The Doctor's Pregnancy Surprise

CHAPTER THREE

SATURDAY night was even busier than Friday had been, so Holly barely had a chance to talk to David during the shift. Just when she was going to take a break, Rick, one of the paramedics, brought in a young man.

‘His name’s Gary—I couldn’t get a second name out of his mates. Collapsed in the middle of a nightclub. His mates say it’s drink.’

‘But you don’t think so?’

‘Nope.’ Rick ran through the usual handover, noting Gary’s pulse, breathing rate and his GCS, or Glasgow coma scale, level, which told Holly how the patient was reacting to stimulation. ‘He’s been drifting in and out of consciousness on the way here. His mates are waiting outside. Want me to send one of them in to see if you can prise anything out of them?’

‘Please.’ Holly smiled at him. ‘Thanks, Rick.’

‘Any time, sugar.’

She turned to her patient. ‘Hello, Gary. My name’s Holly. Do you know where you are?’

The young man looked confused. ‘Dunno. Head hurts.’

‘You’re in London City General. I’m just going to check you over, OK?’

His pulse was way too fast. She shone a torch into his eyes and discovered that his pupils were dilated. He was sweating and a quick examination showed her that he had increased muscle tone. So he must have taken amphetamines of some sort. ‘Gary? What did you take tonight?’

‘Nothing.’ Gary leaned over the side of the bed and was promptly sick.

Before Holly could reach for a kidney dish to catch the vomit, a hand had already pushed one under Gary’s chin. ‘Here you go, mate.’

She winked at Rick. ‘Just in time. Thanks.’

‘Pleasure. I’ve brought Gary’s friend in to have a word with you.’

‘I’m Holly Jones, the registrar,’ she said. The young man looked so nervous that she didn’t ask him his name in case it made him bolt. It was more important to find out more about her patient. ‘Can you tell me a bit more about Gary?’

‘He just collapsed.’

Holly nodded. ‘Has he taken anything?’

‘No. Just drink.’

She raised an eyebrow. ‘Look, I’m not here to lecture you. I’m not going to grass you up to the police or anything like that. I just need to know what he’s taken so I can treat him properly.’ She spread her hands. ‘I’ve seen enough drunks in my time here to know when someone’s drunk. Gary doesn’t smell of booze. What did he take?’

‘He hasn’t taken nothing.’

‘It looks like amphetamines to me. Ecstasy?’

The young man looked at her for a moment, then sighed, as if knowing that he was beaten. ‘No. He couldn’t get no disco biscuits. He bought some Eve.’

Eve, or MDEA, was a type of amphetamine similar to Ecstasy. ‘Thanks,’ Holly said. ‘Do you have any idea how long ago he took it?’

‘Forty minutes—something like that, I guess.’

‘Great.’ She smiled reassuringly at him. ‘Now I know just what to give your mate to get his body back to normal.’

‘He is going to be OK, isn’t he?’

‘It’s too early to say, I’m afraid—though you did the right thing by calling the ambulance. If you want to wait in the relatives’ room, I can come and see you later to let you know how he’s getting on.’

‘Right.’ The young man bit his lip. ‘He’s been doing it for a while. E, I mean. And Eve. I thought he knew what he was doing. But this bloke offered him some cheap. I never saw him before. Must have been dodgy.’

‘It happens.’ And the friends and family were left to pick up the pieces. Holly knew that only too well—both as a doctor and as a relative.

‘You’re really not going to have a go about how drugs are bad for you?’

She shrugged. ‘Not my place. And you’re old enough to know that for yourself.’

‘Yeah.’ He smiled wryly back at her.

‘There’s a coffee-machine in the corridor outside the relatives’ room, if you need it. There’s a vending machine for chocolate, too.’

‘Cheers.’

Holly turned back to her patient. Since he’d taken the drugs less than an hour ago, activated charcoal would help to reduce the amount his body absorbed.

‘Gary, I’m going to give you something to help your body get rid of the drugs still in your stomach. And I’m going to take a blood sample to see how you’re doing.’

