The Baby Emergency

‘I thought you said it was civilised where you were,’ Shelly teased, desperately trying to resume normal services despite her internal bombshell.

‘It was. The clinic I worked in at Tennagarrah was comparable to a luxury caravan. All the basics were there but you weren’t exactly spoilt for choice and you had to work for everything. This in comparison is a five-star hotel.’ With an exaggerated whoop of delight he jumped down and opened the drug fridge. ‘And just look at the mini-bar, where do I start? Bactrim, flucloxacillin, gentamicin, vancomycin. What can I get you, Sister?’

Shelly peered at the monitor in front of her, reading the blood results and the antibiotic sensitivities. ‘Well, a large dose of flucloxacillin would hit the spot.’

‘Coming right up.

‘Anything else I can get you?’ Ross asked, carrying on the joke as he pulled the vial of antibiotic out of the fridge. ‘Have you had a look at the room service menu yet?’

‘This will do just fine.’ Picking up her cake, Shelly effectively ended the playful conversation. Images of five-star hotels and bubbling spas and four-poster beds weren’t exactly doing wonders for her blood pressure, and the sight of the porter wheeling in the gurney carrying the baby provided a very welcome diversion.

‘Kane Anderson,’ the emergency nurse informed them as Shelly pulled down the cot side and greeted Kane’s mum with a warm smile. ‘He’s been down in Emergency so long he’s part of the furniture now. This is his mum, Angela.’

‘Hi, Angela, we’re just going to get Kane into the cot and then I’ll get the handover from Emergency. Once that’s done I’ll come and settle you both in.’ Gently she lifted the infant over, handling him deftly and with minimum fuss so as to avoid any unnecessary exertion.

Although the handover was important and the emergency nurse was obviously in a rush to get back to her department, Shelly took a moment or two to explain how the oxygen tent worked, realising how alarming it must look to Angela.

‘This monitor tells us the oxygen concentration in the tent, it’s very safe.’

‘He can’t suffocate?’ Angela checked.

‘Definitely not,’ Shelly said firmly. ‘If the level drops in the tent the alarm goes off, and this little probe I’ve attached to his foot tells us Kane’s own oxygen levels. I’ll be back in a couple of moments. I’m just outside but if you’re worried at all just bang on the window or call.’

‘She’s being a bit difficult,’ the emergency nurse started.

‘No doubt because she’s worried and exhausted,’ Shelly said quickly, refusing to get drawn into a discussion on the mother’s emotional state, preferring to make her own observations. ‘And eighteen hours in Emergency wouldn’t exactly have helped matters. What’s the story with the baby?’

The story wasn’t very good. Three days of a worsening cough and struggling to feed, two different types of antibiotics from the local GP and a long wait in Emergency. ‘His respiration rate is still very high and his heart rate’s elevated. He’s very grizzly, which isn’t helping his breathing, and he just won’t settle.’

‘Any wet nappies?’ Shelly asked, flicking through the obs chart.

‘Three. He was moderately dehydrated when he came to us but the IV fluids have kicked in now. He’s still very sick, though.’

Shelly nodded in agreement. Her brief assessment of Kane had done nothing to reassure her. He was working hard with each rapid breath, using his stomach muscles, his tiny nostrils flaring, all dangerous signs. ‘I’ll get Ross to have another look at him,’ Shelly concluded, anxious to get back to her small charge. ‘Thanks for that.’

Ross was already at the cot side, rubbing his stethoscope between his hands to warm it before placing it gently on the baby’s rapidly moving chest as Angela stood anxiously wringing her hands, every bleep of the monitors making her jump slightly, every tiny jerking movement Kane made causing her to step forward anxiously, bombarding Ross with questions as he tried to listen to the baby’s breathing.

‘He’s hungry,’ Angela said the second Shelly entered. ‘The sister in Emergency said he might be able to have a bottle once he got up to the ward.’

Pulling the stethoscope out of his ears, Ross straightened, carefully zipping up the oxygen tent and pulling up the cot side. ‘He can’t have a bottle at the moment, Angela, he’s too exhausted to feed.’

‘But he isn’t settling.’

Shelly could hear the slightly hysterical note creeping into Angela’s voice and stood back quietly as she carried on with her outburst.

‘They said they were going to put a tube down his nose and give him the milk that way, but they haven’t even done that. No one seems to be doing anything. He’s not even on any antibiotics!’

‘Look, why don’t you sit down for a minute?’ Ross started, but his well-meant words only inflamed Angela further.

