No one had any idea what was wrong with the baby. They’d taken bloods and blood cultures, thinking she might be septic, but Chris’s gut reaction was it could be something far worse, like an undiagnosed congenital heart defect that was stopping blood from being pumped properly around Sofia’s tiny body. He glanced over at the parents again and gave them a reassuring smile. Their resilience and strength amazed him. Perhaps they didn’t know how serious things were. Tomorrow he planned to visit the maternal and child health nurse and take her a bottle of wine to express his thanks for her diligence.
He was sitting down at the desk typing his notes when a strange sound came from the other side of the department. He listened again. It sounded like stridor, but that couldn’t be right. They didn’t have anyone in the department in respiratory distress other than Sofia, and she was tubed and being watched like a hawk by one of the nurses who’d been called in from upstairs to help.
He listened again. The sound was a combination of a high-pitched noise followed by a deeper barking sound. It didn’t sound like stridor, but it concerned him enough that he stood, his mind working through the list of patients in the department.
Abdominal pain in cubicle one, probably appendicitis, waiting for CT results. Nosebleed in cubicle two that still needed to be cauterized. Cubicle three was a man with chronic pain who refused to leave until they handed over more narcotics. The woman in cubicle four needed sutures to her finger and a possible plastics review. The next three cubicles were filled with monitored patients: two of them had presented with chest pain and were waiting on blood results, the other was massively hypotensive and waiting for an admission. In cubicle eight was a man who had been waiting all day for a non-urgent ambulance transfer to Sydney. The remaining cubicles held kids, and that’s where he headed first.
The first cubicle was empty and the man sitting there informed him that his son was in x-ray. The next two cubicles contained happy-looking kids, lying on their respective beds watching television. No problems there. The final cubicle held a mother and an infant who was currently vomiting into an emesis bag. The mother shot him a flustered look and he hastily retreated, letting her know he’d send a nurse in to give her son an anti-emetic to stop the nausea.
He circled the central desks and drug room and his heart took off when he saw the man in cubicle eight. The ambulance officers had arrived to transport him to Sydney but for some reason, in transferring him from his hospital trolley to the ambulance gurney, he’d gone into respiratory distress, each breath causing the unusual sound. Chris racked his brain for the man’s diagnosis and reason for transfer. It came to him in a flash. He had a tumor pressing on his vocal cords. But he’d been stable the entire admission, hadn’t he?
Tess, one of the nurses, was one step ahead of him. She was already asking the ambulance officers to help her get the man back onto the hospital bed. At the same time, she wrapped the blood pressure cuff around his arm, spoke soothingly to him and placed a pulse oximeter on his finger. Seconds later the monitor above the bed alarmed. His oxygen saturation levels were only eighty-four percent. They should have been greater than ninety-five at least.
He frowned. “How much oxygen are you giving him?” he asked Tess.
“Four liters,” she replied while ripping open the plastic packaging on a Hudson mask and slipping it over the man’s head.
“Put it up to fifteen liters,” he said.
She leaned over behind the bed and cranked the oxygen to the maximum limit. The man continued to struggle with each breath.
“Where’s his wife?” Chris asked.
“She stepped out to grab a coffee, I think.”
“What happened?”
Tess shrugged. “No idea. Like you, I came running when I heard his breathing.”
“And he’s been stable the whole admission?”
“As far as I know. I haven’t been looking after him. He was Drew’s patient.”
“Where’s Drew now?”
“I think he’s gone to tea,” she replied.
The man waved his arms to get their attention. “Can’t. Breathe.” His face was a mottled purple color and he was leaning over his knees, each breath evidently a massive effort.
“Can you give him an adrenalin neb and see if that helps?” Chris asked.
“Sure.”
Tess was back with the nebulized adrenaline moments later. She squirted the liquid into the canister and the mask bubbled and steamed with the drug. The alarm screamed again and Tess stabbed at the button to silence it. Chris glanced up at the monitor. Oxygen levels had dropped further. Despite fifteen liters of oxygen his sats were only eighty-eight percent.
“You’re going to need to tube him,” Tess mumbled, out of the man’s earshot.
“We can’t move him out of here into resus while the baby is still here,” Chris replied.
“What are you going to do?”
He ran his hands through his hair and adjusted his glasses. “Can you find Georgia for me?”
Tess darted off to get the senior doctor. When the man’s wife returned she almost dropped her coffee in shock. Fear flashed through her eyes.
“This is what happened last time,” she said.
“When?” Chris asked.
“Earlier today. That’s why we came in. He’s been waiting all day for a transfer to Sydney. The surgeons are going to review him tomorrow and see if they can operate to remove the tumor. It’s pressing on his throat, causing him to have episodes like this where he can’t breathe.”
“You’re not going to make it to Sydney tonight, I’m afraid,” Chris explained gently. “We’re going to need to get a tube down his throat here.”
“Right here? Now?”
Georgia arrived and immediately assessed the seriousness of the situation. “I think we need to get an ENT and get him into theater to put that tube in,” she said.
Chris felt a large weight come off his shoulders. He wasn’t keen to intubate a man with a difficult airway and would prefer to leave it to the anesthetist and ear, nose and throat specialist.
