“I’m going home now, Joel.” She stroked his arm, feeling the heat radiating from his body as the fever raged. There was no response from him. She reached for a face washer from the pile of linen on the shelf and dipped it under the tap. Laying the cool cloth across his head she spoke again. “It’s getting late – almost ten o’clock. Your family have headed home and we’ll all be back in the morning. You’re doing great, Joel. Don’t fight the machine, just rest and let your body heal itself.” She hoped her words sounded positive and encouraging.
Amanda and Stephanie entered the room together so that Amanda could give Stephanie the report on Joel’s condition.
“I’ll look after him for ya, mate,” Stephanie spoke kindly, her dark eyes full of compassion.
“Thank you, Steph. And you too, Amanda. You’ve done a great job today.”
Kate sighed as she took one last look at Joel in the dimmed lights. She knew in her mind he was going to be okay but her heart was still struggling to catch up. It had been a big day and she was emotionally exhausted. Joel was much sicker than she had imagined him to be, and seeing him wheeled in by the paramedics had shocked her. It was also obvious to her now that her feelings for him ran much deeper than she had first thought. If only she knew if he felt the same way about her. At least he was going to be okay – of that she was certain.
“Is Joel your …” Stephanie didn’t finish the question before Kate interrupted her.
“No – we’re just friends. Good friends.”
“Could have fooled me!” Amanda winked at Stephanie. “I’ve watched Kate with him all day and I can assure you, I don’t look that way at my friends!”
“Ooh a romance!” Stephanie laughed and rubbed her hands together. “You’ve kept this pretty quiet, Kate.”
Kate blushed. “Really, there’s nothing between us. We’re just good friends. Both of us have just come out of long-term relationships so we’re not ready to jump into something new. And anyway, I’m pretty sure he’s not interested in me in that way.”
Kate bit her lip, annoyed with herself for having shared so much private information. She had managed to keep her personal life separate from her work life and she had no right to share Joel’s own story with someone else. She saw the look that passed between Amanda and Stephanie.
“Is that why you moved here,” Amanda asked, “because of a break-up?”
“Partly. Yes.”
“I’m sorry. I didn’t mean to pry. I hope I didn’t upset you,” Amanda said.
“It’s fine.” Kate sighed again. “It’s no big secret anyway. I broke up with my boyfriend and decided one big change wasn’t enough so I took the job here to get away from him and start over. Call it an escape, whatever, but let me assure you, finding love again is not part of the plan – not yet anyway.” There was no way she was going to tell them why she’d left Marcus and she definitely wasn’t going to tell them about her real feelings for Joel.
Kate glanced at Joel, certain she had seen his arm lift spontaneously off the bed at the mention of the word “love.” Amanda and Stephanie followed her gaze but Joel remained lying supine in the bed, the head of his bed at the obligatory thirty-degree angle. His arms remained propped on the pillows by his side, unmoving. Perhaps she had just imagined it.
“Well if you were looking for love again, he’d be a bit of all right wouldn’t he?” Stephanie whispered. “He’s hot!”
“And apparently he’s Irish,” Amanda said, her voice also low. “I can’t wait to hear if he’s got an accent when he wakes up.”
Turning away from her colleagues, Kate spoke over her shoulder as she walked down the hallway. “You’re right, girls. He is pretty hot.” She saw the surprised expression on their faces and grinned to herself. “Oh, and his accent is divine.”
That’ll get the Birrangulla rumor mill working overtime!
She wondered if Joel had heard her, even in his sedated state. She hoped so.
Chapter 27
When Kate returned to work the next morning, she dragged herself up the stairs, already exhausted both physically and emotionally. Having slept poorly, worrying about Joel, she had woken earlier than usual and headed straight into work. Hoping Joel’s condition had improved overnight, Kate frowned when she saw the gathering of people at his bedside. Without stopping to dump her bag in her office, she pushed through the crowd of people to get to him.
“What’s going on? What’s happened?” She looked around, trying to get her bearings.
Stephanie’s face was flushed and she had a worried look in her eyes, making them appear like black buttons in her brown face. She didn’t answer Kate’s question. Kate glanced over and saw that Joel was still lying sedated and intubated, the ventilator keeping its own beat, pushing air into his lungs. Nothing appeared to have changed with his ventilation or oxygenation. There was a slight sheen of sweat on his face and a fan was oscillating, blowing air around the small area, causing the curtains to billow. She surveyed the monitor, saw the fluids running and was still confused.
“Dr. Powell? Bruce. What’s going on?” She tried to gain his attention but he was focused on looking over Joel’s charts.
“We need to filter this young man.”
Kate’s heart plummeted as though she had just been dropped from a great height.
No one had moved when the doctor spoke.
Without acknowledging Kate, he spoke again, frustration clearly heard in his gruff manner. “Now!”
Still no one moved, not even Kate. Her legs were lumps of concrete and she felt like her feet had been glued in place. Time seemed to slow down.
“His urea and creatinine have gone through the roof. We’ve got to get his pH down and the only way is to connect him up to the filter.” Still not acknowledging her, Bruce looked around the room at Stephanie and the others gathered in the small space, his voice gaining strength. He sounded angry. “Unfortunately, Kate, your staff don’t seem to know what they’re doing.”
