Sam had frozen for a moment, after clipping the chart back onto the end of the bed.
‘I understand,’ she said quietly.
Man...she had way more in common with this patient than an age group or a new job.
‘And I’m so sorry to hear about your brother. That’s really rough.’
She knew exactly how rough. Not that her brother had died in a car crash. No. Alistair had been feeding his adrenaline addiction and climbing a mountain. He’d been twenty-five. Sam had only been sixteen and the loss of her only brother and her best friend had been devastating. Her parents were never going to get over it.
‘It wasn’t his fault. They said it was, because he was driving but I don’t believe it. One of his mates in the car said he collapsed at the wheel but he’d had a head injury and nobody believed him.’
There were tears rolling down Jess’s face. ‘It changed everything, you know? It was when I had my first seizure and knew how terrified my parents were. We all miss him...so much...’
Jess was sobbing now. Sam moved to put her arms around her patient. She needed to comfort her. Emotional distress like this wasn’t going to help. It could even possibly trigger another seizure.
And, even as the thought appeared, she could feel the sudden change within her arms. The instant lack of any muscle tension.
‘Jess? Jess...?’
The lack of any response was no surprise. Swiftly, Sam removed the pillows from behind Jess’s head and tilted her chin to ensure her airway was open before pressing her fingers to her neck to check her pulse. The sudden jerking beneath her hand made it impossible to feel anything. All she could do now was to make sure that she kept Jess safe for the duration of this seizure. And to alert the registrar, Sandra, of this new development.
The movements weren’t violent enough to put Jess in danger of falling off the bed so Sam took a quick step back to flick the curtain open far enough to call whoever was closest and ask them to find Sandra urgently.
There was only one person close enough to call.
And this was not an appropriate moment to avoid eye contact.
Oddly, she didn’t need to utter a word.
And, even more oddly, it felt like she’d known that since the first time she had made eye contact with this extraordinary man. It was exactly why she’d been avoiding this—it felt like he could see anything that she might be trying to hide.
Not that she was trying to hide anything right now. She needed back-up and it took only a split second. With two strides, Blake was behind the curtain with her, his intense gaze on Jess as he took in the uncontrolled movements of her body.
‘This is Jess, twenty-five years old,’ Sam told him rapidly. ‘History of epilepsy. She was brought in by ambulance nearly an hour ago and is waiting for an EEG. She...um...got upset when we were talking. Sudden loss of consciousness and the seizure started maybe fifteen seconds later.’
‘Draw up some midazolam,’ Blake ordered. ‘Five milligrams. We’re going to need it if this lasts more than five minutes. Grab some valproate as well, in case the midaz isn’t enough.’
Sam’s hands were rock steady as she swiftly found the ampoules, double checked the name, dose and expiry date with Blake and drew up the drugs.
He checked his watch. ‘Three minutes,’ he murmured. He was resting his hand on the arm that had the IV line inserted, to protect it from being knocked out of place. ‘What was she upset about?’
‘She was telling me about her brother who died in a car crash when he was a teenager. Her epilepsy got diagnosed not long after that.’
‘Oh?’ Blake slanted a glance towards Sam and, again, there was a moment of communication that went beyond the words being spoken. They both found this snippet of information interesting.
‘Apparently, one of the passengers in the car thought he might have collapsed suddenly at the wheel.’
Blake’s glance sharpened with what looked like curiosity.
‘What are you thinking?’
A lot of people wouldn’t have jumped in with both feet the way Sam did. She was a nurse. It wasn’t her place to suggest that a doctor’s diagnosis might have been wrong. But maybe she recognised the significance of something others might have dismissed and she had the feeling that Blake was on the same wavelength.
‘What if it’s not epilepsy at all?’ Sam suggested quietly. ‘But something like long QT syndrome?’
Surprise replaced curiosity in that dark gaze. ‘What do you know about long QT syndrome?’
‘It’s a delayed repolarisation of the heart that can lead to episodes of torsades de pointes and can cause fainting, seizures and sudden death due to ventricular fibrillation. It can be hereditary and run in families.’
‘She must have had ECGs done.’
‘They did a twelve lead in the ambulance this morning. It was reported as sinus rhythm and NAD.’
No abnormalities detected.
Blake checked his watch again but Sam could see that the drugs weren’t going to be needed. The chaotic movements of Jess’s body were subsiding. She could see their patient’s chest heave as she took a deep breath. Blake quickly turned her into the recovery position, talking quietly as he did so.
‘It’s okay, Jess,’ he said gently. He pulled up the bed cover and tucked it around her shoulders. ‘You’re fine. Everything’s okay. Just rest for a minute.’
Then he straightened. ‘Where’s that ECG?’
Sam took the manila folder from where it was clipped behind the observations chart she had been filling in a short time ago. The sheet of pink graph paper was behind the ambulance officer’s report form. She handed it to Blake and he stared at it for a long minute.
Sam waited, holding her breath, but he didn’t say anything. Instead, he handed the trace to her.
‘What do you think?’
Her mouth went suddenly dry. All aspects of cardiology were fascinating to her but she was no expert and traces were difficult to read. Then she let her breath out slowly. She didn’t need to analyse every lead on this ECG. All she needed to look at was the rhythm strip at the bottom and to remember what the normal interval between the downward Q spike and the end of the T wave was. She started counting the tiny squares, the figure of ten being in her head.
‘Eight, nine...ten...’ She was whispering aloud. ‘Eleven...no, it could be twelve.’ Her gaze flicked up from the paper. Was she making an idiot of herself, here?
‘Hard to tell without a ruler, isn’t it?’ Blake’s gaze was steady. He wasn’t looking surprised any more. And curiosity was long gone. This look had a very different message.
He looked seriously impressed.
‘Definitely long.’ One side of his mouth curled up just a fraction. Okay, maybe there was a bit of surprise mixed into that lingering look. He hadn’t expected this from her, had he?
She had wanted a chance to impress him but it was kind of annoying that he was so impressed that she might have a brain. Blake Cooper might be the hottest thing on two legs she’d ever met but his attitude was less than desirable. It wasn’t the first time that Sam had encountered a reaction that suggested she didn’t look as smart as she was. What usually followed was the impression that the fact that she could think was just an added bonus that wasn’t particularly relevant.