Thankfully, emergency trays were set up the same everywhere. Whoever had set the standards knew what they were doing. It meant that a doctor strange to a hospital could work at almost maximum efficiency straight away.
She reached for the syringe and her uncle blenched.
‘See you at home, Fern,’ Al muttered and bolted.
Fern’s escape route was cut.
Fern had to fight an almost overwhelming urge to bolt right after her uncle.
She had to stay. She and Quinn were Bill’s lifeline.
She had no choice.
It was a good two hours before Bill decided to live-for the moment-and at the end of that time Fern was exhausted. Her skills had been stretched to the limit and the fact that Bill was a childhood friend didn’t help one bit.
Finally, Bill drifted into a near-normal sleep, his breath still rasping and laboured but at least it was steady.
‘For now,’ Quinn said bitterly as they left the ward. The night sister was sitting by the bed and would stay there until morning. ‘The pneumonia’s obviously taken hold again-but why? Why?’
They were walking slowly down the corridor together, the tension between them put aside as both concentrated on Bill’s plight.
‘Malignancy?’ Fern suggested and Quinn shook his head.
‘There’s no sign. When Bill started losing weight I persuaded him to spend a couple of days in Sydney. I gave the radiologists carte blanche to find anything-and there was nothing. The antibiotic stops the pneumonia but this is the third bout he’s had. There has to be an underlying cause.’
He paused and dug his hands deep in his pockets. The lights in the corridor were dimmed but the strain around Quinn’s eyes was still obvious. He looked exhausted, Fern thought, her image of the indefatigable Dr Gallagher who never needed sleep fading fast. Now he leaned back against the corridor wall and ran his hand through his hair in a gesture of absolute exhaustion.
‘When Bill was in Sydney I had a physician look at him,’ Quinn continued. ‘He suggested Bill’s only problem was mycoplasma pneumonia and I hadn’t left him on antibiotics long enough the last time he’d had it. He’s been on antibiotics almost continually since then, though, and here he is crook again. I guess…I guess I should send him back to Sydney. Trouble is, I reckon the next we’ll hear of Bill will be of his death. The Sydney physicians don’t seem to have any more of a clue than I have.’
And his death would hurt, Fern knew, looking up at Quinn’s defeated face. This man might be a cheat to the women in his life but there was no doubting that he was a caring doctor.
He was worried sick now.
‘What’s causing the haemoptysis?’ she asked slowly. The plugs of bloody phlegm Bill was coughing were not normal for straight pneumonia.
‘The coughing might be causing it-or the continued infection.’ Quinn shrugged. ‘His cough’s so dry and consistent that he could be breaking small blood vessels. There hasn’t been much haemoptysis till now.’
‘There was a fair bit tonight.’ Fern frowned. ‘You’ve excluded things like AIDS?’
‘Of course.’ Quinn wasn’t offended. He seemed almost grateful to go through the options with another doctor and Fern knew how he was feeling. There was nothing worse than not knowing what was wrong when you were the only one qualified to do anything about it.
Quinn lifted a hand and wearily counted on his fingers. ‘It’s not HIV, or Q fever, or legionella or psittacosis. A CT scan of the thorax and abdomen were normal. Mycoplasma and Brucella serology were normal. He’s been on Aminophylline twice a day and bronchodilator and steroid inhalers for his asthma, and until six months ago his asthma was well controlled. It certainly isn’t now. He’s lost over four stone and is still losing. His sputum grows only a light growth of beta haemolytic Strep Group D and at last count his white cells were 7.38.’
Fern stared. For a country GP without specialist internal medicine training, Quinn’s search for a diagnosis was impressive.
But not conclusive.
There had to be something else.
‘Have you excluded TB?’ asked Fern thoughtfully. TB was rare in this country now-but not unheard-of. Mostly it occurred in migrants coming from more heavily infested areas, in AIDS sufferers or in elderly derelicts whose general poor health made then susceptible. Bill was certainly none of these.
‘His Mantoux test showed a positive response,’ Quinn told her. ‘But we’ve sent off pleural aspirate for cytology with negative results. Pleural biopsy, bronchoscopy and bronchial washings have all shown nothing. If I send him to Sydney now, the hospital’s going to waste time repeating all those tests and meanwhile…’
‘Meanwhile he’ll be dead,’ Fern said brutally. ‘We’ve run out of time for tests.’
‘Bill’s run out of time for living, then.’
‘Maybe.’
Fern scuffed her toe on the polished wood of the corridor, a habit she’d started as a child when she was thinking hard.
Silence.
‘He’s running a fair temperature,’ she said at last.
‘He has all along. Even when we cleared the pneumonia he’s been spiking nocturnal temperatures of thirty nine plus,’ Quinn told her. ‘I saw him the day after your…after your attempt at a wedding…because I was concerned he might have eaten some of those damned oysters.
‘In fact, he hadn’t eaten any because he was feeling off colour, anyway. He hadn’t tried to go to your wedding. I thought his temp was up then-but he wouldn’t come in for a check. Said he was as well as he’d been for a month and he was sick to death of being prodded and poked. I can’t say I blame him.’
‘But his Mantoux test showed positive…’
‘Half the population of the known world shows a positive Mantoux test,’ Quinn said brutally. ‘That doesn’t mean he’s consumptive.’
‘It means TB hasn’t been excluded, though…’
‘The tests were negative…’
‘They often come back with false negatives.’ Fern’s sandal scraped forward and back again. Her personal friction with Quinn was forgotten for the moment. Her mind was all on long-ago lectures.
‘Sometimes asthma treatments can stir up TB,’ she said thoughtfully. ‘It’s been documented.’
‘Yeah?’ Quinn was watching Fern’s face, trying to follow her thought processes. There was no denigration of a junior doctor here. If Fern had an idea that might help, Quinn Gallagher wanted to hear it.
‘It’s true. And somewhere…I remember one of my professors saying over and over, “Never let a patient die with an undiagnosed fever without at least considering TB and a trial of triple therapy”. He was an elderly professor who’d seen a lot of TB-but his advice is still sound. He didn’t trust tests. He trusted what his gut feeling was telling him.’
‘So…’ Quinn was still noncommittal, still watching.
‘So we either give up on Bill and send him to Sydney,’ Fern said. ‘And hope he survives the trip. Or we treat the pneumonia aggressively and at the same time we start him on treatment for TB. My gut feeling’s saying TB and I think we should go with that. We send more pleural fluid for culture but even if that comes back negative we keep him on the regime for a while-just to see.’
‘But if we’re not sure…’
‘Are we sure it’s anything else?’
‘No. But…’
‘Then what’s our choice here, Dr Gallagher?’
Quinn stared at the girl in front of him as if he was seeing her for the first time. Fern’s voice was steady. This was a considered choice and she was ready to accept the consequences if it failed.
‘What on earth’s your training?’ he asked. ‘I asked your aunt if you’d done anaesthetics and she said you’d done a resident rotation-but you don’t talk like any intern I’ve ever met.’
Fern smiled faintly and shook her head. ‘I’m a specialist medical registrar,’ she admitted. ‘I’ve done my first part of internal medicine. In twelve months I’ll be a qualified physician.’
