Top-Notch Men!: In Her Boss's Special Care

Allegra had never felt so incensed in her life. Her hands were clenched by her sides so she didn’t give in to the temptation to slap that supercilious smirk off his face. She didn’t trust herself to speak even if she could have located her voice; it seemed to be trapped somewhere in the middle of her throat where a choking nut of anger was firmly lodged.

‘Good day, Dr Tallis,’ he said, moving past his desk to open the door for her. ‘I’m sure you’ve got patients to see. I don’t want to keep you from them any longer.’

She strode past him with her head high, her mouth tight and her eyes sparking with ire.

‘Oh, and one more thing,’ he said, just as she’d brushed past.

She stopped and turned around to face him, her expression visibly taut with rage. ‘Yes?’

His eyes twinkled with something that looked suspiciously like amusement as he took in her flushed features. ‘If you don’t mind me saying so, for someone who is so into alternative relaxation therapies, you seem a little tense. Have you thought about booking in for a massage yourself?’

‘Why?’ she asked with a curl of her lip. ‘Are you offering your services?’

He suddenly smiled, revealing perfectly even white teeth. ‘I’m not sure in this case that my touch would have the desired effect.’

‘Not unless I was completely comatose,’ she clipped back, and stalked out.

CHAPTER TWO

‘HOW did your meeting with the director go?’ Louise asked later that morning.

‘Grr …’Allegra answered with a fiery look. ‘Every time I think of that man I want to punch something.’

‘That doesn’t sound like you,’ Louise remarked. ‘You’re always the one telling the rest of us how to chill out and relax. Is he really going to put a stop to your study?’

‘He’s giving me a month to prove that it’s worthy of “medical science”—his version of science anyway,’ Allegra answered. ‘But how can I do anything in a month? It all depends on what patients come in. We haven’t had a coma patient since poor Alice Greeson, three weeks ago, and she didn’t recover.’ She blew out a sigh of frustration. ‘I have to change his mind. I really want to do this study, Louise—it’s important to me.’

The hospital intercom suddenly blared out in a tinny voice, ‘Code Blue, Surgical Ward,’ repeating it several times.

‘Got to go, Louise,’ Allegra said, heading for the lift. ‘I’m on the crash team this morning.’

The surgical ward was on the sixth floor, but when Allegra got to the bank of lifts none of them seemed to be moving. She shifted from foot to foot impatiently, before turning and heading for the fire exit. She started running up the stairs two at a time, glad she’d resumed her fitness programme now that Christmas had passed.

When she arrived on the ward the curtains were drawn around one of the beds in room two, the crash trolley, two nurses and the intern already doing cardiac massage on the patient.

‘What’s the story?’ she asked, as she pushed aside the curtains.

‘Sixty-five-year-old male, two days post right hemicolectomy,’ the intern answered. ‘The nurses were getting him out of bed for a wash and he collapsed. Looks like a PE, maybe an infarct.’

‘Is the floor anaesthetist on the way?’ Allegra asked.

‘He might not be coming,’ one of the nurses answered.

‘There’s some sort of complicated case going on in Theatre that’s tied up a lot of staff.’

‘I’ll intubate him,’ Allegra said, moving to the head of the bed and picking up the sucker from the emergency trolley. ‘You’ll need to help me,’ she said to the nurse on her left.

‘But I’m just out of grad school,’ the young and rather nervous-looking nurse said. ‘I’m not sure what I’m doing. I’ve never been to an arrest before.’

‘Just do what I say, you’ll be fine. Turn on wall suction,’ she said, as she suctioned the patient’s mouth and reapplied the oxygen mask. Allegra picked an endotracheal tube and checked the laryngoscope battery. ‘OK,’ she said to the intern who was bagging the patient between cardiac compressions from the surgical ward nurse, ‘I’ll tube now. Put on cricoid pressure, will you?’

The intern stepped aside and applied cricoid pressure while Allegra removed the mask from the bag and oxygen. She rapidly intubated the patient and connected the oxygen, handing the bag back to the intern to continue ventilation while she secured the tube. The medical registrar, Peter Newton, had by now arrived and was looking at the ECG trace.

