The Elusive Consultant

‘Ouch.’ Max rolled his eyes. ‘How many?’

‘Three from the boat, two with seemingly minor injuries and one unconscious, thankfully they were all wearing life jackets.’

‘And the jet-skier?’ Tessa asked, mentally assessing the injuries and matching her staff available.

‘He’s not been so lucky, I’m afraid. It would seem he wasn’t wearing a life jacket. The report from Ambulance Control is that he’s got multiple injuries, including a possible broken neck. They were going to take him straight to the spinal unit, that’s why I held off calling you, but apparently he’s gone into full cardiac arrest in the helicopter so they’re bringing him here.’

The spinal unit was only another thirty minutes or so in the helicopter but, given that full resuscitation was in progress, thirty minutes along the bay was too long and Tessa gave a small grimace. ‘Hopefully we can get him there later. How do you want to work this, Jane?’

Technically the allocation was up to Tessa as she was the charge nurse on duty, but Jane was a senior nurse and this morning Tessa had let her be in charge, gradually allowing more responsibility to fall onto Jane’s shoulders, with the intention being that she could soon oversee the department by herself.

‘Well, I’d like to take the full resus, but I guess if I’m supposed to be running the show I should take the unconscious boat victim and direct traffic.’

‘Good call.’ Tessa’s voice was encouraging, but inwardly she sighed at Jane’s persistent lack of foresight. As good an emergency nurse as Jane was, she had rather too much bravado about her and a noticeable unwillingness to delegate, far happier to be in the thick of things than running the show. It was something Tessa was working on quietly, but with rather limited success. ‘But the boat victim is an unknown entity. You might find yourself just as tied up with him.’

Jane chewed her lip thoughtfully, and Tessa glanced at her fob watch, willing her colleague to hurry up and make a decision.

‘Why don’t you send Kim in?’ Tessa said finally when it was obviously they weren’t getting anywhere.

‘But she’s only a grad nurse,’ Jane protested, itching to pull on her latex gloves and get on with the job she loved.

‘A grad nurse who needs more resuscitation experience,’ Tessa pointed out. ‘First-hand experience is the only way she’ll learn and at least Max is on so he’ll watch her like a hawk. I can oversee them while I deal with the boat victim.’

‘So when I’m in charge I just get to stay in the corridor and direct traffic?’

‘Well, there’s a bit more than that.’ Tessa smiled at her colleague’s disappointed face. ‘You’ll be run off your feet with relatives and us calling for things, but that’s the way it is when you’re in charge, Jane. Someone has to be the chief.’

‘Great,’ Jane muttered as Tessa made her way into Resus, more than happy to be in the thick of things again.

‘Sorry, guys, I was stuck in Theatre. What’s the story?’

Even if Tessa hadn’t recognised the voice, the sudden tension that filled the room told Tessa that Emily had arrived and, more annoyingly, Tessa didn’t even have to look up to know that the sight that would have greeted her would have been one of unruffled, petite beauty.

Emily never looked ruffled. The woman had probably spent the morning pulling dislocated hips and shoulders into place and yet her blonde hair was pulled back into a perfectly neat ponytail, her theatre blues looked tailor-made and her clear, china blue eyes never wandered as she listened intently to the brief history given by a suddenly nervous Jane.

Emily had that effect on women.

On men, too.

Come to think of it, Tessa grumbled to herself as she assembled equipment, even three-year-olds quaked when Emily approached.

She might look like a tiny fragile porcelain doll, but two minutes in her company soon put paid to that. Emily Elves hadn’t made it to orthopaedic registrar courtesy of her good looks, and the fact her father was the top obstetrician in the hospital wouldn’t count for anything when she went for the consultant’s position at the end of the month. No, Emily had made it this far in a man’s world through steely determination, a brilliant medical mind and an utter disregard for emotion.

‘So the jet-skier wasn’t wearing a life jacket.’ Her blue eyes finally swivelled to Max when the history was completed and a wry smile appeared on her smooth face. ‘Did you hear that, Max?’

‘No doubt it’s all I’m going to hear for the next few days,’ Max responded with a slight edge to his voice that instantly had the room enthralled.

‘You see,’ Emily explained, still smiling as she started to pull up some drugs from the trolley, ‘Max Slater, your, oh, so responsible emergency consultant, the lynchpin of the department, the one we’re supposed to look to for guidance, well, he thought he might try his hand at jet-skiing last weekend.’

Everyone laughed. It was the type of conversation that often took place as the adrenaline kicked in while they waited for the arrival of patients, but even though Tessa joined in the laughter a small frown puckered her brow. As commonplace as this type of conversation might be amongst the staff in Emergency, it was a revelation to hear Emily opening up. Emily Elves was eternally private. In fact, normally she went out of her way to keep her professional and personal lives completely separate, yet here she was for the first time in memory telling anyone who was interested about her weekend with Max. There was definitely something strange going on.

But Tessa had no choice but to listen and laugh along with the rest of the rabble and it hurt.

