Beneath the Bleeding

Sunday

Thomas Denby studied the chart again. He was puzzled. He’d diagnosed a severe chest infection when he’d first examined Robbie Bishop. He’d had no reason to doubt that diagnosis. He’d seen enough chest infections in the twenty years since he’d qualified and chosen to specialize in respiratory ailments. In the twelve hours since the footballer had been admitted, Denby’s team had been administering antibiotics and steroids according to the directions he’d given them. But there had been no improvement in Bishop’s condition. In fact, he had deteriorated to the point where the duty SHO had been prepared to risk wrath by summoning Denby from his bed. Mere House Officers didn’t do that to consultants unless they were very, very nervous.

Denby replaced the chart and gave the young man lying on the bed his casually professional smile, all teeth and dimples. His eyes, however, were not smiling; they were scanning Bishop’s face and his torso. The sweat of his fever had glued the hospital gown to his chest, revealing the outline of well-defined muscles currently straining to drag breath into his lungs. When Denby had first examined him, Bishop had complained of weakness, nausea and pain in his joints as well as the obvious difficulty in breathing. Spasms of coughing had doubled him over, their intensity bringing colour back to his pale face. The X-rays had shown fluid on his lungs; the obvious conclusion was the one that Denby had drawn.

Now, it was beginning to look as if whatever ailed Robbie Bishop was no ordinary chest infection. His heart rate was all over the place. His temperature had climbed a further degree and a half. His lungs were incapable of keeping his blood oxygen levels stable, even with the assistance of the oxygen mask. Now, as Denby watched, his eyelids fluttered and stayed shut. Denby frowned. ‘Has he lost consciousness before?’ he asked the SHO.

She shook her head. ‘He’s been mildly delirious because of the fever-I’m not sure how aware he’s been of where he is. But he’s been responsive until now.’

An insistent beeping kicked in, the screen revealing a new low in Bishop’s blood oxygen level. ‘We need to intubate,’ Denby said, sounding distracted. ‘And more fluids. I think he’s a little dehydrated.’ Not that that would explain the fever, or the cough. The SHO, galvanized by the instruction, hurried out of the small room that was the best Bradfield Cross Hospital could provide for those who required their privacy even in extremis. Denby rubbed his chin, wondering. Robbie Bishop was in peak condition; fit, strong and, according to his club doctor, he had been perfectly well after Friday’s training session. He’d missed Saturday’s game, diagnosed initially by the same club doctor as having some sort of flu bug. Now here he was, eighteen hours later, visibly deteriorating. And Thomas Denby had no idea why, nor how to make it stop.

It wasn’t a position he was accustomed to. He was, he knew, a bloody good doctor. A skilled diagnostician, a cunning and often inspired clinician, and a good enough politician to make sure his department’s needs were seldom frustrated by the bureaucrats. He pretty much sailed through his professional life, rarely given pause by the ailments his patients presented. Robbie Bishop felt like an affront to his talent.

As the SHO returned with the intubation kit and a couple of nurses, Denby sighed. He glanced at the door. On the other side, he knew, was Robbie Bishop’s team manager. Martin Flanagan had spent the night slumped in a chair next to his star player. His expensive suit was rumpled now, his craggy face rendered sinister by a scribble of stubble. They’d already gone head to head when Denby had insisted the pugnacious Ulsterman leave the room while the doctors consulted. ‘Do you know what that lad’s worth to Bradfield Victoria?’ Flanagan had demanded.

Denby had eyed him coldly. ‘He’s worth exactly the same to me as every other patient I treat,’ he’d said. ‘I don’t sit on the touchline telling you what tactics to employ. So let me do my job without interference. I need you to give my patient his privacy while I examine him.’ The manager had left, grumbling, but Denby knew he’d still be waiting, his face pinched and anxious, desperate to hear something that would contradict the deterioration he’d already witnessed.

‘When you’re done with that, let’s start him on AZT,’ he said to his SHO. There was nothing left to try but the powerful retroviral medication that might just give them pause enough to figure out what was wrong with Robbie Bishop.