I'll Find You

by Liz Lawler

  Two nurses were in the act of getting ready, one pulling a tunic over his head, the other putting on a pair of trainers. Shelly was sat on a bench, scrolling through her mobile, and was the only staff member Emily recognised. She wondered if the other two had permanent night shifts.

  She gave a friendly smile, opened her locker and said, ‘Hi everyone, I’m Emily. First time on nights. Here, that is.’

  An attractive man in his mid-thirties stepped forward. His light brown hair was smoothed back in a short ponytail. ‘Jim Lanning,’ he said, shaking her hand. ‘I’m agency.’

  ‘Me too,’ added the younger man beside him, fixing a fob watch to his tunic. ‘Ricky. Work mostly days, but saving to do a road trip round America, so I’ll take any shifts on offer.’

  Shelly smiled at Emily in acknowledgement. ‘Nice to see you again.’

  The sound of locker doors banging shut reminded her that she still needed to change into her own uniform. Emily headed into the toilet. She was surprised that the hospital got away with only providing a unisex changing room. The area was certainly big enough to have incorporated two changing rooms. Instead, they had divided the room with four rows of lockers in the centre and a female and male area at each end, offering separate toilets, shower room and changing cubicles. She was not shy about changing in front of the others, but it was a good excuse to use the loo at the same time. When she came out of the cubicle five minutes later, the changing room was deserted, her colleagues already gone. Catching sight of the wall clock, she saw that she was a minute late for the start of her shift. Hurrying, she made her way to the staff room.

  The nurses had pulled chairs close to a desk, forming a half circle, and behind it sat Sister Barrows. She peered over her half-moon glasses. ‘Are we all here now?’

  Emily slipped into the last seat and offered a quiet apology.

  ‘We’re short-staffed tonight, and we have a full house. Two of the healthcare assistants from the late shift are staying on to help out for a while. I want Shelly to work with them and circulate between the four areas. Those of you who were on last night work the same wards again. I’ll take Sulis Ward. Nurse Jacobs, I’m allocating you Allen Ward, but I want Nurse Lanning there too.’

  Emily felt her hackles rise. Was she being given a second pair of trained hands because the ward sister didn’t think her capable?

  ‘You’ve got the busiest ward tonight, three post-ops back in the last hour, one still in theatre, and one of the post-ops needs one-to-one care. I want Nurse Lanning to focus on her, please. She’s a forty-four-year-old who has had a hysterectomy. Her blood pressure’s a little on the low side.’

  ‘Shouldn’t she be transferred to the High Dependency Unit?’ asked Shelly.

  Barrows dipped her head a fraction and looked over the top of her glasses at the healthcare assistant. ‘We’re quite capable of monitoring low blood pressure. And in any case, HDU is full.’

  ‘I’m on it,’ Jim Lanning said in an overly loud, serious voice, as if the man were imagining giving care to a patient who’d had major heart surgery. Emily cringed a little.

  ‘Indeed,’ Barrows replied dryly. ‘When she’s stable I then expect you to give Nurse Jacobs a hand on the ward.’ She stood up. ‘Well, let’s get started then, shall we? I’m sure the day staff are eager to get off home.’

  The staff nurse who handed over to Emily was thorough. She took her through each patient’s medical history – their operation, their vital observations, their pain score – and left Emily feeling confident that she knew as much as she needed to take over. The only patient she hadn’t been introduced to was Mrs Harris, the patient with low blood pressure who Jim was focusing on. Emily was happy to unlock the medicine trolley and get started with the routine jobs.

  An hour on, she had dispensed most oral medication, put up infusion bags, given intravenous antibiotics and inserted a new cannula into one of the patients, who’d winced when she’d flushed it with saline and said it had been playing up all day.

  She stopped by the two-bedded room, the same one that she had occupied as a patient, and put her head round the door. ‘Everything OK, Jim? Do you need anything?’

  The patient in the bed was still and sleeping. Oxygen administered via nasal cannulas was secured by tubing fitted around her ears. ‘All good. I’m on it. She’s a little cold. Her temperature is 35.5. You can throw me another blanket if you’re passing.’

