‘So it was a blood clot causing pressure on the brain?’
James nodded. ‘That’s right. I actually got to suction it out, but then Sam took over and stopped the bleeding. He says we have to watch him for swelling on the brain and seizures, and I have to keep an eye on him. I’m just on my way to talk to the man’s wife. She came in to the hospital expecting to take him home, but now, of course, he’ll be admitted to the surgical ward.’
Ruby glanced at James. ‘You sound as though the experience has opened your eyes in some way. I don’t think I’ve ever seen you quite so shaken up.’
He nodded. ‘Well, he’s not out of the woods yet, and that’s a worry, but thinking about what might have happened, and seeing our new boss at work, has given me something to think about. Not only that, but it’s made me wonder if I ought to consider going in for a surgical specialty after my stint here. Watching him operate really made me see how much of a difference a surgeon can make to someone’s chances of recovery.’
‘Then something good has come out of this. I’m pleased for you, James.’
He made a brief smile and went on his way, while Ruby hurried to the ambulance bay, deep in thought. So Sam was more than just a force to be reckoned with on the hospital administration side of things. He was a first-rate doctor as well. It was more or less what she had expected, but somehow she had thought it might take more time for him to prove himself. At least he had managed to win James over to his side, brisk manner notwithstanding.
She went to meet the paramedics a short time later as they wheeled the infant out of the ambulance on a trolley bed.
‘This is Charlie, eighteen months old,’ the paramedic said. ‘He’s struggling to breathe, and there’s some nasal flaring. His blood oxygen level is low, and he’s in severe distress.’
Ruby could see at once that Charlie was very ill and the muscles of his rib cage were sucking inwards. ‘Let’s get him into the treatment room,’ she said. The toddler was breathing in oxygen through a mask, but she could hear him wheezing, and it was clear he needed urgent help.
Once in the treatment room, she called for a nurse to assist with giving oxygen while she examined the boy. Running the stethoscope over his chest, she heard crackles in his lungs and a wheeze whenever he breathed out.
His mother looked on anxiously the whole time, and after a while Ruby said, ‘He’s feverish and obviously struggling. I believe his air passages could be inflamed, so we’ll try him with a medication to help ease his breathing.’
‘What’s wrong with him?’ his mother asked. ‘He’s had a runny nose for a few days now, but suddenly he seemed to go downhill, breathing fast and getting tired and irritable. He’s been off his food too.’
‘It’s probably a viral infection of some sort,’ Ruby explained. ‘I’ll do a nasal swab and send it to the lab to be sure what we’re dealing with, but in the meantime we’ll concentrate on supporting his breathing. We’ll keep him in our observation ward for the next twenty-four hours, and then we’ll most likely have to move him to the paediatric ward for a few days. The nurse will explain everything to you and make arrangements for you to stay with him if that’s what you want to do.’
‘Yes, I do. Thank you.’ The young woman leaned over and stroked her child’s hand, offering him comfort, but the boy was too ill to respond. He just lay there, unmoving, strands of his hair curling damply over his forehead.
‘Here, take a seat,’ the nurse said, pulling a chair to one side of the bed. Michelle was a capable girl, slender and pretty, with dark hair that fell in a sleek bob to the nape of her neck. ‘I’m sure he knows that you’re here with him, and that will help to ease his distress.’
Ruby knew that she was leaving the mother and child in good hands. She wrote up the boy’s chart, detailing the medication to be given, and then arranged for the nasal swab to be sent to the lab. ‘I’ll look in on Charlie again soon,’ she told the mother, knowing that the nurse would let her know if any problem came up in the meantime.
‘So there you are,’ Sam greeted her as she walked back into the main area of A&E. ‘I’m afraid we have to prepare for another intake of crash victims. There are expected to be around ten of them, according to the paramedics at the scene. The first will be arriving in about fifteen minutes, they say.’ He shook his head. ‘I can’t imagine what’s happening out there on the roads today.’
‘People are travelling to the coast for holidays, or driving back home,’ she guessed. ‘I suppose that means there’s a lot more traffic out there.’
‘Maybe.’ He paused. ‘Before we get ourselves immersed in the chaos of dealing with the intake and I lose sight of you again for the next hour or so, I wanted to ask if you know anything about what the situation is here with the domestic staff. We don’t seem to have a proper clean-up crew—to attend to mishaps and the like in the waiting room. There just seems to be a couple of ward assistants who bring round the coffee, or tend to the book trolley, and descend on the unit if and when they’re called for. I’ve been asking various people, but no one seems to want to give me a proper answer.’
‘Hmm.’ Her brow knotted. ‘I believe you’re talking about Dolly and Mabel. Don’t you go upsetting either of them. They’re our in-house treasures. We rely on them for all sorts of odd jobs, and I don’t think people would take kindly to you striking them off the staff list.’
‘No, probably not.’ He studied her thoughtfully. ‘You’re frowning,’ he said. ‘I have the strong feeling that it’s because of me, or something I’ve said. I’ve been getting a lot of that today. Would you care to enlighten me?’
‘Well, I know the situation here is serious,’ she murmured. ‘Times are hard, and we all have to pull together to get the job done and all that…but I think you really need to try and loosen up a bit.’ She hesitated, not wanting to go too far. He was the one in charge, after all.
‘I do?’
She shrugged her shoulders, giving in to his gentle prompting. What would it matter if she were the one to tell him a few home truths? No one else would consider doing it. ‘Quite definitely. We really shouldn’t lose sight of the human touch, you know. We aren’t in the boardroom now, and even the most difficult of tasks can be made sweeter with a modicum of pleasantry.’
He raised a dark brow. ‘You’re saying you think I’m too abrupt?’
She made a vacillating kind of movement, as though she was weighing things in the balance. ‘I’m afraid you run the risk of alienating the people you depend on,’ she said.
He made a face. ‘I dare say you’re the one to put me right on that score. From what I’ve gathered this morning, I’m sure you’ll be well able to assist me in pulling things into shape. You’re the one topic people are prepared to talk about. I’ve been hearing nothing but glowing accounts of your capabilities in this department.’
‘I’m sorry about that,’ she said with a laugh. ‘You sound as though it’s beginning to grate on your nerves.’
‘Not at all. It’s good to know that we have such a diamond in our midst. I’ll be glad of all the help I can get.’
‘We’ve always been a happy crowd here at Ashvale A&E.’ She didn’t add, before he came along, but he probably caught her meaning.
‘I guess I’ve a lot to learn.’ It didn’t seem to bother him, though. He glanced at the watch on his wrist. ‘Anyway, back to the immediate problem. I’ve asked Michelle to do triage, the senior house officers will take the urgent cases, and you and I will deal with the most seriously