Fling with the Doc Next Door
Autor
Alison Roberts
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12
CHAPTER ONE
BEING FACED WITH a potentially life-threatening emergency on her first day in a new job, let alone with her very first patient, was not something that Dr Ella Grisham had been anticipating.
She’d been a specialist obstetrician for long enough now, however, to know that the first signs of an emergency could appear at any time. They could also escalate rapidly and, when there were two lives involved, the stakes—and the tension—could reach overwhelming levels surprisingly rapidly.
Ella was quite aware that, in hindsight, she might excuse what was happening for that reason but, right now, the brusque demand from the man who’d burst through the door of this delivery room, after stopping suddenly to stare through the window on the corridor side, was alarming for everyone, including Ella.
Especially Ella?
‘What’s going on?’ He was glaring at her. ‘Who are you?’
‘Ella Grisham.’
‘Ah, right...our new locum. I’m Logan Walsh.’
Ella simply nodded. She had expected to meet the head of department here in the Queen Mother’s Maternity Hospital—a separate wing of a large general hospital in Aberdeen—before she actually started her first shift but he’d been away presenting a course in obstetric emergencies the day of her interview last month and was apparently running late this morning due to an urgent administration issue that needed his attention. Nobody had time for introductions, anyway, because a midwife was asking for an urgent consult on a woman in labour.
A woman that Ella was currently still examining. She had the transducer of a portable ultrasound machine in her hand and she turned back to the screen.
‘No obvious signs of a placental abruption,’ she said.
Judy, the midwife, gave Ella a cautiously relieved glance but they both knew that even massive internal blood loss could stay hidden for some time. She turned back to the tympanic thermometer she was holding as it beeped. ‘Thirty-seven point six,’ she reported. ‘Heart rate’s up to one ten.’
‘Blood pressure?’
‘One forty over sixty-five.’
‘Can someone tell me what’s going on, please?’ The words were clipped enough to be a command rather than a request. It only took a couple of steps of Logan Walsh’s long legs for him to be beside the CTG machine being used for continuous monitoring of both the baby’s heart rate and the mother’s contractions. He ran the strip of paper, that was long enough to have puddled on the floor, between his fingers.
‘Lauren’s a thirty-two-year-old primigravida,’ Ella told him. ‘She’s coming up to thirty-seven weeks gestation. No concerns with the pregnancy other than the baby being breech but he seemed to decide it was time to turn around by himself a couple of days ago.’
Lauren leaned back against her pillows, her face almost as pale as the hospital linen. ‘It felt like I was being turned inside out,’ she put in. ‘It was my midwife that told me what had happened and she said it was a good thing because it meant I might not need to have a Caesarean.’
‘Lauren came in about half an hour ago with sudden abdominal pain,’ Ella continued.
‘I checked her,’ Judy put in. ‘Waters were intact, she wasn’t having any contractions and there was no bleeding or dilation on an internal exam.’
‘Judy had just called for an urgent consult when I arrived on the ward,’ Ella added.
‘Why?’ Logan’s gaze flicked up from the graph paper to land on Judy.
Ella wanted to suggest that it had probably been more than seeing a staff member he didn’t recognise that had brought him barging into this room after barely more than a glance through the window. It was more likely to have been an instinct—the same kind that was making the hairs prickle on the back of her own neck. Something wasn’t right here.
Judy didn’t get the chance to respond to the HoD because Lauren let out a cry. Her husband reached out to put his hand on her forehead.
‘What’s wrong, babe?’
‘That pain’s getting worse. It hurts in my shoulders now, too.’ She pulled in a sharp breath, and then another, as if it was suddenly becoming difficult to breathe. ‘And I think I’m going to be sick.’
Ella had started wiping the gel off Lauren’s abdomen at the same time she’d cried out in pain and she had caught her own breath as she felt the rigid muscles beneath the tissues in her hand. She couldn’t miss being the sudden focus of Logan’s attention either, despite Judy reaching past him with a container in case Lauren was about to vomit. His stare had the intensity of a laser beam.
‘Abdomen was soft five minutes ago,’ she said quietly. ‘And only slightly tender.’
‘Blood pressure’s dropping.’ Judy was watching for the figures to finish appearing. ‘Seventy-eight over forty. Heart rate’s up to one-forty.’
The blood pressure was suddenly dangerously low and the heart rate too high. Ella didn’t need to check the recording being spat out from the CTG to know that the unborn baby was having a deceleration because she could hear the blips of his heartbeat slowing ominously. She picked up the transducer of the ultrasound with one hand and squeezed a new blob of gel onto the stretched skin of Lauren’s belly with the other. It took only seconds to find something that hadn’t been obvious even a minute or two earlier.
