Emergency Doctor and Cinderella (2 page)

Eamon Chapman didn’t speak but continued to look at her with that piercing green gaze of his.

‘You know what some relatives can be like,’ Erin argued. ‘They don’t believe their loved one was involved in something shady. “He’s a good boy” and all that. “Someone else did this to him”. “The doctors didn’t save him”. Blame anyone and everyone except the person responsible.’

Eamon put the paper back down on his desk. ‘I realise emotions run high in cases like this for everyone involved. Mrs Haddad may well withdraw the complaint after legal counsel. But even so there are still some issues that need to be dealt with in A&E. You will become aware of them once you read my proposal for change.’

Erin rose from the chair, holding the folder against her chest like armour. ‘I’ll read it and get back to you,’ she said.

‘You do that,’ he said with a half-smile that didn’t meet his eyes.

She turned on her heel and was almost out the door when his deep baritone voice stopped her in her tracks.
‘By the way, I checked the numbers in the parking area. Unless they are written in Braille, I am very much afraid a blind man could not see them.’

Erin turned back to face him. There was a hint of mockery in his sea-green gaze that made her scalp prickle in annoyance. ‘I’ll speak to the maintenance guy about having them repainted,’ she said with the arch of an eyebrow. ‘Or would you like him to paint arrows, or a big, fat, fluorescent “X” so you know exactly where to park?’

A tiny muscle moved next to his mouth. Erin wasn’t sure if he was fighting anger or a smile; either way, it made him look even more attractive than he had last night. She felt the tiny flutter of her pulse, and a tingling of her flesh that made her breath catch as his eyes held hers.

‘Just my number would be fine, thanks, Dr Taylor,’ he said, and reached for his ringing mobile that was clipped on his belt. ‘Excuse me. I have to get this.’

Erin spun away and closed the door with a sharp click behind her. She strode back to A&E; for the first time in her career she was immensely glad to see an overflowing waiting room.

It wasn’t until Erin was back at her flat with her cat, Molly, on her lap that she picked up the document Eamon Chapman had given her that morning. She absently stroked Molly’s thick fur as she read through the proposal, trying to ignore the sound of the sliding doors opening on the balcony next door. She had heard him come home about an hour after her. It gave her a slightly unsettled feeling to think of him on the other side of the wall. To her annoyance she found her thoughts drifting to what his routine might be: would he
shower and change before dinner, or would he watch the news on television, perhaps have a beer or a glass of wine if he wasn’t on call? Would he cook his own dinner or eat out? Did he have a partner? Was there a Mrs Chapman who would lie next to him in bed at night and be folded into his arms…?

Erin pulled away from her wayward thoughts and focused back on the words printed in front of her. So far there had been some sensible suggestions on streamlining triage and reducing the number of minor cases that should have been handled in general practice. The next section was on follow-through care. Her eyes narrowed as she read the plan for A&E doctors to conduct their own ward-rounds on the patients that had come into the hospital via the emergency department. As she read each word, she could feel a tide of panic rising inside her. She wasn’t trained to sit by patients’ bedsides and discuss the weather or their personal lives; she was trained to respond to emergencies, to stabilise patients before sending them on to definitive care. She would never be able to cope with all the names and faces, not to mention the added burden of thinking about patients and their lives outside of A&E. She put them out of her mind once they left the department. She had to, otherwise she would end up too involved, unable to remain at a clinical distance.

Erin tossed the document to one side and got to her feet, dislodging Molly, who gave an affronted miaow before turning her back to lick each of her paws with meticulous care.

The doors of the balcony beckoned and Erin slid them open to look out over the view of Sydney Harbour and the city on the opposite shore. Yachts were out,
some with their colourful spinnakers up, looking like one-winged butterflies. Smaller craft bobbed about on the light swell and passenger ferries crisscrossed their way through the water, carrying people home from work or into the city for entertainment or dinner.

She gripped the balcony rail with an iron grip and lifted her face to the breeze, breathing in the salty air, wishing she could be on one of those yachts and sail away into the sunset.

‘You wouldn’t happen to have a cup of sugar, would you?’ Eamon Chapman’s voice sounded from her right.

