Ask the lab to check T4, T3 and TSH as well.’ Checking the tri-iodothyronine, thryoxine and thyroid stimulating hormone levels in the bloodstream would help Holly find out if it was a problem with Lucy’s endocrine system, and if so the results would help her give the right dosage of medication to get Lucy’s levels back to normal.
‘What’s this? A patient with thyroid problems?’ a male voice asked beside her.
Damn. She could do with some kind of early warning system so she could avoid David—so she could avoid situations like this when he might catch her off guard. ‘I’m not sure. That’s why I’m asking for T4, T3 and TSH levels,’ she said shortly, and turned her attention back to Michelle. ‘Thanks, Miche. I’d also like to do some BMGs.’ BMGs, or bedside strip measurement of glucose, would check Lucy’s blood-sugar levels. ‘And a mid-stream urine specimen—Oh, and she’s got a bit of a chest infection, so ask the lab to run blood cultures, so we can see what’s causing it.’
‘What are her symptoms?’ David asked.
‘Acute abdomen, losing weight despite eating a lot, chest pains, a fast heartbeat, sweating, volatile emotions and tiredness.’
‘What about her blink rate?’ If Lucy was blinking less than normal, it was another pointer towards a thyroid problem. ‘Any swelling in the tissues around her eyes?’
Holly looked at him and had to fight to get her thoughts back in control. Hell, this was just how she’d imagined him as a doctor. Completely focused on his patients. Caring.
If only he’d been like that about her. ‘I’m doing bloods to check if it’s thyroid,’ Holly said.
‘I nearly specialised in endocrinology before I settled on emergency medicine. I could have word with her, if you like.’
No. I don’t want to work with you and I don’t want you interfering with my patients.
On the other hand, she’d taken the Hippocratic oath. She had a choice of letting David help or trying to get hold of Fabian, the endocrine specialist, who almost never answered his bleep and needed at least three follow-up nags. Her patient came first. Even if it meant that Holly was in the awkward position of owing David Neave a favour. ‘Thanks. I’ll introduce you.’
To her relief, he simply followed her back to cubicle eight. ‘Lucy, Oliver, this is David Neave, our new senior registrar. I’ve been talking to him about what the problem might be, and he’s your man for any questions.’
He used to be my man.
She pushed the thought away. The past was over. Over.
She forced a smile to her face. ‘Michelle, our staff nurse, is going to come and take blood for tests.’ She didn’t quite trust her hands to be as steady as usual if she had to take the blood under David’s gaze, and Lucy really didn’t need half a dozen puncture wounds from an incompetent doctor.
‘Do you mind if I have a look at your hand?’ David asked. He pinched the skin on the back of Lucy’s hand, very gently, as Holly watched. When the skin didn’t flatten again instantly, Holly knew that Lucy was dehydrated.
‘Has anyone in your family had problems with their thyroid gland?’ he asked.
‘Not that I can think of. Why?’ Lucy asked.
‘Holly told me about your symptoms and I think your thyroid gland’s overactive. What you’re suffering from is something called thyroid storm.’
‘Is it serious?’ Oliver asked.
Yes. If it went untreated, one in ten cases would die.
‘We can do something about it,’ David reassured them both. ‘Holly’s arranged the blood tests, we’ll give you some paracetamol to get your temperature down, a saline drip to help with the dehydration, some antithyroid medication to deal with the excess thyroid hormones and some beta-blockers to help slow your heart rate down to what it should be.’
‘Heart medicine? But…’ Lucy shook her head. ‘What’s wrong with my heart?’
‘It’s all to do with your thyroid gland producing too many hormones. The thyroid gland is just here in your throat, underneath your voice-box,’ David explained.
When he touched Holly’s throat, to demonstrate, her pulse went into overdrive and she only hoped that he couldn’t feel the frantic flutter.
‘It produces the hormones that regulate your body’s energy levels and at the moment it’s producing too much.’
‘That’s why you’re eating so much,’ Holly said, hoping her voice sounded less shaky than it felt. ‘Your body’s metabolism is working too hard, making you feel hungry so you want to eat, but you’re still losing weight.’
‘It’s also making your heart beat faster than it should,’ David added.
So’s mine, Holly thought in desperation. And it shouldn’t be. I don’t want it to.
‘Thyroid problems? Isn’t that something old people get?’ Lucy asked.
‘No. It’s more common in women, and usually it’s young to middle-aged women, in their thirties to fifties,’ Holly said.
‘If you’ve got an overactive thyroid but you haven’t been treated for it, and then you get an infection or you’re under a lot of stress, you can end up with thyroid storm. We’ll need to get you admitted because we’ll need to run more tests,’ David said. When Lucy coughed, he said, ‘We also want to know what’s causing your cough, so we can treat that, too.’ He looked at Holly. ‘Can you ask a porter to bring a fan in to make Lucy more comfortable, please?’
‘You don’t have to do that if it’s going to mean someone else will be all hot and sticky,’ Lucy said.
‘It won’t,’ Holly said. If necessary, she’d use the fan from her own office—she could manage without for a couple of hours. ‘We want your temperature down.’
‘Cool air, tepid sponging and paracetamol should do it,’ David explained with a smile.
Lucy groaned. ‘That’s what you do to babies! I feel such an idiot. I should have gone to see my GP when it all started, but I was busy and I didn’t want to waste his time.’
‘It might have saved you ending up in here,’ Holly agreed wryly. ‘But if it makes you feel any better, I would’ve done exactly the same.’
Yes, David thought bitterly, watching her retreating back. Holly had always done things her way, and to hell with the consequences. Even though he had the nasty suspicion that it was going to rake open old wounds, he knew they had to talk.
An hour and a half later—by which time Holly had calmed down a hysterical toddler and removed a bead from his nose, put a dislocated elbow back in place and removed broken glass from a nasty wound and then stitched it—she was in definite need of caffeine.
‘I’m taking five,’ she told Michelle, and headed for the rest room.
She’d just fixed herself a black coffee from the vending machine, poured the top quarter off and added enough cold water so she could drink it straight down, when David