‘There’s free fluid in the abdomen.’ Most likely blood. A lot of it, although Ella didn’t pass on either of those thoughts aloud. Logan was the only person who needed to know just how serious this situation had suddenly become.
Lauren was sobbing, between agonised groans.
‘Do something,’ her husband begged. ‘Please...’
‘We’re going to take Lauren up to Theatre.’ Logan’s tone was deceptively calm. ‘We can get her pain under control there and start giving her some fluids at the same time as getting her ready for surgery.’
‘Surgery?’
‘It looks like there’s some internal bleeding going on,’ Ella told him. ‘So the sooner we deliver baby, the better.’
‘Can I stay with her?’
‘We’ll see how it goes.’ Ella couldn’t make promises. In the event of a major surgical emergency you didn’t want family members in there watching. ‘You can certainly come up as far as Theatre with us. We’ll need you to sign the consent forms for a Caesarean section.’
‘Are you going to do the operation?’
‘No,’ Logan said. ‘I’ll be doing that.’
‘You’re in the best hands,’ Judy assured them as she began opening both doors to the room to allow for the bed to be wheeled through. ‘Dr Walsh is our top consultant.’
Ella was blinking at having her first patient whisked from her care like this. Okay, this man was her new boss and maybe he hadn’t read her CV and had no idea that she was more than capable of handling an emergency C-section herself but to dismiss her like this, in front of a patient and one of her new colleagues was...well...rather stunningly rude.
She’d probably decide it was mortifying when she gave herself time to think about it and maybe that would be in only a matter of seconds when everybody else had vanished through those doors, leaving her in an empty delivery room.
Lauren was still sobbing as the bed started moving, beside herself now with the fear on top of her pain. ‘But I want Ella to look after me...’
‘She’s coming too,’ Logan said, his tone suggesting that it was a given. He turned as he reached the door, his brows lowering as he saw her still standing beside where the bed had been positioned. ‘Any time you’re ready, Doctor...?’
‘Grisham,’ Ella muttered as she followed the bed. Not that there had been much point in answering the query. He’d probably forgotten he’d even asked by now. Her HoD was holding onto the rails on one side of the bed, Judy on the other, as they sped towards a lift that another staff member was already holding open for them, the tension of an escalating emergency clearly contagious.
Ella squeezed herself into the small space remaining in the lift as the doors began to close. She found she was still holding her breath as they slid open again a very short time later, giving them access to the theatre suite. She got out to allow room for Lauren’s bed to get past and, to her horror, Ella could see a bright red bloodstain beginning to spread on the hospital gown that had become tucked between her legs.
This was definitely the most dramatic start to any job she’d ever had and maybe the worst part was that she was clearly not going to be allowed to take an active role in making sure it didn’t become a catastrophe. Ella could only hope that this tall, rugged-looking man who’d simply assumed command—and who, in fact, was the reason she’d chosen to come to this particular hospital in the first place—was every bit as good as his reputation suggested.
At least she knew better than to make idle small talk at an inappropriate time—like when you were scrubbing in for an emergent situation where every second counted.
It seemed that this new locum was every bit as focused as Logan was on the woman they’d just left in the hands of the anaesthetic team to put in a spinal block and the theatre technicians to drape and prep Lauren’s skin. A sideways glance as Logan pulled on a hat and tied his mask showed him that Ella was already well into the detailed process of decontamination. She was rinsing off the first soaping by holding her hands up to let the water stream down towards her elbows. He noticed that her nails were short and practical and that she wasn’t wearing any rings, although anything other than a plain wedding band had to be removed for surgery anyway. What was far more important was that Ella had just demonstrated skills far more useful than not interrupting his concentration.
‘That was good work,’ he said gruffly. ‘Getting wide bore venous access for fluid resuscitation when someone’s that shut down isn’t easy.’
‘Can the blood bank here do a full group and hold within forty minutes?’
‘Of course. And we’ll have O negative packed red cells, platelets and plasma here by the time we’ve run two litres of saline.’ Logan used his elbow to dispense the liquid surgical scrub onto his hands and then interlaced his fingers to start a ritual he was so familiar with it was automatic. ‘Did you get the chance to do a detailed history?’
‘Enough to know she had no red flags for a placental abruption.’ Ella had taken the soap-impregnated brush from its sterile packaging and was starting to scrub her nails. ‘Her blood pressure’s been normal at every antenatal visit, she doesn’t smoke and she hasn’t experienced any recent traumatic event.’
