HE WAS FINALLY starting to get to grips with things. The new administrator was fabulous. Sen had worked as a PA at a Fortune 500 company and decided to take early retirement. Working for a place like May Mắn Hospital was exactly what she wanted. She’d sat across the desk from Duc at her interview and, after five minutes, had sighed and written him a list of all the things he needed to get in order. She’d started work after he’d taken her for coffee and cake across the road.
For the first time since he’d got here it felt like a little part of the weight was off his shoulders. Sen regularly had a stacked pile on his desk awaiting signature, then would wave him off with her favourite comment. ‘Go, be a doctor!’
Today he was covering partly in one of the drop-in clinics and partly on the wards.
One of the nurses called him in to assess a man with a leg ulcer. Lots of older patients had poor circulation, which caused slow healing of any injuries. Duc checked the man’s notes. This leg ulcer had been there for more than eight months. Whilst some ulcers never healed, with correct treatment most could heal in three to four months.
He peeled back the bandages, taking care not to damage any of the surrounding skin. The ulcer was smothered in a thick gel and covered with a non-adherent dressing. As soon as he started cleaning it, he noticed a slight discharge and a strange aroma. He asked a few questions, then leaned back.
He walked over to the cupboards and came back with some new products. Viv appeared at his side. ‘What are you doing?’
‘Leg ulcer.’
Her nose wrinkled. ‘Okay, new skill. It’s time to learn.’
He gave her a smile. ‘What, midwives don’t deal with leg ulcers?’
‘Debrided wounds, yes. Leg ulcers? No. Thankfully, most of my patients are in a slightly younger age range. But in the future, who knows?’
Duc nodded as he picked up a wound swab and sterile bag. ‘Well, it’s one of the common things you’ll see in the outpatient clinics. Might as well get used to them.’
She moved over and introduced herself to the patient in stilted Vietnamese. She was getting better. He was impressed.
Duc acted as translator as he swabbed the wound. He’d already decided to prescribe some antibiotics. ‘Look at the edges of the wound, there’s some redness and swelling, add in the discharge and slight odour and...’ He let his voice tail off.
‘You have an infection,’ replied Vivienne. She moved a little closer to study the edges and depth of the ulcer.
Duc nodded. ‘I think it’s likely. A lot of venous ulcers that don’t heal have an underlying bacterial infection.’
Viv shot him a curious glance as she looked at the dressings on the sterile tray. ‘So, do you put the same thing back on, or do you try something else?’
He waggled his hand. ‘Actually, a bit of both. We’ll keep using the alginate gel. There’s lots of good research on its effectiveness. But I’m also going to add in a silver-based wound dressing that helps combat infections.’
Vivienne gave a smile. ‘A two-pronged attack.’
Duc nodded as he spoke to the patient and finished dressing the wound. ‘Let’s make it a three-pronged attack. Compression bandage to finish to help keep swelling down. This has gone on long enough.’
Vivienne automatically stood to help with the tidying up as Lien appeared at the door. ‘Oh, good, you’re both here. Can I grab you once you’re finished?’
Duc gave the patient the antibiotics, along with some instructions and a return appointment. He followed Viv into the next room where Lien was standing with her arms folded.
‘What’s wrong? You look worried.’
Lien nodded. ‘I am. You know that Joe gets these ideas in his head.’
Vivienne’s brow creased and Duc realised she’d no idea what they were talking about.
He put his hand on Viv’s shoulder. ‘Joe’s from your neck of the woods. He likes to try and do home visits. Set up more community clinics.’
‘Is that bad?’ Viv held up her hands. ‘That’s just normal.’
Lien shot her a look. ‘I have a hard enough time getting my husband to toe the line. Don’t you encourage him.’
‘What’s the problem, then?’ Viv had mirrored Lien’s position and folded her arms across her chest. It was almost like they were in direct competition with each other.
Lien turned her attention to Duc. ‘We’ve had a few patients with unusual symptoms and Joe decided to investigate.’ She looked sideways at Viv. ‘Two of the women are pregnant.’
Viv instantly straightened. ‘Where are they?’
