Sometimes

Frank had just finished stitching up Ricks' finger and was stripping off his gloves after an angry and injured Ricks absented himself with a swearword, leaving me to deal with his three-year-old patient.

"You alright?" the child's mother asked me.

"Erh, fine. Yes."

"You look a bit pasty in the face. And wot was all that goin's on out there?" she asked.

I was facing her child (no doubt he was sick but I had an idea) so I prodded the hinges of his jaw and he promptly opened his mouth. A quick peek illuminated by penlight and my suspicions were correct. "Tonsillitis," I pronounced for I could see the swollen tissue clearly.

"You sure?" the mum asked. "That other fellow didn't seem so sure of himself."

"I am sure. A round of antibiotics ought to clear this up. For his age I'll prescribe an oral antibiotic. Give him plenty of fluids, child's paracetamol liquid every four hours and keep him comfortable. Do not skimp on the antibiotic. Ten days minimum. If he does not start to rally in three days, or his fever increases, then take him to your GP. Questions?"

The mum's face blanched. "Uhm, no."

"Problem?"

"I don't think I have any paracetamol, that liquid stuff, at my flat. And we don't have a regular GP."

I tore the scrip off the pad and started another one. "The NHS care plan will provide all this for you. The pharmacy is on the ground floor." I sighed, "And you can bring him back to the walk-in clinic here if you need to."

She relaxed. "That's good."

I stood. "Off you go then."

Proctor had just sent his patient and her father away, and the girl weeping, hugging herself, but her father had an arm around her shoulders.

Frank watched as they slowly made their way down the corridor. He turned to me and said, "You were right. Positive pregnancy test," he sighed and shook his head gloomily.

I cleared my throat. "Pubertal or older female who is pre-menopausal with unexplained vomiting, and despite protestations to the contrary about sexual relations, a pregnancy test is always a good idea."

He took a deep breath. "I feel for that young woman."

"Oh?" I murmured.

He shook his head. "That was my mum, 45 years ago."

"Ah," I muttered.

"Family threw her out," he told me. "End up being taken in by a woman in the neighborhood. I always think of Elsie - that kind woman - as both my Gran and Grand," he rubbed an eye. "For she was grand in so many ways. That one?" he nodded to the pair as they were leaving, "I think her father will be supportive. Heaven knows about the child's father."

I sighed; nothing for me to say.

"But Mart?" he went on, "You throwing up in a bin? Feeling under the weather?"

"I…"

"Plus I did notice you avoided watching me stitch up Ricks."

I was caught out. "Ahm, yes. Occasionally, sometimes… that is… I get startled by blood."

"Startled?"

Not something I wanted to discuss. "Discomforted."

He gave me a long look. "You are a surgeon."

My throat still burned from stomach acid. "I gave that up."

"Gave it up?"

"Yes."

"Oh." He winced. "You used to be a surgeon. Past tense."

"Right."

"Quick as a flash?"

I ignored him, turning to the medical clerk who was staring at his computer. "Next patient?"

The man smiled. "All done for now." He looked at his watch. "Schedule says you lot are done for the day."

Meaning that Proctor and I were done; Ricks having jumped ship.

The clerk leaned back in his chair. "Slow afternoon," he yawned.

"Hm." I went to the computer on the desk and examined the list of patients ranked there. "What about these?" I asked him.

"Those?"

"All these patients? There's…" I counted, "four more."

"Look, Mr. Ellingham, two of those are for the trauma team. Another reports a headache. The fourth heartburn; older woman."

Heartburn? "And the heartburn case came here? To A and E? Let me see them," I demanded.

The clerk bristled at my suggestion. "I told you the schedule says you are done."

I leaned over the desk. "Do emergencies happen on schedule?"

"Well, no… and besides, Mr. Beamintser has her."

Stan seemed reliable, if a bit slow and cautious. "Where is he? Beaminster."

Frowning, he replied, "Alcove Number Eight."

I walked around the corner and behind the curtain of Number Eight Stan was examining the woman. Older patient, late fifties, overweight, pale complexion, sweat on her brow.

"Ah, Ellingham," Stan greeted me. "Have a look see."

I looked closer at the patient. She was breathing air in sips; little gasps almost, and as I moved closer to the medical bed, I heard her mutter something.

"What's that?" Stan asked her.

"Now my back is killing me," she repeated.

"BP?" I asked Stan.

"Just getting to that." He got the cuff on her heavy upper arm, pumped it up and laid his stethoscope on her arm, above the elbow, where the artery sounds would be most pronounced; good technique. He listened through the stethoscope. "Hm. A bit low. Heart rate is unsteady…"

I looked at the woman's face, who was working her jaw, mouth opening and closing. "Does your jaw hurt?" I asked her.

"Yeah," she answered.

"The back pain? Sharp or dull? Does it hurt in one area or all over?" I prompted her.

"Dull, kinda," she said, now grunting. "All over."

Stan looked at me with wide eyes. "Heart."

Female heart attacks can present with sharp searing chest pain as in most males, or others, like this woman, present with diffuse pain of back and jaw or arms. I stepped outside, found the EKG machine and wheeled it in, hearing someone protest my action. I got the leads out of the covers, opened the box of electrodes. "I need to place these on your chest," I said to the woman, and she started to pluck at the edge of the hospital gown.

I put the two top ones on, just either side of her sternum between her breasts, when she yelped, and her eyes rolled up in her head and her head fell to one side. "She's arrested," I told Stan calmly.

"Damn," Stan answered. He punched the alarm button and people came running.

First one in was a nurse who glared at me. "You took my EKG machine!"

"Later." I got the oxygen going through a mask, while Stan lowered the head of the bed, and raised the legs.

More nurses came in, plus an emergency doctor. "What's going on?" he asked.

"Full cardiac arrest," Stan told him, as he stripped the gown from her chest and began chest compressions.

Someone pushed an IV stand my way, wrapped the rubber clamping strip around her upper arm, saw the veins come up, so I cleaned the patient's forearm, took the IV needle and slid it home between wrist and elbow in one smooth movement. A strip of tape was given to me so I taped the IV tubing down, plugged in the line and got saline flowing at maximum flow rate.

"BP?" someone asked almost shouting.

"Nil," a nurse said.

Stan leaned more on the chest. "Come on, come on," he urged the unconscious woman. "Get the defib!"

Another clattering cart came in. "Right here."

Stan got the paddles out, charged the machine. "Mart, get away."

I dropped my hands from her head, where I'd been checking her pupils, which were blown and full. The lips were blue. She was going; gone, really. I stepped away just as Stan zapped her.

The woman's body bucked.

"Anything?" someone said.

Stan looked at the defibrillator screen. "One more time, old girl," he exclaimed. "Clear!"

Another jolt, the woman took a strangled gasp, and her heart started beating.

People relaxed a little, and the regular team took over. I stood against the wall, watching them work. Now the heart rate was 58, blood pressure was back, and she began to pink up.

Stan smiled at me. "Thanks for the help." He came over to me. "I had an orthopedics patient do that to me once. On the exam table, examining his bad knee." He sighed. "Keeled over. Dead as a mackerel. He was gone. Couldn't bring him back. Autopsy showed an infarct of his sinoatrial node. Nothing to be done. Sometimes the game is over."

"Right." I muttered. The woman was now breathing; pinking up, heart going very well. They'd move her up to the cardiac floor and support her recovery there. Sometimes we can forestall death; sometimes we get a victory. But other times, not.

Stan clapped me on the shoulder. "Fancy a coffee?"

"Tea."