Jack Reynolds was a hero.
She had heard the undertone of those carefully chosen words. Jack hadn’t intended coming back here for anything more than a visit.
But now he wasn’t sure.
Something had changed.
And, judging by the way he was looking at her right now, that something had a lot to do with her.
The breath was still trapped. Because when she released it, what words might come out?
She’d already told him that his coming back was the best Christmas gift he could ever have given her. Saying anything more could be a mistake. Jack was standing at what could be the biggest crossroads his life was ever going to present but the choice of which direction he took next had to be entirely his own.
‘Dr Matthews?’ The urgency in the voice of the nurse behind her was unmistakable. ‘You’re needed. Curtain Four.’
Her breath came out in a whoosh.
‘Coming...’
CHAPTER FIVE
ONE LOOK AT the young woman lying on the bed behind Curtain Four was enough to tell Emma she had walked into a medical emergency. Pete, the young Australian registrar, was pulling the pillows from beneath her head to lay her flat.
‘What’s going on?’
‘She’s not breathing...’ Pete tilted the woman’s head back to open her airway. ‘The crash cart’s on its way.’
He was putting his fingers on the woman’s neck to check for a pulse but Emma knew there was little point. You only had to look at the skin colour to know that this was a cardiac arrest. She put her foot on the control that lowered the bed and immediately positioned herself at the side, her hands on the middle of the woman’s chest to start compressions.
‘How long has she been like this?’
‘I don’t know.’ Pete was looking distressed. ‘She was asleep. Her boyfriend went home a while ago.’ He had a bag mask in his hands now, waiting for Emma to pause her compressions.
‘Twenty-eight, twenty-nine, thirty...’ Emma stilled her hands to let Pete deliver two breaths.
‘How old is she?’
‘Twenty-nine.’
Emma could feel the tension around her increasing. Or maybe it was coming from within herself. Twenty-nine? This woman was younger than she was. She wasn’t going to die on her watch if there was anything Emma could do about it.
‘How did she present?’
‘Epigastric pain. It didn’t seem too bad but it wasn’t going away. I decided to send her for a scan but they’ve been a bit swamped so it’s been a long wait.’
Something like guilt added a new layer to the awful tension.
‘You told me about her... You asked me to have a look. Ages ago...’ Emma’s brain was replaying the brief conversation in her head. ‘You were bothered about something...’
‘I didn’t know what, though. It didn’t seem urgent but that’s why I didn’t send her home.’
‘Thank goodness for that.’
If this had happened out of hospital, the chances of survival would have been virtually zero. Even here, the chances probably weren’t that great but Emma wasn’t about to let that thought surface.
The rattle of wheels advertised the arrival of the trolley with the life pack that was urgently needed. Pete attached electrodes while Emma kept up her steady compressions. She waited until the machine beeped into life and she could see the jagged lines on the screen and then lifted her hands to let the artefact settle so they could determine whether there was a rhythm.
Any rhythm would be better than a straight line because then they could shock this young woman and potentially save her life in an instant.
You couldn’t shock a straight line.
And you couldn’t shock what looked like a slow but relatively normal rhythm, either. This looked like a rhythm that should be providing a pulse but it wasn’t. It was pulseless electrical activity.
‘Looks like PEA,’ Emma said. ‘Let’s get her into Resus.’
‘They’re full.’ The nurse who’d delivered the monitor shook her head. ‘Alistair’s got a kid with a severe asthma attack in Resus One that’s just gone into respiratory arrest and there’s a stroke patient in Resus Two. They’re both being put on ventilators.’
‘Fine.’ Emma gritted her teeth. ‘We’ll have to cope here, then. Pete—take over compressions. I’m going to intubate.’
* * *
The noise level was increasing steadily and Jack could sense a new tension in the department’s atmosphere.
He couldn’t just lie here and listen to it.
He couldn’t go out and see what was going on either. Not in a hospital gown that was probably gaping at the back.
But his rucksack was sitting in the corner of the room—beside the pile of now useless leather bike clothes and a badly scratched helmet—and he had a full set of street clothes in there. All he needed were his jeans and a T-shirt.
A moment’s dizziness when he got to his feet settled back into the headache he was getting used to. It hurt to put weight on his injured leg but the compression bandage was enough support to be able to move and it was no trouble to use his scraped arm to get dressed.
The dizziness returned when he got to the door of this side room and had to blink against the bright lights and take in the scene in front of him. For a moment, his gaze was caught by the flashing colours of the Christmas decorations on the triage desk but then he saw the stretchers waiting in front of it, the paramedics looking as if the night had already been too long.
It took a longer moment to adjust to the movement going on. People were going in all directions. A consultant he recognised, flanked by junior doctors, was disappearing into the resuscitation area he’d been in when he’d first arrived here. A nurse was hurrying towards a cubicle pushing an IV pole, with a bag of fluids in her free hand. Two security guards were pushing a loudly protesting and obviously very drunk man back towards another cubicle. A cleaner was mopping the floor. A technician rushed past him with a polystyrene bucket full of blood samples and a mother was walking back and forth not far away with a howling toddler in her arms.
