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‘He isn’t my Dr Anyone,’ Talia managed, her tongue feeling altogether too thick for her mouth. ‘Is he still here?’
‘Just going off shift,’ Nyla replied, though Talia had to strain to hear her. Incredible how hard it was to hear anything over the thundering of her own heart. ‘Wait, Talia, is this really what you want to do? Confront him here?’
Talia didn’t answer. She was already racing to the changing area doors just as Liam stepped out.
‘What happened with Augustin?’ she demanded instantly.
Liam paused, and eyed her curiously.
‘Good morning to you, too. Is he your patient?’
‘Well...’ She hesitated, momentarily thrown. ‘I was the one who admitted him a few days ago and diagnosed pneumonia.’
‘You’re a scrub nurse. You’re the one who admitted him?’
‘The community clinic is a hands-on, all-in affair. Besides, it’s good to keep other skills going.’
‘I see.’
Without warning, she bristled defensively.
‘The symptoms he presented with were consistent with pneumonia.’
‘Did I criticise in any way?’ Liam asked evenly.
It did little to assuage Talia’s tenseness.
‘No, but—’
‘There is no but,’ he cut in smoothly. ‘It was a logical assessment, and the past few days offered no further clues from what I can tell, although there was no improvement. However, overnight his condition deteriorated acutely and he developed more intense chest pains, shortness of breath and diaphoresis. It was fortuitous that I was on the floor, and that the nurse on shift thought to get me.’
A hundred questions jostled on the tip of her tongue, ranging from her patient to why Liam had even been volunteering after claiming he wouldn’t.
In the end, it was her concern for Augustin that won out.
‘And?’
‘The patient was afebrile, with a respiratory rate of thirty-six, he had a heart rate of one-twenty, and blood pressure of one-eighteen over seventy. He hadn’t undergone an EKG—’
‘Because it presented as pneumonia.’
‘Again, I wasn’t criticising,’ L
iam replied simply. ‘But since I was there, I performed a bedside ultrasound, in the first instance as a lung ultrasound and, as I suspected, the lungs were obscured by a large anechoic structure.’
Talia sucked in a deep breath. An anechoic structure was often an indication of cysts, fluid or gallbladder ascites. Should she have seen that herself, earlier?
‘You carried out a cardiac ultrasound,’ she pressed Liam urgently.
‘I did.’ He nodded. ‘It revealed a large circumferential pericardial effusion, right diastolic ventricular collapse and the inferior vena cava was dilated without respiratory variation.’
‘So you carried out a pericardiocentesis? What did you yield?’
‘About one thousand and fifty millilitres of serosanguinous fluid that have been sent off for further diagnostic evaluation.’
Meaning cultures and cytology, Talia thought, her head spinning. Hadn’t she read somewhere that around sixty-five percent of pericardial effusions were sanguinous? And that around twenty-five percent of these were, in turn, caused by malignancy?
Desperation sliced through her, but it was the sharp edge of guilt that lacerated her most.
