‘He says he’s got a crushing central chest pain radiating to his jaw and left arm. He’s sweating and nauseated and he’s having palpy something or other.’
‘Palpitations.’ Janet chuckled. ‘You’ll have to borrow Mr Collins’s textbook some time. He doesn’t need it any more. I think he’s learned off every symptom by heart.’ Janet pondered the situation briefly. ‘Tell him to have a seat. Maybe I can keep him happy by taking his blood pressure and doing an ECG. He hasn’t picked a very good day to come looking for a bit of attention, has he?’
Sophie hadn’t quite finished with her patient. She still looked wan as she came into the treatment room ten minutes later.
‘I like powwidge,’ Toby informed Sophie. ‘Wiv toenails.’
Sophie gave Janet a despairing glance and rushed out of the room. Janet had to laugh. ‘I don’t believe this. Let me see if Oliver can come and see Toby. Sophie might be held up for a while. She’s in a rather delicate state.’
It was another fifteen minutes before Margaret was able to take Toby home for his lunch. Sandy took the opportunity to escape for her break and Janet tidied up the treatment room, before moving back to the main office to man the telephones. It was only then that she remembered Mr Collins. He was sitting quietly in the corner of the waiting room. Too quietly.
‘Oliver!’ Janet shouted. ‘Sophie! Come quickly!’
Janet Muir’s strength was out of proportion to her slim build. She had no real difficulty transferring Mr Collins to the floor. She had tilted his head back to open his airway and was feeling his neck for the carotid pulse as both doctors rushed in.
‘No pulse, no respirations,’ she reported. Pinching the elderly man’s nose, Janet covered his mouth with her own and inflated his lungs with two deep, full breaths.
Oliver positioned his hands on Mr Collins’s chest to begin cardiac compressions. ‘Grab the life pack,’ he directed Sophie. ‘And a bag mask unit.’
Sophie was back within seconds. She stuck the electrodes in place and Oliver stopped compressions while they looked at the screen.
‘Ventricular fibrillation,’ Oliver muttered. Sophie had the large sticky pads ready as Oliver cut through Mr Collins’s clothing. He positioned the paddles. ‘Everybody clear,’ he instructed.
Janet lifted the mask away from skin contact. Sandy walked in just as Mr Collins’ body jerked in response to the electrical shock.
‘Oh, my God!’ she said in horror.
‘Grab the oxygen cylinder from my room, Sandy,’ Janet called. ‘And then call an ambulance. Mr Collins has had a cardiac arrest.’
Sandy dropped the tins of cat food and the large bag of kitty litter by the front door. She ran to collect the oxygen cylinder.
‘Good girl,’ Janet said calmly. ‘Now call the ambulance.’
Sandy backed away, staring as Oliver raised the paddles again. ‘Charging to 360 joules,’ he stated. ‘Sophie, get an IV line in as soon as you can and draw up one milligram of adrenaline. Janet, find some lignocaine and some more adrenaline.’
Janet opened the drug cupboard in the treatment room hurriedly to locate the requested drugs. She could hear the wail of the ambulance siren in the distance. She could also hear the loud knocking on the front door. Hoping that Sandy would have the initiative not to allow an early afternoon patient to stumble in on the emergency, Janet grabbed some extra IV supplies and headed back.
‘I’m sorry,’ she heard Sandy calling loudly, ‘but we can’t see any patients just yet. We’re in the middle of an—’
Janet saw the door being pushed open firmly. ‘I’m not a patient,’ she heard the visitor assert. ‘I’m the locum. My God, what’s going on in here?’
‘Cardiac arrest,’ Oliver stated tersely. ‘Come and take over the compressions, would you?’
The newcomer moved swiftly. Janet found herself staring at his back as he crouched over Mr Collins. His hands were positioned unerringly, his compressions smoothly confident. ‘How much adrenaline has he had?’
‘Three doses of one milligram so far.’
‘What about a bolus dose of lignocaine?’
Janet handed the ampoule to Oliver and stepped back. Sophie was ventilating Mr Collins, using the bag mask unit, now attached to high-flow oxygen. Janet stood behind the newcomer, listening to his verbal exchanges with Oliver, thankful she wasn’t needed any closer just now. She was aware of her skin prickling all over. Every word uttered by this man sent a new shiver down her spine.
‘How long has CPR been in progress?’
Oliver glanced at the clock. ‘Ten minutes.’ He injected the dose of lignocaine.
‘Was the collapse witnessed?’
‘Not exactly.’ Sophie was squeezing the bag on the mask automatically. ‘Mr Collins was sitting in the waiting room for a while by himself. He was pulseless but not cyanosed when he was found.’ Sophie glanced up at Janet who bit her lip.
She knew how it would sound. Patients dropping dead in a doctor’s waiting room unnoticed wasn’t exactly a great recommendation for a medical centre. It would seem even worse when it was known that Mr Collins had come in describing the classic symptoms of a heart attack. How could she explain that this patient had turned up repeatedly over the years with the classic symptoms of every ailment known to man. That he’d had baseline cardiological investigations only weeks ago which hadn’t revealed any pathology. That their experienced practice manager, who would have instinctively picked up a genuine emergency, was at present on the other side of the world. The bare facts of the emergency would present a picture of a medical centre that wasn’t up to scratch. Janet didn’t want this locum to have that as his first impression of St David’s.
‘Let’s give this another shot.’ Oliver pushed a button on the life pack. ‘Charging to 360 joules again. If this doesn’t do anything, we’ll intubate.’
The ambulance crew arrived as the interference on the monitor screen settled. The spikes of an effective heart rhythm drifted slowly into view. They all watched for several seconds. Janet moved further back as the number of personnel and supplies of equipment increased. Sandy was standing under the archway, sobbing. Janet put her arm around the young girl.
‘I can’t do this job,’ Sandy groaned. ‘If Mr Collins dies it will be all my fault.’
‘Nonsense,’ Janet said firmly. ‘I’m the one who should have checked on him, and I don’t think he’s going to die. His heart’s started again now. As soon as they’re happy it’s going to keep going, the ambulance will get him into the emergency department and the experts will be able to take over.’
Mr Collins was being lifted onto a stretcher. Janet gave Sandy’s arm a comforting squeeze. She smiled gently at the tearstained face in front of her. At thirty, Janet was only twelve years older than Sandy Smith, but right now she felt old enough to be her grandmother. ‘You go and have a cup of tea and talk to Outboard for a wee while. I’ll help them clear up in here.’
Janet opened the front door to allow the stretcher to be carried out. She reached down and picked up the bag of kitty litter which was still lying where Sandy had dropped it. Oliver was standing up now. He had his hand extended towards the newcomer.
‘Not the ideal way to welcome even a temporary colleague,’ he said dryly, ‘but we’re delighted to see you. I’m Oliver Spencer and that’s my wife, Sophie, who’s about to disappear off to hospital with Mr Collins.’
Sophie was walking beside the stretcher. She looked back and gave an apologetic wave, before heading out the door.
‘I’ve arrived at a bad time. Might it be better if I came back later?’
‘No.’