She twisted her ring around her finger absentmindedly and stared blankly at the computer screen. Whenever she went to touch him, he pulled back. Other than a platonic kiss on the cheek when he left to go home each night, there was no indication from him that he wanted to take the relationship any further than just good friends. His actions were the complete opposite to what he had told her sitting on the straw bale out at his farm. She was totally confused and very frustrated. She liked Joel – a lot – but now she didn’t know if he was having second thoughts.
When the alarm sounded, she flew out of her chair on immediate high alert.
“Code blue. Level Two West.”
Maternity ward. Next to children, maternity patients were another of Kate’s worst case scenarios. It was just too close to home. A crowd of people were gathered around, waiting for more information. Amanda raced out the door, pushing the resuscitation trolley with Ewan in hot pursuit.
Kate called the hospital co-ordinator for more information. “What can you tell me?” she asked when he answered his phone.
“Twenty-six-year-old female, twenty-eight weeks pregnant. Type one diabetic.”
Kate groaned inwardly, having a feeling she knew where this story was headed.
“Type one diabetic or gestational diabetes?” Kate asked.
“Type one,” the co-ordinator clarified. “She’s been unable to eat for the past few days due to the continued morning sickness and she missed taking her insulin. Her husband noticed she was going to the bathroom every hour or so and complaining of abdominal pain and nausea different from her usual morning sickness.”
“Drinking lots too, I suppose?” Kate asked.
“Yes. And drowsy. Husband brought her in half an hour ago. God only knows why he didn’t take her straight into the ED or call an ambulance.” Kate heard the frustration in the co-ordinator’s voice and agreed with him.
“She was non-verbal and could barely open her eyes by the time staff had time to do a set of obs and take a full assessment. When they eventually got around to doing her sugars, they were through the roof. Hubby didn’t even tell them she was a diabetic!”
“What’s her BSL now?” Kate asked.
“Thirty-two-point-five.”
Kate let out a shocked sound. That was almost ten times the normal level.
“Ewan’s just doing an arterial stab now and taking bloods. As soon as we get her stable, she’ll be coming up to you guys.”
The call was disconnected. The co-ordinator had confirmed what Kate already expected and she began preparing the room for the admission the second she hung up the phone. She wondered briefly about the baby and realized that right now, saving the mother’s life was going to be her first priority. Kate gathered the staff around her and quickly explained the situation. As she was speaking, Amanda arrived back with the arterial blood in a syringe to be analyzed on the blood gas machine in the unit.
“How does it look down there?” Kate asked her.
“Not too flash,” came her quick reply as Amanda punched in the numbers on the machine and waited for the sample results.
“The baby?”
Amanda removed her glasses and rubbed the bridge of her nose. “Monitor is on and fetal heart rate is okay for now – no signs of distress. Pediatrician and obstetrician have both been called. They’re on their way and I heard the co-ordinator organizing theater for standby in case they need to take the baby.”
“But we’re not set up to take a premmie that little,” Kate exclaimed.
“I know. But what can you do? I’m sure they’ll be organizing NICU transport if they need it. They can chopper the baby to the city as soon as it’s born.”
The machine printed off the report and Kate waited for Amanda to read the numbers.
Amanda swore softly and Kate looked over her shoulder at the printout. The patient’s numbers were almost incompatible with life.
Two lives depended on the speed and accuracy with which the ICU team worked and Kate watched as everyone switched into high gear. The buzz in the unit was frantic and harried as everyone worked together. Kate’s mind was racing and her legs were shaking with adrenaline. She hated emergencies that involved pregnant mothers almost as much as she hated pediatric codes.
Suddenly the doors of the unit were flung open and the patient was brought through on the bed, pushed by an orderly. Ewan was leading the way and he began giving orders as soon as he saw Kate.
“This is Hannah Smith. Twenty-eight weeks pregnant. Type one diabetic. Baby is doing okay so far. We need to start some infusions now,” he stated. “Can someone put in an IDC please?”
“On it,” Kate responded.
“I’ll do it,” Amanda said at the same time.
Kate turned to Amanda. “Where’s her husband?”
“No one seems to know.”
The alarms on the monitor were pinging and Kate went to silence them. Hannah’s heart was beating erratically and her eyes were closed. Kate stroked the woman’s arm and spoke softly to her, unsure if she was able to hear. Her own heart pounded in her ears as the blood whooshed through her body.
“Where’s Simon?” Ewan asked. “We need to intubate her here. We can’t wait to get her up to theater.”
A moment later Simon was paged and he arrived within minutes. Kate watched as he immediately summed up what was going on. She left the room and returned with the trolley and equipment he would need to intubate.
“Has anyone found her husband yet?” Amanda called out. “We need his consent.”
“I’ll get the co-ordinator to find him,” Kate replied.
“There’s no time,” Simon said, approaching Hannah’s head. “We need to get an arterial line and a central line in and get her tubed – not necessarily in that order.”
“She’s still maintaining her own airway,” Kate said.
“Then get everything set up for an art line and a central line,” Simon replied. He spoke calmly as he rolled up the sleeves on his pink checked shirt and washed his hands at the sink in preparation. “And Ewan, get ready to get that tube down please.”
