Nurse In Need

‘Hello, Daniel. Can you open your eyes for me?’ Jennifer disconnected the portable oxygen cylinder and reattached the line to the wall outlet as Daniel groaned in response. She adjusted the position of the high-concentration oxygen mask he was wearing. Amy used shears to clip away the remnants of clothing on Daniel’s chest. She glanced at the other nurse as she heard the encouraging murmur of her voice soothing their distressed patient. Jennifer was also responsible for talking to the patient and giving support. The rapport she could establish quickly with people was a strength that Amy appreciated more than most. Jennifer was perfect for the job.

Gareth Harvey, the senior emergency consultant, listened to Daniel’s chest with a stethoscope while still receiving information from the ambulance crew.

‘He’s received 1.5 litres of saline so far. He’s also had 10 mg of morphine. Cardiac rhythm’s been stable.’

Amy attached the leads for the department’s cardiac monitor. Now she wrapped the automatic blood-pressure cuff around Daniel’s arm and clipped an oxygen saturation probe over his index finger. They had been unable to get an accurate reading in the ambulance. Judging from Daniel’s colour, it wasn’t going to indicate a good level of circulating oxygen in his bloodstream. A junior nurse, Janice Healey, was struggling to cut away the denim of Daniel’s jeans. He groaned loudly as she tried to pull some fabric clear of the splint on his left leg.

‘Leave that for the moment, Janice,’ Amy advised. ‘And don’t take the dressing off the wound until a doctor is ready to look at it. The more exposure it gets, the more likely it is to get contaminated.’

Jennifer was still trying to establish communication. ‘Do you know where you are at the moment, Daniel?’

‘Can’t…breathe…’ Daniel gasped. ‘Help…me.’

Amy glanced at the monitor. Oxygen saturation was well below ninety per cent. She was reaching for the chest-drain pack before Gareth Harvey requested it. Their patient was desperate to sit up to try and ease his breathing difficulty. Being strapped to a backboard due to the possibility of spinal damage was increasing his distress.

‘Left-sided tension pneumothorax,’ Gareth informed Amy.

Amy was already drawing up the local anaesthetic. A chest drain had to be inserted as the first priority. Air had entered Daniel’s chest outside the lung, probably because of laceration from the broken ribs. The pressure had collapsed the lung and was now threatening the function of the other lung and his heart.

Jennifer had her head bent close to Daniel’s. ‘We’re going to do something to help with your breathing, Daniel,’ she told him clearly. ‘You might feel a bit of stinging. That’s some local anaesthetic going into the side of your chest.’

‘BP’s dropping,’ Amy warned Gareth. ‘Systolic’s down to 80 and we’re getting a few ectopics.’ She kept an eye on the irregular beats showing up on the cardiac monitor as she ripped open sterile packs and assisted the consultant to insert the chest drain.

Daniel’s breathing improved dramatically as the internal pressure of air was relieved but his blood pressure was still dropping. The registrar who had been busy assessing the abdominal and leg injuries looked worried. He directed Gareth’s attention to the abdominal distension that was becoming obvious. Amy changed the bag of IV fluid as the level dropped. The registrar was directed to put in a second IV line and start running Haemaccel instead of saline. Amy ripped open more sterile packs.

The team member responsible for documenting the resuscitation attempt was Peter Milne, one of the department’s nurse managers. Amy showed him the empty bag of saline.

‘That’s the third one so far.’ She glanced at the large preprinted form Peter was filling in. ‘Oxygen saturation’s come up to ninety-three per cent,’ she told him. ‘BP’s dropped to 75.’

Janice Healey was ferrying blood samples. She came back with a distraught-looking middle-aged woman beside her.

‘This is Daniel’s mother,’ she told the team nervously. ‘Is it OK if she comes in?’

The registrar had just exposed the open fracture of Daniel’s leg for assessment. Daniel’s mother lost all the colour from her face. Amy moved to help the woman but Peter beat her to it. He supported her with a firm hand on her arm.

