New Surgeon at Ashvale A&E

‘I almost paged you at one stage, but Dr Boyd said you were dealing with an emergency in the observation ward and we’d cope.’ Olivia pulled a face. ‘I suppose he was right, and we did manage, but we’re run off our feet, and patients are already complaining about waiting times.’

‘I guess Dr Boyd is behind the restriction on agency staff,’ Ruby mused. So he had kept tabs on her while she was working in the observation ward, had he? He obviously had his finger on the pulse of how the department ran, but she could certainly see why the two doctors were feeling under pressure. ‘He didn’t waste any time putting his plans into action, did he? He must be very keen to pull the department into shape.’

‘That’s right. I’m the one who put a stop to the extra staff. It costs way too much to bring in staff from outside.’ A now familiar voice came from behind her, and she swivelled around to see the man himself standing just a couple of feet away. Ruby studied him briefly. He was immaculately dressed, as before, in a dark grey suit and crisply laundered shirt, with a silk tie that was perfect in its understated elegance. ‘What do we have here,’ he asked, ‘a union meeting?’

‘Dr Boyd,’ Ruby acknowledged him. ‘It’s good to see you again…albeit in difficult circumstances.’

‘Call me Sam,’ he said in a brisk tone. ‘No need to stand on ceremony.’ He frowned. ‘As to the circumstances, you should all know from the outset that I don’t believe in letting the grass grow under my feet. It’s important to start as we mean to go on if we’re to have any chance at all of saving the A&E unit. We’re not playing at this. It isn’t a game. It’s for real.’

‘I know. I’m sure we’re all aware of that.’ Ruby made a muted response to his bracing tone. Perhaps he was annoyed because they had been talking about him, and they needed to make allowances for that. She added softly, ‘And I expect the problems that follow will be for real, too. I’ll leave you to deal with the complaints from the patients, shall I, and from the management when we fail to meet targets?’

He acknowledged that with a rueful twist of his mouth. ‘I imagine those will be the least of my worries.’ He gave her an assessing glance, his gaze shimmering downwards over her curves outlined by the soft cotton blouse that clung where it touched and then draped itself loosely over the waistband of her calf-length skirt. ‘Besides, I’m sure I can rely on you to help smooth things over during these difficult times. I hear you’re good at dealing with most problems that come your way. You appear to have a knack for calming troubled waters. Perhaps that’s why the department operated so efficiently while Dr Stanford was winding down for his retirement.’

Ruby’s eyes widened a fraction. Where would he have gleaned that wedge of information? Was it possible that he had been talking to his predecessor? Or maybe one or two of the board members had filled him in on her way of working. They might not have given her the job, but it didn’t necessarily mean they were unaware of her capabilities. Her lips made a wry shape. Perhaps her calm attitude was what had lost her the position. They wanted a lion that would roar and show its teeth.

Sam glanced at James and Olivia. ‘I know this is difficult for all of you, but there’s no point in moping about the situation. What we have to do is prioritise, knuckle down and get on with the job and concentrate on providing the best service we can under the circumstances.’

He turned to James and held out a patient’s file to him, his manner totally businesslike. ‘You examined a man who came in earlier with a broken wrist and suspected head injury after a fall…is that right?’

James nodded. ‘Tony Barton…a young man in his late twenties. I treated him for the wrist fracture and assessed him for brain injury, but his neurological responses were fine. I was getting ready to discharge him.’ He glanced at the file. ‘Are you ready to sign off his notes for me?’

Sam shook his head. ‘His condition has changed, according to the nurse who was following up on him. I’d like you to come with me and take another look at him, please.’

‘Oh…of course.’ James’s colour faded, and Ruby could see that he was wondering if he was in trouble of some sort. He was usually thorough and conscientious in everything that he did, but Sam, being a newcomer, clearly didn’t know that.

Sam nodded towards Ruby and Olivia and then strode off with James in the direction of the treatment room.

