Surgeon On Call

‘I’d better go,’ she announced. ‘Unless I can help in some other way?’

‘No, of course not.’ Joe looked vaguely surprised at the offer. ‘We’ve got plenty of extra hands here. Thanks for your help.’

‘My pleasure.’ Felicity threw a glance over her shoulder as she walked back towards her car. The blades of the scoop stretcher had been eased, one side at a time, beneath Jeff. The halves had been clicked into place and Jeff was now being strapped into position. The scene had been well managed and any injury Jeff had sustained had been in no way exacerbated. No doubt she would see the young fall victim later on in the emergency department. He would probably still be accompanied by the neurosurgeon, who seemed determined to take complete control of his management.

Felicity shook her head as she joined the line of traffic again. Maybe she should have asserted herself and let him know that she wasn’t simply a useful pair of extra hands. It had been a little immature to take offence at the suggestion that she didn’t know what she was doing. It wasn’t as if he could have had any idea she was remotely qualified to act as a colleague, but his attitude had rankled. She had worked long and hard to get where she was now. His dismissal of her, based presumably on what she looked like, had got right up her nose. She was regretting the decision to stay anonymous now, however. It would have been more interesting to have had a professional discussion. She’d like to know where in the States they were doing methyl prednisolone protocols in the field and whether it had been going on long enough to have results on any improvement in long-term outcome. The lights changed and Felicity moved off with a sigh. It was too late now. Best she forget about the whole encounter.

The intention to forget wasn’t easily acted upon. The encounter had left an impression that lasted well past the meeting with the cardiology department. It was still ready to jump into prominence later that morning when Felicity noticed Stanley and Ray handing over another patient to the sorting nurse. She waited until they had transferred their patient to a bed.

‘You guys did a good job with that spinal patient this morning.’

‘Thanks,’ Stanley responded warmly. ‘It was a surprise to see you there, Fliss.’

‘I was just passing. I became rapidly redundant.’ Felicity’s smile gave no hint of her persistent dissatisfaction with the incident. ‘How did the transport go? Did Mr Petersen go with you?’

‘No, thank goodness.’ Stanley grinned. ‘He probably would have complained about every bump on the road. He was a bit over the top, wasn’t he?’

‘He knew what he was doing. I think he was just determined to manage things as well as possible.’ Felicity was surprised to find herself defending Joe, but it would have been unprofessional to complain about another doctor to Stanley despite their long association and Felicity’s appreciation of the paramedic’s level of skill. ‘Jeff was lucky to have someone that experienced on the scene. I imagine that Mr Petersen is only visiting. It sounded as though he’s come from the States.’

‘He’s been in the States but he’s just moved back to New Zealand.’ Stanley fished in his pocket and extracted a slip of paper. ‘He gave me his phone number. He said he’d like to hear some follow-up if I had the chance.’

‘Oh.’ Felicity dismissed the errant thought that she could do the follow-up and contact Joe herself. Why on earth would she want to do that?

‘He’s looking for a job,’ Stanley told her. ‘We had a quick chat while he was giving me his number. Apparently he’s just finished some postgraduate specialist training and he’s come back here for family reasons. He’s hoping to get a position here or at the spinal unit.’

‘Unusual to move countries without a position to go to,’ Felicity observed. ‘Rather a big risk, especially for a consultant. Did he say what the family reasons were?’

‘No. But they must have been compelling. He was dead keen to get away as soon as we’d loaded Jeff. Said he didn’t want to let his daughter down.’ Stanley’s pager sounded at the same instant that Felicity’s beeper went off. They both grinned.

‘No rest for the wicked. See you later, Fliss.’

‘No doubt. Bye, Stan.’ Felicity moved towards the telephone on the sorting desk. This morning’s incident had simply been an interesting and somewhat different start to the day. Now it was time to get on with the many and varied challenges the emergency department could throw at her. She was bound to see Stan again in the near future. She was not likely, however, to see Joe Petersen again, and that was fine. It might have been satisfying to tell him who she was, but if she’d wanted to see him again she could have offered to take that phone number from Stan and use the excuse of a patient follow-up as a reason for contact. The choice had been there and it hadn’t been difficult to make. She had no desire to renew her acquaintance with Joe Petersen. The incident and the man were history.

In fact, she would probably have trouble recognising him if she did see him again.

CHAPTER TWO

THE recognition was instantaneous.

