The Nurse's Christmas Wish (The Cornish Consultants)

Now he was listening to the patient’s heart, a frown on his handsome face. ‘Can we keep the noise down, folks?’ he growled, his eyes shut as he tried to concentrate. Moments later he ripped the stethoscope out of his ears. ‘Muffled heart sounds and hypotension. I’m guessing she has cardiac tamponade. Let’s do a scan. Are those X-rays ready?’

Sue put the films into the light box and Mac studied them carefully.

‘Her pressure is falling,’ Josh murmured, and Mac nodded as he scanned the patient.

Louisa watched as he placed the transducer just to the left of the xiphisternum and angled upwards under the coastal margin.

‘I haven’t seen that done before.’

Mac had his eyes on the screen. ‘It’s just an ultrasound that you can perform by the bedside.’ He moved the transducer. ‘Helps to identify intraperitoneal haemorrhage or, in this case, pericardial tamponade.’

Josh looked at his brother. ‘Her pressure is still falling.’

‘She’s not responding. Hannah, emergency bleep the cardiothoracic surgeons and let’s attach the patient to an ECG. We’re going to have to do an emergency pericardiocentesis—I want to see if I can draw some blood from the pericardial space. Louisa—get me a pack. Let’s move, everyone.

I won’t lose her.’

There was something in his tone that made Louisa glance at his face. It was a mask, not one flicker of emotion showing on his features. She caught Josh’s eye and he gave a brief shake of his head, indicating that she shouldn’t interfere.

Reminding herself that she had a job to do, Louisa quickly grabbed the equipment he needed while Mac scrubbed and donned gloves and an apron.

He prepared the skin surgically and then held out a hand. ‘Local anaesthetic—and then I’m going to need a wide-bore, plastic-sheathed needle.’

Louisa handed him the syringe and watched while he infiltrated the area and then inserted the needle. As the needle advanced Mac aspirated. ‘This doesn’t always work,’ he murmured for the benefit of the more junior doctors who were watching in awed silence. ‘In about a quarter of cases the blood around the pericardium has clotted and it isn’t possible to aspirate.’

His eyes flickering to the ECG and then back to the syringe as it filled with blood. ‘But in this case that hasn’t happened. She’s going to need a surgical exploration.’

‘Her pressure is still falling,’ Josh said, his eyes on the monitors, and Mac’s mouth tightened.

‘Someone get the surgeons up here now!’

His tone was harsh and unusually impatient, and Louisa knew that to Mac this case had become personal.

He was thinking of his wife.

* * *

‘Her husband is still in the relatives’ room,’ Josh said wearily, after they’d handed the patient over to the cardiothoracic team and transferred her to Theatre. ‘Do you want me to talk to him?’

Mac breathed out slowly and shook his head. ‘No, I’ll go and talk to him. But thanks.’ He gave a wintry smile as he ripped off his gloves and dropped them in the bin. ‘Louisa, will you come with me?’

They walked in silence to the relatives’ room and Louisa felt Mac’s tension grow with every step.

She could almost feel his pain.

Was he remembering another winter’s evening when he’d been the one waiting to hear news?

Suddenly it didn’t seem right that he was the one to do this, and she put a hand on his arm and stopped him. ‘Wait.’ Her tone was soft, and she pulled him to one side, conscious of the other members of staff hurrying past. ‘You don’t have to do this, Mac. Josh could do it. Or one of the others.’

He frowned. ‘I’m fine.’

‘You’re not fine, Mac. I can see that you’re—’

‘Louisa, I’m fine.’ He moved his arm, dislodging her hand, as cold and remote as she’d ever seen him. ‘I need to do this. I was the one with the patient in Resus. It’s my job.’

She opened her mouth to point out that Josh had been in Resus, too, but he was already striding down the corridor.

She gave a frustrated sigh and hurried after him.