Ruby’s gaze met Olivia’s, and the senior house officer rolled her eyes. ‘Does that man ever stop to engage in the niceties of getting to know his colleagues?’ Olivia asked. ‘He’s brisk and businesslike, and his whole attitude is “stop fussing and let’s get on with it”, though I must say he seems half inclined to pass the time of day with you…but as to the rest of us…’ Olivia sucked in a deep breath. ‘He’s only been here five minutes, and I’m already beginning to wish Dr Stanford had delayed his retirement.’

Ruby grinned. ‘I dare say we’ll get used to him, given time. He has a huge task ahead of him, and he’s probably still working on his strategies. I expect he has a heart of gold underneath it all.’

‘We’ll have to dig deep to find it,’ Olivia murmured, moving away in search of her next patient. ‘I have the feeling it’s buried under a ton of steel.’

She could be right in that. Ruby frowned as she riffled through the files in the wire tray. Their new boss didn’t appear to be making any concessions to the fact that he was a stranger in their midst, and that they might have difficulty getting used to this different way of working. It was all or nothing with him.

She glanced through the list of patients waiting to be seen. Her first job was to check on the patients from the traffic accident, and in doing that her time was taken up with a host of complications that had arisen from an assortment of broken bones and punctured blood vessels. Worryingly, one man went into cardiac arrest, and she had to use the defibrillator to shock his heart back into a safe rhythm.

‘He’s back with us,’ she said a few minutes later, addressing the nurse who was monitoring his situation. ‘Give the intensive care unit another call, will you, and see if we can move him over there as soon as possible.’

‘I’ll do that,’ the nurse said.

An hour later things settled down a little, giving her time to attend to a young boy who had been injured during a football match on his local playing field.

‘That was an unlucky game for you, Matt, from the sound of things,’ she said, smiling at the seven-year-old and then inspecting the X-ray film displayed in the light box. ‘When you fell to the ground, you hit it with enough force to break your collarbone. That’s this one, here.’ She pointed out the area of the fracture to the boy and his mother. ‘There’s a line across here that shows the break in the bone.’

She turned to look at Matt once more. ‘The good news is, it should heal up quite well because the two pieces of bone are still in line and touching one another. You’ll need to wear a support sling for a week or two while the bone heals, and we’ll give you some painkillers to help you feel better.’

His mouth made a flat line. ‘If I’d done this in a couple of weeks’ time, when school starts again, I could have had some days off. And I don’t even get a plaster cast for my friends to sign.’ He looked thoroughly disgruntled.

‘Isn’t there any street cred in wearing a sling?’ Ruby lifted a brow. ‘I would have thought you could get some pretty good mileage out of that. And it’s the hand that you write with that’s out of action, isn’t it? I’ll bet you can impress your mates with a left-handed signature.’

His expression brightened. ‘Yeah, maybe.’

His mother smiled as they stood up to leave a few minutes later. ‘I’m sure he’ll milk this for all it’s worth,’ she murmured in an undertone to Ruby. ‘He’ll be playing the part of a wounded secret agent before too long, I’ll be bound.’

Ruby nodded agreement, and gave Matt a bravery certificate as he left the room. It seemed he was already working on his game plan. ‘Tyler didn’t get one of these when he sprained his ankle,’ he said. ‘He only got a badge that was this big.’ His fingers made demonstration of its tiny size.

Ruby laughed and watched them leave before going in search of her next patient. She worked steadily through the morning, dealing with a wide variety of injuries suffered by active young children intent on enjoying their summer holidays to the full, while at the same time keeping an eye on the work of the senior house officers in her charge. Sam was nowhere to be seen.

James had been missing for some time, too, but she caught sight of him when she was heading towards the ambulance bay. An infant with breathing difficulties was being brought in to A&E by ambulance, and she expected him to arrive in the next few minutes.

‘Is everything all right, James?’ she asked now, still continuing on her way. ‘You look as though you’re in shock.’

