The Perfect Treatment

Automatically she felt for the carotid artery at the side of the neck and searched for a pulse, holding her own breath as she did so. Yes, there it was—the faint fluttering of a pulse, rapid, irregular.

‘Thank God,’ she said, shifting her position so that she was kneeling beside Will Ryles. ‘Not a cardiac arrest.’

With steady hands she unbuttoned his shirt and loosened his tie, then listened to his chest with her stethoscope, working quickly. After hastily dragging the necessary equipment from her bag, she took his blood pressure. The systolic blood pressure was only ninety. There was little doubt that he had suffered a myocardial infarct, a heart attack.

Abby looked around frantically. Where were other people when you really needed them? She had to get him to the emergency department at once before he sustained brain damage from low blood pressure—get him on oxygen, have cardiac enzyme tests done and get him on the life-saving, clot-dissolving drugs.

Compassion filled her as she looked down at the man’s face which was now an unhealthy yellowish colour and cyanosed from lack of oxygen. He looked exhausted. No doubt he was, she speculated. Beside him on the floor was a cellular telephone, plus a few other items which had obviously fallen out of his pockets. Maybe he had been trying to call for help.

Quickly Abby punched in the number of the emergency department triage station, not knowing whether the phone would function here in the basement. Thankfully, she heard it ringing. Most of the nurses knew her there—she had been there frequently as a medical student and had been one of the last young doctors to do a general training internship before the system had finally been abolished in favour of a new system of early specialization.

‘Hi,’ she said, when a nurse answered. ‘This is Dr Abby Gibson. I’ve just found Dr Will Ryles, the radiologist, collapsed in the east-to-west wing basement corridor. It’s a probable myocardial infarct. He needs oxygen pretty quickly. I need a couple of people here fast with a stretcher. He’ll have to be lifted.’

‘Right,’ the nurse said. ‘I’ll send a doctor and a nurse right away, with a couple of porters.’

‘Thanks.’ Abby disconnected the line. ‘Dr Ryles! Dr Ryles!’ She slapped his face gently, then slightly harder. ‘Open your eyes.’ Again she placed her fingers over his carotid artery, searching for the faint pulse that would indicate he was alive.

The man moaned, his eyes opening feebly. His expression was blank as he tried to focus on Abby’s face while she bent close to him.

‘Take it easy,’ she said, ‘you’re ok. You’re lying on the floor. You fell down, but you’re ok, sir. Just stay where you are, don’t try to move. Help is on the way. I’m Dr Gibson.’

Dr Ryles moaned again, letting out his breath on a long sigh and closing his eyes wearily.

‘Have you got much pain?’ Abby asked, putting her mouth close to his ear and keeping her fingers on his pulse. Poor devil, she thought, feeling her throat close up with emotion. She liked Will Ryles very much; in all his dealings with her he had been unfailingly courteous, very professional, superb at his job, good as a teacher.

He shook his head slightly, mouthed the word ‘Ok.’

As she looked at him, Abby also felt anger and frustration. She knew that his department was one of those that was being downsized, so she had heard. New computer technology was enabling X-rays to be read and diagnoses to be made off-site, away from the hospital where the X-rays were taken and the diagnostic procedures done. Businessmen were making decisions about how things should be done, rather than medical professionals, often making vital and important decisions on things they knew little or nothing about.

‘Hurry…please, hurry!’ Abby whispered the words to herself, looking expectantly down the corridor, praying that the emergency department staff would get a move on.

When she heard the elevator doors opening in the distance and the banging of a stretcher being hastily pushed out, she stood up and gathered up all the bits and pieces of personal belongings that had fallen out of Dr Ryles’s pockets. She shoved them into her attachè case to make sure that they didn’t get lost in the dash to the emergency department; she would get them to him later, or to his family.

It was Dr Marcus Blair, Head of the emergency department, a nurse and two porters who came hurrying towards her as she turned to greet them. In moments they had an oxygen mask, attached to the portable cylinder, on Will Ryles’s face.

‘I found him like this a few minutes ago,’ Abby explained to Dr Blair. ‘He has a pulse, he’s conscious. Breathing ok. Blood pressure ninety.’

Dr Blair nodded. ‘Right. Let’s get him onto the stretcher.’

With all of them helping, they rolled Will Ryles onto a canvas sheet with poles attached, then lifted him onto the wheeled stretcher. Dr Blair put a rubber tourniquet round their patient’s arm, preparatory to taking blood samples—he would do that in the elevator as they were going up to the emergency department on the main floor level. They would need blood for the cardiac enzyme tests, electrolyte levels and a hemoglobin test.

‘We’ve got someone holding the elevator for us,’ Dr Blair said. ‘Come on.’

‘Do you need me, Dr Blair?’ Abby asked.

‘No, we can manage now. Thanks, Dr Gibson. A good thing you came along. It’s like the Sahara desert down here.’ With that, they set off at a quick trot down the corridor. Abby stood to watch them until she heard the elevator doors close and the elevator move upwards. Only then did she realize how tense she was, like the proverbial bowstring.

‘Phew!’ She let out a breath she had been holding. ‘Thank God for that.’

If anything had happened to Will Ryles she would have felt personally responsible. She could have called a code—the cardiac arrest code, she supposed now—but really he hadn’t had a cardiac arrest. He would be all right now.

