Life Support: Escape to the Country

by Nicki Edwards

  “How? What did she say?”

  “She wanted to know when I was going to have a sleepover at your place.”

  Tom sighed. “That’s exactly why I want to take things slowly.”

  “Why?”

  “I don’t want her to get hurt.”

  “Why is she going to get hurt?” Emma rubbed her bare arms. What was he implying?

  He let out another soft sigh. “I’m not saying she will, I’m saying I want to be careful. I don’t want her getting too close to you.”

  Emma, never at a loss for words, had nothing to say. “You don’t want me to get close to Ruby? Why not?”

  “I don’t want her to get ahead of herself and then end up disappointed if our relationship doesn’t work.”

  “So now we’re not just friends, we’re ‘in a relationship’? Emma shook her head to loosen the confusion resting there. “Are you sure that’s wise? Wouldn’t it be better if she sees us spending time together? Gets used to the idea?”

  “Let’s take things slowly, and see where it leads,” he repeated.

  Something heavy sat in her stomach. “Okay,” she said.

  But it wasn’t okay.

  It looked like once again her feelings for him were one-sided.

  Chapter 19

  In the staff room the next day, a bubbly blonde flopped into the seat beside Emma and smiled, displaying a wide gap between her front teeth. “G’day, I’m Lisa. I’ve been hanging out to meet you because I need your help.”

  Emma raised her eyebrows in surprise at the woman’s bluntness. “With what?”

  “I need you to put in a good word about me with your brother.”

  “With Liam?”

  “Yep. He’s so cute.” She rolled her eyes. “And that accent. Hmm-mmm. We’ve gone out a few times, but he keeps fobbing me off when I ask him on another date.”

  Emma took another look at the girl at her side. Lisa’s long lashes framed vivid blue eyes – the lashes had to be extensions – and a slash of bright pink lipstick covered her full lips. In her navy scrubs, it looked like she’d be more at ease on a fashion shoot than working in the emergency department. She was not the kind of woman Liam would lose interest in. If she had a minute, she’d send Liam a text and ask him what was going on between them.

  Lisa checked her watch. “Time to play,” she said as she flounced out, her ponytail bouncing.

  Mackenzie rolled her eyes and Emma stifled a grin.

  “Did she ask you to set her up with Liam again?” Mackenzie asked.

  “Yes.”

  “They went out a couple of times. From what I can tell, things fizzled fast for Liam, but Lisa won’t get the hint.”

  “Poor Lisa.”

  Mackenzie rolled her eyes. “It’s funny when Liam brings a patient in and Lisa’s on. She forgets all about the patient and practically throws herself at him.”

  Emma groaned. “He’d hate that.”

  Her brother loved women, but the minute they became clingy or needy he became a gold-medal-winning Olympic sprinter.

  The morning passed quickly. For the fourth time that day, Lisa tried to pull Emma aside and raise the subject of Liam but thankfully her next patient arrived, putting a halt to any further discussion.

  “Hi, I’m Emma.” Emma greeted an elderly woman in the wheelchair before turning to the man who sat beside her. Both were smiling although the woman’s face was pale and the blood-soaked flannel she held to her forehead was a dead giveaway she was the patient.

  “Hello. I’m Tony Collins. This is my wife Ann. She had a fall at home today and I decided to bring her in. I hope you don’t mind, but I grabbed the wheelchair from out the front. Ann’s having trouble walking.”

  “Is she normally in a wheelchair?”

  “No. She’s fiercely independent. She still drives. We both do,” he added proudly.

  Emma helped Ann out of the wheelchair and onto the bed.

  “What made you fall?” she asked as she felt for Ann’s pulse. Faster than normal but regular and strong.

  Ann shrugged. “I’m not sure. I don’t remember.”

  “Did she lose consciousness?” She wrapped a blood pressure cuff around Ann’s upper arm.

  “I’m not sure. I found her in the garden. She’d fallen and hit her head on a rock.”

  That explained the blood.

  “Blood pressure is up,” Emma said. “And your sats – your oxygen levels – are only eighty-eight percent.”

  Ann frowned. “Is that low?”