Jack didn’t need to hear an alarm sounding somewhere to see that this emergency department was on the brink of chaos.
There had to be some way he could help but where would he be the most useful?
In one of the two occupied resus areas for the critically ill patients? No, wait... It looked like something was going on in one of the curtained cubicles on the far side of the department. As a nurse pushed an IV trolley into the space, the curtain was pulled back far enough for Jack to see that CPR was in progress. Ignoring the pain in his leg, Jack headed for Curtain Four.
* * *
‘You need to get a better seal with the mask. Try that breath again.’
Emma glanced up from her task of checking her gear for intubation as Pete spoke, immediately aware of several different things.
That Pete was delivering excellent compressions. That he was concerned that the young nurse who had been given the task of delivering breaths via the bag mask was struggling and that someone else had come into the curtained cubicle.
Jack...
He was moving towards the head of the bed.
‘I’ll do that,’ he told the nurse.
Pete was looking shocked. ‘What are you doing out of bed?’
‘I’m fine.’ Jack had the mask firmly held between his thumb and forefinger. ‘I could see that some help was needed.’ The other fingers of his same hand were under the jaw of their patient, making sure the seal of the mask was perfect. With his other hand, he held the bag attached to the mask, waiting for Pete to pause the compressions so he could deliver a breath.
Emma could feel her own chest fall in a sigh of relief as she watched the rise and fall of her patient’s chest.
>
‘You sure you’re up to this?’ she asked quietly, meeting Jack’s gaze for a heartbeat.
‘I’m sure.’
The relief kicked up another notch. Jack had many years’ more experience than Pete and...and everybody knew what a brilliant doctor he was. If she could have chosen anybody to face this challenge with her, it would have been Jack.
The light on her laryngoscope was working. The stylet was inside the endotracheal tube and the cuff was inflating. She was ready.
‘Can you give me some suction, please?’
Jack delivered one more breath, cleared the mouth of any secretions with the suction unit and then moved out of the way. Emma tilted her patient’s head back and positioned herself. She gave Pete the nod he was waiting for to interrupt the chest compressions. As she slid the laryngoscope blade into place, she took a breath herself and held it. Holding her own breath while her patient was without oxygen would let her know if her attempt was taking too long. The goal was to secure the airway within ten seconds if she could.
The tube slid into place through the vocal cords. She pulled the laryngoscope blade and then the stylet out before pushing the plunger on the attached syringe to inflate the cuff. Jack attached the bag to the end of the tube and squeezed it and they could both see the rise of the chest.
‘Good job,’ Jack murmured.
Emma said nothing. She hooked her stethoscope into her ears and placed the disc on one side of the chest and then the other as Jack squeezed the bag again. Finally she nodded, reaching for the plastic device that would stabilise the tube and ensure it didn’t get displaced during the chest compressions that Pete was recommencing.
But he had already been doing the compressions for longer than the two minutes protocol demanded for efficacy.
‘How’s your arm?’ she asked Jack. ‘Do you think you can take over compressions?’
‘Of course.’
‘We need IV access, too.’
‘You do that. I’ll do compressions. Pete—you come and bag her.’
The small team shifted positions. Emma clicked a tourniquet into place, watching the screen during the brief pause.
‘Still PEA,’ she said.
‘What’s her name?’ Jack asked.
‘Melissa,’ Pete answered. ‘But her boyfriend calls her Mel.’
‘She’s very young...’
‘Twenty-nine.’
Emma caught Jack’s gaze again. The briefest of glances but she knew he was as determined as she was to save this young woman.
They both knew how devastating it could be to lose someone so young. Mel had a boyfriend. Probably a whole family who were unaware of this catastrophic development and were probably expecting her to come home within hours to share their Christmas celebrations.
‘There has to be a reversible cause,’ Emma said. ‘There has to be...’
‘How did she present?’
‘Epigastric pain.’
‘Poisoning? An anaphylactic reaction to something?’
Emma slid the cannula into place and taped it down. ‘I don’t think so. We can rule out hypothermia, hypovolaemia and a tension pneumothorax, too.’
The list of potentially reversible causes was getting shorter. As Emma reached up to move the small wheel on the IV line and start fluids running, her gaze caught Jack’s.
‘Thrombosis,’ they both said at the same time.
Emma’s gaze flew to Pete. ‘Has she been on any long-haul flights recently?’
‘Not that she mentioned.’
‘Is she on an oral contraceptive?’
‘Yes.’ Pete’s eyes widened. ‘It’s the only medication she takes.’
Emma looked back at Jack. ‘Abdominal pain is an unusual presentation.’
‘But not unheard of.’
‘No.’ For the first time Emma felt a glimmer of hope. They could potentially do something about this. The flash in Jack’s eyes told her he was thinking the same thing. More than that, it was all the encouragement she needed to pull out all the stops and tackle this head-on. They could do this...together...
