Midwives On Call: Stealing The Surgeon's Heart. Marion Lennox

Alyssa answered, ‘but Mum gives me—’

      ‘Just some vitamins,’ Mrs Harrison said quickly. ‘I get them at the chemist.’

      ‘OK.’ Ciro didn’t push for any further details, acted as if the information barely merited a comment, but Harriet knew, just knew, it had been noted, but that for now he was focussed on the important task of gaining Alyssa’s trust.

      He listened to her chest, warming the stethoscope in his palms first, all the while keeping as much of Alyssa covered as possible. When he’d finished listening he probed her abdomen for a moment before replacing the blanket.

      ‘Thank you, Alyssa. I know that wasn’t pleasant for you, but it was necessary. I’m going to take some blood now. I’m going to insert a small cannula and leave it there, but from that I can take blood, and if we need to give you any fluids or medication we can do it all through there, so at least you’ll only get one needle. I’ll try not to hurt you.’

      He didn’t. Slipping the needle in neatly, he collected several vials of blood before unclipping the tourniquet and flushing the bung to keep it patent with the heparin flush Harriet had pulled up. Only when the blood had been taken, when the IV was in and Alyssa attached to a monitor did he approach the most difficult part of the whole subject. ‘How much do you weigh, Alyssa?’

      ‘I’m not sure…’

      ‘Would you get the scales?’ Ciro asked Harriet.

      ‘Alyssa knows her weight,’ Harriet responded without looking up at him, keeping her eyes on Alyssa. It would be easy to go and get the scales, but Harriet also knew that the delay and interruption could ruin the relatively compliant mood that they had somehow managed to foster, and it would be far better to forge ahead while the going was good. So instead she broached her patient, knowing, somehow knowing, this was what Ciro wanted her to do. Effective interview skills in Emergency required as much teamwork and synchrony as a surgeon and scrub nurse required, and with some doctors it took for ever—if ever—to perfect, yet with Ciro they fell into it easily, Harriet handing him the metaphoric scalpel without him needing to ask for it. ‘How much do you weigh, Alyssa?’

      ‘Forty kilos.’ When still Harriet held her gaze, she answered again. ‘Thirty-eight and a half.’

      Deliberately Harriet didn’t flinch and she was thankful that, when Ciro spoke, his voice was matter-of-fact.

      ‘We’ll need to check it before we give any medication,’ he said, more to Harriet, ‘but whatever way you look at it, this is very underweight.’

      ‘She’s a ballet dancer.’ Mrs Harrison’s voice was terse. ‘She has to watch her weight.’

      ‘Of course.’ Ciro nodded, smiling at the agitated woman. ‘But Alyssa is extremely underweight. I’m going to run some tests and then I’ll ask one of my colleagues to come down.’

      ‘And how long is that going to take?’

      ‘It might take a while,’ Ciro admitted, ‘but I will tell you that it is my belief that Alyssa needs to be admitted—’

      ‘No!’ Furiously Mrs Harrison shook her head. ‘This can all wait.’

      ‘I’m afraid not.’ Ciro shook his head. ‘Look, I understand—’

      ‘No, Doctor, clearly you don’t!’ Mrs Harrison angrily interrupted. ‘My daughter is dancing next week in a role that could see her getting into the most elite dancing school in Australia. She has to rehearse, she has to—’

      ‘Perhaps we could talk outside,’ Harriet suggested, anxious to move what could be a very emotional discussion well away from Alyssa’s bedside, but Mrs Harrison wasn’t going anywhere.

      ‘Perhaps we can’t!’ she smartly retorted, and Harriet knew that for now the conversation was over. ‘I’ll wait for those blood results, and then I’m taking my daughter home.’

      ‘Thank you for your help in there.’ Ciro caught up with Harriet at the nurses’ station as Harriet attempted to put to paper what had just taken place, knowing that a detailed record, though always required, was especially important in cases such as this, so that the staff that were involved later knew exactly what had been broached and what the response had been. ‘You were very good with Alyssa, the mother, too. It looked as if you actually knew what you were doing.’ He smiled as she frowned. ‘That came out wrong, forgive me. What I am trying to say is that you—’

      ‘I worked on an adolescent psychiatric unit when I did my training,’ Harriet explained, realising that no offence had been meant. ‘I really enjoyed it. For a while there I even thought of…’ Her voice trailed off, long-forgotten dreams briefly surfacing as she remembered the thrill of excitement at being accepted to study psychology and the thud of disappointment when her fledgling plans had been effectively doused. A part-time nursing wage, while she’d studied at uni, had been nowhere near enough to cover a very part-time actor, whose dreams had always somehow been more important than her own. But this was neither the time nor place for what could have been and, quashing memories, she concentrated instead on the matter in hand. ‘Mrs Harrison was shocked when she first saw Alyssa undressed,’ Harriet said. ‘I don’t think she knew, until then, just how thin her daughter was.’

      ‘Because she doesn’t want to know,’ Ciro responded. ‘At least, not until the concert is over and Alyssa has her scholarship. She wants her daughter to get into this dance school—that is her sole focus.’

      ‘I think you’re being a bit harsh.’ Harriet frowned, but Ciro stood unmoved.

      ‘I have worked with many athletes, and with their parents, too. Believe me, Mrs Harrison doesn’t want to hear anything that might compromise her daughter’s chances of performing next week, whatever the cost.’

      His arrogant assumption annoyed her, and Harriet let it show, her forehead puckering into a frown, her mouth opening to speak, but Ciro got there first.

      ‘I don’t want them to leave the department.’

      ‘We can’t force them to stay—’ Harriet started, but Ciro halted her with a stern gaze, his voice clipped when he spoke.

      ‘I was not exaggerating earlier, Harriet. I will call Community Services if I have to. If Alyssa goes home, I can guarantee she will be back at the bar first thing tomorrow, rehearsing for her performance. And, from my clinical examination, it is my belief that that child is in danger of collapse and possibly sudden death if she exerts herself.

      ‘So, I repeat—I do not want her leaving this department!’

      As Ciro called over the porter and handed him the bloods to take directly to Pathology, Harriet stood stock-still at the desk, pen poised over the notes she was writing, her eyes shuttered for a moment. It wasn’t Ciro’s ominous warning that caused her eyes to close in horror, but the use of the word ‘child’.

      They were talking about a fifteen-year-old child, and she mustn’t lose sight of that fact. It was their duty to protect her, especially if Ciro’s educated hunch proved to be correct.

      ‘What was all that about?’ Charlotte nudged her, putting a massive pile of drug charts in front of Harriet that needed to be checked.

      ‘The patient in cubicle four,’ Harriet murmured, her mind ticking over. ‘Alyssa Harrison…’

      ‘The head injury that’s here with her mother?’ Charlotte checked. ‘I thought she was being discharged.’

      ‘Not any more. Ciro doesn’t want her to leave the department. I’m going to ask Security to keep an eye on them.’

      ‘But what if the mother wants to take her?’

      ‘Then a simple head injury will become incredibly complicated.’ Harriet gave a thin smile. ‘Let’s hope it doesn’t come to that. For now just keep an eye open and let me know straight away if they show signs of leaving.’ The emergency phone trilling