It was Charles who finished her sentence for her, as he appeared beside her, pushing his arms through the sleeves of a gown. He didn’t smile at her, but there was a crinkle at the corners of his eyes that gave her a boost of confidence.
‘Thought you might like a hand,’ he murmured. ‘We’ve done this before, remember?’
Grace tilted her head in a single nod of acknowledgement. She was focused on the gurney being wheeled rapidly towards them through the doors. Of course she remembered. It had been the only time she and Charles had worked so closely together during those long years of training. They had been left to deal with a case of severe hypothermia in an overstretched emergency department when they had been no more than senior medical students. Their patient had been an older homeless woman that nobody had seemed to want to bother with.
They had looked at each other and quietly chanted their new mantra in unison.
‘You’re not dead until you’re warm and dead.’
And they’d stayed with her, taking turns to change heat packs and blankets while keeping up continuous CPR for more than ninety minutes. Until her body temperature was high enough for defibrillation to be an effective option.
Nobody ever forgot the first time they defibrillated somebody.
Especially when it was successful.
But this was very different. This wasn’t an elderly woman who might not have even been missed if she had succumbed to her hypothermia. This was a precious child who had distraught members of his family watching their every move. A tiny body that looked, and felt, as if it was made of chilled wax as he was gently transferred to the heated mattress, where his soaked, frozen nappy was removed and heat packs were nestled under his arms and in his groin.
‘Pupils?’
‘Fixed and dilated.’
Grace caught Charles’s gaze as she answered his query and it was no surprise that she couldn’t see any hint of a suggestion that it might be too late to help this child. It was more an acknowledgement that the battle had just begun. That they’d done this before and they could do it again. And they might be surrounded by other staff members but it almost felt like it was just them again. A tight team, bonded by an enormous challenge and the determination to succeed.
Finding a vein to start infusing warmed IV fluids presented a challenge they didn’t have time for so Grace used an intraosseous needle to place a catheter inside the tibia where the bone marrow provided a reliable connection to the central circulation. It was Charles who took over the chest compressions from the paramedics and initiated the start of warmed oxygen for ventilation and then it was Elijah who stepped in to continue while Charles and Grace worked together to intubate and hook the baby up to the ventilator.
The cardiac surgical team arrived soon after that, along with the equipment that could be used for more aggressive internal warming, by direct cannulation of major veins and arteries to both warm the blood and take over the work of the heart and lungs or the procedure of infusing the chest cavity with warmed fluids and then draining it off again. If ECMO or bypass was going to be used, the decision had to be made whether to do it here in the department or move their small patient to Theatre.
‘How long has CPR been going?’
‘Seventy-five minutes.’
‘Body temperature?’
‘Twenty-two degrees Celsius. Up from twenty-one on arrival. It was under twenty on scene.’
‘Rhythm?’
‘Still ventricular fibrillation.’
‘Has he been shocked?’
‘Once. On scene.’ Again, it was Charles’s gaze that Grace sought. ‘We were waiting to get his temperature up a bit more before we tried again but maybe...’
‘It’s worth a try,’ one of the cardiac team said. ‘Before we start cannulation.’
But it was the nod from Charles that Grace really wanted to see before she pushed the charge button on the defibrillator.
‘Stand clear,’ she warned as crescendo of sound switched to a loud beeping. ‘Shocking now.’
It was very unlikely that one shock would convert the fatal rhythm into one that was capable of pumping blood but, to everyone’s astonishment, that was exactly what it did. Charles had his fingers resting gently near a tiny elbow.
‘I’ve got a pulse.’
‘Might not last,’ the surgeon warned. ‘He’s still cold enough for it to deteriorate back into VF at any time, especially if he’s moved.’
Grace nodded. ‘We won’t move him. Let’s keep on with what we’re doing with active external rewarming and ventilation. We’ll add in some inotropes as well.’
‘It could take hours.’ The surgeon looked at his watch. ‘I can’t stay, I’m afraid. I’ve got a theatre list I’m already late for but page me if you run into trouble.’
Charles nodded but the glance he gave Grace echoed what she was thinking herself. They had won the first round of this battle and, together, they would win the next.
There wasn’t much that they could do, other than keep up an intensive monitoring that meant not stepping away from this bedside. Heat packs were refreshed and body temperature crept up, half a degree at a time. There were blood tests to run and drugs to be cautiously administered. They could let the parents come in for a short time to see what was happening and to reassure them that everything possible was being done but they couldn’t be allowed to touch their son yet. The situation was still fragile and only time would give them the answers they all needed.
His name, they learned, was Toby.
It wasn’t necessary to have two senior doctors present the whole time but neither Charles nor Grace gave any hint of wanting to be anywhere else and, fortunately, there were enough staff to cover everything else that was happening in the department.
More than once, they were the only people in the room with Toby. Their conversation was quiet and professional, focused solely on the challenge they were dealing with and, at first, any eye contact was that of colleagues. Encouraging. Appreciative. Hopeful...
It was an odd bubble to be in, at the centre of a busy department but isolated at the same time. And when it was just the two of them, when a nurse left to deliver blood samples or collect new heat packs, there was an atmosphere that Grace could only describe as...peaceful?
No. That wasn’t the right word. It felt as though she was a piece of a puzzle that was complete enough to see what the whole picture was going to be. There were only a few pieces still to fit into the puzzle and they were lying close by, waiting to be picked up. It was a feeling of trust that went a step beyond hope. It was simply a matter of time.
So perhaps that was why those moments of eye contact changed as one hour morphed into the next. Why it was so hard to look away, because that was when she could feel it the most—that feeling that the puzzle was going to be completed and that it was a picture she had been waiting her whole life to see.
It felt like...happiness.
Nearly three hours later, Toby was declared stable enough to move to the paediatric intensive care unit. He was still unconscious but his heart and other organs were functioning normally again. Whether he had suffered any brain damage would not be able to be assessed until he woke up.
If he woke up?
Was that why Grace was left with the feeling that she hadn’t quite been able to reach those last puzzle pieces? Why the picture she wanted to see so badly was still a little blurred?
No. The way Charles was looking at her as Toby’s bed disappeared through the internal doors of the ER assured Grace that she had done the best job she could and, for now, the outcome was the