Felicity spotted Joe in the emergency department from as far away as it was possible to get. She was entering the double doors that led from the end of the corridor dividing the department into the main area of Queen Mary Hospital. Joe was standing beside the bed in cubicle 3. On top of the bed sat a small girl with curly red hair. Even from that distance Felicity could recognise a struggle to keep on top of the fear, confusion and probably pain the child was experiencing.

The characteristic decisiveness in Felicity’s forward movement took her swiftly towards the sorting desk.

‘Who’s in cubicle 3, Mike?’

The nurse manager had been talking to senior consultant Gareth Harvey as he was entering information into a computer program. ‘Samantha Petersen. Four years old. Query greenstick fracture of the left radius.’

Felicity nodded. Joe Petersen’s daughter, then. Part of the family whose circumstances had somehow brought Joe to Christchurch. ‘Did she come in by ambulance?’

‘No. Her father brought her in a couple of minutes ago. He’s some sort of medic, apparently.’ Mike raised an eyebrow as he glanced up from the computer screen, clearly puzzled by the interest shown by a consultant in such a minor case.

‘Do you know him?’ Gareth also looked curious.

‘We’ve met.’ Felicity’s gaze flicked to the whiteboard. The spaces beside cubicle 3 had yet to be filled in.

Mike had followed her line of query. ‘I’m giving her to Mary. Colin White can see her later.’

Felicity’s gaze shifted again. The nurse, Mary, was pushing an IV trolley out of cubicle 6 so she hadn’t caught up on her new case assignment. She knew that Colin, one of the registrars, was still busy in the observation ward she had just come from herself. Nobody had attended to the Petersens yet.

‘I’ll deal with it, Mike. I’ve got a clear space unless there’s something urgent on the way.’

‘Nothing major. Possible infarct coming from out of town but they’re twenty minutes or so away yet.’

‘OK.’ Felicity’s nod was brisk. ‘This shouldn’t take long.’ She was already moving towards cubicle 3. It might not take very long but, boy, was she going to enjoy it! She pulled the curtain closed around the cubicle to create a more private examination area.

‘Hi, there, sweetheart.’ Felicity smiled at the child whose right arm was clutching a soft toy that looked like some kind of floppy dog. ‘What’s your name?’

Small lips pressed together tightly but the movement was not enough to stop a noticeable chin wobble. Large, frightened brown eyes were fixed on Felicity.

‘Tell the nurse your name, Samantha.’ The order was given in a kindly voice but the only effect was to make the child’s eyes swim with tears.

Felicity flicked Joe a brief glance. Nurse indeed. This was going to be even better than she had anticipated. She smiled at Joe’s daughter again.

‘My name’s Fliss,’ she told the child. ‘Do you go to school, Samantha?’

‘She’s not old enough for school. She goes to kindergarten.’ Joe’s tone was wary. Felicity knew he had recognised her now. His brain was ticking over, probably remembering their encounter with the spinal injury patient. Maybe he was wondering if he might have insulted her by not knowing she was a nurse. Nurse, ha! Felicity bit back a tiny smile. Joe would keep for the moment.

‘Do they call you Samantha at kindy, sweetheart?’

This time Felicity was rewarded with an almost imperceptible head shake.

‘What do they call you? Sam? Sammie?’

The slight movement changed to an affirmative direction. Felicity mirrored the nod as she perched casually on the bed beside the small girl.

‘Which do you like better? Sam or Sammie?’

‘Sam.’ The response was a whisper.

Felicity lowered her own voice to a similarly conspiratorial level. ‘Can I call you Sam?’

‘OK.’

‘Cool.’ Felicity winked at Samantha. ‘I’ll call you Sam and you can call me Fliss. Is that a deal?’

The smile was worth winning. It brightened up a pale little face which was dusted with freckles that matched the luxurious reddish blonde curls. Felicity’s visual impression had included more than the skin colour of her patient, however. She had, by now, assessed the level of the child’s responsiveness and distress, noted her respiration rate and seen the slight but obvious deformity of the left forearm that lay limply on the child’s lap. The right arm still clutched the tattered toy dog.

‘How did you hurt your arm, Sam?’

‘I...I fell out of the swing.’ The child’s glance towards her father made Felicity blink. Was Samantha afraid of giving the wrong answer? Was she afraid of her father? The continuation of the hesitant response raised Felicity’s suspicions another notch.

‘I...I didn’t hang on tight enough.’ A huge tear escaped and rolled down a freckled cheek.

