The Pregnant Intern

She tried desperately to concentrate as they made their way around the ward, to ignore the flutter of butterflies Jeremy seemed to so effortlessly have started. Linda had the most to say—after all she had already met most of the patients and seemed to take every available opportunity to ram home how well she had coped. Jeremy didn’t seem fazed by her attitude, listening intently. But every now and then he overrode a decision Linda had made or changed a drug regime, effectively assuring all present that he was the one in charge. It soon became apparent to everyone that Linda was having a lot of trouble accepting her boss’s return. Her simmering resentment became increasingly obvious as they made their way around and at the final patient’s bedside Linda let her bitterness surface.

‘Mrs Marshall came in on Thursday with acute pancreatitis. She has a history of alcohol abuse. She’s been nil by mouth on IV fluids with a pethidine infusion to control her pain. Currently, we’re weaning her off the pethidine and she’s now on five mls an hour. I was thinking of starting her this morning on clear fluids.’

‘Good morning, Mrs Marshall. I’m Mr Foster, the surgical consultant. How are you feeling this morning?’

Mrs Marshall was struggling to sit up. ‘A bit better, but I’d really like a drink of water.’ Alice looked on. If this was Mrs Marshall looking better she’d have hated to have seen her on Thursday. Pancreatitis could either be acute or chronic. It caused severe abdominal pain and the patient rapidly became seriously ill. Although managed medically, it still came under the domain of the surgeons. In this case it had been precipitated by Mrs Marshall’s ingestion of large quantities of alcohol.

Jeremy flicked through the patient’s blood results as Mrs Marshall fiddled in her locker. ‘Her amylase levels are still very high.’

‘But they’ve come down markedly,’ Linda said.

‘Still, it might be a bit early to be starting her on fluids,’ Jeremy responded calmly.

‘Just small sips—you can see yourself how agitated she is,’ Linda pointed out. ‘She’s making a lot of work for the nursing staff, trying to get out of bed and get a drink.’

‘Which is probably more related to her pain and her alcoholism. Keep her nil by mouth for now and increase her pethidine,’ Jeremy said.

Linda pursed her lips. ‘Surely we’re just replacing one addiction with another. A few sips of water must be better than increasing her pethidine.’

Jeremy picked up the drug chart. ‘Mrs Marshall is in pain, and that needs to be addressed. A PRN order of Valium might be wise also, given her withdrawal from alcohol.’

He turned from Linda’s angry gaze and addressed the patient.

‘Mrs Marshall, we’re going to keep you nil by mouth for now. I know you want a drink but it really is safer not to at the moment. We’ll increase your pain control and I’ve written up an order for some Valium which will help you to settle.’

Surprisingly, Mrs Marshall seemed a lot happier with his decision than Linda and leant back resignedly on her pillows.

‘A psychiatric and social work referral would also be appropriate,’ Jeremy said, handing her folder back to the charge nurse.

‘She had all that last time she was in,’ Linda said. ‘That’s why I didn’t order the works this time around. She always swears she’s going to give up this time, and then back she bounces.’

Jeremy nodded. ‘Which, while mildly frustrating for us, must be absolute hell for Mrs Marshall and her family. See she gets the appropriate referrals.’

‘Bravo, Jeremy,’ Josh whispered, and Alice actually found she felt like cheering herself. Jeremy had certainly put the obnoxious Linda in her place.

‘I’m not entirely happy with her.’ Jeremy looked over at Alice. ‘When we finish up here, can you do some blood gases on Mrs Marshall?’

‘Sure.’

‘I’ll see you both later in pre-op clinic.’ With a small nod he walked off, as Linda marched furiously behind him.

‘I’ll start writing up the notes, then, while you do the gases,’ Josh suggested. ‘Then we can grab a coffee.’

‘I doubt it,’ Alice said with a sigh. ‘I’ve got three IVs to resite and a pile of drug charts that need writing up, and there’s a couple of bloods that need doing.’

‘Alice, Alice, Alice.’ Josh gave her a wide smile. ‘You have so much to learn. Fi,’ he called to the charge nurse, who came over with a smile, ‘this young intern hasn’t yet learnt how to ask for favours. Do you think we should teach her?’

Fi smiled warmly at Alice. ‘You’re not listening to Josh, are you? He’ll get you into all sorts of trouble.’ Fi had delicate oriental features and a kind smile but, despite her seemingly easygoing nature, Alice knew just from this morning’s ward round that Fi ran the ward with impeccable efficiency.

‘That’s not fair, Fi.’ Josh winked at Alice. ‘Fi and I worked together when I was a surgical intern,’ he explained. ‘Now, Fi, tell Alice the truth—didn’t I always come at night when you paged me? Didn’t I listen to you and call the reg when you were worried? Didn’t I always bring doughnuts in?’

Fi nodded. ‘And in return I had to do half your bloods and IVs.’

‘Cheap at half the price. Come on, Fi, don’t say you’ve gone all hard on me? You’re the only reason I came back to this ward.’

Fi laughed. ‘All right, I’ll help with your bloods, if I get the time. But I’m on nights next week,’ she warned, ‘and you’d better remember your side of the deal.’

As Josh made his way to do his notes, Fi turned her attention to Alice, who was filling up a kidney dish with blood-gas syringes and alcohol swabs.

‘When you’ve done the blood gases, I’ll show you around,’ she offered. ‘Let you know how Jeremy likes things.’

‘Thanks ever so much.’

Fi looked at her thoughtfully for a moment. ‘Listen to me for a moment, Alice. I know I always look busy but I’ve always got time if you need to run something by me. If there’s something you’re not sure about, you can always come to me.’

Alice nodded. It was a kind offer that a lot of charge nurses made when new interns started and one that was much appreciated. Heaven knew, it was a busy enough job and you needed all the support you could get. But there was something about Fi’s offer that sounded ominous, as if she almost expected trouble.

‘I’d better get those gases done.’

‘I’ll get you some ice.’

Although Mrs Marshall was on oxygen, Alice removed the mask before she took the blood gases, as the blood taken while the patient was breathing only air would enable them to get a truer picture of her condition. Although obviously unwell, the increased pain control had already kicked in and she actually seemed in the mood for a chat.

‘I’m just going to take a small sample of blood from your wrist, Mrs Marshall, so just hold still while I inject some anaesthetic.’

‘No one else has bothered with anaesthetic. How come?’

‘Maybe you were too sick and they needed the blood urgently,’ Alice suggested diplomatically.

‘Maybe they were in too much of a hurry,’ the patient said pointedly. ‘When are you due?’

‘In about three months’ time,’ Alice muttered reluctantly.

‘Your first?’

Alice nodded. She really didn’t want to discuss her private life with Mrs Marshall but, as she was increasingly finding out, her obvious condition seemed to be a licence for all and sundry to strike up a conversation about the most personal of subjects.

‘Must be hard on your own.’ She gestured to Alice’s naked ring finger.

Alice concentrated on finding the pulsing artery. ‘Hold still, please, Mrs Marshall.’

Thankfully she hit the jackpot first time and the bright red arterial blood spurted up the syringe.

‘She got it first go and even gave me an anaesthetic first,’ Mrs Marshall said loudly—to whom, Alice had no idea.

‘Glad to hear it.’

Alice nearly jumped out of her skin as Jeremy made his way over. ‘Let’s pop your oxygen back on now.’ He replaced the mask over the patient’s face.