The Pregnant Intern

‘It’s Dianne ringing,’ he said, referring to his wife. Grabbing the nearest phone, he picked it up and, shaking, attempted to dial home, but kept misdialling.

‘Josh, give it here.’ Alice laughed. ‘She probably just wants you to pick up a pizza tonight. Now, what’s the number?’

But Dianne didn’t want a pizza. She wanted Josh home now or she was going to dial for an ambulance herself.

‘How far apart are the contractions?’ Alice asked as Josh replaced the telephone, his face white.

‘Two to three minutes apart, and from the noises she’s making they’re pretty full on.’ He scratched his head. ‘She was fine this morning, not a peep. I thought first labours went on for ever.’

‘In the text books maybe, but this is real life. You’d better go now, Josh.’

‘What about—?’

‘Go,’ Alice insisted. ‘I’ll tell Jeremy and Linda. Give me your pager. And ring me with the news,’ she ordered, as he handed her his pager and notes. Josh was in such a state that he handed her his wallet. ‘You don’t have to pay me.’ Alice laughed again.

‘Wish me luck,’ Josh grinned. ‘Next time you see me I’ll be a responsible father of two.’

Alice shook her head. ‘A father, yes—responsible, no. Good luck,’ she called to his rapidly departing back. And as he left Alice was suddenly filled with a hollow sadness. Josh was so excited, so ready for all that was ahead. She imagined him holding his wife’s hands, working with her, guiding her through her labour. And afterwards, when their babies were born, sharing in each other’s joy, united as a family. Her hand moved down to the solid swell beneath her theatre greens. Her baby was missing out on so much. And that hurt Alice, not for herself but for her unborn baby.

Maybe lots of women had babies without a partner these days, some even by choice, but it had never been her intention. She had always assumed that when—if—the time came to have children, it would be with the man she loved at her side. She knew the pain she felt now would only magnify with time. It had been hard enough at the antenatal classes, listening as the midwife had explained the role of the partner during labour. Alice had felt the weight of the pitying smiles then as she had sat alone, pretending to take notes.

What would it be like when she was actually in labour? When the pain got too much and there was no one she knew there to comfort her, to guide her and cheer her on? And then... Alice closed her eyes as they started to fill. How would it feel when the baby was born and there was no one to share it with, no one to gloat with and gaze in wonder at the miracle of birth?

‘He’s waking up.’

Alice snapped back to attention at Carrie’s words, and made her way over to the gurney.

‘What are his obs doing?’

‘Stable. His blood pressure’s good, still febrile and his temp’s thirty-eight.’

‘We’ll just have to wait for the antibiotics to kick in. Lachlan, it’s Dr Masters. I saw you briefly in the accident department. Lie still now, Lachlan, you’re just coming to after an operation.’ Alice kept her voice low and steady, trying to orientate and at the same time reassure the young man.

The anaesthetist had entered and was setting up a pethidine infusion for Lachlan. For the immediate post-op period a high dose of analgesic would be administered automatically, to control his pain, but as his consciousness and condition improved he would be using a patient controlled analgesia machine which would enable him to administer a safe dose of analgesic to himself as required.

‘How’s he doing?’ Jeremy asked. Looking refreshed from his shower and, as usual, immaculately presented, he accepted the chart from Carrie. His question was directed more at the anaesthetist than Alice.

‘Happy from this end. Where are you sending him?’

‘There’s a HDU bed on Surgical 1.’

‘Josh’s wife rang,’ Alice informed him. ‘Apparently—’

‘I know already,’ Jeremy answered, without looking up. ‘I collided with him on my way here.’

And that was that. No small talk, no casual remarks about wishing him well, or the usual groan about twins. Jeremy obviously wasn’t remotely interested.

‘He said he’s left his pager with you.’ The blue eyes turned to her and Alice nodded.

‘Well, if it gets too much, let Linda know. She’ll have to pitch in.’

Which was about as helpful as suggesting she ring Josh if there were any problems. There was as much chance of Linda resiting an IV as Josh leaving his wife’s side.

‘How were Lachlan’s family?’ Carrie asked.

‘Upset, relieved—the usual. I said they could pop in for two minutes before we transfer him.’

But Carrie wasn’t having any of it. ‘You know the rules. They’ll have to wait until he’s transferred to the ward, like every other family has to. Just because his father’s a consultant here—’

‘His father’s not the only consultant here,’ Jeremy reminded her. ‘If you’re so against staff having the occasional perk, like seeing their critically ill son in the recovery room, maybe it’s just as well you work in the operating room, Carrie. Your personality wouldn’t go down too well with a conscious patient.’

