Buch lesen: «Nurse In Need»

CHAPTER ONE

RED and blue lights flashed their signal of an emergency.

The ambulance siren had been turned off on the final approach to the hospital but the beacons were still going as the vehicle turned swiftly and backed up to the doors of Christchurch’s Queen Mary Hospital’s Emergency Department. The day-shift resuscitation team stood waiting. The medical staff hadn’t needed the warning lights of the ambulance to notify them that a critically ill patient was incoming. That information had been transmitted en route ten minutes ago, and the team had rapidly assembled and prepared one of the highly equipped resuscitation areas in the emergency department.

Senior Nurse Amy Brooks cast a swift glance into Resus 1 as the stretcher was being unloaded. IV fluid bags were hanging, their giving sets already primed. Trolleys stood ready. The staff knew their patient was in severe respiratory distress. Equipment for intubation and ventilation was available. A chest-drain tray was prepared and draped.

As the circulation nurse on the resus team, it was Amy’s responsibility to have all the equipment prepared and to assist the doctors in using it. She needed to have the IV fluids ready and to assist with or insert IV lines herself, if necessary. She needed to help other nurses to remove the patient’s clothing and to record baseline observations of temperature, pulse, respiration, blood pressure and cardiac monitoring. It was the most demanding role in the nursing team, but Amy Brooks revelled in the different challenges every critically ill or injured patient provided.

Amy even welcomed the apparent initial chaos of receiving and transferring such a patient. Ambulance crew, consultants, registrars, nurses and technical staff all tackling their own tasks within the set protocols. So much happening and so much information being gathered and passed. It took a special ability to be able to assimilate the details, to focus on each task and to switch focus with speed should the situation dictate a new urgency.

‘This is Daniel Lever. He’s nineteen years old.’ The ambulance officer was reinforcing information they had previously radioed through to the department. Transmission was often patchy. ‘Car versus truck. Daniel was the single occupant of the car.’

The stretcher was positioned alongside the bed.

‘High-speed impact with vehicle rollover.’

Amy noted the cervical collar around the young man’s neck and the backboard he was strapped onto. Spinal injuries had to be high on the index of suspicion after the description of the accident.

‘Daniel was trapped in the car for approximately forty-five minutes.’ The ambulance officer shifted the portable cardiac monitor out of the way. ‘Are we ready? One, two…three!’

Amy moved to help lift the backboard. Entrapment time had already eaten well into the ‘golden hour’.

‘Systolic BP of 90, heart rate 125, respiration rate of 30. Daniel has remained conscious but confused with a GCS of 13. He has chest injuries, including a flail segment with possible pneumothorax, abdominal tenderness and a compound fracture of the left femur.’

Jennifer Bowman was the airway nurse on the team. She was first into action as their patient was transferred to the bed.

‘Hello, Daniel. Can you open your eyes for me?’ Jennifer disconnected the portable oxygen cylinder and reattached the line to the wall outlet as Daniel groaned in response. She adjusted the position of the high-concentration oxygen mask he was wearing. Amy used shears to clip away the remnants of clothing on Daniel’s chest. She glanced at the other nurse as she heard the encouraging murmur of her voice soothing their distressed patient. Jennifer was also responsible for talking to the patient and giving support. The rapport she could establish quickly with people was a strength that Amy appreciated more than most. Jennifer was perfect for the job.

Gareth Harvey, the senior emergency consultant, listened to Daniel’s chest with a stethoscope while still receiving information from the ambulance crew.

‘He’s received 1.5 litres of saline so far. He’s also had 10 mg of morphine. Cardiac rhythm’s been stable.’

Amy attached the leads for the department’s cardiac monitor. Now she wrapped the automatic blood-pressure cuff around Daniel’s arm and clipped an oxygen saturation probe over his index finger. They had been unable to get an accurate reading in the ambulance. Judging from Daniel’s colour, it wasn’t going to indicate a good level of circulating oxygen in his bloodstream. A junior nurse, Janice Healey, was struggling to cut away the denim of Daniel’s jeans. He groaned loudly as she tried to pull some fabric clear of the splint on his left leg.

‘Leave that for the moment, Janice,’ Amy advised. ‘And don’t take the dressing off the wound until a doctor is ready to look at it. The more exposure it gets, the more likely it is to get contaminated.’

