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She collected her things together, said her goodbyes and then headed towards town and the Castle Hill hospital.
She had been hoping that she might avoid bumping into the consultant as soon as she entered the A and E department, but it wasn’t to be. She wasn’t that lucky.
He was there, by the reception desk, talking to Chloe. He didn’t seem to notice Amber as she walked in, and she kept a low profile, talking quietly to the desk clerk and generally gathering information about the set-up in the unit.
‘I’ll hand you over to Mandy, our triage nurse,’ the desk clerk said. ‘She’ll give you a quick rundown of everything.’
‘Thanks.’
Mandy had been at the party the other night, and Amber recalled that she was a lively girl, with dark hair that shone with good health and warm, brown eyes. She greeted Amber cheerfully. ‘It’s good to see you again. That was a terrible end to the evening, when the fire started, wasn’t it?’ she said. ‘I’m just so relieved that we all managed to escape.’
‘Me, too.’
‘Come on. I’ll show you where we keep everything. We’ll start off round here at the back of the reception desk. That’s where we keep most of the forms that you’ll need.’
Amber followed her, and tried to keep track of where she would find blood-test forms, lab-request slips and relevant charts.
‘I know it can be difficult when you start a new job, getting used to the place, but you’ll soon get the hang of our system, I’m sure,’ Mandy said.
‘I hope so.’ Mandy was friendly and helpful, and Amber did her best to concentrate on what the nurse was saying, but snatches of conversation came to her from the other side of the desk, and she couldn’t help hearing all the ins and outs of Chloe’s problems. She wasn’t making any attempt to keep her voice down.
She was clearly was upset. ‘Did you see this article?’ she was saying. She waved a newspaper in front of Nick’s face. ‘It’s all about the fire the other night, and they have a photograph of me on the front page— I can’t believe they put my picture in the paper.’ Her face crumpled. ‘What am I going to do? If my ex-husband sees this, he’ll know where I am, and he’ll come after me.’
‘That’s not necessarily true,’ Nick said softly. ‘You’re not living there now, are you?’
‘No, but as soon as the repairs are done and I move back in, he’s going to find me, isn’t he?’
Nick gently placed his hands on her shoulders and made her look at him. ‘You must stop upsetting yourself like this. I’ll speak to my father, and between us we’ll find you somewhere else to live. That will solve the problem, won’t it?’
‘I suppose so.’ She stared up at him, her blue eyes wide and troubled. ‘I’m sorry to lay this on you, Nick. It’s just that he frightens me so much. He was such a violent man.’
‘Try not to be afraid,’ he murmured. ‘If you’re really worried, you should go to the police and get a restraining order. In the meantime, can you stay with your cousin until we get you fixed up somewhere?’
Chloe nodded. Her blonde curls shimmered in the glow from the overhead light. She was a pretty girl, and Amber could understand how any man would feel protective towards her. She looked vulnerable and needy, and the consultant was obviously responding by giving her his full support.
Mandy was called away, and she left Amber to familiarise herself with the system. ‘I’ll be back in a while,’ she promised. ‘I just need to go and look in on one of my patients.’
Amber nodded, and went on rummaging through the various types of forms. After a while, though, her mind began to wander.
Her mother had seen the same article in the newspaper, and it seemed that the fire at the accommodation block was the talk of the neighbourhood.
It just showed how great the power of the press could be. What if she could use that power to her own ends? Could it be one of the ways that she could try to contact her brother? If he was living in the area, it was possible that he would read the local news.
‘What are you doing?’
She looked up with a start as a now-familiar male voice intruded on her reverie. ‘I’m sorry?’ she floundered, trying to get her wits together once more. She gazed at her boss in confusion. ‘Did you say something?’
Nick was staring at her with a look of exasperation that she was beginning to recognise.
‘Yes, I did. I’m sorry if I’m interrupting your daydream, but I would appreciate it if you could drag your attention my way for a moment or two.’