  Emma nodded. “Do you suffer from asthma? COAD? Any history of respiratory problems?”

  “None.” Ann sighed. “I can’t believe it.”

  Emma snapped on a pair of rubber gloves and grabbed a handful of non-sterile gauze. “Can’t believe what?”

  “That I was so stupid.”

  “It’s not your fault, love,” Tony said as he patted Ann’s arm.

  “Can you let go of the towel Ann so I can see where all this blood is coming from?” Emma asked.

  It took some convincing for Ann to let go of the towel. Emma peeled it back gently, revealing a deep gash that oozed blood.

  “Are you on blood thinners? Aspirin? Warfarin?”

  “Yes, warfarin.”

  That explained the excessive bleeding. Emma cleaned the wound, applied steri strips and put a fresh dressing on it.

  When Emma asked her to sit forward so she could listen to her chest, Ann grimaced.

  “Does it hurt anywhere else?”

  “Yes. My chest hurts here.” She pointed gingerly to the right side of her chest. “When I breathe in it’s worse and my right arm hurts too. I guess that’s the side I fell on.”

  “Do you think you tripped or did you become lightheaded or pass out?”

  “I don’t know.”

  “Any chest pain?”

  “Not that I remember.”

  “What about now?”

  “Just here.” Again, Ann indicated the right side of her chest below her ribs.

  Emma used her stethoscope to listen to Ann’s breathing. “Can you take a deep breath please?”

  Ann tried, but her face contorted in pain again. Emma frowned as she listened. She pulled the stethoscope from her ears and wrapped it back around her neck. Mackenzie stuck her head around the curtain. Good timing.

  “Hey. Can you have a listen and see what you think? I can’t hear anything on the right side.”

  After listening to Ann’s chest, Mackenzie applied light pressure and watched as Ann flinched. “We need to get an x-ray to see if she’s broken any ribs.”

  The orderly arrived and took Ann to x-ray. Emma and Mackenzie restocked trolleys and tidied cubicles while they waited.

  “How are you settling back in?” Mackenzie asked.

  “Better than I expected.”

  “You didn’t mind coming back to Birrangulla after living in Melbourne?”

  “I thought I’d hate it, but it’s been so good. Until I came back, I didn’t realize how much I missed the country life. The change of pace has been so good. Melbourne is an amazing city – if you like living in the city. There’s something so good about being minutes from everything and I love being able to park my car out the front of a shop and dash in to get what I need.”

  “And how’s it going living back with your parents?”

  Emma chuckled and rolled her eyes in mock horror. “Do you need to ask?”

  “Why aren’t you living out at Lexton Downs?”

  “There’s nowhere for me to live out there. The homestead is being used for the guest accommodation and Tom’s mum lives in Bluestone Cottage, the manager’s house. There’s a small one bedroom cottage, but Tom lives there.”

  Mackenzie frowned. “It’s crazy that you own this huge property and there’s no room for you. Why don’t you ask Tom’s mum to move out of the manager’s house? Maybe she could move into Tom’s cottage and he can find somewhere else to go.”

  “I couldn’t do that.”

&nb
sp; “It’s your house Emma.”

  Emma exhaled. “I know, but I don’t want to put anyone out.”

  “I think they’re taking advantage of you.”

  The orderly brought Ann from her x-ray, who was complaining of increasing pain. Emma was glad it meant Mackenzie had to change the subject.

  Mackenzie was probably right. Emma needed to talk to Tom about their long-term plans for the property.

  “I’ll go and find a doctor,” Mackenzie said.

  Moments later Damian Wilson arrived, his face serious, and Emma pushed all thoughts of Tom and Lexton Downs from her mind.

  He introduced himself to Tony and Ann before getting straight to the point.

  “Your right arm looks fine. Most likely only bruised, but you have four broken ribs on the right lower chest and bleeding around the bottom of your right lung. We’re going to need to put a chest drain in to drain off the blood and reinflate your lung. That means you’re going to need to be admitted for a few nights.”

  Tony and Ann nodded solemnly.

  “I’ll go and get things organized,” Damian said.

  Tony reached down to hold Ann’s hand and a worried look passed between them.