Really hurt.

‘Of course,’ Emily continued, ‘I knew nothing about it. There I was, having a doze on the beach, half listening as some hoon came in way too close to the shore, laughing his head off, whooping with enjoyment and generally making a nuisance of himself, you get the picture. It was only when the yob in question started calling my name did I sit up and take notice...’

‘I was only on the jet-ski for ten minutes,’ Max argued. ‘If that. Mind you...’ he grinned ‘...it was the best ten minutes of my life.’

‘And it could very well have been the last ten minutes,’ Emily said pointedly, cocking her head as the sound of the chopper got louder. ‘Need I say more?’

Thankfully she didn’t. The last thing Tessa needed this morning was cosy little images of Emily and Max at the beach, no doubt with Emily skinny and gorgeous, some tiny little bikini accentuating her smooth brown skin, good-naturedly bickering about Max’s casual attitude to the world at large, Max’s take-it-or-leave-it slant on things.

It was a relief when the patients arrived and Tessa could concentrate on work.

The first victim to arrive was the unfortunate jet-skier. Though no longer in full arrest, he was still dangerously close to it.

‘OK, Kim, just listen to Max, he’s supporting the neck so he’s the team leader.’ Tessa hovered in the background, watching closely as Kim worked intently. As important as it was to give the staff experience, it could never be at the expense of patient care, and in this instance any hesitation could prove fatal. The lift over to the trolley was swift but very controlled, given the likelihood of spinal injuries, and Tessa tried not to interfere too much as she watched Kim’s shaking hands change over the equipment from the rescue team’s to the unit’s own. Already the young man was intubated. The paramedics had put a tube in place in his throat, thus securing the airway, and intravenous access had been established.

‘Right, Kim, look at the cardiac monitor. What do you see?’

Kim swallowed hard, her cheeks colouring as she stared at the machine. ‘His heart rate’s slow.’

‘Yep, he’s in sinus bradycardia, so what drugs do you think he’ll need?’

‘Atropine?’ The answer was right but Tessa could hear the question in the Kim’s voice.

‘Good,’ Tessa said encouragingly. ‘Max is checking his airway now—that’s the first priority—but once he looks at the monitor no doubt he’ll be calling for atropine or adrenaline so if you can try to preempt what he’ll need, you’ll have a head start. You may well be wrong but at least it’s easier to pull up the drugs and have them ready to hand over to him before he starts calling for them.’

‘Atropine.’ Max’s word was clipped, not even looking up he placed an impatient hand out, and thankfully Kim was able to pass him the drug immediately.

‘Get the chest-tube pack out,’ Tessa whispered, watching Max frown as he palpated the young man’s ribcage and run through a flask of mannitol. As the resus doors slid open and Tessa’s patient arrived, she gave her colleague’s shoulder a quick squeeze. ‘Don’t mind Max if he shouts. It’s not aimed at you personally, it’s just his way.’

It was just his way, Tessa thought as she started to work on her own patient, ignoring a rather loud expletive coming from Max’s general direction. Max, passionate about every patient, would be working on the young jet-skier as if it were his own family member lying near to death on the resus trolley. And if he lost his temper, if he shouted because the equipment he’d only just asked for wasn’t in his hand now, it was easily forgiven. Everyone knew they were watching a genius at work, and a genius was surely allowed the odd eccentricity.

Unlike Emily, Tessa thought to herself as she set to work on the latest admission. Not that Emily wasn’t a diligent and talented doctor, but her work technique and bedside manner didn’t even begin to compare to Max’s. The young man before them was flailing around on the gurney, distressed, in pain, terrified and, Tessa thought, confused, which was more ominous than the rest of his symptoms put together. And with little reassurance to her patient, Emily commenced her examination as Tessa struggled to hold the young man down and reassure him.

‘Stay still for me.’ That was the sum total of Emily’s communication with her patient as her hands worked their way down his body, leaving it to Tessa to attempt an explanation. But explanations were hard to give in the absence of information and Emily, as usual, was giving nothing away.

Emily worked in a completely different manner to Max. Emotions were kept strictly in check as she thought things through in her own time, and from a nursing perspective she wasn’t the easiest doctor to work with. There was no pre-empting her, no little clues along the way, nothing in her calm exterior to indicate what was going in that clever head of hers.

‘What’s his blood pressure?’ Emily’s voice was completely calm, as if she were asking if there was any milk in the fridge or if anyone had thought to buy a newspaper this morning. The coffee-room or the resus ward was all dealt with in the same unflappable manner. Her meticulous, very neat little hands methodically examined the restless body.

‘It’s up,’ Tessa said, glancing over at the machine. ‘One hundred and ninety on a hundred.’

There was no reaction from Emily as she carried on working her way down the patient. ‘Do we have a name?’

‘Phil’s all we’ve got at the moment,’ a voice called from the back of the room, and Tessa nodded her thanks to the paramedic who was writing up his notes in the corner.