Marion Lennox - Prescription-One Bride

Frank was in no condition to receive visitors.

The old man was vomiting. He’d been vomiting for a while, Jess could see, as he was past the stage where he was able to sit and hold the kidney basin for himself. He was dry-retching, heaving uselessly as the nurse watched helplessly beside him.

Jess stared down in dismay.

This was no normal gastric upset. Frank’s eyes were sunk deep in their sockets. His skin was parchment dry and the hand clutching the coverlet was gripping convulsively.

‘What’s happening, Sarah?’ Jess asked quickly, moving across to Frank’s side. Frank was so far gone that he didn’t even try to acknowledge her presence.

‘I don’t know.’ The middle-aged nurse shook her head in indecision. ‘I don’t like it, Jess, and that’s the truth. He’s been vomiting since just after you left. He was so upset about the dog-and then he lost his breakfast and he’s just kept on being sick.’

‘Have you rung Dr Hurd?’

Sarah shouldn’t be coping on her own here, Jessie knew. The nurse had done basic training twenty years ago but had been involved in little medicine since. She’d only just started back at the hospital after raising her family, filling in while one of the regular nurses was on holiday.

‘I rang Dr Hurd twice,’ the nurse whispered. ‘He said to give metaclopramide-which I’ve done-but it’s not helping. I rang him again half an hour ago and he just said to give him more. He’ll be in later…’

Later…

Jess stared down at Frank and knew without doubt that there was no ‘later’. She knew what death looked like.

Dear heaven…

‘Ring him again, then,’ she said harshly. ‘Tell him Mr Reid’s in real trouble and he must come now!’

‘He’s at Clinic,’ the nurse told her. ‘He yelled last time when I disturbed him. He said he’d come when he was ready and not before.’

Instinctively Jess looked to Niall.

Niall Mountmarche had followed her into the room and was surveying the room with a face that was totally devoid of any expression. It was as if he was deliberately holding himself apart.

He didn’t want to get involved.

‘Dr Mountmarche…’ Jess started.

‘Yes?’ It was a clipped, clinical reply. It could have meant anything.

‘Please…’ Jessie said helplessly and then, at the look on that cold face, she went further. ‘Frank’s…Frank’s my friend…’

‘I’m not practising medicine here, Dr Harvey-especially on someone else’s patient. It’s none of my business.’

‘Then Frank will die.’

The words hung in the air and everyone in the room knew that they were absolute truth.

Niall looked down at the man on the bed for a long moment. Frank hadn’t acknowledged their presence in any way. His frail body was heaving as if it was trying to rid itself of a poison that was overwhelming.

‘Damn him,’ Niall Mountmarche said savagely and Jessie knew that he wasn’t talking of Frank. He was talking of the absent Lionel Hurd. He walked over to the bed and lifted the chart. ‘He’s diabetic, isn’t he?’

‘Yes.’ Jessie was hardly breathing.

‘What’s his blood sugar?’ Niall snapped at the nurse and the nurse faltered.

‘B-blood sugar?’

‘Blood sugar, Nurse,’ Niall said and his voice was dangerously calm. Jessie had a sudden vision of Niall in a large teaching hospital, with students behind him. The image of the Ogre of Barega was thoroughly replaced now. There was clinical calm-and clinical, icy professionalism.

‘The patient is diabetic, Nurse,’ Niall snapped. ‘You must be doing blood-sugar readings?’

‘Dr Hurd didn’t tell me to…’

‘Well, I’m telling you,’ Niall snapped. ‘When was the last one done? Yesterday?’

‘I don’t know…I mean…We give him his pills for diabetes but I didn’t know we had to do blood sugars…’

The nurse was close to tears.

‘Well, do one now, Nurse,’ Niall said with that same icy calm. ‘Fast.’ He lifted the chart from the end of the bed. ‘History. Dr Harvey, do you know it?’ The nurse was already scurrying for the diabetic testing kit, sniffing back tears, and Niall had obviously given her up as a source of useful information.

‘Frank was admitted to hospital a week ago with a bad leg,’ Jess told him. ‘It doesn’t seem to be getting any better. I’m not…Dr Hurd doesn’t discuss his treatment with me. That’s all I know.’

Niall flicked up the blankets. Frank was wearing short pyjamas and his leg was exposed on the white sheet. The right leg from ankle to knee was red and swollen.

‘Cellulitis,’ Niall said grimly. He was holding Frank’s chart in his free hand and glanced at the line of figures. Sarah had filled in temperature and blood pressure readings with neat, precise figures. It was one thing she was good at.

The nurse was taking a tiny fingerprick blood sample now for a blood-sugar reading and her hand trembled.

‘He’s been running a temp of over thirty-eight for seven days,’ Niall said incredulously. ‘There’s no drip up? Has Dr Hurd discontinued intravenous antibiotics?’

Sarah was placing the blood sample on the stick. She nearly dropped it in her fright.

