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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.
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.
CHAPTER TWO (#ulink_602b1a55-8c4a-5571-bcd6-ccf2cff43be3)
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.’
The old boy shook his head. ‘Very kind of you, I’m sure, but I can’t see why you should want to.’
Patrick quelled the pain. ‘Would you rather I didn’t come?’ he asked quietly.
‘Oh, no. I enjoy your company, young fella. Too many old girls in this place for my liking. No, I was thinking of you. I just can’t see the attraction in talking to an old codger like me.’
Patrick smiled, a sad half-smile that didn’t reach his eyes.
‘I find you very interesting. You’ve had a fascinating life.’
The man snorted. ‘You must have a very boring life, young man, if you find mine fascinating. Very boring.’
Patrick thought back over the last few years, and gave a wry, quiet laugh. ‘It’s quite exciting enough for me. I’ll see you tomorrow.’
They shook hands formally, and Patrick turned to leave. As he did so the man called him back.
‘Patrick?’ he said.
He turned towards him again. ‘Yes?’
‘I don’t know who you are, young man, but I’d be proud if you were my son.’
Patrick’s face twisted slightly. ‘Thank you,’ he said softly. ‘Thank you very much. Goodnight.’
He went out, waving a greeting at the sister who was busy wheeling another resident through the grounds, and slipped behind the wheel of his car—his father’s car, in fact.
For a moment he remained motionless, letting the pain ease away, giving himself time. Then he started the car and drove back to the lovely Tudor house where he had grown up, and where he was now staying with his mother.
She was in the front garden when he pulled up, and she straightened and went to greet him with a kiss. ‘How was he?’ she asked.
Patrick shrugged. The same.’
‘Still doesn’t know you?’
He shook his head. His eyes blurred, fogging his vision, and he blinked hard. ‘I miss him,’ he said unevenly.
‘So do I,’ his mother said sadly. Oh, Patrick, I’m so glad you’re home.’
They hugged each other, drawing comfort from the contact, sharing their sorrow. The lump in Patrick’s throat grew, and he eased away.
‘I’ll put the car in the garage, then I need to change.’
‘Don’t be long. I want to hear all about your day.’
He didn’t doubt it. He put the car away and went in through the side door into the converted stable-block that had been turned into a self-contained annexe for guests. He had refused to stay in the house with his mother, preferring instead to maintain his independence and privacy while still being close at hand.
Now, as he stripped in the airy bedroom and wandered through to the little bathroom to shower, he was glad he had insisted. He needed room to himself, a little time and space to be quiet and recharge his batteries.
And God knows they were flat enough. This sudden deterioration of his father’s was the last straw, the Alzheimer’s that had been creeping up now claiming his memory and distancing him from the son who had travelled back across half the world to be near him.
A heavy sadness settled in Patrick’s chest, joining the other weight that lay there at all times, ignored for the most part but omnipresent, a constant anchor round his heart.
He turned on the shower and stood under the hot, stinging spray, his eyes closed, letting the water pelt over him and wash away the smell of the nursing-home.
Ideally he would like to bring his father home, but his mother couldn’t cope alone now her husband was incontinent. Perhaps, with Patrick’s help and the services of an agency nurse, it would be possible.
He would consider it, talk it over with his mother.
Half an hour later he joined her in the conservatory overlooking the garden that had been his father’s pride and joy. It was a mess, the weeds forming a mat between the perennials, the vegetable patch untended. Patrick had cut the grass at the weekend but already it seemed to be growing. His mother did what she could, but there was too much for one person to look after. They needed a gardener.
