‘I’m the acting consultant while Mr Ramsay is away. I was brought in to take over from him.’
She winced. She might have known. He certainly looked the part. He was wearing another immaculate grey suit, which sat well on his tall, firmly muscled frame, and he appeared to be every inch the consultant, an authoritative, confident man, totally in command. Her spirits sank.
He stared at her. ‘If what you say is correct, I’m afraid it looks very much as though you and I are going to be working together for some time. Perhaps we had both better get used to the idea.’
He wasn’t taking any chances, though. It was only after he had verified that she really was supposed to be there that he reluctantly allowed her to go and start work. As she moved away from him and went in search of her patient, she felt his gaze searing into her back and she had the feeling that he was going to be watching her like a hawk.
She tried to put him out of her mind and hurried to meet the ambulance crew as they wheeled in a little boy on a trolley.
‘This is Dean Matthews,’ the paramedic said, bringing the trolley to a halt in a side bay. ‘He’s four years old, suspected poisoning from beta-blockers—propranolol. Apparently he took some pills out of his grandmother’s bag. We have the bottle, and it’s almost empty.’
Jade was worried. The child looked very ill, and she knew that a propranolol overdose could be fatal. ‘Do we know how many he took?’
The paramedic shook his head. ‘No, but there should have been a fair few in the bottle, and the family think he must have taken them well over an hour ago. His heart rate has fallen dramatically and he’s hypotensive. We’ve been monitoring his cardiac output on the way here.’
‘It doesn’t look good, does it?’ Jade said in an undertone. She signalled for a nurse to come and help. ‘I’m going to get him on activated charcoal right away.’ She worked quickly, hoping that the charcoal would help to remove any of the drug that hadn’t already been absorbed into his bloodstream. The boy was being given oxygen through a mask, and her main concern was that the drug had reduced the activity of his heart to an extent where it could damage his organ systems. Her priority was to restore perfusion to those systems.
‘Thanks,’ she told the young paramedic, who had hung around to await results. She could see that he was worried. ‘We’ll take over from here. Do you want me to let you know how he gets on?’
He nodded. ‘Please. I’ve another call coming in, but I would like to know what happens here.’
‘Of course. I’ll update you when you come in again.’
‘Thank you. I’m Sam, by the way.’
‘OK, Sam.’ She acknowledged him briefly, and with that he went away. With the nurse’s help, Jade wheeled the child into an available treatment room and made sure that he was hooked up to the monitors. Just as they settled him, though, the little boy started to convulse, and a few seconds later he lost consciousness.
‘I’m not getting a pulse,’ Jade said anxiously. ‘He’s gone into cardiac arrest.’ She worked as fast as she was able to put in an endotracheal airway, and then started chest compressions with the palm of her hand, while the nurse took over with the oxygen.
Jade was desperately afraid that her efforts were to no avail, but after a while the nurse glanced at the monitor and said, ‘He’s back with us.’
Jade was relieved, but she was still feeling apprehensive. The child’s cardiac output was thready, and she swiftly established an intravenous line and gave the child atropine.
It didn’t appear to be having much effect. ‘Helen,’ she said, “we’ll start him on the charcoal. You’ll need to watch him in case of vomiting.’
The nurse nodded. ‘What about blood tests?’
‘I want U and E and blood glucose, a complete blood count and a toxicology screen. We’ll monitor him for pulse, blood pressure and perfusion.’
‘OK.’
A woman came into the treatment room and clutched at Jade’s arm. ‘What’s happening to my little boy? Nobody’s telling me anything. He’s just lying there. Can you do something to help him?’
‘We’re doing everything that we can,’ she told the woman, using a soothing tone. ‘He’s absorbed a lot of his grandmother’s medication, and that has had the effect of slowing down his heart and causing a collapse of his vital functions. We’re working to restore his heart and circulation.’
‘But he’ll be all right, won’t he?’
‘I hope so,’ Jade said gently. ‘We’ll need to admit him for observation, so that we can monitor his condition over the next few hours.’
The woman was near to tears. ‘We had no idea that he’d been searching in his grandmother’s bag. It was up on a high cupboard, and we didn’t think he could reach that far. Then we found out that he had pulled up a chair, and climbed on to it. He thought his grandmother had some sweets for him.’
Jade was sympathetic. ‘I know that it can be hard to watch children every minute,’ she said. ‘He’s at an age, though, where he’s likely to be into everything, and you need to make sure that any tablets and medicines are locked away securely.’
‘I will. I won’t ever let this happen again…if only you can save him…’ She sent Jade a pleading look. ‘I want to stay with him.’
Jade nodded. ‘That’s all right. He seems to be stable for the moment, and the nurse will be here to answer any questions that you might have. I have to go and see to my other patients, but I’ll come back and check on him in a few minutes.’
She was glad that the child’s mother was by his side. Seeing them together made her think of her own mother, lying ill in a hospital bed, and a feeling of sadness overwhelmed her. She had been trying so hard to keep going, to do everything that was necessary, but all the time she was struggling with the knowledge that people she loved were fighting major battles of their own. Just as soon as she had the opportunity, she was going to look in on them. She needed to know that her mother and sister-in-law were going to be all right.
‘How is the child?’ Callum was waiting for her as she left the treatment room. He was looking over the boy’s chart, and she wondered if he was checking to see if there was anything that she had omitted to do.
‘It’s too early to say, just yet. His condition has stabilised for the moment, but he isn’t out of danger just yet. Helen is monitoring him.’
‘All right. Perhaps you could go and look at the patient in treatment room four. He appears to have trodden on a nail.’ He handed her the chart, his hand brushing hers, and a shower of invisible electric sparks shot along the length of her arm, confusing her and rooting her to the spot.
He seemed to hesitate momentarily, and she hardly dared look at him in case he had registered her sudden tension. Perhaps he was waiting for an answer, but her voice seemed to be stuck in her throat. Instead, she simply nodded.
He moved away from her, and she hoped that would be the end of it, but for the rest of the morning she had the nagging feeling that he was keeping an eye on her. He never made it too obvious, but she was aware that he was checking up on her, either by glancing through the tests she had ordered or by inspecting her notes and scrutinising the medications she had prescribed.
By the time her lunch-break came along, she was glad to get away. It was one thing to be supervised, but it was quite another to be under constant surveillance as though he expected her to make some dreadful mistake at any minute.
Keyed up, and thoroughly on edge, she went up to the ward where her mother was being cared for. Her mother was lying propped up in bed, looking frail and lost, her fair hair falling in soft tendrils against her cheeks. Jade could see that her left arm was in a sling.
Jade