Undercover at City Hospital

by Carol Marinelli

  They were at the drug room now, and Bella could feel her breath bursting in her lungs as they made their way in. She tried desperately to keep up the light-hearted chatter as Jayne unlocked the controlled drugs cupboard and flipped out the book, but her expression changed when she saw a neatly wrapped parcel, pulling it out and turning it over in her hands.

  ‘What on earth’s this?’

  ‘Jim’s gift,’ Bella ventured. ‘Hannah said she was going to ask you to lock it up for her.’

  ‘Did she now?’ Jayne shrugged, replacing the present and getting on with the checking, and Bella found herself frowning, positive Hannah had told her she would be giving the watch to Jayne to lock up. ‘Pethidine, 50 milligrams.’ Jayne started pulling open the box, going through the routine they both knew so well. But even though Bella checked the contents carefully, her eyes darted inside the cupboard, curiously deflated when everything appeared in order. The five boxes of morphine still sat neatly on the shelf. Everything was just as it should be, Jim’s present neatly wrapped and tied with a bow, not a single thing out of place. ‘Right, we’ll give this and then, if you don’t mind, can you go and help Hannah to set up the staffroom?’ Jayne asked, pulling out the present and handing it to Bella. ‘We might as well take advantage while the department’s so quiet and give Jim his present now. Who knows what might come in later?’

  Hannah had done an amazing job in such a short time, the sink for once free of cups, a massive handmade banner hanging on the wall, wishing Jim every luck for his retirement.

  ‘You’ve been busy.’ Bella smiled, taking a couple of peanuts from the table Hannah had laid, then opening the staff fridge and pulling out a box.

  ‘I bought a cake.’

  ‘Oh, you didn’t have to do that,’ Hannah tutted. ‘You’ve only been here a week.’

  ‘I’ve met a few Jims in my time, though,’ Bella said fondly. ‘I’m sure he more than deserves it. Is there anything I can do to help?’

  ‘Round up the staff, I guess,’ Hannah said excitedly, eyeing her handiwork. ‘I’ll go and ask Jayne to get the present.’

  ‘She already gave it to me.’ Bella pulled it out of her pocket, trying to keep her voice even as she added, hopefully lightly, ‘I thought you said that Jayne had locked it up for you?’

  ‘She did,’ Hannah said absent-mindedly, cutting the cake into generous slices. ‘Why?’

  ‘She just seemed surprised to see it, that’s all. As if she didn’t even know it was in there.’

  ‘Then she’s losing her mind.’ Hannah gave Bella a queer look as she took the precious parcel. ‘I hope that Jim likes it. I took for ever to choose it.’

  ‘I’m sure he will.’

  Jim didn’t just like it, he loved it. Tears filled his eyes as he unwrapped the little parcel, pulling out a beautiful watch and holding it fondly.

  ‘Turn it over.’ Hannah beamed, and everyone stood silent as Jim read the inscription.

  ‘I’ll miss you all, too,’ he said in a voice thick with emotion. ‘No doubt more than you’ll miss me.’

  ‘Rubbish,’ everyone called, raising their glasses, but the noise died down as Heath made his way over, coming to stand beside Jim and addressing the gathered crowd.

  ‘I started here ten years ago, and I know it’s probably hard to believe but I wasn’t nearly as good-looking or confident then.’ A few more catcalls and giggles, before his voice grew more serious. ‘Jim was on the first night I worked, and in those days there wasn’t a consultant or registrar in the department, just me on my lonesome, and I don’t mind telling you I was bloody terrified. All night Jim came up to me—“Are you going to take those bloods soon, Doctor? Only I’m on my way to the lab,” or “Did you want that child to have another nebulizer before I take her round for her chest X-ray?” And it wasn’t until about five in the morning when I was sitting smugly nursing my cup of tea and realizing I’d got through my first night alone without killing anyone, feeling pretty pleased with myself how I’d run the show, that I realized it hadn’t been me running the show at all. Instead, it was this guy.’ He held out a hand to Jim and shook his warmly. ‘A guy who’d already been here for thirty years by then, who’d seen the first patient wheeled through the doors when the department opened. A guy who in his own quiet, unassuming way has helped all of us through our first nights. And you’re wrong, Jim, to suggest you won’t be missed. Everyone in this room is going to miss you, but it’s not just us who are going to miss you, it’s the new staff who start from here on who won’t have you to guide them and the patients who won’t have the benefit of your wisdom.’

