Stormbound Surgeon

CHAPTER SIX

THIS was not hysteria.

Emma Crammond was one sick little girl. By the time they reached Margy and Harry Crammond’s house, the girl’s grandmother was beside herself with worry and her grandfather was coming a very close second.

‘She can’t make anything work,’ Margy told them as she led them through the house. She glanced up at Joss with gratitude. The whole town knew who Joss was now. News travelled fast in a small community. ‘Oh, Dr Braden, thank heaven you’re here. She looks just awful.’

She did.

The child was still in bed, but she was wide-eyed and frantic. Her breathing was fast and furious-as if she’d just run a marathon-but by her skin pallor Joss could see that she wasn’t getting enough oxygen no matter how hard she breathed. Even from the doorway he could see that she was cyanosed, her skin taking on the tell-tale bluish tinge arising from inadequate oxygen.

What on earth was wrong?

They’d travelled in Amy’s car. Joss usually travelled with a basic medical kit but it had been pulped along with the rest of the rear of his car. So he was dependent on Amy. ‘Do we have oxygen?’ he asked, expecting the worst, but Amy was nodding, moving already back to the front door.

‘Yes. I’ll get it.’

She had more than just oxygen. She had a complete and extensive medical kit.

She was back in seconds, handing Joss a stethoscope as she hauled out the oxygen mask to attach to the cylinder by her side. Whew, Joss thought-and then reminded himself that he should have expected no less. Amy obviously acted as district nurse and was first port of call in emergency for Iluka’s elderly. Oxygen would be something she needed all the time.

So he had what he required. Now he could concentrate on the child. He needed to concentrate. Her illness was frightening.

‘I can’t…’ The little girl was frantic. She was tossing wildly on the bed-as if trying to escape some unknown demon-and her grandfather was vainly trying to restrain her. ‘My legs… I can’t move them… Oh, I want my mummy.’

‘Her mother’s in Bowra.’ Beside the bed, her grandmother was sobbing with fear. ‘Dear God, what’s wrong?’

‘Emma, you must hush and keep still while the doctor works,’ Amy told the little girl. She signalled to Harry to stand clear and sat on the bed. ‘I’m fitting a mask over your face to help you breathe. But if you fight it, it won’t help. You must keep still. Do you hear?’

The little girl nodded, but her terror was still almost palpable.

‘We don’t know what’s wrong with you yet.’ Amy was already sliding the mask over the little girl’s face. ‘But here we have Dr Braden who’s stuck in Iluka like you are, because the bridge fell down. So we have our very own Iluka doctor. Isn’t that lucky?’

Lucky? Yeah, great. Except he didn’t know what was wrong with her. Hell, he was a surgeon, not a physician.

But he had gone through basic medical training. He’d worked for two years in an emergency department of a busy city hospital before he’d specialised-but this wasn’t fitting into anything he’d ever seen.

The child was badly cyanosed. Her skin was growing more blue by the minute, which meant she still wasn’t getting enough oxygen. Her heartbeat was rating 170 beats a minute and her breathing was far too fast. Yet she wasn’t running a temperature. She was completely afebrile and both lungs sounded normal.

The oxygen didn’t seem to be making a difference.

‘What’s she eaten tonight?’ Joss asked. This wasn’t making any sense.

‘Just what we ate. Roast beef and veggies. Apple pie. Nothing else.’

‘You’re sure?’

‘Yes.’

They’d have three patients here in a minute, Joss thought grimly, and sent an unspoken message to Amy with his eyes. They had to get the pressure off the elderly couple before they collapsed.

‘We need to get Emma to hospital,’ he told them. ‘I want a chest X-ray. There must be something going on.’

But what?

‘She’s asthmatic,’ Harry told Joss. He took that on board but still it wasn’t making sense. ‘It’s only mild…’ The old man gulped and swallowed a couple of times. ‘I thought-I thought you should know.’

Asthma he could deal with, but this wasn’t asthma. Still, it was something… ‘OK. Amy, do we have salbutamol?’

‘Sure.’ Amy was already preparing it. She was a fine nurse, Joss thought. A wonderful team member. He could work alongside her any day.

‘We’ll give her salbutamol just to make sure,’ Joss said, looking at the little girl’s frantic eyes. He shook his head. ‘But asthma…it doesn’t make sense.’

Nothing did.