Jennifer was still trying to establish communication. ‘Do you know where you are at the moment, Daniel?’

‘Can’t…breathe…’ Daniel gasped. ‘Help…me.’

Amy glanced at the monitor. Oxygen saturation was well below ninety per cent. She was reaching for the chest-drain pack before Gareth Harvey requested it. Their patient was desperate to sit up to try and ease his breathing difficulty. Being strapped to a backboard due to the possibility of spinal damage was increasing his distress.

‘Left-sided tension pneumothorax,’ Gareth informed Amy.

Amy was already drawing up the local anaesthetic. A chest drain had to be inserted as the first priority. Air had entered Daniel’s chest outside the lung, probably because of laceration from the broken ribs. The pressure had collapsed the lung and was now threatening the function of the other lung and his heart.

Jennifer had her head bent close to Daniel’s. ‘We’re going to do something to help with your breathing, Daniel,’ she told him clearly. ‘You might feel a bit of stinging. That’s some local anaesthetic going into the side of your chest.’

‘BP’s dropping,’ Amy warned Gareth. ‘Systolic’s down to 80 and we’re getting a few ectopics.’ She kept an eye on the irregular beats showing up on the cardiac monitor as she ripped open sterile packs and assisted the consultant to insert the chest drain.

Daniel’s breathing improved dramatically as the internal pressure of air was relieved but his blood pressure was still dropping. The registrar who had been busy assessing the abdominal and leg injuries looked worried. He directed Gareth’s attention to the abdominal distension that was becoming obvious. Amy changed the bag of IV fluid as the level dropped. The registrar was directed to put in a second IV line and start running Haemaccel instead of saline. Amy ripped open more sterile packs.

The team member responsible for documenting the resuscitation attempt was Peter Milne, one of the department’s nurse managers. Amy showed him the empty bag of saline.

‘That’s the third one so far.’ She glanced at the large preprinted form Peter was filling in. ‘Oxygen saturation’s come up to ninety-three per cent,’ she told him. ‘BP’s dropped to 75.’

Janice Healey was ferrying blood samples. She came back with a distraught-looking middle-aged woman beside her.

‘This is Daniel’s mother,’ she told the team nervously. ‘Is it OK if she comes in?’

The registrar had just exposed the open fracture of Daniel’s leg for assessment. Daniel’s mother lost all the colour from her face. Amy moved to help the woman but Peter beat her to it. He supported her with a firm hand on her arm.

‘Janice, take Daniel’s mother down to the relatives’ room for the moment and stay with her. I’ll come down as soon as we have all the information we need to give her the full picture.’

Janice stepped away. ‘Come with me, Mrs Lever,’ she said hesitantly. Daniel’s mother remained glued to the spot, her terrified gaze fixed on her son. Peter raised an eyebrow at Amy, who nodded. She would take over documenting the case until Peter had settled Mrs Lever somewhere a little less traumatic. Amy was confident she could remember the details and be able to record them during the lull coming up when X-rays would be taken. It took another twenty minutes until the team were satisfied that their patient was stable enough to transfer to Theatre. Surgery was certainly the next priority. The cause of the abdominal bleeding had to be found and treated if Daniel was going to survive.

‘Orthopaedics might want a look at that leg at the same time,’ the registrar suggested. ‘Limb baselines are all well down.’

At the mention of the orthopaedic department Jennifer caught Amy’s eye and winked. Amy ignored the gesture but was immediately reminded of the knot of tension she had been harbouring all morning. Not that she could do anything about it right now. The trauma case had added to an already busy shift. Amy had two other patients she needed to go back to monitoring.

The adrenaline rush of working on Daniel’s emergency admission wore off only too quickly and Amy was left feeling strangely nervous. The soft peal of laughter she heard only minutes later made her turn swiftly. She couldn’t see anything, of course. The curtain around cubicle 4, which she had entered to check on the elderly Mrs Benny, screened the rest of the department from view. Amy waited several seconds but couldn’t resist the urge to peer around the edge of the curtain as the sound was repeated. For some peculiar reason the quiet adult laughter had all the subtlety of a child’s gleeful squeal as far as Amy was concerned.