  And even though Bella had never worked with Jim, just seen him going off duty a few times, she could feel her own eyes filling as Heath delivered his lovely speech, knew how proud Heath’s words had made Jim feel.

  ‘To Jim,’ everyone called, downing their fizzy drinks and slapping him on the back before diving onto the table, emergency staff always ready to party.

  ‘That was great, Heath.’ Hannah’s voice was choked as Heath came over. ‘It will have meant a lot to Jim.’

  ‘It’s the truth,’ Heath said easily. ‘But, Hannah…’ His voice lowered. ‘There’s no way there was enough in that envelope for that watch.’

  ‘A couple of people put in after you.’ Hannah blushed, shrinking under Heath’s knowing gaze.

  ‘Not that much, Hannah. How much extra did you end up putting in?’

  ‘Just a few dollars. Please, don’t make a big deal out of it, Heath,’ Hannah begged as Jim started to make his way over. ‘Jim’s been really wonderful with all my problems with Ken. Don’t say anything.’

  ‘On one condition,’ Heath warned. ‘You catch up with me later and tell me what the difference was. OK?’

  ‘OK!’ Hannah snapped, then painted on a bright smile as the man of the moment joined them, proudly displaying his new watch for everyone to admire.

  ‘I was hoping for a busy night,’ Jim sighed. ‘I’d like to go out with a bang.’

  Hannah glanced down at his watch.

  ‘There’s still plenty of time for that yet, Jim.’

  ‘Can you believe we’ve got a clear board?’ Jayne smothered a yawn, staring around at the empty department. Every gurney had been stripped and re-made, every trolley cleaned. The night seemed impossibly long with so few patients to fill it. Only Bella sat nervously bouncing her knee up and down, twisting a stray lock of hair round and round her finger, as the rest of the staff slumped lethargically. The students were on an extended meal break, and the other RNs were either taking the final patients up to the wards or around in the overnight obs ward, trying to calm an elderly Alzheimer’s patient who had risen before the sun and was loudly demanding to go home this very instant!

  ‘Who are those two guys in the waiting room? I might go and tell them to move.’

  ‘They’ve got a niece or something on the children’s ward.’ Bella answered Jayne quickly, using the line that had been rehearsed in case anyone asked about the undercover detectives in the waiting room, especially conspicuous now that the department was empty. ‘They didn’t want to go home, but there’s only one family member allowed to stay up on the ward, so I said it would be OK if they waited here.’

  ‘Fair enough. Don’t,’ she groaned as Heath came over, yawning. ‘It’s infectious, you know.’

  ‘I’m bored,’ Heath whined like a petulant two-year-old.

  ‘Then why don’t you go and lie down in the on-call room?’ Jayne suggested.

  ‘Because the second I close my eyes, no doubt something will come in.’

  ‘We won’t call you unless it’s serious,’ Jayne responded, shooing him off. ‘Go and put your head down for a couple of hours. If nothing comes in, I’ll give you a knock before I go off duty.’

  Heath didn’t need to be asked a third time, taking off his white coat and stethoscope in record time and tossing them over a chair. ‘You’ll call me?’ he checked, but didn’t wait for an answer, heading straight fo
r the on-call room, happy to grab a couple of hours’ sleep whenever he could get it.

  ‘I suppose I should try and get some rosters done,’ Jayne sighed with a distinct lack of enthusiasm. ‘Or I could just make another cup of coffee.’

  ‘Coffee sounds good.’ Hannah looked up from the magazine she was reading. ‘Do you want me to make it?’

  ‘I’ll do it,’ Jayne said, getting up.

  Bella stood up as well. ‘I’ll go and check on the guys in the waiting room, see if they want me to ring up to the ward for them for any news.’

  ‘It’s like a bloody ghost town,’ Detective Miller moaned as soon as Bella came over.

  ‘Tell me about it. The only controlled drug that’s been given is 50 milligrams of pethidine, and everything seemed in order. Except for one thing,’ Bella added, almost as an afterthought, not sure whether or not it was relevant. ‘Hannah told me she gave Jayne a leaving present to lock up in the drug cupboard.’