They drove Emma to the hospital in Amy’s wreckage-mobile with Joss cradling the child in the back seat as he held the oxygen mask in place. They’d left her grandparents collecting her night things and contacting her mother-and pulling themselves together. The old people were shocked and shaky, and Amy rang their neighbours, asking them to drive the couple in. The neighbours just happened to be Joss’s father and stepmother.

Amy didn’t refer to Joss before she rang them. Joss had enough to worry about keeping Emma alive. David and Daisy were dependable and solid; she could rely on them to look after Emma’s grandparents and she didn’t want any more casualties tonight.

One was enough-and maybe even one was too many to save. By the time they reached the hospital things were deteriorating even further.

Amy found herself making silent pleas as she drove, and as she helped Joss lift Emma out of the car her pleas grew more desperate. Were they going to lose her?

Why? This was no asthma attack. What was going on?

Joss was agreeing with her. ‘There’s no way this is just asthma,’ Joss muttered as they carried her swiftly through to X-Ray. The nursing home was settled for the night. It was darkened and at peace, and Sue-Ellen, the night nurse, emerged from the nurses’ station, shocked at the startling interruption to her night.

Sue-Ellen, like Amy, had done her training in an acute hospital and she switched to acute care without a murmur. Joss couldn’t have asked for a better team as they set up the drip, monitored the oxygen flow and organised the child for an X-ray.

Emma was still terrified. The most important thing had to be reassurance-but how to do that when they didn’t know what they were dealing with?

The X-rays told them nothing. The X-rays were normal.

Hell, what? What?

Joss was raking his hair as he looked helplessly down at the child on the bed. ‘We need blood tests. I don’t suppose you have the facilities here…’

Amy shook her head, knowing what he needed was beyond them. ‘We can do blood sugars and we have an oxi-meter to measure oxygen levels.’

‘I want to do blood gases.’

‘We can’t.’

Hell!

He wanted his teaching hospital, he thought desperately. He wanted a specialist paediatrician and a pathologist. He wanted some answers…

The child was slipping into unconsciousness and he’d never felt so helpless.

‘Joss?’

‘Mmm.’ He was holding the child’s wrist, feeling her racing pulse. His mind was turning over and over. What…?

‘Joss, the swab…’ Amy sounded hesitant-unsure-and she caught Joss’s attention.

What was she looking at? He followed her gaze.

He’d set up a drip before the X-ray, thinking that they might need adrenalin at any minute. The child couldn’t keep this pulse rate up for ever, and the cyanosis was at dangerous levels. So he’d inserted a drip and placed tape over the back of Emma’s hand to hold it steady. But the insertion site had bled a little. Amy had swabbed the blood away and the swab lay in a kidney dish. Sue-Ellen had lifted the dish out of the way but Amy was reaching to grip her hand.

Sue-Ellen paused, the dish with the swab held before her. The light was directly on it.

‘It’s brown,’ Amy said stupidly, and she looked up at Joss. ‘Surely that can’t be right?’

He stared. There it was. The bloodstained swab had turned to a deep, chocolate brown colour.

No, it wasn’t right, but there it was. Unmistakable.

Where had he read about that? Joss closed his eyes, his mind racing. Where…?

And there it was. An article studied for a long forgotten exam. Useless information suddenly resurrected.

‘Methaemoglobinaemia.’ Joss could hardly frame the word. He could barely remember it. But it must be. He stared at the swab as if he couldn’t believe his eyes.

Amy was still confused. ‘What?’ She’d never heard the word. ‘Methaem-’

‘Methaemoglobinaemia. It’s a type of acute anaemia caused by exposure to some sort of poison.’ Joss could hardly take his eyes off the swab. ‘I’ve never seen it before-I’ve only read about it. But some chemicals-some poisons-oxidise the iron in the blood, meaning the blood can’t carry oxygen. That describes exactly what we’ve got here. Chocolate brown blood. I must be right. I can’t think of anything else. Amy, get me Sydney Central. I want to talk to a haematologist. Tell them we want an expert in poisons-the best they have-and I don’t care if you have to wake him up to speak to him. This is urgent.’

His mind was whirring over half-forgotten textbook cases. ‘I’d guess activated charcoal or…’ The article was becoming clearer in his mind as he spoke, forgotten texts somehow dredged up into memory. ‘Do we have any methylene blue?’

‘Methylene blue?’

