Life Support: Escape to the Country

by Nicki Edwards

  His eyes flicked up and met Helen and Emma’s gaze through the thick glass window. “Is this the emergency department?” Every breath took an effort.

  Helen nodded, pointed toward the closed doors and pressed a button to release the automatic doors.

  “Go Emma. Get him.” Helen turned her attention to the next person in line.

  Emma’s pulse raced at a staccato beat. Grabbing a wheelchair, she sprinted toward the man. She barely noticed the noise, the smells, the sounds of the waiting room. Barely noticed the way people stopped talking to watch the unfolding scene. Barely noticed the way the man staggered and swayed. Curling her fingers around his fleshy forearm, she captured his attention, indicating the wheelchair. A whoosh of air escaped his pursed lips as he flopped into it like a marionette with severed strings. Emma pushed him through the open doors and straight into the last remaining empty cubicle. Where was everyone? At the very moment she needed help, the department appeared to have entirely emptied itself of staff.

  She touched his shoulder as she wheeled him to an available cubicle. “I’m Emma, one of the nurses. What’s your name?”

  “Jeff,” he said, panting as if he’d run a hundred-meter sprint, which she doubted he’d ever done in his life, judging by the look of him.

  “I need to assess you, Jeff. Do you think you can get up onto this bed?” Emma patted the starched white sheet on the narrow bed.

  Jeff huffed and puffed his way out of the wheelchair. Could he move any slower? Emma yanked the curtain closed and tamped down her impatience. Did he not comprehend how sick he was? Maybe his brain wasn’t getting enough oxygen. She indicated the bed again.

  He shot her a suspicious look before bending to remove his shoes. By the time he’d unlaced them and placed them side by side next to the chair, Emma’s frustration had gone up another few notches. Evidently, Jeff’s priorities were different from her own. It took him two complete 360-degree turns and four attempts to get his bum properly onto the bed. She clenched her fists at her side and struggled to stop herself from telling him to hurry up. Every second was a delay in her valuable assessment time. In the end, she couldn’t help herself.

  “Jeff, I need to get your clothes off now.”

  Unmoved by the urgency in her tone, or ignoring it – she couldn’t tell which – he slowly removed his jumper. He started to fold it before Emma yanked it from his hands and threw it under the bed. He clearly didn’t comprehend how unwell he was. Puffy fingers fumbled at the buttons on his shirt and at that point Emma couldn’t wait any longer. He looked as if he was about to pass out. Or die. Neither of which was going to happen on her shift.

  She yanked his shirt up and over his head, gently pushed him by the shoulders until he was lying back against the pillow and attached ECG dots to his clammy chest, arms and legs.

  Cath Reid stuck her head around the curtain. “Do you need help?”

  Emma looked up at her colleague. Cath towered above everyone, even most of the men. Known for her blunt and bossy approach, she was the perfect nurse to have around when a patient was misbehaving.

  “Perfect timing. While I hook him up to the monitor and finish doing the ECG, can you check his BP and sats please?”

  Cath glanced at Jeff and her frown deepened. “He looks like he’s about to crash.” Her movements hurried, she wrapped a blood pressure cuff around Jeff’s upper arm and attached an oxygen saturation probe to his finger.

  Emma shot questions at him, trying to gain vital information about his medical history. He met every question with the same answer. “You’ll have to ask my wife.”

  “Sats seventy-eight percent on room air. Heart rate fifty.” Cath felt for Jeff’s pulse with one hand while with the other she grabbed an oxygen mask out of a box on the wall. “Pulse is thready.”

  “Blood pressure?”

  “One-ninety-five on seventy.”

  Cath attached the oxygen tubing to the nipple on the wall and slipped the mask over Jeff’s face. Shoving her stethoscope in her ears, she listened to Jeff’s chest, her face serious. She glanced at Emma. “Decreased air entry. Widespread crackles to the bases.”

  “You think APO?” Emma asked.

  Yanking her stethoscope from her ears and wrapping it back around her neck, Cath nodded and pulled a face. “I’d say so.”

  Acute Pulmonary Oedema. Not good. Emma wiped sweaty palms down the front of her scrubs as she stared at the green lines tracing across the screen on the ECG machine.

