Christmas on the Children's Ward

by Carol Marinelli

  ‘Where no one can see it,’ Eden retorted.

  ‘Where it doesn’t get in the way,’ Becky countered with a grin. ‘She’ll have a fit when she sees that you’ve moved it.’

  ‘Then she shouldn’t have asked me to sort out the Christmas decorations, “given that the ward’s so quiet”.’ Eden’s rather purse-lipped impression of her senior rapidly faded as Becky gave a quick cough and started shuffling a pile of papers in front of her. Eden sucked in her breath as Donna Adams arrived at the nurses’ station with a mountain of empty boxes. She was clearly not in the least impressed with what she was seeing.

  ‘What, may I ask, is the tree doing there, Sister?’

  ‘I thought it was more visible,’ Eden attempted. ‘That more of the children would be able to see it from their beds.’

  ‘It’s in the way,’ Donna clipped. ‘This is a hospital, Eden, not the local shopping centre. If, or rather when, there’s an emergency the staff have enough to deal with, without manoeuvring crash carts around a blessed tree.’

  ‘But there’s plenty of room.’ Eden stood firm, determined not to back down, determined for once in her life to stand up to Donna. ‘I’ve measured it. And, yes, this is a hospital, but it’s also a children’s ward—’

  ‘Nice tree!’ Nick announced, depositing a mug of coffee and smothering a yawn, clearly oblivious to the argument that was taking place. ‘When are the decorations going up?’

  ‘Once Sister Hadley moves it back to the other side of the nurses’ station,’ Donna said tartly, and as Nick’s eyes darted between the two women, Eden saw a twist of a smile on his lips as he picked up on the tension. ‘I was just explaining that the reason we keep it at the far side of the table is that in the event of an emergency we need to be able to manoeuvre the trolleys—’

  ‘There’s plenty of room,’ Nick broke in. ‘They’re not supermarket trolleys, Donna, we do have some control over them.’

  ‘But the patient files are kept there.’

  ‘Then move them,’ Nick responded. ‘It’s much better here—more of the kids can see it.’

  Given that Nick was the consultant, the argument was effectively over, but Donna wasn’t particularly gracious in defeat, thrusting a pile of empty boxes in Eden’s direction. ‘You can wrap these for under the tree, and I do not want to come in tomorrow morning to mountains of tinsel and fake snow over all my windows and plastic Santas stuck to the wall. Could we try and aim for tasteful?’

  ‘Children and tasteful don’t exactly mix,’ Eden muttered, but only when Donna was safely halfway down the corridor and heading for home! ‘What is her problem?’

  ‘She just likes to remind everyone she’s the boss,’ Nick answered, scribbling furiously on some notes and not looking up as he spoke. ‘She’s a honey really.’

  ‘Only because you’re the real boss.’ Becky grinned, leaning over and peering down the corridor to make sure Donna really had left before rummaging in her wicker basket under the desk. She pulled out a container and shovelled a delectable-looking slice of cake on a paper towel and placed it beside Nick’s mug. ‘Here you go, Nick, have some chocolate cake with your coffee. ‘Eden?’ she offered, but Eden shook her head.

  ‘Not for me, thanks. I’d better get on with this tree, given that I’m going to be seeing so much of it.’

  ‘Oh, Eden, I am sorry about that, but it wasn’t just for me that I said no.’

  ‘I know,’ Eden admitted. ‘It’s hardly fair on Conner as you worked last year.’

  ‘It’s not just Conner who’d be upset.’ Becky let out a low sigh. ‘I don’t think Hamish would have taken it too well if I’d had to tell him that I was going to be working. Believe me, his tantrums lately are worse than anything Conner can pull off.’

  Eden carried on listening to Becky’s woes as she climbed onto a footstool, unraveling a bundle of fairy lights as she did so. She felt horribly self-conscious all of a sudden, acutely aware of Nick just a few metres away. Not that he was paying any attention, Eden consoled herself, tugging down her dress with one hand as she reached up to the top of the tree with the other and started draping the lights—he was too wrapped up in his notes.

  ‘You should check them first.’ Nick’s voice caught her unawares and she swung around too quickly, embarrassed but grateful that, almost like a reflex action, he reached out his arm to steady her. ‘Careful, Eden,’ he warned, and Eden was grateful for the semi-darkness, which meant that Nick couldn’t see her blushing, which she was—furiously. His fingers tightened around her wrist. ‘Do you want me to do it?’