Kate could hear the sarcastic tone in his voice and wondered what on earth was going on.
“Okay,” she said, trying to assess the situation. Her mind was spinning. This was Joel, her friend, not just any patient. Her own anger began to grow and she looked around for someone on whom to cast blame. “What’s going on? And why didn’t someone call me and let me know Joel wasn’t doing well?”
“Because I’ve only just been shown his blood results when I arrived,” Bruce snapped. “I didn’t know how sick he was when they called me in.”
“Isn’t this your week off, Bruce? I thought it was Simon’s week on duty.” Kate frowned in confusion. Her brain was sluggish. It seemed to be in slow motion. I haven’t even had a cup of coffee yet, she remembered.
The two doctors rotated, working one week on, one week off. At the mention of his name, the younger doctor walked in, dumping his backpack at the end of the bed. His shirt sleeves were rolled up and the back of his shirt was untucked from his pants. The collar of his shirt was still damp from his wet hair. He looked like he’d rushed in. Kate hoped he’d had his morning coffee.
“Good morning, Bruce.” He spoke to the older doctor and then nodded once in Kate’s direction. “Kate.”
What is happening here? “Simon? What’s going on? Why are you both here?”
“Relax, Kate. It’s okay. Pippa wasn’t able to get hold of me this morning – I was out riding – so she left a message on my phone and then obviously called Bruce in to cover until I arrived.”
“I’m finding it a bit hard to relax. Joel is my friend. I want to know what’s going on.” Kate’s voice cracked slightly as she looked from one doctor to the other, seeking answers.
Pippa had been working the twenty-four-hour shift and Kate figured she must have been concerned enough to call the more senior, experienced doctors to come in and assess Joel’s condition. Kate looked across at Pippa and saw her standing to the side, looking uncertain. Kate had never seen her looking anything less than confident and it made Kate worr
y about how sick Joel really was.
The three doctors conferred at the desk and Kate heard them discussing multisystem organ failure as well as confirming their decision to put Joel on dialysis using the hemofilter, the machine that would remove blood from his body, filtering it through a series of tubes where waste products and toxins would be removed, before returning the cleaned blood back to his body.
“Are you saying he’s in septic shock?” Kate interrupted the doctors, worry and stress causing her to forget her manners.
“Yes.”
“So the antis haven’t worked?” She twisted the ring on her finger as she did whenever she was uncertain.
“Not at this stage.”
“How’s his breathing then?”
“So far his lungs are doing okay and I’m pretty sure the antis are working but I’m mostly concerned about his kidneys right now. Renal function’s totally off. Creatinine’s over four hundred and urea is sitting at thirty-five,” Simon replied.
Kate raised her eyebrows in surprise at the exceptionally high figures. Acute renal failure. This isn’t good. Why wasn’t anybody moving?
“Have you got the filter ready, Steph?” Kate turned to her, wondering why she wasn’t doing anything.
“No.”
“Why not? It takes at least twenty minutes to get it set up.” Kate’s voice was terse – a combination of worry and anger.
“I don’t know how to use it, mate,” Stephanie said in a voice so quiet Kate could hardly hear her.
“What do you mean? Why not?”
“No one here knows how to connect up the filter. We haven’t used this one before – most of the staff only know how to use the old one. And the last time we filtered anyone was ages ago. That’s why Pip called Simon. After I took gases and got the bloods sent off around five I showed her the numbers. Then pathology rang with the results and Pip was pretty sure he needed filtering but because we don’t know how to use the machine she wanted a second opinion in case we could get away with not needing to filter him. She waited ’til six to call Simon and when she couldn’t get hold of him she called Bruce in.” Her long explanation did nothing to appease Kate’s frustration.
“Why didn’t you just call me?”
Stephanie shrugged her shoulders. “I didn’t think to. We’ve never called the NUM in emergencies, always the doctor.”
Kate let out an expletive which was unusual for her. “That’s bloody ridiculous! What are Bruce or Simon going to know about operating the filter? It’s a nursing responsibility!”
“I don’t know, mate.” Stephanie’s answer was not what Kate wanted to hear and she struggled to keep her temper in check and her frustration from spilling out. She knew Stephanie was an excellent nurse, but she was staggered that no one in the unit knew how to operate the equipment. Joel was deteriorating while he was lying there and no one was doing anything about it!
“I can’t believe this! Hasn’t the educator gone through the new filter with everyone?”
“Kate, can you deal with that later? We need to get that filter on,” Simon said, cutting off her tirade. “And I suggest you get onto it quickly. This is one very sick young man,” he said as he left the room.
Kate looked at the doctor and her heart began to race at his words. He was usually very calm but she sensed the urgency in his voice, causing fear to course through her body and coil itself in the pit of her stomach. Was she too emotionally involved to be able to care for Joel? She tried to mentally take a step back but her thoughts were in turmoil, spinning in a vortex.
“What filter have you been using?” Kate asked, trying to refocus her attention on the job in front of her.
