he was one with a title. And one who’d been linked in the press with too many gorgeous women to count.
He flashed a smile—one she’d bet he’d practised. A lot. ‘But thanks for telling me about Mrs Ward.’
It was a dismissal, and the nurse knew it. ‘See you later, Charlie.’ She actually gave him a coy little wave. What was it about this man that fried women’s brain cells? Sophie wondered in disgust.
Though that smile was definitely a lethal weapon. She’d have to be careful. Very careful.
‘So what happened?’ Abby asked.
‘Full-thickness burns to the palm of the dominant hand and two amputated fingertips. Guy did an excellent job of debridement and repairing the fingertips,’ Charlie said.
‘And Charlie did the skin grafts.’
Usually, skin grafts were delayed for a couple of weeks after the burn, when the dead skin started sloughing off—but in certain cases, such as fingers and eyelids, primary skin grafts had to be made as soon as possible after the injury to reduce the likelihood of infection.
‘I assume he’s staying in Paeds for a few days?’ Sophie asked. Burns to the hand were very difficult to manage at home, and there was a high risk of infection by Streptococcus pyogenes in the first week. The boy would definitely be on a course of antibiotics to reduce the risk of infection.
Charlie nodded. ‘I want to keep a check on him in case of fibrotic contractions.’ The fibres around the burn often contracted as they healed, and could cause problems with movement. The likelihood was that the boy would need multiple plastic surgery operations. ‘Plus he needs to keep his hand elevated.’ That would reduce the risk of swelling, or oedema, which could cause problems as the burn healed.
‘I think you’ve made a hit in ED,’ Guy said.
Charlie grinned. ‘They’ll get over it. When people get to know me better, they’ll realise I’m just like any other surgeon around here.’
Like any other? Hmm. Sophie didn’t think so.
‘I’m happiest when I’ve got a scalpel in my hand,’ Charlie added. ‘Now, please, let the coffee here be better than at my last place…’
Smooth. Very, very smooth.
But Sophie wasn’t tugging her forelock to anyone.
She gave him a cool little smile, and turned her attention back to her lunch.
‘I CAN’T believe Tom didn’t even notice his foot was gangrenous!’ Abby said.
‘Type-one diabetic, male, early thirties, single, lives on his own—no, I can buy it,’ Sophie said.
Abby shook her head. ‘I can’t, even though I know people with diabetes are more at risk of foot infections and ulcers—their circulation doesn’t work properly and it affects the motor, sensory and autonomic nerves.’
‘Which means?’ Sophie asked.
‘The motor nerves supplying the small muscles of the foot and the calf don’t work properly so the weight-bearing bit of the foot is distorted,’ Abby recited. ‘The effect on the autonomic nerves means the foot doesn’t sweat, and the sensory nerves don’t work so the patient doesn’t feel any pain.’
‘Exactly.’ Sophie thought Abby was shaping up to be an excellent doctor—she knew the textbook stuff. Now she just needed to understand her patients a bit more and empathise with them. ‘You don’t feel it, so you don’t do anything about it. Nearly half the time diabetic patients spend in hospital is because of foot problems.’
‘But surely he must have seen it?’ Abby asked.
‘He probably hoped it would just go away on its own. A lot of people do—they’re scared of doctors and hope if they ignore the problem it’ll go away.’
Abby shook her head in disgust. ‘So why didn’t his diabetic nurse pick it up?’
‘Because,’ Sophie said, ‘he didn’t turn up for any of his appointments. He got divorced last year and his mum told me yesterday he cut himself off from the rest of the world. The only reason we know about his foot is because he had a hypoglycaemic attack at work and the foreman insisted on him coming to hospital. Lucky ED was clued up enough to guess if he wasn’t keeping his glucose levels under proper control, he probably wasn’t looking after himself and might have a bit of ulceration on his feet as well.’
‘A bit of ulceration? Soph, the entire dorsum of his foot is necrotic!’ Abby said, aghast.
‘Yup.’ The top of Tom’s foot was red, swollen and puffy, and the tissue beneath was dead. ‘The sad thing is, it could all have been avoided if he’d come for treatment earlier.’ Sophie sighed. ‘The gangrene’s too bad for me to save his foot. I just wish I could have done reconstructive surgery on it—which I would have been able to do if he’d seen us weeks ago. He might have lost a toe or two, but it would still have been workable. Whereas this…It’s going to take him months of physiotherapy to get used to a false leg.’
‘What does Charlie say?’
‘Same as me. It has to come off.’ Sophie had checked with him the previous afternoon, and together they’d explained the options to Tom. She’d been impressed by the way Charlie had handled it and had tried to give Tom some dignity. ‘He’s doing the op with me this afternoon. We’ve been giving Tom an epidural for the last twenty-four hours.’
‘Why?’
‘Studies show he’s less likely to suffer from phantom limb pain after the amputation,’ Sophie explained. ‘We’re going to do a below-knee amputation—I need to go high enough to make sure the tissue I cut through is healthy. Why?’
‘Because otherwise there’s a risk the wound will break down and become ulcerated, so you have to do another amputation. You’re going below the knee—mid-tibia—because it’ll improve his mobility with a prosthesis,’ Abby added.
‘Perfect textbook answer,’ a voice said beside them.
Sophie did her best to ignore the tingling at the back of her neck. Charlie was just another one of the team, and she was going to treat him accordingly. He was just another doctor. So what if he had the sexiest mouth she’d ever seen? So what if his neck just invited you to caress it? The two of them were worlds apart, and it would stay that way.
‘Want to come and watch, if Guy can spare you?’ Charlie asked. ‘The full op takes about an hour and a half, but if he can only spare you for part of it, that’s fine.’
‘Could I?’ Abby beamed at him. ‘I’ll go and ask Guy!’
When she’d gone, that left Charlie and Sophie together. Alone.
Well, they had to work together. Just because she didn’t like what he stood for, it didn’t mean she’d be deliberately obstructive—not where work was concerned. Patients took priority in Sophie’s eyes.
‘How’s Tom?’ Charlie asked.
‘Pretty miserable. And wishing he’d seen a doctor earlier,’ Sophie said wryly.
‘Poor bloke. But there was too much necrosis for us to be able to save the foot.’ He looked at Sophie. ‘You didn’t mind me asking Abby if she wanted to watch, did you?’
‘No. It’s good experience for her.’ And he had at least said it was on condition Guy could spare his house officer. He wasn’t just expecting everyone to drop everything because the director of surgery said so.
‘I noticed you coaching her just then,’ Charlie added.
Sophie shrugged. ‘Just doing