Doris, in cubicle 3, was eighty-four and had slipped on her bathroom floor to present with a classic neck of femur fracture. The orderlies had just taken her away to X-Ray and then she would most likely need surgical referral for a total hip replacement.
Nine-year-old Jake had had an asthma attack that hadn’t responded well to his usual medications and his frightened mother had rushed him into Emergency just as the victims from the multi-vehicle pile-up on the motorway had started arriving. Judging the attack to be of moderate severity, Pip had started Jack on a continuous inhalation of salbutamol solution nebulised by oxygen. She had also placed a cannula in a forearm vein in case IV drug therapy was needed, but his oxygen saturation levels were creeping up and the anxiety levels dropping in both mother and child.
Pip was about to check on Jake again and consider whether he needed admission to the paediatric ward.
Toni Costa’s ward.
Seeing another child waiting for assessment made her think of Toni again, but Pip was getting quite used to that. It wasn’t just Alice’s fault for making that unwarranted but rather delicious suggestion that he’d been attracted to her. Pip preferred to think the explanation was because she’d been so impressed with the man as a paediatrician. How good he was with interacting with his young patients and what a good example he’d set in making such a thorough assessment of a new case. How he’d taken Pip’s unspoken concerns seriously and made her feel that her daughter was in safe hands.
Toni wouldn’t leave an obviously unwell child just sitting to one side of an emergency department and waiting too long for assessment because of pressure on resources, would he?
The small boy looked febrile. His face was flushed and appeared puffy. What bothered Pip more, however, was how quiet the child was. With the alien bustle of an overworked emergency department flowing past in what should have been a frightening environment, the boy was just lying limply in his mother’s arms and staring blankly.
Even from several metres away Pip could see that the little boy was in respiratory distress. A small chest was heaving under a thin T-shirt…way too fast.
Pip moved towards him, pausing for a moment beside the central triage desk.
‘Doris has gone to X-Ray so we’ve got an empty cubicle for a while. Could you find me a bed, please, Suzie? I think I should take a look at that little boy over there.’
‘Oh, would you?’ Suzie sounded relieved. ‘That would be great. I was just going to upgrade him for an urgent assessment. He’s looking a lot worse than he did when he came in.’ She sent a nurse aide to find a bed in the storage area off the main corridor to the hospital. ‘Put it in cubicle 3. Hopefully we’ll have another free space by the time Doris comes back.’
A stretcher was coming through the double doors from the ambulance bay. Another one was lined up behind that.
‘What’s the history?’ Pip queried briskly, before Suzie could get distracted by the new arrivals.
‘Just became unwell today. Running a temperature, off his food. Family’s new in town so they didn’t have a GP to go to.’
‘Cough? Runny nose?’
‘Apparently not. Temp’s well up, though—39.6 when we took it on arrival.’ Suzie was moving to intercept the first stretcher. ‘His name’s Dylan Harris. Turns two next month.’
Pip smiled at a mother who was probably her own age. What would life be like for herself, she wondered briefly, if she had a two-year-old instead of a twelve-year-old? She certainly wouldn’t be doing what she was doing now—a job she loved with a passion.
‘Mrs Harris?’
‘Yes…Jenny.’
‘I’m Dr Murdoch.’ The thrill of saying those words had never worn off. Worth all those long years of hard work and heartache. ‘Follow me. We’re just finding a bed so I can check Dylan for you.’
‘Oh, thank goodness! I think he’s getting sicker.’
The bed wasn’t needed immediately. Pip carried the chair Jenny had been sitting on as she led the way to cubicle 3.
‘Keep Dylan sitting on your lap for the moment, Jenny. It’ll keep him happier and help his breathing as well.’
‘He’s started making funny noises.’
‘Mmm.’ Pip was listening to the soft stridor on expiration and a gurgle on inspiration with mounting alarm. ‘And how long has he been dribbling like that?’
‘Is he?’ Jenny looked down at her son. ‘I hadn’t noticed. It must have started just now.’
Something that could compromise a child’s airway this quickly was extremely serious and Pip already had a fair idea of what she might be dealing with. She signalled Suzie to indicate the need for assistance but the senior nurse was still occupied with a patient on an ambulance stretcher. Her apologetic wave and nod let Pip know she would do something as soon as she could. Pip reached for an oxygen mask.
‘Hold this as close as you can to Dylan’s face without upsetting him,’ she instructed Jenny.
Pip could see the way the skin at the base of his neck was being tugged in as Dylan struggled to breathe and the retraction of his rib-cage when she lifted his T-shirt to place the disc of her stethoscope on the small chest.
An empty bed was being pushed into the cubicle behind her.
‘Get me a nurse, please,’ Pip told the orderly. ‘Preferably Suzie, if she’s available.’ She took another glance at Dylan’s face. ‘You’re being such a good boy. You’re not feeling too good, are you, sweetheart?’
She got no response. Not even eye contact from the toddler. Pip looked up at Jenny.
‘Has he been talking much today?’
‘He hasn’t said anything since we got here. He’s not even crying, which is weird. He usually cries a lot. Does that mean it’s not that serious?’
‘Not necessarily.’ Pip wasn’t going to alarm Jenny by telling her that it was the quiet children that were usually most at risk. With the oxygen mask held close to his face, Dylan was leaning back on his mother’s shoulder, his chin raised. The ‘sniffing the air’ position that indicated an instinctive method of maximising airway calibre.
‘And he hasn’t been coughing at all?’
‘No. This came on really suddenly. He seemed fine except he wouldn’t eat his toast this morning. I wondered if he might have a sore throat.’ She cast a worried glance at her son. ‘It’s getting worse, isn’t it?’
It was. Dylan’s eyes drifted shut and his head drooped. Pip touched his face.
‘Dylan? Wake up, love. Open your eyes.’ She got a response but it wasn’t enough. ‘I’ll be back in a second,’ she told Jenny. Slipping through the curtain, Pip nearly collided with Suzie.
‘Any of the consultants free at the moment?’
The nurse shook her head. ‘One of the trauma cases has arrested. It’s a circus in Resus.’
‘I need a paediatric anaesthetist here,’ Pip said. ‘And we need to get Dylan to Theatre. I’m pretty sure he’s got epiglottitis and his level of consciousness is dropping.’
Suzie’s eyes widened. ‘I’ll find someone.’
‘Get me an airway trolley in the meantime?’
‘Sure.’
Pip could only hope that intervention could be avoided until Dylan was safely under the care of an expert anaesthetist.
‘I