‘What makes you so sure it’s a placental abruption?’ Logan clasped his arm with his other hand and rotated it as he moved his hand towards his elbow. ‘Why wouldn’t you think it could be a uterine rupture?’
The glance he got then was wide-eyed. ‘Because the chances of that in a primigravida with no history of trauma or surgery are virtually non-existent. What’s that saying about thinking of horses when you hear hoofbeats and not zebras?’
‘When you’re the only maternity hospital for a very large catchment area, maybe it pays to remember there might be a zoo nearby.’ It was Logan’s turn to reach for the nailbrush.
Ella was unfolding the sterile towel to dry each hand and arm. ‘Lauren’s not an older mother, she’s less than forty weeks gestation with a baby of normal weight.’ She picked up the gown on the top of the opened sterile pack, giving it an expert shake before pushing her arms into the sleeves without letting her fingers come through the cuffs. ‘As far as anyone knows, she doesn’t have a malformed uterus and hasn’t got a placenta praevia. She’s never had a C-section or surgery for fibroids. She’s not even in labour...’
Logan said nothing as he let her finish demonstrating her knowledge of known risk factors for the major complication of a ruptured uterus. While it wouldn’t change the initial management of getting both this mother and baby out of danger, it was disappointing that this new colleague was dismissing what was always top of his own list of potential diagnoses with this kind of presentation. He stayed silent as he put on his own gown and gloves. Ella was turning to wrap the tie of her gown around her body while a nurse held the end. She tied it in a bow, clasped both gloved hands in front of her body and stood back, clearly waiting for him to lead the way into Theatre. Her gaze was steady.
‘You’re quite right,’ she said quietly. ‘About keeping even the rarest of things in mind.’ She didn’t let go of his gaze.
Logan was still silent for a heartbeat but then he gave her a single approving nod. ‘Let’s go and find out, shall we?’
He was right.
Against those unbelievable odds, Logan Walsh had picked the correct cause for the sudden life-threatening deterioration of Lauren’s condition. The massive amount of blood that had been lost became dramatically obvious the moment the abdomen was opened and at least a litre of blood spilled out to soak the drapes and trickle onto the floor of the operating theatre.
‘Suction, please.’ Logan’s voice was deceptively calm.
Ella held the tube of the suction unit and could see the collection chamber filling rapidly with another litre of blood. Lauren’s husband, sitting on the other side of the screen and holding tight to her hand, couldn’t see the operating field but he went several shades paler as he saw the blood on the floor.
It was only when Ella had suctioned even more blood out of the abdomen that the tear in the uterus became evident. For a split second she caught Logan’s gaze and it was a silent acknowledgement that, from now on, she would always be more prepared for even the most unlikely diagnosis.
It was impressive just how calmly Logan was dealing with this. Within a remarkably short period of time he was lifting a completely motionless baby from the damaged womb and placing him onto towels that a paediatric registrar was holding. Ella took another glance as the baby was placed on the trolley in front of the senior neonatal paediatrician and a bag mask was fitted over the tiny face to begin an attempt to resuscitate the newborn.
‘Is he all right?’ The baby’s father had twisted his neck to watch but could see nothing past the backs of so many people.
‘Can I see him?’ It was Lauren’s voice this time. ‘Just for a minute?’
‘Not just yet.’ Logan’s voice held a note that Ella hadn’t heard before. ‘He needs a wee bit of help but he’s in the best hands.’
He wasn’t just being reassuring without making promises that might not be possible to keep. There was something deeper in that tone. A hint of an empathy that Ella could actually feel rather than hear.
‘Suction, thanks.’
This time Logan’s tone told Ella not to lose focus on the task ahead of them now—to stop the blood loss and hopefully be able to repair the uterus so that Lauren wouldn’t lose the chance to have another child in the future. It didn’t look promising with the distortion she could see in the uterine structure but, as the minutes ticked past and more blood products and then whole blood were hung for transfusion, Logan worked with the utmost concentration and a skill that Ella recognised as being possibly the best she’d ever seen to repair the jagged damage.
Even better, the ominous silence from the corner of the theatre where the paediatric team were working to resuscitate the baby was finally broken by the warbling cry of an infant who sounded as if he’d got over the shock of his tumultuous entrance to the world and he wanted everybody to know he wasn’t happy about it.
His parents both burst into tears and Ella could feel herself welling up too, because the survival of a tiny baby against the odds was always going to be something that squeezed her heart hard enough to push a lump into her throat and tears into her eyes, but she had to blink them back. Fast.