  ‘Her blood pressure still low?’

  ‘Same, nothing to worry about.’

  ‘You want me to take a look?’ Emily asked.

  Jim stared at her as if she’d just said something outrageous and gave a short answer. ‘No.’ Then added, ‘Quite capable of assessing her, thank you.’

  Emily stepped back, embarrassed. ‘OK. I’ll just get you the blanket then.’

  The next couple of hours flew by and Emily was kept busy after receiving her last patient back from theatre, a forty-three-year-old woman who’d had her gall bladder removed. She was violently sick, probably from the morphine, but finally settled after Emily gave her an IV anti-emetic for the nausea.

  The noises and call bells, the toing and froing to carry out tasks and see to patients, had ceased for a while. She listened to the silence and thought how different it was to A&E, where night and day merged into one and where it was never quiet. It was strange to be waiting for a patient to call.

  Chapter Eight

  It was 3 a.m. and all was quiet. Emily yawned. She had neither seen nor heard from Shelly all night, and suspected the others thought she didn’t need help with two staff nurses working on the ward. She would have liked to have seen her, if only for a five-minute chat. She’d left Jim alone after her last visit and had only seen the back of him once earlier when he’d nipped along to the toilet. She’d called out to him, asking did he want her to watch his patient, but he’d waved his hand in the air and she saw the back of his head shake from side to side as he called out his laconic reply: ‘No.’ She wondered why he was still in with the patient and hadn’t bothered to come out and help on the ward, so she got out of her chair, deciding she’d pop along and ask him if he needed a break or a cup of coffee or a pillow for his own head if he was nodding off in the room. He could even be lying down on the other bed for all she knew. She wasn’t that bothered if she didn’t see him, but she’d let him know she wasn’t a fool either.

  At first she didn’t see him in the room, as she was expecting to see him standing by the bed or sitting in the chair. The other bed remained unoccupied, the covers pristine. When he raised his head off the woman’s chest she saw fear in his face.

  ‘I don’t think she’s breathing!’

  Emily immediately switched on the overhead lights and advanced towards the bed. Placing her hands firmly on the woman’s shoulders she spoke loudly, ‘Hello, can you hear me, Mrs Harris? Hello. Mrs Harris! Hello!’ The woman gave no sign of response.

  ‘Shit,’ Jim uttered, standing still as a statue, unable to move. ‘I don’t understand. I thought she was OK.’

  ‘Get the crash trolley,’ Emily said, and at the same time she took the brakes off the bed, moved it away from the wall, then reapplied them.

  ‘Where?’ he asked, his eyes desperately scanning the room as if hoping to see it there.

  Emily kept her voice calm, and at the same time pulled the emergency call bell. ‘Go out the door, turn left. It’s between here and the next room. Unplug it from the wall and bring it here.’

  He fled the room. Emily took the headboard off the bed and positioned herself at the patient’s head. With two fingers beneath the woman’s chin she tilted the head back and put her ear near the woman’s mouth, watching for a rise and fall in the chest. The woman was making a feeble effort to breathe. From her pocket Emily pulled out her Tuff Cut scissors and quickly snipped open the woman’s theatre gown. The dressing over the abdomen was intact and dry; but the belly was swollen.

  When Jim returned she told him to move the bedside locker away from
the bed and bring the crash trolley nearer to her. Taking a Guedel airway from a drawer, she quickly inserted it into the woman’s mouth to keep her tongue from falling back, and replaced the nasal cannulas with a bag valve mask, attaching the tubing to the oxygen outlet on the wall and turning the flow up high. She watched as the woman made another feeble effort to inhale, and she squeezed the rugby-ball-shaped resuscitator to push more oxygen into her.

  ‘Jim, fast-bleep the RMO.’ Resident medical officer was a term Emily was still getting used to. In private practice it was the title for the on-call doctor, whereas in the NHS she would have just asked for the senior registrar to be bleeped. ‘And get the anaesthetist to come back in, tell them this patient is peri-arrest, and then bring back two litres of warmed Hartmann’s solution and rapid infusion bags.’