Kate set up the tray and Simon sterilized Hannah’s wrist.
“Small sting.” Simon injected some local anesthetic into her skin and after waiting a few moments he then placed the small needle straight into her radial artery, guiding the sterile wire through the needle and advancing the plastic catheter over the wire. Hannah did not even flinch.
“Done,” Simon said as he securely taped the catheter in place with a clear plastic dressing and connected the arterial line to the flush bag that hung above the head of the bed.
“You’ve got a good trace,” Kate told him, referring to the waveform displayed on the overhead monitor, “but BP is two-thirty over one hundred.” This was way too high and could further complicate Hannah’s condition. They would need to give her some medication to bring her blood pressure down.
“Do you want me to grab some clonidine?” Amanda asked, referring to the medication that could be administered in quick, short bolus doses to temporarily reduce Hannah’s blood pressure.
“Check the non-invasive first please,” Simon said.
With shaking hands Kate wrapped the blood pressure cuff around Hannah’s arm and waited for the cuff to inflate. “Two-ten systolic,” she called out.
“Kate, while I get everything set up for a central line, can you get the drugs we need for an RSI?”
He spoke to her without looking up and Kate’s mind rolled the letters around in her brain for a split second before remembering what they stood for. Rapid sequence intubation. How could she have forgotten that? In the heat of the moment she was usually so calm and controlled but for some reason Hannah’s situation was causing her to falter.
“You’ll also need fent and prope and while you’re there, grab some mannitol and phenytoin. I’m worried she’s going to have a seizure.”
Kate hurried from the room to get the drugs Simon needed. Calling out to Debbie as Kate went past, she a
sked, “Can you get another pair of hands in here please Deb? We’re going to have to intubate and we might need the orderlies on standby too, just in case she has a seizure. They can help hold her down. And could someone please find her husband!”
As Kate walked back into the room a few moments later, Hannah’s blood pressure had dropped considerably but she was having a seizure. Snapping the glass vials open, Kate drew up the drugs that would help stop the seizure and handed the other medications to Simon. Within a minute of pushing the drug into Hannah’s vein, she stopped seizing.
“What the hell is going on?” A male’s loud voice could be heard shouting down the hallway. “Where’s my wife? I want to see my wife.” Kate heard the panic in his voice.
“Stop him,” Simon said, not even looking at Kate.
She rushed to meet the man who was striding purposefully toward her.
“Mr. …?” She couldn’t even remember his name.
“Smith. Ben Smith. Where’s Hannah? What the hell has happened to my wife? Is our baby okay? I just went to get a coffee and I came back to the room and she was gone. They said she was in intensive care!”
Kate held her hands up and they met with his chest as he continued to barrel toward her.
“Ben. Hannah is very unwell. It’s her diabetes.” Kate knew it was pointless trying to explain further. She could almost smell the man’s fear.
“Our baby?”
“They are both okay but we have to intubate her.” She tried to put a hand on his arm but he brushed her off.
“What does that mean? Where is she?” He looked around him, eyes wild with worry.
Kate tried again, speaking as calmly as she could. “Ben, we’re about to put a tube down Hannah’s throat to help her breathe and then we have to take her up to theater. They need to do an emergency cesarean.”
His eyes were wide with terror. “But you said our baby was okay,” he stammered.
“Yes, at the moment, the baby is fine. But it will probably have to be flown out to Sydney.”
Ben was wringing his hands together – something Kate had never actually seen anyone do. He was on the verge of tears. Kate tried once more to reassure him.
“As soon as the tube is in, you can come and see her. But she’ll be asleep, okay?”
“Okay.” He nodded but Kate could see he didn’t really understand what she was saying.
“Stay here. I’ll be right back.” She left him standing in the middle of the hallway and was pleased when Debbie approached him and drew him over to a chair.
Kate pulled the curtain aside just in time to see Ewan standing in position, ready to place the tube in Hannah’s throat. Ewan opened her mouth and inserted the laryngoscope.
“I see her vocal cords,” he said, manipulating the scope.
He placed the tube into Hannah’s trachea, confirmed it was in the right position and blew up the small balloon that would ensure it stayed inflated and in position. Amanda helped Kate wrap the white tracheostomy tape securely around the tube and back around Hannah’s head and connected her to the ventilator. It was all over in a matter of seconds.
Everyone fell strangely quiet. The beeping heart rate on the monitor and the slow rhythmic sound of air being gently pumped from the ventilator into Hannah’s lungs were the only sounds heard in the room. To Kate they seemed as loud as thunder in the small space.
Kate exhaled, not even realizing she had been holding her breath. “Good job everyone.”
With Hannah now sedated and ventilated, Amanda took another sample of blood from the line in Hannah’s wrist and Kate went back to Ben.
“You can come and see her.” She held her arm out and indicated that he should follow her. She passed Amanda who was standing at the blood gas machine as it spat out its report.
“Potassium is coming down,” she said.
“Sugar?” Kate asked.
“Also coming down.”
“Great. What about the pH? Is it also correcting?”
“Yes.”