Erin swivelled her head to look at him, her heart giving a little free fall. He was bare-chested, his legs encased in dark blue denim slung low on his lean hips. Every muscle on his chest and abdomen looked like it had been carved into place by a master craftsman. She had studied anatomy, yet not one of her textbooks would have done Dr Eamon Chapman justice. ‘Um…sugar?’

His mouth tilted wryly. ‘Yeah, that sweet stuff you put in coffee. I forgot to get some when I shopped on the way home.’

Erin brushed a strand of hair that the breeze had worked loose from her chignon away from her face. ‘The shops are only a short walk away,’ she pointed out.

‘So you don’t have any?’ he asked, leaning on the dividing rail with his strong forearms. ‘Sugar, I mean?’

Erin tried not to look at the way his biceps bulged as he leaned his weight on the railing. He was more or less at eye level, which was disconcerting to say the least. This close she could see tiny brown flecks in his green eyes that fanned out from his dark-as-ink pupils. ‘I…I don’t take sugar,’ she said.

His mouth tilted even further. ‘Sweet enough, huh?’

This time Erin was sure he was mocking her. ‘I have five fillings,’ she said primly. ‘I am not keen on getting any more.’

‘Didn’t your mother teach you the importance of dental care?’ he asked.

She schooled her features into a blank mask, hoping he hadn’t noticed the slight flinch at the mention of her mother. ‘It wasn’t one of her strong points, no.’

Erin felt his silent scrutiny, as if he was reading her word by word, page by page. She wanted to go back inside but she felt inexplicably drawn to him, like tiny iron filings to a strong magnet.

‘It’s quite a coincidence, me moving in next door, don’t you think?’ he asked.

She gave a little shrug. ‘There are three nurses and an orderly in this apartment block. Mosman’s a convenient suburb. It’s close to Sydney Met.’

‘Are you renting or do you own your apartment?’

‘The bank owns it,’ she said. ‘I work to keep up the payments.’

Erin had forgotten to close the balcony doors and Molly chose that moment to strut out like a model on a catwalk.

‘I didn’t realise you were allowed pets here,’ he said, looking down as Molly began to weave around Erin’s legs.

She grimaced as she scooped up the big fluffy bundle of fur. ‘I–I’ve got special permission from the body corporate,’ she lied.

Eamon Chapman cocked his head, as if debating whether to believe her. ‘Isn’t it cruel to house a cat indoors all the time?’

Erin stroked Molly’s silky head. ‘She’s a Ragdoll. They prefer to be indoors.’

‘What’s its name?’

‘Molly.’

‘One of my sisters has a cat,’ he said. ‘Personally I’m a dog man, but yours looks cute.’

‘Thank you.’

He straightened from the railing and stretched. Erin’s eyes nearly popped out of her head, like popcorn from a hot pan, as each of his muscles rippled in response.

‘Have you had time to look at my proposal?’ he asked as his arms came back down to his sides.

Erin had to blink a couple of times to reorient herself. ‘Um…yes, I have. I’m not sure it’s going to work—that follow-through care thing—it’s too complicated. A&E is too busy as it is to expect us to wander off to plump up patients’ pillows on the wards.’

‘You’re missing the point, Dr Taylor,’ he said. ‘It’s not about plumping up pillows; it’s about treating the patient from start to finish as a person, not a statistic.’

‘I don’t treat patients as statistics.’

‘Tell me the names of the last five patients you saw today.’

Erin stared at him as her mind went completely blank. She could barely remember faces, let alone names. It had been so frantic, especially when an elderly woman had been brought in with a cardiac arrest at the same time a head injury had arrived. Names hadn’t been important; what had been important was saving lives that were hanging by a gossamer thread. ‘I didn’t have time to memorise their names,’ she said, putting Molly down. ‘My job is to save their lives.’

‘Do you ever wonder what happens to them after they leave you?’ he asked.

Erin didn’t want to admit how much she wondered about them. She saw it as a weakness in herself, a frailty
that should have been knocked out of her way back in medical school. She fought against her human feelings all the time; they kept her awake at night—the sea of faces that floated past like ghosts. ‘Not really,’ she said, her tone chilly. ‘As I said, it’s not my job.’

‘You might want to have a rethink about that, Dr Taylor,’ he said. ‘The first trial ward-round begins tomorrow at the end of your shift.’