It wasn’t difficult to pinpoint the source of the sound. The man was still grinning as he straightened up from leaning on the sorting-desk counter. The unexpected speed with which his gaze shifted from the staff member he’d been in conversation with was unfortunately too sudden to allow Amy’s curiosity to remain undetected.

Amy felt the contact as their lines of vision coincided. Their gazes held only for a split second but it was quite long enough for the stranger’s mouth to soften and then to begin another curve into a new smile. A smile that was obviously intended for Amy Brooks. Amy whisked the curtain closed hurriedly, turning back to her patient as she cursed her inability to resist peeking. Mrs Benny appeared to be asleep and Amy took the opportunity both to assess her patient and calm herself.

She still felt unnerved. As though the gaze that had caught her own was still there, burning through the thin fabric of the curtain. With a deliberate effort, Amy turned her attention to the fob watch she wore pinned to her uniform. She counted Mrs Benny’s rate of breathing, consciously taking several deep breaths herself. It wasn’t the stranger’s fault she felt rattled. Neither could it be attributed to her current patient. Thanks to the heavy frost that morning, Gladys Benny was the third case of a fractured neck of femur to come through the doors of Queen Mary Hospital’s Emergency Department. Straightforward cases with no hint of the drama that had surrounded young Daniel Lever’s admission. As common and easy to deal with as the alcohol overdose case Amy was also responsible for in cubicle 2.

The sudden movement of the curtain behind Amy made her jump. The orderly, Derek, grinned widely.

‘Gave you a fright, didn’t I?’ he observed. ‘Who did you think I was?’

Amy smiled but ignored the query. She also resisted the urge to look over Derek’s shoulder to see who might be standing at the counter being amused by Laura, the sorting-desk clerk. She stifled the slight sense of annoyance that anybody could find being in an emergency department amusing, but her sense of disquiet couldn’t be displaced so easily onto some stranger or his laughter. Amy had no one to blame except herself. Her nerves were due to the fact that she was rapidly running out of time. And it wasn’t at all funny. Amy touched her patient’s hand gently.

‘Mrs Benny? Derek is here to take you up to X-ray. How’s the pain at the moment?’

Gladys Benny opened her eyes and smiled faintly. ‘Much better, thank you, dear. That injection you gave me did the trick nicely. I think I even fell asleep.’

‘That’s good. We’ll see you again as soon as you get back from X-ray.’ Amy stood aside as Derek began pushing the bed clear of the cubicle, but Mrs Benny caught hold of Amy’s hand and halted the progress.

‘What’s going to happen to me?’ she queried anxiously.

Amy squeezed the frail hand gently. ‘It seems likely that you’ve broken your hip, Mrs Benny. If the X-rays confirm that, then you’re going to need an operation, I’m afraid.’

‘Oh, dear.’ Faded blue eyes filled with tears and the old woman’s voice wobbled. ‘Where are they going to take me?’

‘To X-ray,’ Amy reminded her patiently. ‘Then you’ll come back here and we’ll ask the orthopaedic doctors to come and see you. If you do need an operation, we’ll arrange admission to one of the wards.’

‘So I’m coming back here?’ The watery gaze fixed on Amy begged for reassurance.

‘Yes, you are, Mrs Benny.’ Amy smiled. ‘And your daughter’s on her way in. I expect she’ll be here by the time you get back.’

Amy watched the bed as it was manoeuvred between the sorting-desk counter and an empty ambulance stretcher. Her gaze continued a sweep around the emergency department. The stranger had vanished. Several cubicles and a resus area were empty and the atmosphere was relaxed, with several staff members heading towards the staffroom for a quick break. Jennifer Bowman was amongst the group, in animated conversation with a junior doctor. Amy smiled to herself at the play of expression on her colleague’s face.

Jennifer was naturally lively. Gregarious, outspoken—even outrageous at times. To a casual observer, she couldn’t have provided much more of a contrast to Amy. It often surprised people to find that the two young women were flatmates, let alone the closest of friends. Amy’s inward smile faded and she sighed audibly. It was now past lunchtime on Friday and she was still no closer to the goal she’d set herself a week ago. The pursuit of that goal would have to be postponed yet again if the noises emanating from cubicle 2 were anything to go by.

