The Pregnant Intern

‘How are you feeling, Lachlan?’ Alice asked.

‘Tired.’

‘Are you in any pain?’

Not bothering to open his eyes, Lachlan shook his head as Alice gently palpated his abdomen. Again there was no real change since the last time she’d seen him. Listening to his chest, she found the story was the same—nothing remarkable.

But Fi was worried and Alice wasn’t going to ignore the fact.

Suddenly Lachlan opened his eyes. ‘I should be in the library. I’ve got an exam in the morning.’

Alice gave Fi a worried glance.

‘Lachlan, do you know where you are?’ Fi asked urgently.

Closing his eyes, Lachlan nodded.

‘Where, Lachlan?’

‘Melbourne City.’ Which, of course, was the right answer, but his moment of confusion prompted Alice into action.

‘Do another set of obs and I’ll ring Linda.’

Linda was particularly unhelpful. ‘So let me get this straight. His obs are fine, and you can’t find anything wrong on examination. Exactly why are you calling me, Alice?’

‘Because the nursing staff are concerned—I’m concerned,’ she said trying to sound confident. ‘And, as I said, he’s confused.’

‘Momentarily,’ Linda pointed out. ‘He’s had major surgery, he’s on a high dose of pethidine and you’ve just woken him up in the middle of the night. You said yourself he’s orientated now. Look, Alice, I just had A and E on the telephone complaining there’s still a patient waiting to be clerked. I’m stuck on Intensive Care with a sick patient and I’ve still got a list of patients to see on the wards. Now you’re ringing to tell me a patient I reviewed an hour ago is in the exact same condition as when I left.’

‘I’d just like you to review him,’ Alice said as evenly as she could. ‘I’d really value your opinion,’ she added tactfully.

‘When I get a moment,’ was all Linda could offer.

‘Is she coming?’ Fi asked as Alice replaced the receiver.

‘When she gets time.’ Alice shrugged. ‘What are his obs doing now?’

‘Not much change. His temp’s down a bit further—it’s 35.0 now.’ Which was low. Not dangerously low, but low enough to set an alarm bell ringing in Alice’s head.

‘He could be septic.’

‘But wouldn’t his temperature be high then?’ Kate asked.

Alice shook her head. ‘Not necessarily. Sometimes when the body’s overwhelmed with infection a patient can actually become hypothermic.’

Alice wasn’t a brilliant doctor, she was the first to admit that. She had got into and through medical school by sheer hard work and diligence. But she was a good doctor, and she knew that, too. And part of being a good doctor involved listening. Fi, with her years of knowledge and experience, had called on her because she was worried, and now Alice was worried as well. She wrung her hands anxiously. ‘I’d better ring Jeremy.’ She looked at Fi for her reaction.

‘Good. I’ll share the flak if it’s nothing.’

She had obviously woken him when she’d rung, and Jeremy listened without interruption as she relayed her findings.

‘What did Linda say?’

‘She’s a bit busy at the moment. His temperature wasn’t quite so low, though, when I spoke to her,’ Alice said hesitantly. ‘Maybe I should have called her back...’

‘Doesn’t matter now. Look, take some gases and bloods, do some cultures as well, and I’ll be straight in.’

Alice, unsure whether her concern for the patient was entirely merited, was somewhat taken aback by how amenable he was being. ‘I could ring Linda again,’ she offered. ‘Or call you back with the blood results. It could be nothing.’

‘Let’s hope it is,’ Jeremy said darkly. ‘I’m on my way.’

Linda wasn’t all bad, and in fairness she did come over almost immediately. But Alice’s relief at seeing her senior quickly vanished when Linda heard she had already contacted Jeremy.

‘You what? You just went ahead and called him? How dare you, without running it by me first?’

Alice was trying to concentrate on finding a vein and didn’t look up as she answered. ‘I did run it by you first. I felt Lachlan needed to be seen, and urgently. I knew how busy you were.’

‘So you went straight over my head?’

Alice didn’t reply; she was becoming increasingly worried about Lachlan now. His veins were proving extremely difficult to find, again a rather ominous sign in a young healthy man.

‘It’s not your responsibility to ring the consultant. You ring me and then I decide. It’s not your concern...’

Alice had heard enough. Rowing at a sick patient’s bedside really wasn’t her style. ‘I’m paid to be concerned, Linda, and right now I’d appreciate your help in finding a vein. You can bawl me out later.’

‘Let’s concentrate on the patient, shall we?’ Jeremy’s rich tones filled the room, and Linda immediately snapped to attention.

‘You got here quickly,’ Fi said appreciatively.

‘I’m sleeping at the hospital tonight.’

Alice’s eyebrows shot up in surprise but she didn’t say anything.

In the short space of time it had taken Jeremy and Linda to arrive, it had become obvious that Lachlan was extremely unwell. He kept pulling off his oxygen mask, confused rantings coming from his mouth.

‘Linda, run over to ICU and get the gases done,’ Jeremy said quickly. ‘Fi, call a MET.’

Fi nodded and turned to Kate. ‘You do it. Tell them the room number and bring back the resusc trolley with you.’

As the overhead chimes relayed their urgent message, Alice felt her adrenaline kick into overdrive. A medical emergency team was called when a patient was suffering a life-threatening incident. It was a relatively new innovation, and not practised at many hospitals, but it had on many occasions proved to be more than effective. Once the call was put out, the ICU anaesthetist, along with an ICU nurse and the on-call physicians, would make their way urgently to the patient’s bedside to implement urgent intervention before the patient arrested. And though it was becoming increasingly obvious to Alice that Lachlan really was very sick, she was somewhat surprised at the dramatic measure Jeremy had taken.

From then on Alice felt she was somewhat supernumerary as a multitude of staff and equipment appeared, all far more skilled and experienced at coping with emergencies than she was. Jeremy relayed the findings to the MET team as IV fluids were pumped into Lachlan’s system and his oxygen concentration was turned up. The head of the bed had been removed by Fi to allow the anaesthetist more access to Lachlan’s airway, and the patient was now attached to a cardiac monitor with a probe clipped onto his earlobe to continually measure his oxygen saturation.

‘Ring the lab, Alice, and ask them to step on his bloods,’ Jeremy ordered, just as Linda returned breathlessly with his blood gas results.

‘We’ll get him over to ICU,’ the anaesthetist addressed Jeremy. ‘We’ll need to put in a central line and do the works, but hopefully the antibiotics will kick in soon. It’s lucky we got to him in time. That was a good pick-up, Jeremy. Glad to have you back on board.’

By the time Lachlan had been wheeled over to ICU it was a white, shaking Alice that stood in the empty room as Fi started to clear up the large mess that had been created. ICU wasn’t Alice’s domain. It was up to her to cover the rest of the wards.