“Joel, tell me what’s happening.”
“I. Can’t. Breathe.”
“Do you ever get asthma, Joel?”
“No.”
“Have you ever felt like this before?”
“Never.”
“Does it hurt anywhere else?”
“My chest. It hurts to breathe in.”
“Have you been drinking?”
“No!” His reply was emphatic and Kate instantly regretted doubting him.
“Can you put Emma back on the phone for me?” Kate tried to keep her voice calm.
“Kate, he can’t even talk. I’m really scared.” Emma’s voice was almost a whisper.
“Emma. Listen to me carefully. Hang up and call an ambulance immediately. I’m calling the emergency department to let them know he’s coming in. Okay? Will you do that now?”
“Okay. Yes. Yes. I’ll call them.” Emma now sounded frantic with worry and Kate was sorry she had alarmed her. Disconnecting the call, Kate dialed the emergency department as she started walking in the direction of the nurses’ station.
“Emergency. Can I help you?” The phone was finally answered on the tenth ring.
“This is Kate Kennedy from ICU. You’re going to be getting an admission, a friend of mine. From the sound of it he’s in some sort of respiratory distress. I’ve told his sister to call triple O. I’ll come down to meet the ambulance as soon as it gets there. Can you call me when it arrives, please? Also, I’ve got a bed up here if you need it.” Kate disconnected the call and hoped that the ambulance would get to Joel quickly.
“What’s going on?” Debbie had overheard Kate’s end of the conversation.
Briefly Kate filled the ward receptionist in. By now some of the other staff had gathered around and Kate remained tense as she retold the story, waiting for her phone to ring. Most people knew of Joel and his family and Kate was also sure most of them assumed that the two of them were a couple. Their faces reflected the concern that she was feeling.
Amanda approached Kate and pulled her off to the side, her usual cheery disposition looking grim. She pushed her red glasses up to the top of her head and looked intently at her. “Kate, I know Joel’s family very well. I also know you two have become good friends since you arrived, so I’ll cover things up here for you for as long as you need. Go and take care of Joel. He needs you.”
“Thanks, Amanda. That means so much to me.” Kate reached out and touched her arm. “Really. Thank you.”
“Go!”
Just then Kate’s phone rang and, recognizing the caller ID, she started walking in the direction of the elevators as she answered. “Kate here.”
“Ambulance is pulling into the bay now. He’s not in a good way. I reckon we’re going to need that bed.” She didn’t recognize the voice of the emergency doctor but she was glad he had taken her phone call seriously. She turned away from the elevators and ran for the stairs, knowing the elevator would be too slow.
The adrenaline kicked in and her stomach was churning by the time she waved her swipe card across the security pad to allow her access into the emergency department. She met the paramedics as they were wheeling Joel into one of the resuscitation bays. While she desperately wanted to help, she also knew that it wasn’t her place to get involved. She let the emergency staff do their job and stood to the side, watching them work.
A few minutes later Emma was brought into the resuscitation bay by a nurse and surprised Kate when she greeted her with a tight hug.
“Oh Kate. I’m so glad you are here. He can’t die.” The tears were already threatening to fall and she was pale with worry.
“Shh! It’s okay. He’s going to be okay. He’s in good hands here.” Kate hugged her in return. “We won’t let him die. I promise.”
Hearing the voices of Kate and his sister, Joel tried to lift his head from the trolley but his breathing was so labored that the effort exhausted him and he collapsed back onto the pillow.
“Stay still, Joel.” Kate got up close to him and spoke calmly. “Everything’s going to be okay. Emma is here with me. When things have settled down a bit I’ll call your parents. You’re in good hands.”
“Kate, can you tell me what’s happening?” Emma asked, her eyes wide and frightened.
Kate didn’t want to leave the resuscitation area so she pulled Emma farther away from the action and spoke quietly to her. “It looks to me like oxygen just isn’t getting into the blood from his lungs for some reason. He might have pneumonia or even a collapsed lung. We won’t know until they run some tests. They’ll take an x-ray and maybe a CT scan. It actually doesn’t matter what the underlying cause is, if the tissues aren’t getting enough oxygen, this will trigger his shortness of breath. The other issue is that his heart may not be pumping the blood properly so they have to rule out a heart attack too. He said he was having some chest pain.”
