by Leah Martyn
Nikki took a thoughtful swallow of her tea. She didn’t believe in giving up so easily. She was part of this small community now. There had to be something they could do.
‘But on the other hand…’ Grace, it seemed, had more information to convey. ‘I heard some good news this morning as well.’ She paused for effect. ‘Bernie Hardy’s been appointed as the new manager for the caravan park. He’s positively bursting with pride. And you, Doctor…’ she laughingly aimed an index finger at Nikki ‘…encouraged him to apply, I believe?’
Nikki huffed a dismissive laugh. ‘I made a couple of phone calls, that’s all. Bernie got the job on his merits.’
Liam straightened slowly, narrowing a questioning look at her. ‘Sounds like community medicine at its best. You’re full of surprises, Nikki. As always.’
Nikki returned to her consulting room to take her afternoon clinic. She felt miserable. Why did she let Liam rock her equilibrium like this?
She went across to the window and stood staring out at the marigolds and nasturtiums blooming bravely despite the harsh climatic conditions.
She sighed. Even the plants were making an effort to hold on, to finish what they’d begun. She and Liam couldn’t even seem to make a beginning…
The harsh ring of the telephone jarred her senses. Inhaling a ragged little breath, Nikki yanked herself back to the real world. She slipped into her chair and picked up the phone.
‘Nicola Barrett.’
‘Oh, Nikki, it’s Wendy Palmer from the child-care centre. I think we’ve huge trouble on our hands.’
Nikki’s hand tightened on the receiver. Wendy was the centre’s director and from what Nikki could judge, after just a couple of visits to the centre, she didn’t appear to be the panicky type. ‘OK, Wendy, slow down. What kind of trouble are we talking about here?’
‘Meningococcal.’
Just the sound of the word sent a cold river of dread flooding down Nikki’s spine. ‘Who’s affected and what are the symptoms?’
‘One of the babies. We’ve been concerned about her for the last little while. Now she’s developed a kind of light, pink-spotted rash—’
‘Is the rash smudgy or small?’ Nikki rapped.
‘Small. Her temperature’s up and she’s screaming the place down. Oh, Nikki, it’s hell on wheels here.’
Nikki was already on her feet. ‘Get hold of the parents, Wendy. It’s imperative.’
‘We’ve been trying since Taylor seemed so unwell. But the mother’s mobile is switched off and there’s no father on the scene. Oh—hang on a minute, Nikki.’
Nikki heard the sound of agitated voices and then Wendy was back on the line. ‘My workers have just informed me two of their toddler group are displaying similar symptoms. What should we do?’
‘Stay put. No one is to go in or out of the centre unless we authorise it, Wendy. And that’s an order.’
‘Yes—yes, I understand.’
Mentally Nikki crossed her fingers as she asked the next question. ‘Have you and the staff all had your vaccinations against meningococcal?’
‘Yes.’
‘Liam and I will be straight there. And, Wendy, have the three affected children’s health particulars ready, please.’
Nikki slammed the phone down, personal problems shoved aside as she sped across the corridor to Liam’s room. She burst in without knocking. ‘Emergency at the child-care centre. We’re needed over there.’ Using medical shorthand, she took only a few seconds to fill him in.
‘Right.’ Liam hefted his bag and tore ahead of her out of the room. ‘Grab what vaccinations we have, please. I’ll give Grace a few instructions, then wait in the car for you. Run, Nikki. These minutes could be crucial.’
Nikki ran.
At Reception, Liam began giving a stream of orders to Grace. ‘Ring the hospital. Speak to Anna and tell her we have an emergency at the child-care centre. We need her and another nurse to meet us there. Ask her bring all their available meningococcal vaccine and a paediatrics trauma kit. And we need both ambulances on standby and someone waiting in Pathology.’
Grace snatched up the phone. ‘Should I cancel all appointments for this afternoon?’
‘Please.’ Liam hauled the door open. ‘This could take the rest of the day.’
‘Not a good feeling, is it?’ With Nikki on board, Liam reversed the Land Rover in a swift arc.
‘No.’ Nikki searched his grim profile. ‘I had the slender hope it could have been measles. We’ll have to notify the health department.’
‘We’ll do that as soon as we’ve confirmed it’s meningococcal. Just let’s hope we can contain it.’