Amy donned gloves and collected some towels, one of which she dampened at the washbasin. She used the moist towel to clean the face of her patient in cubicle 2.

‘Are you feeling better now, Patrick?’

‘Aye.’ Bleary, bloodshot eyes regarded Amy and then focused to produce a hint of a familiar twinkle. ‘You’re an angel, so you are, Amy Brooks.’

‘Mmm.’ Amy shook her head as she smiled. Patrick Moore was a regular customer, a lonely old Irishman who collected his pension on a Thursday and was often brought into Emergency on a Friday morning, having been discovered hypothermic and drunk in a public park. Unlike many similar patients, Patrick was always grateful for the attention he received and he had a charm that even excessive alcohol abuse couldn’t obliterate.

‘An angel,’ Patrick repeated fervently. ‘You’ve even got a halo.’ The old man’s expression was so reverent that Amy wondered if he might be experiencing visual disturbances. She held up one hand.

‘How many fingers can you see, Patrick?’

‘Three,’ he told her promptly. ‘And beautiful fingers they are, too. Long and dainty—just like the rest of you.’ Patrick hiccuped softly and returned his gaze to her head. ‘An angel of mercy,’ he whispered contentedly. ‘With a beautiful golden halo.’

Amy’s hand went to her head despite herself. Then she chuckled. ‘It’s just my hair, Patrick.’

Patrick shook his head and closed his eyes. ‘Your hair’s all tied up in that fancy knot. It’s even speared with that little stick. And it’s dark, not shiny and golden. I know a halo when I see one, lassie.’

Amy folded back the blanket covering her patient. There wasn’t much point in explaining to Patrick that she’d run out of the hairspray that normally controlled the wispy short tendrils currently escaping her neat hairstyle, and that because it was new growth it was much blonder than the rest of her hair. Or the fact that standing in front of the light source in the cubicle had highlighted the effect. If Patrick wanted to think of her as an angel then that was OK with her.

‘It’s time to go home again, Patrick,’ Amy announced. Mrs Benny would be back from X-ray soon and the increase in general activity and noise beyond the cubicle curtain indicated that the quiet spell was over. Amy helped Patrick to his feet where he stood for a moment, swaying slightly. She pulled back the curtain, glancing up automatically as she did so.

It seemed as though the stranger had been waiting for her to appear. How else could she have caught his eye so instantly? He wasn’t laughing this time. Not even smiling, but Amy recognised him. She tore her gaze away. It was like a physical touch, that eye contact. It was too personal. Intimate, even, which was ridiculous. Amy made eye contact with perfect strangers all the time. Why on earth should this man be any different?

‘Come on, Patrick. You’re all right now.’

Amy turned so that she was side on to the stranger. He was talking to Noel Fenton, an orthopaedic registrar who was probably on his way to see Mrs Benny. Could the man be a relative perhaps? Mrs Benny’s son? Amy shook her head unconsciously. No. Mrs Benny was in her eighties and this man didn’t look much over thirty. A grandson, maybe.

Amy waited patiently while Patrick collected his hat and walking stick from the end of his bed. She was quite aware of the men in her peripheral line of vision, however. Noel was introducing the man to Gareth Harvey. Amy risked another glance as he shook hands with the consultant. He was smiling again now. His manner was as relaxed and casual as his faded jeans and the leather jacket over an open-necked shirt. Not a frantically worried relative, then.

Amy turned away quickly as the trio of men started moving towards her. Her movement coincided with Patrick’s tentative foray back into the world, and the old man staggered a little. He caught Amy’s arm and then hooked her waist with a bony hand.

‘You’re an angel, Amy Brooks,’ he proclaimed loudly. ‘I love you. Will you marry me?’

Amy prised the hand from her waist. ‘Come on, Patrick.’ She could sense the proximity of the consultant and his companions. She heard the appreciative chuckle that could only have come from one person. Amy gritted her teeth and spoke with quiet desperation.

‘Come on, Patrick.’ Amy kept hold of her charge’s arm and began to steer him very firmly towards the door. Patrick was looking back over his shoulder.

‘Sent by heaven, she was,’ he informed the department triumphantly. ‘An angel, to be sure.’