She blinked. His sarcasm wasn’t wasted on her. It seemed that she hadn’t even managed to get through the first half an hour here without crossing him.
‘I’m afraid I was a little preoccupied,’ she mumbled.
He made a faint grimace. He said slowly, ‘I was asking what you’re doing behind the desk. It seems to me that you’re in an area where you have no business to be. Is that correct?’
‘Er, no…’ She straightened up, a little intimidated by his brooding expression. ‘What I mean to say is, it is all right for me to be here. I was just familiarising myself with the way things are organised. I’m going to be working in this department.’
He stared at her in disbelief, and then shook his head. ‘No, I don’t think you have that quite right.’ He frowned. ‘This is an A and E unit. Perhaps you were looking for the records office or something?’
Her mouth made an odd shape. ‘Actually, I think you’ll find that I’m your new senior house officer— or rather, one of them.’
He didn’t say anything for quite some time, but simply studied her as though she had descended from another planet.
When the silence became unbearable, she thrust out her hand to him and said, ‘I’m Amber Cavell…Dr Cavell. I don’t think you were here when the interviews took place, but Professor McIntyre arranged everything in your absence. I’m here to start a staff grade posting.’
He stared at her hand, and when she started to think that he was going to ignore her, he finally grasped it and said in a kindly tone, ‘You know, I’m sure there must have been some mistake.’ He almost patted her hand. Then, collecting himself, he let her go as though he had been stung.
He said lightly, ‘Even so, I must say I’m pleased to see you again and to find that you seem to have recovered from your ordeal.’ He looked at her searchingly. ‘I take it you have recovered?’
Amber disguised a wince. Did he think she’d taken leave of her senses once more? His manner was almost patronising. ‘Yes, thank you,’ she said. ‘I seem to have come out of it with no after-effects. I’m very lucky, and I realise that I have you to thank for that.’
‘Possibly.’ He turned to the desk clerk, and said, ‘Would you let me have the file on the new senior house officer post, please? There are a few details that I would like to check.’
It was Amber’s turn to stare. Surely he wasn’t going to search for a reason to have her evicted from her post before she had even started it? Could he do that?
The desk clerk hunted through a filing cabinet and handed him a folder. ‘I believe this is the one,’ he said.
‘Thank you.’ The consultant flicked through the paperwork, his dark brows edging closer together as the seconds passed. Amber watched him guardedly.
After a while, he looked up, and said in a clipped voice, ‘Professor McIntyre’s handwriting doesn’t improve with time, unfortunately.’ He looked at her once more. ‘I was expecting a Dr Andy Carmel.’ His mouth made a straight line. ‘It looks as though I owe you an apology. I should welcome you to our department.’
He said it calmly enough, but his lips were stiff, and Amber wondered how much of an ordeal it was for him to accept her on his team. It didn’t bode well for the future. Things were not going to be easy, working alongside him, that was for sure.
He said carefully, ‘I’ll get someone to show you around, and as soon as you feel ready, you can start seeing patients. Mandy will direct them your way.’ He frowned as a siren sounded in the distance. ‘You’ll have to excuse me—we have patients from a road traffic accident coming in. You don’t need to be involved with that—I already have the staff in place to attend to them.’
Amber had the feeling that he didn’t trust her to assist, and already he was moving away, his mind seemingly elsewhere. Surely she would be able to prove herself to him over the next few hours and days?
She did as he had suggested, going on a quick tour of the department before she started work. She was worried about making a mistake—her nerves were already in shreds—but as the morning wore on, her professional instincts took over.
‘There’s a patient waiting for you in room three,’ Mandy said at one point. ‘Jack Carstairs. He’s complaining of a sudden loss of vision, and the paramedic was querying migraine.’
‘OK, I’ll see to him.’ Amber glanced at the chart Mandy handed to her and then hurried towards the room.
Her patient was a man in his late fifties. ‘Hello, Mr Carstairs,’ she greeted him warmly, trying to put him at ease. It was clear that he was unsettled and anxious. ‘I’m Dr Cavell, and I’m just going to have a quick look at you and see if we can find out what’s causing the trouble. Can you describe the loss of vision to me?’
