One Tiny Miracle...

‘You do know exercise is bad for you?’ His mother and girlfriend had both come around to see him into the observation ward, but now he was there and settled they would be heading home. Celeste did a careful set of neurological observations, warning Matthew this would be happening on the hour, every hour. ‘Whether you’re asleep or not…’

She told Matthew’s family about visiting and discharge times and wrote down the hospital and extension numbers for them. Just as she was about to get started on the admission paperwork, the doors opened.

‘Another admission for you…’ Deb, a fellow grad, was wheeling round a rather delightful Fleur—with rouged cheeks and painted on eyebrows, she was dressed in a blue and white polka-dot skirt with a smart white blouse, which unfortunately had been splattered with blood. ‘Fleur Edwards, 82, a hand injury—’ Deb started.

‘Ben’s already told me about her,’ Celeste said, sensing Deb was in a rush. ‘Any family?’

‘Her daughter’s coming in this afternoon.’ They flicked through the charts. ‘No allergies, she suffers with arthritis, but apart from that she seems very well…’

‘I’ll sort things out, then,’ Celeste said, smiling over at Fleur, who was patiently sitting in a wheelchair, her arm in a sling. ‘Is it getting busy out there?’ she asked Deb.

‘It’s starting to—we’ve got a multi-trauma coming in.’

Though she smiled as she went over to help Fleur, Celeste was hit with a pang as Deb left, just a pang of something. She should be out there, would have loved to really immerse herself in this emergency programme, and though she hoped to when she came back from maternity leave, Celeste was also realistic enough to know that her head would be full of other things by then, and that she’d be exhausted for other reasons, namely the baby who was kicking at her diaphragm right now. Still, it wasn’t Fleur’s problem.

‘Hello, Mrs Edwards.’

‘Fleur.’ Fleur smiled.

‘I’m Celeste—I’ll be looking after you this shift.’

‘You should be the one being looked after.’ Fleur clucked. She really was gorgeous. Widowed for twenty years, she was an independent old lady, and she had cut her hand peeling an orange for her morning snack, Celeste found out as she took her history.

‘Well, for now we’ll get you into a gown and into bed, so that we can elevate your hand on an IV pole. You’ve had something for pain—has that helped?’

‘I can hardly feel it, the bandage is so tight.’ Fleur said. ‘Would you mind taking me over to the ladies’ before I get into bed?’

‘Of course.’ Only at that moment Matthew sat up, with that anxious, frantic look Celeste knew all too well, and with a quick ‘Won’t be a moment’ to Fleur she raced over, locating a kidney dish just in time and pulling the curtain around him.

‘It’s okay, Matthew,’ she soothed. ‘I’ll just fetch you a wet cloth…’ And run another set of obs, Celeste thought. He really was terribly pale.

‘I’ve got to get work,’ Matthew muttered. He wasn’t a particularly large 18-year-old, but none the less he was trying to climb out of bed and he resisted as Celeste tried to guide him to lie back down. ‘I have to get to work, I’m going to be late…’

‘You’re in hospital, Matthew,’ Celeste said. ‘You’ve had a bang on your head, remember?’

She was trying to reach for the call bell to summon help, worried that if he became agitated he might fall if he did get out of bed and hurt himself further, but as quickly as it had happened, Matthew seemed to remember where he was and stopped trying to climb out of bed and instead lay back down. ‘Sorry.’ He gave a wan smile and said it again. ‘Sorry. I’m fine now.’ And he seemed so, except, like Ben, Celeste was now worried.

‘Matthew. Do you know where you are?’

‘Hospital.’

She went through his obs—they were the same as before, his blood pressure a smudge higher, but his momentary confusion still troubled Celeste and she buzzed on the intercom. ‘Can you send a doctor round to the observation ward?’

‘Is it urgent?’ Meg checked. ‘They’re just assessing a multi-trauma.’ Celeste looked over at Matthew’s pale but relaxed face and wavered for a moment. He seemed absolutely fine now and his obs were stable but, still, she just wasn’t sure.

‘I need the head injury assessed again,’ she said, thinking it was likely Meg was rolling her eyes now. ‘Let Ben know—he saw him.’ She headed back to Matthew and Fleur gave a worried nod when Celeste said, ‘I’ll be with you soon.’

‘Look after him!’ the old lady said. ‘Don’t worry about me.’

Of course, by the time Ben arrived Matthew was sitting up and joking about his moment of confusion and refusing the oxygen that Celeste was trying to give him. ‘Look, I’m sorry to pull you away,’ she told Ben.

