The Elusive Consultant

‘Phil, try and stay still for me while I examine you.’

Which didn’t exactly calm the agitated man down.

‘You’ve been in an accident, Phil,’ Tessa added as diplomatically as she could, keeping her voice calm and even as she orientated her patient. ‘You’re at Peninsula Hospital. Dr Elves here is just going have a look at you.’

‘His shoulder’s dislocated,’ Emily said, more to herself than anyone.

‘His oxygen sats are low,’ Tessa said grimly, ‘even though he’s on ten litres of oxygen.’

‘Hmm, he’s got a few fractured ribs as well.’

Sometimes Tessa wanted to shake Emily. An excellent doctor she might be, but she was a lousy team player. Nothing in her calm expression, her clear blue eyes let the staff know what she was thinking—unlike Max, who wore his heart on the sleeve. Right now Tessa was worried about the head injury. By all accounts, Phil had been unconscious for some time, his agitated ramblings and high blood pressure all indicative of a serious head injury, but Emily, though aware of the facts, seemed more concerned about his shoulder.

‘Let’s get his shoulder back in place then we’ll see where we are.’

‘Do you need anything?’ Tessa ventured, hoping against hope Emily wasn’t going to do the procedure without anaesthetic but knowing the call was Emily’s.

‘Some traction, please,’ Emily said without looking up. ‘And make sure the brakes are on the trolley.’

Tessa bit her tongue. Giving the patient pain control now would mask any symptoms of his head injury, but to do it without anaesthetic would be agony. She watched as Emily slipped off her shoes and realised Phil was going to need all the sweet-talking Tessa could manage.

‘It will only take a second,’ Emily said assuredly. ‘Are you going to provide the traction?’

It was more an order than a request. Reluctantly, and trying hard not to show it, Tessa held onto the unfortunate man’s shoulder, watching as Emily placed the ball of her foot in his armpit. For someone so tiny she was incredibly strong, which was an absolute prerequisite in orthopaedics. Leaning back, Emily pulled as Tessa took the head end and utilised every last bit of her strength to hold the trolley steady and provide the necessary traction that would enable Emily to slip the shoulder back into place. Engaged in their own tug of war for a moment, just as Emily had predicted, the shoulder slipped back easily into place and instantly Tessa felt Phil relax under her hands.

Emily was good, Tessa admitted grudgingly.

Very good.

‘Better?’ Tessa asked gently, smiling as her patient nodded, responding appropriately for the first time since his arrival. His eyes were closed, though, only opening when Tessa spoke.

‘It was killing me.’

‘Do you know where you are?’

Phil didn’t answer immediately, his eyes closing between sentences, and Tessa had to prompt him to stay awake. ‘Phil, do you know where you are?’

His battered, sunburnt face turned and stared at the badge hanging around Tessa’s neck. ‘Hospital?’

Tessa smiled. ‘Is that an educated guess?’

‘I’m afraid so,’ he answered, drifting off again until Tessa none too gently tweaked his ear, which roused him enough for a slightly longer conversation.

‘Do you remember anything that happened?’ Ticking off Phil’s responses in the observation chart, Tessa tried to keep the assessment as light as possible. She could see the effort in Phil’s face as he attempted to recall the morning’s events, see the fear in his eyes, the slight note of panic in his voice, and knew it was only a matter of time before the full impact of what had happened took hold.

‘We were just out, doing some waterskiing, having a laugh...’ He frowned as loud rhythmic banging came from behind the curtain, and Tessa felt her heart sink as she realised that the other young man had obviously slipped back into cardiac arrest, the rhythmic banging a desperate attempt to massage the stilled heart into action. ‘Some kid on a jet-ski, he’d have only been about nineteen... He just came from nowhere.’

Max’s orders were coming thick and fast now, and as she heard his call for two hundred joules Tessa forced her eyes to stay on her patient, listening to the defibrillator charging up behind her. She could hear Jane’s voice, so there was no need for her to go and help, but it didn’t mean her heart wasn’t on the other side of the curtain, willing the young man to pull through.

‘Do you remember anything else?’ Tessa asked gently, but as Phil went to answer again Max’s voice broke in.

‘Everybody back.’

Phil lay in agonised silence as the click of the shock being delivered filled the resuscitation room. ‘Is that him?’