She took the sample, capped it and called to the staff nurse working on her team. ‘Miche, can you get the bloods sorted, please? Usual stuff—full blood count, Us and Es, creatinine, glucose and arterial blood gases. And if you could give me a hand with some activated charcoal?’

‘My favourite,’ Michelle said wryly. ‘I’ll get these to the lab and then I’ll come back.’

The charcoal was messy but effective.

‘I’m not happy about his temperature—or his blood pressure,’ Holly muttered to Michelle a little later.

‘Or his ECG,’ Michelle said, looking at the display. ‘He’s still tachycardic.’

Before either of them could say another word, Gary started having a fit.

‘Oh, no. Can someone get me some chlormethiazole?’ she called. Although diazepam was usually used to control fits, chlormethiazole had the extra benefit of helping to lower a fever.

‘Hold his arm still for me. I’ll get it in,’ David said, appearing with a syringe.

‘Sure,’ Holly said, knowing that now wasn’t the time to be proud. She needed his hands as well as the contents of the syringe. When someone was having an epileptic fit, it was much easier if one person held the arm still while another did the injection. Michelle was holding Gary’s head, making sure he didn’t swallow his tongue. Holly held Gary’s arm still and David injected the chlormethiazole.

The fit stopped, and then Gary was sick again.

‘It’s OK,’ Holly soothed, wiping his face. How many times had a doctor given the same treatment to her brother, back in Liverpool? And how many more times would it have to happen before Dan realised what an idiot he was being?

Gary couldn’t be more than a year or two younger than her brother. For a moment her vision blurred and she saw Daniel’s face in front of her. Then she blinked. Hard. This wasn’t Dan. And her brother had been clean for months now. He might even have turned the corner.

And elephants were pink, with wings.

When Holly was sure that Gary was responding to his treatment, she almost staggered to the rest room for a break. She nearly walked out again when she saw David already sitting there. She really, really wasn’t in the mood for facing him right now.

‘Hey.’ Almost as if he’d guessed that she was about to back away, he held up a bar of chocolate. ‘I owe you half, I think. Seeing as you shared your brownie with me last night.’

Colleagues. Yes. She could handle that.

She grabbed a coffee and sank into the chair next to his. ‘Thanks,’ she said, taking the proffered squares.

‘Tough night?’ he asked.

‘Drug cases always get to me. I suppose it’s because of Dan,’ she said. ‘I always think it could be him.’

‘Why?’

She sighed. ‘He got in with a bad crowd at uni and went off the rails pretty spectacularly. He’s living with Mum and Dad right now, in a temporary truce—but every so often he does something stupid, Mum gets too heavy with him and I have to go back to broker peace between them again.’

‘Little Danny does drugs?’ Disbelief was written all over David’s face.

‘Dan’s not so little now,’ she said wryly. ‘He’s twenty-five—bigger than me. Bigger than you, actually.’ She shrugged. ‘Ah, well. Your mother was right. Our family’s stuck-up, and we’ve had our comeuppance for it. Both of the kids brought shame on the family.’

‘What do you mean?’ he asked.

As if he didn’t know. ‘Forget it,’ she said shortly.

‘Holly—’

‘Just forget it,’ she said, and walked out before she said something she’d regret.

Just what was going on in her head? She was impossible. Really, really impossible, David thought angrily. Holly might be a good doctor—and good at defusing awkward situations with patients—but her manner with him left a hell of a lot to be desired. Yes, they had a history, but she shouldn’t take out her guilt on him!

Maybe on Monday, after he’d had some sleep, he’d have a word with Sue and see if he could be moved to the other team.

‘Peter Kirby. Suspected multiple rib fractures,’ Rick said as he ran through the handover. ‘Query organ damage, too.’

Holly glanced at their patient and winced. ‘Someone’s given him a hell of a kicking. Funny, he doesn’t look the fighting type.’

‘Probably just in the wrong place at the wrong time,’ Rick said wryly. ‘Wouldn’t surprise me if it was gay-bashing.’