‘He’s had antibiotics orally, Doctor,’ she whispered. ‘And his diabetic tablets…’

‘So he’s not on insulin?’

‘Tablet only.’ Sarah was sure of her ground here.

‘And you haven’t taken a blood-sugar reading?’

‘I don’t…’ Sarah looked wildly across at Jessie. ‘Maybe the night nurse did-or Dr Hurd himself-’

‘Pigs might fly,’ Niall snapped. He laid the chart on the bed and lifted Frank’s wrist. ‘I need a drip set up fast,’ he told Jess. ‘Can you arrange it…?’

‘Dr Harvey’s a vet,’ the nurse said, shocked.

‘Yes, she’s a vet,’ Niall growled. ‘And she wouldn’t treat a dog like this man’s been treated. What’s the blood sugar, Nurse?’

He waited.

Sarah stared at the tiny chart. It was as much as she could do to keep her hands from trembling too much to read it.

‘Th-thirty-two…’

‘Thirty-two.’ Niall sighed. His voice was dangerously quiet. ‘A blood sugar of sixteen should be sending danger signals. Thirty-two, and you haven’t been testing…’

His face set into grim lines. ‘Someone’s been criminally negligent here,’ he snapped. ‘But we’ll worry about that later.

‘I want his urine tested for ketones as soon as possible but I won’t wait on the result. He has to be suffering from diabetic ketacidosis and I’ll work on that assumption. I want insulin-now-and I want saline intravenously at maximum flow. We’ll also need blood for electrolytes.’

‘H-how much insulin do we give him?’

‘Twenty units to begin with.’

‘And saline?’ The nurse was practically weeping and Niall winced.

‘As much as we can get aboard,’ he said icily. He was taking Frank’s blood pressure as he spoke. ‘Ninety on fifty…And you ask me how much…?’

‘Can I help?’ Jess asked quietly.

‘I need equipment for an IV line…’

Jessie had already found it. She’d moved swiftly next door to the small theatre and brought back what was needed. Before Dr Hurd’s arrival, her presence had been welcome in the hospital-as the island doctors’ presence had been welcome in her vet’s clinic. Two halves of a medical team…

Not now. Not with Dr Hurd…

Maybe she could again with Niall Mountmarche. He seemed to have accepted her completely as a medical equal. Niall accepted the syringe Jess handed him without comment.

‘I want insulin in now and the first litre of saline through within the hour. Then keep right on going-if we’re in time,’ he told Sarah. He was swabbing the back of Frank’s hand and sliding the catheter into place ready for the IV line, taking the blood sample for elecrolytes in the process.

‘The insulin can go in with the first litre. You don’t stop the flow until I tell you and I’ll tell you when to stop. You’re not taking instructions from Dr Hurd for this patient, Nurse, but from me. Move…’

‘But Dr Hurd…’

The nurse stared wildly with frightened eyes. She clearly had no idea who this strange man was-to be marching into her ward and giving orders.

‘Dr Mountmarche is a qualified doctor,’ Jess said quickly, but the nurse’s unease didn’t diminish.

‘I don’t know…’

Then her face cleared at the sound of footsteps in the hospital corridor.

‘Oh, here comes Dr Hurd now,’ she said in relief. ‘He’ll give me orders.’

‘You will do as I say. Now!’ Niall snapped. ‘There’s no time for argument. If you don’t then this man will be dead within an hour. Jessie, stay here and see she does what I’ve asked. Brain her and do it yourself if necessary.’ His mouth tightened in a grim line.

‘But Dr Hurd won’t let me,’ the nurse sobbed.

‘Leave me to deal with Dr Hurd.’

He hesitated, clearly unsure whether to stop Lionel Hurd in the corridor or stay and risk an altercation in Frank’s room. Jess saw his dilemma. A shouting match by his bedside was the last thing that Frank needed.

‘We’ll be right here,’ she said swiftly, and Niall’s eyes met hers in a fleeting moment of comprehension.

‘You’re in charge then, Dr Harvey. OK?’

‘OK.’

He nodded, a trace of a smile curving the sides of his mouth. ‘Rather medicine than Dr Hurd?’

‘Any day.’

The smile deepened. ‘So you’re sending me to battle. Well, they don’t call me the Ogre of Barega for nothing,’ he told her, and let his hand drop to touch the back of hers in a fleeting gesture of reassurance.

Then he handed the tray of equipment across to Jessie and walked out of the room.

JESSIE tried hard not to listen. The voices in the corridor were muted. One doctor discussing a case with another?

Not likely.

If Frank wasn’t so desperately ill she’d have no compunction in putting her ear to the door but there was enough to do in the ward for Jessie’s attention to be fully occupied. She worked swiftly with Sarah to set up the drip, trying to dispel the nurse’s doubts as she went but aware all the time that the most important thing was to get the drip going and the fluid and insulin into Frank’s dehydrated body.