  ‘Has it gone missing?’

  ‘Nothing like that.’ Bella shook her head. ‘It’s just that when Jayne and I checked the pethidine, Jayne seemed surprised to see it there, as if Hannah hadn’t told her. It could be nothing, it could have just slipped her mind, I guess.’

  ‘Look, you’d better get back to it,’ Detective Miller said. ‘Just keep your eyes and ears open. There’s something going on.’

  ‘There’s nothing going on,’ Bella insisted. ‘We couldn’t have picked a more ordinary night. There’s nothing going to go down.’

  But Detective Miller shook his head. ‘I can smell it, Bella, so keep your wits about you, because this is exactly the time when crimes happen—when you’re least expecting it.’

  The waiting-room door slid open then and Bella watched as Jim wheeled in a patient, assessing the situation in a matter of seconds.

  In obvious pain, the man was clutching at his chest, and even though the few words he spoke weren’t in English, Bella didn’t need a translator to work out that he was in serious discomfort. She took the man’s pulse as Jim deftly wheeled him straight through to Resus. Hannah put down her magazine and made her way over as Jim told them the little he knew.

  ‘His family are just moving the car. None of them speak very good English but I think his name’s Mr Kapur.’

  ‘Thanks, Jim.’ Hannah nodded gratefully, deftly applying a chest monitor as Bella did a swift set of obs, speaking all the while in reassuring tones, even though the patient probably didn’t understand her, but even more so in this case a calm, assured demeanour was called for. ‘Can you get IV access?’ Hannah asked, programming the monitor to do a 12-lead ECG, which would give a comprehensive indication of the patient’s cardiac status. ‘And then we’d better give Heath a call.’

  Just as Bella swabbed the area, needle poised at the back of a rather poor-looking vein, the emergency phone trilled loudly, and Bella looked up anxiously, before concentrating on the important task in hand.

  ‘It’s OK.’ Hannah was looking over towards the nurses’ station. ‘Jayne’s back. She’s picking up the phone.

  ‘Well done,’ she added as the cannula slipped into place on Bella’s first attempt, handing over some tape so that she could secure the access.

  ‘Jim’s big bang’s about to come off.’ Jayne made her way over swiftly to deliver the news. ‘We’ve got a single vehicle motor accident. Three passengers, two adults and one child. Multiple injuries is all the information we’ve got at this stage. I’ll start setting up and call down the trauma team. Hannah, buzz round to the girls in the obs ward and tell one of them to come back. Jess should be back from the ward at any moment, she’ll run anyway when she hears the overhead chimes. Bella, can you go and wake up Heath?’

  Running through the department, her rubber soles barely making a sound, Bella almost skidded into Jim, who was guiding Mr Kapur’s relatives through to the interview room.

  ‘There’s a multi-trauma coming in,’ Bella called out to him, and Jim gave a knowing nod, heading straight off towards Resus to see what Jayne wanted him to do.

  Knocking loudly on Heath’s door, Bella suppressed a smile as she heard a sleepy curse. The door opened a matter of seconds later, his usually immaculate hair sticking up at right angles, the crease marks from a pillow on the side of his face. Never had he looked more gorgeous.

  ‘Multiple trauma coming in.’ Bella explained as Heath pulled on his shoes and followed her out, raking fingers through his hair as he walked. Almost annoyingly, Bella noted, his hair fell into perfect shape. ‘Two adults and a child. That’s all we’ve got so far.’

  ‘OK, call down the trauma team.’

  ‘Done,’ Bella responded. ‘There’s a chest pain just come in as well, although he doesn’t looked too bad at this stage. We’ve got IV access.’

  They were at Resus now. Nurses were gathering around the beds as the trauma team started to arrive. Not a single yawn came from anyone, adrenaline already starting to kick in as they awaited the arrival of the patients. Immediately Heath made his way over to Mr Kapur, introducing himself to the bewildered man and then listening carefully to his chest with his stethoscope before reading the ECG.

  ‘Does any of his family speak English?’ he asked after a few fruitless attempts at trying to get a history from Mr Kapur.

  ‘None of them, I’m afraid,’ Hannah answered. ‘I’ve just been out to the waiting room to try and get a better history but I couldn’t get them to understand. They gave me some Anganine tablets that have his name on them, so I guess we at least know he suffers from angina.’

