn’t want to scare them.’ She blinked, frightened eyes connecting with Iris’s. ‘I’m forty-four. I thought when I passed all the crucial points I was safe. Twelve weeks. Twenty weeks and the detailed scan. Then, twenty-four weeks. I thought I’d made it past all the bad stuff.’ Her voice started to shake. ‘I mean, this is supposed to be the final bit. The bit where you just get bigger and bigger and wait for the main event.’
Iris reached out and squeezed Carrie’s hand. Empathy was washing all over her. Carrie was forty-four and thirty-five weeks pregnant with a much-wanted baby. She’d already named her little girl and made plans to do this on her own. Some of the things that she’d said struck a chord with Iris—on a personal level that she would never normally reveal to a patient. Her heart gave an unconscious twist in her chest. She really, really didn’t want to give bad news to this woman today. She tempered the swelling rage in her chest that the obstetricians hadn’t prioritised her. They could well be dealing with some emergencies, but Iris was well aware of the fact that in a few minutes her own attentions would be urgently needed elsewhere.
She lifted the tube of gel and showed it to Carrie. ‘I need to squeeze a little of this on your stomach.’
Carrie pulled up her maternity top, revealing her pale skin with some stretch marks and Iris squeezed the gel out. Using the transducer, she spread the gel across Carrie’s stomach, holding the monitor in her other hand. She flicked the switch and held her breath.
Almost immediately there was the sound of a rapid heartbeat. Iris couldn’t stop the immediate smile that appeared on her face. Carrie gave an audible sigh of relief and her whole body seemed to relax. ‘Ruthie,’ she breathed.
‘Ruthie.’ Iris nodded. She moved the transducer a little, watching her black and white screen. The portable ultrasound monitors in the A&E department weren’t quite top of the range, but they were certainly good enough for their purpose. She held it steady for a full minute, letting Carrie savour the sound of the heartbeat. ‘Everything is in normal ranges,’ she said reassuringly. ‘Ruthie’s heartbeat. Your blood pressure that our nurse took earlier, and the urine sample that you gave just after you arrived.’
‘So, I don’t need to worry?’ Carrie’s eyes were wide.
‘Everything looks good,’ said Iris. ‘Do you mind if I get you booked into the maternity hospital for a review tomorrow?’ She put her hand back over Carrie’s. ‘Only because their doctor didn’t manage to see you today. I can’t find anything to worry about, but we’ll give you a chart to complete about foetal movement, and they can have another look at you tomorrow to make sure that they are happy too.’
Carrie looked a little wary. ‘You’re sure there’s nothing wrong?’
Iris nodded. ‘I am. I’m a very experienced A&E doctor. All your tests are normal. But I’m not your obstetrician, and if I was, and one of my patients had an A&E visit, I’d want to see them for myself.’
This seemed to make sense to Carrie, and she breathed out slowly. ‘Okay, then.’ Iris wiped the gel from Carrie’s stomach. ‘Give me five minutes and one of my staff will come back with the details. But look after yourself, Carrie. And good luck with Ruthie. She’ll be in great hands.’
This time it was Carrie who reached out and grabbed Iris’s hand. ‘Thank you,’ she breathed. ‘I was so scared when I came in today. You’ve no idea how relieved I am.’
‘I get it.’ Iris smiled. ‘And I’m glad we were able to help.’
She pulled back the curtain and walked quickly to the desk, giving instructions to one of her colleagues to make the appointment for Carrie and make sure she got home safely.
The thump-thump of the helicopter sounded overhead. Iris could feel the flip inside her stomach—that familiar apprehension over what might lie ahead. All she knew was that a fishing boat had overturned due to the storm and all four crew had been in the sea. She didn’t even know yet if all four had been successfully winched to safety. There must have been at least two rescue helicopters out there, and doubtless some of the life craft crew too. All of those personnel would have been exposed to the cruel elements currently battering Dublin.
She could well have more than four critical patients to deal with.
‘Everyone ready?’ she gave a shout to the staff. It was the oddest thing. Voices quietened in the usually buzzing department. Iris could see that the two patients in Resus had been moved and the trolleys prepared. Two of the other medical patients had disappeared too, leaving two empty bays directly next to Resus.
Emergency trolleys were ready, staff were aproned, gloved and masked. Rena had bags of saline and glucose in the warmers and warming blankets prepared—standard procedures for any unit receiving potentially hypothermic patients.
There was still some background noise, but she could feel the buzz in the air. The hush only emphasised it. She’d spent ten years of her life working in A&E. It had always been her first choice. Always been her home. She’d never felt drawn to any other speciality and this was exactly why.