‘He’s got a rhythm,’ he said. ‘Looks like VT We’ll need to cardiovert. I’ll do it.’ He took the paddles from the defibrillator and dialled up 100, applied the paddles to the patient’s chest and called, ‘Clear.’ All staff removed their hands from the patient while the intern continued to ventilate. With a jerk the patient’s back arched and then fell back as the current was applied.

‘He’s in sinus rhythm,’ Allegra noted, looking at the monitor. ‘What drugs do you want up?’ she asked the registrar.

‘He’s had an infarct is my guess. There’s a few VEBs. I’ll start a lignocaine infusion, but we need to get him round to ICTU and keep him well oxygenated. I’ll contact my boss and bring him round to ICTU for a consult.’

‘You look as if you could do with a bit of oxygen yourself,’ Allegra said, taking in Peter’s flushed features. ‘Are you OK?’

He gave her sheepish look. ‘The lifts were busy. I had to run up two flights of stairs. I guess I’m not as fit as I thought.’

‘Lucky you,’ she said as she moved aside for the trolley men who had come to do the transfer. ‘I had to run up six.’ She gave him a smile and added, ‘Go and have a glass of water. I’m going back to ICTU anyway so I’ll hand the patient over.’

Allegra accompanied the patient, Gareth Fisher, to ICTU and had not long informed the surgeon, Bruce Crickton, of his patient’s condition when the ICTU registrar Danielle Capper approached.

‘Dr Tallis, can you help me on bed five?’ she asked. ‘It’s Mr Munsfield, the Whipple procedure. He was extubated yesterday and was doing OK, but his sats have gone down in the last hour and he’s on 60 per cent oxygen. He’s become febrile and has abdo pain.’

‘Sure.’ Allegra began walking with Danielle to the far end of ICTU, where bed five was situated. ‘Have you had any bloods done?’

‘They should be on the fax now in the office. I’ll grab them and see you there,’ Danielle said.

Allegra reached bed five and after greeting Fiona Clark, the nurse in charge of beds four and five, took a look at the patient, who was pale, slightly cyanosed and very breathless. His sats monitor showed 80 per cent, BP 100 and pulse 110.

‘Deep breaths, Mr Munsfield,’ Fiona instructed the patient. ‘I’ve just given you some IV morphine for the pain.’

‘What was the last temperature, Fiona?’ Allegra asked.

‘Thirty-nine. It’s been up all morning,’ Fiona answered.

‘Where’s the pain, Mr Munsfield?’ Allegra addressed the patient gently.

‘In … my stomach, and in my back …’ he gasped and puffed. ‘In the middle of my back … like a knife …’

Danielle arrived with the printouts, accompanied by Joel Addison, who had been collecting pathology reports from the printer. ‘Hb is 80, white cell count 25 with neutrophilia, and his amylase and lipase are through the roof, Dr Tallis,’ he said, looking intently through the sheath of figures before he met her eyes briefly. ‘What do you feel is the problem?’

‘Looks like we’ve got pancreatitis, maybe pancreatic sepsis. Could have an anastomotic leak,’ Allegra said.

‘I agree. We should also consider an anastomotic leak as the precipitating problem,’ he suggested.

‘Danielle, get the surgeon down here now. We need an urgent surgical review, and get X-ray up here, too—we need a chest X-ray. Those sats are worse. My guess is adult respiratory distress syndrome.’

‘ARDS is almost certain, Dr Tallis. We’ll need to intubate pretty much straight away but it’s your call,’ Joel said, giving her an unreadable look.

Allegra explained to the patient that there was a problem in his abdomen and that it was affecting his lungs, making it hard for him to breathe. She explained the procedure of intubation to him before instructing Fiona to obtain drugs and airway equipment.

‘His Hb has dropped too, Dr Tallis,’ Joel said, when she’d turned back from the patient. ‘There are a couple of cross-matched units left over from surgery.’ He turned to address Danielle. ‘Can you retrieve those from the blood fridge while I help Dr Tallis here?’