Emergency Doctor and Cinderella. Melanie Milburne
can be undone by isolating later management teams from the acute-care team. When was the last time you did a tertiary survey? It’s mentioned in EMST and ATLS, but hardly ever happens. Sometimes injuries and clinical clues get missed in the wards. There is clear evidence that tertiary survey by the doctor who carried out the primary and secondary surveys is more likely to detect missed injuries, and so avoid complications which eat up beds and cost money.’
She continued to eyeball him in that ‘I don’t give a damn’ way of hers. ‘So, how long do you intend on propping up the public system before you scoot off for far more lucrative returns in the private sector?’
Eamon cocked an eyebrow at her. ‘I could ask you the very same question.’
She held his look for a moment before turning to look at the harbour. The sun was low in the sky, casting a pinkish glow over the sails of the Opera House and the towering skyscrapers of the city on the opposite shore. ‘I’ve thought about it plenty of times,’ she said. ‘But so far I haven’t got round to doing anything about it.’
‘You don’t like change, do you, Dr Taylor?’ Eamon asked.
She turned to look at him, her expression like curtains pulled across a window. ‘I can deal with change when I think it’s appropriate,’ she said, and without another word slipped inside her apartment and shut the sliding doors—locking him out in more ways than one, he suspected.
CHAPTER TWO
ERIN had not long finished stitching a leg wound on a teenager the following morning when Tammy alerted her to a new admission.
‘Forty-five-year-old male complaining of severe back pain,’ Tammy said, reading from the notes she had taken down. ‘His wife found him on the floor of the bathroom. He’s nauseous and vomited prior to arriving in A&E.’
Erin twitched aside the curtains in bay four and introduced herself. ‘Hello, I’mDr Taylor. The triage nurse tells me you’ve got back pain. Can you describe it exactly?’
The man pointed to his left loin. ‘Here…’ he said somewhat breathlessly. ‘Every couple of minutes…I…ahh…!’ He writhed and groaned on the bed as his ashen-faced wife clutched one of his hands in hers.
‘We’ll give you something for the pain and nausea,’ Erin said, administering morphine, buscopan and stemetil IV, with Tammy assisting.
‘Is he going to be all right?’ the man’s wife asked.
‘How long have you been unwell, Mr…’ Erin glanced at the notes ‘…Aston?’
‘I…I haven’t been sick for years,’ he said, and turned his head to his wife. ‘Have I, love?’
Mrs Aston nodded. ‘That’s right, Doctor. He’s never even taken a day off work in thirty-odd years. He’s always been—’
‘How’s the pain now?’ Erin asked as she clicked her pen open.
‘Eased off a bit,’ Mr Aston said, regaining some colour in his face as the pain-relief flooded his system.
‘When did you first feel unwell?’ Erin asked, pen poised over her patient-history clipboard.
‘First thing this morning,’ he said. ‘I woke up to go to the toilet and then it hit me, didn’t it, love?’
‘I found him on the floor of the bathroom,’ his wife put in. ‘I nearly had a heart attack myself.’
Erin acknowledged the wife’s statement with a movement of her lips that was neither a smile nor a grimace but something in between. ‘I need you to give me a urine sample if you can manage it, Mr Aston,’ she said, addressing the patient once more. ‘I’d also like you to have an abdominal X-ray. The nurse will organise that while I see to another patient. Once we have the results of the urine sample, we’ll know more.’
‘Is it cancer?’ Mrs Aston asked hollowly. ‘Jeff used to smoke, didn’t you, dear? He gave it up…what?…ten years ago now, it must be. I remember the day. It was when we went to—’
‘We’ll know more once we get the results back from the tests I’ve ordered,’ Erin said briskly.
Tammy took over the care of the patient as Erin moved to the next bay. She parted the curtains to see Dr Chapman standing by the bedside of a young child with his mother. ‘Oh, sorry,’ Erin said. ‘My patient must have been moved into another bay.’
Eamon gave her a formal smile which Erin suspected was for the sake of the patient. ‘Mrs Forster has been taken for a CT scan. This is Hamish, and his mother, Karen Young. Hamish here has had a persistent discharge from his right nostril for about a week, but this morning the discharge was blood-stained. We were about to have a look inside, weren’t we, Hamish? You don’t mind if Dr Taylor watches, do you? I bet she’s never seen a braver young man around here.’
The young boy of about three stared wide-eyed but trustingly at Eamon, who picked up a nasal speculum and bright light. Erin was privately a little impressed at how biddable the child became under Eamon’s care. She’d had a child with a foreign object up its nose only a month ago, and the floor above had heard its screams when she had tried to retrieve it. In the end she had handed the case over to the ear, nose and throat surgeon who had removed a plastic bead under general anaesthesia.
‘There,’ Eamon said as he showed the child and his mother the bright blue bead he had found. ‘You were a champion, Hamish. I’ve seen kids twice your age who would have screamed the place down.’
‘Weally?’ Hamish asked, still a little bug-eyed.
‘You betcha,’ Eamon said, and then he turned and winked at the young mother. ‘You can take him home now, Mrs Young. He’s good to go. Just put the ointment Nurse will get for you up his nostril three times a day, and massage it in a bit, until you’ve finished the whole tube.’
Once the young mother and her son had left, Eamon turned to Erin. ‘I’d like a word with you if you are free, Dr Taylor.’
Erin gave him a wary look. ‘I have a patient who should be back from X-ray by now.’
‘That would be Mr Aston next door?’ he asked.
She flattened her mouth at his expression. ‘I thought the plan was to have some sort of continuity of care around here,’ she said, keeping her voice down in case the patient had returned. ‘If I go off for a lengthy discussion with you, who’s going to follow up Mr Aston?’
‘Meet me in my office once you have finished assessing him,’ he said, pushing the curtains aside. ‘Unless, of course, anything urgent comes in.’
Erin blew out a breath once he moved past. It would be just her luck that today would be one of those quiet days, leaving her with no excuse to avoid another confrontation with him.
Mr Aston was being wheeled back to the examination bay when Erin returned, after responding to an HMO’s phone call about another patient who had been admitted the day before.
Mr Aston’s urine sample was positive for blood and his X-ray almost certainly showed a stone at the end of the right ureter. Erin ordered a rapid-sequence urinarytract CT, which confirmed the finding, and she explained the results to the patient and his wife. ‘You have renal colic, Mr Aston, which basically means you have a kidney stone. Very often stones pass spontaneously, but occasionally they don’t.’
‘What happens then?’ Mrs Aston asked.
‘If the stone doesn’t pass, it may have to be removed under anaesthesia. We’d get a urologist to see you to do a cystoscopy—put a camera up the front passage into the bladder—and use a wire basket to grab the stone and pull it out.’
‘Oh dear, it sounds horribly painful,’ Mrs Aston said, grasping her husband’s hand again.
‘He’ll be fine, Mrs Aston,’ Erin said. ‘The ENT specialist