‘I don’t want to sit down,’ she shouted. ‘I want someone to tell me what’s being done for my baby.’

‘I know you’re upset—’ Shelly started.

‘Oh, what would you know?’ Angela snapped, turning her fury on Shelly, her face livid.

‘That you’re exhausted, and terrified?’ Shelly ventured, her stance relaxed, her voice calm and sympathetic. ‘That you’ve probably had more people offering their opinions and telling you what might be, could be, should be done than you can even count?’

Mistrusting eyes finally made contact and Angela gave a grudging nod.

‘Well, you’re on the children’s ward now, and Ross is the doctor and Melissa and I are the nurses looking after you and your son tonight. If you’ll let us, we can tell you what we’re going to be doing, but shouting and getting upset is only going to unsettle Kane—can you see that?’

The nod Angela gave wasn’t so grudging this time, more sheepish, and Shelly felt her heart go out to the other woman as she burst into noisy tears. ‘I’m sorry, it’s not you, I’m just so scared, he keeps getting worse.’

‘He’s been sick for a few days, hasn’t he?’ Shelly asked gently.

‘Since the weekend. I thought it was just a cold at first then he got this cough and then he started wheezing. I haven’t slept for the last two nights.’

‘Kane has bronchiolitis,’ Ross broke in, gently taking Angela’s arm and guiding her to a chair before pulling one up for himself. ‘It’s a respiratory virus that can be particularity nasty in young babies. Now, because it’s a virus antibiotics aren’t going to do any good, none at all,’ he emphasised as Angela opened her mouth to argue. ‘What Kane needs at the moment is what we call supportive care. That means he needs to be kept warm and rested, with lots of oxygen to help him breathe and fluids through a drip to keep him hydrated. All of this we’re doing for him, and this in turn gives his body a chance to concentrate on fighting the virus. If we give him a bottle now he wouldn’t be able to cope with it, he simply hasn’t got enough energy to feed. If we give him one at this stage he could become a very sick little boy indeed.’

‘What about the tube they were talking about?’ Angela asked hopefully, her mind still focussed on her baby getting fed, but Ross firmly shook his head.

‘The tube we would pass is very small and fine, but it would still upset him while we passed it and I don’t want to cause him any more distress, that’s why I’m going to try and not to do any blood tests or anything that might upset him, for now we just want him to rest. Kane’s getting what he needs from the drip and we can give him a dummy to settle him.’

‘He keeps spitting it out.’ Angela’s voice was rising again, her shredded nerves ready to snap at any moment, but Ross carried on chatting, his voice amicable and easy.

‘We can soon fix that.’

‘How?’ Angela snapped.

‘Glycerine.’ Ross gave an easy shrug as Angela immediately shook her head.

‘You’re not supposed to put anything on their dummies, it says so in all the books. The child health nurse said—’

‘Kane’s very sick,’ Ross interrupted gently. ‘He needs to rest, and if a smear of glycerine on his dummy achieves that, then it’s merited.’

‘Ross.’ Shelly gave him a wide-eyed look and Ross frowned slightly at the interruption. ‘Can I have a quick word, please?’

‘What’s up, Shelly?’ Following her outside, there was a slight impatience to Ross’s stance. ‘I’m trying to calm the mother. Pulling me outside isn’t really helping.’

‘I know that,’ Shelly responded. ‘But putting anything on the babies’ dummies really is frowned on. Tania will have a fit…’

‘Tania isn’t here,’ Ross pointed out. ‘And if she was I’d tell her what I’m about to tell you. That baby’s sick—any further slide in his condition and he’ll be on a ventilator in intensive care. Now, given this hospital hasn’t even got an intensive-care cot, that will mean sending him and Angela for a ten-minute jaunt in a helicopter. Now, if a bit of glycerine on a dummy can prevent that, I’m all for it.’

‘But, Ross.’ Shelly pulled at his sleeve as he turned to go, the contact tiny but enough to throw her, the sleeve of his white coat new and crisp, the solid bulge of his forearm, even the scent of his aftershave wafting over as he turned to go, all enough to distract her. Shelly fumbled to finish her argument.

‘I know it seems petty, but the department has strict guidelines on this. The dental damage—’

‘Shelly.’ Ross’s voice was quiet, but his words were very clear as he spoke, his eyes looking right into hers, unblinking, unwavering. ‘Let’s get this little guy through tonight, huh? Lose this battle and tooth decay will be something Angela can only dream about.’