‘No problem. The trauma team is with the patient and he’s actually not that bad. So what’s going on with Matthew?’

‘Nothing!’ Matthew said and it certainly looked that way.

‘He was fine,’ Celeste explained. ‘In fact, he seems fine now, but he had a vomit a little earlier and was certainly confused and restless for a moment. He didn’t look at all well—’ She was trying to think up reasons to justify pulling a registrar out from an emergency, but Ben quickly interrupted.

‘I agree.’

He didn’t seem remotely annoyed that she had called him. Instead, he was checking Matthew’s pupils and his blood pressure for himself as Celeste explained that he had tried to climb out of bed, insisting he had to get to work.

‘How are you feeling, Matthew?’

‘Fine. Well, a bit of a headache…’

‘Okay,’ Ben said, ‘I’m just going to lay you flat and have a good look at you.’ It was Ben who never got to finish this time as Matthew started to retch again, his face more grey than pale now, and he was moaning loudly about a pain in his head.

‘How do you get urgent help around here?’ Ben asked, and it was only then that Celeste remembered that it was his first day here—he seemed so assured and competent. He was also a lot bigger than Matthew. He ignored the patient’s protests to push off the oxygen mask and attempts to climb out of bed as Celeste pressed the switch on the wall. The light flashed above the door like a strobe as one of the team came to the intercom and Celeste explained what was happening.

The trauma team was still with the multi-trauma, so it was Belinda Hamilton, the rather snooty but exceptionally good-looking senior emergency registrar who came, along with Meg and a porter to get the patient to Resus if required. Had Matthew still been on a gurney it would have been easier to wheel him straight to Resus, but time was of the essence and the observation ward was set up, like any other ward, for such an emergency, so instead Celeste wheeled over the crash trolley. Matthew was like a tethered bull now, and it was Ben doing the tethering as he rapidly explained what had occurred to his senior. But he didn’t await her verdict, just told her what was required. ‘He needs to intubated and sent for a scan,’ Ben said. ‘Can you alert the neuro surgeons?’

Celeste was busy opening packs for the intubation, her heart hammering in her chest, stunned at how quickly Matthew had deteriorated.

Though Meg had also come to assist, she didn’t take over, just guided and advised Celeste, who was setting up for the intubation. Raji, the anaesthetist, arrived just as Matthew started seizing, his body jerking violently. The whole thing was horrible. In a matter of moments Matthew’s condition had become critical—his family would have barely made it to the car park.

Raji was shooting drugs into the patient as Ben gave him the lowdown and thankfully the jerking stopped. Matthew was taking long, laboured breaths, but at least he wasn’t seizing or fighting any more, though Celeste could feel her blood pounding, surely up near Matthew’s as she wrestled to remove the bedhead to give Raji more access to the patient’s airway.

‘Here.’ Ben must have seen her struggle and removed the bedhead easily for her. Raji was a pleasure to work with, a laid-back guy who really just got on with things, checking all the drugs she had prepared and pulling up for himself the others he required. Matthew was on a cardiac monitor, the seizing had stopped, but he was gravely ill and as Celeste watched Raji intubate the patient, Meg liaised with the porters and Imaging.

‘Should we let his family know?’ Celeste asked. ‘They only just left.’

‘Let’s just worry about the patient for now,’ Belinda snapped, and Celeste felt herself redden.

‘I’ll call them as soon as I can,’ Ben said. ‘He’ll probably go straight up to Theatre from Imaging.’

It took ten, maybe fifteen minutes at the most before Matthew was paralysed and intubated and on a trolley, being wheeled up to Imaging and probably then on to Theatre. All that was left from his time in the obs ward was a mountain of paperwork and a lot of chaos. The suction equipment was still on and gurgling, and would need cleaning, the oxygen tubing and masks would need replacing; the bedhead was abandoned on the other side of the room, there were packs open everywhere. The crash cart was in chaos and there were syringes and vials on its surface. Everything would need to be tidied and checked and replaced and then checked again.

‘So much for giving you a quiet afternoon!’ Meg gave her a sympathetic smile, but her pager went off, and there really was no chance of her staying to help.

Letting out a long breath, forcing herself to just get on with it, Celeste turned around and saw Fleur’s worried face.

‘Will he be okay?’ she asked worriedly.

‘I think so,’ Celeste said, and came over, her heart sinking as the proud, dignified lady burst into tears and said sorry over and over.

‘I’ve wet my pants!’

‘I’m so sorry!’ It was Celeste saying it to Fleur now. ‘It was my fault for not taking you.’