How embarrassing would it be if her new boss caught her crying right now? He was already unimpressed that she’d picked the wrong potential cause for a dangerous internal bleed in a pregnant woman. She kept her head down, using the swab she had clasped in some forceps to clear a small pooling of blood, but that wasn’t the reason Logan paused his meticulous stitching for a moment. Ella could feel, for that heartbeat, that he was staring at her.
She also had the distinct feeling that he knew just how easy it was for her to get a bit too emotionally involved with her cases. And that he was even less impressed with her because of it.
‘I can’t thank you enough, Ella.’
But Ella shook her head. ‘It’s not me that deserves the thanks, Lauren.’ She smiled down at the young mother, propped against her pillows, who was holding her sound asleep baby boy in her arms. ‘You were lucky enough to be in the hands of one of the best surgeons I’ve ever worked with—and I’ve worked with a lot, given that I never stay in one place for long.’
‘What made you come to Aberdeen?’ Lauren was still too pale and obviously exhausted but happy enough to be smiling back at Ella. ‘Can’t possibly be for the weather.’
Both women—and the nurse who was tidying Lauren’s bedside table—looked towards the window of the room, where the rain was coming down in sheets that would have been thick enough to blur the view of the old grey stone buildings in this older western area of the Scottish city even if the daylight wasn’t rapidly fading.
‘My grandparents used to live here and I visited frequently as a child. Maybe I felt the need for a place that felt more like home for a change. I’ve been in California for the last six months, doing some advanced training, and I had a condo right on the beach.’
‘Some people have all the luck,’ the nurse muttered, but her smile was friendly.
Lauren shook her head sadly. ‘You won’t want to live on any beach around here.’
‘No... And I’m only here for three months, filling in for someone on maternity leave, so it’s not worth even looking for my own place.’ Ella picked up the chart on the end of Lauren’s bed to check the latest vital sign recordings, taking a glance at the catheter bag on the way. Bladder injuries from a uterine rupture were not uncommon and it was reassuring not to see any tinge of pink in the bag. ‘I’ve been given a room in the doctors’ residence,’ she said when she’d taken in recordings that were all within normal limits. ‘Which was another good reason to come here. Not the most important one, of course.’
‘What was the most important one?’ Lauren sounded curious.
‘Working with the surgeon who did your operation,’ Ella told her. ‘He’s had some papers published around his mission to reduce the risk of obstetric emergencies, especially in remote areas. He’s developed a course to train paramedics and supply refresher courses to GPs and midwives. He also heads a response team that’s available to be in the emergency department when a serious case is brought in or they ride out with the crew on ambulances or with helicopter rescue teams if there’s enough time. They work with a NETS team as well, which is the neonatal emergency transfer service if an incubator is needed. I’m really hoping I can get involved with the programme while I’m here.’
‘You might be out of luck this time...’ It was the nurse who was shaking her head now. ‘I know people who’d happily give up an eye tooth to get in on that front line obstetric stuff, including the doctor you’re filling in for, who’s never been included. He’s very picky about who gets to work with him, is our Dr Walsh.’
‘Hmm...’
Ella’s tone was noncommittal but yes...she’d got the impression that her new boss might be rather picky about quite a few things. This morning’s emergency hadn’t been the time to even think about him on a personal level but those first impressions had been surfacing somewhere in the back of her mind over the course of the rest of the day which had, fortunately, been full of perfectly routine, easy to manage obstetrical tasks, including two straightforward deliveries and an antenatal clinic that had taken up most of the afternoon.
The impression that stood out above all others was the sheer presence of the man. If she’d been a fly on the wall, watching the way he simply assumed command of a situation he’d chosen to walk into, she might have labelled it arrogance but, even though she’d been the person who’d been pushed aside, it hadn’t felt as if Logan Walsh was a self-centred or uncaring man. Quite the opposite, really. It was just that what he cared about so fiercely had nothing to do with what others might think of him or the feelings of colleagues he might be trampling on. The intensity of his focus—that, in hindsight, was a perfect match for his very Scottish kind of ruggedness and the dark, slightly unkempt waves of his hair—had been on what actually mattered in the moment, however, and that was saving the lives of this young mother and her first baby.
‘It’s so good to see you looking so much better,’ Ella said to Lauren. ‘You had us all worried there for a little while this morning.’
‘I was kind of terrified myself.’ Lauren’s smile was full of joy now, though, as she gazed at the scrunched-up face of the tiny boy in her arms. ‘But he’s just perfect, isn’t he?’
‘He’s gorgeous,’ Ella agreed. ‘But how are you? How’s the pain level?’
‘The pain’s not too bad. I’m just so tired...’
