Love Without Measure

She groaned. ‘Internal politics? I try and stay out of it. Funding, of course, is always a hassle. So far they haven’t threatened to close us down, but funding for our emergency teams going out to incidents is always a bit of a fraught issue. They say it’s very expensive, and I’m sure it is, but it’s absolutely vital that we continue to keep the service available and I’m sure in the long run we actually save money.’

He nodded. ‘Who usually goes?’

‘The most senior members of staff available to a small incident. To a major incident with multiple casualties we usually keep several senior staff here to deal with the casualties as they come in, but others, of course, go out for on-the-spot surgery and emergency resuscitation. The first job in major incidents is Triage, really, sorting the patients into priority for transfer to hospital, and that’s something we’re all very used to.’

‘Do you have a Triage system operating in the unit all the time?’ he asked.

Anna nodded. ‘Yes—it’s often me doing that. We only bother if it gets busy, but the reception staff are excellent and keep us in touch all the time with what’s coming through the door.’

Patrick stretched out, his long legs crossed at the ankle, and balanced his coffee-cup on his chest. ‘What’s the usual waiting-time?’

She laughed softly. ‘You tell me. Certainly less than several days, unlike your Africa. We try and keep it down to under half an hour, and patients are always seen by the Triage nurse within a few minutes of arrival in any case, unless we’re so quiet that they’re virtually straight in. Sometimes, though, it can be up to an hour before they get seen and that really bothers me. It’s the malingerers that mess up the system—the people that won’t go to their GP because they don’t like to bother him, or because they have to wait in the surgery, or because this is more convenient than trying to get an appointment. Last week we had a man who came in with piles.’

‘They can be very painful,’ Patrick said reasonably. ‘He might well have been worried, especially if they were bleeding.’

‘They weren’t,’ she retorted, ‘and he’d had them twenty years!’

Patrick chuckled. ‘So who had the pleasure of telling him where to go?’

‘Kathleen—and very effective she was, too! She has a pet thing about people who abuse the system. She asked him if he’d left his glasses behind, and pointed out the sign. “Have you had an accident?” she asked. “Is it an emergency?” He left quite quickly.’

‘I’ll bet. She’s a little fire-cracker, I should think.’

Anna smiled indulgently. ‘She can be. She’s also very gentle and kind.’

‘And married to the boss, of course.’

‘Oh, yes. They can be quite nauseating.’

He chuckled. ‘Really?’

‘Really, although you’d think they’d have grown out of it by now. They’ve been married nearly eighteen months.’

‘Nah, they’re still newly-weds,’ he said with another of his infectious chuckles. He tipped his coffee-cup and she watched his very masculine throat work as he swallowed. Then he stretched luxuriously, totally unselfconscious, and hauled himself to his feet.

‘I suppose we ought to let the love-birds go to lunch and do some work,’ he said with a smile. ‘There’s still some food left—want another doughnut?’

She shook her head. ‘No. I won’t need to eat again for days.’

He snorted rudely, grabbed a sandwich as they passed the table, and headed towards the cubicles.

Stifling a smile, Anna followed.

A few minutes later she lost all urge to smile.

A message came from ambulance control to say that a young boy, Simeon Wilding, was being brought in direct from school with a severe asthma attack, and he was reported to be in a serious condition.

‘OK,’ Patrick said calmly. ‘We’ll take him straight into Crash. Can someone clear it, please, and get it ready? We may need to ventilate him. Any information on drugs?’

Anna shook her head. ‘No, nothing. He’s a known asthmatic; we may have the notes. Julie’s searching for them.’

Julie was the receptionist, and, having checked for notes held in the unit, would then check with the asthma clinic. If they were in the hospital, Julie would track them down in the next few minutes.

Until then, they just had to play it by ear. They prepared the nebuliser with salbutamol, cleared the decks and waited.

They heard the ambulance coming and went to the door in time to see it sweep in very rapidly. The doors were flung open and the boy was out, heading for the department, with Patrick running beside the trolley and examining the lad as they came.

Anna could see that his lips were blue, his eyes wide, and he was clearly fighting for breath. Then, as she watched, his eyes closed and he stopped breathing.

Patrick swore, very softly, and yanked down the blanket, slapping the stethoscope on his chest as they manoeuvred through the doors.

‘Damn. He’s arrested. Get him into Crash.’

They ran, leaving him on the trolley for speed as they all went automatically into action as soon as the trolley was stationary.

Feeling for the breastbone, Patrick crossed his hands and pumped hard on the boy’s chest.

Anna heard a dull creak and winced. A rib had gone. Oh, well, it was better than dying. She didn’t have time to think about it, though, because she had to take over from Patrick while he inserted the cuffed tube and blew it up, sealing the airway. Then he connected it to the humidified air from the ventilator unit on the wall and watched as the boy’s chest rose and fell.

They alternated cardiac massage with positive ventilation, to allow the air to be forced into his lungs, together with a measured dose of a bronchodilator to combat the swollen tubes in his lungs that were preventing him from breathing.

While Anna worked another nurse was putting monitor leads on his chest, and then he was connected up and they could see the flat trace that indicated the heart was still not beating.

‘Damn you, don’t you dare die,’ Patrick muttered, and, pushing Anna out of the way, he thumped the boy’s chest hard.

The line wiggled, then settled into an erratic rhythm. ‘He’s fibrillating—I’ll give him a jolt. Stand back, everyone, please.’

They took a pace back while Patrick held the paddles to the boy’s chest. ‘Shock, please,’ Patrick said.

The boy’s body arched and flopped, and the trace suddenly corrected itself. As it did, the boy’s lips turned less blue and he started to fidget.

‘I’ll give him a minute and then we’ll try him off the ventilator,’ Patrick told them, and bent over the boy.

‘Simeon, it’s OK, you’re going to be fine,’ he said calmly, his voice reassuring.

The boy’s eyelids fluttered up and he started to fight the ventilator. Patrick disconnected him from the machine and watched to see if he could breathe alone. To their relief his chest rose and fell gently. ‘Good,’ Patrick said, and, letting down the cuff, he withdrew the endotracheal tube from the boy’s mouth.

He coughed, his breath rasping, and Anna replaced the tube with a mask connected to a nebuliser. Warm, damp air flowed into his lungs, and within minutes he looked much better.

‘My chest hurts—I want my mum,’ he said in a small voice, and beside her Anna felt Patrick almost sag with relief. He was all right; the fight for air had been won before it was too late. Another few seconds and he could have suffered irreversible brain damage.

Even so, Patrick was worried about him.

‘I think he ought to go into ITU for a day or so, if the paediatrician agrees,’ he said quietly to Anna.

She nodded. It was standard procedure to overprotect their young asthmatic patients, because attacks of that severity rarely happened in isolation and in ITU everything necessary was there at hand.

The paediatric consultant, Andrew Barrett, arrived then and took over, examining the boy and chatting quietly to him.