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His colleague gave a brief smile of acknowledgement. 'What's the story?'
'Overdose,' Zach said briefly. 'Don't know what yet. We're working on it, but we're guessing tricyclics.'
The anaesthetist rolled his eyes and snapped open the laryngoscope. 'Bloody antidepressants.'
'Quite.' Zach's gaze returned to his patient. 'He's got no gag reflex. I want to wash him out. We need to intubate him with a cuffed tube.'
'By "we" I assume you mean me,' the anaesthetist said dryly, and Zach grinned.
'I do indeed. I'm not rummaging around in someone's vocal cords unless I have to.'
The anaesthetist frowned and reached for an endotracheal tube. 'Isn't it a bit late for gastric lavage? When did he take them?'
'His friends saw him two hours ago and he was fine,' Zach said calmly. 'I want t
o try it and I want to give him some charcoal.'
'You're the boss.' The anaesthetist shrugged and intubated the patient quickly, using a cuffed endotracheal tube designed to prevent liquid accidentally entering the lungs.
'Great.' Zach lifted his eyes to Nicky. 'Let's wash him out. Keep 20 mils of the aspirate for a drug screen. Then I want 50 grams of activated charcoal down the tube. And let's do an ECG.'
His steady stream of instructions left Keely's head reeling and she watched in awe as he and Nicky worked together, their smooth teamwork a result of years of experience. Nicky seemed to anticipate Zach's every move without being asked and he was so calm and relaxed that Keely's admiration quickly turned to gloom. Would she ever be as confident as that?
'He's in urinary retention,' Nicky said quietly, and Zach nodded.
'That's common after a tricyclic overdose. Try suprapubic pressure. If that doesn't work then let's put in a catheter. How's that ECG?'
He leaned over her shoulder, frowning as he saw the trace. 'Well, that pretty much confirms Keely's diagnosis.'
As if to prove the point the student nurse came back in at that point. 'I've spoken to the GP. He was taking tricyclics. Amitriptyline.'
'Well done, Keely.'
Zach's quiet words of praise brought a faint colour to her cheeks and she suddenly felt deliciously warm inside. Maybe she would be as confident as him one day. He was the consultant after all.
Zach lifted the ECG trace and stared down at it. 'All right, Keely, you're the one who wants to be a cardiologist. Take a look at that and tell me what you see?'
He handed her the ECG trace and waited while she looked at it.
'Prolonged PR interval and QRS widening.'
'Right.' Zach took the trace back. 'Consistent with a tricyclic overdose. Let's give him 8.4 per cent sodium bicarbonate.'
Nicky turned away to do as he'd instructed and Zach turned back to Adam. 'He needs to be admitted to CCU for cardiac monitoring. Can you bleep the medical reg and I'll have a word with him?'
Half an hour later the man was stabilised and had been admitted by the medical team.
'Will he live?' The student nurse stared at Zach, her eyes wide and slightly stunned.
'Probably. And he'll probably do it again,' Zach said calmly, folding the ECG trace and putting it carefully in the notes.
'You were amazing, Mr Jordan. You knew exactly what to do. You saved his life.' She stared at him with a mixture of awe and reverence and Keely felt some empathy with the girl. Watching Zach in action was a humbling experience. Not only was he clearly a skilled doctor but his cool self-confidence had transmitted itself to the rest of the staff. There was no panic with Zach around.
The student nurse was still round eyed with admiration and Keely saw Zach frown slightly as he registered her longing gaze.
How would he react? Would he demolish the girl? No, that wasn't his style. Look how kind he'd been to her for a start.
But she sensed that his style had changed over the years. The easy charm was still there on the surface but underneath she sensed a cynicism, a hard edge that hadn't been part of the Zach that she'd known all those years ago. Was it just maturity? Or something else? Had something happened to change him?
