Australian Affairs: Tempted: Tempted by Dr. Morales

‘Wow! I think Harry just gave Juan a compliment. He said that he was pleased that he was here. That’s a bit of a turnaround.’

‘I’m actually very glad to see Juan here this morning,’ Renée, the night nurse, said. ‘The child Harry is concerned about has got Goldenhar syndrome. Have you heard of it?’

Cate shook her head. There were many, many different syndromes, some relatively common, some rare, as was the case with this admission.

‘It mainly presents as facial abnormalities. In Jason’s case he’s got a very underdeveloped left ear and he was born with a cleft palate and other problems. I’ve looked it up on the computer if you want to read about it. The main problem today is that he has presented with severe asthma, for which he’s had several ICU admissions. Usually he’s seen at the children’s hospital and, understandably, the parents tend to stay close but, given the heat, they thought a couple of days near the beach might be nice.’

‘It should have been nice,’ Cate said. ‘Poor things.’

‘Yes, Jason has a very tricky airway and is really difficult to intubate—he’s had to have a tracheostomy in the past. I think that was why Harry was so pleased to see Juan. The on-call anaesthetist has already been down to check on him a couple of times.’

‘How come Harry is here?’ Cate checked. ‘I thought that Dr Vermont was on call last night.’

‘He was,’ Renée said. ‘He was here till one o’clock but then he was unwell and had to go home. Jason came in just before five. I tried to get the paediatricians down but they’re busy with a sick baby and so really I had no choice but to call Harry in.’ Renée grimaced. ‘I didn’t realise that he’d have to wake up the twins.’

‘Well, it sounds like Jason needed someone senior on hand,’ Cate said. ‘So, what else could you do?’

‘Do you want to go in and take over?’ Renée suggested. ‘From Monday you’ll be spending a lot of time in the office.’

‘No, I shan’t be.’ Cate didn’t elaborate, it wouldn’t be fair on Christine, but Cate had no desire to disappear for hours into the office, as Christine all too often did. Still, Cate knew that she wouldn’t be able to get as involved with individual patients—like it or not, the more senior she had become, the more hands off her role had been, so it was nice to take the opportunity to look after Jason.

Cate took the handover from Mary, the night nurse, as Juan examined the young patient.

‘The parents are incredibly tense.’ Mary pulled Cate aside. ‘I don’t blame them a bit, it must be awful to be away from all the specialists they need, but I think they’re really making Jason more upset. Harry was talking about transferring him to the children’s hospital and getting them to send out their emergency transfer team, but Lisa, the mum, got really distressed. Apparently Jason is petrified of flying, especially given that he’s had more than his fair share of emergency transfers.’

They went through the drugs Jason had been given so far, before a grateful Mary headed for home.

Juan had been speaking with the parents, and had only just started to examine Jason. The little boy was exhausted but, despite that, his eyes were still anxious.

‘So, you’re a regular on the ICU at the children’s hospital, are you?’ Juan asked, after listening to his chest, and Jason nodded. ‘I was working there last week and I’ll probably be there again soon. Do you know Paddy?’

‘We know Paddy,’ Jason’s mum said.

‘Ken…do you know Ken?’ the little boy said. He could still talk but only just.

‘Do you mean Kent?’ Juan checked. ‘The ICU nurse?’ Jason nodded. ‘He’s good fun. I might just have to give Paddy a call and let him know that you’re here.’

Cate knew Juan was just putting the boy at ease, letting Jason know that he knew the staff there, while letting the parents know he worked there too.

He must be as popular there as he is here, Cate thought, strangely jealous of the other worlds of Juan.

‘I just want a look in your mouth, Jason. Can you open it, please?’ Juan removed the mask that was delivering medication and shone a light in. He looked carefully and then replaced the nebuliser, which was nearly finished.

‘Okay, Jason,’ Juan said. ‘Just rest now and let the medicine start to work.’ Juan looked over at Harry. ‘Continuous nebulisers now…’ Juan said, which moved Jason from severe to critical; but Juan seemed calm and Cate was a little surprised how Harry was stepping back and letting Juan take over the case. She knew Juan was good and a trained anaesthetist, but as it turned out Cate didn’t know just how good he really was.

