Christmas With Her Daredevil Doc

This was a truly humbling experience, Hayley thought; it made her feel glad to be alive.

But then, a few minutes later, the guide called, ‘Do we have a doctor on board?’

Her heart skipped a beat. When a tour guide put out that kind of call, it could mean a true emergency, and right now they were almost an hour’s sail away from Reykjavik. She had no idea how the emergency services worked here. Would they send out a helicopter to the ship, or would the tour guide have to cut the trip short and they’d have to sail straight back to the city?

She made her way to the guide’s post. ‘I’m Hayley Clark, a doctor from England. Can I help?’

‘My husband’s having an asthma attack,’ an American woman said, looking anxious and wringing her hands. ‘And we don’t have his inhaler with us.’

Just as well she worked in the emergency department, Hayley thought. ‘Can you put out a call to see if anyone has a reliever inhaler we could borrow, please?’ she asked the guide. ‘Even a preventer inhaler would help.’

‘Will do,’ the guide said.

She turned to the woman. ‘Would you like to take me to your husband? My name’s Hayley and I work in the emergency department of a London hospital.’

‘I’m Lulu Adams and thank God you’re on board,’ the woman said, leading her towards the next deck down. ‘I can’t believe Milton’s having an attack out here. Normally it’s pollen and cat hair that sets him off.’

‘Cold can set off asthma, too, and the air’s quite cool out here,’ Hayley said, ‘so it’s always a good idea to keep a reliever inhaler with you—even if you don’t think you’re going to come across your usual triggers. Does your husband take his preventer inhaler regularly?’

‘He’s a man. You can’t tell him anything,’ the woman said with a sigh.

So this was probably an attack that had been brewing for a while, Hayley thought, with a patient who didn’t bother taking his preventer inhaler that often. Milton Adams’s doctor definitely needed to talk to him about the importance of asthma control. She just hoped she could keep him stable until they managed to get some proper bronchodilator medication for him. ‘Does he have any other medical conditions?’ she asked.

‘Just the asthma.’

Which was tricky enough to deal with, by the sound of things. ‘OK. Thanks.’

* * *

Do we have a doctor on board?

There were maybe a couple of hundred other people on the boat. The chances were, Sam was the only doctor. Plus this would be a test. Had he done the right thing in accepting the job at a London hospital, or had his experience in Manchester soured his love affair with medicine to the point where he really didn’t want to go back to it?

He made his way to the bridge to talk to the guide, and on the way he heard her ask if anyone had an asthma inhaler that another passenger could borrow.

‘My name’s Sam Price, and I’m an emergency doctor from England. It sounds as if you have a passenger who’s having an asthma attack and doesn’t have an inhaler. Can I help?’ he asked.

‘There’s another doctor gone to see him already, if you want to join her,’ the guide said. ‘You’ll see her on the deck below. She’s wearing a yellow raincoat.’

‘OK. Thanks. Has anyone come up with an inhaler?’

‘Not yet, but I’m going to put another call out,’ she said.

Asthma attacks could be tricky. If nothing else, Sam thought, he could help calm down whoever was with the patient, so the other doctor could get on with treating the patient. He headed down to the next deck, and saw a woman wearing a yellow raincoat. She was talking to a man who was clearly panicking and wheezing, and the woman with them was wringing her hands and looking equally panicky.

‘Hello. I’m Sam Price, and I’m an emergency doctor,’ he said as he joined them. ‘Can I help?’

‘Hayley Clark—also an emergency doctor, from London,’ the woman in the yellow raincoat said.

He noticed how blue her eyes were—like an Icelandic summer sky—and her sun-streaked blonde hair was caught back at the nape of her neck, with soft tendrils framing a perfect oval face.

What the hell was he doing, noticing the colour of her eyes when there was a sick patient who needed their attention? Besides, even if he was looking for a relationship—which he wasn’t, after Lynda—she was probably already spoken for. Cross with himself for getting distracted, he paid attention to what she was saying.

‘This is Milton Adams and his wife Lulu,’ Hayley continued. ‘He doesn’t have his reliever or preventer inhaler with him, and we think the cold air probably brought on his asthma attack. He doesn’t have any other medical conditions.’

‘The guide’s putting out a second call to see if anyone on board has an inhaler with them,’ Sam said. ‘But even if there isn’t anyone, we can help you, Mr Adams.’

The man continued to wheeze, fighting for air, clearly panicked by the tightness in his chest.

Really, they needed to get him away from the cold air that had triggered the attack and into a warm place. But, given the state of his breathing right now and the fact that he was quite overweight, no way would Mr Adams be able to cope with the steep stairs to go back inside the ship. First, Sam thought, they needed to get Mr Adams stabilised so he was calm, and breathing more slowly. Anxiety released cortisol in the body, constricting the bronchial tubes even further, and panicking that you couldn’t breathe caused a vicious circle: it tightened the chest muscles, which made it harder to breathe, which in turn made the patient panic more and then the chest muscles tightened even further.

‘Mr Adams, can you sit up straight for us?’ Sam asked. ‘It’ll help you breathe more easily, because bending over constricts your breathing.’

Milton Adams continued gasping, but to Sam’s relief, he did as he was told.

‘I’m going to loosen your tie and undo the button of your collar,’ Hayley said, ‘because that’s also going to help you breathe more easily. Is that all right?’

The man nodded.

‘I told him he ought to bring his inhaler. I told him,’ Mrs Adams said, almost in tears.

Hayley reached over and squeezed her hand. ‘Mrs Adams—can we call you Lulu?’ At the woman’s nod, she continued, ‘I know how worried you are about your husband, but right now I really need you to do an important job for me and count. Can you do that for me?’

‘Yes,’ Mrs Adams said, her voice slightly quavery.

Brilliant management, Sam thought—she’d acknowledged the woman’s fears and distracted her by making her feel useful. What Hayley had just said about counting told him that she’d intended to use the same method he would’ve used.

‘Mr Adams—can we call you Milton?’ At the man’s nod, Sam continued, ‘We want you to try to take some really long, deep breaths for us. I know right now it’s scary, but I promise we can make you feel better. I want you to breathe in through your nose for a count of four and out through your mouth for a count of six. Can you do that for us?’

Mr Adams nodded, still fighting for breath.

‘Can you count for us now, Lulu?’ Hayley asked. ‘Four in, then six out. Count with me for the first set so we can get the rhythm right together. One, two, three, four...’

Mrs Adams joined in with counting.

Sam took the older man’s hand to reassure him. ‘OK. Breathe in—now out.’ Breathing to the counts would slow Milton’s breathing down, making it easier for him.

‘Purse your lips as you breathe out, Milton,’ Hayley said. ‘That helps to slow your breathing and keeps your airways open. That’s it. Keep going. You’re both doing really great.’

Mr Adams was still wheezing, but his colour was improving. ‘Can you place one hand on your stomach, Milton, just below your ribcage?’ Sam asked. ‘Then, when you breathe in, focus on pulling down into your stomach. Use your stomach muscles to help you push out,’ he said. ‘It’s called diaphragmatic breathing and it will really help you take deep, slow breaths.’

Eventually, Mr Adams’s breathing pattern settled and he seemed noticeably calmer.

Sam caught Hayley’s eye. ‘Shall we all go downstairs, so we’re away from the cold air?’

She nodded. ‘And we can ask the crew if they’ll sort out a bowl of hot water and lend us a towel.’

‘Good call,’ he said. They could make a tent with the towel and the bowl of hot water, and then Milton Adams could breathe in the moist air to help him recover.