Spanish Doctor, Pregnant Nurse Page 12

  ‘Charlotte.’ Harriet’s voice was unusually sharp. ‘In case you haven’t noticed, this is a resuscitation room, not the staff social club or the locker room. And if your friend Becky wants to keep her job I suggest she learns to be more discreet. How dare she disclose something so personal?’

  ‘She only told me—’ Charlotte attempted, but Harriet had heard enough.

  ‘Quite, which is tantamount to walking around the department with a megaphone! Now, instead of worrying about how you’re going deal with Dr Delgato’s sudden departure, I suggest that you expend your mental energy on the rather more relevant task of ensuring the equipment is all in order.’

  ‘I was,’ Charlotte protested, colouring. ‘I can talk and work at the same time.’

  ‘Oh, you can talk,’ Harriet retorted, then checked herself, realising that, however upset she was at Charlotte’s remarks, her anger was misdirected. ‘Just check these ET tubes properly, please. They need to be in order of size. There isn’t time to fumble around trying to find the right sized tube when the anaesthetist is calling for it to intubate someone.’

  Aware of Charlotte’s eyes constantly on her, it came almost as a relief when the department picked up, the occasional dribble of ambulances and walking wounded soon replaced with a constant procession. More than a few found their way into Resus. But, annoying as Charlotte could be, she had all the makings of being a very good emergency nurse. Her sharp eyes picked up even the most subtle of grimaces, her effortless chatter put even the most anxious patients at ease and, most importantly of all, when she wasn’t sure of something she wasn’t too proud to ask for advice. As Resus steadily filled, Harriet was glad to have her on board.

  ‘How’s it going?’ Judith popped her head in, groaning at the sight of full trolleys as Harriet pulled up a vial of Valium. ‘Do you need me to send someone in to help?’

  ‘If you can spare someone.’ Harriet nodded.

  Which meant ‘Yes, please’!

  ‘I’ll see what I can do, but we’ve just had three in from a motor vehicle accident. It wasn’t high impact,’ Judith quickly assured her as Harriet’s eyes widened in concern. ‘We didn’t even get an alert from Ambulance Control. But one of the patients has developed severe abdo pain since she arrived. Ciro’s in with her now. I just thought I should let you know in case you need to make some space.’

  ‘Charlotte’s just about to take that MI to the ward,’ Harriet said, ‘so if you need to, you can bring her over now.’

  ‘Since when did I need an invitation?’ Judith laughed, making to go, but Harriet called her back.

  ‘Can you just check this Valium with me?’ Harriet asked. ‘It will save me calling Charlotte out. The sooner she gets that patient to CCU the better.’

  ‘Sure.’ Pulling on her glasses, Judith checked the vial against the scribble that passed for a prescription on the casualty card. ‘How’s she doing?’

  ‘Not great,’ Harriet answered. ‘She came in convulsing, with a temp of 40.3, and we haven’t got it down yet. Paeds are in with her now so I’m pulling this up just in case she starts having seizures again.’

  ‘I meant Charlotte,’ Judith said, lowering her voice and signalling for Harriet to come closer. ‘I’ve got to do her appraisal this afternoon. She’s applied for one of the permanent RN positions now that her grad year’s nearly up, and I have to admit I’m stumped. I just don’t know what way to go with Charlotte. How have you found her?’

  ‘Good,’ Harriet said tersely, tapping the bubbles out of the syringe as Charlotte wheeled the patient out of the resus doors, chatting away to the concerned wife as if they were old friends yet keeping one beady eye on the cardiac monitor on the patient’s gurney. ‘She’s on the ball, her knowledge is great, and she knows when she’s out of her depth—’

  ‘I know all that,’ Judith answered, irritated. ‘I’m asking for your opinion on Charlotte. How do you think she’d do down here as a permanent member of staff?’

  ‘It’s not my call,’ Harriet answered, but it didn’t appease Judith for a moment.

  ‘If you’re going to be ANUM, this is the type of decision you’ll be making, so stop sitting on the fence and tell me what you think, Harriet.’

  So she did. Pushing personal feelings aside, Harriet pondered the issue for a moment and, though it galled her to admit it, she finally gave a tight shrug. ‘She’ll make a great emergency nurse.’