  ‘Do what?’ Eden blinked, her mind having wandered well away from the subject.

  ‘To check the lights for you,’ Nick explained patiently. ‘Before you go to all the trouble of decorating the tree, first you ought to plug them in to make sure they’re working.’

  ‘Oh, Nick!’ Eden simpered. ‘What on earth would we do without you?’

  ‘That’s why he’s a doctor,’ Becky said in a proud, village-idiot type of voice, and Nick started to realize he was being teased. ‘Because he’s so clever.’

  ‘I was only trying to help.’ Nick moaned, finally getting around to his coffee and cake. ‘I’ll keep my mouth shut next time.’

  ‘Please.’ Eden grinned, resuming the difficult task as Nick picked up his cake and eyed it greedily.

  ‘I’ve just realised that I’m starving.’

  ‘Well, enjoy.’ Becky smiled. ‘Eden didn’t want any so there’s another piece here if you fancy it.’

  Quite simply, Eden couldn’t resist it. Still on the footstool, the fairy lights poised in her hand, she turned her head to watch Nick’s face as he took a bite of the moist chocolate sponge and Becky pushed the container holding Eden’s slice towards him. ‘Help yourself, Nick.’

  It was sheer poetry in motion. Nick closed his eyes, just as one did when one was about to sink teeth into something divine. Eden watched as he took a very generous bite of the chocolate cake and then witnessed his eyes snapping open. The public school system had certainly done its job when they’d taught young Nicholas his manners because his moan of horror turned in an instant to a groan of approval.

  ‘What ingredients do you use, Becky,’ Eden asked innocently, turning her attention to the tree and smothering a smile, ‘to get it so moist?’

  ‘Tofu,’ Becky smiled. ‘Though I swear a good soy milk helps—none of that genetically engineered rubbish. And Hamish has found a store that does the most delectable vegan chocolate chips. I’m going to make one of those for Christmas—this was just a practice run. You will come,’ Becky checked, jumping up as a buzzer went off. ‘I’ll get it.’

  ‘What the hell is it?’ Nick choked, using the paper towel Becky had thoughtfully provided but for a reason she had never intended!

  ‘It’s awful, isn’t it?’ Eden giggled. ‘All her food’s the same. It looks fantastic, but when you taste it. Don’t!’ Eden yelped as Nick went to toss the rest of his cake in the waste-paper basket. ‘She’ll see. Use the sharps bin.’

  ‘I gather that you’ve done this before,’ Nick said in a loud whisper, shoving the remains into the sharps bin, which had a closed lid that hid the contents from sight.

  ‘Many times,’ Eden admitted.

  ‘You absolutely cannot go there for Christmas. It’s no wonder Conner and Hamish are throwing tantrums if that’s what Becky’s trying to feed them!’

  ‘What can I say to her?’ Eden giggled again. ‘She knows that I can’t get home and, given she was there when I found out, it’s not as if I can pretend I’ve got other plans.’

  ‘You could have,’ Nick reminded her, but thankfully her pager bleeped, giving Eden an excuse not to get into the uncomfortable topic. Glancing down at her neon yellow pager, the numbers displayed were instantly recognisable as Accident and Emergency. As Eden was the admitting nurse for the paediatric unit that evening and all admissions had to come through her in order to be allocated, it could only mean one thing—a new admission
was on the way.

  ‘Eden Hadley, admitting nurse for Paeds,’ Eden said as she was connected, listening to an unfamiliar nursing sister and scribbling down an initial diagnosis as Nick looked on. ‘Chest infection or difficulty feeding.’ She shared a wry grin with Nick as Emergency attempted to shuffle their patient to the top of the list. ‘And he’s three years old. Have we had him before?’

  An incredibly long wait ensued as the nurse attempted to locate the patient’s history, reeling off a long list of complaints until finally Eden halted her.

  ‘Ben!’

  ‘No,’ came a hesitant voice down the line. ‘The name I’ve got is Maxwell Benjamin Reece, he’s a three-year-old with Down’s syndrome. He’s also…’ The nurse lowered her voice and Eden rolled her eyes, finishing the sentence for her.

