‘Kerry, you’ve been great. My life was an absolute mess when I first came here, and you’ve helped me a lot. I’ve lost weight, toned up, I’m drinking soy milk and I’m finally in the black, but as for the emotional side…’ Madison picked up the clipboard and stared at the unfilled boxes, the goals she should set out to attain, the ticks that would somehow decipher the perfect man in a perfect world, and knew that nothing she wrote there could even begin to explain her needs. ‘I guess I’m going to have to leave that to a greater power…’
‘One that doesn’t charge eighty dollars an hour.’ Kerry gave a thin smile, but it reached her eyes and for the first time in all the while she’d been there, Madison actually warmed to the other woman.
‘I’ve met someone,’ Madison admitted. ‘Every pore in me is screaming that he’s a wanderer, that say the C word and he’ll walk. He’s certainly not what I’ve got planned for Emily and I, and yet…’ Her voice faltered for a moment but then she found it again. ‘Yesterday I thought it was impossible, I told him it wasn’t going to happen.’
‘So what’s changed?’
‘He asked me to think about it,’ Madison answered. ‘Which I have been, but I’m still none the wiser.’ Madison gave a tired laugh. ‘To save myself from possible pain in the future, I’m inflicting a massive dose now.’
‘So the treatment’s worse than the cure?’ Kerry smiled and Madison stared back, her mouth opening slightly to argue but realizing that she didn’t have an answer!
‘You know what? I dumped my fiancé this weekend.’ Suddenly Kerry didn’t look so much the confident professional she portrayed so well. In fact, on closer inspection her well-made-up eyes revealed puffiness, and despite the porcelain powdered complexion her nose was just a touch red. Madison stood dangling her bag in her hand as Kerry went on. ‘On paper he was perfect. He had every attribute I could list in a man, there was nothing about him I could really object to—he was supportive, funny, good-looking and educated…’
‘But?’ Madison gave a sympathetic smile as she rummaged in her bag for her cheque book.
‘That’s what I’m trying to work out,’ Kerry admitted, waving her hand as Madison started to write out a cheque. ‘Why, when it looked so perfect on paper, didn’t it feel quite so good in real life?’
‘Here.’ Tearing out the cheque, Madison went to hand it over, but Kerry waved it away.
‘This one’s on me.’
‘You’re sure?’ Madison checked. ‘I’m more than happy to pay.’
‘I know you are but, yes, I’m sure.’ Kerry nodded. ‘I assume you don’t want to make another appointment on your way out?’
‘No.’ Madison shook her head. ‘But thank you, Kerry, thank you for all your help.’
‘Good luck,’ Kerry called as Madison stepped out of the office, and out into the early afternoon sun, blinking at a world that seemed brighter all of a sudden. Madison finally admitted why—Guy. Though initially she had been appalled, their love-making had been an utter revelation, a complete awakening, the side of her she’d suppressed for so very long, the impulsive, fun-loving Madison that had been buried with her husband. Walking the short distance back to the hospital, for the first time in years she wasn’t rushing, merely walking; for the first time in a long time she literally stopped to smell the roses, to take stock of all she had and all she’d achieved…
To bravely face the future.
‘We’ve got a problem!’ Annie, the permanently frazzled ward clerk, jumped up from her desk as Madison slipped off her jacket. ‘Beth’s son, Jackson, is being brought in by ambulance. Apparently he’s had a severe asthma attack at school. It sounds pretty bad.’
‘Poor Beth.’ Madison grimaced. ‘OK, Beth knows, I assume?’
‘Guy’s talking to her now, getting Jackson’s history and everything.’
‘Good,’ Madison said crisply. ‘OK, who’s the nurse in Resus…’ Her voice trailed off as she realised the predicament. Beth Anderson was the most senior staff member on duty that afternoon and she was in charge of Resus. Annie nodded as the problem dawned.
‘I’ll go into Resus.’
‘But you’ve got a full diary,’ Annie pointed out. An occupational health and safety lecture in fifteen minutes and then there’s a management meeting to attend at two. Alanna’s already said that she can take over Resus, so long as we can get an agency nurse to fill the gap. I just need you to sign off on it.’