Alice watched as Carrie’s shoulders stiffened, two spots of colour burning on her angry, taut cheeks. And though Alice knew Carrie had been out of line, the way she had addressed Jeremy, she actually felt sorry for her. Jeremy might have been a consultant, but he had by all accounts been more to her than that, and from her reaction towards him it wasn’t all over where Carrie was concerned.

‘Any news on Josh?’

Alice shook her head as she made her way over to Fi, who was coming out from handover. ‘Not yet. I suppose he’s got a million relatives and friends to ring before he gets around to letting us know.’

Fi shrugged. ‘Dianne’s probably still in labour. Looks like it’s going to be a long hard night for womankind tonight. I suppose you’re covering for Josh as well as your own work?’

‘Linda’s going to help out,’ Alice said without much enthusiasm.

‘Like I said, it’s going to be a long hard night.’

Alice wasn’t given to moaning about her colleagues, but Fi’s inference was so spot on that Alice couldn’t help but give a small smile. ‘I bought some doughnuts,’ she said holding out a brown paper bag, which Fi accepted with a laugh.

‘Then what have I got to moan about? I’d better start doing the drugs. How about you? Do you need anything?’

Alice shook her head. ‘I’m pretty much up to date. I’ve got a couple of bloods to do at eleven so I’ll be back then. I’m going to head down to A and E—there’s a couple of patients Linda wants to admit that need to be clerked before they can be sent up to the ward, and then...’ Her voice trailed off as Jeremy and Linda walked through the ward doors.

‘Bit late for a ward round,’ Fi muttered.

‘How’s Lachlan Scott doing?’ Jeremy enquired.

‘His temperature’s come down and his obs are stable,’ Alice answered. ‘I just left him.’

‘Good. We’re just going to have a quick look before I head off.’

‘Sure.’

But though Linda headed off to the HDU section, Jeremy just stood there. ‘Er, I was wondering if I could have a word?’

‘I’ll get on with the drugs,’ Fi said cheerfully, but Jeremy shook his head. ‘With both of you, please. Fi, do you mind if we go into your office?’ Not waiting for an answer, he led the way. Fi and Alice followed, a worried look passing between the two women. There must be a problem on the ward they didn’t know about. ‘Sit down, please.’

Alice felt as if she were being hauled into the headmaster’s office for a telling-off, but when she finally looked up at Jeremy she realised that he wasn’t angry.

‘I’m afraid I’ve got some bad news.’

Alice swallowed nervously.

‘What?’ Fi asked bluntly.

‘It would seem that Dianne’s labour wasn’t very straightforward.’

Alice felt a cold shiver run down her spine.

‘Apparently, the first twin, a little boy, was delivered successfully, but there were problems getting the second twin out.’

‘Shoulder dystocia?’ Fi asked, her voice shaky, referring to a condition in labour where a baby’s shoulders have difficulty negotiating the bony pelvis.

Jeremy shook his head. ‘No, Josh wasn’t very clear on the telephone but it would seem the second twin just didn’t descend at all. They had to use forceps, but they couldn’t get a grip. They made a number of attempts...’

Alice winced at the thought, and Jeremy shot her a look.

‘Sorry, you probably don’t need to hear all the details.’

But Alice shook her head fiercely ‘No, tell me. I’m all right.’

‘Well,’ he continued tentatively, ‘it would seem by the time they delivered the second twin, another little boy, he wasn’t breathing and there was no output. He had to be resuscitated. Apparently it was rather lengthy, though they did get him back. Anyway, the upshot is that the baby’s pretty sick. He’s on PICU. He’s bruised and battered from the forceps and he’s got some breathing difficulties.’

‘Poor Josh,’ Alice whispered, almost to herself. ‘And poor Dianne,’ she added. Although she had never met Dianne, her heart went out to this woman and the pain she must be feeling.

‘Obviously Josh will be taking some time off, which is going to mean more work for you, Alice.’

‘I’ll be fine,’ she said, her grey eyes brimming with tears. ‘It kind of puts things into perspective, doesn’t it?’

Jeremy gave a brief nod. He wasn’t going to be drawn into a deep discussion, but she could tell from his eyes that this news had shaken him, too.

It was a rather subdued group that made their way quietly out of the office. Linda was breaking the news rather less tactfully to the anaesthetic registrar.