  While he rushed once more from the room, Barrows and Shelly arrived. ‘Where do you want me?’ asked Barrows.

  ‘If you can take over ventilating her, I’ll get the defibrillator ready and put another cannula into her.’ Barrows took over, positioning herself at the head of the bed. Emily addressed Shelly. ‘Shelly, I’m not sure Jim knows where to find everything. I want two warmed bags of Hartmann’s and rapid infusion bags.’ Emily suspected the woman would need a blood transfusion but until the doctor gave the go-ahead, Hartmann’s solution would act as a substance to replace any blood loss. ‘Can you also bring the HemoCue machine?’ Shelly nodded and pelted back out the door.

  Freed up, Emily hit the start button on the patient’s monitor to get a fresh reading of vital signs. She grabbed two defibrillator pads, unpeeled their sticky covers and slapped them on, one above the right breast, the other below the left breast, then switched on the defibrillator. Quickly, she pulled out another drawer on the crash trolley and chose a large cannula. She strapped her tourniquet above the elbow of the woman’s right arm and let the arm dangle over the side of the bed. When the hand had turned a reddish blue and a vein began to surface in the crook of the arm, she inserted the wide-bore cannula into the bulb of the vein and was glad to see the instant flowback of blood. Filling a syringe with saline, she flushed it to ensure its patency.

  ‘What’s the situation?’ she heard a familiar voice ask, and was relieved to see Meredith come into the room.

  ‘Feeble respiratory effort when I got here. Immediately commenced bag valve mask ventilation. She has a size four airway in situ. She has a distended abdomen and as you can see she’s tachycardic and her blood pressure is eighty-five systolic. I don’t know how long it’s been that low as I haven’t had a chance to look at previous recordings.’

  Meredith picked up the observations chart, quickly scanning it. ‘Christ, her systolic pressure’s not risen above ninety-five for the last three hours. Why the hell wasn’t I called?’

  ‘I’ve only been in the room a few minutes. You’ll have to ask Staff Nurse Lanning. He’s fetching Hartmann’s.’

  ‘Good call, but she needs blood as soon as possible. So let’s give her two units to start with.’

  After quickly examining the woman, particularly around the abdomen, Meredith went over to the crash trolley and pulled out a longer flexible plastic tube which would go further down the back of the throat to replace the smaller airway already in situ. It would permit air to pass freely to and from the lungs and allow the patient to be ventilated during surgery. The procedure would require two people. ‘You alright to help me, Emily? Sister Barrows, can you grab Mr Dalloway, he is just finishing in theatre two. And we’d better let Mr Davies know his patient’s condition.’ Emily nodded, as did Barrows.

  Over the next half an hour Emily assisted Meredith, making ready and passing all the equipment required when needed. At the same time she instructed Jim to fetch blood and oversaw him and Shelly check it and put it up. The woman was deathly white, and while her blood pressure had dropped no lower, she had made no visible recovery. Whatever was causing the bleed inside her needed to be found quickly and stopped.

  The patient trolley, loaded with drip lines, monitors, portable ventilator and a pale patient was pushed by a porter and escorted by Meredith back to theatre. Emily sank down on the empty bed and took a couple of deep breaths. She couldn’t help but think about what a close call that had been. Any further delay and the woman could have died. It was still touch and go, and until she came back out of theatre stabilised they couldn’t count their blessings yet.

  ‘I’m going to make us some tea,’ Barrows announced from the doorway. ‘Nurse Jacobs, all your patients are fine so please take five minutes. The same goes for you, Nurse Lanning. We’ll have a debrief in the staff room at four o’clock.’

  Emily looked at her watch and was surprised to see that it was only a quarter to four. The last forty-five minutes had felt like hours. The two-bedded ward showed the aftermath of an emergency situation, with equipment and instruments left abandoned. The floor on the other side of the bed was splattered with spilled blood. In his haste to get the blood into the woman, Jim hadn’t connected the transfusion set firmly enough to the cannula and blood had poured out.

  Jim had not yet spoken about what had just occurred, even though he was probably desperate for reassurance, and Emily, from her experience of dealing with many emergencies, chose not to give it. She would give the facts and not her opinion when asked. It was up to Barrows to investigate why the patient’s deterioration was not picked up on sooner.