Lien pressed her lips together. ‘Everyone in the family is sick. They all stay in a building a few streets away. At a guess, there are eight family members. Two elderly parents, a son and daughter who are both married with a child of their own.’
‘They can’t get in to the clinic?’ Duc asked—even though he could already guess the answer.
Lien shook her head. ‘All of them have fevers, muscle and joint pain—so severe they can hardly get of bed. Throw in some nausea, vomiting and other GI symptoms.’
Duc let out a long slow breath. ‘It could virtually be anything from norovirus to dengue fever, zika or chikungunya. Even food poisoning, or a weird strain of malaria.’
He nodded slowly. ‘Okay, Lien, you know I’ve been working in Surgical lately. But I still remember all the basics.’ He turned to Viv. ‘I’ll need to brief you on a few of these as they might not be too familiar.’ He nodded again, decision made. ‘Lien, call Joe. Tell him that we’ll join him at the address in around an hour. Are you okay to cover the hospital?’
She nodded and he paused for a second. ‘Lien, can you organise some supplies to take with us, and I’ll brief Viv and arrange some transport for us.’
Lien’s tight shoulders dropped, as if some of the tension had just left her body. It was clear she was relieved that Joe wasn’t going to be left in that situation alone.
Duc hurried down the corridor with Viv close behind him. ‘I’m going to give you some crib sheets.’
‘What?’
He smiled and reached for a folder above the desk. ‘Sen found a whole pile of things randomly filed by my dad. It seemed he made crib sheets for some of the international doctors on conditions that crop up in Vietnam that aren’t so well known in other countries. Just to give them some first line information. She’s duplicated and filed them all in here.’ He raised his eyebrows. ‘Apparently, in future we’re going to have induction packs for staff. Maybe even send the information beforehand to let them study it.’
Viv looked around the office and smiled. ‘This place looks a whole lot tidier.’
Duc paused and gave a thoughtful nod. ‘It is. My parents loved being doctors too much to worry about the paperwork. Sen has been a blessing. She’s gone through this place with military precision. I think half the contents ended up shredded because they were out of date or not important any more. She’s scanned some things for electronic filing and cleared out the filing cabinets and reorganised the rest.’ He gestured to the seat behind the desk. ‘I can actually pull the chair in now, instead of having to dodge the boxes under the desk.’
He pulled out the sheets for Viv. ‘And watch out. She’s got her eye on how we deal with patient records. Apparently, she’s also getting us a quote about electronic prescribing.’
Viv nodded as she stared down at the crib sheets. For the first time since she’d got here she looked a little swamped.
Duc put his hand on her shoulder. ‘Don’t worry. Lien and I will talk you through anything.’
Viv shook her head. ‘Zika. I heard news reports about it, but I just never had a patient who’d been exposed.’ She pulled a face. ‘So I didn’t really read up on it. Now I’m feeling like a prize idiot.’
Duc squeezed her shoulder. ‘You’re never an idiot. This is an entirely new place. Look at what you did a couple of hours after you arrived.’ His face grew serious. ‘And you have no idea how relieved I am that you were here.’
He waited for a few seconds, giving her time to get over the little burst of nerves. ‘Now, let me talk to Sen and organise the transport. Sit down for ten minutes and give yourself the chance to read the basics. I’ll shout for you when we’re ready to go.’
Duc walked back down the corridor, giving some instructions to Sen and then pulling his phone out of his pocket and calling Joe’s number. ‘Hello, crazy Scot number two, tell me what you’ve got.’
It was the first time since she’d got here that she felt nervous about her clinical skills. She’d always known that there were diseases endemic to Vietnam, and if this had been a job she’d applied for, she would have researched them completely. But there hadn’t been time, and she’d just been so caught up in getting to Duc that she hadn’t really thought about the job properly.
Her first experience had thrown her in at the deep end. She’d quickly taken stock of the fact there was no functioning obstetrician and had taken steps to try and put safety measures in place.
But all her running around and organising had left her at a disadvantage. How could she really serve as an efficient and competent midwife or nurse if she didn’t know the basics about the population? She was letting them down, and she was letting the hospital down. A single bead of sweat trailed down her back and she shifted uncomfortably. It was unbearably hot today.