Kate let out a sigh and realized she had been holding her breath again.
Ben took one look at his wife and almost crumbled to the ground as he began to sob. “I didn’t know she was so sick,” Ben cried. He was so distraught he couldn’t bring himself to get any closer to his wife. He stood aimlessly at the end of the bed, watching her. Kate wasn’t used to men crying, and the sound made her feel as though her own heart was ripping in half.
Just as Hannah was stabilized, the fetal monitor indicated the baby’s heart rate was climbing. The pediatrician took over and within moments Hannah was wheeled out the door to theater, her bed laden with the equipment needed to monitor her condition on her transfer from ICU to the operating theater. Ben trailed behind, looking lost and out of place. Kate hoped he was going to be okay.
As the doors closed behind them Kate looked around her and wanted to cry. The place was in complete disarray, with packages and leads and lines and bags of fluid lying everywhere and she had no idea where to even begin. She also knew the real reason for her tears and she wasn’t sure she was going to be able to hold her secret much longer.
Chapter 35
Less than half an hour later, Kate looked out the window of her office when she heard the sound of the helicopter’s blades and she sent up a silent prayer that Hannah and her baby would both survive. As she was about to get stuck back into paperwork, her phone rang and she smiled broadly when she saw the caller ID displayed on the screen.
“Melissa! It’s so good to hear from you.”
“Well since you haven’t called me in ages, I thought I’d better call you! I’m sick of just commenting on all your Facebook status updates and photos. Have you forgotten how to use a phone and actually call me?”
Kate heard the teasing laughter in Melissa’s voice and decided to tease back in return. “Sorry, I’ve been so busy! And you could have called me!”
“True,” Melissa laughed. “So what’s been keeping you so busy in the bustling town of Birrangulla?”
“Well we just flew a baby out to Sydney half an hour ago.”
“Oh wow!”
“Yeah, sometimes it seems like we go from one crisis to another here. First I get mild hypothermia from spending too long making a snowman, then one of my best friends nearly dies because no one here knew how to use the hemofilter. And then to top it all off I’ve been busy trying to juggle Joel, Liam, Baxter and Rupert, so I guess that’s why I haven’t had time to call you! I’ve been a bit busy.”
As she spoke, Kate kicked her shoes off and rubbed her sore feet.
“Whoa, wait a minute! Slow down! You’d better start talking quickly Kate Kennedy and explain yourself. First of all, who have you just flown out?”
Kate’s usual coping mechanism for dealing with tragedies and difficult days at work was to try to put them out of her mind as quickly as possible, but she knew better than that. Debriefing with Melissa would be the perfect way to end the day she had just had. Kate quickly explained what had just occurred. She didn’t realize until Melissa asked all the right questions how frightened she had been. Talking it over with her friend helped ease some of the tension that had built up as Melissa reassured Kate that she’d done everything right.
“So now tell me all about these men in your life,” Melissa laughed, lightening the mood by changing topics.
“Well Rupert is my scarecrow so that counts him out,” Kate replied, laughing in return.
Hannah, Ben and their baby were immediately forgotten. One minute she had felt like curling up in a ball and crying, and the next she was joking about her love life. I guess that’s pretty typical of nurses, she thought.
“Scarecrow?”
“I told you I moved to a farm – and farms have veggie gardens and veggie gardens need scarecrows. To scare away the crows.” Kate laughed again.
“Veggie gardens? Hang on, have I got the right number? This is Kathryn Anne Kennedy isn’t it? My friend who has never had anything to do with gardens? Or s
carecrows for that matter!”
“I’ve got chickens too!”
“Chickens?” Melissa repeated.
“Yeah, you know, chickens that lay eggs.”
“First a scarecrow and veggie gardens, and now chickens. I don’t think I know who you are anymore! What’s next?”
“Um.” Kate started laughing. “Would you believe I’ve got a dog?”
“Really? Wow. What type?”
“Border collie. He’s gorgeous. His name is Baxter.”
“Okay, well the story of the gorgeous dog can wait but you’d better explain yourself a bit more. I heard you mention two other names. Liam and who?”
“Joel,” Kate replied.
“Spill it, Kate.”
Kate decided to tease Melissa some more. “Liam and Joel. They’re twins, they’re Irish, they’re single and they’re very, very cute!”
“You’re making it up.”
“I wish I was.”
“So let me guess – they’re probably someone’s kids you’re babysitting,” Melissa sighed melodramatically, “and here I was hoping you’d fallen in love.”
“Well …” Kate let the word drawl, enjoying the suspense.
“What?”
“I think I have fallen in love.”
“And don’t tell me – you can’t tell them apart and you don’t know which one you’ve fallen in love with!”
Kate laughed. “Nothing like that!”
“So what’s the story?”
Kate spent the next few minutes filling her friend in on her and Joel’s relationship, right from the day she’d met him in the elevator in Sydney.
“He sounds perfect. So, what’s the catch?” Melissa asked.
“It’s complicated,” Kate replied.
“Most relationships are,” Melissa said with a chuckle. “Surely you’ve worked that out by now. So, what aren’t you telling me?”
Intensive Care: Escape to the Country Page 27
