The Surgeon's Special Delivery

Vince grimaced and spoke between quick breaths. ‘Today’s a lot worse. I feel really crook, like I’m going to hurl, and I’ve got gut-ache too.’ He gripped the bowl Esther had given him, his knuckles white against the metal.

‘Have you vomited today?’

Beads of sweat formed on his forehead. ‘No, but I’ve had some diarrhoea and I dunno what my sister cooked but it was as black as tar!’

Tess immediately glanced over their patient’s head and caught Callum’s gaze, her brown eyes full of concern. Black bowel motions meant blood.

Callum reached for the stethoscope that hung over the top of the BP machine, planning to hand it to Tess.

‘Vince, we need to examine you and I’m going to ask Callum to do that while I insert an intravenous drip into your arm. When the nurse took your temperature it was up, and it’s always good to have some extra fluids on board when you have a fever.’

And when there’s a possibility that you’re bleeding internally. Tess knew her stuff and had swung into a team action approach. He couldn’t fault her decision and the thrill of excitement he got from work kicked in.

‘If you can lie down for me, I’ll palpate your abdomen.’ Callum put the stethoscope around his neck.

Vince’s expression became confused. ‘Do what?’

Tess raised her brows at Callum, a dimple appearing briefly in one cheek. Almost as quickly the muscles in her face schooled themselves into impassivity and she looked directly at Mr Renaldo. ‘He’s going to gently press your stomach to see if it’s tender.’

The patient’s brow immediately cleared. ‘Oh, right.’ He turned to Callum. ‘You should have said so, Doc.’ He gingerly shuffled down the bed and lifted the gown. ‘At least in this heat your hands will be warm.’

Callum silently groaned; sleeping patients didn’t give cheek. He scanned the patient’s abdomen, immediately noticing it was bloated. ‘Let me know if any of this hurts.’ His fingeres pressed firmly but gently, moving over the area, seeking guarding and rigidity, and then he examined the upper midline.

Callum pressed close to the upper midline.

Vince hissed. ‘Hell, Doc, that hurts.’ He pressed his fist to his epigastric area.

‘Sorry.’ Callum helped him sit up to relieve the reflux pain and then wrapped the blood-pressure cuff around the man’s upper arm. ‘Are you on any medications?’

‘Me knees are arthritic so I take some painkillers for that.’

Tess swabbed Vince’s left arm. ‘What sort of painkillers?’

‘Aspirin mostly or that new stuff with the funny name I.-B.-something.’

The story was coming together. ‘Ibuprofen.’ Callum pumped up the BP cuff.

Callum heard the swish and thud of blood in the arteries as he released the air from the cuff and matched the sounds to the fall of the arrow. He decided to leave the cuff in place, wanting to monitor Vince’s blood pressure closely.

‘Your BP is 110 on 75, which is a bit low. Do you know what your usual blood press—’

Vince suddenly heaved, his eyes wide with alarm as bright red blood filled the basin. The ECG machine screamed a high-pitched warning sound.

Esther came running into the room, quickly taking in the emergency. She deftly removed the bowl. ‘I’ll measure this for blood loss.’

‘Tess, is that IV in yet?’ Callum quickly dropped the back of the bed down so their patient was lying flat and strapped a clear oxygen mask onto his face. For the first time since arriving at the hospital Callum relaxed. Emergencies were what he did best.

‘I’ve got Hartmann’s solution going in full bore.’ Tess taped the drip into place, her expression grave. ‘It looks like he just dropped a litre of blood.’

Callum gave a grim nod. ‘It fits in with all the classic signs of a bleeding ulcer probably exacerbated by using non-steroidal anti-inflammatories for his arthritis.’

She placed her hand on their patient’s wrist, checking his pulse. ‘Vince, you’re bleeding somewhere in your gut. We’re replacing the blood with an electrolyte solution but we’ll need to evacuate you to Mildura Base Hospital for a procedure to stop the bleeding.’