  Judith gave a low laugh. ‘You mean she’s an utter bitch!’

  ‘Judith?’

  Two syllables, but somehow Ciro managed to make them sound sexy, and even though Harriet had seen him on and off all morning, just the sight of him walking over, tired and a little ragged, scratching his head as he held out a casualty card, had Harriet’s heart tripping over itself. Her cheeks positively flamed, and she wished he didn’t trigger such a violent reaction in her, that she could be one of those women who somehow managed to deliver a cool, vague greeting even if they were dying inside.

  ‘What can I do you for?’ Judith smiled, a stark contrast to the angry woman Harriet had seen on Ciro’s first night on duty, clearly yet another female who had succumbed to his undeniable charms! ‘How’s young Pippa doing?’

  ‘Not so good.’ Ciro shook his head, his expression serious.

  ‘Do you want to bring her over?’ Judith asked, but Ciro declined.

  ‘I want to speak with you both.’ As Harriet opened her mouth to question him he got there first. ‘Simple MVA, she was a rear-seat passenger and initially presented as a possible seat-belt injury. However, she developed abdo pain on arrival. I’ve done a brief examination and she’s pregnant.’

  ‘She’s fifteen years old,’ Judith barked and Ciro raised his hands in an elaborate ‘not my fault’ gesture.

  ‘That’s right, Judith. And not only is Pippa pregnant, she is also insisting that she is a virgin, that there is no way she could possibly be pregnant. She’s absolutely terrified…’

  ‘How far along do you think she is?’ Harriet asked, her own feelings of discomfort around Ciro firmly pushed aside. The patient was the priority now.

  ‘She won’t let me formally examine her, but I briefly felt her stomach and I would put her at thirty, maybe thirty-two weeks. She is contracting…’

  ‘She’ll have to go to the maternity department,’ Judith started, but Ciro put his hand up to halt her.

  ‘This girl may have internal injuries from the accident—there is no way I am going to transfer her. The maternity department can send down a team if she is about to deliver, but until I examine her I won’t know how far along she is. We might even be able to stop the labour. Right now my main concern is convincing this very scared young girl that she really is in labour and about to have a baby.’

  ‘You’d probably do better with her.’ Judith looked over at Harriet. ‘A labour I can deal with blindfolded, but I’m not exactly the world’s most patient person.’

  ‘I’d never have guessed!’ Ciro teased, but he gave Judith a very grateful smile, no doubt pushing his own personal feelings aside in the name of patient care. Harriet was definitely the best person for the job. ‘So, can I take Harriet?’

  ‘For now,’ Judith agreed. ‘Do you want me to call the maternity department, tell them to have a team on standby?’

  ‘Please.’ Ciro nodded. ‘Her mother is in cubicle two with a nasty laceration to her forehead, and the father is out in the waiting room ringing relatives. Keep them out of the way of Pippa for now.’

  ‘I suppose you want me to talk to them?’

  ‘You are so strict.’ Ciro somehow made it sound like a compliment. ‘So very matter-of-fact. I think it would be better if they heard it from you—naturally not until I have properly examined Pippa and hopefully have her consent. But before that, get me the obstetrician on call. If her labour’s not that advanced, hopefully we can stop it.’

  ‘Right.’ Judith pulled out the hands-free phone from her tabard. ‘But if there’s any chance of her delivering soon, I
want her brought straight over here. I’ll set up the paediatric resus cot just in case…’

  A wail from resus two halted the conversation. As Harriet had predicted, the febrile child was having another seizure and Judith took the vial of Valium from Harriet, calling out to Susan to come in to Resus and assist, the already busy department stepping up a notch. ‘Keep me up to date,’ she called, and Harriet nodded, grabbing an emergency delivery pack from the resus shelves and hoping it wouldn’t be needed.

  Pippa was very young, very scared and, as Harriet quickly realised, very much in active labour!

  ‘She’s moved along quickly,’ Ciro said almost as soon as he stepped inside.