‘It was an accident.’ Was Joe Petersen annoyed with the child or the inconvenience of a trip to the emergency department? Whatever the reason, the tone was inappropriate and not the normal interaction between a parent and child in such a situation. Felicity had already noted the lack of physical contact between the pair. What was going on here?

‘It doesn’t matter how it happened,’ she told Samantha gently. ‘What matters is that we fix up your arm. Does it hurt at the moment?’

Samantha nodded.

‘Did you hit your head when you fell out of the swing?’

‘She wasn’t KO’d,’ Joe said.

Felicity ignored him. ‘Does anything else hurt you, Sam?’

‘No.’ Again Joe answered on behalf of his daughter.

Felicity drew in a deep breath. She spoke calmly. ‘I think Samantha might be better qualified to answer that question than you, Mr Petersen.’

The muscular twitch in the man’s face gave away the incredulity his tone managed to conceal. ‘I believe my daughter has a greenstick fracture of the left radius. Perhaps you could do whatever baseline measurements your protocols dictate and then find a doctor who can authorise the necessary pain relief and treatment this injury requires.’

Felicity met the stare with equal directness. ‘I am a doctor, as a matter of fact. I’m one of the consultants in this emergency department.’ She allowed only a moment to let the implications sink in before adding a punchline she couldn’t quite resist. ‘And don’t worry, Mr Petersen. I may not be a neurosurgeon but I do know what I’m doing.’

She turned back to Samantha, satisfied that the stunned and distinctly discomfited expression on Joe’s face would take some time to dissipate.

‘I know your arm is sore, sweetheart, but I want you to try and wiggle your fingers for me. Can you do that?’

The movement produced was tentative but reassuring. ‘Good girl, Sam. That’s fantastic. Now, I’m going to hold your hand—just gently. Can you feel me touching your fingers?’ Felicity noted the temperature and colour of Samantha’s hand as she responded affirmatively. ‘OK, see if you can squeeze my fingers.’

Felicity compared the responses with Samantha’s uninjured limb. She could still feel Joe’s stare. She checked the radial pulses on both wrists before glancing up. ‘No neurological or circulatory deficit. That’s good.’

‘Why didn’t you tell me before?’

‘I hadn’t done the necessary examination.’ Felicity gave in to the temptation to be deliberately obtuse.

‘I meant, why didn’t you tell me that you were a doctor?’

‘I’ve only been in here a few minutes.’

‘I’m not talking about now. I’m talking about last week.’ Joe Petersen’s tone suggested he was unamused by this verbal sparring.

Felicity shrugged as though it was a matter of little importance. ‘I don’t remember having the opportunity,’ she said thoughtfully. ‘You had the situation well controlled—and, anyway,’ she added mischievously, ‘stabilising the head and neck of a spinal injury patient is a pretty useful thing to do.’ She turned back to Samantha.

‘We’re going to get a special picture taken of your arm,’ she told the child. ‘An X-ray. It looks at the inside of your arm. Do you know what there is inside there?’

Samantha shook her head. The fearful look returned to the large, brown eyes.

‘It’s nothing to worry about,’ Felicity reassured her. ‘An X-ray doesn’t hurt. It’s just a special camera that can see what we can’t see. Bones. They’re the hard bits inside your arms and legs.’ She was debating whether the trauma of inserting an IV line to give some narcotic pain relief was justified, given how easily Samantha could be distracted from her injury. She still looked ready to cry again so Felicity decided to test the distraction level once more.

‘Does your dog have a name?’

‘Snowy.’ The firm response came from Joe.

Felicity saw the expression on Samantha’s face and sighed inwardly. The little girl might be distracted from the pain but upsetting her wasn’t going to help. Maybe she needed to push a little harder and find out what was going on in this relationship. The vibes she was getting were making her distinctly uneasy now.

‘He looks pretty special,’ she told Samantha quietly. ‘Is his name really Snowy?’

Samantha shook her head slowly and dislodged another tear. Then another. ‘His name’s not Snowy,’ she sobbed. ‘His name is Woof Woof Snowball.’

Felicity bit her lip. Her peripheral vision caught the wince on Joe’s face and it was extremely hard not to laugh aloud. The neurosurgeon was acutely embarrassed by the childish name for the toy.

‘‘‘Woof Woof Snowball’’,’ Felicity repeated with some relish. ‘That’s a great name.’ She peered more closely at the toy. ‘He’s a rather grubby snowball right now, though. Did he fall out of the swing, too?’

Samantha nodded.