She felt drained, as though she had already done half a day’s work, as well as shaken up by this sad encounter with someone she knew fairly well as a colleague. Someone would now have the unpleasant task of calling his wife to let her know.

‘Not a good way to start the morning,’ she muttered to herself as she resumed her journey. There was no point now in rushing to the rounds—a good part of the first presentation would be over.

Usually two or three of the residents-in-training, young doctors, presented interesting cases to the department of medicine and anyone else who cared to attend the rounds for learning or interest purposes. As a trainee, she was expected to attend. Sometimes there were photographic slides to look at, sometimes microscopic slides as well if the patient had had a surgical biopsy or other lab work.

Perhaps she could just slip in unnoticed to the small lecture theatre where the rounds were being held this time. If not, she would just have to apologize to Dr Contini, who was running the rounds, and explain the delay.

No such luck, Abby thought resignedly as she entered the room just as one of the window blinds was being let up so that brilliant spring sunshine entered the room at the same time, as though to highlight her late appearance. A slide presentation was obviously just over, indicating that the first case had already been presented. There would probably be one or two more.

Quite a lot of people were present, juniors and seniors alike. Some turned to look at her as she came in. She moved to the back of the room to try to blend in with the small crowd around the coffee urn that was set up on a table.

Moments later she was sipping hot coffee thankfully, holding her bag and books awkwardly with one arm, her mind soberly on Will Ryles. By now they would have the life-saving drugs dripping into his veins via an intravenous line. Would he be relieved, knowing he was out of it for a while, out of the workforce, even though he had a serious condition? Or would he constantly fret about the work he was missing? He was probably one of those guys who pushed himself too hard, not wanting to admit that he needed a break.

Several of her close colleagues were there, those who were in the same training program, and she made her way towards them. It was then that a firm hand grasped her arm from behind, halting her progress.

‘Dr Abigail Gibson, I presume?’ a masculine voice said. It wasn’t, it seemed to her, a warm voice. It held a sardonic note, a note of censure, and Abby cringed inwardly as she turned to look at the owner of the voice.

As she turned, the heavy books once again slipped from her grasp and landed with a thump at the feet of the speaker, partly covering his shoes. Then, as she stared down at them, a few splatters of coffee from the Styrofoam cup she was holding dotted the cover of the uppermost book.

Feeling clumsy and disconcerted, her mind elsewhere, she found herself stammering. ‘Y-yes, I’m Dr Gibson,’ she confirmed, raising her eyes to the man who stood looking down at her.

With a sense of shock she looked into cool blue eyes, intelligent eyes that were regarding her with undisguised perceptiveness and not a little exasperation, tinged with surprise…perhaps from the weight of the books on his toes? Abby swallowed convulsively.

‘S-sorry,’ she added.

He had an attractive, very masculine face, with a fine chiselled bone structure. Instantly she thought of a racehorse, a thoroughbred, with its fine aristocratic frame, perfectly formed for its function. The face was not smiling.

So this must be Dr Blake Contini. Abby felt slightly breathless, rather as though she had been punched in the solar plexus, not least because he was now frowning at her in a way that did not seem justified by her lateness or by the fact that she was a junior doctor in a training position or by the weight on his feet. After all, she was not even in his department as such. It brought an odd feeling, this astute appraisal, coming as it did on top of a sense of mourning that she had for the plight of Will Ryles.

‘Sorry,’ she muttered again, unable to think of anything else. As she bent carefully at the knees to retrieve her books, a few more drops of coffee escaped from her cup.

‘Let me do it, Dr Gibson,’ he said, putting out a restraining hand. Abby flushed, feeling as though the entire room had gone silent, that she was the focus of attention. Keeping her gaze lowered, she watched his lean hands wipe the coffee off her books with a handkerchief and pick them up.

‘Here,’ he said, thrusting the books at her and helping her to tuck them under her arm. ‘Better get yourself another cup of coffee.’

‘Th-thanks.’ For a couple of seconds she thought she detected a touch of humour in his eyes as he looked at her when their hands touched warmly for a moment.

He took a sheet of paper, a computer printout, from the pocket of his lab coat, holding it so that she could see it. For a few seconds she gazed at it blankly.

‘This is the summary of the first case we’ve reviewed today, which you’ve managed to miss entirely,’ he said. ‘We’re about to start on the second case.’ He tucked the paper between the pages of one of her books. Abruptly he turned away.

‘Wait a minute,’ she said, recovering something of her habitual confidence and composure. ‘And you are? I didn’t get your name.’ He hadn’t given his name—that had been a bit boorish, she considered belatedly.

It was almost certain that he was who she supposed him to be, as he had been avidly described to her by several of her women co-workers, yet he could not make the assumption that she would automatically know who he was. The thought of such an assumption fuelled niggles of annoyance.

He turned back to her slowly, an expression of muted surprise on his face. Fixing her with a look that might have quelled a lesser mortal, he held out a hand to her. With his other hand he deftly plucked the coffee-cup from her. ‘Don’t want any more accidents, do we?’ he said sardonically, while Abby was only too aware that other people nearby were staring at them curiously. ‘I’m Dr Contini,’ he added dryly, gripping her vacant hand firmly. ‘Blake Contini—Acting Head of the department of internal medicine.’