He answered her questions as best he could, and she made a quick examination, checking his perception of light and his ability to detect hand movement or count the fingers she held up before him. She became increasingly concerned as she went on to examine the affected eye through a slit lamp.
‘There are one or two more things that I want to check, Mr Carstairs,’ she said. ‘I’d like to listen to your heart through my stethoscope to check for any murmurs and so on, and then I want to take some blood from your arm for testing.’
He let her proceed, and when she had finished and sent off the relevant samples to the laboratory, he asked worriedly, ‘Do you know what’s causing the problem?’
‘I can’t say for certain just yet,’ she answered. ‘It will depend on the results of all the tests. I’ve arranged for an ophthalmologist to come and take a look at you.’
‘Am I going to lose my sight permanently?’ It was a blunt question, and Amber thought he deserved an honest answer.
‘I’m not sure,’ she said. ‘It’s possible that you have a blockage in the retinal artery, and the outcome very much depends on how quickly we can move that blockage. We need to find out what’s causing the obstruction in order to be able to treat it.’
‘But you must have some idea?’
‘It’s probable that you suffered an embolism, and that might be because you have a degree of atherosclerosis. We won’t know until the results come back. In the meantime, I’m going to attempt to lessen the pressure within the eye. That’s probably the best way of trying to save your sight.’
He looked frightened, and she did her best to reassure him. ‘I need to massage your eye,’ she told him, ‘because that may dislodge the embolus and allow the eye to recover a little.’
She settled him into a comfortable position and then for a few seconds she applied direct pressure to the globe. Then she released it and repeated the action several times.
There was still no sign of the specialist putting in an appearance, and Amber was beginning to be concerned. ‘There is something else I can try, while we’re waiting for the consultant,’ she told the man. ‘I can draw a little fluid from the eye to move the embolus even further away. It sounds horrible, I know, but don’t worry—I’ll give you a local anaesthetic. Try to relax and I’ll do what I can to save your sight.’ She called for assistance from a nurse, and Chloe came to help.
‘Are you going to use the slit lamp?’ Chloe asked, and Amber nodded. ‘I’ll need a tuberculin syringe and 27-gauge needle.’
Amber worked carefully for some time, and eventually she was relieved that the pressure within the eye had been reduced. She said, ‘All right, Mr Carstairs…that’s all finished now. Just rest for a while, and then I’ll arrange for you to have a magnetic resonance angiogram so that we can see what’s happened to the embolus now.’
He looked anxious and she said, ‘It’s nothing to worry about, I promise, and when we have a clear picture of what we are dealing with, we’ll be able to give you further treatment to dissolve the blockage and to prevent any further damage. It all depends what the specialist decides once he’s looked over your case notes.’
She smiled at him. ‘You’ve been very brave. Take it easy now, and I’ll leave you with the nurse for a while. I’m sure she’ll answer any questions that you have.’
Chloe went to attend to him, and Amber hurried away to chase up the specialist.
‘He’s dealing with another emergency,’ Mandy said. ‘He said he would get down here as soon as he could.’
Amber wasn’t happy about that. In cases like Jack Carstairs’s, she knew that speedy treatment was imperative. A matter of a few hours could make all the difference. She had done what she could to save his sight, but it all depended whether he had been treated early enough.
She laid her stethoscope down on the desk, and began to write up her notes. Perhaps she should enquire into the possibility of Jack being treated with hyperbaric oxygen therapy. At least if she had set the wheels in motion, the treatment would be available if the specialist decided to go ahead. It was a fine line to tread, but she went ahead anyway and organised it.
The last thing she needed was to be taken to task by the ophthalmologist for not acting quickly enough or for taking on too much and impinging on his area of specialisation. She didn’t know what the rules were here, or anything about individual sensitivities, and she didn’t want to tread on any toes, but her patient’s welfare had to come first. If the consultant decided not to go ahead with what she had arranged, nothing had been lost.
