Olivia felt curiously disappointed. So the way he’d looked at her, as if she were the only woman in the world, was all an act. But why should it matter? As she’d told Kelly, she wasn’t looking for a relationship. She had more than enough to be getting on with.
The phone that linked them to the emergency services rang and Olivia’s attention focussed on Kelly.
‘We’ll expect you,’ Kelly said, replacing the phone after listening for a few moments. She stood and immediately was all business. ‘Male. Forty. Suspected stroke. ETA ten minutes. Let’s get to work.’
Although Brad Schwimmer was displaying the signs of someone who had some sort of cerebral event, Olivia wasn’t sure what it was. His speech was unintelligible and he was disoriented, but Olivia didn’t believe he’d had a stroke.
His wife, a distraught woman in her early thirties called Sally, watched anxiously as the nurses cut away her husband’s clothes and attached him to the monitors.
‘I did the school run. I was away longer than usual—for over an hour. I met a friend I hadn’t seen for a while and we chatted. When I got back I thought he’d gone to work, but then I went into the kitchen and he was just lying there.’
‘BP one hundred and two over fifty-six, pulse rapid and weak,’ one of the nurses called out.
‘How was he this morning?’ Olivia asked. ‘Was he complaining of anything? A headache? Feeling dizzy? Sick?’
‘No, he’d just come back from his run before I left. He goes every morning before work—when he’s at home, that is.’
‘Does he travel much?’ ‘He’s a sales executive. He travels out of the country for a few days most weeks. Is he going to be all right? Please! You have to help him!’
‘We’ll do everything we can, I promise. But first we’re going to have to do a few tests to find out what exactly we’re dealing with. Would you like to wait in the family room?’
‘I want to stay with him. Please let me. I promise I won’t get in your way.’
‘Okay, Sally. He’ll probably find it reassuring to have you here. Talk to him. It’s possible that he can still hear what we’re saying even though he’s not responding. When was he last away?’
‘He just came back from Thailand yesterday.’
Thailand. Recent foreign travel added a long list of possible diagnoses they had to rule out. Although rare, Japanese encephalitis was one possibility.
‘Was he vaccinated for encephalitis? And did he take prophylaxis for malaria before he left?’ she asked. Cerebral malaria was something else she should exclude.
‘He always takes the meds he’s supposed to. He knows the risks if he doesn’t. He’s very particular about his health.’
‘Could we get a consult from Infectious Diseases?’ Olivia asked. Something wasn’t adding up. ‘In the meantime, let’s get a CT scan of his head and draw blood for a full infection screen, including malaria. Keep him on twenty-eight per cent oxygen.’
‘Dr Simpson?’ One of the interns popped her head through the door. ‘Dr Scutari is asking for help in room two if you’re free?’
Olivia peeled off her gloves and apron and chucked them in the bin. ‘I’m on my way.’ She turned to the nurses. ‘I’ll be next door. Call me if there is any change, or when the attending from Infectious Diseases gets here.’
This was typical of the ER on a weekday morning. Often it was busy and there was no predicting what they’d get in. It was what she loved about working here. Not everyone enjoyed the high-octane atmosphere, but most of them who worked in the department loved the buzz.
She helped the intern deal with his patient, a straightforward MI, then returned to Resus and was surprised to find Dr Stuart bending over her patient. However, if she was surprised to see him, he looked floored to see her.
‘You’re a doctor! Why didn’t you say?’ he said, glancing up at her.
Because you didn’t give me the chance. Because once you saw I was pregnant, I might as well have been invisible. Of course none of that could be said out loud but it didn’t mean she wasn’t enjoying his discomfort. That would teach him to go around introducing himself as a neurosurgeon to strange women.
‘I’m Dr Olivia Simpson. ER resident.’ She smiled briefly in his direction. In the time she’d been away, dealing with the other patient, Brad had lost some of his pallor. However, there was no improvement in his conscious level. ‘I didn’t ask for a neuro consult.’ She raised her voice. ‘Do we have Brad’s CT scan?’
‘I have it here.’ Candice, one of the ER nurses, flicked on a screen.
‘Besides, aren’t you supposed to be in Theatre—saving lives?’ Olivia couldn’t resist adding, sotto voce, as he stepped alongside her to study the scan.
He didn’t even look mildly embarrassed. ‘I was. Job done. I was at a loose end so I thought I’d come down to the ER to see if you had anything for me. Failing that, I hoped to scrounge a cup of coffee.’
Job done? She couldn’t have been in the department more than twenty minutes before her patient had arrived. Take another twenty-five when she’d been examining Brad and helping Dr Scutari—he was still done pretty quickly. What sort of neurological procedure took so little time? She hoped to hell Dr Stuart knew what he was doing.
‘Now you’re here, what do you think?’ She gestured to the screen.
‘I’m pretty sure he has an infarct of the right cerebellum,’ he said after only a few moments. He pointed to the area of the brain he was talking about. ‘But we need to find out what caused it. I’m guessing a clot. We should let the radiologists do an angiogram. If there is a clot they can be pretty good at aspirating it.’
Dr Stuart turned to Sally, who had been listening to the exchange with frightened, uncomprehending eyes.
‘We think that your husband might have a blood clot blocking an artery inside his brain. That’s what is making him so unresponsive. There is a procedure that can help. The radiologists put a catheter, a fine tube, into the artery in his groin and locate the blockage. If there is a clot present, they’ll try to suck it out.’
‘But …’ Olivia shot Dr Stuart a warning look ‘… you should be aware that the procedure carries some risks.’
‘What kind of risks?’ Sally’s voice rose to a squeak.
‘It’s possible that the procedure could well make whatever is wrong with your husband worse.’
‘On the other hand, if he doesn’t have it, he may not improve from where he is.’ Dr Stuart interrupted.
Typical of a surgeon, Olivia seethed. Any chance to intervene and they always took it over the more conservative approaches. She kept her voice level and matter-of-fact. ‘If Brad has had a stroke then he might well improve over the coming months.’
‘That’s true,’ David said easily. ‘But until we do the angiogram we won’t know for certain. Here’s what I suggest we do. We get him up to the MRI suite, ask the radiologists to take a look, and make a decision from there. How does that sound, Dr Simpson?’
It was, Olivia had to admit, a sensible approach. There was no point at this stage in giving the wife options and possibly scaring her further until they knew what the radiologists had to say.
‘Why don’t you come up and, if my diagnosis proves correct, watch the procedure?’ Dr Stuart said to Olivia. ‘You’ll find it interesting. The radiologists can do some pretty amazing stuff.’
‘Let me check what Kelly has waiting first, but if they can spare