‘Janice, take Daniel’s mother down to the relatives’ room for the moment and stay with her. I’ll come down as soon as we have all the information we need to give her the full picture.’

Janice stepped away. ‘Come with me, Mrs Lever,’ she said hesitantly. Daniel’s mother remained glued to the spot, her terrified gaze fixed on her son. Peter raised an eyebrow at Amy, who nodded. She would take over documenting the case until Peter had settled Mrs Lever somewhere a little less traumatic. Amy was confident she could remember the details and be able to record them during the lull coming up when X-rays would be taken. It took another twenty minutes until the team were satisfied that their patient was stable enough to transfer to Theatre. Surgery was certainly the next priority. The cause of the abdominal bleeding had to be found and treated if Daniel was going to survive.

‘Orthopaedics might want a look at that leg at the same time,’ the registrar suggested. ‘Limb baselines are all well down.’

At the mention of the orthopaedic department Jennifer caught Amy’s eye and winked. Amy ignored the gesture but was immediately reminded of the knot of tension she had been harbouring all morning. Not that she could do anything about it right now. The trauma case had added to an already busy shift. Amy had two other patients she needed to go back to monitoring.

The adrenaline rush of working on Daniel’s emergency admission wore off only too quickly and Amy was left feeling strangely nervous. The soft peal of laughter she heard only minutes later made her turn swiftly. She couldn’t see anything, of course. The curtain around cubicle 4, which she had entered to check on the elderly Mrs Benny, screened the rest of the department from view. Amy waited several seconds but couldn’t resist the urge to peer around the edge of the curtain as the sound was repeated. For some peculiar reason the quiet adult laughter had all the subtlety of a child’s gleeful squeal as far as Amy was concerned.

It wasn’t difficult to pinpoint the source of the sound. The man was still grinning as he straightened up from leaning on the sorting-desk counter. The unexpected speed with which his gaze shifted from the staff member he’d been in conversation with was unfortunately too sudden to allow Amy’s curiosity to remain undetected.

Amy felt the contact as their lines of vision coincided. Their gazes held only for a split second but it was quite long enough for the stranger’s mouth to soften and then to begin another curve into a new smile. A smile that was obviously intended for Amy Brooks. Amy whisked the curtain closed hurriedly, turning back to her patient as she cursed her inability to resist peeking. Mrs Benny appeared to be asleep and Amy took the opportunity both to assess her patient and calm herself.

She still felt unnerved. As though the gaze that had caught her own was still there, burning through the thin fabric of the curtain. With a deliberate effort, Amy turned her attention to the fob watch she wore pinned to her uniform. She counted Mrs Benny’s rate of breathing, consciously taking several deep breaths herself. It wasn’t the stranger’s fault she felt rattled. Neither could it be attributed to her current patient. Thanks to the heavy frost that morning, Gladys Benny was the third case of a fractured neck of femur to come through the doors of Queen Mary Hospital’s Emergency Department. Straightforward cases with no hint of the drama that had surrounded young Daniel Lever’s admission. As common and easy to deal with as the alcohol overdose case Amy was also responsible for in cubicle 2.

The sudden movement of the curtain behind Amy made her jump. The orderly, Derek, grinned widely.

‘Gave you a fright, didn’t I?’ he observed. ‘Who did you think I was?’

Amy smiled but ignored the query. She also resisted the urge to look over Derek’s shoulder to see who might be standing at the counter being amused by Laura, the sorting-desk clerk. She stifled the slight sense of annoyance that anybody could find being in an emergency department amusing, but her sense of disquiet couldn’t be displaced so easily onto some stranger or his laughter. Amy had no one to blame except herself. Her nerves were due to the fact that she was rapidly running out of time. And it wasn’t at all funny. Amy touched her patient’s hand gently.

‘Mrs Benny? Derek is here to take you up to X-ray. How’s the pain at the moment?’