‘Hey. We’re not all homophobic,’ she said gently, touching his arm. ‘Do you know him?’

He rolled his eyes. ‘I don’t know every gay male in London.’

‘What? A seasoned flirt like you?’ Holly teased.

He grinned. ‘Let’s just say the old radar tells me something.’

‘Be careful out there, yeah?’ she asked.

‘I can look after myself.’

It wasn’t a macho boast. Rick had run self-defence classes for the staff last year, and was qualified in martial arts. ‘You know what I mean.’

‘Yeah, sugar. I know. Right, I’m going to do my reports. And then I’m going home to sleep, sleep, sleep.’

‘I should be so lucky.’ Holly smiled at him, then went over to her patient and introduced herself. ‘I’m just going to examine you, Peter. I’ll be as gentle as I can, but tell me if you need me to stop, OK?’

‘My chest hurts,’ he whispered. ‘Hurts all over.’

‘OK, Peter. I’ll give you something to help that.’ She inserted a couple of IV lines then gave him IV analgesics, noting as she did so that his breathing was a little faster than she would have liked and there were slight traces of blue round his lips, a condition known as cyanosis.

Which meant compromised respiration.

‘Hurts to breathe,’ he said.

It could be a tension pneumothorax, where air leaked into the space around the lungs and was trapped. The pressure caused one of the lungs to collapse and could rapidly lead to a cardiac arrest.

Then Holly noticed something she really, really hadn’t wanted to see. As Peter breathed in, part of his chest moved inwards too, and as he breathed out the same segment moved out again. Flail chest, she thought with a sinking heart. Where at least three ribs had broken, in two or more places, part of the chest wall could move independently—known as ‘flail chest’, it meant that there was likely to be significant damage to the lung underneath it. If he got through surgery, he’d be in Intensive Care for a while.

A quick check on the pulse oximeter showed her that Peter’s oxygen saturation was dropping. His blood pressure was low, too, so either it was a tension pneumothorax or there was a chance that the kicking he’d received had ruptured something, possibly his spleen.

‘I’m going to put you on an oxygen mask,’ she told him. ‘That’ll help you breathe more easily. Take it slowly—in and one and out and one,’ she counted as she slipped the mask over his head. ‘Miche, we need a chest X-ray and the usual bloods, cross-matching,’ she said. She slipped on the earpieces to her stethoscope. ‘Can you get David?’

David was at her side almost immediately. Holly turned away from Peter for a moment and gave David a quick rundown in a low voice. ‘There’s definitely flail chest but I don’t know how bad the damage is. I’m not happy with his blood pressure or his oxygen sats. I don’t think it’s a tension pneumothorax—I’ve checked and there’s no absence of breath sounds on one side, no tracheal deviation, and his neck veins aren’t distended. I think the low BP could be related to organ damage rather than a tension pneumothorax.’

‘Have you ordered a chest X-ray?’

‘Yes, and the usual bloods.’

‘OK. We’ll get Theatre on standby and warn the anaesthetist there’s a strong risk of pneumothorax,’ David said. ‘We need to find out if there’s any internal bleeding. Any obvious signs?’

‘No.’

‘DPL, then.’ Diagnostic peritoneal lavage, or DPL, was used in patients with multiple injuries to assess possible abdominal injuries. ‘Can you get the patient’s consent?’

Holly held Peter’s hand and explained what they wanted to do and why. ‘Can you sign a consent form for me, sweetheart?’

‘Yeah,’ he whispered.

The scrawl was barely decipherable but it was enough.

While David fitted a nasogastric tube, Holly inserted a catheter to decompress Peter’s bladder. Holly cleaned Peter’s skin while David draped sterile towels over the area, then gave Peter a local anaesthetic.

‘Ready?’ he said to Holly.

‘Ready.’ Strange how easily they’d gelled into a team, working together without getting in each other’s way or even needing to say much to the other. But then, she’d known him so well, all those years ago. She’d almost been able to read his thoughts.

Which was why his behaviour had hurt so very much when he’d let her down. Because it had been the last thing she’d expected.