This was the moment that all department staff drew together. As she looked at the sea of faces—silently wishing there were a few more—she knew she could count on the colleagues around her. It was the same when any major casualties were expected. They were the biggest hospital in Dublin, with over six hundred beds. They always received the majority of casualties. They were always ready. And she was proud to be part of this team.
Iris Conway had done good. From the abandoned baby, to the adopted daughter of two parents who had rapidly became disinterested in her once they’d had a child of their own and then emigrated to Australia as soon as she’d gone to medical school, she only wished there was occasionally someone around to be proud of her and tell her so. That’s why she relied on the team around her so much.
The doors burst open behind her, and the air rescue team ran in with their trolley, two of the A&E staff beside them. St Mary’s had a helicopter landing pad on the roof, with direct access to a lift that brought them straight down to A&E.
The paramedic spoke quickly as the trolley rolled into Resus. The staff moved automatically, positioning themselves and quickly pulling the patient over. ‘Owen Moore, twenty-seven. Part of the crew of the McGonigal. We think he was in the sea for approximately thirty minutes. Temperature currently twenty-eight degrees. Bradycardic, hypotensive. On oxygen, saturation ninety-two percent.’
Iris nodded. ‘How long has he been out of the water?’
‘Eight minutes.’
She held back the wow. These guys were real-life superheroes. ‘You have more than one?’
‘Second guy is coming in right behind us.’ He paused and she knew there was something else.
‘What?’
The doors crashed again, and she knew the second patient would be there in moments. He spoke into the radio pinned to his shoulder for a moment, then met her gaze. ‘The winds have picked up again. Our second helicopter is having trouble landing.’
She gulped. Hoping her face wasn’t showing the immediate thoughts in her head. As soon the first rescue craft had offloaded their patients, she knew it would have taken off again to leave room for its partner to land. These guys were experts.
The second trolley rolled into the room and she listened to the report. Almost identical to the first, only this guy was slightly older.
‘Get the clothes off these guys. Both are right on the cusp between moderate and severe hypothermia. Recheck their temps. Cardiac monitoring is essential. Quick check for any other injuries and get me a blood glucose level and I need IV access and a set of bloods on both.’
She moved into position, next to the first patient, expertly sliding a Venflon into his shut-down peripheries. He was young. It was probably the only reason she’d managed to get venous access. She looked up to see Ryan, one of her other doctors, struggling to get access for the other patient. ‘Need a hand?’
She could see the frustration on his face and knew he didn’t want to give up. Sometimes with a hypothermic patient they had to put in a central line, or even use an infusion into the bone marrow. Taking over wouldn’t help Ryan, but she’d do it if she had to. The needs of the patient always came first.
‘I’m in,’ he said after a few moments.
‘Warming blankets,’ she instructed, catching sight of the paramedic still at the door. She moved over and lowered her voice. ‘Do you need someone to check you over?’ Before she could stop herself, she reached over and touched his arm. It was icily cold, and that was through his jacket. ‘Fergus?’ Her shout echoed down the corridor, and the shaggy-haired nurse stuck his head out from behind a set of curtains. ‘Take a look at our colleague for me,’ she said, shaking her head as the paramedic tried to object. ‘It will be a while before you can get back on duty,’ she said quickly. ‘I expect you want to hang around to make sure your other colleagues are fine anyway.’
She knew the words gave him the out. She’d been around these rescue guys for too many years. Looking after everyone else was always the priority over looking after themselves. He nodded as Fergus appeared and guided him away. He’d wanted to make sure the other helicopter landed safely and his fellow paramedic had delivered his own patients to the unit.
She moved, still assessing both patients. The second guy, Euan, looked like he may have fractured a rib at some point. The radiographer appeared with the portable machine after a quick call.
The doors at the end of the corridor burst open again, and this time, one of her staff was on top of the trolley doing chest compressions. Relief firstly flooded over her as she realised the second helicopter must have landed safely, then disappeared rapidly at the acknowledgement of how sick the next patient was. ‘Let’s move these two guys to the bays at the side,’ she said instantly, waving to the two patients currently in Resus. They would both still need constant monitoring, but at least they were certainly more stable than the patient on his way towards her.
Sean, one of their experienced anaesthetists, appeared. ‘Call me your guardian angel. Just assessed the surgical patients,’ he said quietly. ‘Want me to hang around?’
‘Absolutely,’ she said instantly. Her brain wanted to question why he’d assessed the surgical patients instead of one of the actual surgeons, but there was no time for that.
