by Amy Andrews
H for haemorrhage. Bingo! ‘Hey, mate,’ said Daniel, snapping on some gloves and pulling a sterile dressing pad out of his kit. The assistant gratefully gave up his spot so Daniel had room to work. ‘I’m Daniel. I’m a paramedic. What’s your name?’
Daniel eased the makeshift dressing away from the wound gently so he could assess the damage, not wanting to disturb any clot that may have formed. The injury was in mid-thigh. Not pumping and the blood seemed darker and therefore venous. That was good but it was still oozing considerably. Taking a rough guess at his patient’s blood loss, Daniel thought he’d probably lost close to a litre.
‘Gordon,’ he groaned. ‘He shot me. I can’t believe he bloody shot me!’
‘Are you hurt anywhere else?’ asked Daniel as he replaced the pad with a sterile one and bandaged it firmly in place, exerting more pressure over the top with his hand. He did a quick visual head-to-toe check.
The man shook his head vigorously. ‘It’s just me bloody leg!’
‘Right, you,’ said Daniel, pointing to the person who had been helping when Daniel had arrived. He’d introduced himself as Reg. ‘You were doing a great job, Reg. You reckon you can hold this for me again? Firm pressure, OK?’
His helper did as he was asked but their patient continued to roll around a bit.
‘Gordon, you need to keep still so we can apply effective pressure.’
‘Hurts too bloody much to stay still,’ he yelled, and groaned again.
Daniel heard his back-up arrive. ‘I’m going to put you on oxygen and then put in a drip. We’ll be able to give you some pain relief then. OK?’
‘Whatever, mate! Just do it,’ he snapped.
The back-up paramedics joined the scene and Daniel quickly allocated them jobs. Being an IC para, Daniel had seniority and controlled the scene. As he inserted the IV, Gordon was being hooked up to a monitor and having his vital signs recorded.
‘BP ninety systolic.’
Daniel assessed the information. It wasn’t too low but for a man in extreme pain you’d have expected it to be higher, unless he’d lost a large amount of circulating blood volume. Hypovolemic shock was to be avoided at all costs.
Daniel hooked up a plasma supplement and ran it in as fast as it would go to replace the blood loss. He also administered a dose of morphine and Gordon became easier to manage.
Daniel’s next concern was whether Gordon’s femur was fractured. That could be causing a large part of Gordon’s pain. Daniel suspected it had been, and guessed it had probably splintered into many shards if it had taken the full force of the bullet.
If he could splint the leg, using a figure-of-eight technique applied to Gordon’s feet, he would be able to apply traction to his injured leg and hopefully reduce his pain further. Daniel didn’t want to move him until they’d stabilised his femur.
Working as a team, the three paramedics quickly and efficiently applied the figure-of-eight bandage and then splinted both legs together. Daniel was satisfied they could load Gordon now his haemorrhage was being efficiently controlled, his fracture reduced and his lost fluids were being replaced.
Daniel drove to the hospital behind the ambulance. His patient was as stabilised as he could be in a pre-hospital setting, so he found his thoughts returning to Sophie. He knew she was working today. What were the chances they would meet?
Very good actually. Sophie’s face was the first he saw as he entered St Jude’s. He stared at her and saw her momentary surprise.
‘Sophie.’
‘Daniel.’ Her tone was brisk. Her actions methodical. ‘What have we got here?’ she asked, refusing to look him in the eye.
Daniel sighed and handed his patient over to her with the most professional façade he could muster. If she could pretend nothing had happened, so could he. He fought the urge to stick around, guessing it would make her job a lot easier without him hovering in the background. Gordon was in good hands and he had definitely been dismissed!
The silent treatment continued at Arabella. Thank goodness for Max. At least he didn’t treat him like a pariah. Not that he didn’t deserve it. Daniel knew he had been way out of line the other night. He had tried to talk to Sophie about it a couple of times but she was obviously still pretty angry with him.
‘What did you do to my mummy?’ Max asked him one morning after Sophie had left the breakfast table the minute Daniel had arrived—again.