  “Is there anyone I can call for you? Any family? Kids?” Emma asked.

  “No, there’s only us here,” Tony said. “All the kids live interstate.”

  Emma rubbed Ann’s arm and gave her an encouraging smile. “We’ll take good care of you, I promise.”

  Emma headed to the doctor’s station. Damian was on the phone. When she realized he was talking about Ann, she pulled up a chair, sat and listened.

  “G’day Carl, it’s Damian from ED here. I have an eighty-six-year-old woman who needs a chest tube. She had a fall at home earlier today. Fractured ribs and a hemothorax. Have you got any interns up there who want to practice?” There was a pause as he waited for the reply. “Okay no worries. She’s in exam room six. She’s stable. Not bad for her age either. Give me a yell if you need me. I’ll be around. Yep. Cheers.” He ended the call and noticed Emma. “When Carl Schneider from the medical ward gets down here with his med student, can you let me know?”

  Twenty minutes later two unfamiliar doctors arrived and Emma saw them head to Ann’s bed. She arrived as everyone was making the introductions.

  The older doctor introduced himself. “My name’s Dr. Schneider and I’m one of the doctors on the medical ward. This is Dr. Swan. She will be inserting the chest drain.”

  Ann nodded and flicked a nervous smile at the younger doctor.

  “Hello Ann. My name’s Tracey. Dr. Schneider will be assisting me. As you know, there are always risks involved with any medical procedure. Do we have your permission to insert a drain tube?”

  Ann glanced at Tony. The color had drained from his face. “Yes. Yes. Absolutely. Of course,” Ann said, still looking uncertain.

  Tracey looked at Emma with a questioning look.

  “Hi. I’m Emma. One of the nurses. I did the work up on Mrs. Collins. I can help you if you would like.”

  While Tracey washed her hands, gloved, and gowned, Emma took Tony to the waiting room. She returned and stood quietly to one side, holding Ann’s hand.

  Carl and Emma looked on as Tracey covered Ann in sterile green drapes before sterilizing a large area of Ann’s chest from her armpit to her abdomen and across the center of her chest with betadine. Using local anesthetic, she numbed the area and waited a few minutes before using a scalpel and making a small incision between Ann’s ribs. Using her fingers first then a pair of large curved metal clamps, she gently opened a space in the chest cavity by spreading and splitting the muscle fibers.

  “How are you doing Mrs. Collins?” Tracey asked.

  “All right,” came the mumbled reply from under the drapes.

  “It’s not hurting too much is it?”

  “It’s not bad.”

  “Now you insert the trocar and that forms a track to insert the chest drain,” Carl said.

  Emma’s head whipped up to stare at the older doctor. Metal trocars were no longer routinely used for these procedures.

  Tracey hesitated before picking up the blunt instrument. Emma grimaced as Tracey forced the trocar through the chest wall. She inserted the chest drain and attached it to the one-way drainage system, which allowed air and fluid to flow out, and stopped drainage back in the lung. Suturing it in place and then covering it carefully in an occlusive dressing, Tracey stepped back and pulled off her gown. Emma noticed a sheen of perspiration on her brow. Emma was about to attach a suction tube to the drain when she noticed dark red fluid rapidly flowing into the box. She frowned. That wasn’t right. She stepped aside and pointed to the drainage canister.

  “Check her blood pressure,” Carl demanded. “I’ll be back in a moment.”

  He fled without explanation, leaving Tracey oblivious to his concerns. She continued to clean up while Emma wrapped the blood pressure cuff around Ann’s arm and hit the button to inflate it. Ninety systolic on forty diastolic. It was low. Lower than on admission. She turned to tell Tracey but she had left the room too. Biting her bottom lip, Emma was about to search for Carl when Damian barged in.

  “Talk to me,” Damian snapped, without as much as a sideways glance at Emma. He checked the drain, saw the blood, scowled.

  Emma’s heart rate rose. She couldn’t bring herself to look at Ann.

  “Dr. Schneider told Dr. Swan to use the trocar. I think it’s gone into her liver or abdominal cavity.” Emma spoke quietly, trying not to alarm Tony or Ann.