  ‘HIV positive. He’s familiar to the ward, but he goes by the name of Ben. Could you let the staff who are dealing with him know that, please? Who’s with him?’

  The frantic scribbling on her notepad had stopped—Ben was familiar to anyone who worked on the paediatric unit and Eden didn’t need to write down his past history. She gave a frown as the emergency nurse cheerfully declared that he had come in accompanied by Lorna, a social worker. It became clear that, yet again, little Ben was a ward of the state, that he’d had a chest X-ray and that they wanted to send him up soon as they were getting pretty full. Maybe it would be better if he was in familiar surroundings.

  ‘Send him straight up,’ Eden said, replacing the phone in its cradle.

  ‘Ben?’ Nick checked.

  ‘Minus his new foster-parents.’ Eden ran a hand through her hair, pulling out her tie and collecting all the loose curls that had fallen out and replacing them, an automatic gesture she did ten, maybe twenty times a day,

  ‘What’s the diagnosis?’

  ‘They’re fumbling to get one.’ Eden gave a tight smile. ‘Why don’t they just admit that little Ben’s too much like hard work?’ Closing her eyes for a moment, she instantly regretted her words. It wasn’t for her to judge. Ben wasn’t just her favourite patient. Everyone, from cleaner to consultant, adored Ben, but, as cute as he was, he had been dealt more than his fair share in life. Genetic, social and hereditary problems seemed to have aligned when he had been conceived. ‘I’m just sick of seeing him passed around, Nick. It just doesn’t seem fair that one little boy should have to put up with so much.’

  ‘He’s happy,’ Nick said soothingly.

  ‘Is he?’ Eden wasn’t so sure. ‘He just doesn’t know any better, Nick. He’s never been given a chance.’

  And though no one could have expected a drug-addicted teenage mum to deal with a Down’s syndrome baby, if Ben’s mum had only revealed her pregnancy earlier than in the labour ward, had received antenatal care and been diagnosed as HIV positive, then she could have taken some measures that could have lowered the chances of her transmitting the disease to her son. Sophisticated antiretroviral drugs could have been given during pregnancy and labour, even in the period following birth, but Ben had received none of these. Only when his mother’s results had come back ten days post-birth had her HIV status been revealed, and despite the best preventative treatment her HIV status had been passed on to her son. As the weeks had dragged by into months, as endless foster-parents had tried and failed, little Ben was constantly returned to the hospital. It would seem that hospital was the only home this little boy knew. But Nick seemed to understand how Eden was feeling.

  ‘Someone will come along soon for him.’

  ‘When?’ Eden asked, not even attempting to hide the bitterness in her voice. ‘He’s not going to live long, Nick—you and I both know that. I just really hoped…’ She didn’t finish, couldn’t, tears stinging her eyes.

  ‘Really hoped what?’

  ‘That he’d get one Christmas with a family, that this foster-placement would work out…’ Eden choked, ‘One Christmas of being of spoilt and cuddled, one Christmas being loved…’

  ‘Ben doesn’t go short of cuddles,’ Nick pointed out, ‘All the staff love Ben. He’ll get all that here.’

  Eden shook her head. ‘Twenty-eight kids will get that here, Nick—the nurses will make sure of it—but most kids that are here over Christmas are here because they’re very sick. We’re stretched to the limit normally, but especially over Christmas. Most of the children will have parents and siblings, aunties and uncles to dote on them, and Santa will come and visit. We’ll do our very best for Ben, but no matter how hard we try it’s not the same as…’ she took a deep breath ‘…a family Christmas. As much as you mock it, Nick, as much as we all grimace sometimes at the thought of it, we wouldn’t have it any other way. And that little guy has never had it, not even once.’ Eden shook her head, more to clear it. She couldn’t allow herself to get so involved, it wasn’t healthy for anyone. ‘I’d better go and get a cot ready—he’s already on his way up.’

  One look at those big brown eyes and Eden was instantly reminded why Ben was everyone’s favourite—it wasn’t just sympathy for his ailments that evoked such a response, it was all to do with a little guy who could melt the hardest heart at fifty paces. His dark hair was a wild mop around his little face, his almond-shaped eyes were always expressive, and his cute mouth broke into a wide grin despite the bottle he was half-heartedly sucking on as Eden greeted him.

  ‘Hey Ben, we’ve missed you!’

