Accidental Reunion (9 page)

Declan didn’t even bother to be polite and pointedly called her ‘Sister’, even then only speaking when he absolutely had to.

Yvonne was blushing at every turn, not sure who knew and what had been said.

Sue was equally jumpy, darting out off the nurses’ station every time Lila even came near.

During a quiet moment, as Lila tackled the never-ending problem that was the roster, she called Sue back when her colleague did a sudden about-turn, realising Lila was at the desk.

‘For heaven’s sake, Sue,’ Lila finally confronted her. ‘What on earth’s going on? Look, I’m sorry I disappeared. I know I asked you to get me a drink…’

‘It’s not that.’ Sue blushed.

‘Then what?’

‘You won’t be cross?’

‘Just tell me,’ Lila demanded. ‘It’s like working in a minefield here.’

‘Well, the bar closed soon after I got your drink and, well, when you didn’t come back…’

‘Sue!’

‘All right. Jez wanted a drink. I gave him yours and, well, one thing sort of led to another. We went out last night. Look, I don’t want to tread on your toes—’

Lila laughed. ‘You’re not.’

‘Truly.’

‘No, in fact, I’m delighted for you both.’

‘So what happened to you, then? Where did you disappear to?’

‘I just had enough all of a sudden.’

‘Hmm.’ Sue gave her a sceptical look. ‘If you say so. Anyway, I got one thing right. Declan and Yvonne are hardly talking. He looks like he’s about to explode he’s so angry. I’ve never seen him like this. Declan’s normally so friendly. She must have really upset him.’

Lila certainly wasn’t about to enlighten Sue.

‘Lila, can I have a hand?’

‘Sure, Lucy.’ Glad to end the conversation, Lila jumped down off her stool, closing the roster book shut with a snap.

‘It’s Jessica Stevens, the overdose patient.’

‘What’s the problem?’ Jessica had taken a large number of analgesics some hours ago and had arrived in the department a short time before. Given the time that had passed since her overdose, washing her stomach out would have proved pointless so it had been decided to give her some Carbomix—a black charcoal drink that lined the stomach and bowel and prevented further absorption of the medicines she had taken.

‘She’s extremely agitated and refusing to drink the mixture.’ That often happened. Overdose patients were often distressed and in some cases disorientated.

‘Has the doctor explained the consequences of refusing treatment?’ Lila asked as she flicked through the casualty card.

‘Well Declan has, but her husband has just arrived with some more empty bottles. It would seem she’s Amitriptyline as well as the other pills and alcohol. I’m just not happy with her, Lila.’

Lila grimaced. Amitriptyline was a particularly nasty drug that, when taken in excess, could cause cardiac arrhythmias. And Lucy’s ominous statement
about not being happy with the patient was enough to ring a warning bell in Lila’s head.

‘OK, let’s get her over to Resus and on a monitor. I’ll talk to her. Can you go and accept the patient the paramedics are wheeling in? Just let me know if there are any concerns.’

‘Sure.’ Lila liked working with Lucy. Although she had just completed her grad year, Lucy had already developed a sixth sense for when something wasn’t quite right. It was an essential tool all good Emergency nurses possessed and one that wasn’t easily defined. A hunch perhaps that, despite what the observation chart said, despite how the patient looked, there was something more sinister going on.

Lucy, also more than happy to defer to her superiors when necessary, another essential tool when building a strong and co-operative nursing team.

Jessica was extremely upset, crying and thrashing about.

‘Mrs Stevens.’ Lila patted her shoulder. ‘Jessica, my name is Lila Bailey. I’m the nurse in charge tonight. I’ve been told you don’t want to take the Carbomix.’

‘It’s disgusting.’

Jessica’s teeth were black from her previous attempts at drinking the mixture.

‘I know, but it really is practically tasteless, and it’s imperative that you have it.’ Lila was working quickly as she spoke, clipping the cardiac monitor to the red dots she had placed on the woman’s chest.

‘She has to have it,’ the medical registrar stated unhelpfully, only inflaming Jessica’s anger even further.

‘I don’t have to do anything! You can’t make me!’

Jessica was upset, distressed, but Lila felt she wasn’t beyond reason. ‘No, Jessica, we can’t make you. You have every right to refuse treatment. However, refusing treatment could end your life.’ She stared directly at the distraught woman. ‘You could die, Jessica.’

‘I took a few too many painkillers…’

‘Enough to do serious damage.’ Lila’s voice was more insistent now. She was also acutely aware that Declan had joined them. As the senior doctor on that night he had every right to be there, every right to ensure things were going all right, but his appearance did nothing to help Lila. She focussed her attention on the patient.