Nikki bit down on her bottom lip. ‘Children are so vulnerable, aren’t they?’
‘The very young and the very old,’ Liam agreed, and his voice sounded throaty.
Anna and Michelle arrived at the centre within seconds of the doctors. Wendy met them at the door. ‘We’ve put the baby in the sick bay and isolated the two toddlers in the small playroom,’ she said without preamble. ‘I’ve checked all three children’s enrolment details. No allergic reactions are listed.’
‘Thanks, Wendy. That’s brilliant.’ Liam strode between the rows of little mattresses on the floor. ‘Nikki and I will do the baby first. And, Anna, if you and Michelle will check on the toddlers and report back to us?’
‘You’ll find them in there.’ Wendy pointed the nurses towards the small playroom.
‘Where are the other children?’ Nikki’s gaze swept the empty room.
Wendy lifted a hand and rubbed a finger across her temple. ‘They’re on the back verandah. I’ve sent Rosie to read to them and do whatever else she can to keep them occupied.’ The director gave a strained smile. ‘Thank heavens for those little puppets you left here on your last visit, Nikki!’
Nikki nodded. ‘Just remember, Wendy, no one is to be allowed in or out until we say so.’
Wendy put a hand to her throat. ‘Some of the parents will be arriving soon to collect their children.’
‘Make a sign quickly and hang it outside. If they’ve mobiles, they’ll probably ring so be ready with your answers. We’ll give you more information as soon as we can.’
Nikki almost sprinted along the corridor to the sick bay. ‘We’ll take over now,’ she said gently to the young worker who was standing beside the little change table, looking down at the baby.
‘She’s very ill.’
‘Yes, she is.’ Nikki’s heart ached for the young worker, whose name badge proclaimed she was called Cathy.
‘I’ve looked after her since she’s been coming to the centre.’
‘We’ll do all we can,’ Nikki promised. ‘Meanwhile, could you help the two nurses with the sick toddlers, please?’
Cathy cast a lingering look at the baby and then left.
‘She’s unconscious, Nikki.’ Liam was checking the child’s vital signs as he spoke. ‘Temperature’s way up, 39, fast pulse and rapid respiration rates.’
Nikki pulled up the tiny T-shirt and loosened the nappy. ‘The rash appears to have spread all over. Let’s get her on oxygen, Liam. I’d say six litres per minute. Will you do the IV? We need to get fluids and an antibiotic into her.’
Because all young children tended to thrash their arms about, Liam deftly slid the cannula into the infant’s ankle.
‘Anything I can do to help?’ Wendy appeared at the door.
‘Some wet towels, please.’ Liam was quickly drawing up the dose of antibiotics. ‘We need to get her temperature down.’
‘Coming up.’ Wendy left at a run.
‘What are you giving her?’ Nikki swabbed the cannula in readiness.
‘Vancomycin. That seems to be the consensus in Paeds at the moment. There you are, little one,’ he said softly, as he injected the antibiotic, willing the tiny vein to begin carrying the lifesaving drug to every part of the infant’s body.
Michelle stuck her head in the door. ‘Both toddlers have high temps and rash. Cathy’s
presently running a bath and we’ll start sponging them. We’ll be ready when you’re free to cannulate. I should warn you, you’ll need all your skills, they’re very distressed.’
‘Thanks, Michelle,’ Liam acknowledged with a grim twist to his mouth. ‘We should be through here shortly. Ambulance arrived?’
‘Just pulled up, someone said. And they could only send one, unfortunately.’
‘Liam!’ Nikki’s alarm tore through the room. ‘She’s fitting! Valium, quick!’ The baby’s eyes were rolling back in her head and she was beginning to stiffen.
‘Hold her!’ Liam’s reaction was instantaneous. He grabbed for the drugs pack. They were working frantically against time but in seconds he’d drawn up the infant dosage and sent it home.
‘I’ve increased the oxygen to eight litres per minute.’ Nikki’s heart was in her mouth. They couldn’t lose this little one. They just couldn’t!
‘Thirty seconds.’ Liam monitored his watch. ‘Damn! She should be coming out of it.’