  “She needs to get an urgent CT scan,” Damian said.

  “What’s wrong?” Ann asked.

  Damian drew in a deep breath and smiled. It didn’t reach his eyes. “We’re not sure, but there’s a lot of blood in the drain – a lot more than we would have expected. The blood might be coming from somewhere else and we’ll know more after we run some tests.”

  He sounded calm but the thin bead of sweat on his upper lip gave an indication of how serious the situation was.

  “Is she cannulated?”

  “Yes, but it’s only a small gauge.”

  “Can you put in a large bore into her cubi fossa?”

  Emma nodded. “I can do it now.” She grabbed the metal trolley and pulled it toward her.

  “Good. While you’re doing that I’ll get the portable ultrasound and arrange an urgent CT.”

  Tony stuck his head around the curtain. Worry lined his face. “What’s happening? What’s taking so long?”

  “They want to check the drain is in the right place,” Emma said, touching him lightly on the arm. “If you head back to the waiting room I promise I’ll come and get you as soon as we’re done.”

  Tony looked unconvinced but nodded anyway. “Promise you’ll come and get me if anything is wrong.”

  “I promise.”

  Tony dragged his feet back to the waiting room as Damian wheeled the portable ultrasound in. He slid the plastic sleeve over the probe, added conducer gel and placed the probe on Ann’s abdomen. Emma stared at the screen with no idea what she was really looking at but filled with a sense of unease anyway. Damian swore softly.

  “What?” Emma asked.

  Damian didn’t take his eyes from the screen. “Can you go and get her husband please?”

  Emma rushed from the room and returned with Tony to find Mackenzie in the room. There was no sign of either Dr. Schneider or Dr. Swan. Damian had probably sent them packing, back to the medical ward.

  “BP’s seventy systolic,” Mackenzie called out. Ann looked pale and her eyes were closed. She was having difficulty breathing.

  Mackenzie squatted at the side of the bed, inspecting the drain with a deep frown on her face. “Sixteen hundred mills so far. It doesn’t look hemoserous to me. It looks like frank blood.”

  “What’s wrong?” Tony asked.

  “Unfortunately, very occasionally, there are complications with inserting a chest tube,” Damian said gently. “It appears Ann’s
liver has been nicked and that’s what’s causing the massive amount of bleeding. It’s easily fixed, but we need to get your wife into theater straight away. Is there anyone we can call to come and sit with you?”

  “I’ve ordered two bags of blood,” Lisa said, as she burst into the room.

  “I don’t want a transfusion.” Ann’s voice was weak but clear.

  Goosebumps exploded on Emma’s skin.

  “Blood is safe, Ann,” Damian assured her, looking at Tony for support. Instead Tony sank into the chair beside the bed and dropped his head into his hands.

  “We’re Jehovah’s Witnesses. Ann can’t receive blood.”

  Emma let out a small gasp before clapping her hand to her mouth. Why hadn’t anyone checked their admission paperwork?

  All the air seemed to be sucked from the room.

  “Even if it’s life or death?” Damian asked gently.

  Tony’s face looked anguished and he grabbed Ann’s hand.

  “What do you think sweetheart?”

  “I’d rather die than disappoint God. You know we can’t change our beliefs when it suits us, dear. We’ve been taught to respect life as a gift and not try to sustain it by taking blood. Even in an emergency.” The speech exhausted her and she fell back in the bed.

  Shocked silence filled the room as the medical staff looked from one to the other in bewilderment.

  “Does she really need a blood transfusion?” Tony asked.

  “We need to control her bleeding which we can try to do in theater. They’ll pack the liver and try to help with clotting, but the liver is made up of a spongy material that acts as a filter for blood. They’ll attempt to sew it together but doing so is like trying to sew a sponge up while it sits under a tap of running water. We’ll try to fill her with non-blood products, but I can’t promise you anything. I don’t yet know what her blood count is but I can see from the drain that she’s already lost massive amounts. I expect her Hb to be very low.”

  Tony nodded, his face grave, barely comprehending.

  “Tony, you need to know that without a blood transfusion, the fatality rate for a liver laceration is very high. If she survives the surgery, she may not survive intensive care.”