spare than a house officer.
‘Stuck with what?’ she asked.
‘Nothing,’ he muttered. ‘Just stuff. And we’ve got a patient to see.’
Well, her patient.
In the ED, Paul introduced them to Katrina, who was white with pain.
‘Katrina, may I examine you?’ Sophie asked.
The girl nodded. Sophie examined her as gently as she could, noting that the girl’s ribs were discoloured, there was localised tenderness and guarding in her abdomen and pain in the upper left quadrant.
‘Does it hurt anywhere else?’ Sophie asked.
‘My shoulder. The left one.’
Kehr’s sign, meaning that there was definitely a problem with Sophie’s spleen, In addition to that, Katrina’s abdomen was distended and Sophie already knew there was an internal bleed, thanks to Paul’s lavage.
‘Mr and Mrs Jackson, I think your daughter has a ruptured spleen,’ Sophie explained to Katrina’s parents. ‘She’s going to need an operation.’
‘She can’t have a transfusion,’ Mrs Jackson said immediately. ‘We’re Jehovah’s Witnesses. It’s against our religion.’
‘I’ll do my best to respect your wishes,’ Sophie said. ‘I need to take a closer look—I’ll do a procedure called a laparotomy. It’s a small incision in her stomach, and it will show me how bad the damage is. I may be able to glue it back together if the damage isn’t too bad, but I might need to remove her spleen.’
‘She can’t have a transfusion,’ Mrs Jackson repeated.
‘As I said, I’ll respect your wishes as far as I can,’ Sophie replied.
‘If there are complications during surgery and she needs blood, she could die without a transfusion,’ Charlie warned quietly.
Mrs Jackson’s face was set. ‘I know my rights. You can’t give her a transfusion without my permission, and I won’t give it.’
‘I know. But I have responsibilities to my patient, too. In an emergency, my priority will be to save your daughter’s life,’ Sophie explained.
‘If it’s willed…’ Mrs Jackson shook her head. ‘No.’
‘All right, Mrs Jackson. If you’ll excuse me, I just need a word with my consultant.’ Sophie looked at Charlie and slid her eyes sideways, indicating that she wanted a word away from the Jacksons.
‘What?’ he asked softly.
‘I’ve got a hunch that Katrina’s dad doesn’t feel the same way as his wife. Can you do me a favour and keep Mrs Jackson talking while I have a quick word with Mr Jackson?’
‘Sophie, you’re opening a can of worms here,’ Charlie warned.
‘What’s the choice? A row between the parents or the unnecessary death of a child. I know where my vote goes. We haven’t got time to fight. Please. Just keep her talking.’
He nodded. ‘I’ll explain autologous transfusion and see what her views are on that. But if you get the slightest indication from Katrina’s father that you’re going the wrong way, stop. We’ll get a co-ordinator in to do the talking for us.’
‘But—’
‘No arguments, Sophie.’
His accent was suddenly cut-glass, and it raised her hackles—particularly as she knew he was right. ‘OK. I’ll tread carefully,’ she promised.
While Charlie talked to Mrs Jackson, Sophie drew Katrina’s father to one side. ‘Mr Jackson, you know that the treatment we give people is confidential, don’t you? The only people who will know anything about Sophie’s treatment are you and your wife.’
He nodded. ‘My wife’s a Jehovah’s Witness.’
Meaning that he wasn’t? ‘Do you share your wife’s beliefs?’ Sophie asked carefully.
He closed his eyes. ‘No. She was converted by some friends. She was depressed after Katrina was born, but going to meetings made her happy again, so I went along with it.’ He opened his eyes again and looked at Sophie. ‘Could Katrina die if she doesn’t have a transfusion?’
She had to be honest with him. ‘I won’t know until she’s in Theatre. But it’s a possibility, yes. If she needs a transfusion and I can’t give it to her…’ She spread her hands. ‘That’s the worst-case scenario. Hopefully it won’t come to that.’
He shuddered. ‘I don’t want her to die.’
‘This isn’t about a battle of wills or judging your wife. But I want to give Katrina the best treatment available. We only need one parent to agree,’ Sophie said softly. ‘I know it could make things difficult between you and your wife.’
‘Katrina comes first. I’ll sign the consent form,’ he said.
‘Thank you,’ she said quietly. ‘I won’t say anything to your wife. It might not even come to this. But if it does—it’s good to know there’s a safety net there.’
But Mrs Jackson had clearly anticipated Sophie’s move. ‘If you sign that form, Derek, I’ll make sure you never see Katrina again.’
Mr Jackson paled. ‘Alice, be reasonable. Katrina’s life could be at stake.’
‘If it’s a bad rupture, she could bleed to death,’ Sophie said quietly. ‘And I need to take her to Theatre now.’
Charlie stepped in. ‘Maybe we can do the autologous transfusion we talked about.’
Alice Jackson’s face set. ‘Maybe.’
‘Mrs Jackson, I will do my best to abide by your wishes,’ Sophie said, ‘but as a surgeon I cannot allow your daughter to die due to the lack of a transfusion.’
‘BP’s dropping,’ Charlie said quietly. ‘Mrs Jackson, we have to go to Theatre now.’
‘You’re doing the operation? I’ve seen you in the papers. Out with all those women.’ She shook her head. ‘No. I don’t want you touching my daughter.’
‘Katrina is my patient. I’ll be doing the operation,’ Sophie said. ‘But if Charlie did it, she’d be in excellent hands. He’s the director of surgery. He got the post because he’s an excellent surgeon. And the papers whip up all that stuff about him to sell copies, so don’t believe what you read. I’ll come and see you immediately after the operation,’ she said, and started moving the trolley out of the emergency department.
‘Thank you for the vote of confidence,’ Charlie said as they went into Theatre.
‘It’s the official line, isn’t it?’
So she hadn’t meant it. Not personally. ‘Yeah,’ he said, trying to ignore the sinking disappointment in the pit of his stomach. Why should it matter what she thought of him?
Though it did.
‘It stopped the discussion. That’s the main thing. Where’s Sammy?’ she asked the scrub nurse, wanting to know where her senior house officer was.
‘Held up.’
‘I’ll assist,’ Charlie said as Sophie started to scrub up. ‘I was planning to observe all the surgeons anyway, so I may as well kill two birds with one stone.’
‘Observe?’ Sophie asked coolly.
‘I need to know my team’s capabilities. Where your strengths are, how you do things, where we can learn from each other.’
‘So, despite what you said to me, you are planning new-broom stuff.’
‘No.’ He kept his temper under wraps. Just. Hadn’t they agreed