‘She is.’ Nikki’s heart returned to its rightful place. ‘The drug’s working. She’s stopping. Oh, thank God…’
Liam’s face remained grim. ‘We don’t have a minute to spare, Nikki. We have to get this infant to hospital. I’ll have to leave you to manage the toddlers.’
Nikki knew time was of the essence but before they could proceed any further the path lab would have to run a blood test to confirm the meningococcal virus. ‘Go. I’ll start working on the toddlers.’
‘Can you manage?’ A frown creased Liam’s forehead.
Nikki hefted her case and the trauma pack. ‘With Anna and Michelle to help me, of course. Send the ambulance back as soon as you can.’
Liam looked torn. ‘I’ll try to get back if I can.’
‘Just save that baby.’ She waved him out. ‘I’ll cope.’
‘This isn’t over by a long shot, Nikki,’ Liam warned.
‘I’m aware of that,’ she snapped, the strain of the past twenty-four hours catching up with her. There were a mountain of tasks yet to be completed. Vaccination of all the children attending the day-care centre plus their parents and siblings.
And it would all have to be done today.
The toddlers were screaming. ‘The sponging’s helped to bring the temps down a bit.’ Anna struggled to hold one of the children as he arched back and fought for freedom from the confining arms.
Nikki took in the scene, her mind sharp and practical. ‘We need some triage here, guys. Michelle, put your toddler in the cot for a second and give Anna and Cathy a hand to hold this little man. There’s no way I can get an IV in with him thrashing about like a wounded bull calf.’
That analogy brought the semblance of a smile from the team. ‘I hope you’ve got nimble fingers, Nikki!’ Anna raised her voice above the din.
Nikki worked instinctively, her movements swift and sure. In seconds the cannula was in and holding. ‘Right, that’s number one. We’ll run in normal saline and I’ll administer the antibiotic. As soon as I’ve done that, Michelle, I want you to bandage the IV firmly so this little chap can’t kick out the line.’
The second toddler was a sturdy little girl who fought tooth and nail against the procedure and consequently the whole thing took longer. Finally it was done.
‘Now, let’s get them both on oxygen, please,’ Nikki instructed. ‘Run it at four litres per minute.’
Nikki was still hard at work when Wendy appeared at the door. ‘Liam just called.’ Her face had taken on a pinched look. ‘The lab rushed through the blood test. It’s confirmed meningococcal.’
Well, it was what they’d thought—and dreaded. Nikki felt her nerve-ends tighten to a hard knot in her stomach. ‘Right, then. From this moment the centre is quarantined.’
‘Oh.’ Wendy made a tiny sound of dismay and bit her lips together. ‘The rest of the children will have to be vaccinated, won’t they?’
‘They will,’ Nikki agreed. ‘But first we’re going to need the parents’ consent. So, Wendy, you’d better have your staff begin working the phones.’
‘We’ve only the one line.’ The director looked aghast. ‘But most of us have mobile phones.’
‘Good. Use them and I’ll see you’re all reimbursed for the calls. And remind the parents they’ll have to present themselves here for vaccination, along with any siblings of the children here at the centre. But they’ll have to remain outside. I’m sure we can get a tent or something put up and some chairs sent over.’
‘The SES will have it in hand,’ Michelle said confidently. ‘And one of the church groups will organise hot drinks and sandwiches as a matter of course.’
‘I’ve managed to contact the mothers of the children at risk,’ Wendy said. ‘I’ve told them to go straight to the hospital.’
‘Thanks for all your help, Wendy.’ Nikki began packing up her case. ‘I’ll leave Anna and Michelle here to begin the vaccinations but I need to get these two little people to hospital. We’ll keep in touch.’
The infant and the toddlers had been placed in the tiny isolation ward, all confirmed as having the meningococcal virus.
‘I’ve made arrangements to medivac them to the Royal Children’s this evening,’ Liam told Nikki. His brow furrowed. ‘Let’s hope they all pull through.’
‘What about the parents?’ Nikki’s mind flew ahead. ‘Are they going to be able to accompany their little ones?’
‘They’re making arrangements now. And the Royal has parent accommodation nearby so that’s one less thing they’ll have to worry about.’
‘Mmm.’ Nikki glanced at her watch. ‘I should get back to the child-care centre and begin taking the bloods. Our lab is not going to be able to cope with the testing, though, Liam.’
