She kept her voice light, but her words were carefully chosen.
One of the other docs in the room snorted into her coffee. She lifted her cup to Clara. ‘Welcome, and I like you already. I’m Lucy and, if you don’t know it yet, these morning meetings are like a race to see who can get here first.’ Lucy looked at Joshua. ‘Although the boss usually waits until everyone is in the room.’
Lucy connected her gaze with Joshua’s frown and stared him straight in the eye. There was an unspoken implication there, and Clara appreciated it.
She sat down in one of the chairs. ‘Well, I’m sure if I’ve missed anything significant Dr Woodhouse can fill me in later.’
There were a few seconds’ silence and then Joshua shifted on his chair before he started speaking again. The meeting went quickly and was over in thirty minutes. Joshua briefed the staff on a product recall, new dosage instructions for a drug used commonly in paediatrics, sick leave cover and alerted them to a few patients he wanted closely monitored. Dr Morran followed up, highlighting a few of her own patients with special instructions. Other members of staff jumped in with general information about delayed results, special consults awaited from other areas and new admissions. Now Clara knew why Ron had told her to bring coffee. The amount of information crammed into that thirty minutes was huge, but crucial for a safe, smooth-running department.
She scanned the room, putting names to faces she hadn’t met yet. Her phone vibrated in her pocket and she tilted it sideways to see who it was. Ryan. Guilt swamped her. She hadn’t really had a chance to have a real conversation with him since she’d got here. They’d left messages, but kept missing each other. She knew there had been a complication about him moving out of her place—and she had emailed Georgie an apology—but the reply had been short and sweet.
No problem. These things happen.
She wondered what Ryan was making of the mysterious Georgie. Everyone here talked about her with real affection. She couldn’t help but hope her colleagues back in Scotland had been a bit more friendly than Joshua.
‘Dr Connolly?’
She jumped at the stern-sounding tone, embarrassed that her mind had wandered off while the others were leaving the room.
But, before she got a chance to respond, her pager sounded in her pocket.
She glanced at the pager. ‘Duty calls,’ she said with an uncomfortable smile on her face, before disappearing out of the ward towards the stairs.
As she hurried down the stairs to A&E she wondered if she’d already got herself in trouble. The doctor in A&E had asked her to attend. She already knew that the protocol stated that all children got fast-tracked up to the assessment unit, so they weren’t left in the A&E environment which could, on occasion, be stressful for children. But Clara liked to have a little faith in her colleagues. If an A&E consultant was asking for the paediatric page holder to attend, then she would go.
She pushed through the swinging doors and made her way to the nurses’ station. Joe Banks, a guy she’d met briefly the previous week, gave her a wave. ‘You on call?’
She nodded.
‘Good. I’ve got an unusual one for you; feel free to ask for a second opinion.’
Clara flinched, wondering if he was questioning her skills. But her rational brain made her take a deep breath. The guy had barely met her. If this was an unusual case, it wasn’t strange to ask for a second opinion.
He pointed to the screen in front of him and pushed a chart towards her with his other hand. She scanned the screen. A seven-year-old girl with fever, tachycardic and itchy rash. It could be any one of a hundred things, and not that unusual a case.
Joe lifted his hand as if he’d read her mind. ‘Wait until you see the rash. I’ve put this kid in a side room meantime, until you decide if she’s infectious or not.’
Ahh... Now she understood. If the triaging doctor in A&E thought a child could have an infectious disease, they wouldn’t send them up to the assessment unit. That could result in a whole host of other children and relatives becoming exposed to whatever virus they carried.
Clara picked up the notes and gave him a smile, ‘Thanks,’ she said as she walked towards the side room. Outside were some basics—gloves, masks and aprons, along with hand sanitiser. For an airborne infection, masks like these weren’t effective, but old habits seemed to die hard. Clara used all the equipment provided and went in to make her own assessment.
‘Hi there, I’m Clara, the paediatric doctor.’ She smiled at the anxious-looking mother and the little girl, who was lying sleepily on the bed. ‘I’m going to ask you a few questions and take a look at Jessica, if that’s all right with you.’
