Spanish Doctor, Pregnant Nurse

Harriet felt her confident introduction dissipate into a croak.

‘That would be me,’ she somehow managed, dragging her eyes upwards. Incredibly tall, he was easily a good few inches taller than Drew who stood at six-one, but there was nothing remotely slender about him. Ciro was an absolute brute of a man, impossibly wide shoulders, the short-sleeved theatre blues displaying muscular forearms, dusted with dark hairs. Even his hands, holding out a casualty card towards her, were somehow sexy—olive-skinned and long-fingered. Harriet immediately felt incredibly guilty for even noticing they were utterly devoid of a wedding ring.

‘The sister who was on before was very dismissive, but I am preocupado…’ Ciro hesitated. ‘Worried,’ he corrected, and even though she’d already guessed what he was alluding to she gave a small appreciative nod when he translated his word effectively. ‘Very worried and concerned about this patient.’

Grateful for something to concentrate on other than this divine specimen, she took the casualty card and skimmed through the notes written by the evening doctor Ciro had taken over from, cutting through the medical jargon in a moment and summing up the bare facts. ‘Alyssa Harrison, fifteen years old. Fell at a ballet rehearsal, lacerated scalp, sutured, neuro obs stable, ready for discharge. What’s concerning you, Doctor?’

‘A lot, I think.’ His voice was serious, and he gestured to an empty cubicle. ‘Can I speak with you for a moment?’

‘Of course!’ Harriet agreed, but nothing was that simple in Emergency. Before heading off, she flagged down a passing RN with the words, ‘I won’t be long,’ and, handing the drug keys to Susan, she added, ‘Dr Delgato wants a word in private.’

‘Lucky thing.’ Susan grinned. ‘Take as long as you need—I would.’

Thankfully the short walk allowed her blush to fade. No man had even come close to causing such a reaction in her and Harriet didn’t even need to glance at the ring that adorned her own finger to know that whatever she was feeling was inappropriate.

‘It would appear straightforward.’ Ciro wasted no time getting to the point. ‘Alyssa was seen and stitched before I arrived on duty—she had no neurological signs, etcetera, but the doctor who saw her suggested we keep her in for a few hours for head-injury observations, which have all been normal. Now her mother is very keen to get her home.’

‘But?’ Harriet asked, because clearly there was one.

‘I don’t think this young girl is well at all, I’m not happy to discharge her, yet she doesn’t want to get undressed for a full examination,’ Ciro said grimly.

‘A lot of fifteen-year-olds wouldn’t,’ Harriet ventured, ‘especially…’ Her voice trailed off, but in the interests of patient care she cleared her throat and boldly continued, ‘Well, you’re a young man, good-looking—’

‘I have taken that into consideration,’ Ciro broke in, apparently not remotely embarrassed by Harriet’s rather personal observation. ‘She is swathed in legwarmers and a cardigan. All I have managed is to roll up her sleeve, check her blood pressure and take a small look at her ankles while I checked her reflexes. That was enough for me to see that this girl is not just thin, but I would say anorexic and severely malnourished. Her ankles are swollen and oedematous, which would suggest severe malnutrition, and her arms are very thin. Now, usually you would have the parent helping, telling the child not to worry, that it is a doctor examining her and this needs to be done, but instead the mother is agreeing with the daughter when she says that she doesn’t want to get undressed and loudly insisting that any further investigations are unnecessary and that she wants to take her home.’

‘OK.’ Harriet chewed her bottom lip as she realised the possible gravity of the situation, listening intently as Ciro continued.

‘I took her pulse for a full five minutes and she is having arrhythmias. I suggested that we put her on a monitor and do an ECG and some bloods, but the mother again refused. She said that she would take her to the family doctor tomorrow. It is my belief that the mother knows her daughter is grossly underweight, knows that if she is examined properly she will be kept in hospital, and is trying to avoid it.’

‘Have you managed to speak to Alyssa alone?’

‘No.’ Ciro shrugged, his shoulders moving just a fraction. ‘Sister…’

‘Harriet,’ she corrected automatically.

‘Harriet, I do not overreact.’ He stared unblinkingly at her. ‘I do not make problems when there are none. I have asked for the most senior nurse to come with me, as I am going to attempt again to examine Alyssa properly, and if the mother again refuses then I am going to have to get…’ Again he paused, again Harriet guessed he was trying to find the right word—only this time she attempted to help him.

‘Heavy?’ Harriet suggested, and from his slightly bemused expression clearly that wasn’t the word he’d been searching for!

‘If the mother doesn’t comply, then the polite requests and friendly small talk ends and I will call the mother into the interview room and tell her that unless the daughter is examined and treated properly tonight, not only will I be consulting with the paediatrician but also the Department of Community Services, because, although it may be unusual circumstances, Alyssa is at risk.’

‘You’ll get heavy!’ Harriet summed up for him with a smile.

‘Very!’ Briefly he smiled back as the alternative meaning of the word dawned on him, but it faded quickly, his voice slightly urgent when he spoke. ‘Harriet, this is not good.’

She believed him.

Despite the fact she hadn’t even observed him with a patient, had only known him for a few moments, Harriet knew, as nurses just did, that this was a voice of experience talking, knew to go along with his hunch in the knowledge it would be reciprocated; that one day when it was Harriet that was concerned, that when everything on paper told her that the patient was fine, she’d be able to turn to him and tell him that today or tonight or whenever the time came to follow a hunch, she was worried about a patient.