The pallid and sweaty man barely nodded his understanding.

Callum’s brain went into overdrive. Vince was in no fit state for evacuation and unless they could keep his circulating volume up, he could go into cardiac arrest. He walked around to Tess, his hand gently closing around her forearm, her skin warm and soft on his palm. Guiding her a few steps aside, he spoke sotto voce. ‘I don’t suppose there’s any chance that Narranbool Bush Hospital runs to an operating theatre and gastroscope?’

Tess bristled. ‘We have visiting specialists come through here on rotation from Mildura and, yes, we do have a ’scope but no one qualified to use…’ Her eyes sparkled as realisation dawned. ‘You can do the scope and clip the ulcer. That’s fantastic—you’re just what we need.’

Her appreciation wound through him, spreading into every cell with a zing of something he didn’t recognise. He grinned like a fool, which was crazy as he was only going to do something he was very qualified to do and did on a regular basis. ‘I can, if you can do the anaesthetic.’

She beamed. ‘That I can do.’ As she started to turn back to their patient she stopped abruptly and immediately put her hand on her lower ribs.

Callum stilled. ‘Something wrong?’ He had this growing premonition that the baby was in danger. It was irrational, unfounded and absurd, but it bothered him that she was still working.

She laughed. ‘No, just Oscar’s foot doing some break dancing.’ She turned back to their patient. ‘Mr Renaldo, I have good news. Callum can operate on you here in Narranbool. Esther will get you ready for Theatre and I’ll organise all the paperwork.’

‘Whatever you have to do, Doc.’ Vince’s voice trembled with anxiety. ‘Can you tell my sister?’

‘Absolutely.’ Tess squeezed Vince’s hand.

Relief rolled through Callum. Tess would deal with the hysterical relatives, which suited him just fine.

‘Right, let’s get moving.’ Completely in his element, he took charge. Grabbing the chart, he scrawled down a drug dose. ‘Esther, take blood for cross-matching.’

‘Right you are, Mr Halroyd.’ Esther’s face shone with sympathy. ‘Your brother was a great doctor and Narranbool is very fortunate to have you on board now James has gone.’

No way am I ‘on board’. The words rose to his mouth but he stopped them from tripping off his lips. Now wasn’t the time to say that country life and country medicine were an anathema to him. They had a sick patient who needed his bleeding ulcer clipped.

Giving Esther a curt nod of appreciation, he turned to Tess, whose expression was unexpectedly calculating. But he didn’t have time to wonder about that—the clock was ticking, and his adrenaline was pumping. He clapped his hands together. ‘Let’s get this man to Theatre now, before he bleeds any more.’

CHAPTER THREE

‘I KNOW you wanted to get in fast so I’ve sedated him with midazolam and propofol and he’s all set to go.’ Tess’s worried eyes looked at Callum over her theatre mask. ‘He’s lucky you’re here.’

A niggle of concern pulled at Cal but the beeping of the monitor registering Vince’s low blood pressure intervened. ‘Let’s start.’ He put his gloved hand out for the gastroscope.

Ken Liu, the theatre nurse, handed him the long, black, flexible tube, whose plain colour belied its ability to light and electronically magnify the gut.

Cal had to give the staff credit—they’d mobilised quickly and there’d been no messing around. He glanced up at the screen as he passed the tube down the oesophagus. ‘No sign of varices, always good.’

‘Excellent news.’ Tess’s hidden smile played through her voice. ‘Often patients aren’t one hundred per cent honest about their history if alcohol is involved.’ The ECG monitor beeped rhythmically and reassuringly next to her. ‘Esther, is the blood here?’

‘It’s on its way but we’ve got plasma expander. Do you want that put up?’ Esther’s questioning brows rose over her green surgical mask.

Tess checked Vince’s BP. ‘Right now his pressure’s holding so I think we can wait for the blood.’

Cal grunted in frustration. ‘His stomach’s full of blood. Sucker, quickly.’ He needed to clear the area and find the source of the bleeding.