James fell into step beside her. ‘I’m fine,’ he said. ‘I just don’t know how my patient could have gone downhill so rapidly. One minute he was sitting there, talking to us, and the next his speech started to slur, and he began to sink into unconsciousness. And to think I almost sent him home.’

‘What happened?’

‘Sam—Dr Boyd—did a CT scan and then whisked him up to the operating theatre. He told me to scrub in. It turns out that he specialised as a neurosurgeon originally and then after several years of doing that decided to take up emergency medicine.’ He shook his head in wonder. ‘Everything happened so fast. It seemed like within minutes the anaesthetist was there and the patient was out for the count, and then Sam was cutting a segment out of his skull.’

‘So it was a blood clot causing pressure on the brain?’

James nodded. ‘That’s right. I actually got to suction it out, but then Sam took over and stopped the bleeding. He says we have to watch him for swelling on the brain and seizures, and I have to keep an eye on him. I’m just on my way to talk to the man’s wife. She came in to the hospital expecting to take him home, but now, of course, he’ll be admitted to the surgical ward.’

Ruby glanced at James. ‘You sound as though the experience has opened your eyes in some way. I don’t think I’ve ever seen you quite so shaken up.’

He nodded. ‘Well, he’s not out of the woods yet, and that’s a worry, but thinking about what might have happened, and seeing our new boss at work, has given me something to think about. Not only that, but it’s made me wonder if I ought to consider going in for a surgical specialty after my stint here. Watching him operate really made me see how much of a difference a surgeon can make to someone’s chances of recovery.’

‘Then something good has come out of this. I’m pleased for you, James.’

He made a brief smile and went on his way, while Ruby hurried to the ambulance bay, deep in thought. So Sam was more than just a force to be reckoned with on the hospital administration side of things. He was a first-rate doctor as well. It was more or less what she had expected, but somehow she had thought it might take more time for him to prove himself. At least he had managed to win James over to his side, brisk manner notwithstanding.

She went to meet the paramedics a short time later as they wheeled the infant out of the ambulance on a trolley bed.

‘This is Charlie, eighteen months old,’ the paramedic said. ‘He’s struggling to breathe, and there’s some nasal flaring. His blood oxygen level is low, and he’s in severe distress.’

Ruby could see at once that Charlie was very ill and the muscles of his rib cage were sucking inwards. ‘Let’s get him into the treatment room,’ she said. The toddler was breathing in oxygen through a mask, but she could hear him wheezing, and it was clear he needed urgent help.

Once in the treatment room, she called for a nurse to assist with giving oxygen while she examined the boy. Running the stethoscope over his chest, she heard crackles in his lungs and a wheeze whenever he breathed out.

His mother looked on anxiously the whole time, and after a while Ruby said, ‘He’s feverish and obviously struggling. I believe his air passages could be inflamed, so we’ll try him with a medication to help ease his breathing.’

‘What’s wrong with him?’ his mother asked. ‘He’s had a runny nose for a few days now, but suddenly he seemed to go downhill, breathing fast and getting tired and irritable. He’s been off his food too.’

‘It’s probably a viral infection of some sort,’ Ruby explained. ‘I’ll do a nasal swab and send it to the lab to be sure what we’re dealing with, but in the meantime we’ll concentrate on supporting his breathing. We’ll keep him in our observation ward for the next twenty-four hours, and then we’ll most likely have to move him to the paediatric ward for a few days. The nurse will explain everything to you and make arrangements for you to stay with him if that’s what you want to do.’

‘Yes, I do. Thank you.’ The young woman leaned over and stroked her child’s hand, offering him comfort, but the boy was too ill to respond. He just lay there, unmoving, strands of his hair curling damply over his forehead.

‘Here, take a seat,’ the nurse said, pulling a chair to one side of the bed. Michelle was a capable girl, slender and pretty, with dark hair that fell in a sleek bob to the nape of her neck. ‘I’m sure he knows that you’re here with him, and that will help to ease his distress.’