The woman nodded. ‘I’m Meg.’ Her eyes ran up and down Clara’s body. ‘Should I be wearing those?’
Clara shook her head. ‘We’re not even sure if Jessica has anything infectious yet. If she does, we’ll take the right precautions.’
She proceeded with a list of questions, gathering the background and history of Jessica presenting at hospital today. She also asked Meg a few questions, checking to see if she was pregnant, or if she, or any other members of the family, had any symptoms of their own. It was all just precautions. Some infectious diseases spread easily between close contacts, and some were risky if a woman was pregnant.
Once she’d asked all her questions, she rechecked Jessica’s temperature, her heart-rate, and gently removed the hospital gown to get a better look at the rash.
Her pager sounded and she glanced down to where it was clipped to the pocket of her coat. The number was for the ward upstairs. She had a horrible feeling in the pit of her stomach that someone was checking up on her.
There were so many conditions that this could actually be—measles, meningitis, or even just a viral infection. Although some rashes were distinctive, many—in the early stages—were indistinguishable. As she kept examining Jessica she turned over one of the palms of her hands and stopped, turning back. There, on the side edge of her hand, was a strange mark. Clara leaned a bit closer. Was that a bite, or a scratch?
Either way, the area around it was slightly red and inflamed. It wasn’t completely obvious, and could easily be missed.
‘Do you have any pets?’ she asked Meg.
Meg nodded. ‘Two cats, an ancient tortoise and a rat.’
Clara gave a small nod in reply and made some notes. ‘First of all, I’m going to prescribe something for Jessica to bring her temperature down, and then I’m going to order some tests. I’ll try and ensure they happen as quickly as possible. Let me do that, and then I’ll come back and talk to you again.’
Meg gave a half-smile, looking semi-relieved. Something was flickering in Clara’s brain—a condition she’d only seen once before. She wanted to check some of the details before she asked any more questions.
It was odd. She absolutely knew that she had to rule out all the normal things that could cause a fever and rash. The list was almost endless, but something deep down inside her was just telling her not to ignore that tiny bite mark.
She’d seen a case before of a disease caused by a rat bite. But she had to check the details. She had to be sure.
A voice appeared at her back. ‘What’s the problem down here?’
Her muscles stiffened. She hadn’t even had a chance to chart her preliminary findings. Last thing she wanted was her new boss looking over her shoulder while she ordered some unusual tests.
‘Don’t you realise that all children go straight up to the assessment unit? It’s a well-known fact that A&E environments can cause unnecessary stress for both children and their families.’
She bristled, trying at first to bite her tongue, and then deciding to just go with how she felt. She spun around, keeping her demeanour entirely professional. ‘Of course I know that. I’m not some half-ass student. If I’m keeping our patient down here, I have an entirely good reason to do so.
’
He flinched, obviously not expecting her answer to be so direct. But he was acting so pompous, talking to her as if she were some kind of inexperienced idiot. She heard a gentle cough next to them both and turned to see Alan Turner, the head of A&E, raise one eyebrow and give her a half smile.
She tried to restrain her flare of anger back into a less flammable state. ‘Don’t worry, Dr Woodhouse,’ she said quickly. ‘If I need your expertise I’ll be sure to let you know. Everything is under control.’
Joshua stared at her, long and hard. She could almost see his brain whirring, trying to decide whether to reprimand her or leave it for the time being. He glanced sideways at Alan, who was pretending not to listen to them both—even though he clearly was.
‘I expect to hear from you soon,’ Joshua said through clenched teeth.
‘Of course,’ she said with an enforced breeziness in her tone and watched as he spun around and strode down the corridor so fast he looked as if he might break into a sprint.
Alan moved over next to her, looking down at the forms in her hand. The blood test she’d been looking for hadn’t appeared on the IT system—probably because it was so unusual, so she’d written the order by hand.
He made a surprised nod. ‘Haven’t seen that one before.’