Gladys Benny opened her eyes and smiled faintly. ‘Much better, thank you, dear. That injection you gave me did the trick nicely. I think I even fell asleep.’

‘That’s good. We’ll see you again as soon as you get back from X-ray.’ Amy stood aside as Derek began pushing the bed clear of the cubicle, but Mrs Benny caught hold of Amy’s hand and halted the progress.

‘What’s going to happen to me?’ she queried anxiously.

Amy squeezed the frail hand gently. ‘It seems likely that you’ve broken your hip, Mrs Benny. If the X-rays confirm that, then you’re going to need an operation, I’m afraid.’

‘Oh, dear.’ Faded blue eyes filled with tears and the old woman’s voice wobbled. ‘Where are they going to take me?’

‘To X-ray,’ Amy reminded her patiently. ‘Then you’ll come back here and we’ll ask the orthopaedic doctors to come and see you. If you do need an operation, we’ll arrange admission to one of the wards.’

‘So I’m coming back here?’ The watery gaze fixed on Amy begged for reassurance.

‘Yes, you are, Mrs Benny.’ Amy smiled. ‘And your daughter’s on her way in. I expect she’ll be here by the time you get back.’

Amy watched the bed as it was manoeuvred between the sorting-desk counter and an empty ambulance stretcher. Her gaze continued a sweep around the emergency department. The stranger had vanished. Several cubicles and a resus area were empty and the atmosphere was relaxed, with several staff members heading towards the staffroom for a quick break. Jennifer Bowman was amongst the group, in animated conversation with a junior doctor. Amy smiled to herself at the play of expression on her colleague’s face.

Jennifer was naturally lively. Gregarious, outspoken—even outrageous at times. To a casual observer, she couldn’t have provided much more of a contrast to Amy. It often surprised people to find that the two young women were flatmates, let alone the closest of friends. Amy’s inward smile faded and she sighed audibly. It was now past lunchtime on Friday and she was still no closer to the goal she’d set herself a week ago. The pursuit of that goal would have to be postponed yet again if the noises emanating from cubicle 2 were anything to go by.

Amy donned gloves and collected some towels, one of which she dampened at the washbasin. She used the moist towel to clean the face of her patient in cubicle 2.

‘Are you feeling better now, Patrick?’

‘Aye.’ Bleary, bloodshot eyes regarded Amy and then focused to produce a hint of a familiar twinkle. ‘You’re an angel, so you are, Amy Brooks.’

‘Mmm.’ Amy shook her head as she smiled. Patrick Moore was a regular customer, a lonely old Irishman who collected his pension on a Thursday and was often brought into Emergency on a Friday morning, having been discovered hypothermic and drunk in a public park. Unlike many similar patients, Patrick was always grateful for the attention he received and he had a charm that even excessive alcohol abuse couldn’t obliterate.

‘An angel,’ Patrick repeated fervently. ‘You’ve even got a halo.’ The old man’s expression was so reverent that Amy wondered if he might be experiencing visual disturbances. She held up one hand.

‘How many fingers can you see, Patrick?’

‘Three,’ he told her promptly. ‘And beautiful fingers they are, too. Long and dainty—just like the rest of you.’ Patrick hiccuped softly and returned his gaze to her head. ‘An angel of mercy,’ he whispered contentedly. ‘With a beautiful golden halo.’

Amy’s hand went to her head despite herself. Then she chuckled. ‘It’s just my hair, Patrick.’

Patrick shook his head and closed his eyes. ‘Your hair’s all tied up in that fancy knot. It’s even speared with that little stick. And it’s dark, not shiny and golden. I know a halo when I see one, lassie.’

Amy folded back the blanket covering her patient. There wasn’t much point in explaining to Patrick that she’d run out of the hairspray that normally controlled the wispy short tendrils currently escaping her neat hairstyle, and that because it was new growth it was much blonder than the rest of her hair. Or the fact that standing in front of the light source in the cubicle had highlighted the effect. If Patrick wanted to think of her as an angel then that was OK with her.