Georgia already had the phone to her ear and was making calls so he inserted another IV line into the man’s hand while Tess prepared everything they needed to transfer the man to theater upstairs. They loaded up the bed with the transport monitor, the emergency intubation kit, the box of emergency drugs, two oxygen cylinders and a mag valve mask. The man continued to struggle with each breath. Time was ticking.
From then everything happened in a rush. They arrived in theater and within minutes an anesthetist and an anesthetic nurse greeted them, transferred the patient from the emergency department trolley onto the operating table and had him sedated and intubated.
Chris exhaled loudly. With a secure airway, it was now up to the surgical team to decide what they would do. Either operate and try to remove the tumor in Birrangulla, or transfer him intubated and ventilated by air ambulance. At the least, he’d spend one night in ICU.
He checked his watch as he jogged back down the stairs. Almost ten o’clock. An hour to go.
“Great job,” Georgia said when he returned.
While he’d been in theater the NETS team had arrived and taken Sofia and there had been three other discharges home and one transfer to the ward. The volume in the department had considerably decreased and the nursing staff were taking a well-earned break before the night duty staff arrived. They were laughing and chatting together at the desk.
One of the things Chris loved most about his job was the camaraderie between nursing and medical staff. They were a tight-knit team who worked hard and fast together when it counted, but then played hard too. Most of them socialized together outside of work and he counted them among his best friends – mates, he reminded himself.
“Hey, we’re going to miss you here over Christmas,” Tess said.
“I’m going to miss you guys too,” he said. “But I’m only gone for six weeks.”
“When was the last time you went home?” Pete asked.
Pete, an experienced triage nurse, was one of Chris’s closest friends in Australia. “Five years?”
“I haven’t been back since Jasmine was born.” Chris rubbed the bridge of his nose and adjusted his glasses. His daughter was five. “Man, it must be nearly seven years ago.”
“Your family will be looking forward to meeting her,” Tess said.
He grinned. “I haven’t actually told them I’m coming.”
“You’re joking. Why not?”
“Last minute decision. Until I had the paperwork signed from the lawyer saying I had full custody of Jaz, I couldn’t get a passport or take her out of the country.”
Tess and Pete gave him sympathetic looks. Over the past year they’d heard all the stories about his ex-wife, Erin, and her antics.
Erin was the reason he was in Australia. At her insistence, a year into their marriage, Chris applied for, and was offered, the position he currently held. Jumping at the chance to explore another country and hoping the move would make Erin happy, Chris went willingly.
Erin fell feet first in love with Australia and flatly refused to return to Canada, even to visit and even after Jasmine was born. As much as Chris loved Birrangulla, loved his job and had made good friends in Australia, with each passing year he missed home a little bit more.
Following the shock revelation of Erin’s longstanding affair, a messy divorce and an expensive custody battle, he was heading home for Christmas with his daughter.
“Ten bucks you won’t come back,” Pete said, slapping him on the back as he headed to triage.
Chris held his breath and pasted a blank expression on his face. Was the guy a mind reader? He hadn’t breathed a word to anyone about the possibility that he might not return to Australia after his annual leave. He brushed the comment aside. While he was away, he simply planned to use the time to come up with a plan for their future – his and Jasmine’s.
Whether that was in Australia or Canada, he still hadn’t decided, but whatever he chose, Jaz had to be the central focus.
Chapter 3
“Can someone give me a hand?” Pete called out from the triage desk moments later.
Chris pushed thoughts of Canada from his mind and spun around to see Pete pushing a wheelchair which held a young girl with an emesis bag pressed to her mouth. Her skin was the color of chalk. Chris strode over to them.
“What’s up?”
“Massive bleed post tonsillectomy,” Pete said as he maneuvered the chair into the cubicle and helped the girl get onto the bed. “This is nineteen-year-old Grace. She had a tonsillectomy yesterday. Small amount of blood loss about an hour ago then she says she lost about two hundred mill before coming in here. She’s just had a further five hundred mills at triage,” Pete said, pointing to the white plastic bag.
“Clots?” Chris asked.
Pete shook his head. “Bright blood. I haven’t even triaged her properly, just brought her straight in. No idea of past history or anything.”
Tess appeared and began her assessment, only stopping when Grace had another large vomit of bright blood.
“Parents here?” Chris asked.
Pete shook his head. “Boyfriend brought her in. He’s at the desk giving the receptionist her Medicare details.”
“Someone needs to get a hold of them please.” He turned to Grace and touched her lightly on the shoulder. “Hey Grace, I’m Chris, one of the doctors. We’re going to try to stop the bleeding okay?”
Grace nodded.
Tess connected the blood pressure cuff and pulse oximeter. He glanced at the screen while he felt her pulse. It was bounding at one-thirty beats per minute. Blood pressure was adequate, but low, as he would expect. As well as being pale her skin felt clammy. Not good.
“Temp’s normal,” Tess said, after the thermometer in her hand beeped.
Chris grabbed a disposable yellow gown and yanked two gloves out of the box and put them on. He pulled the overhead light down and switched it on.
“I need to have a look inside your mouth, Grace.”