  ‘Pippa, my name’s Harriet,’ she introduced herself as she walked in, taking in the dark hair plastered to the girl’s head and the terrified eyes in her chubby face as Pippa attempted to climb down from the trolley. ‘Dr Delgato said that—’

  Harriet didn’t even get to finish the sentence as a guttural groan escaped the young girl’s lips as she stilled for a moment, her hands fiercely clutching the side of the trolley. Harriet put her arm around the tense shoulders. Glancing down at her watch, she placed her other hand on Pippa’s stomach, timing the length and strength of the contraction as she watched the young girl’s toes literally curling in pain. Harriet knew that the gentle speech she had mentally rehearsed on her brisk walk over to the cubicle was already past its use-by date, that the restlessness and agitation wasn’t just down to denial and fear, but because Pippa was in transition, the first stage of labour over, her body ready to push.

  ‘Pippa.’ Harriet’s voice was gentle but firm as the contraction ended, and she deliberately stared into the young girl’s eyes as she spoke. ‘You’re having contractions—’

  ‘No!’

  ‘Yes!’ Harriet said immediately. ‘Yes,’ she said again, only more slowly this time, nodding her head as she did so. Thankfully this time Pippa didn’t argue. ‘Dr Delgato has to examine you now. We need to see how far along you are and how the baby’s doing.’

  ‘I can’t be having a baby,’ Pippa wailed, starting to panic all over again. ‘I’ve never even—’

  ‘Yes, Pippa, you have,’ Harriet said firmly, absolutely refusing to be drawn into a pointless argument when there simply wasn’t time. Ciro had placed a Doppler on Pippa’s stomach, a tiny microphone that amplified the baby’s heartbeat, and Harriet could hear it fast and regular, which was a reassuring sign. ‘Do you remember when your last period was? We need to know so we can try to work out how far along your pregnancy is.’

  ‘We were just messing,’ Pippa sobbed. ‘It was only the once.’

  ‘When? Pippa, I’m just going to examine you. I will be as gentle as I can.’ Ciro was peeling back the blanket as Harriet took over holding the Doppler. Time really was of the essence. ‘When did you have intercourse? Do you remember the date?’

  ‘No!’ A scream escaped her lips as Ciro attempted to examine her, sheer fear taking over.

  ‘Pippa.’ Ciro took a moment, which perhaps they didn’t have, but reassuring this terrified young woman was the absolute priority. Without her trust, without her on side, the entire process would be made all the more traumatic, not just for Pippa but possibly for her baby.

  ‘Pippa.’ Walking to the top end of the bed, he lifted her chin, forcing the young girl to look at him. ‘I am a doctor. My only concern is your health and that of your baby…’ He let the word sink in, then elaborated further. ‘You are having a baby, and, from what I can see, the baby is very small. Now, I need to examine you to see how far along your labour is.’ She didn’t answer but at least now Pippa wasn’t refusing. She appeared to actually be listening. ‘I know this is very scary for you, that you are worried about so many things…’

  ‘My parents…’

  ‘Your parents are being looked after, they are not going to come in just yet. If it makes things easier, we will speak to your parents for you.’

  ‘No!’

  ‘They have to know, Pippa.’ Ciro’s voice was very firm. ‘This is not going to go away by just pretending it isn’t happening. It is happening and we have to deal with it. For now I am asking you to trust me, to try and not worry about your parents or anything that is scaring you. Right now you need only to concentrate on what Harriet or I are saying. Everything else we can deal with later.’

  There was something immeasurably reassuring about Ciro, Harriet realised as he spoke to Pippa. For all the jokes among the nursing staff that finally there was a man who knew what women wanted, they were actually speaking the truth. Ciro had an elusive skill he had somehow perfected, reaching out to his patient and somehow establishing trust, somehow managing to throw out the superfluous and get straight to what mattered. Harriet remembered how scared and alone she had felt the night she had been brought into Emergency. Remembered, perhaps for the first time, just how utterly wretched she had felt that night. Yet somehow Ciro had reached her, somehow in the most trying of circumstances he had offered her a mental hand to hold and she had grasped it. And Pippa was doing the same.

  ‘Easter! It was the Easter holiday…’ she attempted as Ciro examined her, but there was no other information forthcoming as another contraction hit.

  ‘She’s fully dilated.’