‘Which is just great. We’ve got the consultant just back from sick leave, the reg on annual leave, the resident on paternity leave and the intern about to go on maternity leave. I’m carrying the lot of them.’

‘That’s what I like about you, Linda,’ Jeremy said dryly, as the anaesthetic reg signalled a desperate look at Linda to stop. ‘Your sense of team spirit.’ And without a backward glance he made his way across to Lachlan Scott, leaving Linda spluttering her excuses to his departing back.

Blinking back tears, Alice made her way down to A and E. How could it all have gone so terribly wrong? She remembered Josh’s excited face just this morning. Oh, she knew things went wrong, that there were no guarantees of a perfect healthy baby, but why did it have to happen? And why to Josh and Dianne? It just wasn’t fair.

A and E was busy, but wasn’t it always?

‘Hi, Alice.’ Fay, the Unit Manager greeted her.

‘Hi, Fay. I didn’t expect to see you. How come you’re on nights?’

‘Don’t ask.’ Fay rolled her eyes. ‘Given the fact that it’s me who does the roster, I guess I’ve only got myself to blame. Anyway, it might be chaotic down here, but from a surgical point of view it’s not too bad. There’s just two for you to clerk in. Linda’s seen them and ordered a few tests, but most can wait for the morning. As soon as you’re done I can shift them up to the ward and free up a couple of trolleys.’

Which was an extremely nice way of saying ‘get on with it’.

So she did, or at least she tried to, but no sooner had she clerked the first patient and was about to start with the second one than the sound of her pager signalled the end of her introduction to the patient.

‘I’m sorry, Mr West, I’ll just have to answer this. I’ll be back to clerk you, hopefully soon.’

‘No worries, love.’

Dialing the number as she flicked through Mr West’s medical history, she was surprised when Fi answered. Normally Fi held off from paging when she knew Alice was coming back. Something must be up.

‘I haven’t forgotten the bloods, Fi. I’ve just got one more patient to clerk then I’ll be up.’

But that wasn’t why Fi was ringing. ‘I’ve already done your bloods, so don’t worry about that. Look, Alice, I’m a bit worried about Lachlan Scott. Would you mind coming and having a look?’

Alice didn’t need to be asked twice. Ignoring the pained look from Fay, she made her way straight up to the ward.

‘Thanks,’ Fi said when Alice arrived. ‘Hopefully I’m worrying about nothing, but he just doesn’t seem right to me.’

‘What are his obs doing?’ Alice asked as they made the way to his bedside.

‘Nothing remarkable. His temp’s normal and his blood pressure’s a tiny bit low, but I guess that could be put down to his analgesia.’

Lachlan Scott looked pretty much the same as when Alice had last seen him, maybe a little paler but nothing that would cause Alice too much concern. ‘Lachlan, I’m just going to have a look at you,’ Alice informed him, as Fi and Kate, the student nurse, helped her with the bedclothes. Lachlan gave a small nod.

‘How are you feeling, Lachlan?’ Alice asked.

‘Tired.’

‘Are you in any pain?’

Not bothering to open his eyes, Lachlan shook his head as Alice gently palpated his abdomen. Again there was no real change since the last time she’d seen him. Listening to his chest, she found the story was the same—nothing remarkable.

But Fi was worried and Alice wasn’t going to ignore the fact.

Suddenly Lachlan opened his eyes. ‘I should be in the library. I’ve got an exam in the morning.’

Alice gave Fi a worried glance.

‘Lachlan, do you know where you are?’ Fi asked urgently.

Closing his eyes, Lachlan nodded.

‘Where, Lachlan?’

‘Melbourne City.’ Which, of course, was the right answer, but his moment of confusion prompted Alice into action.

‘Do another set of obs and I’ll ring Linda.’

Linda was particularly unhelpful. ‘So let me get this straight. His obs are fine, and you can’t find anything wrong on examination. Exactly why are you calling me, Alice?’

‘Because the nursing staff are concerned—I’m concerned,’ she said trying to sound confident. ‘And, as I said, he’s confused.’

‘Momentarily,’ Linda pointed out. ‘He’s had major surgery, he’s on a high dose of pethidine and you’ve just woken him up in the middle of the night. You said yourself he’s orientated now. Look, Alice, I just had A and E on the telephone complaining there’s still a patient waiting to be clerked. I’m stuck on Intensive Care with a sick patient and I’ve still got a list of patients to see on the wards. Now you’re ringing to tell me a patient I reviewed an hour ago is in the exact same condition as when I left.’