David made a vertical incision in the skin, about three centimetres long. ‘Can you put pressure on the edges, Hol?’

To minimise bleeding. ‘OK.’

‘Dividing the linea alba,’ he said. To her relief, he was the type who said exactly what he was doing so she didn’t have to second-guess him. ‘I’ve got the peritoneum. Can I have clips, please?’

Holly was already passing them to him.

‘Thanks.’ David brought the peritoneum into the wound and felt the edge between his thumbs to check no bowel had been caught into the clips. When he was satisfied, he made a tiny incision and inserted a peritoneal dialysis catheter, made sure the seal was tight and aspirated the fluid.

‘Positive,’ Holly said very quietly as blood started to appear. ‘He needs a laparotomy.’

‘I’ll close. You get Theatre,’ David said.

While Peter was being whisked to Theatre, Holly and David cleared up in Resus.

‘Thanks for your help,’ Holly said. ‘It’s good to know I can rely on you…’

David frowned. Was it his imagination, or had she muttered ‘now’? Her face said it, too. ‘What do you mean, now?’ he demanded.

She smiled thinly. ‘You know exactly what I mean.’

‘I think,’ he said quietly, ‘we need to talk.’

‘The time for talking was twelve years ago. You weren’t interested then—and I’m not interested now.’

‘What?’ His frown deepened. ‘Hang on a minute. Twelve years ago you dumped me.’

She scoffed. ‘More like you abandoned me. Just when I needed you.’

His eyes narrowed. ‘I can’t be hearing you straight. I must be in caffeine withdrawal.’ He glanced at his watch. ‘Look, we’re both at the end of our shifts. It’s been a long night and we’re both tired. Come and have breakfast with me. I just want a bacon sandwich—preferably with a ton of tomato ketchup.’

She shook her head. ‘Forget it.’

‘Hol, we need to talk.’

‘I don’t think your wife will be very happy about that.’

‘I’m divorced. And, anyway, I’m only asking you to talk to me.’ He paused. ‘What about you? Anyone waiting at home who’d be worried if you were late?’

‘No.’

‘Then I think we owe it to each other to get this straightened out. If nothing else, it’s going to be easier to work together. That, or I’m going to have to ask for a transfer to the other team because I can’t work with you—not if there’s all this stuff bubbling under the surface. Everybody knows you went to school with me. So what’s the gossip machine going to claim when we can’t work together?’

Holly sighed. ‘All right. Breakfast it is—but not in the hospital canteen. There’s a greasy spoon just down the road. It’ll be quieter.’

‘We need to do our handovers. Meet you in—’ he glanced at his watch ‘—ten minutes?’

‘By the entrance.’

‘OK. And if anyone asks, we’re simply colleagues flaking together after a heavy shift, in need of breakfast.’

They didn’t speak as Holly led the way to the café. Not until David had ordered two bacon sandwiches with lots of ketchup and two large black coffees.

‘I’m too tired to be polite. Let’s cut to the chase,’ he said as they sat down at a table at the back of the café. ‘Where do you get this “abandon” thing from?’

‘I can understand why you did it. Typical teenage boy. Can’t face telling his girl it’s over, so he doesn’t ring her, doesn’t contact her, doesn’t return any of her calls—and if she’s pushy he gets his mum to tell her it’s over.’

He snorted. ‘Rubbish! More like you’d finished slumming it and you got your mum to tell me it was over. And don’t lie, Hol. You didn’t return any of my calls.’

‘What calls?’

‘Come on. I must have phoned you dozens of times, and every time you got your mum to say you were out. When you didn’t turn up to take your A levels, I asked Mrs Smith what had happened to you.’ Their old biology teacher. ‘She was in the exam room. She told me you’d arranged to take your exams somewhere else.’

She frowned. ‘Yes.’

David’s lip curled. ‘So you’d had it planned for God knows how long.’

‘No. It was a last-minute thing.’

He scoffed. ‘Come off it. You can’t change your exam centre at the last minute.’