Erin forced her gaze to remain connected to his. ‘Well, I can’t see that working. You know as well as anyone that A&E shifts don’t end according to the clock—they end when you finish treating your last patient, or at least get them to the point where you can hand them over to the next shift. You can’t just breeze out to start chatting with folks on the ward.’

‘You’re so right. I am quite aware of that,’ he said. ‘If you read the plan properly, you would see that wind-up on your last patient starts an hour before your shift ends—that gives you at least part of the last hour to do ward follow-through.’

Erin gave him a mutinous look. ‘Oh, so we just walk out an hour
before
our shift ends then, and I suppose the next shift starts an hour early to fill in the gap? Or maybe we just abandon A&E altogether for an hour. Look, you can hardly force already overworked staff to take on even more responsibility.’

‘If you had read the proposal carefully, Dr Taylor, you would see that new arrangements do not mean more responsibility, just different responsibility. And, as far as implementing this plan, I’m not a great believer in using force to achieve anything,’ he said. ‘But I am the director, and I would like those working in my team to actually
be
a part of that team. The response from
everyone else has been very positive, actually. I think you are going to find yourself out of touch with what everyone else is doing if you simply reject the department’s policies.’

She arched her eyebrows. ‘So, what do you plan to do, Dr Chapman? Hand-hold every A&E doctor until you’re confident they’re doing things your way?’

Eamon held her pert look, privately enjoying the way her burnt-toffee-brown eyes challenged his. Her defensive stance made him wonder why she was so against change. None of the other doctors he had briefed that morning had expressed any opposition to his proposal. In fact, three of them had cited cases where if such a plan had already been in place patient outcomes would have been better.

From what he had heard Erin Taylor was not one of the more social members of the department. Apparently she never joined in with regular drinks on Friday evenings at one of the local bars, and as far as he could tell she lived alone, apart from a contraband cat. She was prickly and unfriendly, yet her clinical management of patients was spot-on. She was competent and efficient, although one or two of the nurses had mentioned in passing her bedside manner needed work.

‘I have certain goals I would like to achieve during my appointment,’ he said. ‘One of them is to improve overall outcomes for patients coming through A&E in this hospital. What you might not be aware of is how your expert work in A&E can be undone by isolating later management teams from the acute-care team. When was the last time you did a tertiary survey? It’s mentioned in EMST and ATLS, but hardly ever happens. Sometimes injuries and clinical clues get missed
in the wards. There is clear evidence that tertiary survey by the doctor who carried out the primary and secondary surveys is more likely to detect missed injuries, and so avoid complications which eat up beds and cost money.’

She continued to eyeball him in that ‘I don’t give a damn’ way of hers. ‘So, how long do you intend on propping up the public system before you scoot off for far more lucrative returns in the private sector?’

Eamon cocked an eyebrow at her. ‘I could ask you the very same question.’

She held his look for a moment before turning to look at the harbour. The sun was low in the sky, casting a pinkish glow over the sails of the Opera House and the towering skyscrapers of the city on the opposite shore. ‘I’ve thought about it plenty of times,’ she said. ‘But so far I haven’t got round to doing anything about it.’

‘You don’t like change, do you, Dr Taylor?’ Eamon asked.

She turned to look at him, her expression like curtains pulled across a window. ‘I can deal with change when I think it’s appropriate,’ she said, and without another word slipped inside her apartment and shut the sliding doors—locking him out in more ways than one, he suspected.

E
RIN
had not long finished stitching a leg wound on a teenager the following morning when Tammy alerted her to a new admission.

‘Forty-five-year-old male complaining of severe back pain,’ Tammy said, reading from the notes she had taken down. ‘His wife found him on the floor of the bathroom. He’s nauseous and vomited prior to arriving in A&E.’

Erin twitched aside the curtains in bay four and introduced herself. ‘Hello, I’m Dr Taylor. The triage nurse tells me you’ve got back pain. Can you describe it exactly?’

The man pointed to his left loin. ‘Here…’ he said somewhat breathlessly. ‘Every couple of minutes…I…. ahh…!’ He writhed and groaned on the bed as his ashen-faced wife clutched one of his hands in hers.