‘He does need to be transferred, Lisa.’ Juan spoke now to the mother. ‘But I’m happy to keep a close eye on him here at this stage. I think we can wait for the rush hour to pass and then we will go by road ambulance…’

‘What if something happens in the meantime?’ Lisa was clearly petrified of being stuck in the outer suburbs without all the specialist doctors. But it was then that Cate realised exactly why Harry had been so pleased to see Juan this morning, and why he was so readily stepping back. ‘What if something happens in the ambulance?’ Lisa said, her eyes filling with nervous tears.

‘I have worked with a lot of children who have similar problems to Jason,’ Juan said, and went on to explain that he had spent a year as an anaesthetist in America, working at a major craniofacial hospital, and was very used to performing the most difficult of intubations on children.

‘You’ve seen children with Jason’s problems before?’ Lisa asked.

‘I have.’ Juan smiled at Jason but Lisa still wasn’t quite convinced.

‘Jason had to be put on a ventilator the last time he had an asthma attack,’ she said. ‘They couldn’t wean him off and in the end they couldn’t keep the tube in his throat for any longer and so he had to have a tracheostomy…’

‘Let’s just focus on today,’ Juan said, and started checking all the equipment. Harry had already brought over the difficult intubation box and Juan commenced pulling up drugs and taping the vials to the syringes, as relaxed as if he were making a coffee rather than preparing for a difficult intubation, and chatting away to Jason as he did so.

In a child with severe asthma everything was assessed clinically, there were no blood gases taken as it would simply upset Jason further. The fact that he was petrified of flying was an important issue because it was important not to distress Jason, but if he became much worse, there would be no choice.

‘What’s the protocol for IV aminophylline here?’ Juan asked, after having another listen to Jason’s chest.

‘We don’t give it here,’ Cate said, because it was a drug that required constant monitoring. ‘It’s only given on ICU.’

‘This has just become ICU,’ Juan said. ‘I’m not leaving him.’

Cate looked over at Harry.

‘Fine.’ Harry nodded and rolled his eyes. ‘In Juan we trust.’ Which actually made Lisa laugh.

‘How long are you on till?’ Lisa asked Juan.

‘All day,’ Juan said. ‘Don’t worry, when Jason is transferred I will go with him.’ He didn’t need to ask Harry’s permission. Yes, it left them a doctor down, which would have to be sorted, but that was simply how it must be and no one argued. You could feel some of the tension leave not just Jason’s parents but Jason himself. Clearly black boots and long black hair and an unshaven doctor didn’t worry Jason a bit.

‘Well,’ Harry said, ‘I’ll leave you in Juan’s capable hands and I’ll come back in soon and see how Jason is doing.’ He looked at Cate. ‘I’m just going to get the twins some breakfast and then take them over to childcare.’

‘I’ve already given them breakfast,’ Cate said, and Harry gave a grateful nod. ‘They’re just watching cartoons in the staffroom.’

‘Thanks so much for coming in, Doctor.’ Jason’s father stood and shook Harry’s hand. ‘It meant a lot.’

‘Not a problem,’ Harry said.

It was, though, a huge problem, and Juan commented on it after they had set up the aminophylline infusion and were waiting for the paramedics to transfer Jason. Juan had double-checked that he had everything and Cate had done the same until, happy they were well equipped, they moved to have a quick coffee at the nurses’ station, watching Jason from a slight distance. They had no idea when they might get another chance to take a quick break because they would both go on the transfer with Jason and then rush back to work at Bayside—unless there were any emergencies on the journey.

‘Harry got here at five a.m. to see Jason,’ Juan commented.

‘I know.’

‘Did he bring the twins in with him then?’

Cate gave a small worried nod.

‘And does he do that sort of thing a lot?’

‘Harry’s wife died last year,’ Cate said, by way of explanation.

‘I know that,’ Juan said. ‘I asked if he did this sort of thing a lot.’