  “Hold still Jeff,” she instructed.

  Seconds later she stabbed at the button on the machine and waited for it to spew out the printed page. She stared at it for a second then sucked in her breath before handing it to Cath. Cath’s eyes widened. Neither nurse needed a cardiologist to interpret the squiggles running across the red graph paper. The waveform wasn’t called a “tombstone” for no reason. As well as potentially having APO, it looked like Jeff was having a STEMI – an ST-elevation myocardial infarct – a heart attack – right in front of their eyes.

  Cath snatched the ECG from Emma’s hands and tore off to find a doctor. Emma dragged an IV trolley into the cubicle. Wrapping a tourniquet around Jeff’s upper arm, she pulled it tight with shaky hands.

  “I’m going to take some blood and put a drip in,” she said.

  Laying out her equipment on a plastic sheet, she prayed for a vein to pop up. She swabbed Jeff’s arm with alcohol solution and waited for it to air dry before sliding the large bore cannula straight into the cubital fossa vein. She let out a quiet sigh of relief that she had hit the vein on her first attempt. She drew off a set of bloods for pathology before attaching a bung to the end of the needle and flushing it with normal saline.

  “Do you have any pain in your chest?”

  He squeezed his right hand into a balled fist and touched his sternum. “No pain, but it feels like someone’s sitting right here and it’s hard to breathe.”

  Emma’s own breathing and pulse quickened.

  Jeff was still a pasty color and becoming drowsier. His oxygen saturation levels were dropping despite the oxygen he was receiving. Emma turned the flow up as high as it would go. She checked the time on the wall. Although it felt like ages, Jeff had been in the department for less than ten minutes. He needed aspirin, GTN, morphine. And she needed a doctor. Now.

  Bridget Russell burst into the cubicle, eyes flashing. She shot Emma a questioning look. “Who have we got here?”

  Emma told the doctor what she knew. Which was practically nothing. “I thought he was going to be trouble the minute Helen called for help.”

  “I’ve seen worse,” Bridget said with a grin.

  Emma chuckled. “I suppose that’s meant to be reassuring, but it’s not.”

  Bridget laughed in return. “He actually looks like sh—”

  Jeff grimaced, took a deep breath, closed his eyes and lay back on the bed.

  Unconscious.

  Emma and Bridget exchanged a look of disbelief.

  Bridget swore. “I’ll go get the defib.”

  Fear crawled up Emma’s spine but she shook it off and went straight into action. A, B, C, she reminded herself. Airway, breathing, circulation. She began her checks. Jeff’s airway was clear. Tick. She bent closer, looked and listened, but she couldn’t tell if he was still breathing. Dammit. She smacked the emergency buzzer on the wall to alert more staff to come and assist. She was laying the head of the bed down ready to start CPR when Bridget returned with the trolley and defibrillator. Emma ripped open the packages and positioned the defibrillation pads on Jeff’s chest, breathing a thankful sigh he had no chest hairs and the pads stuck properly.

  They stared at the machine as the waveform finally traced across the screen.

  VT. Ventricular Tachycardia. Wide and shockable.

  “Charge it,” Bridget said.

  With shaking hands, Emma pressed a button. “Stand clear.” she shouted.

  The machine delivered the defibrillation joules, causing Jeff to arch his b
ack and lift his head before his body thumped back onto the bed, limbs bouncing in an uncoordinated way. Within seconds, he was conscious. He sat bolt upright and stared at them, his eyes wild and glazed, like a crazed animal. He clearly had no idea where he was or what had happened.

  Bridget’s eyes sparkled. “Well that was fun.”

  Emma didn’t say anything because the truth was, she didn’t share Bridget’s sentiment. Emma had four years’ experience in ED, but was embarrassed to admit she had yet to perform CPR on a real patient. And she did not want tonight to be the first time.

  “I’ll go and let the in-charge doc know,” Bridget said. Without waiting for an answer, she bounced down the corridor, her ponytail swinging.

  “I didn’t see that coming.” Cath said.

  “Me either,” Emma replied. “And I can’t believe Bridge thought that was fun.”