‘What makes you think I did something?’ asked Daniel, amused by the observation skills of his three-year-old nephew. It must be fairly obvious if Max had noticed!
‘She does that dippy thing with her eyebrows when she looks at you,’ he said, stuffing some toast into his mouth. ‘Like she does at me when I’ve been naughty.’ Max did a fairly good impression of his mother’s frown.
‘Oh,’ said Daniel, chuckling. Out of the mouths of babes… ‘I said something to upset Mummy. Something I shouldn’t have said.’
‘Don’t worry, Unca Dan,’ said Max, patting Daniel on the hand. ‘Mummy never stays angry for long.’
Oh? The way he figured it she’d been angry at him for longer than Max had been on the planet. He looked down at his nephew’s hand on his and felt a little pang in his gut. Oh, to be so innocent, so trusting! Sophie had done a great job. Michael, too. The pang intensified. How lucky his brother had been.
In many ways he hadn’t, of course. He’d been a paraplegic and had died too young, but he’d also had Sophie and sired a son. Surely, in the grand scheme of things, those were the things that mattered?
Looking down at the little hand, he found himself absurdly jealous of his brother. And something else. Determination crystallised in his mind. Determination to be a part of this little boy’s life, maybe pick up where his brother had been so cruelly torn away.
He suddenly regretted the last two years he had wasted on the other side of the world. Max needed him. As a role model, a father figure, even as a link to Michael. What was that old saying? It took a whole village to raise a good child. He knew with sudden clarity as the little hand warmed his that he wanted to be a big part of his nephew’s life.
Daniel hung onto the side of his seat as the ambulance flew through the streets of Brisbane. The first rays of daylight streaked the sky. He was in the back with Beryl and she was in serious trouble. He could hear the screaming sirens from the inside and hoped they’d make it in time. If she stopped breathing and they had to pull over so he could intubate her, the outlook would be extremely grim.
‘What’s our ETA?’ Daniel called to Adam, the student paramedic, who, despite his inexperience, was driving like a rally car professional. Beryl’s husband, Fred, was in front beside Adam.
‘Two minutes.’
‘Radio Coms to update St Jude’s on our ETA. Let them know she’s developing ST elevation.’ Daniel put on his best clinical voice so as not to alarm Fred, but the changes to Beryl’s heart rhythm were worrying.
Beryl was sitting upright on the trolley, hanging onto the rails for stability as the ambulance swayed from side to side. She reminded him of a frog—large frightened eyes practically bulging out of her head, leaning as far forward as she could get, her neck outstretched and gulping in the oxygen through the mask like a frog catching flies. The effort to breathe was so severe she couldn’t even manage the occasional word.
‘Beryl, have you got any chest pain?’ he asked, touching her sweaty arm.
She nodded, unable to talk. He looked at her blood-pressure reading on the monitor and decided it could handle a shot of glyceryl trinitrate. If, as he suspected, she was developing cardiac ischaemia due to hypoxia then a quick spray of the drug under her tongue should dilate the coronary arteries and improve the blood flow to the heart muscle itself.
An infarction of her cardiac tissue would indeed be a very bad complication and anything he could do to avert such an event was essential. He administered one spray underneath her tongue with barely a disruption to her oxygenation.
The vehicle swung into St J
ude’s ambulance bay shortly after that and Daniel didn’t wait to be let out. He opened the doors from the inside and had the trolley half out by the time Adam joined him.
‘Let’s hustle,’ he said, his jaw set in a grim line as they rushed the trolley inside.
The team met them on their way in and rushed the trolley through to the resus bay. Sophie was there and Daniel nodded silently as he helped the team move Beryl quickly and efficiently from his stretcher to their trolley.
‘Acute exacerbation of COAD. Administered bronchodilators and IV steroids on scene with no noticeable improvement. Poor bilateral air entry. Developed ST elevation in the last two minutes. One dose of GTN given.’
Sophie listened to Daniel’s concise handover as she hooked her patient up to the monitor. She looked at him and saw his blue eyes convey the things that he hadn’t said. He was worried. Really worried.
