keep him nil by mouth for the next two or three hours. Nobody’s going to be able to sit with him while he drinks and then for a few minutes afterwards to make sure he’s OK—there just won’t be the time.’
‘Good points, and noted.’
Mr Kemp was sitting on a bed, waiting to be seen.
Isla introduced him quickly. ‘Mr Kemp, this is Dr Gardiner.’
‘Everyone calls me Harry,’ Harry said with a smile. ‘So can you tell me about what happened this morning, Mr Kemp?’
‘I had a bit of a headache, then I tripped and fell and I couldn’t get up again,’ Mr Kemp said. ‘My carer found me when she came in to give me my tablets and my breakfast.’
Isla noticed that Harry sat on the chair and held the old man’s hand, encouraging him to talk. He was kind and waited for an answer, rather than rushing the patient or pressuring him to stop rambling and hurry up. Lorraine had been spot on about his skills as a doctor, she thought. ‘Can you remember, either before or after you fell, did you black out at all?’ Harry asked. ‘Or did you hit your head?’
Arthur looked confused. ‘I’m not sure. I don’t think I blacked out and I don’t remember hitting my head. It’s hard to say.’ He grimaced. ‘Sorry, Doctor. I’m not much use. My daughter’s husband says I’m an old fool.’
So there were family tensions, too. The chances were, if they suggested that he went to stay with his family for a few days, the answer would be no—even if they had the room to let the old man stay. ‘Don’t worry, it’s fine,’ Harry reassured him. ‘I’m just going to do a couple of checks now to see how you’re doing. Is that OK?’
‘Yes, Doctor. And I’m sorry I’m such a nuisance.’
Either the old man was used to being made to feel as if he was a problem, or he was habitually anxious. Or maybe a bit of both, Harry thought. He checked Mr Kemp’s visual fields and encouraged him to raise his arms; the residual weakness on Mr Kemp’s left side that Isla had mentioned early was very clear. And there was a walking frame next to the bed, he noticed. ‘Do you normally walk with a frame?’
‘Yes, though I hate the wretched thing.’ Arthur grimaced. ‘It always trips me up. It did that this morning. That’s why I fell. Useless thing.’
Harry guessed that Mr Kemp did what a lot of elderly people did with a walking frame—he lifted it and carried it a couple of centimetres above the ground, rather than leaving the feet on the floor and pushing it along and letting it support him. Maybe he could arrange some support to help the old man use the frame properly, so it helped him rather than hindered him.
‘Can you see if you can walk a little bit with me?’ he asked.
He helped Mr Kemp to his feet, then walked into the corridor with him, encouraged him to turn round and then walk back to the cubicle. Harry noticed that his patient was shuffling. He was also leaning slightly to the left—the same as when he was sitting up—and leaning back slightly when he walked. Harry would need to put that on Mr Kemp’s notes to be passed on to any carers, so they could help guide him with a hand resting just behind his back, and stop him as soon as he started shuffling and encourage him to take bigger steps.
Once Mr Kemp was seated safely again, Harry said, ‘I’m going to send you for an MRI scan, because you had a headache and I want to rule out anything nasty, but I think Sister McKenna here is right and you’ve had a small stroke.’
‘A stroke?’ Arthur looked as if he couldn’t quite take it in. ‘How could I have had a stroke?’
‘The most likely cause is a blood clot that stopped the blood supply to your brain for a little while,’ Harry explained. ‘It should be cleared by now because you’re able to walk and talk and move your arms, but I’m going to admit you to the acute medical unit so we can keep an eye on you for a day or two.’ He decided not to tell Mr Kemp that his risk of a second stroke was higher over the next day or two; there was no point in worrying the poor man sick. Though his family would definitely need to know. ‘Has anyone been in touch with your family?’
‘Sharon, my carer—she should have rung my daughter, but Becky’ll be at work and won’t be able to come right away.’ He grimaced. ‘I feel bad about taking her away from her job. Her work is so important.’
‘And I bet she’ll think her dad is just as important as her job,’ Isla said reassuringly.
‘Too right,’ Harry said. Even though he didn’t quite feel that about his own father. Then again, Bertie Gardiner was more than capable of looking after himself—that, or his wife-to-be Trixie, who was a couple of years younger than Harry, could look out for him.
He shook himself. Not now. He wasn’t going to think about the upcoming wedding. Or the fact that his father was still trying to talk him into being his best man, and Harry had done that job twice already—did he really need to do it all over again for his father’s seventh wedding? ‘We’ll have had your scan done by the time your daughter comes to see you,’ Harry said, ‘and we’ll be able to give her a better idea of your treatment plan.’
‘Treatment?’ Mr Kemp asked.
‘The stroke has affected your left side, so you’ll need a little bit of help from a physiotherapist to get you back to how you were before the stroke,’ Harry said. ‘I’m also going to write you up for some medication which you can take after your scan.’
‘Is there anything you’d like to ask us?’ Isla asked.
‘Well, I’d really like a nice cup of tea,’ Mr Kemp said wistfully. ‘If it wouldn’t be too much trouble.’
‘We can sort that out in a few minutes, after you’ve had your scan,’ Isla said. ‘At the moment you’re finding it hard to swallow and I don’t want you to choke or burn yourself on a hot drink, but we’ll try again in half an hour and you might be able to swallow better by then. And I’ll make sure you get your cup of tea, even if I have to make it myself.’
‘Seconded,’ Harry said, ‘though I’ll admit my tea isn’t the best and you’d be better off with coffee if I’m the one who ends up making it.’ He smiled at the old man. ‘We’ll get things sorted out and make sure your daughter finds you.’ He shook the old man’s hand and stood up. ‘Try not to worry. We’ll make sure you get looked after properly.’
‘I’ll be back with you in a second, Mr Kemp,’ Isla said, and followed Harry out of the cubicles.
‘Can you organise a scan and then transfer him to the acute unit?’ he asked quietly when they were outside the cubicle.
She smiled at him. ‘Sure, no problem.’
Her smile transformed her face completely. Harry felt the lick of desire deep inside his gut and had to remind himself that his new colleague might be gorgeous, but she was also off limits. ‘Thanks,’ he said. ‘I’ll write everything up.’
It was a busy morning, with the usual falls and sprains and strains, and a six-month-old baby with a temperature that wouldn’t go down and had then started having a fit. The baby’s mother had panicked and asked a neighbour to drive them in rather than waiting for an ambulance, and the triage team had rushed her straight into the department.
The baby’s jaws were clenched firmly together, so Harry looked at Isla and said quietly, ‘Naso-pharyngeal, I think.’
Almost as soon as he’d finished talking, she had an appropriately sized tube in her hand and was lubricating the end. Between them, they secured the baby’s airway and gave her oxygen, and Isla was already drawing up a phial of diazepam.
Clearly she’d come across convulsions in babies before.
Between them, they checked the baby’s blood glucose and temperature.
‘Pyrexia,’ Harry said softly. ‘I’m pretty sure this is a febrile convulsion.’
‘So