She tried to memorise everything on the sheets—then pulled out her phone to search for specific effects on pregnant women. The conversation between Duc and Lien seemed accurate. At first glance, any of these conditions could be mistaken for each other—but all had different results. It was important to diagnose correctly.
Lien appeared at the door. ‘Are you ready?’ she asked.
Viv nodded and stood, but Lien pointed at the table. ‘Put on some more mosquito repellent before we go.’ She handed Viv a lightweight long-sleeved jacket. ‘Just to be safe,’ she added.
The journey only took ten minutes. Duc, Viv and Mai Ahn were packed into a four-by-four with a pile of equipment.
Viv watched out the window as they turned into a street on the outskirts of Hanoi. The street was cluttered with bikes, mopeds and trash cans. A number of washing lines hung between the tightly packed buildings.
She climbed out the car and watched as Joe opened a door nearby and gave them all a wave.
His brow was creased as they approached. ‘Eight people. Most dehydrated and likely requiring some IV fluids. One of them is elderly, two are pregnant and two are kids.’
‘Then we’ll deal with them first,’ said Duc. ‘What about the rest of them?’
Joe handed over a notebook where he’d scribbled some notes. ‘Most of them are pyrexial. Some are also hypotensive.’
Duc looked around and split the patients between them all. Viv found herself with the two pregnant women. Mai Ahn stayed by her side.
Vivienne looked around. The house was clearly in disarray—but when every member of the household was sick, that was no surprise. During her variety of jobs as a midwife she’d often worked in people’s homes both during delivery and post-delivery.
Her first woman was paler than could be reasonable and was lying in bed, her breathing shallow. Vivienne sat down at the bedside and introduced herself, asking her name and for permission to check the woman over.
‘This is Mai-Lyn. She’s twenty-four, and sixteen weeks pregnant.’ Mai Ahn pulled a sympathetic face. ‘She didn’t realise she was sick at first. She thought maybe she just had late symptoms of early morning sickness. She’d been fine up until that point.’
It only took Vivienne five minutes to do some general checks. Mai-Lyn was very dehydrated. She had marks on her skin that looked like infected mosquito bites. Her blood pressure was low and her temperature high and a quick finger-prick blood test also revealed low blood sugar. Vivienne asked some pregnancy-related questions. Mai-Lyn had been having severe stomach cramps, but there had been no bleeding.
Vivienne pulled out her portable sonogram machine, and smeared some gel on Mai-Lyn’s abdomen, breathing a sigh of relief when the rapid noise of a heartbeat could be heard.
Duc appeared at Viv’s side. ‘What have you got?’
‘Are we moving these people to hospital or treating them here?’
He looked around and sighed. ‘They could all do with hospitalisation, but there is still a chance this could be infectious. For now, we’ll treat them here.’
Viv nodded and stood up. ‘In that case I need to set up some IV fluids, including some dextrose. I also want to administer some antipyretic for her temperature. She needs fluids quickly in the first instance. I think she’s got some infected mosquito bites. What the mosquitos might have carried?’ She looked up into his dark eyes. ‘I’ll let you experts get to the bottom of that. It could be anyone of the three conditions you showed me earlier.’
Duc nodded. ‘Let’s treat the symptoms and put the pieces together once we know all the patients are stable.’ He handed her some blood bottles. ‘Get some samples when you set up the IV.’
Vivienne nodded and got to work, quickly taking the sample and then setting up an IV, then moved on to the other pregnant woman. Her symptoms were almost identical but her history of mosquito bites went back a few days earlier.
She treated her patient and made her way back through to Duc, who was conferring with Joe.
‘I’m concerned by just how much joint pain both my ladies have. They’ve been bed bound for the last few days. One has a particularly nasty rash too. Is there anything safe to give them for the mosquito bites? A cream perhaps, as well as the antibiotics? I’m worried they’ll end up breaking the skin they’re both scratching so much.’
Joe pulled out a medical bag and rummaged through it, pulling out a mild steroid cream. ‘This should stop the itching and inflammation.’ He gave her a look. ‘If we were back home, I’d recommend a bath with porridge oats.’