‘I’ll go into Resus,’ Madison said again, more firmly this time. ‘Beth deserves the most senior staff available to look after her son.’
‘Only you’re not available,’ Annie pointed out, running to keep up with Madison who was marching through the department. ‘What do I tell everyone?’
‘Tell them that something more important came up,’ Madison responded. ‘Tell them that I’m needed down here in the real world.’
‘Right.’ Madison nodded to Alanna. ‘Have you alerted the paediatricians and anaesthetist?’
‘I’ve just put out a page.’ Alanna nodded.
‘Well done. OK, Alanna, I’m going to take over in here, you carry on with the cubicles.’
‘I am capable of running Resus,’ Alanna said, a distinctly brittle edge to her voice, which, despite the critical time factor, Madison chose not to ignore, pulling out the red crash cart and pulling up drugs as she spoke.
‘I don’t doubt that for a moment but the fact is, Beth is the nurse down for Resus this afternoon, and clearly she can’t be expected to run her own son’s resuscitation. Now, given that you’re up to date on what’s happening out there, it makes far more sense for you to carry on and I’ll pick up in here, rather than spending what little time we have before Jackson arrives trying to bring me up to speed. Annie’s clearing my diary for the afternoon, but if I need a hand, I’ll call.’
Only slightly mollified, Alanna gave a reluctant nod and walked out. Madison didn’t dwell on it, her only thought right now for the seven-year-old boy coming in. She saw the flash of blue lights and heard the skid of brakes and a final wail of a siren that heralded the arrival of Jackson. Madison knew it was indeed serious. Blue lights and sirens on the streets were to alert traffic to move out of the way, but when they were used in the hospital driveway it was for the opposite reason, to alert people that help was needed, to move in close and try to save a life.
‘Jackson Anderson,’ a paramedic gasped as they skidded to a halt with the stretcher. Guy raced in alongside them, with a distraught Beth trying to hold herself back but desperate to get near. ‘Seven-year-old, chronic asthmatic. Became breathless in the classroom and deteriorated quickly, semi-conscious on our arrival, tachypnoeic, using accessory muscles, with tracheal tug. His oxygen saturations were eighty-two per cent on our arrival and have come up to ninety per cent on oxygen and continued Ventolin nebuliser. He’s been cannulated…’
All this was said as the little boy was swiftly moved over, his dark eyes rolling as Madison leant him forward, resting his frame on a large pad—upright being the best position, the most comfortable during an asthmatic episode to allow for greater lung expansion. But Jackson was too weak to support himself and Madison supported him with pillows as another nurse attached him to the monitors and connected the oxygen tube to the hospital supply, sharing a brief anxious look with the paramedics.
‘Thanks, Ben,’ Madison said. ‘Good job.’
‘We’ll grab a cuppa,’ Ben said, which might have sounded a strange thing to say, but everyone present knew it had nothing to do with a brew and everything to do with hanging around to find out what was going to happen to the little boy, who was working so hard simply to breathe.
‘This is more like a massive anaphylactic reaction,’ Guy said, listening to Jackson’s chest, then probing his neck with his fingers. ‘Beth said he had a nut allergy…’
‘He wouldn’t eat nuts,’ Beth shouted. ‘He doesn’t eat anything that I don’t give him.’
‘Let’s lay him flat and get some adrenaline into h
im,’ Guy said, ignoring Beth for now, his only focus on the patient, a steady hand taking the drugs Madison handed to him. She could only marvel at his cool. A child as sick as this meant a tense resuscitation room, especially given the fact it was a staff member’s child and that she was present.
‘Do you want Beth to leave?’ Madison asked, turning her eyes to the saturation monitor. The percentages were dropping ominously as Jackson’s heart rate accelerated, his tiny heart working overtime to drag vital oxygen in and failing, his lungs too rigid to allow for any air expansion.
‘Let her stay for now,’ Guy replied. ‘Where are the paediatricians?’
‘On their way,’ Jane answered. ‘I’ve just put out an urgent call for the anaesthetist.’
