By the time Kate arrived at work fifteen minutes later, she had almost forgotten about the phone call from Marcus. The unit had been quiet for most of the day until Debbie had taken the phone call from the emergency department. A twenty-four-year-old man had been involved in a quad bike accident on the family farm. Knocked unconscious, he had sustained severe head injuries. His condition was critical and he wasn’t expected to live. He was being sent to the unit for monitoring and management.
Amanda Collins and Mitch Wood were the only two nurses on duty and Kate was glad Debbie had decided to call her in. Although Amanda was a senior nurse with years of ICU experience, Mitch was only two years since graduating and he had a tendency to be a bit gung ho during emergency situations. She hoped he didn’t know the patient personally, but figured it was likely that he did, given the size of the town. Great, she thought sarcastically, that’s all I need.
Kate guessed Amanda was in her early forties but it was difficult to tell. She wore bright red-framed glasses that matched her lipstick. She was an excellent nurse and patients and staff alike all loved her.
At twenty-six, Mitch had a shock of red hair and the obligatory freckles that most redheads have. He wore the freckles well, and despite his naturally pale skin, he had somehow managed to acquire a tan in the middle of winter.
By the time Kate arrived, Amanda and Mitch had prepared the room and all they could do was wait for the emergency department staff to bring the patient up to the unit. Kate wondered what the delay was. Two orderlies were quietly standing outside the room, one of them holding the pat slide that would be used to transfer the patient from the trolley onto the ICU bed. No one was saying much and there was a somber mood in the air.
Simon Barclay, one of the other intensive care consultants, arrived shortly after Kate. He began conversing with Ewan as they all waited. In the short time Kate had worked at the hospital she already loved working alongside Simon. He was young, tall and exceptionally good-looking. He wore his clothes well, usually brand names, and always the latest fashion. He was clearly intelligent and it was obvious by the way he spoke and carried himself that he was privately educated. Although he had a hint of over-confidence about him, he was an exceptional doctor with a great bedside manner.
*
Just before five o’clock Pete Anderson arrived. As he was wheeled into the unit, Kate’s adrenaline kicked in and she felt her heart begin to race. Pete’s large-framed muscular body was covered with a mix of dried and fresh blood. Most of his clothes had been cut from his body and Kate caught a glimpse of a tattoo sleeve on his right arm. His right foot angled off to the side and it was obvious his right leg had sustained multiple fractures. There was a large laceration on the back of his head where much of the blood was pooling and becoming matted in his hair, but it was the swelling on the left side of his head that Kate knew was the reason Pete was unlikely to survive.
A CT scan in the ED had confirmed a subdural hematoma on his brain. The pressure caused by the large and increasing volume of blood pushing against his skull meant that he would likely die unless the pressure could be relieved. The doctors in emergency had already intubated him, inserting an endo-tracheal tube into his mouth and down his throat. This tube was attached to a small transport ventilator, and the machine was breathing on Pete’s behalf. The white tracheostomy tape that held the tube in position and prevented it from coming out was already stained a bright red color from the laceration at the back of his head. Kate’s nose wrinkled at the metallic smell of blood.
“Crap,” Mitch exclaimed and Kate caught sight of his shocked expression. She felt a sour taste in her mouth.
“Do you know him?”
“Yeah. Not all that well though. We went to school together. He was the year below me.”
“Will you be okay?”
“Should be.”
His usual jovial manner was noticeably absent. Kate knew she was going to have to keep an eye on him. As well as teach him the basics of trauma response and management, she would probably have to help him deal with the stress this case was going to bring when it was all over.
“Why haven’t they got the ICP monitoring set up for us already?” Amanda asked, referring to the intra-cranial pressure monitoring that Kate too had expected to see attached via thin wires to Pete’s skull. It was the first time Kate had seen her without a smile on her face.
“Let’s wait to hear the handover and we’ll work out what’s going on,” Kate replied tersely.