‘Did he hurt himself, do you think?’

The head shook this time. The tears were gone again and Samantha tried to smile. ‘I think he just got dirty.’

‘Maybe he needs a bath.’

‘I’m not allowed to have squashy toys in the bath. Mum says they take too long to dry.’

‘Ah.’ Felicity digested the information offhandedly as she began to record her medical observations on Samantha’s chart. So there was a mother. Joe’s wife, presumably. Maybe there were brothers and sisters as well. A whole family, in fact, including some cute, fluffy dog. ‘Have you got a real dog at home, too, Sam?’

‘No. Mum doesn’t like dogs.’

‘Oh.’ Felicity continued her rapid note-taking. ‘Does Daddy like dogs?’

‘I don’t know.’

Felicity’s glance was too automatic and too quick to hide her astonishment. How could Samantha not know whether her father liked dogs? Joe was frowning.

‘Of course I like dogs, Sam.’

Felicity tried to dismiss the notions that flitted through her head as she charted some oral analgesics for Samantha and filled in a requisition form for an X-ray. She needed a bit of time to think about this one. Standing up, she smiled brightly at Samantha.

‘I like dogs, too,’ she told her. ‘In fact, I’ve got a real dog. He’s an Irish setter called Rusty.’ Her smile widened. ‘Maybe I should have called him ‘‘Woof Woof Rusty’’.’

Samantha giggled. It was a delightful chortle that prompted Felicity to reach out and gently ruffle the child’s curls. ‘Rusty is a lovely dark auburn colour,’ she continued. ‘But he has long hair on his tail which is much lighter. On the ends it’s exactly the same colour as your hair.’

Samantha looked delighted with the information. ‘Sometimes Daddy calls me Nas—Nas...’ She struggled with the word. ‘Nastagmus,’ she managed triumphantly. ‘He says that’s what my hair reminds him of.’

‘Really?’ A nystagmus was a word used to refer to an abnormal and rapid type of involuntary eye movement. She caught Joe’s gaze and a lopsided smile appeared on his face.

‘She means ‘‘nasturtium’’.’

‘Oh!’ Felicity grinned. She loved the amusing verbal errors children often made, though she was usually careful not to show her amusement in front of them. It was difficult to hide her delight at present, however, and Felicity knew quite well that Samantha’s mistake had only provided part of the pleasure she was experiencing.

That lopsided twist of his lips was the first time she had seen anything like a smile on Joe’s face, and its effect was dramatic. His features softened and crinkles appeared around his eyes. The dark brown eyes were exactly the same colour as Samantha’s. In fact, Samantha looked very much like her father, and while their relationship was oddly formal for a parent and child there was really no doubt about their genetic bond.

Maybe there wasn’t anything too odd about their interaction either. Samantha’s face lit up at the sight of her father’s smile and the look that passed between the pair suggested a genuine closeness. Warmth, even. Felicity had the fleeting and rather disturbing thought that she would like just such a look directed at her from this man.

She excused herself hurriedly. She had no time to ponder the intricacies of this particular family’s relationships with each other and she certainly didn’t want to be distracted by any peculiar reactions to Joe. There were other patients waiting to be seen.

The potential heart-attack patient from out of town had arrived in the department. Felicity accompanied the man during his rapid transfer to a resus area. Geoffrey Pinnington was a forty-year-old farmer from a rural area well north of the city.

‘I’d been feeling a few niggles all morning,’ he told Felicity in response to her first query. ‘I thought I must have pulled a muscle, heaving hay bales around. I’d just finished my lunch when I started feeling really terrible. I went all sweaty and lost my lunch and this awful pain started up.’

‘Where was the pain?’

‘Right here.’ Geoffrey slapped a hand on the centre of his chest. The nurse attending to the 12-lead ECG hastily reattached a dislodged electrode.

‘Try and keep still for a moment, please, Mr Pinnington,’ the nurse requested.

‘Was the pain just in the one spot?’ Felicity asked.

‘No. It went into my neck and then all the way down my left arm.’

‘Given a scale of zero to ten, with zero being no pain and ten being the worst you could imagine, what score would you have given it?’

‘Twelve.’ Geoffrey smiled wryly. ‘I’ve never felt so bad in my life. I really thought I was about to die.’

Felicity nodded sympathetically. A feeling of impending doom was a common symptom of a heart attack. ‘What time did the pain come on?’

‘One o’clock or thereabouts. Maybe a quarter past.’

