Bill leaned against the doorjamb, studying the back of her head, and the arc of cheek he could see, dark eyelashes fanned against her skin like a tiny feather that had drifted from a baby blackbird.
He shook his head, thinking now not of baby birds but of the baby Esther had lost—they had lost. They’d both been so excited by her pregnancy. Let’s face it, he’d been excited by everything about Esther from the moment he’d met her, and the fact that his love had been reciprocated had seemed like a miraculous gift.
Not that it had been easy, loving Esther. Brought up in foster-homes, chary of love, always expecting it to be snatched from her. She’d been so doubtful of its permanence she’d swoop from ecstatic bliss to cool detachment in the blink of an eye, hiding her emotions away as if by not acknowledging them they might cease to exist. He’d known it was her way of protecting herself, but at times it had driven him to distraction.
Then—
‘How long have you been there?’ she demanded, and he realised his musings had taken him so far he hadn’t noticed her waking.
‘Two minutes maybe,’ he said, watching the familiar way she scrubbed her face with her hands when waking from even the shortest sleep. It took him back to where his mind had been. ‘Did you never think I lost that baby, too?’
The colour she’d rubbed into her cheeks faded immediately, leaving her face a chalky white, and Bill filled with guilt.
‘Of course I realised that.’ She spat the words at him. ‘Do you think I’d have been so devastated—felt so bloody guilty—if I hadn’t been thinking about you? I was used to losing things, to having nothing, but you—you’d been brought up with everything. You had the perfect life. You were a perfect person—in my eyes anyway. And I let you down. I lost your baby.’
She was quivering with emotion, and her eyes held such haunted pain Bill could hardly bear to look at them. He wanted to touch her—comfort her—help her forget, but she was speaking again, the words rushing out of some deep well of emotion.
‘Doing something as stupid as hanging up Christmas decorations. And do you know why? Because I was selfish! Because for the first time in my life—in the life I could remember—I had my own home, a place I could decorate for Christmas. Gold and white, I wanted it to be—a Christmas dream I’d had for ever. My dream, Bill. My, selfish, selfish dream!’
She stood up, stormed around the desk and out the door, putting one hand on his chest, as she had done earlier, to shove him out of her way. There were no tears on her face, but he knew Esther never cried—not outwardly.
All her tears were inside—held in a dam too deep and dark for him to even imagine…
She hadn’t gone far, he discovered when he returned to the ward, where Esther was pulling on rubber gloves, a mask already hanging around her neck.
‘How did you get on with the CEO?’ she asked him, as if they hadn’t just had a gut-wrenching exchange and dredged up ghosts of the past.
‘He’s not happy, but as four of the ICU beds are already taken up with dengue patients, he can see the sense in isolating the rest down there. I told him it was that or the cancer ward where there are high-tech filters for the immuno-suppressed patients, and he practically had a heart attack that I’d even consider putting these patients down there.’
‘Scare tactics. Good thinking,’ Esther said, and she smiled, reminding him of how professional she had always been in her job, no matter what turmoil might have been happening in her personal life. ‘When are we moving them?’
‘Not now!’
Esther heard the tiredness she’d been so aware of since first seeing him again. It dragged at his slow vowels, and roughened his deep voice. Guilt about her emotional outburst earlier clutched at her intestines. As if he needed her getting hysterical about the past when he had people dying here!
‘Of course not,’ she said. ‘Look, why don’t you go home? You can have a play with your little girl before she goes to bed. I want to see the rest of the patients here and then the ones in the ICU, just to get a feel for what we’re fighting. I can grab a bite to eat in the canteen—I assume there’s one still operating—and walk back to the apartment later. I don’t suppose I could have your key? That way I wouldn’t have to disturb anyone coming in.’
‘Or have my mother open the door to you,’ Bill offered, a small smile quivering on his lips.
‘As you say,’ Esther conceded, smiling back at him because she’d never been able to resist Bill’s smiles.
But her smile didn’t seem to have the same effect on him, for his disappeared, and his face closed down, wiped of all emotion.
‘I am tired,’ he said, and she noticed he didn’t mention the child. ‘But you can’t walk back on your own. I know the streets are safe, but most of the streetlighting’s gone. Here. Take the car keys. The small brassy-looking key opens the apartment.’
He passed them to her, his fingers touching her gloves, which, while they might prevent transmission of bacteria, did nothing to prevent transmissions of other kinds.
‘You’re staying with Bill?’ the nurse asked when he’d departed.
‘Billeted with him and his mother,’ Esther said, keeping to the barest of facts.
‘Lucky you,’ the nurse remarked. ‘Every unattached woman on the staff, and probably a lot of the married ones if they’d admit it, have been panting after him since he arrived. That dark hair and blue eyes—it’s a winning combination. And the voice—makes you think of velvet nights and moonlight and seduction. That man could sweet-talk me any time he likes.’
‘He’s married. He’s got a child. I met her,’ Esther said, because saying something seemed a better option than strangling the drooling young woman. ‘Now, is there someone on duty who could accompany me around the ward to see all the patients?’
The nurse gave her a dark look, suggesting she’d far rather have gossiped about Bill, then depressed a button on the phone and called Nurse Weller to the desk.