“I guess you’re used to seeing patients like this in the city,” Amanda snapped, “but we’re not.” Kate was momentarily stung by the barb in Amanda’s comment. At the Royal Sydney she had been used to dealing with trauma patients, but each time Kate received a patient like Pete she still felt totally unprepared. A wave of emotions washed over her. The room felt cramped and she could already feel the sweat running between her shoulder blades. She decided to ignore Amanda’s remark, figuring she was probably feeling as stressed as Kate was.
Kate made certain everyone was ready and they lined the trolley up alongside the ICU bed. Kate disconnected Pete from the transport ventilator and attached the tubing to the bag-valve-mask. This allowed her to push air into his lungs via the tube until they swapped him across to the ventilator that had been set up in the room.
“On my count,” Kate instructed the other staff. On the count of three they slid him across the slippery slide sheets laid across the large plastic board used to transfer patients from one bed to another. No one spoke as the next few minutes were spent re-connecting him to the ventilator that would continue breathing on his behalf, untangling lines and ensuring his fluids, sedation and pain relief were adequate.
“Is there any talk of doing a crainy?” Mitch asked. Kate could hear from the tone of his voice that he was now pumped and ready for action.
“It’s not like television, Mitch. Real life situations aren’t always as action-packed and fast-paced as you might think. In this case, there’s no rush,” Kate told him.
As soon as she saw the look that Mitch gave Amanda, she instantly regretted her words. She’d come across sounding stuck up and exactly like the city girl they clearly thought she was.
“There’s probably no point,” Simon added quietly. “We’re waiting on the neurosurgeon. He’s on his way back from a conference in Adelaide. He should be here in a few hours.”
She turned to Simon and softly asked, “What are his chances?”
Meeting her gaze, Simon replied, “It’s not looking good. He’s not going to last long.”
As soon as he spoke, a painful lump formed in the back of her throat and her shoulders slumped. She knew all the signs were pointing to brain death but Simon had confirmed her worst fears. She continued working on the spaghetti-like tangle of leads and lines that was inevitably caused when a patient was transferred. It was going to be a long night and everything within her wanted to be as far away from this tragedy as possible. She wanted to flee from the room and be alone, but she knew she had a job to do. She just wished Pete had been airlifted straight to Sydney.
She moved to stand at the large desk at the end of Pete’s bed and unfolded the critical care flow sheet that was used to record all patient observations. She began filling the details in. Time of arrival, vital signs, medications, results of neurological checks, lab results. While she duly recorded all these figures, Amanda and Mitch were left with the unenviable task of cleaning up the blood and making Pete look presentable for when his parents arrived.
“So you think he’s brain dead?” Mitch asked incredulously, causing Kate to look at him closely. Is he going to be able to deal with this?
“Yes. Possibly,” Kate replied cautiously.
“Oh.” Mitch sounded completely deflated and Kate’s heart went out to him. His tan seemed to have faded by several shades, and Kate could see he was clearly affected by the young man’s dire prognosis. An image of the small cross on the side of the road came to Kate’s mind. Another local life
lost in tragic circumstances.
Simon spoke quietly, “There’s no need to go all out. At this stage it’s mostly comfort measures until we can get his parents here. Then we’re going to need to discuss organ retrieval.”
“Really? You can do that here? This far away from the city?”
Simon nodded. “Yes. We’re not out in the sticks here, Kate. All the systems are in place for organ donation the same as they would be in the city. We just have to get his parents’ consent.”
Once again she’d put her foot in it, coming across all wrong. “Do we even know what his wishes are?” she asked.
“According to the card in his wallet, yes, he wants to be an organ donor,” Ewan answered from where he was standing, writing notes. Kate had almost forgotten he was still in the room.
“But you know as well as I do that as he can’t speak for himself, his parents still make the final call,” Simon added.
“Let’s hope it’s the right one,” Kate replied.