  Jeff didn’t see the humor in it either. He let out a soft grunt and projectile vomited. Both nurses jumped back in time. Emma gagged.

  “I’ll grab towels,” Cath said, sprinting off.

  Growling, Jeff pulled at the ECG leads on his chest. Yanking on gloves, Emma tried to restrain him. For an unwell man, he was incredibly strong. He grabbed at the mask hanging loosely around his neck and pulled tight. The elastic stretched before he released the mask and it slapped with a thwack back against his neck. He then yanked at the plastic tube until it disconnected from the wall. Oxygen hissed like a rattlesnake. Emma reached behind the bed to reconnect the tubing as Jeff went straight for the IV cannula in his arm.

  “No.” she wailed, launching herself across the bed at him. It was too late. He pulled it out in one swift movement.

  Blood dripped, splattering everywhere and mixing with the vomit on the floor. Emma leaned over and pressed against the bleeding IV site with two gloved fingers. Jeff thrashed around on the bed. “I need a hand in here,” she cried out.

  Two more nurses appeared immediately, followed by an orderly a moment later, then Cath with an armload of towels. It took five of them to hold Jeff down. He was breathing hard, but at least he was still conscious.

  “Where’s Bridge now?” Cath asked with a grin. “She’s missing all the fun.”

  Eventually he settled and while he lay quietly with his eyes closed, Emma and Cath cleaned up the blood and vomit and washed his sweat-covered body. They re-attached the ECG monitoring leads and Cath inserted another IV bung in the opposite arm. His oxygen levels remained low and a new mask was slid over his mouth and nose.

  “Nothing like a bit of night duty drama,” Cath said, fifteen minutes later.

  Emma yanked off her gloves and tossed them in the trash. She went to the sink and scrubbed her hands and arms. “I am totally over drama.”

  Cath chuckled. “Then you’ve picked the wrong place to work.”

  Cath was right. Emma rolled her shoulders forward and backward in an attempt to relieve the tension. The stress of the last few months had caused a chronic pain in her neck. A wave of dizziness hit her and she had to place her hand on the wall to steady herself.

  “You okay?” Cath asked, tilting her head to one side. “You haven’t been your usual chirpy self lately.”

  “I’m fine.” She wasn’t, but she and Cath weren’t close friends, and Emma wasn’t one to talk about her personal life with her colleagues.

  “Maybe you need to take time off. Take a mental health day.”

  “I’ve just had two weeks off,” Emma said. “Tonight’s my first shift back.”

  “What happened?” Jeff asked. It was the first time he’d spoken.

  Emma was grateful for the interruption. “You had a heart attack and we had to shock you to get your heart started again.”

  “I thought I must have fainted. Everything went black.”

  Emma shook her head. “No, you didn’t faint. You were unconscious because your heart stopped beating properly.”

  Jeff went quiet, taking this in. “I wondered why I wasn’t feeling very well.”

  “Are you on any medication for your heart?” Cath asked.

  Jeff shrugged. “You’ll have to ask my wife.”

  “We would if we could get hold of her.”

  “She’s—” Jeff’s eyes rolled upward and his head flopped back against the pillow.

  Emma’s jaw dropped and her chest tightened. “You have got to be kidding me.”

  How dare he collapse on her again. Emma went through the same checks as before. Airway. Breathing. Circulation. Nothing. She hit the emergency buzzer as Cath clambered onto the narrow bed ready to start CPR. Staff rushed in for a repeat performance. They attached new defibrillator pads as Bridget and the doctor in charge arrived in time to watch the same wide shockable rhythm scroll across the screen. Emma removed Jeff’s oxygen and everyone stood back as the machine delivered a second shock. His body convulsed again before his heart started beating.

  “Take him to cath lab.” the doctor in charge yelled. “Bridget, ring one of the cardiologists. I want him out of our department now.”

  *

  Four hours later, the shift was mercifully over. It had been a brutal, drama-filled night from start to end. Her neck hurt. Her head hurt. Her feet hurt. Climbing into her car a little after seven thirty, she rolled her head forward and backward and forward again. The bright morning sun and cloudless blue skies promised another perfect winter day, but she was too tired to care. Her pillow was calling her name. Loudly. Bone deep weariness and exhaustion settled on her shoulders like a heavy cloak. The entire night had been filled with people and their problems, but they were nothing compared to what was facing Emma at home.