‘We’ll give you something for the pain and nausea,’ Erin said, administering morphine, buscopan and stemetil IV, with Tammy assisting.

‘Is he going to be all right?’ the man’s wife asked.

‘How long have you been unwell, Mr…’ Erin glanced at the notes ‘…Aston?’

‘I…I haven’t been sick for years,’ he said, and turned his head to his wife. ‘Have I, love?’

Mrs Aston nodded. ‘That’s right, Doctor. He’s never even taken a day off work in thirty-odd years. He’s always been—’

‘How’s the pain now?’ Erin asked as she clicked her pen open.

‘Eased off a bit,’ Mr Aston said, regaining some colour in his face as the pain-relief flooded his system.

‘When did you first feel unwell?’ Erin asked, pen poised over her patient-history clipboard.

‘First thing this morning,’ he said. ‘I woke up to go to the toilet and then it hit me, didn’t it, love?’

‘I found him on the floor of the bathroom,’ his wife put in. ‘I nearly had a heart attack myself.’

Erin acknowledged the wife’s statement with a movement of her lips that was neither a smile nor a grimace but something in between. ‘I need you to give me a urine sample if you can manage it, Mr Aston,’ she said, addressing the patient once more. ‘I’d also like you to have an abdominal X-ray. The nurse will organise that while I see to another patient. Once we have the results of the urine sample, we’ll know more.’

‘Is it cancer?’ Mrs Aston asked hollowly. ‘Jeff used to smoke, didn’t you, dear? He gave it up…what?…ten years ago now, it must be. I remember the day. It was when we went to—’

‘We’ll know more once we get the results back from the tests I’ve ordered,’ Erin said briskly.

Tammy took over the care of the patient as Erin moved to the next bay. She parted the curtains to see Dr Chapman standing by the bedside of a young child with his mother. ‘Oh, sorry,’ Erin said. ‘My patient must have been moved into another bay.’

Eamon gave her a formal smile which Erin suspected
was for the sake of the patient. ‘Mrs Forster has been taken for a CT scan. This is Hamish, and his mother, Karen Young. Hamish here has had a persistent discharge from his right nostril for about a week, but this morning the discharge was blood-stained. We were about to have a look inside, weren’t we, Hamish? You don’t mind if Dr Taylor watches, do you? I bet she’s never seen a braver young man around here.’

The young boy of about three stared wide-eyed but trustingly at Eamon, who picked up a nasal speculum and bright light. Erin was privately a little impressed at how biddable the child became under Eamon’s care. She’d had a child with a foreign object up its nose only a month ago, and the floor above had heard its screams when she had tried to retrieve it. In the end she had handed the case over to the ear, nose and throat surgeon who had removed a plastic bead under general anaesthesia.

‘There,’ Eamon said as he showed the child and his mother the bright blue bead he had found. ‘You were a champion, Hamish. I’ve seen kids twice your age who would have screamed the place down.’

‘Weally?’ Hamish asked, still a little bug-eyed.

‘You betcha,’ Eamon said, and then he turned and winked at the young mother. ‘You can take him home now, Mrs Young. He’s good to go. Just put the ointment Nurse will get for you up his nostril three times a day, and massage it in a bit, until you’ve finished the whole tube.’

Once the young mother and her son had left, Eamon turned to Erin. ‘I’d like a word with you if you are free, Dr Taylor.’

Erin gave him a wary look. ‘I have a patient who should be back from X-ray by now.’

‘That would be Mr Aston next door?’ he asked.

She flattened her mouth at his expression. ‘I thought the plan was to have some sort of continuity of care around here,’ she said, keeping her voice down in case the patient had returned. ‘If I go off for a lengthy discussion with you, who’s going to follow up Mr Aston?’

‘Meet me in my office once you have finished assessing him,’ he said, pushing the curtains aside. ‘Unless, of course, anything urgent comes in.’

Erin blew out a breath once he moved past. It would be just her luck that today would be one of those quiet days, leaving her with no excuse to avoid another confrontation with him.

Mr Aston was being wheeled back to the examination bay when Erin returned, after responding to an HMO’s phone call about another patient who had been admitted the day before.