*
Pete’s parents arrived half an hour later and their eyes held the look Kate had seen many times before. It was a look people have when they are trying desperately to hold themselves together and are blindly clinging to hope. Kate met them at the door of the ICU and introduced herself.
“Hello. My name is Kate Kennedy. I’m the nurse in charge. I’m terribly sorry about your son’s accident.” Kate tried to maintain eye contact with them as she ushered them gently into the unit.
“John and Heather.” The man’s voice matched his craggy face as he introduced himself and his equally weather-beaten wife. Clearly straight off the farm, they both looked exhausted, scared and out of place in the hospital environment. John was still wearing his work gear and the smell of cow dung clung to him. Heather had dirt under her fingernails and although Kate knew the importance of hand hygiene, now wasn’t the time or place to reinforce the rules.
“How’s he doin’?” Heather was forthright in her question. “Can we see him?”
“Yes, of course you can.”
They followed Kate as she walked toward Pete’s room and she stopped at the doorway before letting them enter. “Do you want me to explain what all the machines are for?”
It appeared they hadn’t heard her and Kate watched as they caught sight of their son for the first time. He was positioned on his back and his tall muscular body lay immobile. A white sheet was folded neatly across his chest and his arms lay propped on pillows at his side. Amanda and Mitch had done a great job tidying him up and Kate made a mental note to thank them. John and Heather went to either side of the bed and each held one of his hands, almost oblivious to the tubes coming from his mouth and nose and the various leads and lines attached to his body.
Kate surreptitiously watched Pete’s parents. There were no tears, no hysterics and no words. She stayed in the room, there for them if they needed her.
Finally John spoke up. “He’s our only son you know. Wanted to be a farmer just like me. He’s been off at Marcus Oldham College in Geelong studying farm management. Almost finished. I was going to hand him the running of the farm next year. I’m getting a bit long in the tooth for it now. Time for the young blood to take over.”
He didn’t look at Kate while he spoke, never taking his eyes off his son’s hands. Kate kept silent, feeling her pulse in her throat keeping time with the machines in the room.
“How long?” Heather spoke up after a long pause.
Kate was unsure what Heather was really asking her. How long until what? Until the neurosurgeon arrives? Until we know what’s going on? Until he dies? Kate looked at Heather. It was as though the woman had a mother’s intuition that her son wasn’t going to make it. Before Kate had a chance to answer Heather’s question, the ventilator alarm screeched, signaling a change in Pete’s oxygenation levels. Kate silenced the alarm and adjusted some settings on the machine. Pulling a yankauer catheter out of its position attached to the ventilator, she suctioned his tube. He didn’t cough or respond in any way. His parents remained silent, watching her work.
“How long before he dies?” Heather addressed the question to Kate again.
“There’s no way of really knowing just yet,” Kate replied hesitantly, shrugging her shoulders slightly.
She hated squashing their hope but she was a realist and there was no sense in giving them false encouragement. She wasn’t trying to put Heather off, she really didn’t know. Although Kate knew it was most likely that Pete was brain dead, it wasn’t her place to inform his parents.
“The neurosurgeon is on his way back from a conference in Adelaide. I’m sure when he arrives he can answer all your questions. There are protocols to follow.”
Kate was avoiding the inevitable, but she had no other words to offer Heather and John. What words can anyone offer a mother about to lose her only child?
She already knew the answer to that question. There were no appropriate words.
John remained silent, not taking his eyes off his son, but he was clearly listening to everything Kate was saying. He nodded absently while she spoke.
Heather reached into her bag and pulled out her wallet. She opened it and removed a photo which she wordlessly handed to Kate. As Kate took it she looked and saw a very different face staring back at her. Pete. Tall and handsome, he had a wide grin and beautiful eyes. The man in the photo looked nothing like the figure in the bed with his puffy eyes and bloodstained hair. The tube coming out of his mouth had caused Pete’s mouth to form into an unnatural grimace, reminding Kate of the Joker character with his pale face and blood-red lips. Kate smiled sadly at Heather as she handed back the photo. There was nothing she could say that would ease the grief that was about to enfold the whole family.
