Joanna Neil - New Surgeon at Ashvale A&E

‘He’s back with us,’ she said a few minutes later, addressing the nurse who was monitoring his situation. ‘Give the intensive care unit another call, will you, and see if we can move him over there as soon as possible.’

‘I’ll do that,’ the nurse said.

An hour later things settled down a little, giving her time to attend to a young boy who had been injured during a football match on his local playing field.

‘That was an unlucky game for you, Matt, from the sound of things,’ she said, smiling at the seven-year-old and then inspecting the X-ray film displayed in the light box. ‘When you fell to the ground, you hit it with enough force to break your collarbone. That’s this one, here.’ She pointed out the area of the fracture to the boy and his mother. ‘There’s a line across here that shows the break in the bone.’

She turned to look at Matt once more. ‘The good news is, it should heal up quite well because the two pieces of bone are still in line and touching one another. You’ll need to wear a support sling for a week or two while the bone heals, and we’ll give you some painkillers to help you feel better.’

His mouth made a flat line. ‘If I’d done this in a couple of weeks’ time, when school starts again, I could have had some days off. And I don’t even get a plaster cast for my friends to sign.’ He looked thoroughly disgruntled.

‘Isn’t there any street cred in wearing a sling?’ Ruby lifted a brow. ‘I would have thought you could get some pretty good mileage out of that. And it’s the hand that you write with that’s out of action, isn’t it? I’ll bet you can impress your mates with a left-handed signature.’

His expression brightened. ‘Yeah, maybe.’

His mother smiled as they stood up to leave a few minutes later. ‘I’m sure he’ll milk this for all it’s worth,’ she murmured in an undertone to Ruby. ‘He’ll be playing the part of a wounded secret agent before too long, I’ll be bound.’

Ruby nodded agreement, and gave Matt a bravery certificate as he left the room. It seemed he was already working on his game plan. ‘Tyler didn’t get one of these when he sprained his ankle,’ he said. ‘He only got a badge that was this big.’ His fingers made demonstration of its tiny size.

Ruby laughed and watched them leave before going in search of her next patient. She worked steadily through the morning, dealing with a wide variety of injuries suffered by active young children intent on enjoying their summer holidays to the full, while at the same time keeping an eye on the work of the senior house officers in her charge. Sam was nowhere to be seen.

James had been missing for some time, too, but she caught sight of him when she was heading towards the ambulance bay. An infant with breathing difficulties was being brought in to A&E by ambulance, and she expected him to arrive in the next few minutes.

‘Is everything all right, James?’ she asked now, still continuing on her way. ‘You look as though you’re in shock.’

James fell into step beside her. ‘I’m fine,’ he said. ‘I just don’t know how my patient could have gone downhill so rapidly. One minute he was sitting there, talking to us, and the next his speech started to slur, and he began to sink into unconsciousness. And to think I almost sent him home.’

‘What happened?’

‘Sam—Dr Boyd—did a CT scan and then whisked him up to the operating theatre. He told me to scrub in. It turns out that he specialised as a neurosurgeon originally and then after several years of doing that decided to take up emergency medicine.’ He shook his head in wonder. ‘Everything happened so fast. It seemed like within minutes the anaesthetist was there and the patient was out for the count, and then Sam was cutting a segment out of his skull.’

‘So it was a blood clot causing pressure on the brain?’

James nodded. ‘That’s right. I actually got to suction it out, but then Sam took over and stopped the bleeding. He says we have to watch him for swelling on the brain and seizures, and I have to keep an eye on him. I’m just on my way to talk to the man’s wife. She came in to the hospital expecting to take him home, but now, of course, he’ll be admitted to the surgical ward.’

Ruby glanced at James. ‘You sound as though the experience has opened your eyes in some way. I don’t think I’ve ever seen you quite so shaken up.’

He nodded. ‘Well, he’s not out of the woods yet, and that’s a worry, but thinking about what might have happened, and seeing our new boss at work, has given me something to think about. Not only that, but it’s made me wonder if I ought to consider going in for a surgical specialty after my stint here. Watching him operate really made me see how much of a difference a surgeon can make to someone’s chances of recovery.’

‘Then something good has come out of this. I’m pleased for you, James.’

He made a brief smile and went on his way, while Ruby hurried to the ambulance bay, deep in thought. So Sam was more than just a force to be reckoned with on the hospital administration side of things. He was a first-rate doctor as well. It was more or less what she had expected, but somehow she had thought it might take more time for him to prove himself. At least he had managed to win James over to his side, brisk manner notwithstanding.

She went to meet the paramedics a short time later as they wheeled the infant out of the ambulance on a trolley bed.

‘This is Charlie, eighteen months old,’ the paramedic said. ‘He’s struggling to breathe, and there’s some nasal flaring. His blood oxygen level is low, and he’s in severe distress.’

Ruby could see at once that Charlie was very ill and the muscles of his rib cage were sucking inwards. ‘Let’s get him into the treatment room,’ she said. The toddler was breathing in oxygen through a mask, but she could hear him wheezing, and it was clear he needed urgent help.

Once in the treatment room, she called for a nurse to assist with giving oxygen while she examined the boy. Running the stethoscope over his chest, she heard crackles in his lungs and a wheeze whenever he breathed out.

His mother looked on anxiously the whole time, and after a while Ruby said, ‘He’s feverish and obviously struggling. I believe his air passages could be inflamed, so we’ll try him with a medication to help ease his breathing.’

‘What’s wrong with him?’ his mother asked. ‘He’s had a runny nose for a few days now, but suddenly he seemed to go downhill, breathing fast and getting tired and irritable. He’s been off his food too.’

‘It’s probably a viral infection of some sort,’ Ruby explained. ‘I’ll do a nasal swab and send it to the lab to be sure what we’re dealing with, but in the meantime we’ll concentrate on supporting his breathing. We’ll keep him in our observation ward for the next twenty-four hours, and then we’ll most likely have to move him to the paediatric ward for a few days. The nurse will explain everything to you and make arrangements for you to stay with him if that’s what you want to do.’

‘Yes, I do. Thank you.’ The young woman leaned over and stroked her child’s hand, offering him comfort, but the boy was too ill to respond. He just lay there, unmoving, strands of his hair curling damply over his forehead.

‘Here, take a seat,’ the nurse said, pulling a chair to one side of the bed. Michelle was a capable girl, slender and pretty, with dark hair that fell in a sleek bob to the nape of her neck. ‘I’m sure he knows that you’re here with him, and that will help to ease his distress.’

Ruby knew that she was leaving the mother and child in good hands. She wrote up the boy’s chart, detailing the medication to be given, and then arranged for the nasal swab to be sent to the lab. ‘I’ll look in on Charlie again soon,’ she told the mother, knowing that the nurse would let her know if any problem came up in the meantime.