His Emergency Fiancée Read Online Free PDF Page A

up.’
    ‘I expect my staff to stay where I can find them,’ he rapped out.
    ‘Well, I know that now. It won’t be a problem in the future.’ Given his mood, she didn’t quite dare ask for five minutes to fill Ben in on her findings. But there was one thing he couldn’t deny her… ‘I’ll just go to the loo, if you don’t mind.’
    Three minutes. Enough to scribble Ben a quick note about Adam. And she’d have to be very, very careful in Theatre this afternoon.
    * * *
    ‘Have you seen much keyhole surgery, Fisher?’ Chambers asked.
    ‘Er—not really,’ Paul said, flushing.
    Kirsty noted that he didn’t ask her. Obviously she was still in disgrace for daring to leave the surgical ward without his permission.
    ‘We’re presented with a case of chronic cholecystitis. Which means what, Fisher?’
    ‘Inflammation of the gall bladder that’s gone on for a long time.’
    ‘Good. Symptoms?’
    Paul seemed to relax, back on familiar ground. ‘Vague digestive complaints—abdominal discomfort, flatulence, especially after rich or fatty foods, dull pain, nausea and vomiting.’
    ‘Presence of calculi?’
    ‘If there are gallstones, they’ll grow larger in size or number as the condition goes on.’
    Textbook answer, Kirsty thought approvingly.
    ‘Jaundice?’
    Paul thought about it. ‘Not sure.’
    Was he going to ask her? Kirsty waited. But, no, Chambers went straight into the answer. ‘May be present if the inflammation involves the bile ducts. Other symptoms?’
    ‘Scarring and thickening of the wall of the gall bladder,’ Paul said.
    ‘And cholestasis,’ Chambers added. ‘Well done, Fisher.’ He gave Kirsty a look. ‘And we’ll remove the stones how, Brown?’
    She’d have preferred him to have used her first name—or at least add her title to her surname, to be more courteous—but it was obviously his way and she’d have to lump it. ‘If they’re just in the gall bladder, either by cholecystostomy—drainage—or by cholecystectomy—removal. If the patient’s already had the gall bladder removed but still has symptoms, we’d try ERCP,’ she said. Endoscopic retrograde cholangiopancreatopgraphy, or ERCP, was where a combination of a fibre-optic endoscope and a contrast medium showed the location of gallstones, usually in the bile ducts. ‘We’d need to measure the patient’s blood coagulation levels, do cross-matching and check blood type, and give antibiotics and IV fluid before the procedure.’
    He nodded. ‘Major problems?’
    ‘Haemorrhage and infection.’
    ‘In this case, the gall bladder’s still present so we’ll do a cholecystectomy by laparoscope,’ he said. ‘Keyhole surgery means a faster recovery time.’
    And Kirsty was itching to do this herself—keyhole surgery was what she really wanted to specialise in, something she loved even more than cardiothoracic work. Maybe she could learn from him. Maybe this would be the thing to smooth over the cracks in their working relationship.
    He was thorough, she thought as she watched him remove the gall bladder and explore the bile duct for stones. He just needed to work on his people skills—not that she could suggest it. For a start, it wasn’t protocol; and how could you tell a difficult person that they were hopeless with people, without making them defensive and their behaviour even worse?
    She watched as he inserted a T-tube to drain the bileduct.
    ‘Close for me, Fisher.’
    This time, he left Kirsty to supervise. Paul carefully closed, clamped the T-tube ready for transfer, and they accompanied the patient back down to Recovery.
    ‘Are you OK with what happens next?’ she asked Paul. ‘Post-op care?’
    ‘Attach drainage tube to receptacle, check tube for kinks, secure to dressing and lower bed linen and show patient how to turn over without pulling or compressing the tube,’ he recited. ‘Check dressings frequently for leakage or bleeding, check the patient is taking proper breaths instead of shallow