The trolley swished in with the man being resuscitated. He was obviously older. ‘Captain of the McGonigal,’ said the ashen-faced paramedic. ‘Was unconscious in the water by the time we winched him out. Had previously been conscious and told us we had to take all his crew first. Rob King. Fifty-seven.’
Her brain was trying hard to keep track of everything. ‘Next guy’s not quite as bad,’ said the paramedic, as if he’d just read her thoughts.
Rena appeared in the doorway. ‘New doc’s just arrived. The replacement for Claire. He’s looking after the two just moved out of Resus and seems to know his stuff. Ryan’s breathing a sigh of relief.’
Iris gave a careful nod. Ryan was good, but only a year into the job. He didn’t have enough experience yet, and she was glad the new doctor had arrived, because with patients like these, they really needed a doctor each.
She moved next to Sean, who had already expertly intubated Mr King and was attempting to get an IV in place, while the member of staff above kept chest compressions up. Iris wasn’t in any way hierarchical. She wasn’t going to tell Sean to let her take over, or move her staff member before she should. She seamlessly worked around them, placing the electrodes for the cardiac monitor around her colleagues’ hands, taking a core temperature again and then a blood sugar reading. She wordlessly handed the warmed glucose IV line to Sean once he’d finished drawing off the bloods.
The fourth trolley rolled into place and Ryan came in on its heels. ‘I’ll take this one,’ he said.
‘What about the other two?’
‘New guy’s got them,’ he said with an easy confidence that let her know they were in capable hands. She didn’t even know the new guy’s name.
She glanced quickly over at the fourth patient. Younger again, and he looked in a similar condition to the first two. Mr King was definitely the sickest. ‘Lori,’ she shouted to one of the other staff nurses. ‘Come in and work with Ryan.’
Rena was bagging Mr King methodically. ‘Wait!’ Sean held his hand up to the nurse doing the compressions.
All eyes glanced at the monitor, and after a few moments of stuttering, a blip appeared. The nurse gave a sigh and jumped down from the trolley. ‘Well done, Amy,’ said Iris, tapping her staff member on the shoulder.
There was a shout from outside and Iris froze at the sound of the male voice.
It was almost like she’d jumped into the Irish Sea herself. Cold flooded through her veins and she was pretty sure her heart stopped.
Another voice joined in. Joan’s. She was indignant and obviously giving someone a piece of her mind. Sean looked up. ‘All yours,’ he said, with a hint of a smile. ‘I’ll stay with Mr King.’
She was torn. Mr King was the sickest man here, and she was head of the department—she should be looking after him. But something was obviously awry in the next room, and as head of department, she should take control.
She knew exactly why her feet seemed to be sticking to the floor right now. But her brain hadn’t really caught up with her body yet.
She could hear the ping, ping of the monitor in the cubicle next door. ‘Stand clear,’ came the steady male voice again, followed by the familiar sound of a shock being delivered.
‘Move!’ yelled Joan, and even though the words weren’t aimed at Iris, they seemed to have the desired effect on her feet.
She took the few steps out of the resus room and into the bay next door.
A dark, slightly curled head was leaning over one of the patients from earlier who’d clearly gone into a cardiac arrest. The young medical student was practically pinned against the wall by Joan, an endotracheal tube clutched in one hand. Joan was barely five feet tall, and almost as wide, but she was a formidable force. ‘You do not do anything in this department you are not qualified to do,’ she hissed as she wordlessly handed a new sealed airway to the doctor beside her.
He glanced up, those familiar dark eyes locking on hers.
For a moment, the world froze. Lachlan Brodie. Her ex-husband. The man who’d stolen her heart years ago, and never given it back.
Lachlan looked just as shocked as she was, but in the blink of an eye, he was sliding the airway effortlessly into the patient’s throat, moving to allow Joan to start bagging the patient. It was almost an echo of what was happening in the resus room right now.
She watched, still unable to move, as he turned his head to the monitor, checking the erratic beat of the man’s heart. This wasn’t uncommon in hypothermic patients. Episodes of ventricular fibrillation could occur in someone as their temperature rose.
‘Temperature.’ The words came out her mouth automatically, as the rules in these situations came back to her.
‘Thirty,’ came the curt reply. She grabbed adrenaline from the emergency cart and delivered it into the man’s IV. ‘Stand clear,’ Lachlan repeated as he delivered a second shock.
A few seconds later, the heartbeat appeared again. But Iris didn’t have time to breathe a sigh of relief. Because Lachlan straightened up and looked her in the eye. ‘Tell me you’re not in charge here?’
‘Why?’ was her stunned reply. Every tiny hair on the back of her neck stood indignantly on end.
‘Because this is worst run department I’ve ever seen,’ came the brutal, cutting response.