  Rolling her shoulders back, and mentally giving herself a shake, she stood up and began the task of putting the room back in order. She would start first with the crash trolley and ensure it was restocked and ready for use for the next time. Jim followed her lead and started putting the headboard back on the bed, his movements energetic, his breathing and sighs too loud. He was irritating the hell out of her by just being in the room. Angrily, she shoved the bedside locker and an injection tray slid off and fell to the floor, scattering used needles and syringes.

  ‘I’ll get that,’ he offered.

  She was already on her knees, ignoring him and gathering up the contents. ‘Just pass me the sharps box, please.’

  ‘I thought she was OK,’ he said. ‘I thought you—’

  She glared at him and he shut up.

  She dropped each unsheathed needle carefully into the yellow plastic tub and let her eyes wander over the area for any she may have missed.

  A glint attracted her attention to the crevice where floor met skirting board. Using her fingernail, she carefully scooped it free and watched a chain of small links follow her finger. Her eyes fixed on her find and her heart beat uncomfortably. She had found a bracelet. A silver bracelet – too big to stay on a small wrist.

  *

  ‘Hey Emily, hold the lift!’

  Emily turned around and saw Meredith running to catch her up. She put her hand out to stop the lift door from closing. The anaesthetist was dressed in pink and navy Lycra knee-length running shorts and pink short-sleeved polo shirt. On her feet she wore navy Skechers.

  ‘You are one incredible nurse. Do you know that?’

  Emily coloured self-consciously and tried to hide her face.

  ‘No, don’t look away,’ Meredith said, touching Emily’s shoulder till she looked back at her. ‘I’ve just torn into Ratched after reading yours and Fuckup’s statements and asked her how someone who is clearly as inexperienced as him can work here? Without you last night we would have had a dead woman on our hands. Do you know he hadn’t even done a HemoCue test on her? A simple prick of the finger would have told him what was going on. He said he asked you to do one. Said you had said it was normal?’

  Emily stared at her, astonished. ‘Me? He wouldn’t let me into the room! I offered to check on her!’

  Meredith smiled in amusement. ‘Easy does it. We know he lied. He knows you saved that woman’s life. Dalloway is singing your praises right now to Mr Davies, so don’t be surprised if you get a call from the man. It was his patient.’

  ‘Thank you, Meredith,’ Emily finally sai
d, still feeling shocked at what Jim had said. ‘I’m glad I could help.’

  ‘Ditto, Emily. Big-time ditto.’

  The lift reached the ground floor and both women stepped out. Emily swung her rucksack onto her other shoulder and it caught the side of her breast, making her wince. Meredith saw her face. ‘Hey, are you OK? You need to be careful. It’s alright coming back to work if you sit down for your job, but ours is a physical one, so take it easy with lifting and things.’

  ‘I’m OK. It’s healed nicely.’

  ‘Tough cookie, aren’t you?’ Meredith remarked, and Emily smiled.

  ‘What was the cause of the bleed?’ Emily asked as they carried on walking to the exit. ‘I haven’t had a chance to find out.’

  Meredith raised her eyebrows and sighed heavily. ‘Nicked vessel. So Mr Davies is going to have to answer for it. Fortunately for him Dalloway was on hand to sort it out and, with luck, the woman will have no lasting damage, other than a delayed recovery time. It was a slow bleeder that should have been picked up on a lot sooner. I don’t think we’ll be seeing Nurse Lanning back here again.’

  Emily gave a thankful sigh. ‘Thank god for that. Not about him, but that the patient survived it.’

  ‘Indeed. There but for the grace of god, and all that.’

  Emily smiled. She felt tired. ‘You know you’re already losing your accent.’

  ‘I know,’ Meredith nodded, before pulling her right foot up behind her leg and holding it against the back of her knee to stretch. ‘My colleagues back in the States will think I talk all posh when I return. Jeez, my husband won’t be able to keep his hands off me.’

  Emily laughed, then added a little shyly, ‘Well, I for one am glad that you’re still here. Though not if your family member is still poorly.’