“The old Aquarius. We only got the new Prismaflex a few months ago and we haven’t had to use it yet. We don’t get many filtered patients here in the country,” Stephanie emphasized. Kate felt the sting of her words but chose to ignore what she was implying.
“Well where’s the Aquarius then? Why haven’t you just connected that up if you all know how to use it?”
“That was the first thing I suggested to Pip but we can’t use the old machine because all the stock is out of date and the software needs updating or something.”
Kate’s eyes widened as she stared at Stephanie. She was so angry she was speechless but she managed to hold her temper in check. Losing it wasn’t going to make Joel better.
“Kate? Have you sorted the filter situation out yet?” Simon came back into the room, pushing the metal trolley that contained the equipment he needed for the insertion of the catheter into Joel’s groin. He was frowning at her.
“Steph, go and get the Prismaflex and bring it in here.” Kate knew she sounded rude but she was still staggered by what Stephanie had told her.
A few moments later Stephanie wheeled the bulky green machine into the bed area. “Have you used the Prismaflex before?” she asked Kate.
“Yes, I have. I’m very familiar with it.” Kate knew she sounded arrogant but she was under pressure from Simon and increasingly worried about Joel. By now the other nurses had gathered around Joel’s bed and were watching Kate.
“So none of you have had any training on this machine,” Kate confirmed as she turned it on.
“No.”
“None.”
“Nope.”
Kate shook her head. “Later this morning I want someone to call the educator.”
Greg spoke up, “I actually did think about calling him in earlier, but by then Pippa had already called Simon and Bruce.”
“Okay, well I’m not going to take the time to explain how to set the machine up right now because we need it done immediately, but feel free to watch. I’ll make sure the educator does a full training session on the filter over the next few days.”
Kate began loading the tubing that Stephanie handed her, feeding it into the correct places on the front of the machine. The others watched her in silence, handing her the large bags of fluid when she asked for them. Within a short amount of time the machine was ready for use.
“Well done, Kate,” Simon applauded her as together they connected Joel up to the machine and waited while the wheels began spinning, extracting the blood from his body.
The other nurses finished putting excess stock away and Kate composed herself enough to spend time explaining the operation of the machine to Amanda who was going to look after Joel for that day.
As she left the room she found the doctors and spoke quietly to them. “Sorry Dr. Powell. Simon. I had no idea the staff hadn’t used this filter before,” Kate apologized, “and I’m sorry for my anger. Joel is a friend and I probably overreacted.”
“Well at least it’s all sorted now,” Simon said, smiling reassuringly at her. “As long as they know to come and get one of us urgently if it blocks or if they’re unsure of anything.”
“Of course,” Kate replied. “I’ll make sure they all know.”
*
During rest period that afternoon when the lights had been turned down and all the visitors had left the unit, Kate finally had a chance to check on Joel. She was aware that Sean and Lorraine had sat with him all morning and she knew Emma had visited. She had yet to meet Liam.
“How’s he doing?”
“Great. He’s responding really quickly to the filter.”
Kate glanced over at Joel and then looked at the numbers on the chart on Amanda’s desk. She was pleased to see everything trending in the right direction. Relief pushed her exhaustion aside and dulled the tension that had been gripping her tighter than a tourniquet over the past couple of days. Thank you, God. Maybe Sean’s prayers were going to be answered and Joel was going to be okay.
“Go and have your lunch, Amanda – I’m covering for you.”
“Oh thanks, Kate. That would be great. I’ve actually got a shocking headache.”
“You okay?”
“Oh I’ll be fine – you know what it’s like – one of those headaches you get when you’re learning something new and it’s a st
ressful day.”
“How are you finding the filter?”
“Surprisingly easy.”
“Has the educator spent any time with you?”
“He was here all morning. He’s been great.”
“Well he should have trained you all before a patient needed to be filtered.”
“Don’t blame him, Kate. There’s been a lot of changes here lately and that’s just something that got missed.”
“Well it could have had catastrophic consequences if Joel had died while we were waiting to work out how to turn a machine on.”
“But he didn’t die, Kate. No use thrashing it out with Ian – or any of us for that matter. The fact is, Joel is okay.”
Kate sighed. She knew Amanda was right, but the pressure she was feeling was immense. She had allowed fatigue and worry to weaken her to the point that she was finding it difficult to think clearly.
“You’re right. Anyway, enjoy your lunch and take your time. I’m happy to sit here as long as you need. Take an hour, okay? And grab a couple of Panadol.”
Kate looked over the chart and paperwork on the desk, and seeing everything was in order, she pulled up a chair and sat beside Joel. Her back was stiff and knots had formed in her neck from all the stress. She tilted her head from side to side and raised her shoulders to meet her ears, but it did little to ease the tension that was there.
“Hey you,” Kate said softly as she squeezed Joel’s hand.
Beneath his closed eyelids she saw slight movement as he struggled to open his lids. She knew the amount of sedation he was receiving was enough to keep him relaxed and to prevent him from pulling out the tube, but she desperately wanted to lighten the level of sedation to let him know she was there with him. Pushing buttons on the IV pump, she waited a few minutes for the decreased dose to have an effect. She squeezed his hand again.
Intensive Care: Escape to the Country Page 22