  ‘I think it’s angina he’s got now,’ Heath said, ‘but we’d better take some blood and check his troponin levels just in case he is having an infarct. I’ll get Cardiology to come straight down and assess him. If these three are badly injured, we’re going to be busy.

  ‘This is your fault, Jayne.’ Heath gave a slow lazy smile, assuming control and calming everyone at the same time. ‘I told you I shouldn’t have gone to bed.’

  As the blue lights flashed past the window, all joking was put on hold, all faces grim as they awaited their patients, everyone in the room aware that this was probably a family that might just have been torn apart.

  ‘Driver!’ a breathless paramedic announced, following Heath’s command and taking him to the far end bed. ‘He was unconscious on arrival, his GCS was only five at the scene, but he’s picked up since then and it’s lifted to ten. He’s really irritable.’ The rapid shorthand that was delivered as the patient was carefully lifted over to the waiting bed told the gathered staff a lot. The normal GCS score was fifteen, and the man lying on the bed was a dangerous way off that figure. Clearly disorientated, he was moaning and thrashing around the bed, one hand twitching ominously, Bella had the uneasy feeling he was about to start to convulse.

  ‘Have we got a name?’ the anaesthetist called, flashing a light into the man’s pupils and doing a rapid assessment, then calling for anticonvulsants as the patient went into a full-blown convulsion.

  ‘Patrick O’Keefe, according to his driver’s licence,’ the paramedic answered, watching as the patient’s fit was swiftly brought under control and the anaesthetist made the decision to paralyse and intubate him, inserting a tube down his throat to take over the patient’s breathing while they concentrated on his injuries. ‘Though it’s an overseas one. Apparently they were on their way to the airport. Some end to their holiday. Some families have all the bad luck…’

  Horrified, Bella watched as Heath closed his eyes in a tiny moment of regret, his grim face tensing further as the resus doors slid open again and their worst fears were confirmed. The pale, terrified features of Lucy came into sharp focus, her glorious headscarf wrapped around her neck, her tiny frame racked with frightened sobs as the paramedics wheeled her in.

  ‘Take her, Bella,’ Heath ordered, his voice unusually tense as he headed over to Patrick. ‘She needs a familiar face.’

  Hands shaking involuntarily, Bella listened to the paramedic’s hand
over as she gently slipped Lucy into a hospital gown, retrieving the scarf and tying it around her smooth, bald head before recording a set of obs. She desperately tried to console her terrified patient, but knew how hollow her comforting words sounded to a woman who had already been through way too much and had to face yet more.

  ‘My daughter, Marnie.’ Lucy was inconsolable, saying her child’s name over and over. ‘She was screaming. Where is she?’

  ‘She’s coming in,’ Bella said gently. ‘The paramedics said she was in the ambulance behind.’

  ‘She was screaming so loudly. The poor child was terrified.’

  ‘That’s good,’ Bella soothed. ‘I know that sounds like a strange thing to say, but the fact she was screaming is actually a good sign, Lucy. It means that she’s conscious.’

  While the conversation was going on Bella was observing her patient, doing a set of obs and then assisting Heath in his examination when he finally came over, leaning Lucy forward as Heath listened to her frail chest, then laying her down as he gently probed her flat stomach. There was not a pound of spare flesh on Lucy’s tiny emaciated body, and not for the first time Bella wondered just how much one person was supposed to take.

  ‘You’ve got some bruising across your chest,’ Heath explained gently, ‘which normally wouldn’t be serious, but we’re going to need to admit you, Lucy. We need to check your bleeding times…’

  ‘Don’t worry about me. What about Marnie? What about Patrick?’

  ‘Patrick’s been sedated.’ Heath spoke very slowly and clearly. ‘When he first came in to us he started to convulse so the anaesthetist has put a tube down to help with his breathing, just until we know what’s going on and he’s a bit more stable. The neurosurgeon has come down and Patrick’s going straight round for a CAT scan. As soon as we’ve got the results we’ll know more.’

  Lucy was consoled only for a second as piercing screams filled the air, Lucy sat bolt upright, ‘That’s Marnie,’ she wailed, and if she’d had an ounce of strength left in her, Bella would have sworn Lucy would have climbed down from the trolley there and then.