Dr Right All Along

Lucy frowned. That hadn’t caused him too many problems before, so what had been different about this time?

‘Were you on your feet for longer than usual?’

He managed a sheepish half smile. ‘I went to play with some of the toys across the other side of the ward.’ Talking exhausted him and he closed his eyes.

‘Until the nurse found him and shooed him back to bed,’ his mother finished for him. ‘He’s not been well since then. I’d gone to get a cup of coffee, or I’d have stopped him. He’s always been too lively for his own good.’

Lucy acknowledged that with a smile. Of course most children, especially boys, were naturally adventurous, and could stray into trouble from time to time. She kept her thoughts hidden, but she was worried about the drop in the boy’s blood pressure and his increased heart rate. His pulse was weak. Put together, they added up to signs of imminent shock.

‘I just want to examine your tummy, William,’ she said. ‘I’ll be as gentle as possible.’

Even so, it was clear that he was in pain, and his abdomen was distended, which made her even more concerned. There was an area of bruising under his ribcage on the left side, in the region of his spleen, plus another, more recent, reddened patch.

‘Did you bump into something when you got out of bed?’ she asked quietly.

He pressed his lips together, and she guessed he was unwilling to answer so she said quickly, ‘You’re not in any kind of trouble. It’s all right to tell me.’

‘I tried to climb up on a chair to reach something, but I felt dizzy and slipped and banged myself on the seat.’ Breathless, he fell silent once more and after a few seconds he began to retch.

His mother helped him with the kidney dish and silently sucked in her breath while Lucy quickly jotted down her findings on his chart. Everything was becoming clear to her now. Wasn’t it likely that the fall would have been the cause of his problems? An injury coming on top of an already damaged spleen could have been the final straw, causing an increase in the internal bleeding from the initial injury, to such an extent that now it looked as though blood was building up inside his abdominal cavity. If she was right, this was extremely bad news—an emergency situation. Too much blood loss could be fatal.

‘All right, sweetheart,’ she murmured, keeping her tone calm and pacifying. ‘I’ll get the doctor to come and look at you and we’ll make sure you’re feeling better soon.’ Turning to his mother, she said, ‘He needs to rest completely, and lying back with a couple of pillows under his legs might be best. I’ll be back in a minute or two.’

She moved away from the side of the bed, debating what to do next. What if she was wrong in her diagnosis and there was some other interpretation to be drawn from his symptoms? Even so, she sent out urgent pager messages calling for Matt and the professor to come and look at the patient, and then she went to find Mandy, the nurse in charge of the ward.