The Consultant's Italian Knight. Maggie Kingsley
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cool him down fast!’ she exclaimed as the paramedics wheeled their stretcher out of the cubicle. ‘I want 5 milligrams midazolam, supplemental oxygen, his head, neck and chest kept cold with cold water, and can you get me a fan? If we can control his agitation and temperature we might be able to get his BP down. If not…’
The sister’s eyes met hers, and Kate knew what Terri was thinking. Duncan Hamilton could code at any minute, and with so much cocaine travelling through his body the chances of pulling him back were slim.
‘I’ll get the fan,’ Terri said but, to Kate’s dismay, the minute the sister had gone Duncan Hamilton wrenched the ambu-bag from his face.
‘Need to…tell you something,’ he said, his breath coming in great, ragged gulps.
‘Later—you can tell me later,’ Kate declared, desperately trying to get the ambu-bag back in place but he fought her all the way.
‘Important!’ he exclaimed, grasping her wrist tightly. ‘Have to tell you. Names…Important names. Bolton…Faranelli—’
‘Duncan, will you please let me put this back on you,’ Kate insisted, seeing the heart monitor starting to display an increasingly erratic tracing.
‘Mackay…Di Angelis…And addresses—I have addresses. You must hear the addresses.’
‘OK—OK, I’m listening,’ Kate replied, hoping that the quicker the young man told her whatever he wanted so desperately to tell her, the sooner she might be able to re-affix the ambu-bag.
‘6 Mount Stewart Street…12 Picard Avenue…’
Oh, shut up, Kate thought as Duncan rambled on and she scarcely listened. He was dying, and yet he was giving her what sounded like the entire contents of the telephone directory.
‘Did…did you get all that?’ Duncan Hamilton demanded eventually, and Kate nodded.
‘Absolutely,’ she lied, sighing with relief as she snapped the ambu-bag back in place, but neither it, nor the fan Terri brought, nor the sedation, reduced Duncan Hamilton’s soaring temperature.
‘If we don’t get his temperature down soon he’s going to develop hypothermia,’ Terri declared, worry plain in her voice. ‘Will I start him on lidocaine?’
‘It won’t help,’ Kate replied, no less concerned than the sister was. ‘It produces similar effects on the myocardial cell membrane to cocaine. I’ve used sodium bicarbonate for tricyclic antidepressant overdoses and it worked with them so maybe…’
She didn’t get a chance to finish what she’d been about to say. Duncan Hamilton suddenly gave an odd breath, and the heart monitor let out a low and constant tone. He’d coded, and immediately Kate hit him squarely in the centre of his sternum, then glanced across at the monitor. Nothing. No change. The heart line remained resolutely flat.
‘Paddles, Terri!’ she exclaimed.
Swiftly, the sister handed them to her, and equally quickly, Kate rubbed the defibrillating paddles together with electrical conducting gel. It was on occasions like this she wished she was six feet tall instead of five feet nothing. To successfully shock a patient you had to lean over the examination trolley, place the paddles in exactly the right place, then press down really hard, but the trolleys had metal rails and if any part of you touched them…
‘Instant cardiac arrest, Kate,’ she muttered, standing as high on her toes as she could. ‘Stand clear, Terri!’
The sister stepped back from the trolley, Kate pressed the paddles down as hard as she could on either side of Duncan Hamilton’s chest, and he convulsed briefly.
‘Nothing,’ Terri said, her voice tense.
‘I’ll tube him,’ Kate declared. ‘The ambu-bag’s not enough any more, so I’ll tube him and then I want the power up to 300.’
Terri waited until Kate had inserted an endotracheal tube down Duncan Hamilton’s throat, then upped the power on the defibrillator paddles to 300, but though Duncan Hamilton’s body convulsed again when Kate placed the paddles on either side of his chest the monitor reading didn’t change.
‘IV bolus of 500 milligrams of beryllium,’ Kate said in desperation. ‘Power up to 360 joules.’
Again, and again, she placed the defibrillator paddles on either side of the young man’s chest, but no amount of electricity kick-started the young man’s heart and eventually she stepped back from the trolley, and switched off the current.
‘You did your best, Kate,’ Terri declared, watching her. ‘It’s just…’
‘This time we didn’t win.’ Kate’s eyes clouded. ‘I know.’
‘Look, why don’t you take a break, grab yourself a cup of coffee?’ the sister suggested. ‘I’ll clear up in here for you.’
‘Thanks,’ Kate replied. ‘I just want…’
‘A few minutes alone with him,’ Terri finished for her. ‘I understand.’
And Terri did, Kate thought. The sister knew how much she hated losing a patient—any patient—and this man was so young. Nineteen, the paramedic had said. Nineteen, and his whole life should have been ahead of him, but now…
Tears pricked at the back of her eyes, and desperately she tried to blink them away. It wasn’t like her to break down like this, and if the other consultants at the hospital could see her they’d have a field day.
‘Head of A and E isn’t a suitable position for a woman,’ they’d whispered when she’d got the job three years ago. ‘And thirty-two’s far too young.’
Maybe they’d been right, she thought as she gently closed Duncan Hamilton’s eyes, and whispered, ‘I’m sorry—so sorry,’ as she always did when she lost a patient. Maybe if she hadn’t been quite so driven, quite so determined to prove she was up to the job, but the glossy magazines had said she could have it all, and she’d believed them.
She’d kept on believing them even when John had started muttering that he hardly ever saw her. She hadn’t even worried when he’d begun booking himself on seminars without talking to her about them first, but her morning’s post had burst her illusory bubble once and for all. You couldn’t have it all. Or, at least, she couldn’t.
‘Did you forget something, Terri?’ she said, wiping her eyes quickly with the back of her hand as she heard the sound of the cubicle curtains opening behind her.
‘I’m not Terri.’
He wasn’t. He was the dark-haired, olive-skinned man from the waiting room and, as he advanced towards her, she wondered why she had ever thought him attractive. Up close, with a twoday stubble that wouldn’t have looked out of place on a convict, and a good sixteen inches taller than she was, he looked even more intimidating than he had at a distance.
‘I’m sorry, but we don’t allow friends or family members into this part of A and E,’ she said with a calmness she was very far from feeling. ‘If you’d care to wait outside—’
‘I’m not a friend or family.’
That didn’t surprise her. In fact, she had a sudden horrifying suspicion that he was probably the man who had put Duncan Hamilton into A and E in the first place.
‘If you’re not a friend, or family, you’ll definitely have to wait outside,’ she said. ‘Somebody—’ hopefully not her ‘—will be able to give you an update on Mr Hamilton’s condition in a few minutes.’
The man glanced down at Duncan Hamilton.
‘Not much need of an update when he’s rather obviously dead,’ he said. ‘What I’m more interested in is what he might have said to you before he died.’
That didn’t sound good, and neither did the way this man was looking at her.
‘We