*
When Kate finally turned the key in her front door, it was almost four o’clock on Sunday morning. Her body clock was confused and she felt as though she was on autopilot. Her early morning run with Joel seemed like weeks earlier rather than just the day before.
Kate’s knees gave out and she collapsed on the bed, her heavy limbs protesting at having had to stand upright for so many hours. She kicked off her shoes and crawled beneath the covers, not even bothering to undress. It wasn’t long before Matilda joined her. The cat purred and walked in circles for a moment before marching on the spot until she found a perfect position and snuggled down, curling into a tight ball. Kate stared at the ceiling, thinking back over the previous few hours. She stroked the cat’s fur, willing her mind to slow down and switch off.
John and Heather had made the brave decision to allow their son’s organs to be donated. Thankfully, Pete had made his wishes clearly known to his parents and they loved their son enough to want to honor his request. They seemed to understand that Pete was brain dead and no recovery was possible.
Their decision quickly set the wheels in motion for the Donate Life team to fly in, and an organ donor co-ordinator had arrived within hours to provide much needed support. The medical team had arrived soon after and two senior doctors independently conducted the same set of clinical tests on Pete at the bedside.
It was around ten o’clock when Pete was taken to theater for the organ retrieval surgery. Kate was allowed to watch the procedure, and was astounded with the care that was taken, and the way Pete was treated with respect and dignity. She felt privileged to be part of this process.
Over a five-hour period, specialist doctors and their teams arrived and left the hospital. All of them had flown in from various parts of the country and would return to their own hospitals to perform life-giving transplantation surgery within the next few hours. Just thinking of it again brought tears to Kate’s eyes.
John and Heather had remained in the ICU waiting room and this was where Kate had found them when the surgery was finally over. The hospital chaplain had sat with the family all night. Other family members had arrived, as well as many of Pete’s friends. They looked up as she walked into the room but none of them rose from their seats. Their ey
es were red from crying and their faces were pale and washed out. How is it people manage to look as though they have aged twenty years overnight after a tragic event?
Someone eventually made way for her to sit beside Heather on the couch. Kate went to her side, and Heather held Kate’s hands in her own and said two words that Kate never expected to hear.
“Thank you.”
Wrapping her arms around Heather, the dam burst and it was Kate who cried uncontrollably.
Chapter 14
A week later the gentle patter of rain on the tin roof woke Kate. She was groggy and disorientated from another bad night’s sleep. She wondered if she’d been dreaming of Marcus again. Rolling over, she noted the red digital numbers on her clock read eleven-fifteen. Surprised, she realized she had slept longer than she had in months. She lay still, relishing the sound of the rain, listening as it slowly grew heavier. She pictured it bouncing off the roof like drumsticks bouncing off a snare drum. Judging by the sound, it had settled in for the day and she was glad. According to the farmers, they needed the rain.
Living in the city, Kate was used to the inconvenience of rain, but in Birrangulla it was good news for the farmers, and she knew there would be lots of smiles among the locals in the coming weeks if the forecast wet weather continued. She was told that many farmers had watched their crops wither year after year when the rain didn’t come, their souls crumbling a little more each time the clouds passed them by.
The hidden underside to living in the country was that too many farmers and their sons had taken their own lives because of the years of drought, their cups of optimism as dry as the clouds that passed overhead. Just thinking about it broke Kate’s heart.
Kate pulled aside her bedroom curtains and looked out at the heavy dark clouds hanging so low they seemed to scrape the tops of the trees. The heaviness of the clouds over the distant hills matched her mood.
She dragged herself off to work just after two o’clock with the beginnings of a headache. The unit was disturbingly quiet. Kate leaned back in her chair, watching the bank of cardiac monitors in front of her. She yawned and folded her arms across her chest.
Intensive Care: Escape to the Country Page 10