‘I’m not drinking that sludge.’

‘OK, fair enough, but what if we passed a soft tube into your stomach and gave you the drink through that? You wouldn’t have to taste it then.’ She glanced up at the medical registrar, who nodded.

‘Is that going to hurt?’

Lila took her patient’s hand. It was imperative she keep Jessica’s confidence. Lying wasn’t going to achieve that.

‘It won’t hurt, Jessica, but it will be uncomfortable. A soft rubber tube will be passed through your nose into your stomach—that’s the uncomfortable bit. Once it’s in place it won’t hurt at all.’

‘And you’ll do it?’ Jessica looked over to the med reg. ‘He’s not coming near me.’

‘Jessica, I’ll do it, but it really is imperative that it’s done soon.’

Passing a nasogastric tube was a basic procedure,
but with a conscious patient it required some degree of co-operation and patience. Neither of which Jessica possessed tonight.

‘Page me when her bloods come back’ was the total of the med reg’s contribution to the procedure.

Lila had passed NG tubes numerous times, and not just at work. Sometimes, when Elizabeth was particularly difficult to feed and she was starting to become dehydrated, rather than having her admitted to hospital for an intravenous infusion, Lila would pass a tube and give her mother some extra fluids.

But Elizabeth Bailey in her twilight world was a different patient entirely to Jessica, who thrashed around, gagging and pulling the tube, resisting all efforts.

‘Here.’ Declan saw she was struggling. ‘Jessica, I’m going to hold your hands so you’re not tempted to pull at the tube when Sister passes it.’

Not a look passed between them and, as uncomfortable as his presence made her, Lila was grateful for his help.

‘Is it in?’ he asked as Lila listened with her stethoscope to Jessica’s stomach. Pushing air into the tube with a syringe allowed you to hear the air gurgling in the stomach, ensuring the tube was safely in place. Only Lila couldn’t hear it. ‘I don’t think so. It didn’t go in easily. I think I should reinsert it.’

Jessica had calmed down now, but this did nothing to reassure Lila.

‘She’s becoming drowsy.’

‘Chest X-ray.’ The radiographer announced from the corridor as he arrived with his portable machine.

‘Over here, thanks,’ Declan called. ‘Let them do
the film and then take out the tube and have another go. Is there anything else she might have taken?’ he asked as they put on the lead gowns the radiographer passed them. Jessica was too unwell to be left alone.

‘Not sure.’ Lila frowned. ‘Her husband’s had a lot to drink. He’s taken a taxi home to check for any other tablets that might be missing. Hopefully he’ll ring soon.’

‘Well, let’s get the Carbomix into her—I’m not too happy. Where’s the med reg?’

‘Guess.’

‘On the wards?’

Lila nodded.

‘OK, pass the tube again and I’ll give him a friendly call.’ The wry note in his voice didn’t go unnoticed.

The tube was easy to pass this time. Jessica was complacent now. Listening with her stethoscope, though sure it was now in place Lila still aspirated some fluid, testing it on litmus paper. The colour change on the litmus paper due to the acidic contents of the stomach was a further safeguard.

‘You in?’ Declan asked, coming over.

‘Listen for me?’

He did as asked, and Lila pushed some more air down the tube as Declan placed his stethoscope over Jessica’s stomach. ‘Gurgling away,’ he stated, pulling his stethoscope out of his ears. ‘Put the Carbomix down and I’ll ring the lab, see if there’s any more of her bloods back.’

It took only a moment to pass the Carbomix down the tube. Jessica’s consciousness level was definitely
decreasing and Lila popped her head out into the corridor as Declan returned from his telephone call.

‘Lucy, come into Resus, I’ve a feeling we might be needing you soon. What did the lab say?’ she asked as he made his way back.

But Declan didn’t answer. Moving forward, he suddenly spoke loudly to the patient, rubbing his hand on her sternum as he did so to initiate some kind of response.

‘Mrs Stevens.’

Lila looked at the monitor as she felt for the patient’s pulse. It was strong and rapid but she wasn’t breathing. In one fluid movement Lila pulled down the headrest of the trolley and started to bag the patient.

‘Put out a call,’ she instructed Lucy.

Declan had reached for a large syringe, quickly pulling back the Carbomix Lila had so recently put down in a desperate bid to empty Jessica’s stomach as Lila inflated her patient’s lungs with air.