‘I’d just like you to review him,’ Alice said as evenly as she could. ‘I’d really value your opinion,’ she added tactfully.

‘When I get a moment,’ was all Linda could offer.

‘Is she coming?’ Fi asked as Alice replaced the receiver.

‘When she gets time.’ Alice shrugged. ‘What are his obs doing now?’

‘Not much change. His temp’s down a bit further—it’s 35.0 now.’ Which was low. Not dangerously low, but low enough to set an alarm bell ringing in Alice’s head.

‘He could be septic.’

‘But wouldn’t his temperature be high then?’ Kate asked.

Alice shook her head. ‘Not necessarily. Sometimes when the body’s overwhelmed with infection a patient can actually become hypothermic.’

Alice wasn’t a brilliant doctor, she was the first to admit that. She had got into and through medical school by sheer hard work and diligence. But she was a good doctor, and she knew that, too. And part of being a good doctor involved listening. Fi, with her years of knowledge and experience, had called on her because she was worried, and now Alice was worried as well. She wrung her hands anxiously. ‘I’d better ring Jeremy.’ She looked at Fi for her reaction.

‘Good. I’ll share the flak if it’s nothing.’

She had obviously woken him when she’d rung, and Jeremy listened without interruption as she relayed her findings.

‘What did Linda say?’

‘She’s a bit busy at the moment. His temperature wasn’t quite so low, though, when I spoke to her,’ Alice said hesitantly. ‘Maybe I should have called her back...’

‘Doesn’t matter now. Look, take some gases and bloods, do some cultures as well, and I’ll be straight in.’

Alice, unsure whether her concern for the patient was entirely merited, was somewhat taken aback by how amenable he was being. ‘I could ring Linda again,’ she offered. ‘Or call you back with the blood results. It could be nothing.’

‘Let’s hope it is,’ Jeremy said darkly. ‘I’m on my way.’

Linda wasn’t all bad, and in fairness she did come over almost immediately. But Alice’s relief at seeing her senior quickly vanished when Linda heard she had already contacted Jeremy.

‘You what? You just went ahead and called him? How dare you, without running it by me first?’

Alice was trying to concentrate on finding a vein and didn’t look up as she answered. ‘I did run it by you first. I felt Lachlan needed to be seen, and urgently. I knew how busy you were.’

‘So you went straight over my head?’

Alice didn’t reply; she was becoming increasingly worried about Lachlan now. His veins were proving extremely difficult to find, again a rather ominous sign in a young healthy man.

‘It’s not your responsibility to ring the consultant. You ring me and then I decide. It’s not your concern...’

Alice had heard enough. Rowing at a sick patient’s bedside really wasn’t her style. ‘I’m paid to be concerned, Linda, and right now I’d appreciate your help in finding a vein. You can bawl me out later.’

‘Let’s concentrate on the patient, shall we?’ Jeremy’s rich tones filled the room, and Linda immediately snapped to attention.

‘You got here quickly,’ Fi said appreciatively.

‘I’m sleeping at the hospital tonight.’

Alice’s eyebrows shot up in surprise but she didn’t say anything.

In the short space of time it had taken Jeremy and Linda to arrive, it had become obvious that Lachlan was extremely unwell. He kept pulling off his oxygen mask, confused rantings coming from his mouth.

‘Linda, run over to ICU and get the gases done,’ Jeremy said quickly. ‘Fi, call a MET.’

Fi nodded and turned to Kate. ‘You do it. Tell them the room number and bring back the resusc trolley with you.’

As the overhead chimes relayed their urgent message, Alice felt her adrenaline kick into overdrive. A medical emergency team was called when a patient was suffering a life-threatening incident. It was a relatively new innovation, and not practised at many hospitals, but it had on many occasions proved to be more than effective. Once the call was put out, the ICU anaesthetist, along with an ICU nurse and the on-call physicians, would make their way urgently to the patient’s bedside to implement urgent intervention before the patient arrested. And though it was becoming increasingly obvious to Alice that Lachlan really was very sick, she was somewhat surprised at the dramatic measure Jeremy had taken.

From then on Alice felt she was somewhat supernumerary as a multitude of staff and equipment appeared, all far more skilled and experienced at coping with emergencies than she was. Jeremy relayed the findings to the MET team as IV fluids were pumped into Lachlan’s system and his oxygen concentration was turned up. The head of the bed had been removed by Fi to allow the anaesthetist more access to Lachlan’s airway, and the patient was now attached to a cardiac monitor with a probe clipped onto his earlobe to continually measure his oxygen saturation.

