Callum stilled. ‘Something wrong?’ He had this growing premonition that the baby was in danger. It was irrational, unfounded and absurd, but it bothered him that she was still working.
She laughed. ‘No, just Oscar’s foot doing some break dancing.’ She turned back to their patient. ‘Mr Renaldo, I have good news. Callum can operate on you here in Narranbool. Esther will get you ready for Theatre and I’ll organise all the paperwork.’
‘Whatever you have to do, Doc.’ Vince’s voice trembled with anxiety. ‘Can you tell my sister?’
‘Absolutely.’ Tess squeezed Vince’s hand.
Relief rolled through Callum. Tess would deal with the hysterical relatives, which suited him just fine.
‘Right, let’s get moving.’ Completely in his element, he took charge. Grabbing the chart, he scrawled down a drug dose. ‘Esther, take blood for cross-matching.’
‘Right you are, Mr Halroyd.’ Esther’s face shone with sympathy. ‘Your brother was a great doctor and Narranbool is very fortunate to have you on board now James has gone.’
No way am I ‘on board’. The words rose to his mouth but he stopped them from tripping off his lips. Now wasn’t the time to say that country life and country medicine were an anathema to him. They had a sick patient who needed his bleeding ulcer clipped.
Giving Esther a curt nod of appreciation, he turned to Tess, whose expression was unexpectedly calculating. But he didn’t have time to wonder about that—the clock was ticking, and his adrenaline was pumping. He clapped his hands together. ‘Let’s get this man to Theatre now, before he bleeds any more.’
CHAPTER THREE
‘I KNOW you wanted to get in fast so I’ve sedated him with midazolam and propofol and he’s all set to go.’ Tess’s worried eyes looked at Callum over her theatre mask. ‘He’s lucky you’re here.’
A niggle of concern pulled at Cal but the beeping of the monitor registering Vince’s low blood pressure intervened. ‘Let’s start.’ He put his gloved hand out for the gastroscope.
Ken Liu, the theatre nurse, handed him the long, black, flexible tube, whose plain colour belied its ability to light and electronically magnify the gut.
Cal had to give the staff credit—they’d mobilised quickly and there’d been no messing around. He glanced up at the screen as he passed the tube down the oesophagus. ‘No sign of varices, always good.’
‘Excellent news.’ Tess’s hidden smile played through her voice. ‘Often patients aren’t one hundred per cent honest about their history if alcohol is involved.’ The ECG monitor beeped rhythmically and reassuringly next to her. ‘Esther, is the blood here?’
‘It’s on its way but we’ve got plasma expander. Do you want that put up?’ Esther’s questioning brows rose over her green surgical mask.
Tess checked Vince’s BP. ‘Right now his pressure’s holding so I think we can wait for the blood.’
Cal grunted in frustration. ‘His stomach’s full of blood. Sucker, quickly.’ He needed to clear the area and find the source of the bleeding.
Ken handed him the instrument and the sound of suction filled the tense air of Theatre. Just as suddenly it stopped. ‘Damn it, the sucker’s blocked by clots. Saline. I need saline to clear it.’
‘Pressure’s falling,’ Tess stated in words what the incessant beeping told them.
He swore softly under his breath. ‘I’m scubadiving here and I can’t see anything except blood.’ He readjusted the sucker, his hand gripping tightly, and pressed his eye hard against the viewfinder of the ’scope. Don’t bleed out on me before I find the cause.
‘The blood’s arrived.’ Esther called out in relief as she accepted the welcome units from the blood-bank technician.
Tess moved fast. ‘Esther! Start squeezing one unit of blood into the left IV, now.’ She quickly snatched the second unit out of the nurse’s hands and attached it to the other large-bore IV she’d inserted.
Four hands worked furiously, pushing life saving blood into their patient, giving his heart the much-needed volume to pump around. A frown line appeared on the bridge of Tess’s nose. ‘Callum, how much of this is going straight into his gut?’
‘More than we want.’ His terse voice carried his apprehension.
‘I should have tubed him.’ Tess’s usually calm voice sounded ragged at the edges.
He couldn’t look up but he wanted to reassure her. ‘You made the right choice at the time. You’re not an anaesthetist and light sedation is usually better.’ Tension strained every muscle as Callum moved the ’scope to find the bleeder. ‘He’s hosing blood, damn it, but from where?’
The sedated Vince suddenly shuddered and blood and clots projected from his mouth, all over the floor and onto Callum’s shoes. He moved his feet. ‘At least now I can see a bit better. No sign of a peptic ulcer.’
‘I should tube him—he could aspirate.’ Tess ran a fine nasal suction tube down into Vince’s trachea.
Vince’s half-empty stomach immediately filled with blood as Callum probed into the duodenum, the sucker working overtime. Suddenly he caught sight of inflammation, the ugly ragged edges of an ulcer with an enormous clot in the centre. Thank you. ‘Found it. It’s an enormous duodenal ulcer. No wonder he’s been bleeding like a stuck pig.’
He injected the saline down the three-millimetre channel in the ’scope and sent up a prayer that it wouldn’t make things worse.
Ken’s eyes were glued to the screen, his voice disbelieving. ‘Is that a spurting artery at the base of the ulcer?’
It had made things worse. ‘Hell, yes.’ The clot had been trying to seal the bleeding. He sent down more saline to clear the area of blood so he could see what needed haemotosis.
Ken immediately passed him adrenaline. ‘Or will you use diathermy?’
‘Adrenaline first.’ His concentration brought conversation down to the bare minimum. He injected the adrenaline, wishing it speed in constricting the blood vessels and bringing the bleeding under control.
Bringing the whole situation under control. He relaxed slightly. ‘Right, I’ll just put the—’
The monitor screamed and Tess picked up her laryngoscope. ‘His O2 sats are dropping, and he’s got a lung full of blood. Callum, you need to pull out now so I can tube him.’
Sweat pooled on his forehead. He was so close. ‘Give me a minute to put on the haemoclip. I’m almost done.’
‘We don’t have a minute.’ Her eyes flashed with fear and steely determination.
‘Yes, we do. I’ve done this before.’ Callum put out his hand. ‘Kenny, the clip.’
The nurse hesitated, glancing between them.
‘Now,’
