The London Doctor by Joanna Neil

Author:Joanna Neil
Language: eng
Format: epub
Publisher: Harlequin
Published: 2013-10-19T04:00:00+00:00

CHAPTER SIX

‘I’M WORRIED about Ryan.’ Hannah’s adoptive mother sounded distracted on the phone, as though she was making the call while she was on the move. ‘I was talking to one of his friends, and he let slip that Ryan was having problems with his tutor. It sounds as though he was being hostile and argumentative, and the tutor was threatening to throw him off his course, but the friend wouldn’t tell me any more. Do you know what’s going on, Hannah?’

‘This is the first I’ve heard of it,’ Hannah admitted. It didn’t sound like the Ryan she knew, but it worried her all the same. ‘It might just be the pressure of exams,’ she said, searching for a reason. ‘Anyway, I’ll try to get in touch with him and find out more, but I don’t know how much he’ll tell me. Whatever the outcome, I’ll do my best to help him out, I promise.’

‘Thanks, Hannah, I knew I could rely on you. I must go. I have to take the dog to the vet for his booster injection. You know how difficult that’s going to be. Saxon hates going in the car.’

Hannah laughed. ‘I remember…A bit of bribery’s called for…a few biscuits or treats strategically placed on the back seat might do the trick. Best of luck. Bye, Mum. I’ll talk to you later.’

Hannah cut the call, and walked from the inner courtyard, where she had been taking a quick afternoon break, back into A and E. She wasn’t having a good day. All of her patients so far had been difficult to treat and had suffered complications, and Adam was watching her like a hawk. Now she had the added worry of wondering what was going on with Ryan.

‘I see that you have your patient on a cardiac monitor,’ Adam said when he found her studying some lab test results a few minutes later. ‘Have you thought about the differential diagnosis?’ His tone was brisk, and he seemed to be in a hurry, flicking casually through the patient’s notes while he was on the move.

‘Yes, I have, but I’m not convinced that there isn’t a primary hyperparathyroidism.’ Hannah stood her ground. He was putting her through a cross-examination, but she was sure of her facts and she didn’t see why he would want to interfere with her treatment of this patient.

‘She’s lost weight, has generalised aches and pains, muscle weakness, thirst and excessive urination, and the blood tests have come back showing loss of magnesium and potassium and a high serum calcium. Given all her symptoms, I want to start her on fluids right away. I planned on rehydrating her with isotonic saline and 5 per cent dextrose, with potassium and magnesium supplements.’

‘That will certainly help to lower the serum calcium.’ He glanced at the results. ‘Give her a bisphosphonate in saline infusion over four hours. That will inhibit the resorption from bone.’ He handed the chart back to her. ‘You should get a parathyroid hormone measurement, and then you might need to refer her for surgery.

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