CAROL MARINELLI - The Elusive Consultant

‘And it could very well have been the last ten minutes,’ Emily said pointedly, cocking her head as the sound of the chopper got louder. ‘Need I say more?’

Thankfully she didn’t. The last thing Tessa needed this morning was cosy little images of Emily and Max at the beach, no doubt with Emily skinny and gorgeous, some tiny little bikini accentuating her smooth brown skin, good-naturedly bickering about Max’s casual attitude to the world at large, Max’s take-it-or-leave-it slant on things.

It was a relief when the patients arrived and Tessa could concentrate on work.

The first victim to arrive was the unfortunate jet-skier. Though no longer in full arrest, he was still dangerously close to it.

‘OK, Kim, just listen to Max, he’s supporting the neck so he’s the team leader.’ Tessa hovered in the background, watching closely as Kim worked intently. As important as it was to give the staff experience, it could never be at the expense of patient care, and in this instance any hesitation could prove fatal. The lift over to the trolley was swift but very controlled, given the likelihood of spinal injuries, and Tessa tried not to interfere too much as she watched Kim’s shaking hands change over the equipment from the rescue team’s to the unit’s own. Already the young man was intubated. The paramedics had put a tube in place in his throat, thus securing the airway, and intravenous access had been established.

‘Right, Kim, look at the cardiac monitor. What do you see?’

Kim swallowed hard, her cheeks colouring as she stared at the machine. ‘His heart rate’s slow.’

‘Yep, he’s in sinus bradycardia, so what drugs do you think he’ll need?’

‘Atropine?’ The answer was right but Tessa could hear the question in the Kim’s voice.

‘Good,’ Tessa said encouragingly. ‘Max is checking his airway now—that’s the first priority—but once he looks at the monitor no doubt he’ll be calling for atropine or adrenaline so if you can try to preempt what he’ll need, you’ll have a head start. You may well be wrong but at least it’s easier to pull up the drugs and have them ready to hand over to him before he starts calling for them.’

‘Atropine.’ Max’s word was clipped, not even looking up he placed an impatient hand out, and thankfully Kim was able to pass him the drug immediately.

‘Get the chest-tube pack out,’ Tessa whispered, watching Max frown as he palpated the young man’s ribcage and run through a flask of mannitol. As the resus doors slid open and Tessa’s patient arrived, she gave her colleague’s shoulder a quick squeeze. ‘Don’t mind Max if he shouts. It’s not aimed at you personally, it’s just his way.’

It was just his way, Tessa thought as she started to work on her own patient, ignoring a rather loud expletive coming from Max’s general direction. Max, passionate about every patient, would be working on the young jet-skier as if it were his own family member lying near to death on the resus trolley. And if he lost his temper, if he shouted because the equipment he’d only just asked for wasn’t in his hand now , it was easily forgiven. Everyone knew they were watching a genius at work, and a genius was surely allowed the odd eccentricity.

Unlike Emily, Tessa thought to herself as she set to work on the latest admission. Not that Emily wasn’t a diligent and talented doctor, but her work technique and bedside manner didn’t even begin to compare to Max’s. The young man before them was flailing around on the gurney, distressed, in pain, terrified and, Tessa thought, confused, which was more ominous than the rest of his symptoms put together. And with little reassurance to her patient, Emily commenced her examination as Tessa struggled to hold the young man down and reassure him.

‘Stay still for me.’ That was the sum total of Emily’s communication with her patient as her hands worked their way down his body, leaving it to Tessa to attempt an explanation. But explanations were hard to give in the absence of information and Emily, as usual, was giving nothing away.

Emily worked in a completely different manner to Max. Emotions were kept strictly in check as she thought things through in her own time, and from a nursing perspective she wasn’t the easiest doctor to work with. There was no pre-empting her, no little clues along the way, nothing in her calm exterior to indicate what was going in that clever head of hers.

‘What’s his blood pressure?’ Emily’s voice was completely calm, as if she were asking if there was any milk in the fridge or if anyone had thought to buy a newspaper this morning. The coffee-room or the resus ward was all dealt with in the same unflappable manner. Her meticulous, very neat little hands methodically examined the restless body.

‘It’s up,’ Tessa said, glancing over at the machine. ‘One hundred and ninety on a hundred.’

There was no reaction from Emily as she carried on working her way down the patient. ‘Do we have a name?’

‘Phil’s all we’ve got at the moment,’ a voice called from the back of the room, and Tessa nodded her thanks to the paramedic who was writing up his notes in the corner.

‘Phil, try and stay still for me while I examine you.’

Which didn’t exactly calm the agitated man down.

‘You’ve been in an accident, Phil,’ Tessa added as diplomatically as she could, keeping her voice calm and even as she orientated her patient. ‘You’re at Peninsula Hospital. Dr Elves here is just going have a look at you.’

‘His shoulder’s dislocated,’ Emily said, more to herself than anyone.

‘His oxygen sats are low,’ Tessa said grimly, ‘even though he’s on ten litres of oxygen.’

‘Hmm, he’s got a few fractured ribs as well.’

Sometimes Tessa wanted to shake Emily. An excellent doctor she might be, but she was a lousy team player. Nothing in her calm expression, her clear blue eyes let the staff know what she was thinking—unlike Max, who wore his heart on the sleeve. Right now Tessa was worried about the head injury. By all accounts, Phil had been unconscious for some time, his agitated ramblings and high blood pressure all indicative of a serious head injury, but Emily, though aware of the facts, seemed more concerned about his shoulder.

‘Let’s get his shoulder back in place then we’ll see where we are.’

‘Do you need anything?’ Tessa ventured, hoping against hope Emily wasn’t going to do the procedure without anaesthetic but knowing the call was Emily’s.

‘Some traction, please,’ Emily said without looking up. ‘And make sure the brakes are on the trolley.’

Tessa bit her tongue. Giving the patient pain control now would mask any symptoms of his head injury, but to do it without anaesthetic would be agony. She watched as Emily slipped off her shoes and realised Phil was going to need all the sweet-talking Tessa could manage.

‘It will only take a second,’ Emily said assuredly. ‘Are you going to provide the traction?’

It was more an order than a request. Reluctantly, and trying hard not to show it, Tessa held onto the unfortunate man’s shoulder, watching as Emily placed the ball of her foot in his armpit. For someone so tiny she was incredibly strong, which was an absolute prerequisite in orthopaedics. Leaning back, Emily pulled as Tessa took the head end and utilised every last bit of her strength to hold the trolley steady and provide the necessary traction that would enable Emily to slip the shoulder back into place. Engaged in their own tug of war for a moment, just as Emily had predicted, the shoulder slipped back easily into place and instantly Tessa felt Phil relax under her hands.

Emily was good, Tessa admitted grudgingly.

Very good.