  ‘Den!’ Ben answered, and Eden was thrilled that he remembered her name. He’d only just started to talk a few weeks ago when he’d last been admitted as a patient, and Den had been one of his early words, more being near the top of the list.

  More milk.

  More chocolate.

  More cuddles.

  But his first word had been the one that had torn at Eden. Whereas most children started their vocabulary with a gummy mum or dada, Ben’s first word had been no.

  No to the endless drips and IVs, no to the mountain of medicine he had to take and, saddest of all, no, when his favourite nurses’ shifts ended and they popped in to say goodnight.

  Lifting him up off the trolley, Eden expertly negotiated the oxygen tubing and carried him to his freshly made-up cot. She propped Ben up on a couple of pillows she had prepared so that he remained semiupright to allow for greater chest expansion and strapped an oxygen saturation probe to his fat foot. There was no murmur of protest. Ben was way too used to the procedure to fuss, as most toddlers would have.

  ‘I’m just going to speak to the nurse and then I’ll be back, Ben.’

  The nurse giving handover didn’t have much more information to give than she’d had over the telephone. ‘He’s reluctant to take fluids and mildly dehydrated and his ears are clear. But he wasn’t about to let us look down his throat…’

  ‘Typical Ben.’ Eden smiled, knowing how much Ben hated having his throat examined. ‘Why hasn’t he got an IV?’

  ‘The doctor thought we should rehydrate him via a nasogastric tube first.’

  ‘But he hasn’t got one in,’ Eden pointed out.

  ‘We tried to put it down but he got very distressed. We’re trying him with his bottle.’ The nurse didn’t quite meet Eden’s eyes as she answered and even before her next question came, Eden already knew the answer.

  ‘Has he been given any antibiotics?’

  ‘Oral,’ the nurse said, pointing to the prescription chart. ‘He’s only got a mild infection—this admission seems more social.’

  Lorna, the social worker, gave a murmur of agreement. ‘The family just couldn’t cope. We’re going to have to look for some alternative type of placement. Ben’s just proving too hard to place with a family. His medical needs are so time-consuming and behaviourally he’s very demanding as well…’

  ‘Because he’s confused,’ Eden argued futilely. ‘Once he settles into a routine he’s fine. Look how good he is here.’

  ‘I know,’ Lorna sighed. ‘But it’s looking more and more likely that Ben’s going to end up in a residential unit—there ar
en’t many foster-families out there capable of looking after a child with Ben’s needs. I’ll speak to Donna first thing tomorrow and pencil in a team meeting for the end of this week. We really do need to look at some other options for Ben.’

  ‘Donna?’ The emergency nurse asked.

  ‘She’s the paediatric unit manager,’ Eden explained as she took the admission notes and X-ray films, her heart sinking at the thought of Ben living out his short life in a long-stay residential facility. ‘As you can probably tell, we all know Ben pretty well. What bloods have been done?’

  ‘None.’ The emergency nurse gave a rather too casual shrug. ‘It was a locum and he’s not used to taking blood from a child. He thought it might be better for Maxwell, I mean Ben, if the paediatrician did it on the ward.’

  It would have been easier to say nothing, to just take the notes and say goodbye, but Eden simply couldn’t just walk away.

  ‘Did you remind the doctor about universal precautions?’

  ‘I’m sorry?’ Confused, the nurse frowned back at her.

  ‘Did you remind the doctor that every patient, regardless of their symptoms or status, should be treated as if they have a communicable blood disease?’

  ‘I don’t know what you mean,’ the nurse said, but from the colouring in her cheeks she clearly did.

  ‘We know Ben’s HIV positive,’ Eden said tersely. ‘Remind the doctor for me that it’s the patients we don’t know about that should cause us the most concern.’

  ‘Eden.’ As the emergency nurse stormed off, Lorna touched her arm. ‘Don’t go getting upset.’

  ‘Why don’t they just admit that they didn’t want to put an IV in, rather than coming up with all that nonsense about pushing fluids and the doctor wasn’t used to taking blood from children? What the hell’s he doing a shift in Emergency for? It’s a cop-out and everyone knows it!’

  ‘Just who are you really cross with here, Eden?’

  ‘Don’t try your psychobabble on me, Lorna,’ Eden said, running a worried hand over her forehead. ‘Do you really think he’s going to end up in residential care?’