“Mr Denton is going to be dischargedtoday, Dr Murphy,” Simon told me as he looked down at me in my crouched position next to Kevin.
“Dr Tabard,” I said as I pushed up to my feet, unfortunately the bastard still loomed over me, but never mind. I shoved down that sick, anxious feeling he provoked and tried to keep my voice steady. “I really don’t think that it’s safe for–”
“Dr Murphy,” he continued, with that slimy smile on his face to cover the fact he was shaking with rage. “When you’re the consultant, maybe you will understand that non-urgent patients can be investigated on an outpatient basis. If we all practiced medicine like you, the NHS would be bankrupt within a week . . . Kira? Are you listening to me?”
No, no I wasn’t, because at some point during that little speech, Kevin had started to fall off the bed. I lurched forward at the same time as Mark to catch him and we both hauled him back up. That was when the fitting started. His eyes rolled back, his body went stiff, and he started convulsing so violently that the bed was shaking. Simon was the most senior doctor there and therefore should have taken the lead. I glanced around from my attempts to stop Kevin from falling to the floor, but saw that Simon had taken a step back and was staring at us in shock with his mouth hanging open. No help there.
“Sandra, call the outreach team, then get some rectal diazepam and the crash trolley please,” I said as Kevin started frothing at the mouth. “And a Guedel airway and some more help here.”
“Right, yes,” she said, sprinting away from us.
“Mark, help me secure his airway and let’s put the cot sides up. Simon? Simon, can you do that?”
“Er . . . what?” he asked, then took a deep swallow.
“Can you put the cot sides up?” He remained rooted to his spot a few feet from us. “Now!” I snapped and he flinched before finally moving forward to do as I asked.
“Okay,” Sandra panted after sprinting back to us. “I’ve got it. Tamra is calling the team.”
“Right, help me roll him,” I said. Kevin was still shaking and thrashing on the bed. Sandra went to his legs and Mark was at his head. Simon, the unhelpful wankpuffin, had taken a step back again. “Okay, three, two, one roll.” We rolled Kevin onto his side.
I glanced up to see Mr Lucas at the entrance to the bay with his mouth open. “Curtains!” I yelled at Simon, who thankfully pulled them around so I could pull Kevin’s trousers down and administer the rectal diazepam. We held him on his side for a few seconds. I managed to get IV access and Mark hooked Kevin up to the monitoring.
“Right, we’ve got to secure an airway properly. His stats are too low. Where is the outreach bloody team? Okay, turn him again.” Kevin’s oxygen levels on the monitor were falling despite the Guedel airway and oxygen we were administering. I swapped with Mark and went to the head end, tilted Kevin’s back and lifted his chin. “Laryngoscope,” I barked, and Sandra handed it to me. I pushed it down into his mouth and visualised the chords despite Kevin’s continued movements. “Airway.” Sandra handed me a laryngeal airway tube and I pushed it down past the chords. Once it was in, Mark passed me the bag, already attached to oxygen, and we started ventilating Kevin. Kevin’s oxygen stats were low but on the rise, slowly.
“Blood glucose?” I asked Lily.
“Normal.”
“Okay, he needs a four-milligram lorazepam bolus IV.”
“On it,” Lily said, routing around in the crash trolley.
“Hey, Kira?” Tim, the anaesthetist on the outreach team pulled the curtain back and I breathed a sigh of relief. One of Tim’s team took over the ventilating of Kevin from me and I took a step back. “Bugger me, you’ve intubated him already?”
“Well, whilst you guys were scratching your arses on ICU, Kevin’s stats were dropping and I–”
“Hey,” Tim said, and I broke off to take a deep breath. My hands were shaking and my voice had been too. “I wasn’t having a go. You’ve done really well.” I let the air out through my nose and gave a quick nod, tucking the hair that had come loose from my ponytail behind my ears.
“Shall I give the lorazepam?” Sandra asked, pushing in behind Tim. I nodded and then started to do the patient hand-over to Tim. My heart was still pounding, but at least my voice was steadier. I included the fact that I suspected cerebral toxoplasmosis and that Kevin was due for an inpatient MRI.
“What are these discharge papers doing here, then?” Tim asked, picking them up from where they’d fallen to the floor.
“Dr Tabard was going to discharge him,” I said as Tim drew the curtain back and stepped out to look at Simon, whose face was a little green.
“You were gonna send this dude home, Si?” Tim asked, his eyebrows going up in disbelief. “Ballsy move, mate. There was focal neurology.”
“I, well . . . I–”
Simon’s face was flushed now and there was a trickle of sweat making its way down his temple.
“Good job you’ve got such great juniors taking your back, eh?” said Tim, his eyes narrowing on Simon, no doubt wondering why I was leading the peri-arrest when there was a consultant right there to take over. “Well done, Kira,” Tim said, giving me a quick pat on the shoulder. “We’ll get him up to ITU and sort him out.”
My bleep chose that moment to go off and I looked down at the extension number for the medical assessment unit flashing at me.
“Thanks Tim. Gotta go. I’m on-call so . . .”
“No worries.” Tim turned back towards the cubicle, not bothering to acknowledge Simon again.