She opened her mouth wide and he peered in.
“Looks like it’s only coming from the left side,” he said.
Georgia appeared over his shoulder and he turned to get her advice.
“I’d put some co-phenylcaine onto some gauze and clamp the gauze with a pair of Magill’s forceps. Grace needs to press that against the back of her throat. Some pressure should stop the bleeding,” Georgia said.
Chris turned to give Tess instructions about what he needed, but she’d already darted off, returning moments later with everything piled on a stainless steel trolley. While they were getting everything ready, Grace vomited again.
Tess handed her a fresh emesis bag and held the old one to the light. “There’s seven hundred in here,” she said, a frown creasing her brow.
“Has anyone called the surgeon?” Georgia asked.
“Not yet.”
“Call him.”
Pete was already at the computer searching for the doctor’s number. He punched it into the phone and held it to his ear.
“No answer,” he said moments later.
“Call again and leave a message,” Georgia said.
“Is he the same ENT as the guy upstairs in theater?” Tess asked.
“Probably,” Georgia replied.
Pete was making another call. Seconds later he pocketed the phone. “They’ve finished surgery upstairs and the surgeon will come down and see Grace. They’ll be here in fifteen minutes.”
Chris exhaled. “Good.”
While Chris doused the gauze with the drug, ready to insert into Grace’s mouth, Tess got an intravenous cannula in and took a set of bloods for pathology.
“Give her a liter of saline stat,” he said.
Pete had already preempted him and was hanging the bag of fluids on the pole.
“Can you hand pump it in please?” Chris asked.
“Too easy,” Pete replied, squeezing the chamber on the IV line.
“Can someone call Blood Bank? We need some urgent O Neg blood.”
“I’ll do that,” Georgia said.
Chris held the forceps in Grace’s mouth, apologizing for making her gag. Tess provided reassurance while Pete called Grace’s parents. When Grace vomited again despite the pressure he was applying to her mouth, Georgia snapped into action.
“Take her upstairs. We don’t have time to wait for the surgeon to get here. She needs to be in theater. Now!”
“What about the blood?” Tess asked.
“I’ll get someone to bring it upstairs. Go.”
Chris kicked the brakes off the bed while Pete loaded it with the emergency equipment they hopefully wouldn’t need. Moments later they were running down the corridor toward the elevator to take them up to theater.
Tess held the Magill’s forceps in position, the other gloved hand pressing lightly against the back of Grace’s head. Grace’s eyes closed as they shot up to the second floor. For a moment Chris thought she’d passed out and he was about to jump into action, but thankfully she opened her eyes again and he let out a silent sigh.
Tess chatted nonstop, partly to keep Grace awake, partly to keep her calm. She asked Grace whether she was a student. Grace nodded and for the next few minutes Tess played a guessing game. She suggested hairdressing, beauty therapy, fitness training and even plumbing but Grace shook her head with each guess.
They wheeled her into the anesthetic bay and two theater nurses burst in to assist. Chris indicated Tess could remove the forceps from Grace’s mouth.
“I give up,” Tess said. “What are you studying?”
“Nursing,” Grace said before vomiting blood again.
Chris stared at the fluid in the bag as Grace passed out.
*
“What a shift,” Chris said as he packed his laptop into his Crumpler bag and slung it across his torso.
“You saved lives tonight,” Georgia said, walking with him to the door. “That always feels good.”
<
br /> He smiled. “It’s good to know they’re all going to be okay.”
They’d received a call from Sydney to inform them that Sofia was in ICU and remained stable. Upstairs, the man with the throat cancer was also in ICU and he was stable too. Grace was back on the ward feeling groggy after the anesthetic, but otherwise fine. She’d required four units of blood, three liters of fluid and a bottle of albumen. Her parents had eventually arrived, having no idea what the hurry was and how serious her situation had been.
“When do you head off?” Georgia asked as they walked through darkened corridors toward the exit.
“Monday.”
“How’s Jasmine doing? Is she looking forward to the trip? And to meeting your parents?”
“She’s more excited about seeing snow and having a white Christmas,” he said.
“Do you think she’ll miss Erin?”
He shrugged. “Hard to know. She’s so young. At this stage all she’s worried about is whether Santa will find her in Canada.”
“Kids are resilient. Have you told her Santa comes from the North Pole and that’s right next door to Canada?”
He laughed. “I hadn’t thought of telling her that. Good idea.”
“Do you think you’ll come back?”
He knew he wore his heart on his sleeve, but he didn’t think he was that easy to read. “At this stage I fully intend to,” he said.
They’d reached Georgia’s car. “Come on, Chris, be honest. I know you’ve loved your time here, but surely once you go home and see your family, you’re not going to want to come back.”
He shrugged. “Maybe.”
She gave him a tight hug. “If I don’t see you again, it’s been a pleasure working with you. Merry Christmas.”
Chapter 4
Chris had forgotten how busy Lakefield became in the lead up to Christmas. As he drove slowly into town he took everything in. Unlike everyone else, he was in no hurry. He’d finished all his shopping weeks earlier so could simply enjoy taking in the sights and smells of the Christmas season.
Operation Mistletoe Magic Page 2