‘It’s used to treat methaemoglobinaemia-when the blood can’t deliver oxygen where it’s needed in the body. It’s also used as a dye to stain certain parts of the body during surgery.’ What was the chance of having it in Iluka? Damn, why didn’t they have a pharmacy? Though even a normal city pharmacy might not stock this.

Amy shook her head, dazed by the speed and certainty of his diagnosis. ‘Methylene… I’ll check. We’re set up with emergency supplies so if the Bowra doctor’s here she has everything she needs in the drug cupboard.’

‘I think we might have something called that,’ Sue-Ellen said diffidently. ‘If I remember right. Dr Scott-the doctor from Bowra-gave us a list when we opened four years ago. She put all sorts of weird things on the list. I remember the pharmacist who supplied us scoffing and saying she was way out of date, and I think it was the methylene blue he was talking about when he said it.’

Please… ‘Let’s hope you’re right,’ Joss told her. ‘But even if you are, I don’t know the dosage. Amy, get onto the phone. I need a haematologist with paediatric back-up. Now!’

What followed was an example of a medical community at its best.

Within five minutes Amy had a telephone link set up-a conference line with a paediatrician, a haematologist and a pathologist for good measure. They’d all been woken from sleep but their concern was audible through the teleconferencing link from Sydney.

They were fascinated as well as concerned. If we have to have a dangerous illness maybe it’s as well to have an interesting one, Amy thought ruefully. All doors were open to a case of a perilously ill child with an unusual diagnosis.

The case conference was swift, intelligent and concise, and by the time Sue-Ellen had located a dated bottle of methylene blue from the back of the drug cupboard Joss was ready. While everyone held their breath-including the three specialists on the end of the phone-Joss administered fifty milligrams.

Then they waited. They all waited, and the specialists from Sydney stayed on the phone and waited with them. There was no appreciable change but at least Emma didn’t get worse. She was drifting in and out of consciousness, fighting the oxygen mask every time she surfaced. More and more Amy wanted her mother to be there. In her mother’s absence she cuddled the child herself.

After twenty minutes the combined opinion was to wait no longer. Thanking his lucky stars for a comprehensive drug cupboard-and that methylene blue didn’t suffer a use-by date-Joss administered another twenty-five milligrams.

Then they stood back and waited again, and it was the hardest thing-dreadful-to do. To watch and wait as a child fought for life.

And then results.

At first they thought they were imagining it. There was a combined holding of breath, and then they were almost certain. The awful blue was fading. The cyanosis was easing-just a bit, but enough to think that maybe…

Maybe was right. Another few minutes and they were sure. Emma was improving while they watched. The specialists on the end of the phone were jubilant, and so was everyone in the room. Sue-Ellen burst into tears, and it was all Joss and Amy could do not to join her.

Still they watched, but the child’s agitation was settling. Her colour was improving by the minute. Her breathing was easing as the oxygen was finally reaching her blood. The danger was over.

‘Look for a poison,’ the haematologist growled, before disconnecting and returning to his bed. He was a gruff man but there was emotion in his gruffness. ‘She must have eaten something that oxidises the ferrous iron in the blood. Sodium nitrate, maybe? Don’t let the kid go home until you discover the source or you’ll have her back in with another episode, and next time you mightn’t be so lucky. And if anyone’s eating where she’s been eating, get them out of the house until you know where the hell it came from.’

He left them to it and went back to his bed.

There was the sound of a patient’s bell from somewhere else in the nursing home. Life went on. Sue-Ellen made her escape, weeping audibly into her handkerchief, leaving Joss and Amy staring at each other in disbelief.

‘Oh, thank God,’ Amy murmured. Emma was drifting into an exhausted natural sleep, and her colour was almost back to normal. Amy had been cradling her to comfort her distress. Now the child’s lashes had fluttered closed. Amy laid her back on her pillows and gently tucked her in.

‘Do you want to tell her grandparents the good news?’ Joss asked, and by his voice Amy could tell he was as shaken as she had been. Margy and Harry Crammond hadn’t come into the room. They’d stayed out in Reception and panicked in isolation. Their distress had just upset their granddaughter more.

‘You tell them.’ Amy was smiling and smiling. ‘You made the diagnosis.’

‘You noticed the swab.’

