protective layer to the armour she wore very comfortably.
‘Hmm-hmm...’ Juliet coughed. ‘I said I’m happy there’s no need for a closed reduction.’
‘That makes two of us,’ he replied, turning back to the radiographic films.
‘So there’ll be no intervention to realign the bones, just a cast as we already discussed, then?’ Juliet continued as she fought to keep her thoughts professional.
‘It’s standard practice to give the arm a few days in a sling to allow swelling to subside,’ Charlie explained to everyone in the room. ‘But I’m concerned at Bea’s age she may cause further damage if we don’t protect the fracture with a cast. There’s a marginal amount of swelling around the fracture site but not enough to warrant risking further damage by allowing it to be without protection.’ He then asked the nurse to prepare for the cast while three medical students, who had quickly become part of the furniture, continued listening intently. The nurse moved swiftly, while the medication still kept Bea’s pain at bay. ‘And we need pink. That is the colour you want, isn’t it, Bea?’
Bea looked up and nodded.
‘Then pink it is,’ he told her. The nurse helped Juliet to carefully roll up Bea’s long-sleeved top that she had worn underneath the woollen jacket that was still under Juliet’s arm.
‘You were all layered up, weren’t you, young lady?’ the nurse commented with a smile. ‘Rugged up for our chilly winter?’
Bea nodded and watched as her mother and the nurse worked gently to lift the clothing free so the cast could be applied.
‘It’s a nice loose top so it should roll down again afterwards, but the jacket will never fit so we’ll have to just rest that over her shoulders and go shopping for a cape,’ Juliet mentioned as she dropped the little coat on the nearest chair.
Charlie began the process of applying the cast, explaining to Bea in simple language every step, while also including a short tutorial for the students’ benefit as they stood observing the process from the sidelines. Juliet listened to the way he spoke so tenderly to her daughter and she felt the flutter of the annoying butterflies emerging once again. She hated the feeling but she was unable to control it. His manner and tone to Bea made him appear almost fatherly. She sternly told herself it had to be his standard bedside manner...but she wasn’t completely convinced.
‘Applying a cast is quite a simple procedure,’ he began as he turned his attention to the students. ‘I’ll begin by wrapping several layers of soft cotton around the injured area. Today I’ll be applying a short cast that extends from the wrist to just below the elbow as the break is a distal radial fracture so extending further than that would cause unnecessary discomfort to the patient.’ Charlie worked at wrapping Bea’s tiny injured arm, and as he spoke the fibreglass outer layer was being soaked in water. Gently he wrapped the fibreglass around the soft first layer. ‘While the outer layer is wet at the moment, it will dry to a hard, protective covering. I’ll make some tiny incisions in the cast to allow for any potential swelling.’
In less than thirty minutes, Beatrice Turner was the proud owner of a pretty pink cast. And her mother could not help but be impressed with the way in which Dr Charlie Warren had attended to her daughter, executed the delicate procedure and managed to deliver a tutorial to the students. All the while continuing to look devastatingly handsome. She shook herself mentally and tried to remind herself of his initial overbearing attitude. But it was difficult when he was displaying such empathy to the little person she loved most in the world.
‘Now you need to rest this arm quite still for about an hour, Bea,’ Charlie said. ‘The nurse will keep an eye on it and we’ll leave your top rolled up for the time being.’
Bea just looked at the cast. Her eyes told the story. They were filled with confusion. It had been an overwhelming experience for her and she wasn’t taking in much of what was being said at that moment.
‘And we can give you a sling to hold it up because it might get heavy over the next few weeks.’
Still Bea just sat in silence. Juliet suspected it was a combination of jet lag and the pain beginning to resurface.
‘Mummy will be here,’ she told her softly as she stroked her hair.
Juliet waited for another snide remark, in fact she hoped for one, but Charlie made none. She didn’t like not having a reason to dislike the man.
‘It may get itchy, Bea, and if it does you can tap on the outside and that might help, but don’t put anything inside like a pencil because it might scratch your skin and we don’t want germs in there.’
Juliet watched as Bea tilted her head slightly with a curious expression on her beautiful face. She knew her daughter was still a little confused by everything that had happened so quickly. It was a lot for a four-year-old to take in such a short amount of time.
‘Is there anything else we can do?’ Juliet asked, holding Bea’s free hand and quickly trying to recall her training in paediatric fractures during medical school. It had been so long since she had graduated from her general medical studies before specialising and she was stretching her memory.
‘It would be best to sponge-bathe Bea so that the cast doesn’t fill with water in the bath or shower. While the outside of the cast is waterproof, as you know, the inside isn’t, even with the special lining. It needs to be kept dry, so no lotions or oils either.’ He paused to recall the other instructions that once rolled off his tongue as an A&E resident. ‘And if the itching starts to bother Bea, you can use a cool hairdryer to blow air in around the edge of the cast and check now and then that she hasn’t hidden small toys or sweets inside the cast. Believe it or not, during my A&E rotation I had more than one child think of it as their secret hideyhole.’
‘No doubt,’ Juliet said with a smile that she hadn’t thought previously she would ever display in Charlie’s presence. Her defences were slowly melting as his bedside manner warmed the room. She began a mental inventory of Bea’s belongings, wondering if she’d brought anything that small with her on the trip. She felt certain as she looked at the tiny gap that Bea’s possessions would not fit inside.
‘I’m sure you’ll have it under control,’ Charlie said to her before he turned his attention once again to the medical students. ‘Along with asking the parents or caregivers to check the cast regularly for cracks, breaks, tears and soft spots, what else would you ask them to look out for and what would warrant medical attention?’
‘Pain that doesn’t get better with the prescribed pain relief,’ one of the students offered.
‘Yes, anything else?’
‘If the child complains of feeling numb or tingly in the vicinity of the fracture,’ another chimed in with a self-satisfied smile.
‘Good.’
‘Blisters inside the cast,’ the third student said confidently, then continued, ‘and fever, or any significant increase in temperature.’
While being a tutor was nothing new to Charlie, doing so back in A&E was a change of pace and very different subject content but he didn’t want to exclude the students. ‘Well done. You seem to have a good understanding of the basics of paediatric fractures.’
The A&E resident poked her head in at that moment and directed her conversation to the medical students. ‘If you’re