‘We’ll send the samples back with the CareFlight people. One of the Brisbane labs will work through the night and knock them off in no time. We should have the results back as early as tomorrow morning. Right.’ He folded his stethoscope and placed it to one side. ‘Let’s get back to the centre.’
Nikki’s gaze widened in query. ‘I thought you’d want to stay and monitor the children.’
Liam shook his head. ‘One of the senior nurses can do that. Anna’s called in all staff to help out. Even Dion offered to dust off her nursing skills if we need her.’
Nikki blocked a yawn. ‘Good for her.’
Outside in the car park once more, they piled into the Land Rover. ‘You’ve been magnificent through this, Nik,’ Liam murmured, his voice husky.
Nikki drew an unsteady breath. ‘You’ve been pretty inspiring yourself.’ Their eyes met for an intense moment before each looked uncomfortably away.
When they arrived back at the centre, Nikki went in search of Anna. Two more nurses had come to help out but nevertheless Anna and Michelle must be out on their feet, she thought worriedly. ‘How’s it going?’ She’d finally tracked the charge nurse down at the end of a long line of people.
‘We’ve just about finished the jabs.’ Lifting her forearm, Anna brushed a strand of hair away from her forehead. ‘Are you and Liam going to do the bloods?’
‘Yes.’ Nikki went on to explain the arrangements that had been made to fly the samples to Brisbane for testing. Her gaze flew over the group of anxious faces. ‘How have folk coped through all this, Anna?’
Anna smothered a dry laugh. ‘Apart from complaining that the tea was either too hot or not hot enough, they’ve been quite stoic, really. But, oh, lord, what a day!’
They were home at last.
Nikki got stiffly out of the Land Rover and stretched. Tipping her head up, she peered at the trees. ‘Is that actually a moist little breeze I can feel?’
Liam dropped a hand on her shoulder. ‘Perhaps it’s a forerunner of rain.’
Her eyes flew wide. ‘Could it be?’
‘Anything’s possible, as they say.’ He turned her towards him and searched her face in the dim light. ‘You OK?’
‘Yes—once I’ve had my shower and wa
shed today’s events down the plughole. How about you?’
His mouth tipped into a crooked smile. ‘A bit rough, actually.’ He drew her into his arms and rested his head against hers. ‘I know I keep saying it, but you were magnificent today, Nikki.’
Nikki pulled back and made a face at him. ‘Flattery at this time of night will get you nowhere, Doctor.’
He laughed and hugged her. ‘Once you get cleaned up and have a sleep, you’ll feel better.’ He walked her towards the front door, opened it and pushed her gently inside.
Almost stumbling with exhaustion, Nikki made her way along the hallway to her bedroom. A few minutes later, showered and with her hair briefly dried, she fell into bed. She was asleep in seconds.
Next morning dawned bright and clear with no hint of rain. Nikki gave a rueful smile. Perhaps, she’d imagined her moist breeze. Automatically, she dropped bread in the toaster.
‘I’ve just been on to the Royal,’ Liam announced, coming through to the kitchen. ‘Our three little people are holding their own.’
‘Oh, thank goodness!’ Nikki’s hand flew to her heart. ‘Anything yet on the bloods?’
‘Later this morning, they said.’ He sent her a trapped smile. ‘But no one’s called in with any symptoms so far. If we end up with just the three cases, it’ll be nothing short of a miracle.’
Nikki rescued the bacon from under the grill. ‘Miracles happen all the time. Didn’t you know?’
CHAPTER NINE
IT WAS with some surprise Nikki noted the name of her last patient for the day. ‘You’re the teacher aide at the school, aren’t you?’
‘Fancy you knowing that!’ Jade Murphy tinkled a laugh, touching a hand to her cloud of auburn hair.
Nikki waved her to a chair. ‘How can I help you today, Jade?’
The young woman made a small face. ‘Actually, I feel a bit of fraud coming here. But I’d made the appointment…’ She trailed off and looked down at her hands.
‘I heard about your work hours being cut.’ Nikki’s quiet statement filled the vacuum.
‘The whole town will have heard by now.’ Jade raised stricken eyes. ‘This drought is having a domino effect right throughout the district. One thing happens and it goes on and on right down the line.’