She smiled. ‘The well-known remedy for itchy chicken pox. I remember it well.’ It was like a blast from the past. ‘But, considering I wouldn’t trust either of my pregnant women in a bath right now, I’ll stick with the cream, thanks.’
She looked around the room. Most of the others had IVs running. She’d basically never seen such a dehydrated bunch of patients in her life.
‘This has hit really hard and fast,’ she said. ‘What on earth does this?’
‘We’re just deciding,’ said Duc. ‘It’s crucial we get this right. Particularly for Zika—because that could have real implications for your pregnant women.’
Inside the pocket in her scrubs Vivienne secretly crossed her fingers. They still had to recruit another obstetrician. And if Zika was the diagnosis they needed one quickly.
Joe frowned. ‘Most of the symptoms fitted with being unwell days after being bitten by mosquitos. The sudden fever, muscle and joint pains all fitted. Some have had headaches, fatigue and nausea. A few have GI symptoms—and most have the nasty rash.’
Duc turned to him. ‘You’re thinking chikungunya?’ He gave a considered nod.
Joe nodded. ‘For me it’s the joint pains being so intense and prolific. Other than that, the symptoms could literally be interchangeable.’ He turned to Duc. ‘What do you think?’
Duc was weighing everything up. ‘It’s just unusual. For some people chikungunya is symptomless,’ he explained to Vivienne. ‘But this has hit this family so hard and so fast it must be some kind of vicious strain.’
Viv wrinkled her nose. ‘What does that mean? They’ve all been bitten by the same mosquito?’
Duc shook his head. ‘No. One person usually gets bitten and becomes infectious. If they then get bitten by another mosquito, it can pass the virus to another person. Literally, the virus could have passed between them all in a matter of days.’
‘Is there a cure? A treatment?’ Viv asked hopefully. She hadn’t got that far in the crib sheet yet—there just hadn’t been time.
She liked the way they were discussing the case. They were all comparing notes, looking for the most likely cause.
Duc shook his head again. ‘No cure. No vaccine. Just treatment. Those with underlying conditions, the young, and the elderly are most at risk of developing complications.’
‘But if we keep our eye on this family over the next few days,’ Joe said, ‘by this time next week, they could all be on the road to recovery.’
Joe pulled some sample bottles from one of the bags. ‘Okay, folks. Is there anyone we haven’t taken blood from yet? We need to get samples and get them to the lab.’
Duc pointed to the two people who hadn’t quite required IVs. ‘Just these guys. I’ll do it if you want.’
‘I’m going to keep an eye on my ladies,’ said Viv. ‘One of them is having stomach cramps that I hope don’t turn into anything else. I’m sure it’s just a symptom of the disease but I’m going to keep an eye on her in case I need to recheck things.’
Joe pulled out some paperwork. ‘Okay, let’s get this up to date for each patient and make sure everything is charted and prescribed.’ He raised his eyebrows. ‘Then we’ll have a chat about how we’re going to manage this situation for the next few days.’
Viv put her hand up straight away. ‘I’m happy to cover a few nights. I know I’m really a midwife, but general observations, IVs and antibiotics are all things I can cover—just as long as I’m not needed at the hospital.’
‘How many patients do you have due right now?’
Viv pulled out the work phone that Sen had given to her that morning. ‘Well, thanks to our wonder admin assistant I’ll be able to tell you. Let me check. Yip. Twelve due this month. Seven have already delivered and we’ve had one from next month deliver already.’ She gave them all a big smile. ‘I actually don’t have anyone due this week.’
Joe laughed. ‘You know that means nothing. Let’s hope you didn’t just curse yourself by saying those words out loud.’
Vivienne laughed too. She liked how well everyone worked together. Teamwork was essential in any hospital, and the way that everyone had been willing to pack up and come out here had impressed her. Could they really have found ambulances to ferry all these people back to May Mắn? She simply wasn’t sure.
She went back to check on her patients, turning up the speed on one of the IVs. Duc appeared and slung an arm around her shoulder. ‘How do you feel about us both covering the night shift so we can send Joe home to his son?’