‘Together we make a great team.’ Amy’s eyes were bright with unshed tears. She was still holding Emma’s hand but the little girl was slipping into a deep and natural sleep. ‘Off you go. Tell her grandma and grandpa while I watch over her. And, Joss?’

‘Yes?’ He paused at the door and looked back.

‘Thank you.’

‘Think nothing of it.’ His chest was expanding by the moment. The child would live, and it felt great! ‘What else is a doctor for but to save lives? Given nursing staff with the power of observation you seem to have…well, as you say, we make a great team.’

He looked down at Amy and the child. They looked…magnificent. He closed the door behind him before she could see that his own eyes weren’t exactly dry.

There were four people in Reception-Emma’s grandparents, Joss’s father and Daisy.

‘We drove them here,’ David told his son. ‘And then we stayed. Did you really think we could go home before knowing the little one was safe?’

Joss looked at his father with affection. No. He didn’t.

He operated with his heart, did his dad. It got him into all sorts of trouble. He’d buried three wives! His heart had been broken so many times, Joss thought, and each time he surfaced again to set himself up for more heartbreak.

Joss had never understood, but tonight, as he watched his father embrace his friends and celebrate this wonderful news-tonight he saw where his father was coming from.

Sure it hurt to give your heart. But now… This was such jubilation. Maybe…

Maybe what? What was he thinking of?

Was he thinking of giving his heart to Amy?

It wasn’t wanted, he told himself savagely. Amy had a fiancé. She had a life. She had nothing to do with him.

‘Can you put Mr and Mrs Crammond up for the night? Give them a bed?’ he asked his father, but he knew before he answered what the response would be.

‘Sure. But why?’ The four elderly people were looking at him now with varying degrees of confusion.

‘Emma ate something she shouldn’t have,’ he told them. ‘You said she had roast meat and veggies and apple pie for dinner. Is that all? Did she eat anything that you didn’t eat?’

Her grandparents were shaking their heads. ‘No. She didn’t.’

‘And you’re both feeling fine now?’ They looked fine, he thought. Stressed but fine. Emma’s illness had been dramatic. If they’d eaten the same thing they would have been ill by now.

‘We’re good.’

‘Then I want you to stay that way. There’s something that’s contaminated Emma and until we know what it is I want you out of your kitchen. I don’t want you to make so much as a cup of tea there before everything’s tested. I’ll ring Sergeant Packer and we’ll go through the kitchen first thing in the morning.’

‘She wouldn’t…’ Margy Crammond was becoming distressed. ‘She wouldn’t have eaten anything she shouldn’t. Sergeant Packer… The police… You’re not suggesting we poisoned her?’

‘I’m doing no such thing.’ Then, because it seemed the right thing to do-even though such a thing was unheard of in his professional life-he reached out and gave her a hug. ‘Sergeant Packer’s better at investigating than me. He’s trained to figure out unusual circumstances, which is the only reason I suggested I’d call in his help. By tomorrow Emma should be up to answering questions and we’ll sort out what happened in no time. But for now you should phone her parents and tell them she’s fine. Then go to bed. And don’t worry.’

He pulled back and lifted the old lady’s face so she was forced to meet his smile. ‘Can you do that?’

She nodded and gulped.

His father was watching with a strange expression on his face. ‘Do you want Daisy and me to stay awake and watch them-just in case they’re poisoned and it takes longer to take effect in adults?’ Joss’s father asked his question idly, as if it’d be no more than a mild inconvenience to stay up all night, and Joss thought, Yeah, he’d do that, too. He wore his heart on his sleeve did his father. He loved…

May Daisy live for ever. But if she didn’t…

Loss wouldn’t stop his father loving again, he thought. Loving was a part of the man he was.

And all of a sudden-for the first time in his life-he was jealous. Ever since his mother had died he’d thought his father was a fool to love. And here he himself was, being jealous.

He needed to go take a cold shower. He needed to go home. To bed.

In the room next to Amy. Yeah, right.

He took a deep breath.

‘OK. We’ve had enough for tonight. Dad, don’t worry about checking. If the Crammonds are sleeping in the same room they’ll wake if either becomes ill, and I know they’ll have enough sense to wake you. But if they had been poisoned by what they ate for dinner, they’d be ill by now. So relax. It’s time for bed.’

They nodded and turned wearily away, but before David left, he gripped Joss’s hand. ‘Thanks, Joss,’ he said softly. And then his grip hardened. ‘I’m proud of you.’