‘Beth.’ Guy looked up briefly. ‘I’m going to intubate Jackson. His saturations are dropping, we need to do this. Do you want to stay or go?’
Beth opened her mouth to argue, no doubt to insist that this couldn’t be happening, that her child didn’t need such drastic measures, that her baby wasn’t at death’s door, but somehow she held back and summoned the strength to resist holding her child, in her eyes a desperate plea for help as she nodded her consent to Guy and handed her trust over to him.
‘Stay, I want to stay…’
‘Hold his hand,’ Guy responded, nodding to the staff to make room for her. ‘Talk to him, Beth, tell him he’s going to be OK.’
But was he?
Jackson’s blood pressure was dangerously low, his oxygen saturations rapidly diminishing, his body collapsing. His respiration rate, which had been so high in an exhausting attempt to get vital oxygen, was now starting to decrease. Even his heart rate was slowing, and Madison knew that Guy couldn’t wait for an anaesthetist. If they didn’t intubate Jackson now, they would lose him.
Guy’s hand was amazingly steady, just one impatient curse as he attempted to put the tube into the boy’s spasmed throat, and failed. Madison found she was holding her own breath as Guy steadied himself, forced himself to focus, to ignore the machines bleeping behind him, to drown out Beth’s frantic loving words to her son and concentrate on the vital task in hand.
‘I’m in.’ He held the tube very still as Madison secured it carefully, making sure they didn’t move the vital connection, then Madison took over, bagging the little boy as Guy listened to his chest, making sure the airway was indeed in the right place, giving a relieved nod when he heard the breath sounds.
‘Poor air entry…’
Madison didn’t need to point out that at least he had some air entry now. The last few seconds before Guy had intubated Jackson had really been dire and Madison stood watching as the oxygen saturations that had been dipping into the high fifties started to lift, into the seventies then eighties, reaching a plateau around ninety per cent, which wasn’t great but was certainly much better than they’d had.
‘I want an adrenaline infusion,’ Guy said, not stopping when the paediatrician raced in, giving out orders. He had control, the patient still too critical to allow for a handover. The paediatric team respected that, listening intently as Madison filled them in while Guy worked on. But slowly he started handing over the reins when the situation allowed, discussing latest treatments and protocols, checking on the intensive care situation, working with the paediatricians and anaesthetist to stabilise this little life, until finally Beth had the confidence to leave him for a few moments, to go to the interview room and make an endless round of phone calls to let her family know what had taken place.
‘There’s no ICU beds, Mark.’ Madison came off the phone from the supervisor and addressed the paediatrician. ‘The one they did have has just been taken by a surgical patient. They’re extubating a patient in the next couple of hours so there’s a chance there could be one by evening…’
‘Or someone could die,’ Guy added. The appalling, hopeless irony hit its mark and Madison gave a weary smile.
‘There’s always that chance, I guess.’
‘He needs good intensive care.’ Mark tapped his pen against his thigh as he looked at the little boy. ‘I’m not saying that he won’t get that down here—’
‘I know you’re not,’ Madison broke in. ‘But there’s a very good chance that the ICU patient they’re talking about extubating won’t be up to being transferred and, as Guy pointed out, unless someone dies there’s not going to be an intensive care bed. Frankly, Mark, I don’t have the staff to special one patient for an indefinite period. Who knows what’s about to come through the doors? I’ve already rung the children’s hospital and told them the situation. They’re happy to take him, they can arrange for the paediatric emergency transfer team to collect him, but they need a doctor to give the go-ahead.’
‘Do you think I should ask for a helicopter or ambulance?’ Mark asked.
Madison glanced down at her watch. It was already nudging two forty-five and by the time the team were mobilized, it would be another hour before they arrived. The paediatric emergency transfer team was highly skilled and organized, and they would take their time to get a good handover from the paediatrician and ensure Jackson was as stable as possible before the journey. So even though their response would be rapid, the actual retrieval would take some time and rush-hour traffic, combined with a critically ill child, wasn’t an ideal situation even if they were heading in the opposite direction to the peak-hour cars.
‘Helicopter,’ Madison said, and Mark nodded, heading out to pick up where Madison had left off.