“But he’s too young to have a heart attack!”
Emma began to look even more worried and although Kate tried to reassure her, she was getting more anxious every minute and Kate didn’t want to have two patients to deal with. She spied Lou, the friendly nurse who had looked after her when she was ill, and told her where they would be if needed, then led Emma into one of the small waiting rooms near the entrance to the department.
“How about I go and grab you a drink while you give your parents a call? What can I get you?”
“Anything. I don’t care. Diet Coke. Sprite. Whatever. Thanks Kate.”
Leaving Emma in the room, Kate went back and checked with the staff caring for Joel.
“What can you tell me?” Kate asked the doctor.
“Chest x-ray shows that he’s developed a pneumothorax on top of pneumonia. With every breath he’s taking, air is being delivered into the pleural space causing pressure inside his lungs to build.”
“I know what a pneumothorax is.”
The doctor looked at Kate as though just noticing her scrubs and hospital identification for the first time. He raised his eyebrows in question.
“I’m Kate Kennedy. I was the one that called to say he was coming in. I’m the new NUM of ICU. We haven’t met before.” She extended her hand which he shook warmly.
“I’m sorry. I had no idea. G’day, I’m Damien. Damo. Anyway, as you know, the pneumothorax is severely compromising the ability of his lungs to expand and ultimately one of his lungs has completely collapsed.”
Kate pictured Joel’s lung, folded in on itself like a deflated balloon.
Damien continued to speak. “Unfortunately, what’s complicating this case is that his other lung is showing signs of the chest infection and pneumonia he has obviously been battling for the past few weeks.”
Kate peeked her head back into the resuscitation bay, hoping to see an improvement in Joel’s condition, however he was looking even more distressed than earlier and she was certain he looked as though he was about to go into respiratory arrest. He was blue, almost cyanotic, and tachycardic, his heart racing far too quickly. She was worried enough to express her concerns out loud to the doctor.
“Are you thinking tension pneumothorax?” Kate asked.
If the pressures within Joel’s chest continued to rise, his lungs would be squashed to the point that there would be no air entry on the affected side. This would result in a displacement of his heart, kinking off the vessels in the heart, preventing blood from returning to the heart. It would be fatal if not treated immediately. The only way to treat a tension pneumothorax was to release pressure from the pleura by using a large needle and placing it into a patient’s chest. As pressure is immediately released, the heart is able to resume its normal position and blood can continue to circulate.
“No.” Damien’s answer was brief but Kate saw the look in his eyes and heard the words he wasn’t saying out loud. Not yet. “I think he’s going to be okay but we’re going to tube him now then get a chest drain in. Once we’re done, we’ll bring him upstairs to you guys.”
“Thanks,
Damien.”
Kate appreciated that this was not her department and although she wanted to remain with Joel, she knew that she also needed to be with Emma. Kate was glad Lou was working and she left the staff to administer the drugs that would sedate and paralyze Joel before they intubated him and placed him on the ventilator that would breathe on his behalf, allowing his lungs the chance to rest and recover. At the same time Kate knew they would place a large chest drain into the lung cavity to release the air that was causing the pneumothorax.
Kate found Emma still in the waiting room, on the phone. She looked up as Kate walked in the door, searching Kate’s face for clues to Joel’s condition. Kate realized she’d forgotten to get Emma a drink.
“Hang on, Liam, Kate’s just walked in.”
Not bothering to put her hand over the mouthpiece of the phone, Emma spoke to Kate.
“It’s Liam on the phone. He’s in Sydney. I’ve already called Mum and Dad and they’re on their way here. Liam wants to know what’s happening. Can you tell him?”
Kate took the phone from Emma’s hand. “Hi Liam. This is Kate Kennedy.”
“Hi Kate. What can you tell me?” Liam’s voice sounded identical to Joel’s and Kate had to stop and consciously force herself to remember she wasn’t talking to Joel on the phone.
“How much has Emma told you?”