And he would listen.

‘Let’s go and get Alyssa examined and speak with Mrs Harrison, shall we?’

‘Are you OK, Harriet?’ He was still frowning. ‘You look a bit…flushed.’

She felt a bit flushed, only, unlike earlier, it had nothing to do with six feet four of Mediterranean hunk and everything to do with her stomach pain which, despite a hot-water bottle and some painkillers, was still making itself known, but she certainly wasn’t about to tell Ciro that.

‘I’m fine.’ Harriet shook her head dismissively, walking briskly towards the cubicles, ignoring the griping pain in her stomach and mentally preparing for the potentially unpleasant task ahead.

But Ciro clearly hadn’t quite finished. One hand caught her arm as she went to go, those observant eyes staring down at her, narrowing slightly as he took in the pale lips in her flushed face and the tiny grimace of pain as she swung around to face him.

‘You are unwell.’ His statement was delivered as fact, his eyes holding hers as Harriet’s mind raced for some witty response, desperate to shrug off his attention. Sympathy was the very last thing she wanted or needed right now if she was going to get through the night but, given that she had no choice but to get through the night, Harriet decided to swallow her pride and ask this relative stranger for a bit of help.

‘I’m feeling a bit nauseous,’ she admitted. ‘Would you mind writing a script for some Maxalon for me?’ She watched as his eyes narrowed slightly. ‘I don’t usually ask things like this, anyone will tell you that, if I could just have something to get rid of the nausea…’

‘Fine.’ He gave a short smile and Harriet gave a relieved one. ‘After I’ve examined you.’

‘Examined me?’ Horrified, her mouth dropped open. ‘I just asked you to write me up for two anti-emetics, Dr Delgato. Most doctors—’

‘Are you saying that doctors here are prepared to prescribe drugs without examining their patients?’ Ciro questioned, his frown deepening.

‘I’m not your patient, Dr Delgato,’ Harriet pointed out. ‘I’m your colleague.’

‘Well, in that case,’ Ciro answered in the same tight vein, ‘the answer is no.’

‘Then we’d better get on with our work,’ she responded tersely, reclaiming her arm from his grip and walking towards the cubicle more determinedly now. ‘If you can give me a couple of minutes alone with her before you come in, I’ll see if I can get Alyssa undressed so that you can examine her.’

‘You won’t get anywhere with the mother,’ Ciro warned.

‘Just watch me.’

Smiling, Harriet breezed into the cubicle, introducing herself to the patient who lay on the trolley. As Ciro had said, she was swathed in legwarmers and a thick cardigan. Her dark hair was drawn back in a small bun and gorgeous velvet-brown eyes, huge in her face, were blinking in confusion as Harriet produced a gown. Without pausing for breath, as if the entire conversation with Ciro hadn’t happened, as if she had no idea that the mother and patient were resisting treatment, Harriet explained in clear terms what was going to happen.

‘Mrs Harrison.’ Smile still in place, Harriet faced the well-groomed, heavily made-up woman. ‘We’re concerned that Alyssa’s heartbeat is rather irregular at times, so I’m just going to pop her into one of our gowns and then the doctor can examine her properly.’

‘No!’ Mrs Harrison’s voice was firm, her bracelets jangling as she went to grab at the gown, rouged lips furious, but Harriet’s smile remained intact. ‘I’ve already been through all this. I want to take my daughter home.’

‘Of course you do,’ Harriet replied sweetly, ‘but it really is imperative that Alyssa be examined thoroughly. Hopefully it’s nothing serious, but, as I’m sure you’ll understand, Mrs Harrison, we can’t just ignore an irregular heartbeat.’

‘As I’ve explained,’ Mrs Harrison snarled, ‘on several occasions, I’d rather my daughter was seen by our family doctor. I’ll take her there first thing tomorrow—’

‘This can’t wait till tomorrow.’ Harriet’s smile was still intact, but the slightly dizzy air to her tone had gone. Her voice was firm, holding the woman’s gaze as she spoke. ‘Your daughter has a cardiac arrhythmia.’ Still she stared directly at Mrs Harrison. ‘It has to be dealt with tonight. I’m going to get Alyssa into a gown and put her onto one of our monitors so we can keep a closer eye on her.’

And something in her unequivocal stance, something in her voice, must have told the woman that this was non-negotiable, and even though Harriet would never have forced Alyssa to undress, she demanded the mother’s co-operation, told her with her eyes that this had to be confronted. Finally, after the longest time, she felt an inward sigh of relief as Mrs Harrison gave a tiny reluctant nod and turned to her daughter.

‘Listen to the sister, Alyssa.’

‘Harriet,’ she offered, her smile softer now, her eyes kind as she approached the young girl. If Alyssa was, as Ciro suspected, suffering from anorexia nervosa then being undressed and exposed would be traumatic for her, and Harriet was determined to make the entire procedure as gentle and as unintrusive as possible, covering the young girl with a blanket as she helped her out of her clothes. Harriet had to keep her own emotions firmly in check as she briefly witnessed the stick-thin limbs. She talked in gentle soothing tones as she gently leant her patient forward to tie up the gown and even though there hadn’t been much room for doubt, any that might have lingered was quashed as she saw the length of Alyssa’s spinal column, vertebrae protruding, dry, flaky skin hanging off. Glancing up at Mrs Harrison, Harriet saw a flash of shock on the woman’s face but she didn’t comment.