Technically Tessa didn’t need to answer. Discussing other patients was taboo at the best of times but, given that only a thin curtain separated the two patients, it seemed cruel and pointless to dismiss Phil’s heavy question with a dismissive shrug, so instead she gave a small nod, watching as Phil’s face dropped, placing a gentle hand on his good arm.

‘They’re doing everything they can.’

‘How’s it going?’ Jane’s grim face popped around the curtain.

‘Emily’s just popped his shoulder back, he’s a lot more comfortable.’

‘Do you want to move him over to one of the cubicles?’ Jane’s wide eyes left Tessa in no doubt that the news was only going to get worse for the young jet-skier. And it would probably be kinder to move Phil, less traumatic for him to be in his own space with his own thoughts, rather than listening to the terrible events unfolding a few steps away. Now was a time for one of nursings tough calls. Despite the reduction of his shoulder dislocation, Phil’s blood pressure was still dangerously high, and Tessa still wasn’t satisfied with his consciousness level. The ease at which he drifted off when she wasn’t prompting him worried Tessa, and the thought of him unobserved in a cubicle couldn’t be justified because of the traumatic events taking place in the resuscitation room.

‘We’ll keep him here for now.’ Tessa made a small gesture to the monitors and Jane nodded her understanding, moving aside as Luke appeared with the portable X-ray machine and handed Tessa a lead gown.

‘I think Max wants a quick C-spine in the next cubicle,’ Tessa said in businesslike tones, ignoring the rather eager smile Luke was wearing. Six weeks ago they had shared one very questionable date, and for Luke, at least, it wasn’t over yet. ‘Then, no doubt, there’ll be a pile of films for you to do here. I’ll take a lead gown for the doctors, and Kim next door as well.’

‘Tessa.’ Kim’s call from the next cubicle merited more than a ‘yes’ and, nodding to Emily, Tessa ducked round the curtain, attempting to slip a very heavy lead coat over Max’s head as he examined the patient, tying it up at the sides she tried, and failed, not to notice the musky scent of him, the light hairs on his arms, the quiet strength of his lean body.

He didn’t acknowledge her and neither did Tessa expect him to.

‘Sorry to be a pain,’ Kim started, as Tessa offered to slip a protective coat gown on her, her face red from the exertion of giving cardiac massage. ‘It’s just...I’d rather not be here while they do the X-rays.’

Her already red face was almost beetroot now and Tessa felt sorry for her. That was the trouble with nursing: nothing was sacred. The fact Kim didn’t want to stay while the films were being done could only mean she was either pregnant or hoping to be, and while most of the general population were able to sit on their secrets, emergency nurses didn’t have that luxury. Though Tessa’s curiosity was naturally aroused, she didn’t show it.

‘Sure,’ Tessa said lightly. ‘You take over Phil next door and duck outside while the X-rays are being done.’

‘I’m sorry,’ Kim said again, needlessly. ‘I should have said something earlier.’

‘That’s the trouble with this place,’ Max said dryly, ‘it’s never early enough. Go,’ he said with a small wink. ‘Tessa and I know now, that’s enough to be going on with, and don’t worry about Fred here.’ He gestured to the anaesthetist who looked up at the mention of his name. ‘We’ll cover for you till you’re ready for the world at large. Isn’t that right, Fred?’

‘Sure,’ Fred mumbled, obviously bemused at what he was agreeing to.

‘Thanks, guys.’

Taking over the massage, Tessa called Kim back. ‘Phil’s upset about this one,’ she said in low tones, ‘but I don’t think he’s well enough to be moved. I know that he looks pretty good on paper, but I’m not happy with him.’

‘What does Emily say about him?’ Max asked, not even bothering to look up from the array of monitors he was watching like a hawk.

‘Not much,’ Tessa said tactfully. ‘She’s reduced his shoulder, so he’s a lot more settled. She’ll probably do another neurological assessment now that he’s calmer.’

‘Well, keep a close eye on his neuro obs, and if you’re worried, I’m only here,’ he offered, which was the closest to an acknowledgment of Emily’s poor communication skills they were going to get.

‘Sure.’

Fred spoke with an air of weary resignation. ‘Max, we’ve been going for fifteen minutes with no response—there’s been nothing since he arrested in the ambulance.’