‘Her pupils are pinpoint,’ Declan stated as he flashed a light into Jessica’s eyes.

He looked up at Lila for a second.

‘Lucy, pull up some Narcan.’

Declan hadn’t even needed to say it, she knew what he was thinking. He nodded his agreement as Lucy passed the drug that would reverse any narcotics Jessica might have taken. Combined with alcohol, some drugs can lead to sudden respiratory arrest, and even though Jessica hadn’t admitted to taking such a drug she was displaying obvious symptoms. Administering Narcan would do no harm if they were wrong,
but if Jessica had indeed taken a narcotic overdose the drug might just save her life.

Narcan, when appropriate, works quickly, so quickly in fact that by the time the cardiac arrest team had arrived Jessica was back to her restless self.

‘Respiratory arrest, guys. We just reversed it with Narcan—she must have also taken some opiates.’

Jessica was vomiting now. Despite her stomach having been speedily emptied, some of the Carbomix obviously remained.

‘It’s all right, Jessica,’ Lila soothed. Holding Jessica’s hair back, she felt her suddenly slump under her touch.

‘She’s gone again.’

Lucy handed over another syringe of Narcan as the anaesthetist suctioned her airway.

There was tension in the room. All were concerned, but this was a regular occurrence in Emergency and all the staff, apart from Lucy, were senior and used to dealing with such crises.

‘She’ll need a Narcan infusion,’ Declan stated. ‘While this drug’s in her system she’s just going to keep going off.’

‘Her chest is a bit rattly,’ the anaesthetist stated. ‘She may well have aspirated. Look, I’ve got a bed on ICU and she’d probably be better off there. We’ll get another chest X-ray first and I’ll let the staff know.’

Of course, it was never that easy. ICU might have a bed but they needed another nurse to be pulled from the wards to cover it. And ICU-trained nurses were rarer than hen’s teeth. Jessica was going to be there for a while.

Lila was glad to be busy, glad that the cubicles were full and there were plenty of patients on the board waiting to be seen. Glad she didn’t have to face any uncomfortable silences with Declan.

She watched him, though, surreptitiously listening as he shot a few sharp words at the med reg or chatted amicably to a rather inebriated teenager he was stitching.

He was so in control, friendly but undoubtedly in charge, knowledgeable but never superior. If she hadn’t loved him, Lila thought ruefully, Declan Haversham would be a sheer pleasure to work with.

They waded through the patients, waded through the long night. Emergency wasn’t the kind of place you could avoid each other even if you wanted to.

Jessica settled down, so much so, in fact, that she no longer required the precious ICU bed, which heralded an even longer wait as a high-dependency bed was located. Checking her observations, Lila gave the patient a reassuring smile.

‘Your observations are all stable, Jessica. As the doctor explained, we’re waiting for a bed on the high-dependency unit, so I’m afraid it might take a while. I’m sorry. I know that you’ve been down here for ages.’

‘That’s all right.’ Jessica lay back against the pillow. ‘I’m just sorry I’ve put everyone to all this bother. I don’t even feel sick, just a bit wobbly. I’d really rather just be at home.’

‘Don’t even think about it.’ Lila gave the woman a smile. ‘You really do need to be here. I know that now you might not feel too bad, but the tablets you’ve taken really can cause serious damage.’

‘The doctor said that I stopped breathing before—is that true?’

Lila nodded. ‘But luckily you were here when that happened. That’s why it’s imperative that you stay. And not just for the medication. Jessica, you took a lot of tablets. It’s clear you’ve got some problems that need to be dealt with.’

‘It’s a bit late for all that.’

Lila didn’t answer. She waited to see whether or not Jessica chose to continue, not wanting to push at this fragile stage.

‘We’ve been having a lot of problems, Mark and I.’

‘Mark’s your husband?’

Jessica nodded. ‘Since the twins came along I just don’t seem to be able to cope any more. He’s always saying he doesn’t mind the mess, doesn’t mind that there’s never any dinner on the table when he gets home from work. All he wants is for me to be happier.’

‘He sounds nice.’

‘He is nice. That’s the whole problem.’ Jessica started to cry. ‘Too nice for me. He deserves better. He’s bought us tickets to go to the theatre next weekend and then stay at some posh hotel. He thinks that if I have a break from the children…’ She started to cry and Lila ran a washcloth under the tap in the cubicle, wiping the tears and streaks of Carbomix from Jessica’s face. As Declan stepped into Resus Lila put a finger up to her lips, indicating for him to stay quiet. What Jessica had to say was important if she was going to get the appropriate treatment.