‘Pete?’ Emma reached to take hold of the bag. ‘Go and grab the transoesophageal echo from Resus One.’
‘Are you thinking thrombolysis or surgical embolectomy?’ Jack asked.
‘I’m thinking anything and everything right now,’ Emma responded. She squeezed the bag to deliver another breath. ‘I just hope we’re right...’
* * *
Jack focused on his compressions again but he could feel that Emma was still watching his face. He had to resist the urge to look back at her. To see that hope in her eyes. That confidence that they could do this if they did it together.
To feel that connection that made him want to shift heaven and earth to give her exactly what she wanted.
To see that hope morph into joy.
He channelled the edge that these unfamiliar emotions created into doing the best he could with the task he was responsible for. He kept his arms straight with his weight balanced over them so he could keep going for as long as necessary without tiring. He pressed hard enough to make sure the pressure was squeezing enough blood from the heart. Fast enough to ensure there was enough circulating oxygen to keep this young woman’s brain alive.
He tried to keep his own breathing steady too and kept his lips pressed together so that nobody would guess how painful it was to keep standing on his injured leg or that his head was throbbing with the physical effort.
‘You need a break,’ Emma said, a minute later. ‘I’ll take over compressions.’
But Jack didn’t pause. ‘Have you used TEE before?’
Emma nodded. ‘A few times now. We got trained by Cardiology. They use it to rule out clots before converting atrial arrhythmias.’
‘Then I’ll keep going. Pete can take over when he gets back.’
Except that Pete was looking worried when he got back. ‘Everything’s hitting the fan out there right now. Can you cope without me for a few minutes?’
A glance at the nurse who was looking terrified at the prospect of taking over compressions was enough to elicit a terse response from Jack.
‘Yes,’ he said. ‘Go.’
Emma must have seen the look on the nurse’s face as well.
‘Go to the drug cupboard,’ she told her. ‘We need drugs to deal with a clot, if that’s what’s causing this. We’ll need TPA. Alteplase or tenecteplase. Get someone to check it with you.’
The ultrasound probe was on the end of a long, flexible tube that Emma could easily slip into their patient’s mouth and down into the oesophagus.
‘The beauty of this is that you don’t need to stop compressions,’ she told Jack. ‘We can still get a clear picture. Look at that...’ She angled the probe. ‘You can see the valves opening and closing. And if I put the colour flow on...’ For a moment she watched the movement of the red and blue on the screen. ‘You’re doing fantastic compressions, Jack. The flow looks almost normal.’
For a moment, pride wiped out any physical discomfort Jack was feeling. He was doing a good job. They were doing a good job. And the skill Emma was demonstrating in using this sophisticated equipment shouldn’t be a surprise but it was certainly impressive.
He was proud of her, too.
‘Oh, my God...’ Emma breathed. ‘Look...’
The rhythm of Jack’s compressions didn’t alter as he turned his head and focused on the screen.
‘Is that what I think it is?’
‘It’s a massive clot. Moving from the right atrium into the ventricle.’
The nurse was back with the drugs needed to break down the clot that was stopping Mel’s heart from working. Emma injected the first dose and then took over compressions from Jack.
Minutes ticked by as
they kept up the resuscitation effort. Five minutes and then ten. He could see by the determined lines on Emma’s face that her arms were aching more each time she took over the compressions. It was Jack who finally glanced up at the clock. ‘How long has she been down?’
‘Twenty-five minutes.’
The glance Emma gave him was shocked. Did she think that Jack was going to suggest they give up this resuscitation? That he was going to walk away from this team effort?
Of course he wasn’t.
‘Swap,’ he said, his shoulder pressing against hers as he moved into place to take over. ‘Are you going to give a second bolus?’
Emma nodded, reaching for the syringe that was already loaded with the second dose of the clot buster.
It was past the time when Jack would have expected Emma to insist on changing over the task of compressions but she had her hand on the echocardiography probe again, clearly wanting to see whether there had been any change first.
Jack watched the frown on her face deepen as she changed the angle of the probe.
‘I can’t see it...the clot...I can’t see it...’
‘Maybe it’s gone...’
‘Stop compressions for a sec.’
Emma looked like she was holding her breath. She pushed a button that put the colour flow mode on. His hands were nowhere near Mel’s chest but there was movement on the screen. Valves opening and closing. Blood flowing...
Emma’s lips were parted as she looked up at the ECG monitor. Jack knew exactly how she was feeling.
That she couldn’t believe what she was actually seeing. The trace looked like it had before—almost normal—but now it wasn’t just electrical activity with no result. There was blood flowing again.
Had they won this fierce battle?
As if to dispel any lingering doubt, Mel’s chest heaved as she took her first breath unaided. And then another...
They both looked up at exactly the same moment.
At each other.
Emma’s lips were trembling, hovering on the brink of a joyous smile, but it was the expression in her eyes that caught Jack’s heart and made it squeeze so hard it hurt.
Their First Family Christmas Page 7