The Magic Of Christmas

The patient’s eyes were fixed on Christian’s face. ‘I was at the office Christmas lunch and then all of a sudden I started to feel terrible. Typical. The first time for ages I actually get to eat lunch and I’m ill. Usually I’m too busy working to bother.’

‘Has anything like this ever happened before?’

‘I do get palpitations occasionally,’ Ellen murmured, her face screwed up as she rubbed the flat of her hand against her chest. ‘But I’ve always assumed they’re caused by the amount of coffee and diet cola I consume. I’m a lawyer. I spend whole days in boring meetings and caffeine is the only thing that keeps me conscious.’

Lara quickly attached her to the machine and checked her observations. Seeing that Ellen’s pulse was two hundred, she glanced at Christian and he nodded to indicate that he’d seen the reading.

‘I want to get a line in and take some bloods.’

Knowing that they needed to check the patient’s blood oxygen level, Lara swiftly attached the necessary probe to Ellen’s finger and then picked up the IV tray. ‘Is there anyone you’d like me to call, Ellen?’

‘No one.’ Ellen didn’t look in her direction. Her eyes were occupied with studying the dark stubble that shaded Christian’s hard, angular jaw.

‘Can we check her sats, please, Lara?’ Christian slid the venflon into the vein and released the tourniquet.

‘Just doing it now.’ Lara adjusted the probe and watched the machine. ‘Sats are ninety-eight per cent.’

‘Good. These can go to the lab.’ He dropped the blood bottles onto the tray. ‘I’ll do the forms in a minute.’

Lara handed him some tape so that he could secure the venflon, her eyes still watching the pulse and blood-pressure readings. ‘She’s still tachycardic.’

Christian’s gaze followed hers and he moved the IV tray, reached for his stethoscope and hooked it into his ears.

‘I’m just going to listen to your chest, Ellen.’

Ellen lowered her eyelashes in an unmistakably flirtatious gesture. ‘Anytime. I suppose the one good thing about all this is having you leaning over me. I thought doctors as good-looking and sexy as you only appeared on television. Are you real or have they flown you in from Hollywood to perk up everyone’s Christmas?’

In the process of labelling blood bottles, Lara winced slightly at the patient’s less than subtle approach and glanced towards Christian, anticipating a cool putdown.

But he chose not to respond to the comment. He was probably used to female adulation, Lara thought to herself as she dropped the bottles into the bag and handed them to another nurse to take to the lab. He was so impossibly attractive he had to have been fending off desperately hopeful women all of his adult life.

She pulled the ECG machine closer to the trolley and tried to ignore the fact that Ellen was still flirting with Christian.

‘Do you play poker?’ Her voice was husky. ‘I bet you do. You have one of those faces that gives nothing away. Inscrutable. You must win millions. Oh, dear.’ She closed her eyes. ‘I feel horribly, horribly dizzy. And sadly I don’t think it’s anything to do with the fact that a gorgeous man is listening to my chest.’

Wondering whether she’d even noticed anyone other than Christian, Lara ripped open some pads. ‘I just need to attach these to your chest, Ellen, so that we can get a reading of your heart rate.’

Ellen didn’t look at her.

‘Pulse is two hundred and twenty,’ Lara said, her eyes flickering to the monitor as she swiftly and competently attached the electrodes to the patient. ‘Do you want me to call the cardiologists?’

Christian looped the stethoscope back around his neck and gave a swift nod. ‘Please.’

Ellen clutched his arm, her outward appearance of calm slipping. ‘Am I having a heart attack?’

‘We need to perform some tests before we make a diagnosis, but I don’t think you’re having a heart attack, Ellen.’ His gaze flickered to Lara just as she switched on the machine. ‘Are you ready to do a trace?’

‘Coming right up.’

Ellen gave a whimper and shifted on the trolley. ‘I feel all sweaty and clammy. Oh, God, something awful is happening, isn’t it? I knew I’d been working too hard lately.’

‘Try not to panic,’ Lara murmured, but Ellen didn’t even look in her direction. It was clear that all her hope for the future was fixed on Christian, who was studying the ECG machine. It purred softly as it produced a trace and he watched for a moment, his eyes narrowed. ‘Her ECG is showing regular narrow complex tachycardia with retrograde P waves.’

Interested, Lara leaned forward to take a closer look. ‘Mmm. There’s a shortened PR interval and a delta wave.’

Christian glanced at her in astonishment. ‘Yes,’ he murmured, ‘there is.’

‘So…’ Why was he staring at her? ‘Do you want to try adenosine or go straight for cardioversion?’ She knew that some doctors were reluctant to give adenosine in the emergency setting.

He was still staring. ‘We’ll give her 6 milligrams of adenosine by rapid IV push and see if we can get her back into sinus rhythm.’ He paused and she nodded to indicate that she understood that there was always the chance that the patient might develop a life-threatening arrhythmia.

‘So we’ll just have this within grabbing distance,’ she said quietly, moving the defibrillator next to the trolley.

Then she prepared the drug and handed it to Christian, who checked it and inserted the syringe into the venflon.

‘What’s happening?’ Ellen moaned, rubbing her hand over her chest. ‘What’s happening?’

‘Ellen, the conduction system of your heart isn’t working properly and your heart is being overstimulated. That’s why you’re feeling the way you are. The drug I’m giving you should prevent some of the electrical impulses getting through and slow the heart.’ Christian depressed the syringe to push the drug into the vein then dropped the empty syringe onto the tray next to him.

‘I’ll do you a rhythm strip,’ Lara said, programming the ECG machine and then standing to one side so that he could see the printout.

Ellen gave a sigh. ‘I’m feeling a bit better. But my face feels really hot.’

‘That’s a side effect of the drug we just gave you. Nothing to worry about.’ Christian’s gaze flickered to the monitor. ‘I’m going to refer you to the cardiologists, Ellen. They’ll want to do some more tests.’

‘Do you know what’s wrong?’

He looped the stethoscope back around his neck. ‘The electric currents that control your heart aren’t working properly. Put simply, they’re taking a short cut.’

‘I’m a lawyer. I don’t need the simple version.’

Christian studied her for a moment. ‘All right. Do you know anything about normal conduction pathways in the heart?’

‘No, but I’m a fast learner.’

Christian pulled a piece of paper and a pen out of his pocket and swiftly drew a diagram. ‘In the normal heart, electrical impulses start in the sinoatrial node in the right atrium—the atria are the chambers at the top of your heart—’ his pen flew over the page to illustrate his point ‘—and pass through the atrioventricular node to the ventricles in the bottom of your heart. The atrioventricular node limits the electrical activity that passes through to the ventricles and acts as a break on the heart rate. That’s what happens in the normal heart.’

Ellen looked at the drawing and gave a hollow laugh. ‘And that’s not me, right?’

‘Sometimes there’s an extra electrical pathway that bypasses the normal process and conducts electricity at a higher rate—there’s no filter, if you like. The result is that the heart can beat very quickly and that causes the symptoms you felt today.’

Lara studied the ECG again. ‘If she has an accessory pathway, why does the QRS complex look normal?’

‘Because ventricular depolarisation can occur through the normal pathway. It’s a combination of pre-excitation and normal conduction.’

‘You’ve lost me.’ Ellen sighed. ‘So how did I get this extra pathway? Was I born with it?’

‘Yes, it’s congenital. Some people have more than one. Basically it happens when the atria and the ventricles fail to separate completely.’