A quick assessment of Beryl had her agreeing. It was the worst she had ever seen the elderly woman. She was cold, pale and clammy and gulping in air as fast as she could. Her body was desperately trying to get as much oxygen as possible. If that meant snatching the next breath before the last one had finished then so be it. She can’t go on like this, Sophie thought.
‘She’s going to arrest,’ said Daniel softly, standing behind her.
Sophie nodded. Beryl certainly couldn’t keep this up for much longer. She moved closer to Beryl and covered her hand with her own.
‘Please, Beryl. Try and slow your breathing down.’ Sophie smiled and spoke in a confident manner. The last thing she wanted to do was panic Beryl by allowing her alarm to colour her voice.
The old woman clutched Beryl’s hand and she noted the iciness. ‘I know you’re scared but you’re here now. Let us take care of you.’
‘H…h…’ Beryl stuttered in a fragile whisper.
Sophie brought her head closer to try and catch what her patient was saying.
‘Help.’
Then suddenly, just as Daniel had predicted, Beryl stopped breathing. Her eyes rolled back and she lost consciousness. Daniel was paged away to another call as the team sprang into action. He left reluctantly, sure that Beryl would not make it through this episode, and he worried how Sophie would cope.
Sophie didn’t even notice his departure as dread settled in the pit of her stomach. Beryl! No. Don’t do this to us, please. Sophie’s thoughts were frantic as she quickly laid the back of the bed flat. For a few minutes as they bagged oxygen into her lungs via a resus mask, her heart trace on the monitor continued. But Sophie watched in dismay as it slowed and the ST elevation returned, indicating major cardiac involvement.
Sophie remembered the heart enlargement on the last chest X-ray Beryl had had. It was a common side effect of chronic airway disease. Years of lung dysfunction eventually put a strain on the heart. The heart grew larger, trying to compensate, and eventually it became too stretched and baggy to work effectively.
Thanks to the two IV lines Daniel had placed on scene, they were able to give drugs to speed up her heart rate and support her blood pressure.
‘I’m in,’ said Todd.
Sophie attached the black bag to the end of the endotracheal tube Todd had placed in Beryl’s throat to allow them to ventilate Beryl’s lungs. She met immediate resistance to her attempts to push air into the lungs.
‘Her lungs are incredibly stiff,’ she stated, her brow puckering in concentration. ‘I can hardly ventilate them at all.’
‘She’s in VF,’ said Richard as the monitor blared a warning at them. He started chest compressions.
‘Charging the defib,’ said Karen as she slapped two self-adhesive pads on Beryl’s bare chest. The machine pinged its readiness. ‘All clear,’ Karen said in a firm, loud voice.
Sophie dropped the bag and stepped back. Everyone stopped what they were doing and did the same. Karen pushed the shock button and delivered the current.
‘Still VF,’ said Todd as they all resumed their places. ‘Charge to 360,’ he said, listening to Beryl’s chest with a stethoscope. ‘She’s not shifting any air at all,’ he confirmed with Sophie. ‘Her lungs have had it.’
Years of chronic airway disease had made Beryl’s lungs difficult to oxygenate adequately. During an acute episode such as this, the airways constricted right down, making it almost impossible to push air into them. Beryl’s lungs had come to the end of the road.
The team worked on her for another fifteen minutes but when they couldn’t ventilate her or restart her heart it became obvious it was futile. They stopped the resuscitation, Todd declaring Beryl’s life extinct.
‘I’d say she had significant cardiac infarction by the look of those ST segments,’ Todd said.
Sophie agreed. Beryl’s lungs were bad enough. Her heart failing also had made it a lethal combination. And it had only ever been a matter of time while she had continued to smoke. Sophie knew that. But that didn’t make it any less sad.
In fact, it probably made it harder. Knowing Beryl could have avoided dying in such a way just highlighted the absolute waste. It was always sad when a favourite patient passed away and more so when their death could have been prevented.
Half an hour later Sophie was startled by the harsh clatter of the curtain being pulled back.
‘Hi,’ said Leah.
Sophie was surprised that the time had got away from her and the morning shift had arrived. She had gathered everything she needed and prepared to make Beryl presentable for Fred.
