have to do that? He was a senior consultant in this department now and he needed to start the way he intended to carry on. Alice was a nurse. A very good nurse, probably, but as far as a balance of power went, it was weighted firmly on his side. An advantage that Andrew couldn’t afford not to use. He needed to take control and make sure he kept it.
The department was relatively quiet for a long time after Janine had been taken to Theatre. Downright boring, really. Alice was looking after an epileptic man who was sleeping off the post-ictal phase of his seizure, a diabetic patient from a rest home who needed her insulin dose adjusted and another very elderly incontinent woman, Miss Stanbury, who was still suffering the effects of a gastric disturbance and needed rehydrating and frequent changing.
When an ambulance brought in a forty-year-old man with a markedly accelerated heart rate, Alice was more than ready to take on the case.
‘This is Roger,’ the paramedic told her. ‘Narrow complex tachycardia. Rate 196. Oxygen saturation ninety-eight per cent. No cardiac history.’
Roger looked pale and frightened but he wasn’t in the kind of danger he would have been in if the spikes on his ECG were wide enough to suggest the ventricles of his heart were in trouble. Alice enjoyed cardiology. She could read a twelve lead ECG better than most junior doctors and she particularly loved this kind of case. One where a dramatic result and relief for the patient could be provided.
‘Have you got any chest pain?’ she asked Roger.
He shook his head. ‘I feel a bit short of breath, that’s all. And I can feel my heart.’
‘Have you ever felt it going this fast before?’
‘No.’
Alice helped the paramedics transfer Roger to the bed in Resus 2, where they had good telemetry facilities to monitor his heart. She raised the back of the bed so their patient was sitting up, which would help his breathing effort. Jo came in as she was transferring the oxygen tubing from the portable cylinder to the overhead outlet.
‘SVT,’ Alice told her. ‘Is Peter around?’
‘No.’ Another figure pushed through the curtains as the paramedics took the stretcher out of the small area. ‘I’ve got this case.’ Andrew was holding the patient report form the ambulance crew had supplied. A long strip of pink paper recording the cardiac rhythm en route was attached to it and he was looking at the monitor beside the bed as he spoke.
He introduced himself to his patient, who was still looking alarmed.
‘Am I having a heart attack?’
‘It’s one of the possibilities we’re going to investigate,’ Andrew told him. ‘But, so far, we’re not seeing any sign of it. Your heart’s going a bit too fast to really see what’s happening so we’re going to try and slow it down for you. Try and relax.’
Roger made a sound like a strangled bark of laughter and Andrew’s smile was sympathetic.
‘I know. Easy for me to say, standing on this side of the equation, isn’t it?’ He touched his patient’s arm. ‘I know this is scary but we’re on the case and you’re in the best possible place to get things sorted.’
His smile and his touch had a visible effect on Roger, who lay back against the pillow with a sigh and a nod.
They had a hopefully invisible effect on Alice.
This was a glimpse of the real Andrew. How many times had she seen the effects of this man’s words and smile and touch? She hadn’t really been aware of how nobody else quite measured up to the standards Andrew Barrett had set. Or how much she’d missed working with him.
Until now.
Andrew had turned to Jo. ‘Got a straw handy?’
‘Sure.’
‘And grab a technician to come and do a twelve lead, will you, please?’
‘I can do that,’ Alice said quietly.
‘Fine. Go ahead.’ Andrew was pulling on gloves. ‘I’ll get the bloods off.’
Alice could have managed that as well, but maybe the consultants were also finding their day somewhat dull. She pulled the machine she needed from the corner and began attaching all the electrodes needed to get a complete picture of the electrical activity of Roger’s heart.
Jo was cutting a short length of plastic straw.
‘I want you to take a deep breath,’ Andrew instructed Roger. ‘Seal your lips around the straw and then blow through it as hard as you can for as long as you can.’
A valsalva manoeuvre was one of the dramatic ways to get this kind of cardiac arrhythmia to revert to normal. They all watched the monitor screen as Roger’s face reddened with the effort. There was no change to the rate.
‘Get your breath back,’ Andrew said. ‘And then we’ll give it another go.’
The respite gave Alice a chance to get the twelve lead ECG. The electrodes were all in place.
‘Try and keep as still as you can,’ she asked Roger as she pressed the start button.
But he was too out of breath to comply and the trace was nothing like the clean image Alice had hoped for. Dammit! She screwed up the sheet of paper, hoping that Andrew wasn’t watching.
‘Let’s try that again,’ she said calmly. ‘If you could manage to hold your breath for just a second or two while the machine captures a picture, that would be great.’
Roger managed but the sheet that emerged was missing several pieces of information that it should have recorded.
‘You’ve lost a leg lead.’ Andrew was probably looking at her with the same kind of studied neutrality his tone held. Alice felt her cheeks reddening as she pushed the sticky patch more firmly to the skin of Roger’s left ankle.
This was mortifying. Such a simple task that she was more than capable of performing, but she was managing to make herself look completely incompetent. Worst of all, this was more important than it should have been. The old need to attract praise by being the best was so ingrained it was automatic. She still wanted to be noticed. To be seen. How pathetic was that?
Andrew was getting Roger to blow through the straw again so he’d be out of breath and she’d have to wait to try getting the recording again. When she did and it worked beautifully, Andrew wasn’t even paying attention. Peter had come in and they were discussing the next management step. Because their patient was wide awake, they couldn’t use an external electrical charge to the heart to revert the rhythm unless they sedated him heavily. The better option was to try adenosine—a drug that gave the chemical equivalent of a jolt of electricity.
It usually worked a treat and Alice knew exactly what to do. The procedure was tricky because the drug had a very short time of being effective. It had to be injected into the right arm to get to the heart as fast as possible and it had to be chased along with a large bolus of saline. Two people had to work in unison and Alice had been the one to push the flush on many occasions.
A favourite task. A bit of a challenge to get the timing right; a few seconds delay and, sometimes with even the first dose, they would watch the screen and see the heart rate magically decreasing. The adenosine was drawn up. The big fifty mil syringe of saline was drawn up. There was one port of the IV line and both needles would go in at the same time.
Peter was hanging around to watch. The paramedics had come back from tidying their ambulance and they wanted to watch, too. Andrew had the adenosine in one hand, the saline in the other. It took two hands to push that flush as fast as possible so he needed a nurse. One who knew what she was doing.
‘Alice is experienced,’ Peter said. ‘Done this a few times, haven’t you, Ally?’
She nodded, aware of a wave of pleasure at the boost to her self-esteem as she moved around the head of the bed to change sides. The perfect twelve lead ECG was