‘Amazing!’ Guy said, shaking his head in disbelief then saying it again. ‘Amazing.’
‘What is?’ Madison asked. She checked Jackson’s obs and popped a fresh sheet over him and a small flat pillow under his head to make him look more comfortable before Beth came back in. But unlike most doctors, Guy unfolded the sheet with Madison from the other side of the bed, picking up a few discarded wrappers and generally tidying up with her as they chatted. Even though they were both avoiding each other’s eyes, both clearly a touch uncomfortable, they pushed aside all that happened yesterday—a patient’s bedside, even if he was unconscious, not the place to discuss what had taken place. Madison was grateful for the small reprieve.
‘Helicopter or ambulance! It just rolls off your tongue. I still can’t get used to it—hell, I still can’t get used to having a choice of antibiotics, a phone I can pick up and have any number of specialists racing down to assist.’
‘But are you enjoying it?’ Madison asked. It sounded like a stupid question but, being used to Emergency, she knew that as angst-ridden as his relief work might have been, in many ways Guy would have enjoyed the autonomy, the chance to make a very real difference in the most dire of circumstances. And he had done that over and over—from the tiny glimpses he had revealed, Madison knew that Guy had witnessed many things.
‘Actually, I am enjoying it,’ Guy said. ‘And I have to admit it’s come as a pleasant surprise. Since I was in England I haven’t worked in an actual structured health system, and I thought I’d be wringing my hands at the injustice of it all. But instead I’m just glad to finally be in a well-stocked, well-run hospital and able to use my brain.’
‘I’m sure you used your brain before,’ Madison rebuked. ‘As you said, you had no back-up.’
‘To tell you the truth, I felt more like an odd-job man at times, making do with this, trying out that. I’ve made hundreds of IV splints out of bits of wood, incubators with a couple of light globes and a rattly old generator. It’s a bit of a novelty asking for something and actually getting it!’ He stared down at Jackson, sedated and with a tube down his throat, lines and monitors everywhere. But his obs were more stable and there was a hint of colour in a face that had been way too pale. Guy brushed back the damp, sweaty hair from his forehead. ‘You might not realize it, Jackson, but you’re a very lucky boy.
‘I’d better go and speak to Beth and tell her about the transfer.’
‘And I’d better hand over Jackson to the late shift, it’s nearly time fo
r me to go home.’
By the time Madison had spoken again with the transfer team, liaised with Mark and handed Jackson over to the late shift nurse who was covering the resuscitation room, Guy was back. ‘How’s Beth?’ Madison asked as she pulled on her jacket and handed over the drug keys and pager to her replacement.
‘Not great,’ Guy admitted. ‘From what Beth told me, she’s really struggled to let go a bit. His asthma and allergies have been difficult to control and it took a lot for her to send him to school, to let him go to parties—this isn’t going to help. I’ve told her that, given the severity of his reaction, Jackson’s going to have to carry adrenaline now, and that his carers will be trained to administer it, but at the end of the day I can’t blame her one bit for not wanting to ever let him out of her sight again. I can’t believe the school let this happen.’
‘Oh, come on, Guy,’ Madison said. Information had started to trickle in and a child sitting next to Jackson had been eating peanut butter sandwiches. ‘We know how sever a genuine nut allergy can be, but most people don’t. Can you imagine how awful the school is feeling right now, how that poor mum who made her kid’s lunch today is going to feel when she finds out that the sandwiches she made nearly killed another child?’
‘I guess.’ Guy gave a weary smile. ‘That’s one kid who won’t be having peanut butter ever again.’
‘Two.’ Madison grinned. ‘At least Emily won’t be having it in her lunchbox at school any more. Anyway, I’d better go.’
‘Me, too,’ Guy said, smothering a yawn. ‘I’ve had enough of this place for a week.’
As she turned to go Guy called her back. ‘Can I walk out with you?’
And even though her back was to him Madison knew that, like her, he was holding his breath. Turning slowly, she nodded, taking the biggest, bravest step of her life. ‘I’d like that.’
Needed: Full-Time Father (Medical Romance) Page 9