Mr Aston’s urine sample was positive for blood and his X-ray almost certainly showed a stone at the end of the right ureter. Erin ordered a rapid-sequence urinary-tract CT, which confirmed the finding, and she explained the results to the patient and his wife. ‘You have renal colic, Mr Aston, which basically means you have a kidney stone. Very often stones pass spontaneously, but occasionally they don’t.’

‘What happens then?’ Mrs Aston asked.

‘If the stone doesn’t pass, it may have to be removed under anaesthesia. We’d get a urologist to see you to do a cystoscopy—put a camera up the front passage into the bladder—and use a wire basket to grab the stone and pull it out.’

‘Oh dear, it sounds horribly painful,’ Mrs Aston said, grasping her husband’s hand again.

‘He’ll be fine, Mrs Aston,’ Erin said. ‘The ENT specialist is one of the best in the city.’

Once she had left the patient’s bay, Erin looked at the clock and thought longingly of a cup of tea and a sandwich, even one from the hospital cafeteria. But over an hour had passed since Eamon Chapman had asked her to meet him in his office, so rather than delay the inevitable any further she trudged through the department to where his office was located. She gave the door a quick knock, secretly wishing he had been called away, but she heard his deep voice commanding her to come in.

He was sitting behind his desk but rose to his feet as she came in. ‘Have you had lunch?’ he asked.

‘No,’ Erin said, wondering if he could read her mind or hear her stomach in this instance. ‘But it can wait.’

‘No need to. Why don’t we head on down to the cafeteria and grab a sandwich now?’ he asked.

She looked at him as if he had gone mad. ‘I take it your plans to improve this hospital from top to bottom haven’t quite made it to the cafeteria?’ she said dryly.

He gave her a rueful smile. ‘That bad, huh?’

She felt her lips twitch, but forced them back into line. ‘Keep away from the salami and the chicken. We lost three staff members to a tandoori wrap three weeks ago.’

His dark brows lifted. ‘“Lost” as in…?’

‘Lost as in sick for a week with a reportable disease,’ she said. ‘A couple of us had to do double shifts to cover them.’

His lips twitched this time, making his eyes crinkle up at the corners. ‘There’s a café on the other side of the car park,’ he said. ‘Does that have any black marks against it I should know about?’

‘They do a mean salad sandwich with mung beans and alfalfa sprouts,’ she said. ‘And their coffee’s passable.’

He picked up his mobile from the desk and clipped it to his belt. ‘Let’s give it a try. I’ll just let Jan at reception know we’ll be within paging distance.’

A few minutes later, sitting opposite Eamon Chapman in the café across from the hospital, Erin wondered how long it had been since she’d shared a meal with a man, even a colleague. She hadn’t dated since medical school, and even then it had been an unmitigated disaster. In the end she’d decided she wasn’t cut out for the couples’ scene. Most of the men she knew were complicated creatures with too much baggage—not that she could talk, given the veritable road-train she had brought with her from Adelaide. But this was hardly a date, she reminded herself. She was pretty certain Eamon Chapman had other things on his mind besides chatting her up. From what she could read from his expression, she was in for a dressing down if anything.

‘So,’ he said, leaning back in his chair to study her pensive features. ‘How long have you been at Sydney Met?’

Erin was aware of his steady gaze on her as she toyed with the thick froth of her latte with a teaspoon. ‘Five years,’ she said, meeting his eyes for a brief moment. ‘I spent a year in the States before that.’

‘Travelling or working?’

‘A bit of both,’ she said.

‘Did you grow up in Sydney?’

Erin’s teaspoon gave a tiny clatter as she placed it back on the saucer. ‘No. I grew up in South Australia. I moved to Sydney when I was a teenager.’

He took a sip of his cappuccino; her gaze was suddenly mesmerised by the tiny trace of chocolate that clung to his top lip before his tongue swept over his mouth to clear it. She swallowed a little restriction in her throat and quickly dropped her gaze, picking up her teaspoon again and stirring her latte with fierce concentration.

‘So, do you have family here or back over there?’ he asked.

Erin put her spoon back down and met his gaze. ‘Look, I hate to be rude, but what’s with the twenty questions?’

His eyes bored into hers for a tense second or two. ‘I like to get a feel for the people I will be working with on a daily basis. It’s an important part of being a leader, knowing the team’s strengths and weaknesses.’