‘Off home for you,’ Leah said, feigning a stern voice. ‘You’ve had an awful night. No one expects you to do this.’
‘No,’ said Sophie, smiling gently at her friend. ‘I can’t leave her like this. I promised her hubby I’d see to her and anyway…I think I need to do it for me as well.’
‘I’ll help.’
‘No,’ Sophie said firmly. ‘It won’t take long. I’ll yell when I need a hand.’
Sophie was grateful that Leah had been around long enough to understand that there were some things you had to do by yourself. Laying someone out was never a great job but if you were particularly fond of a patient it was the final respectful thing you could do for them. It was an honour and a privilege and Sophie didn’t know one nurse who didn’t treat the often sad job with the utmost reverence.
Sophie talked quietly to Beryl as she gently washed the old lady’s wrinkled, papery skin. She removed the endotracheal tube and the IV cannulas. She chatted about the time they had first met when Sophie had been a student nurse.
Leah gave her a hand to change the sheets and put a clean hospital gown on Beryl. Sophie combed Beryl’s thin grey hair as Leah went to find Fred. She pulled a chair up close to the trolley so Fred could sit with her as long as he liked.
He entered a few moments later, looking older than his eighty-odd years, and sat in the chair. Sophie felt her eyes well with tears as Fred took his wife’s hand and a sob choked in his throat.
‘What am I going to do without you, my girl?’ he asked her. He laid his head on the bed beside her and placed her hand against his cheek.
Sophie left quietly, not wanting to intrude on such an intimate moment. It was humbling to witness and Sophie had to remind herself that some people stayed together for a lifetime. That their love for each other at the end of their lives had grown and magnified into something beautiful and ageless.
Sophie left work an hour late that morning but didn’t mind. Tending to Beryl and chatting with Fred for a while had been very rewarding. He had thanked her for making Beryl look as beautiful as the day he had met her and Sophie had blinked rapidly to dispel the tears that had pricked at her eyes.
He obviously hadn’t seen the external ravages of age or chronic disease that Sophie had seen when she’d looked at Beryl. His love and devotion had blinded him to such details. He had seen only the girl he had once known.
Sophie wondered if she’d ever have anyone in her life who would love her that much.
CHAPTER SEVEN
JOHN wa
s an astute old goat, thought Sophie as she headed for the beach house. His suggestion that she get away overnight by herself had been a good one. Beryl’s death had affected her more than she had realized, and with all the recent upheaval it was just one more thing she hadn’t needed.
Sally had urged her as well, insisting that Max would be treated like a king and spoilt rotten until her return. When she had pointed out that that wasn’t exactly what Max needed, Sally had shooed her away and gathered her surrogate grandchild to her ample bosom.
Max had squealed in delight and Sophie had felt a niggle of jealousy. It had looked pretty comforting there in Sally’s arms and for the first time in a long time she found herself missing her mother.
Not that her mother had had the capacity to nurture and love that screamed from every cell of Sally’s body. No, she had always been much too fragile for that. But there was the odd memory of being held tight and feeling totally loved. And it was that that Sophie chose to hold dear.
Sophie heard the crash of waves as she opened the door of her Beetle and the sea breeze lifted her caramel hair off her neck. She looked at the big old bungalow with its wide wrap-around verandah facing the ocean and felt the cloud lift a little.
The water beckoned. She parked her car in the garage and stripped off her clothes to reveal the bikini beneath. She left her overnight bag by the front door and set off for the ten-minute walk down to the sand. She would open up after she’d had her fix of sand and sea.
The water was cool on her hot skin and Sophie dived eagerly into the waves. The ocean was just the right medicine for a hot day and a preoccupied mind. It was hard to think of anything other than one’s place in the cosmos as the rhythm of the waves, as old as time, surged around your body.
Half an hour later Sophie walked out of the ocean and towelled off. The temptation to lie in the sun for a while almost won out, but her common sense overrode it.
She would, no doubt, fall asleep lulled by the rhythmic slapping of the waves against the shoreline and the drugging caress of the UV rays. She’d wake up two hours later burnt to a crisp even though it was getting past the hottest part of the day.