“She’s not making much sense, to be honest. And it doesn’t help that I’m wanting more information than she can give me. I’m a paramedic, Kate, so please explain it to me in medical terms.”
Kate filled Liam in on Joel’s condition and just as she was explaining that Joel would be taken to the ICU shortly, an older couple walked into the room. As Emma hugged them, it was apparent that these were her parents. “Your parents are here now, Liam. Do you want to speak to them?”
“No, it’s okay Kate. Fill them in and let them know I’ll be on my way when my shift’s over. I’ll be there really late tonight or early tomorrow. Tell them not to wait up for me – I’ve still got my old front door key. Oh, and Kate – look after him for me, will ya? He may be me brother but he’s also me best mate.”
“I will, I promise. Drive safely, Liam.” Kate hit the end button and handed Emma her phone back. She paused, realizing everyone’s eyes were on her. There was an awkward silence for a moment before anyone spoke.
“You must be Kate, then.” Lorraine O’Connor was pleasantly plump and not much taller than five feet. She had a face that was obviously more used to smiling than frowning. She extended her arms and pulled Kate into a hug. “We have heard so much about you, dear.”
Kate raised her eyebrows, wondering what Joel had told them.
“Love, we are so sorry to meet you under these circumstances.” Sean looked like an older version of Joel and he too gave Kate a warm hug.
“Thank you so much for being here for our Em too,” Lorraine spoke again.
“You’re very welcome. It’s lovely to meet you and I’m also sorry that it’s here at the hospital,” Kate replied. “Joel’s in good hands but he’s very sick. They’re just taking him up to ICU now. Would you like to come upstairs with me? Oh, and I was just speaking to Liam on the phone – he’s on his way but he won’t get here until late tonight.”
“Good. Good. Yes, let’s go upstairs. But before we go, let’s just take a moment to stop and pray for Joel,” Sean said.
Kate was momentarily unsure what to do. Joel had never mentioned anything about his family being religious and she wasn’t sure what they wanted to do. The only time she had ever seen people openly pray was in the weekly assemblies at the Catholic school she had attended as a child. Before she knew what was happening, Emma reached for one of Kate’s hands and Lorraine reached for the other as Sean closed the circle and began to speak. His lilting Irish accent seemed to have a calming effect on all of them. He finished praying and Lorraine and Emma loudly chorused “Amen,” squeezing Kate’s hands.
“Amen,” Kate whispered in echo, wiping an unexpected tear from the corner of her eye. Clearly Joel’s family were very close and she immediately warmed to his parents.
“Right then, young lady. Lead the way to your ICU,” Sean said to Kate, reaching out and enveloping her in another quick hug.
Chapter 26
“I’m sorry but only two people are allowed in at a time,” Kate explained as she swiped them all into the unit and led them toward the waiting room.
“Of course,” Sean replied, looking between Lorraine and his daughter.
“It’s okay, Mum and Dad. You go in first. I can sit in the waiting room.”
Accompanied by Joel’s parents, Kate approached his bed area with a sense of trepidation. She didn’t know how Sean and Lorraine were going to cope with the shock of seeing their son so unwell. Kate knew that by now he would be sedated and tubed and she knew the shock this caused many people. She wondered if she should prepare them.
As she caught sight of Joel, Lorraine’s knees slightly buckled and Sean grabbed hold of his wife before she fell. Kate pulled up a small chair beside the bed for Lorraine to sit in and she flopped into it noiselessly. Kate looked across at Amanda who smiled at everyone.
“He can hear you. Speak to him,” Amanda said.
“Joel? It’s Dad.” Sean looked uncomfortable, unsure what else to say. Kate saw him looking around the room at the unfamiliar equipment and she mentally kicked herself for not taking a few minutes to prepare them for what they were about to see.
“Hi Joel me love. I’m here too. It’s going to be okay.” Lorraine’s voice cracked. “Kate’s here.”
Joel’s face was unresponsive and Lorraine and Sean looked from Amanda to Kate for clarification. Kate took hold of one of Joel’s hands in her own and squeezed it gently.