‘OK.’ Felicity glanced at her watch. Nearly three hours ago. They were still well within the therapeutic window for an angioplasty procedure which could abort the damage being caused by the lack of coronary blood flow.

‘Give Cardiology a call,’ she directed the registrar beside her. Felicity picked up the ECG trace and scanned it rapidly. The changes were abnormal and clear-cut. ‘Tell them we have a probable anterior infarct in progress here.’ She turned to the junior doctor who was drawing blood from the IV line already in Geoffrey’s arm. ‘We need cardiac enzymes, CBC, electrolytes and lipids done, Sarah.’ Her attention returned to her patient. ‘How’s the pain at the moment?’

‘Not too bad. The stuff the GP gave me was good.’

Felicity nodded. She’d read the ambulance patient report form as she’d walked into the resuscitation area. After a half-hour drive to the local doctor, Geoffrey had been given treatment consisting of oxygen, pain relief, an anti-nausea agent, aspirin and GTN. The GP had then called for an ambulance for urgent transfer to hospital. All the right things had been done and the GP’s note included baseline measurements and a brief medical history that didn’t indicate any risk factors for heart disease. But Felicity wanted to double-check.

‘So you’ve never had any problems with your heart before this, Geoffrey?’

‘No.’

‘No other medical conditions you’re treated for?’

‘No, nothing.’

‘Blood pressure’s always been OK?’

‘As far as I know.’

‘Have you ever had your cholesterol levels checked?’

Geoffrey nodded. ‘Always been fine. I’m fit and healthy, Doctor, and I’m far too young to be having a heart attack, aren’t I?’

‘Unfortunately there are always exceptions to the general rules. Is there any history of heart disease in your family?’

‘My dad gets chest pain sometimes, I reckon. He’s one of the old school and wouldn’t admit to it, but I’ve seen him rubbing his chest and looking a bit grey sometimes.’

‘Do you smoke?’

‘Used to. I knocked it on the head a couple of years ago.’

‘Good for you.’ Felicity had enough information to transfer this patient directly to Cardiology. Baseline measurements and recordings had all been completed by the team in the resus area. When the curtain was drawn back behind her she expected the new arrival to be the cardiology registrar. Instead, it was a woman with two young children beside her.

‘Sorry, Geoff. I couldn’t drive as fast as the ambulance. How are you feeling?’

‘Not too bad, love. Don’t worry.’ Geoffrey smiled at his wife. He winked at his son who was about ten years old but the boy was staring, wide-eyed, at the screens of the monitoring equipment. The younger child, a girl, was clutching her mother’s hand, staring at her father and crying quietly.

‘It’s OK, chicken,’ Geoffrey said gently. ‘Dad’s going to be just fine.’ He held out the arm that wasn’t encumbered by IV tubing and the girl ducked behind a nurse and rushed into the inviting circle, burying her face against her father’s chest. Mrs Pinnington also moved closer and laid her hand on Geoffrey’s leg. Felicity watched as the family drew themselves into a unit again, preparing to cope with whatever was coming next. She answered the querying look Geoffrey’s wife was directing towards her.

‘It looks as though Geoffrey may be having a heart attack,’ Felicity explained. ‘There’s a cardiologist on the way to see him now and they’ll decide what the best course of treatment will be. You’ve done exactly the right thing in getting Geoffrey to the doctor and into hospital as quickly as possible. That means the treatment has much more chance of being successful and that any damage that is occurring can be minimised.’

The cardiology registrar arrived while Felicity was talking. She took over the management of the patient but Felicity stayed in the resus area, listening and watching, for a few minutes. The registrar assimilated the available information quickly. She explained the mechanics of the life-threatening condition Geoffrey was experiencing and outlined the treatment options. Felicity watched as he listened carefully. His daughter was still tucked within his arm and he was stroking her hair. Blonde, straight hair. Not at all like Samantha Petersen’s.

Given the choice between drug therapy and the more invasive but faster and probably more effective procedure of angioplasty, the Pinningtons had no difficulty making a choice, and the staff prepared to move Geoffrey upstairs to the catheter laboratory. It was time for Felicity to move as well. With no urgent cases awaiting her attention, she collected a cup of cold water and stood observing the department for a minute from her position beside the water dispenser. She wasn’t really registering the activity in the department, however. She was still thinking about Geoffrey and his daughter. Or, more specifically, the interaction between them and the contrast it had presented to the way Joe and Samantha had appeared. That easy affection and physical closeness had been non-existent.