She was just signing off on the chart when she felt something tugging at her cotton over-shirt. Looking down, she was startled to see four-year-old Lucy standing by the desk.
‘Do you know where my mummy is?’ the little girl asked.
Amber knelt down beside the child. ‘Hello, Lucy. What are you doing here? Is someone looking after you?’
‘Mrs Denney’s looking after me. She’s over there.’ Lucy pointed to where a woman was in conversation with Mandy. ‘I wasn’t very well,’ Lucy said, ‘and she brought me to see my mummy. Where is she? Do you know?’
‘Yes, she isn’t far away. I’ll go and find her and tell her that you’re here, shall I?’
‘It’s all right. Mandy said she would find her, but she’s talking to Mrs Denney. I want Mummy to come and take me home.’
‘She’ll be here in a minute or so, I expect.’ Amber paused. ‘You said you weren’t feeling very well…what’s the matter? Is there anything I can do to help?’
‘My chest hurts. I want to go home.’
‘Do you think you’ll feel better there?’
Lucy nodded and Amber said cautiously, ‘Does Mrs Denney look after you while your mummy’s working?’
Lucy nodded again. ‘She works in the nursery upstairs.’
‘Oh, I see.’ She looked at Lucy’s pale face. ‘I wonder why your chest’s hurting. Did the smoke upset you the other day? I saw you coughing.’
‘Yes, it did.’ Lucy’s chin jutted. ‘It made me cough and cough and cough, and the man from the ambulance gave me some medicine. It still hurts, though.’
‘Poor you. I expect your mummy will be here soon, and you can tell her all about it.’ She got to her feet and put her hand out to the little girl. ‘Shall we go and talk to Mrs Denney?’
Lucy went with her, and Mrs Denney put an arm around the child’s shoulders. ‘Your mummy’s coming to see you, chick,’ she said. She glanced around, and added, ‘Here she is now, look. Why don’t you go and give her a cuddle?’
The little girl ran off to her mother, and Mrs Denney said, ‘Thanks for bringing her back to me. I was keeping a discreet eye on her, just in case.’
‘Do you think Chloe will take her home?’ Amber asked.
‘I’m not sure. It may be that Lucy just wants a little bit of reassurance, and then she’ll be fine. If that’s the case, I expect they’ll have a few minutes together and then I’ll take her back up to the nursery. Chloe said it’s all right to bring her down here if there’s a problem. It’s better than having the child upset.’
‘It must have been a bit unsettling for her, having to move out of the flat,’ Mandy put in. ‘I expect she’ll be fine in a little while.’ She glanced at Amber. ‘Do you want me to go and take over from Chloe?’
‘That would be good, thank you. I have another patient waiting. Will you let me know when the specialist arrives?’
‘Will do. Leave it with me.’
Amber went to tend to her next patient, a woman suffering from a fractured hand. It was a nasty injury, and Amber took her time checking that blood circulation had not been impeded.
When she had finished, she walked out of the treatment room and straight into her new boss.
‘Sorry,’ she said. ‘I didn’t see you there.’
‘I gathered that,’ he said dryly. ‘It helps if you look around, you know.’
Amber winced. ‘I was thinking about the patient I’ve just attended to. You’re right, though. I’ll look where I’m going next time.’
‘You can come and examine the youth in room two,’ he said, ‘since you’ve finished in there. He’s having some difficulty with his breathing. I’d be interested to see what you make of him.’
Amber followed him to the room. She guessed he was intent on watching her at work, as he was in between patients just now. She might have known he would check up on her.
Going into the room, she greeted the youth. ‘Hello, Sam. I’m Dr Cavell. I understand you are having some problems with your breathing?’
The young man nodded, and she guessed from the way he spoke and outlined his symptoms that he was suffering from asthma. ‘I’ll just listen to your chest, if I may,’ she said. Reaching into her pocket, she searched for her stethoscope. It wasn’t there.
She looked around, a sense of impending doom settling on her.
