‘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.
It seemed they were old friends—the boy a frequent visitor to the paediatric ward. This time, though, Andrew agreed with Patrick. It had been a little too close for comfort, and they were erring on the safe side.
Just as he left the department Jack and Kathleen Lawrence came back in, staring at the trolley in surprise.
‘Was that Simeon Wilding?’
‘Yes—asthma attack. He arrested,’ Patrick told them economically.
‘What?’ Jack looked shocked.
Patrick smiled slightly. ‘He’s OK—well, apart from a rib I may have cracked. He’s going to Paediatric ITU for a couple of days, just to be on the safe side. He stopped breathing, but he’s spoken to us and he’s OK—at least for now.’
Jack’s mouth tipped into a cynical curve. ‘Of course he is—after all, it’s only asthma.’
Anna heard the bitterness in his voice and understood it. Asthma was so common that it tended to be ignored, underestimated, almost brushed aside until a crisis forced it into view.
An event like this brought you up hard against reality, she thought. Most of their critical asthmatics made it, but every now and again they would lose a patient to it, even though it was ‘only asthma’.
They all felt so helpless then, and Jack hated being helpless. Patrick, too, she realised, looking at them as they shared a frustrated smile.
‘Oh, well, we do what we can. Well done for saving him,’ Jack said, and rested his hand on Patrick’s shoulder.
‘I’ve been meaning to give you a guided tour of the department all morning—but I guess you’ve seen Crash now?’
Patrick laughed. ‘Yes—thank you.’
‘How about a coffee?’ Kathleen suggested.
Just then the phone rang, and as one they all turned to look at it, then shrugged.
‘So who needed coffee anyway?’ Kathleen said philosophically, and picked up the phone.
PATRICK stood up to leave. The elderly man in the chair by the window regarded him without curiosity.
‘Are you going now?’ he asked.
‘Yes. I’ll see you tomorrow.’