‘We had to replace almost your whole blood volume,’ Ella said. ‘It’s only to be expected that you’ll feel like you’ve had the stuffing knocked out of you for a few days but you’re doing very well and I can see you’re being extremely well looked after.’ She smiled at the nurse. ‘I’m about to brave that filthy weather out there and find where I’m going to be living because I came straight here from my hotel this morning and left my suitcase at Reception. I don’t think I’m far away, though, so if there’s any problems overnight I’ll be available.’
‘The doctors’ residence is just across the road from the back of this part of the hospital buildings,’ the nurse said. ‘But it’s Dr Walsh who’ll be on call for Lauren. He makes a point of being available for all his own surgical cases.’
Ella blinked. How could any surgeon, let alone a head of department, find the time to do that, on top of running an emergency service for obstetric cases that could be activated at any time of the day or night? Did the man have no life of his own? No need to sleep?
Not that she was about to criticise his lifestyle. Or tread on his toes. She needed some sleep herself after a huge first day on top of the travel and general upheaval that came from shifting her life from one country to another. It would have been sensible to have another night at the hotel with the convenience of the restaurant for an evening meal but it was too late to go back now. Her suitcase—and the keys to her self-contained apartment in the doctors’ residence—were waiting for her at the main reception desk.
The weariness, as well as hunger, were even more noticeable by the time Ella had changed out of her scrubs into jeans, sneakers and a warm jumper over her tee shirt. Any thoughts of finding a nearby supermarket were easy to dismiss when all she wanted was to unpack essentials, have a long, hot shower and crash into bed. Passing a vending machine in one of the corridors on the way to Reception, she stopped and selected a ham and salad sandwich in a plastic triangle. At least she’d found an easy way to prevent herself getting any hungrier.
There was no way to stop herself getting very, very wet as she followed the directions they gave her at Reception, dragged her overly large wheelie case across a main road at the first set of traffic lights and looked for an old stone building with a brass plaque above its front door that had the impression of a crown and the grand title of ‘The Lodge’.
The mosaic tiling in the foyer was magnificent. So was the ornate ceiling, the chandelier and the sweeping staircase of what must have once been a grand private home. The common areas on the ground floor like the big sitting room to one side seemed to be deserted and Ella’s heart sank a little as she realised there was no lift available. She checked the tag attached to the keys she’d been given to both the front door and her own space. Apartment Seven, she confirmed. Second floor.
The big suitcase thumped against every step. Ella stopped to catch her breath on the first-floor landing and then started again, aware that she was still leaving a trail of dripping water from her sodden anorak and the long braid hanging down her back. She was also starting to feel unpleasantly cold.
Apartments Five and Six were the closest to the stairs but the end of the hallway had a wonderful arched window that had the sparkle of lights behind a curtain of the relentless rain so maybe Ella’s apartment would have a nice view of the city. It was a huge relief to park her suitcase beside the door with a shiny brass number seven screwed to the dark wood. She fished in her bag for the key and fitted it into the lock.
Or rather she tried to fit it into the lock. She tried both keys. She tried many times but it was quite obvious that there was no way she was going to open this door. She found her phone and tried to call the woman called Jean who’d been so charming when she’d made the arrangements for this accommodation during a phone call from California.
‘It’ll be perfect for you, Dr Grisham, I promise. You’ll find breakfast supplies like tea, coffee and milk, along with all the linen you’ll need. The bed will be made up and ready for you and you have my number if there are any problems.’
The response to the number was a message that suggested calling back during business hours on weekdays between nine a.m. and five p.m. As Ella hung up she noticed the warning message of low battery power on the screen of her phone. The option of searching online for a number that would get her through to the hospital’s reception desk wasn’t looking promising. She was going to have to go out into that horrible weather again, wasn’t she?
Ella never normally used swear words but she used one now. Quite loudly. She was tempted to kick the door of Apartment Seven but settled with glaring at it instead. And then she made a growling sound, snatching up her shoulder bag as she turned to head for the staircase again. She hadn’t quite finished the turn when the door opposite her own flew open and she froze instantly.
At least she didn’t swear again. Out loud, anyway.
This day had started on an undeniably mortifying note when Ella’s albeit unknown level of skill had been summarily dismissed in the face of a life-or-death emergency. She’d then offered her senior colleague an inaccurate diagnosis of what was causing that emergency. And now...oh, dear Lord...now, she could almost feel him thinking that she was not only demonstrating a lack of control in a frustrating situation but total incompetency in not even being able to unlock a door.
Had she done something terrible in a previous life to earn this kind of karma?
What else could explain this appalling development of discovering that the occupant of Apartment Eight, her closest neighbour, was none other than Logan Walsh?