  Chapter 5

  “… Trauma team to the emergency department. Trauma bay one. Attention all staff. Trauma team to the emergency department.”

  Emma heard the call over the loudspeakers but dismissed it. Today it wasn’t her problem. She was working at the other end of the department, well away from the four resuscitation bays. Ever since the incident at the conference, her mind was still in turmoil, her nerves jangled.

  After talking with her mum two weeks earlier, she’d gone to bed that night and woken the next morning expecting to see Lleyton, but he never came home. Her hopes they would talk and sort things out between them never eventuated. She’d spent her entire annual leave shopping, reading and catching up with friends and in the end didn’t give his absence too much thought. It had been nearly three weeks since she’d seen him and although he hadn’t answered any of her texts or calls, she wasn’t worried, just annoyed.

  Then last night, unexpectedly, she had received a text message from him, letting her know he’d arranged a meeting with his solicitor to discuss the divorce. She would have liked to see him first before they faced off against each other in front of a five-hundred-dollars-an-hour lawyer, but he wasn’t giving her that option. The meeting was for four o’clock that day.

  “It’s not even seven thirty,” Helen complained, striding past. “I hate early morning trauma calls. Wonder what it is?”

  Emma answered Helen’s disappearing back. “No idea. And I don’t care to be honest. I’m just glad I’m not working in resus today.”

  “I overheard them at triage. MVA,” Cath said, sticking her head out from behind a curtain.

  Motor Vehicle Accident.

  “What else did they say?” Emma asked.

  “Single car. One occupant. They’re airlifting him in.”

  “Not good,” Emma said.

  “No,” Cath agreed.

  Emma felt the familiar tingle of foreboding race up her spine and said a quick prayer for the poor family of yet another road accident victim. She then got on with her job, taking care of her own patients. She and Cath had seven patients between them, and judging by the first half hour of their shift, they were going to be run off their feet. At least it meant Emma didn’t have time to wonder what was happening up the other end of the department when the patient arrived. And being busy kept her mind off Lleyton and their meeting with t
he lawyer.

  As usual, when there was a trauma call in the department, everyone knew about it. The noise levels increased as more people flooded the department. Fewer doctors seemed to be available as they gravitated toward the critically ill patient to see if they could help. Emma couldn’t blame them. She was an adrenaline junkie herself and usually a trauma call caused a burst of excitement within her. Not today. Today she was counting down the hours until her lunch break.

  On her way to radiology with one of her patients, Emma snuck a look behind the curtain into the main trauma bay. She glimpsed the soles of a man’s shoes, the toes pointing skyward. Emma usually loved the organized chaos of resus, but she heaved another sigh of relief it wasn’t her turn today.

  Helen was bustling around, barking instructions in her distinctive gruff voice. She was in charge and in her element.

  “Set up for a CVC and art line. We need x-ray here now. And can someone stick in an IDC?”

  Another voice called above the din. “BP’s down to eighty on thirty. Heart rate one-twenty-five. Resps forty and shallow. Pupils non-reactive.”

  Emma shuddered. By the sound of it, he was in a bad way. She couldn’t see much of the man on the trolley, but what she saw didn’t look good. A deep laceration to his thigh would need serious suturing, but that was the least of his worries. Spinal injuries and internal injuries were the biggest concerns. Or if his pupils weren’t responding properly, he undoubtedly had a brain injury. Low blood pressure? Probably bleeding out somewhere. Liver? Spleen? Emma’s mind raced through all the possibilities. All of them bad.

  Voices called backward and forward while nursing staff moved around the room quickly and purposefully. It must look like a war zone to an outsider.

  Helen caught sight of her. “Want to swap places?” she shouted above the din.

  “Nope. I’m off to x-ray with my patient,” Emma said with a wave. “Simple fractured NOF I reckon.” Emma’s patient was an old lady from a nursing home. She had fallen from her bed and most likely broken her femur neck, a common hip injury in elderly people.