Nurse Weller, when he appeared, was tall and thin, with curly dark hair trimmed close to his scalp and dark skin and eyes suggesting an aboriginal heritage. Esther, who suspected she might also have some native blood somewhere in her ancestry, was immediately drawn to the young man.
Introductions—he was Adam, she Esther—complete, he took her into the two-bedded room opposite the four-bed she’d been in earlier.
‘Glad there’s a doctor still here,’ he said. ‘I don’t like the look of Len Risk. He was OK earlier when Bill saw him, but they go down so quickly. He’s got bloody diarrhoea now. That or vomiting has been the first sign of internal bleeding for all of them.’
‘How’s Bill been treating it?’ Esther asked, wondering if any treatment was possible. Usually with dengue you treated the symptoms, but for something like this, treatment could put further stress on the intestine and exacerbate the bleeding.
Adam explained the process Bill was using. Dehydration was the main worry, so fluid levels and electrolyte balance needed constant checking. Apart from that, Bill was taking whatever steps were necessary to keep the patients comfortable without using measures that could worsen their condition.
‘Of course, once they go into DHS, we’ve got to pull out all the stops. I’ve been visiting the ones transferred to the ICU, and down there they’re getting the works.’
Esther mentally reviewed what she knew of the disease. First stage was simply dengue fever, a mild, flu-like condition most people ignored. Worse was dengue haemorrhagic fever, DHF, where patients presented with petechiae, small red or purple spots which indicated small capillaries bleeding beneath the skin. This was usually accompanied by bleeding in the mouth, and sometimes sufficient bleeding to cause bruising of the skin. These were signs there’d be internal bleeding as well, usually into the gastrointestinal tract.
DHFS—dengue haemorrhagic fever shock syndrome, the second S not used in the abbreviation—was the danger stage for any patient. This was when blood loss and the subsequent effect on the body caused the patient t
o go into shock. It didn’t occur often, dengue being a disease that ran its course then petered out, with few people needing hospitalisation. But here more cases were worsening than getting better. It was a new variant and while a new variant of any disease was dangerous, to have something as potentially deadly as this spreading across northern Australia could be catastrophic.
They’d reached the patient causing Adam concern, and one look at him was enough for Esther to understand that concern. His extremities were cold and clammy, the skin round his mouth a cyanotic blue. She checked his IV and found the vein it was feeding had collapsed. They’d need to find a new site.
‘Let’s get him down to the ICU,’ she said. ‘We’re better off setting up the new drips he’ll need once he’s there, rather than risk shifting him with needles in him.’
Adam looked slightly startled, and muttered something about checking with Bill.
‘Bill Jackson is exhausted,’ Esther told the equivocating nurse. ‘If we contact him, he’ll come rushing back in and probably stay. Another night without sleep is the last thing he needs. I’m here and I say we move him. Actually, we’re moving all the patients down there tomorrow and creating a total isolation ward, so it only means this man is going twelve hours early.’
Adam looked more than startled this time, but he set to, disappearing for a few minutes then returning with two orderlies. While they readied the bed for wheeling, Esther explained to the patient what they were going to do.
‘You need to be watched more carefully than we can manage here,’ she told him, ‘which is why we’re moving you.’
He didn’t seem to care, and why would he? Esther was sure if she was feeling as lousy as this man looked, she wouldn’t have cared either. But she had to care. Not only was she paid to do it, but whenever she worked in hospitals, she treated every patient as her own particular challenge. They would get better or they’d have her to answer to.
The ICU sisters, two of them presiding over the screens that monitored four very ill but very docile patients, weren’t overjoyed to have their workload increased by twenty-five per cent, but they rallied round, one remaining by the monitors while the other showed Esther the layout of the unit and found a nurse to act as a runner for whatever tests or equipment Esther needed.
‘What we’ve got to prevent is complete circulatory collapse,’ Esther told the two women, ‘so fluid and electrolyte replacement are the first concerns. You can see from the red spots on his skin his surface capillaries are bleeding, so you can imagine the same thing’s happening deeper inside him. We have his blood group on file. When you’ve brought in the fluid, make sure you have whole, cross-matched blood in case we need it, and some bags of platelets as well.’
The nurse dashed off, while Esther completed her examination of the man. She was aware, even as she hooked him up to monitors which would keep tabs on his heartbeat and respiration rate and another which would keep a permanent check on the oxygenation in his blood, that it might all be in vain. Blood could be running out inside him faster than she could replace it with fluid.
And with the level of blood in his circulatory system diminished, less oxygen would be delivered to his brain. This organ, programmed to protect the body as best it could, would tell the lungs to work harder, thinking the diminution of oxygen was their fault. Hence the rapid breathing that was typical in the deterioration stage of any haemorrhagic fever. And when the brain still didn’t get enough oxygen, it started shutting down organs and the patient went into haemorrhagic shock.
The hardest part was deciding where to site the catheter for his IV. The bleeding had seriously diminished the man’s blood vessels, so they were flat and hard to access. Esther wanted to cause as little damage to skin and tissues as possible, because any damage would cause more bleeding, so should she try for a surface vein or, because it was likely he’d need massive infusions, should she insert a central venous catheter directly into one of the large vessels in his chest, close to heart and lungs?