‘Yes, you can.’ Holly lifted her chin. ‘Mum organised it. I suppose she knew who to talk to.’

Yeah, well. Laura Jones would. She’d probably been mates with the chairman of the examining board.

His thoughts must have been written all over his face, because Holly folded her arms defensively. ‘But there was a good reason for it.’

‘Such as?’

‘If you remember so much about it, then you’ll also remember there was something else worrying me besides exams.’

‘You were stressed, yes.’

‘Oh, for goodness’ sake! Do I have to spell it out?’

She’d dumped him, and now she was trying to claim it had been the other way round. ‘Yes, Holly. You do.’

‘I’d missed two periods.’

‘You told me it was exam nerves, because the same thing had happened just before your GCSEs. And you were a vir—’ He exhaled sharply, as if someone had just thumped him in the stomach. Hard.

Holly had been a virgin before he’d met her. When their relationship had progressed to making love they’d been careful, but condoms weren’t a hundred per cent reliable. His head started spinning. Was she telling him…?

‘Oh, my God.’ He couldn’t get any air into his lungs. ‘Are you telling me we’ve…we’ve got a child?’ He stared at her in disbelief. ‘I’ve got a son or daughter who’s—’ he calculated the age quickly ‘—about eleven years old?’ How could she have kept a secret like that from him? How could she possibly have had his child and not told him?

Holly shook her head. ‘You don’t have a child, David.’

‘All right. So you didn’t name me as the father.’ But no way could the father have been anyone else. Holly might have dropped him without bothering to tell him it was over, but she’d been faithful to him while they’d been together. He was sure of that without having to ask. But he had to know the truth. Did they have a child? ‘Are you telling me that you have a child who is eleven years old?’ he asked, his voice shaking slightly.

‘No.’

‘Then what? You had the baby adopted?’ Her mother would have put pressure on her. A lot of pressure. Of course Holly would have caved in. Nobody could withstand Laura Jones in full flow.

‘No.’

He stared at her. She couldn’t have…She wouldn’t have…Surely not. Not even if her mother had frogmarched her to a private clinic somewhere…would she? ‘You had a termination?’ he asked, his mouth dry.

‘I had a miscarriage,’ she informed him quietly. ‘It started two hours before I was going to sit my first exam. I was in hospital for two days. So I didn’t take my A levels at all that year. I had a gap year and sat them the following summer.’

‘You had a miscarriage?’ Even though her eyes were telling him to back off, he needed to touch her. Comfort her. Feel her touch comforting him. They’d lost a baby and he’d had no idea. He reached across the table and took her hands. ‘Hol, I’m so, so sorry. I had no idea. If I’d known, or even guessed…I would have been right there with you. I’d have sat by your bedside and held your hand, and to hell with my exams.’

She withdrew her hands. ‘Yeah, right. You cared that much.’

‘You know I did. I loved you, Holly. More than anyone.’ Before—or since. Not that she needed to know that. ‘Your mum said you didn’t want to speak to me. I didn’t believe her, so I waited outside your house, hoping I’d get a chance to see you. You were in the car with your mum. And you blanked me.’

‘What did you expect? David, I’d just had a miscarriage. I couldn’t take my exams so I lost my place at university, and my career plans had gone down the toilet. And, worst of all, my so-called boyfriend couldn’t even be bothered to return my calls.’

‘I did ring you. Several times.’

‘Right. And that’s why you went on holiday with another girl?’

‘I did what?’

‘When I…Afterwards.’ She gulped and David suddenly realised how much it must have affected her. Maybe that was the reason why the sweet Holly Jones he’d once known had become so hard. Since she’d lost their baby and thought he’d deserted her.

‘When I thought I could face you without crying, I went round to your place. Your mum was there on her own. She said you’d gone on holiday, with another girl.’

None of this made sense. Had he just been transported to some weird parallel universe? ‘Don’t be stupid. She wouldn’t say something like that.’

‘You’re calling me a liar?’ She folded her arms. ‘You weren’t there. It was the week after the exams finished.’