* * *
By eleven p.m. the place was full, fit to burst. Not only were there a lot of sick people waiting to be seen and dealt with, but also the pubs were turning out and with them the inevitable fights and arguments that invariably found their way to the emergency department. The staff were all more than used to the organised chaos, and dealt good-humouredly with the constant stream, keeping a careful eye out for any likely sources of trouble.
‘I think I’ve died and gone to heaven,’ a young man slurred as the paramedics lifted him over onto a trolley. ‘I didn’t know nurses were so good-looking.’
Lila rolled her eyes as she pulled on her gloves.
‘Fight outside Kerry’s pub,’ the paramedic reeled off. ‘Terry Linton, eighteen years old, multiple lacerations courtesy of a knife; they all appear superficial and his obs have been stable throughout.’
‘Thanks, guys. Any more to bring in?’
‘But of course.’ He gave her a rueful grin, depositing soiled blankets in the linen skip. ‘No doubt we’ll catch you later.’
‘No doubt about it.’
Undressing Terry, Lila ignored his extremely unsubtle advances, concentrating instead on checking each wound carefully. The paramedics were right; they did look superficial—except for one across his left loin. Though small, Lila couldn’t assess the depth of the wound, and from the paramedic’s description of the knife there was every chance it might have gone deep enough to cause some internal trauma.
‘You ever been to Kerry’s? You should try it. They have a happy hour every night from five till six, drinks half-price—even those fancy cocktails girls like. I could take you when you get a night off. We’d have a real laugh.’
As Lila placed a wad of Melolin and combine over the leaking wound the tell-tale signs of flashing stars appeared before her eyes.
Why did blood have this effect on her? It was ridiculous that after all these years—after all the study she had done, the sights she had seen—for no reason, completely out of the blue, a small wound such as this could turn her stomach.
‘A real laugh,’ Lila said dryly, shifting her mind to Terry’s attempts at a chat-up. ‘I think I might give it a miss, thanks.’ Strapping the combine into place, she popped Terry into a gown and quickly recorded a set of obs.
‘Need a hand?’ Sue’s smiling face appeared at the curtain.
‘Please. I might move this one over to Resus. Can you give me a hand with the trolley?’
That stopped him in his tracks! ‘What are you moving me there for? I’m not dying, am I?’
‘No, Terry, I just want to keep a closer eye on you until you’ve been seen by the doctor.’
‘But Resus is where they put the real crook ones. I’ve seen it on the telly. You’ll be putting those electric shock things on me next.’
Lila grinned. ‘You watch too much television, Terry. Look,’ she said, slipping an oxygen mask over the young man’s face, ‘you’ve got some nasty wounds there. The trouble with knife wounds is that we don’t always know how deep they are until they’ve been explored. I’m just playing it safe by putting you in there for now.’
‘So I’m not dying?’
‘I certainly hope not—it makes far too much paperwork!’ Her humour relaxed Terry, and when she saw him smiling again Lila continued. ‘Still, you’re not going to be going home tonight. Is there anyone I can ring for you?’
‘No way. If my mum finds out she’ll kill me. If you think these wounds are bad just wait till she’s finished with me.’
Lila glanced at the casualty card, checking his age with the one the paramedics had given. Terry was eighteen, the decision was his, and, as was common in his age group, Terry had declined to give his telephone number.
‘Won’t they be expecting you home?’
‘No.’ He screwed up his nose. ‘They’ll think I’m staying at me mate’s. I mean it. I don’t want them told.’
‘Up to you,’ Lila said. ‘But, Terry, if you do become ill—and I’m not saying it’s going to happen; I ask this of everyone—can I contact them then?’
Terry looked at her suspiciously.
‘I promise I’ll only ring them in an emergency.’
‘Promise?’
Lila nodded.
‘Fair enough.’ After relaying the number, Terry sat forward. ‘Can you pass me jeans up so I can get some money out? I’ll get me mate to fetch me a drink from the machine.’
‘Didn’t those medical dramas on the television teach you anything?’ Lila said good-naturedly. ‘Nothing to eat or drink till the doctor’s seen you.’
Declan was tied up, so it was left to the intern, Diana Pool, to assess Terry.
‘They all seem pretty superficial, though I see what you mean about the one to his loin. I’d better refer him to the surgeons. I know Mr Hinkley doesn’t like knife wounds to be sutured down in the department.’
‘Good call,’ Lila agreed. Mr Hinkley was senior consultant of the emergency department and, though not the most exciting of personalities, he was a diligent and respected boss.
The trouble was that Jez, the surgical resident, though thorough in his examination, was less than impressed with the referral.
‘They’re fairly minor injuries. I’m happy for him to be stitched up and discharged.’
‘Fair enough. If you’re happy then so am I.’ Diana accepted back the casualty card Jez had hastily scribbled on.
‘Sorry, guys.’ Lila, anticipating trouble, had been discreetly hovering. ‘He’s a surgical patient now—it’s not up to Diana to stitch him.’
Jez pursed his lips. He was young and good-looking, and also far too used to getting his own way—only not when Lila was on duty. ‘Fine,’ he snapped. ‘If that’s the way you want to play it then I’ll do it myself, but can I at least have a nurse to help in Theatre?’
Lila’s voice remained calm, friendly even, but there was no mistaking the seriousness of her tone. ‘I’m afraid not, Jez. You know as well as I do that surgical patients can’t be stitched down in Emergency. Our theatre’s only designed for superficial wounds.’
‘Which these are.’
‘Not according to Mr Hinkley: ‘‘A stab wound can only be considered superficial when the wound has been thoroughly explored.’’ He’ll either have to go to the main theatre or be stitched up on the ward, if your boss agrees. It’s the department’s policy.’
‘Since when were you such a stickler for policy?’ Declan’s friendly tones as he made his way over broke the rather tense atmosphere that had developed.
‘When the policy concerned is in the best interests of a patient then I’m a stickler.’ Lila turned defiantly from Jez to Declan. ‘I have a young man with multiple lacerations. One in particular looks deep—’
‘It isn’t,’ Jez broke in. ‘Look, I’m happy for him to be stitched up, I’ve even offered to do it myself, but Sister here insists he goes up to Theatre or at least a ward. Considering that the rest of the surgical team are stuck in Theatre, it could be hours until he’s seen.’ He threw a withering look at Lila. ‘And we all know the department’s policy about patient waiting times.’
Declan grinned as Lila gritted her teeth. ‘So it’s stalemate?’
‘It would seem so.’ Lila found she was holding her breath.