She screwed up her mouth in an embittered manner. ‘Do you trust your own judgement on that, or are you usually swayed by others’ opinions?’

He accepted her comment with an unreadable look. ‘I lean towards the “innocent until proven guilty” philosophy where possible.’

She gave a little snort and reached for her coffee again. ‘Yeah, well, I bet it didn’t take long for some members of the jury to swing your opinion.’

‘What makes you say that?’ he asked.

Erin gave her shoulders a gentle shrug. ‘Gut feeling; instinct; experience.’

‘I wanted to have a word with you about how you handled Mr Aston,’ he said after a short silence.

Erin’s gaze flicked back to his. ‘It was straight-out renal colic. He’s got a stone the size of a marble. He’s not going to pass it without surgical intervention.’

‘I’m not for a moment questioning your diagnosis,
Dr Taylor,’ Eamon said. ‘But I think you could improve on your handling of accompanying relatives. Coming into A&E is stressful for both patients
and
relatives.’

She set her mouth into a defensive line. ‘My job is to treat the patient, not pander to their entourage.’

Eamon put his coffee cup back in its saucer, his eyes holding hers. ‘Listen, managing the relatives is
part
of treating the patient. Stressed relatives worsen patients’ stresses. And accompanying relatives are usually going to be the patient’s carers afterwards. One, they need to be well informed. Two, if they are stressed out and decompensate, they won’t be good carers. That means more time for patients in hospital, more hospital expense and more loss to the community. I’ve only been in the department less than twenty-four hours and I have already heard several complaints about your handling of relatives, yesterday’s threat of litigation being a case in point.’

Her slim jaw tightened. ‘Mrs Haddad’s suit will be rejected as soon as the medical council read through my notes and realise the extent of her son’s injuries.’

‘That is most certainly the case; however, the whole thing may well have been avoided if you had softened your approach.’

‘You know nothing of my approach,’ she said, shooting him a livid glare. ‘You weren’t there trying to save the boy’s life. When someone is bleeding out before your eyes, it’s not exactly the time to ask how his mother or his family are feeling, for God’s sake.’

Eamon leaned forward in his chair, his arms resting on the table. Erin moved back, folding her arms across her chest, her chin at a defiant height. ‘As you are now aware, I was in the bay next to you when you were
assessing Mr Aston,’ he said. ‘His wife was clearly distressed to see her normally healthy husband in such a state. A reassuring word to her wouldn’t have gone astray, not cutting her off in mid-sentence.’

Erin rolled her eyes, and, pushing back her chair, got to her feet in one angry movement. ‘I haven’t got time for this. I’ve got patients to see.’

His green eyes hit hers. ‘Sit down, Dr Taylor.’

Erin’s hands gripped the chair-back with white-knuckled fingers. She was so tempted to shove the chair back underneath the table to drive home her point, but the steely look in his eyes forestalled her.

Several tense seconds passed before she reluctantly gave in. She sat back down, crossing her arms and legs as she sent him a querulous look. ‘You said you’d had other complaints about me,’ she said. ‘Am I allowed to know who they were from?’

He leaned back in his chair, but the hardened look hadn’t softened in his eyes. ‘That would be unprofessional of me. The complaints were made in confidence; in fact, they weren’t even official, just passing comments. No one is out to get you, Dr Taylor, far from it. Generally the staff speak very highly of you, on a professional level.’

‘So my bedside manner needs some work,’ she said with a petulant huff of her shoulder. ‘Pardon me for putting patients’ lives in front of politeness.’

‘I don’t see why you can’t manage both,’ he said. ‘Or do you have a particular reason for being so prickly with everyone?’

Erin felt the probe of his gaze and had to work hard to maintain eye contact. Something about him made her feel exposed. Even though she had only met him the day before, that intelligent, penetrating gaze of his had
a habit of catching her off guard. He was seeing things she didn’t want him to see, things she had fought hard to keep hidden. She liked her life in its neat little compartments, but she felt as if he was threatening her stronghold, insisting on her being someone she was not, nor ever could be. ‘I’m not interested in winning the latest popularity contest,’ she said. ‘If people don’t like me, I don’t let it worry me. I have better things to do with my time.’