The Spanish Doctor's Love-Child (1 of 2 free samples)

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COPYRIGHT
The Spanish Doctor's Love-Child by Kate Hardy. Copyright 2008 by Kate Hardy.
All Rights Reserved. Sharing not permitted.

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The Spanish Doctor’s Love-Child

Kate Hardy

For Terri and Lee, with much love

Chapter One

‘ROD HAWES, fifty-four, had just got a strike at tenpin bowling when he started having chest pains,’ Ed, the paramedic, told Becky and David as he wheeled the trolley into Resus. ‘His wife and kids are on their way.’

Becky glanced at their patient, not liking his colour or the sheen of sweat on his skin.

‘He described the pain as being like an elephant sitting on his chest,’ Ed continued.

Classic symptoms. So she was expecting the paramedic’s next comment: ‘The pain wasn’t relieved by GTN and from the trace we think he’s had an MI. We’ve cannulated and given him oxygen, but no aspirin because he’s got a stomach ulcer.’

A complication they could really do without.

Almost before David asked, she had a syringe in her hand and bottles. ‘Usual bloods?’ she asked.

He nodded. ‘Has he had an antiemetic?’ David asked the paramedic.

‘Not yet.’

‘I’m on it,’ Becky said, swiftly sorting out the bloods. She’d administered an antiemetic through the cannula and set up the electrocardiograph leads to take a trace of the heart’s activity by the time David had finished taking the patient’s history.

Strange how everything slowed right down in the middle of an emergency. Their patient’s life was at stake, but the team had worked together for so long that they all knew exactly what to do. Everything slotted together in the right place and at the right time.

And it was a shame that today was going to be the last time they’d work together. David was flying out to Africa almost straight after his shift to do a six-month stint with Doctors Without Borders.

Becky only hoped that the new consultant would be as thorough and as genuinely nice as David, treating the patients and staff alike with respect and kindness. Human Resources hadn’t exactly been generous with their information, and even the hospital grapevine had drawn a blank. All they knew about the new consultant was that he was male.

They were about to administer thrombolytic drugs when she saw the pattern on the ECG change. ‘He’s gone into VT.’

Hardly surprising. Becky knew that most patients who’d had a heart attack developed an abnormal heart rhythm afterwards. VT, or ventricular tachycardia, was where a ventricle, one of the lower chambers of the heart, beat too fast; it could lead to ventricular fibrillation, where the heart contracted but didn’t pump blood around the body, and it was life-threatening.

‘OK. We know the drill,’ David said wryly. ‘Crash team. Mina, can you remove the clothing from Rod’s upper body, so we can position the paddles more easily?’ he asked the first-year foundation doctor.

Mina did so while David checked Rod’s intubation and Becky checked his pulse. ‘He’s in pulseless VT,’ she reported.

David sighed and put one paddle on the apex position and the other on the right of Rod’s breastbone, just below the clavicle. ‘Charging to two hundred,’ he said. ‘Stand clear.’

Everyone took their hands off the patient.

‘Shocking now.’

Becky glanced at the ECG. ‘No response. He’s still in VT.’

They waited ten seconds to see if the ECG trace changed—the protocol was that you didn’t check the pulse after a shock unless the heart rhythm changed.

‘Charging to two hundred again,’ David said, keeping the paddles on the gel pads. ‘And clear. Shocking now.’

Still no response.

‘Charging to three-sixty,’ David said, ‘and clear. Shocking now.’

To everyone’s relief, the ECG showed a clear sinus rhythm—the normal beat of the heart.

Becky checked Rod’s pulse and her stomach plummeted. ‘No pulse. He’s gone into PEA.’ PEA, or pulseless electrical activity, was where the heart rhythm seemed normal on the ECG screen, showing that there was electrical activity within the heart, but the heart wasn’t actually pumping blood around the patient’s body.

He was intubated, on oxygen, and there was no sign of a bleed; they also knew from the history that the patient had given them that he wasn’t on any medication and hadn’t taken any drugs. So that narrowed down the likely causes of the problem.

David grimaced. ‘My money’s on thrombosis—a huge MI.’

Which meant the chances of a good result were slim. Becky knew that when a patient had gone into PEA, if they couldn’t find the underlying cause fast enough, they treated the patient as if they were in cardiac arrest. The odds weren’t on their side, but she drew up a milligram of epinephrine and handed it to David. ‘Want me to bag while you do the compressions?’

He nodded. ‘Sure I can’t persuade you to come with me? We could do with a really good nurse on the team. Especially one who’s a nurse practitioner.’

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