‘Has Bill been using central venous catheters in patients up here?’ she asked the sister who’d remained to help her.
‘Yes. Multi-lumen subclavian catheters,’ the sister replied, and Esther pictured the polyurethane tubing which would be tunnelled beneath the skin then inserted into the subclavian vein. Once stitched into place, the three tubes that ran into it would allow them to administer potentially incompatible fluids and medications at the same time.
Esther sent the nurse to set up the procedure room, telling her the other things she’d need to perform the small operation under local anaesthetic. She explained what she was about to do to her patient, detached all the monitor leads and had him shifted to the specialised room just off the main ICU.
This room was like a small operating suite, with better lighting than the patient rooms and with all the equipment she needed close to hand. But everything she did reminded her of the patient’s precarious condition, blood oozing from the puncture site of the local anaesthetic needle, then more blood lost as she inserted the catheter. Such sites often bled initially, but in this man’s case the blood was thinned by fever and disease and continued to flow.
She sutured the catheter into place and put on an antiseptic dressing, stressing as she did the need for the catheter to be treated with meticulous care.
‘I know you’ll already be doing this with your other patients, but I have to tell you about this one as well. I want the individual lumens flushed after use, all three lumens flushed with heparin solution twelve-hourly, and the sterile dressing changed daily. I’ll write it up in the orders, but it’s helpful if you can pass on the information to the next shift at change-over.’
She glanced around the room, seeing, for the first time, that it had X-ray facilities.
‘We’ll just take a quick picture to make sure of the placement, then Mr Risk can go back to his room and we’ll hook him up to all the super-duper gadgets again.’
She smiled at the patient, though aware he was feeling too low to respond.
The radiography showed the catheter was safely in place and they returned with Mr Risk to his room.
Once she was satisfied she’d done all she could medically, she spoke to the nurse, asking if she was sponging down the patients, especially the skin affected by the rash, at regular intervals, to keep them as comfortable as possible.
‘It’s not really my job,’ the nurse replied, ‘but I do it for all of them whenever I can. The aides we have are terrified of catching it, although Bill’s explained to all the staff it’s not transmitted by touch or through the air. But then he makes everyone working directly with a patient in here double-glove and wear a mask, and that’s what frightens them.’
‘He’s insisting on that because the disease is transmitted through the blood,’ Esther told the other woman. ‘Usually by a mosquito that bites an infected person then, after a certain time, bites someone else. But say a patient vomited and some of the blood spattered on you, and, though you didn’t know it, you had a scratch on your hand.’
‘The virus could enter my system through the scratch,’ the nurse finished for her. ‘Yes, of course. I did know that, but I just kept thinking mosquitoes, not other ways of transmission by blood.’
‘Well, think about it now and take all precautions,’ Esther said, remembering the conversation she’d had with Bill earlier. The scenario she’d outlined wasn’t the usual path of transmission, but she doubted the nurse would know that. Esther’s boss had been adamant they shouldn’t start a scare about the outbreak being something else, not dengue, so she didn’t want to mention the possibility of this strain of dengue behaving differently. But, at the same time, the staff had to be aware that total barrier nursing was essential.
She left the nurse preparing to cool the new patient with a damp cloth, and crossed to the desk, anxious to read about the other patients and how Bill had been treating them. Right now, Mr Risk had fluid with electrolytes flowing into his new catheter, but at what stage did Bil
l give platelets, the smallest of all blood cells, but the ones necessary for coagulation? Or full blood to replace what had been lost?
Both sisters were back at the desk, and while one handed Esther the files of the four patients who were already in the ward the other one explained how to access patient files on the computer.
‘Do you have an access number?’ she asked Esther.
‘Access number?’
‘You can’t just walk in here and check out something on our computers,’ the woman explained. ‘All the information on them is confidential. Didn’t you get an access number when you got your ID card?’
She glanced at Esther’s chest, realised there was no photo ID either clipped to her shirt or hanging around her neck, and frowned.
‘You shouldn’t be here at all,’ she said, obviously confused as to what to do next.
‘I’m an epidemiologist sent up from Brisbane to work on the dengue outbreak. I don’t officially start until tomorrow,’ Esther explained. ‘But I’ve been billeted with the Jacksons and I’d just arrived there when Bill had a call about a new patient. He brought me in and left me here to meet the patients and have a look at the work he’s done so far on the spread of the disease.’
The woman looked dubious.
‘Well, I can’t give you my access number for the computer,’ she said.
‘That’s OK,’ Esther said easily. ‘Why don’t you call the ward on the sixth floor and check with the sister there that Bill did introduce me, then let me look at the paper files?’
‘I suppose as you came down with a patient, you must be OK,’ the sister conceded. ‘But you’ll still need to get your own access number for the computer.’
Promising she’d see to it first thing in the morning, Esther took the files the woman offered.
‘Now Jill’s back I’ll take you around the other patients,’ she said, as she handed them to Esther. ‘We’ve one, Mr Armstrong, who’s very low.’
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