‘Ring the lab, Alice, and ask them to step on his bloods,’ Jeremy ordered, just as Linda returned breathlessly with his blood gas results.

‘We’ll get him over to ICU,’ the anaesthetist addressed Jeremy. ‘We’ll need to put in a central line and do the works, but hopefully the antibiotics will kick in soon. It’s lucky we got to him in time. That was a good pick-up, Jeremy. Glad to have you back on board.’

By the time Lachlan had been wheeled over to ICU it was a white, shaking Alice that stood in the empty room as Fi started to clear up the large mess that had been created. ICU wasn’t Alice’s domain. It was up to her to cover the rest of the wards.

‘That was close,’ Fi said.

‘Very,’ agreed Alice. ‘He just seemed to go downhill so quickly.’

Fi nodded. ‘Young, fit ones often do that. They hold their vital signs stable until the last minute. By the time a young guy like that drops his BP you’re often too late. I’m sure there’s a far more technical way of explaining it, but I’ll leave that for Jeremy to explain.’

‘Thanks, Fi, if it hadn’t been for you...’

‘Don’t sell yourself short. It took a lot of guts to ring Jeremy.’

They both looked up simultaneously as Jeremy coughed, making his presence known.

‘I agree.’

Alice didn’t answer.

‘How’s Lachlan?’ Fi asked. ‘Will he be going back to Theatre?’

Jeremy shook his head. ‘Not at this stage. He’s had an ultrasound and it doesn’t look as if there’s a collection in his abdomen. He’s septic from the infection, we think. Hopefully we can keep him going until the antibiotics kick in. His parents have arrived. I was wondering if you could come in with me, Fi?’

Fi nodded. ‘I’ll take them down to the day room.’

‘You might as well head off to bed, Alice,’ Jeremy said, without meeting her eyes.

‘I’ve still got a patient in A and E to clerk.’

‘Don’t worry about that,’ Jeremy said, rather too lightly. ‘I’ve rung A and E and they’re going to send him straight up—he can be clerked later. Linda’s going to be up all night with me, anyway. I can tell her to head over here and do it when there’s time. Is there anything else outstanding?’

‘Just some two a.m. bloods.’ She glanced at her watch. ‘Which are just about due.’

‘I’m sure Fi can help with that. If not, I’ll come and do them.’

‘You?’ Alice said rather ungraciously. Since when did a consultant offer to do an intern’s two a.m. bloods? ‘Are you sure?’

‘I’m sure I can handle it,’ Jeremy said in his superior way, and then his tones softened. ‘Let’s say I owe you one. Linda, too, for that matter,’ he added darkly. A ghost of a smile touched his lips. ‘Go on, get some rest. You might even cram in a couple of hours’ sleep.’

It was then that Alice noticed how pale Jeremy looked. The night’s events had obviously shaken him up as well.

‘Thanks, then,’ she said gratefully. ‘But call if you need me.’

As she made her way out of the room Jeremy called her back.

‘Likewise, Alice. You call if you need me as well. I’ll always listen.’

Never had the thin, hard, on-call bed looked more tempting. Aching and exhausted, Alice slipped off her shoes and slowly lowered herself onto the mattress. Normally she slept on her stomach, but her ever-increasing size had meant that for the last few weeks she had been forced to sleep on her back or side, which inevitably meant most of the night was spent tossing and turning, trying to get comfortable. With a groan she placed her pager on the bedside table and flicked off the lamp, tucking a plastic-covered hospital pillow under her bump she rolled onto her side. A couple of hours sounded good from here. There was still a full day’s work tomorrow to get through. Fancy Jeremy telling her to go to bed. Under normal circumstances she would have insisted she was fine, but Brett Halliday’s warnings had hit home and she wasn’t going to do anything to risk her health—too much depended on it. Anyway, given how the night’s events had panned out, Linda probably did owe her one, Alice mused. Still, it had been extremely nice of Jeremy to pull rank and, in his own way, to thank her. But, then, that was how Jeremy had been all the time she had worked for him—extremely nice. Low as her expectations had been about his demeanour, he had surprised her. Drifting off into a deep sleep, her last conscious thoughts were of Jeremy, and as her subconscious kicked in, her dreams for once were not filled with Marcus and unborn babies, but a certain consultant with blond hair and a smile that set her heart racing.