  Pippa was groaning loudly now, and Harriet rummaged in her pocket and handed him a daisy wheel—a small cardboard chart that enabled a swift calculation of dates. The Doppler was still picking up the baby’s heartbeat but the dip in the heart rate during the contraction and the relatively long delay in it picking up afterwards was extremely concerning—an ominous sign that the baby was in distress and needed to be delivered soon.

  Ciro’s voice was calm but his eyes were worried as they met Harriet’s.

  ‘Thirty-one—maybe thirty-two weeks.’ Ciro fiddled with the cardboard.

  ‘Let’s get her over,’ Harriet started, but that tiny window of opportunity closed. Pippa was bearing down now and Ciro was peeling back the blanket and simultaneously reaching for the glove box.

  ‘Let’s not,’ he said dryly, as Harriet hit the red button and swiftly opened the delivery pack, pulling on her own gloves as Judith’s concerned face appeared in the cubicle.

  ‘Can we have the cot in here, please?’ Harriet gave Judith a wide-eyed look. ‘Tell the maternity department it’s a thirty-one-weeker and to send the team down now!’

  ‘Done!’ Judith said efficiently, and Harriet knew, without Judith having to elaborate, that not only would the maternity department be informed but the anaesthetist and paediatricians, too. Controlled chaos would be breaking out on the other side of the curtains as the emergency department rapidly prepared for their surprise patient—coming, ready or not!

  Small babies often came fast, but to prevent any head trauma the birth needed to be controlled and required the mother’s co-operation. Pippa had clearly had no antenatal care and the baby was premature, which was far from ideal. But far from ideal was the norm in Emergency—the staff ready and able to deal with whatever was thrown at them, to hopefully make the best out of the worst of circumstances.

  ‘Meconium-stained liquor,’ Ciro called as Charlotte came in.

  Thankfully, without having to be asked to, she set about doing an essential but not particularly exciting job—pulling chairs and trolleys out of the rather small cubicle to make room for the resus equipment and the staff that would soon be arriving.

  ‘Pippa.’ Pulling on a gown, Ciro spoke to his patient as the cot was wheeled in and staff started to arrive. ‘There are going to be a lot of people rushing in, a lot of activity, but I want you to listen only to Harriet and me. Just concentrate on what we are telling you to do.’

  ‘I want to push!’ Pippa begged, as Judith whispered something to Ciro.

  ‘Gently, then,’ Ciro said as Harriet pulled up her knees. ‘You hold on behind your knees and give a push, right down into your bottom.’

  His expression was one of pure concentration, and he was seemin
gly oblivious to all the activity taking place in the tiny cubicle around him. The anaesthetist was setting up the resus trolley, unwrapping equipment and connecting a tiny ambu-bag to oxygen. Judith was turning up the heater and pulling up drugs. Ciro’s mouth was set in a grim line as he guided the tiny head and Harriet watched closely, watched every flicker of Ciro’s reaction, so she could relay what was required back to Pippa.

  ‘Enough,’ Ciro said, a frown on his face; the baby’s head almost out of the birth canal.

  ‘OK, stop pushing, Pippa,’ Harriet said, firmly keeping a lid on her own flutter of fear, something in Ciro’s expression telling her that things weren’t right. ‘Just pant.’

  ‘The cord’s wrapped tightly around the neck.’ His eyes locked with Harriet’s for a brief second, conveying the urgency of the situation, and she gave an understanding nod as Pippa bore down again.

  ‘Don’t push,’ Harriet said firmly, because every push was causing the cord to tighten and Ciro needed time to clamp and cut it.

  ‘I have to.’

  ‘You mustn’t.’ Out of the corner of her eye Harriet could see Judith passing Ciro the clamps, but she looked away. Everything possible was being done and she had to focus solely on Pippa, stop her from pushing to give Ciro the time to clamp and cut the cord. She chose her words carefully, aware that Pippa had had no antenatal education and might not understand about the umbilical cord. ‘Your baby’s in trouble. We need you to stop pushing. Breathe over it, Pippa.’ Harriet’s voice was urgent. ‘I know it’s hard, but you have to pant—you mustn’t push.’

  ‘Got it.’ Ciro was clearing the baby’s mouth and nose with a suction bulb now, removing as much as he could of the thick meconium before the baby took its first breath. ‘OK, Pippa,’ he called. ‘With the next contraction you can push! Give me your hand.’