The Consultant's Special Rescue. Joanna Neil
start a staff grade posting.’
He stared at her hand, and when she started to think that he was going to ignore her, he finally grasped it and said in a kindly tone, ‘You know, I’m sure there must have been some mistake.’ He almost patted her hand. Then, collecting himself, he let her go as though he had been stung.
He said lightly, ‘Even so, I must say I’m pleased to see you again and to find that you seem to have recovered from your ordeal.’ He looked at her searchingly. ‘I take it you have recovered?’
Amber disguised a wince. Did he think she’d taken leave of her senses once more? His manner was almost patronising. ‘Yes, thank you,’ she said. ‘I seem to have come out of it with no after-effects. I’m very lucky, and I realise that I have you to thank for that.’
‘Possibly.’ He turned to the desk clerk, and said, ‘Would you let me have the file on the new senior house officer post, please? There are a few details that I would like to check.’
It was Amber’s turn to stare. Surely he wasn’t going to search for a reason to have her evicted from her post before she had even started it? Could he do that?
The desk clerk hunted through a filing cabinet and handed him a folder. ‘I believe this is the one,’ he said.
‘Thank you.’ The consultant flicked through the paperwork, his dark brows edging closer together as the seconds passed. Amber watched him guardedly.
After a while, he looked up, and said in a clipped voice, ‘Professor McIntyre’s handwriting doesn’t improve with time, unfortunately.’ He looked at her once more. ‘I was expecting a Dr Andy Carmel.’ His mouth made a straight line. ‘It looks as though I owe you an apology. I should welcome you to our department.’
He said it calmly enough, but his lips were stiff, and Amber wondered how much of an ordeal it was for him to accept her on his team. It didn’t bode well for the future. Things were not going to be easy, working alongside him, that was for sure.
He said carefully, ‘I’ll get someone to show you around, and as soon as you feel ready, you can start seeing patients. Mandy will direct them your way.’ He frowned as a siren sounded in the distance. ‘You’ll have to excuse me—we have patients from a road traffic accident coming in. You don’t need to be involved with that—I already have the staff in place to attend to them.’
Amber had the feeling that he didn’t trust her to assist, and already he was moving away, his mind seemingly elsewhere. Surely she would be able to prove herself to him over the next few hours and days?
She did as he had suggested, going on a quick tour of the department before she started work. She was worried about making a mistake—her nerves were already in shreds—but as the morning wore on, her professional instincts took over.
‘There’s a patient waiting for you in room three,’ Mandy said at one point. ‘Jack Carstairs. He’s complaining of a sudden loss of vision, and the paramedic was querying migraine.’
‘OK, I’ll see to him.’ Amber glanced at the chart Mandy handed to her and then hurried towards the room.
Her patient was a man in his late fifties. ‘Hello, Mr Carstairs,’ she greeted him warmly, trying to put him at ease. It was clear that he was unsettled and anxious. ‘I’m Dr Cavell, and I’m just going to have a quick look at you and see if we can find out what’s causing the trouble. Can you describe the loss of vision to me?’
He answered her questions as best he could, and she made a quick examination, checking his perception of light and his ability to detect hand movement or count the fingers she held up before him. She became increasingly concerned as she went on to examine the affected eye through a slit lamp.
‘There are one or two more things that I want to check, Mr Carstairs,’ she said. ‘I’d like to listen to your heart through my stethoscope to check for any murmurs and so on, and then I want to take some blood from your arm for testing.’
He let her proceed, and when she had finished and sent off the relevant samples to the laboratory, he asked worriedly, ‘Do you know what’s causing the problem?’
‘I can’t say for certain just yet,’ she answered. ‘It will depend on the results of all the tests. I’ve arranged for an ophthalmologist to come and take a look at you.’
‘Am I going to lose my sight permanently?’ It was a blunt question, and Amber thought he deserved an honest answer.
‘I’m not sure,’ she said. ‘It’s possible that you have a blockage in the retinal artery, and the outcome very much depends on how quickly we can move that blockage. We need to find out what’s causing the obstruction in order to be able to treat it.’
‘But you must have some idea?’
‘It’s probable that you suffered an embolism, and that might be because you have a degree of atherosclerosis. We won’t know until the results come back. In the meantime, I’m going to attempt to lessen the pressure within the eye. That’s probably the best way of trying to save your sight.’
He looked frightened, and she did her best to reassure him. ‘I need to massage your eye,’ she told him, ‘because that may dislodge the embolus and allow the eye to recover a little.’
She settled him into a comfortable position and then for a few seconds she applied direct pressure to the globe. Then she released it and repeated the action several times.
There was still no sign of the specialist putting in an appearance, and Amber was beginning to be concerned. ‘There is something else I can try, while we’re waiting for the consultant,’ she told the man. ‘I can draw a little fluid from the eye to move the embolus even further away. It sounds horrible, I know, but don’t worry—I’ll give you a local anaesthetic. Try to relax and I’ll do what I can to save your sight.’ She called for assistance from a nurse, and Chloe came to help.
‘Are you going to use the slit lamp?’ Chloe asked, and Amber nodded. ‘I’ll need a tuberculin syringe and 27-gauge needle.’
Amber worked carefully for some time, and eventually she was relieved that the pressure within the eye had been reduced. She said, ‘All right, Mr Carstairs…that’s all finished now. Just rest for a while, and then I’ll arrange for you to have a magnetic resonance angiogram so that we can see what’s happened to the embolus now.’
He looked anxious and she said, ‘It’s nothing to worry about, I promise, and when we have a clear picture of what we are dealing with, we’ll be able to give you further treatment to dissolve the blockage and to prevent any further damage. It all depends what the specialist decides once he’s looked over your case notes.’
She smiled at him. ‘You’ve been very brave. Take it easy now, and I’ll leave you with the nurse for a while. I’m sure she’ll answer any questions that you have.’
Chloe went to attend to him, and Amber hurried away to chase up the specialist.
‘He’s dealing with another emergency,’ Mandy said. ‘He said he would get down here as soon as he could.’
Amber wasn’t happy about that. In cases like Jack Carstairs’s, she knew that speedy treatment was imperative. A matter of a few hours could make all the difference. She had done what she could to save his sight, but it all depended whether he had been treated early enough.
She laid her stethoscope down on the desk, and began to write up her notes. Perhaps she should enquire into the possibility of Jack being treated with hyperbaric oxygen therapy. At least if she had set the wheels in motion, the treatment would be available if the specialist decided to go ahead. It was a fine line to tread, but she went ahead anyway and organised it.
The last thing she needed was to be taken to task by the ophthalmologist for not acting quickly enough or for taking on too much and impinging on his area of specialisation. She didn’t know what the rules were here, or anything about individual sensitivities, and she didn’t want to tread