Viv nodded. ‘Fine with me.’
Duc handed her a bottle of cream. ‘First job for us to make sure everyone—including us—is covered from head to toe in mosquito repellent. There could still be virus-laden mosquitos hanging around. We don’t want to be the next victims.’
Vivienne shuddered. ‘You say the nicest things. Can I barter for another dinner for this?’
His eyes twinkled. ‘I think I can manage another dinner.’
They worked comfortably together, settling down on the sofa in the main room once everyone had been tended to. Mai Ahn had come back with some extra bags of IV fluids and some food for them both.
It was dark outside now. Throughout the house they could hear the sounds of deep breathing. All the patients were sleeping.
Viv put her head on Duc’s shoulder. ‘I think I’m too tired to eat right now,’ she murmured.
‘You did good,’ he said.
Her hand moved over to his arm. ‘So did you. We all did. Let’s just pray it’s the right diagnosis.’
There was a long pause. Viv gazed at the dark sky speckled with stars outside the window.
‘I’d forgotten about this part,’ Duc said, his voice sounding a little strange.
She lifted her head. ‘What?’
He made a sad kind of sound. ‘The being a doctor and not just a surgeon part.’ He held up one hand to gesture to the room they were sitting in. ‘I would never do this, haven’t done it in my whole career. I spend my life in a hospital setting, seeing patients in clinics, wards or Theatre.’
Viv smiled. ‘Ah...a home visit virgin. Well, welcome to the world of community nursing. Every home opens a whole new world. You’ve no idea what you’re stepping into.’
He looked at her and she continued. ‘I’ve been in houses where they have giant birthing pools in their living rooms. Some where I’ve had to step over the passed-out drunk person as I step inside. Houses where my feet stick to the carpet and I’m afraid to take my coat off. Then there’s the family pet who snarls and growls at me, looking as if they want to eat me, and there’s the inevitable shout, “Don’t worry, hen, he’ll no’ touch you!” Then...’ she wagged her finger ‘...there’s the pristine houses that are miles cleaner than the hospital and you feel positively shabby as soon as you cross the threshold.’ She rolled her eyes. ‘I’ve been asked to take my shoes off at the door or put those blue coveralls on my feet.’
He shook his head as he smiled back, his brown eyes looking at her fondly.
‘Looking after people in their own environment is a privilege, Duc. I never forget that. And it makes you better at your job. You don’t have a team to back you up. You can’t press an emergency buzzer and a whole team appears in under two minutes. It’s you. You’re it. You have to improvise and make do. It makes a more experienced practitioner, and a more resilient one.’
He gave a slow nod of his head at her words. ‘You love it, don’t you?’
He pressed his lips together as she nodded. ‘And I’ve taken you away from that.’
She squeezed his arm. ‘There’s lots of ways to look after a community, Duc. According to Lien, she’s practically had to put a tracker on Joe because he’s so used to home visiting because he worked as a GP. Maybe there’s a way to look at more outreach work. Or...’ she held out her hand ‘...when it’s needed, taking services to the patients. You did okay this time around.’
He leaned back against the sofa and Viv looked at the expression on his face. She saw something that hadn’t been there before—curiosity.
‘Every job can be a challenge. Sometimes the challenge is what gives you the enthusiasm to keep going.’
She wanted to say more. She wanted him to take a look around and realise just how important the work here was.
He’d risen to the challenge today. But his long-term plans weren’t for working at May Mắn Hospital.
Her stomach gave a little twist. What were her own long-term plans? She’d never had any before. Just living from one six-month contract to the next.
But Hanoi was a wonderful city. Bright, exuberant and filled with special people. She could see a fantastic role here. One that she couldn’t possibly even begin to tackle in six months.
She licked her lips, mouth suddenly dry. This was the first time ever she’d had thoughts like this. And what would be the point in thinking of staying here longer if Duc was going back to the US?
She leaned her head back on his shoulder and murmured, ‘Okay, I bags first sleep. Wake me up in an hour.’
She settled down as he slung his arm around her shoulders again and let her snuggle against him. She’d think about all this later...