Her pulse was up, her blood pressure was dropping and she was showing all the signs of haemorrhage. But, unlike his less experienced colleague, he had no intention of sharing his concerns with an already worried patient.
Billy followed his gaze. ‘The gynae team?’ His tone was level but his expression was confused. ‘I thought after an RTA and trauma, she’d need—’
‘And she’s of childbearing age, and before her husband landed the car in the ditch she was suffering from abdominal pain,’ Alessandro reminded him, ‘so that is not to be forgotten. I want two lines in her straight away, wide-bore cannulae.’
Responding immediately to his decisive tone, Nicky, one of the A and E sisters, pushed a trolley across Resus and Billy put a tourniquet on the woman’s arm and ripped open the first cannula. ‘You think she might have a ruptured ectopic?’
‘I don’t know yet, but let’s just say I have a low threshold of suspicion so I’m treating it as that until I have reason to think otherwise.’ Alessandro continued to deliver a steady stream of instructions while the staff around him bobbed and moved in perfect unison. They were so used to working together that they often anticipated each other’s needs. He turned back to his patient. ‘Megan, is there any chance that you could be pregnant?’
‘No—well, I mean…’ The woman closed her eyes briefly. ‘It’s so unlikely it’s virtually impossible.’
‘In this department we deal with the unlikely and the impossible on a fairly regular basis,’ Alessandro replied with a wry smile. ‘When was your last period?’
‘Months ago,’ she whispered. ‘I have endometriosis.’
He heard the catch in her voice and put a hand on her shoulder. ‘That must be hard for you,’ he said gently. ‘But right now we need to find out what injuries you suffered in the accident and try and get to the bottom of your abdominal pain. We need to undress you so that we can do a proper examination, head to toe, and find out exactly what is going on. Nicky?’
Nicky was already removing clothes, fingers and scissors moving swiftly as Alessandro started his examination.
‘Where’s her husband?’ He was checking the body methodically, on the alert for anything life-threatening. ‘Was he injured?’
‘He’s fine,’ Billy muttered as he successfully put the second line in and taped it in place. ‘Waiting in the relatives’ room. Nicky put him there.’
‘She has a nasty laceration of her shoulder.’ Nicky reached for a sterile pad while Alessandro examined it swiftly.
‘That’s going to need stitching but it can wait,’ he murmured, his gaze sliding to the monitor again. ‘Her pressure is still dropping. I want to know why. And I want to know now. Did someone bleep the gynae team?’
‘On their way,’ a staff nurse reported and Alessandro’s eyes narrowed.
He didn’t like the look of his patient.
‘Oh…’ Nicky finished cutting off the woman’s clothes and her face reflected shock before she quickly masked it. ‘We have some blood loss here, Alessandro.’
One glance was all it took for him to measure the degree of the understatement. ‘Fast-bleep Jake Blackwell,’ he ordered in a calm voice. ‘Cross-match six units of blood and get her rhesus status. We may need to give her anti-D. And someone get a blanket on her before she gets hypothermia.’
Jake Blackwell, the consultant obstetrician, strode into the room minutes later. ‘You need my advice, Garcia? Struggling?’ His eyes mocked but Alessandro was too worried about his patient to take the bait.
‘I need you to do some work for a change,’ he drawled, but although his tone was casual and relaxed, his eyes were sharp and alert and his handover to his colleague was so succinct that Billy threw him a look of admiration.
Jake listened, examined the woman swiftly and then nodded, all traces of humour gone. ‘Megan, it looks as though you might have an ectopic pregnancy—that means that the egg has implanted somewhere other than your uterus and, in your case, it seems that it may have done some damage that we need to put right with an operation.’ He lifted his eyes to Alessandro. ‘She’s going to need surgery. We’ll take her straight to Theatre. Damn. I’m supposed to be somewhere else. I need to make a couple of calls—speak to the anaesthetist, juggle my list.’
Alessandro leaned across and increased the flow of both the oxygen and the IV himself. ‘Just so long as you juggle it quickly. We’ll transfer her to Theatre while you do what you need to do. Her husband is in our relatives’ room if you want to tackle the issue of consent.’
‘Great.’ Jake walked to the phone and punched in a number while Alessandro monitored his patient.
‘Phone down and get that blood sent up to Theatre as soon as it’s available,’ he ordered, and Nicky hurried to the nearest phone to do as he’d instructed.
Minutes later the woman was on her way to Theatre and Jake disappeared to talk to her husband.
He reappeared in the department hours later, after Alessandro had dealt with what felt like a million road accidents, intermingled with a significant number of people with flu.
‘Why don’t people stay in bed when they have flu?’ he grumbled as Jake appeared in the doorway of his office. ‘For a start, if they can get out of bed then it isn’t flu and it certainly isn’t an accident or an emergency. Why come to a hospital and spread it around?’
‘Because they’re generous?’ Jake strolled into the office and dropped onto the nearest chair without even bothering to move the pile of files that were covering it. ‘Hell, I’m knackered. I’ve spent the whole day in Theatre saving lives. One drama after another. You don’t know you’re born, working down here.’
Alessandro thought of the two major RTAs, the heart attack and the sickle-cell crisis he’d dealt with since lunchtime. And the only way he’d known it had been lunchtime had been because he’d looked at the clock on the wall. He hadn’t eaten for hours. ‘That’s right. I spend my life sitting on my backside.’
‘Backside?’ Jake grinned. ‘That doesn’t sound like a particularly Spanish word, amigo.’
Feeling tired and bad-tempered, Alessandro scowled at him. ‘Haven’t you got anything better to do with your time than sit in my office, moaning?’
‘Actually, I came down to see if you fancy grabbing a couple of beers after work. I have a feeling that our problems are nothing that alcohol can’t fix.’
Alessandro pulled a face. ‘Not tonight.’
Jake yawned. ‘You working late?’
‘I’m cleaning up the house.’ Alessandro felt the tension rise inside him. ‘Christy and the kids are arriving tomorrow for Christmas. I need to throw out four months’ worth of take-away cartons and fill the fridge with broccoli or she’ll hit the roof. You know Christy and her obsession with nutrition.’
Jake stared, his blue eyes suddenly keen and interested. ‘You guys are back together?’
‘No. We’re not back together.’ Alessandro all but snapped the words out, his anger suddenly so close to the surface that his fingers tightened on the pencil he was holding and broke it in two. ‘We’re spending Christmas in the same house for the sake of the kids.’
‘I see.’ Jake’s eyes rested on the broken pencil, his