“Hey Joel. It’s me. I’m just going to have a chat with your mum and dad okay? You’re in the ICU and you’re going to be all right. Emma is okay. She’s in the waiting room and Liam is on his way from the city. You’ve got a tube down your throat to help you breathe but it will only be there for a few days. Your lungs are really sick and we just need to help them a bit with the machine.” As she spoke, Kate stroked her fingers across the back of his hand, noting how cool and smooth it felt. She found herself wanting to entwine her fingers through his to give him some of her warmth.
She turned and addressed his parents. “He’s heavily sedated so he can’t respond but he can most likely hear everything you say to him. Right now the best thing to do is to keep offering him reassurance that he’s going to get better. Over the next twenty-four to forty-eight hours they may consider lightening up on his sedation a bit, but for now the most important thing is for his body to rest.”
“I don’t understand, though,” Sean said. “They say it’s just pneumonia.”
“Pneumonia is very serious. A lot more so than most people understand.” She didn’t want to tell him that people died from pneumonia. “Thankfully Joel is young and fit so he will recover well,” Kate explained.
“But how did he get pneumonia?”
“It’s a bug basically,” Kate replied. “He probably had the flu and it just developed into pneumonia.” She wasn’t going to try to explain the physiology of the condition.
“He’s been working very hard out on the farm,” Sean said. “Could he have overdone things?”
“Possibly,” Kate answered. She felt guilty when she thought about how hard Joel had been working at her own place. She knew he was also spending hours at Eagles Ridge Farm getting it ready to open, plus he still had the café. Maybe he had been working too hard.
“So what’s the plan?” Lorraine asked, interrupting her musing.
“To be honest I’m not sure.” Kate turned to look at Amanda. “What have the doctors said?”
“Exactly what you just said, Kate. Rest his lungs and throw antibiotics at the bug. I’ve just got to keep him well sedated.” Amanda pointed to the white liquid dripping from the bottle at the head of the bed. “Also he’s got the chest drain i
n now.” Amanda indicated the small square container placed on the floor attached to the suction tubing that snaked its way to a dial on the wall. The machine was bubbling and it was clear there was blood collecting in the canister.
Lorraine saw it and frowned. “But he’s been on antibiotics for weeks now,” she said.
“The ones we give him here will be much stronger and also specific to the actual bug he’s contracted. Once they get a sample from his lungs they will be able to send it off to pathology and the infectious diseases doctors will work out the exact antibiotic to kill the bug,” Amanda explained.
Lorraine stood up and stepped up to the bed. Kate moved out of her way so that she could get in closer to her son. She stroked the side of his head, brushing the hair away from his ears, being careful to avoid the tube down his throat that was taped to the side of his face.
“My darling boy. You’re going to be okay. Kate’s going to make sure of it.”
“I’ll go and get Emma,” Sean said, his voice breaking slightly. He touched Lorraine gently on the arm. “You stay here with him.”
Lorraine nodded her head, not taking her eyes off her son.
Kate stood to one side, speaking quietly to Amanda as Emma came into the room. Emma went straight to her brother’s side, tears falling down her face. She hugged her mother tightly and the two women stood side by side, their faces expressing the shock they were feeling. Kate felt like an intruder watching the special moment between mother and daughter. She quietly excused herself to Amanda and left Joel’s bedside, unnoticed by either Emma or Lorraine.
*
Joel’s condition hardly changed during the course of the day and by eight o’clock that night Kate finally convinced his family to go home to rest. There was little they could do sitting by his bed while he was so heavily sedated. After they left Kate sat with Joel, holding his hand, listening to the hypnotic sound of the ventilator pumping oxygen into his lungs. Its rhythmic sound made her feel sleepy and she yawned. She needed to get home herself but something compelled her to stay and sit with him. It was the first chance she’d had in the frantic busyness of her day to spend a few moments with him alone. She chatted quietly to him, babbling away about insignificant things, hoping he could hear her voice. Finally when the night staff arrived, Kate realized she had to leave. She would be back at work in a few short hours and she knew the staff would contact her if Joel’s condition deteriorated overnight.
Intensive Care: Escape to the Country Page 21