Amy’s blush had finally receded by the time she had signed Patrick out and seen him to the taxi stand outside the waiting room. The nurse manager, Peter Milne, signalled to her on her return.

‘Can you give Jennifer a hand to sort out Resus 1? It’s still a bit of a mess.’

‘Sure.’ Amy smiled willingly. ‘Any word on Daniel yet?’

‘Still in Theatre, but Noel was in there to check on the leg and things were going pretty well. The bleeding’s under control. Ruptured spleen and some liver damage. I think he’ll pull through.’

‘That’s great.’ Amy spared a thought for the relief Daniel’s mother would feel. Jennifer had the same thought when Amy relayed the information.

‘Can you believe Janice brought her in here at that point in time? You’d think she’d know enough to check first.’

‘I think she feels uncomfortable dealing with relatives,’ Amy said. ‘And sometimes it is better to let them see that everything possible is being done, especially if the outcome is likely to be bad.’

‘Hmm.’ Jennifer was counting empty drug ampoules as she slotted them into the sharps container. She didn’t sound convinced.

Amy began collecting the discarded sterile packaging. ‘Patrick just proposed to me again.’

‘So we heard.’ Jennifer grinned. ‘You’re an angel, to be sure.’

Amy returned the grin. Suddenly the moment she’d been waiting for seemed to present itself. ‘Hey, Jen?’

‘Mmm?’ Jennifer was now peering into the drugs cabinet.

‘About tonight,’ Amy said carefully. She didn’t want this opportunity to go the way all the others had. ‘I thought—’

‘No,’ Jennifer interrupted firmly. She kept her gaze on the contents of the cupboard. ‘We’re low on adrenaline in here. Pretty low on morphine as well. I’ll go and get some more.’

‘Please, Jen,’ Amy said forlornly. ‘I really want you to come to this party.’

‘No. Sorry, Amy, but I’m not going to change my mind.’

‘But you love parties.’

‘Not this one I don’t. I’d rather stay home and stick needles in my eyes.’ Jennifer glanced at Amy. ‘Which reminds me. How are those IV cannula supplies?’

‘Down on 14-gauge,’ Amy responded automatically.

‘I’ll get some of those, too, then.’

Amy straightened the ECG electrode wires and rolled up the blood-pressure cuff. She was tucking in the clean sheet on the bed as Jennifer returned. Amy accepted the bundle of cannula packages and caught her friend’s eye hopefully.

‘It won’t be that bad, you know. The party, I mean.’

‘Yes, it will.’ Jennifer was arranging the fresh supply of ampoules in the drug cabinet. ‘A pack of stuffy consultants and their wives. All geriatric,’ she continued decisively. ‘There’ll probably be a string quartet in the corner and a waiter with a tray of sherry. Everybody will be overdressed and horribly superior.’ Jennifer clicked the cabinet door shut and locked it. She gave Amy a reproachful look. ‘And your boyfriend will be the worst of the lot.’

Amy sighed. This wasn’t going the way she’d planned it at all. ‘Don’t start on Nigel,’ she begged. ‘He’s not that bad. He really wants you to come.’

‘Oh, sure.’ Jennifer’s expression was now openly sceptical. You’re talking about the man who told me, only yesterday, that if my neurons could get close enough to hold hands occasionally then I would have had those scan results available before he had to disrupt his precious schedule to come down to Emergency.’

Amy’s glance slid sideways. ‘OK, so he can be a bit sarcastic sometimes. Major trauma cases can be stressful, as you well know.’

‘He hadn’t even got anywhere near the patient,’ Jennifer countered. Her expression softened. ‘I admit he probably has his good points. He can be very charming when he wants to be.’ It was Jennifer’s turn to sigh. ‘I just can’t pretend to like him, Amy. There’s something about him that I don’t trust, and it’s more than the fact that his eyes are far too close together. I still don’t understand why you started going out with him in the first place.’

‘He asked me,’ Amy said simply. ‘Anyway, that’s months ago, now. It’s ancient history.’

‘Like Nigel.’

‘He’s only forty-two,’ Amy said impatiently. ‘And he’s a very talented surgeon. You don’t have to like him, Jen. Just come to the party. For me.’

‘No way.’ Jenny pulled back the curtain. Resus 1 was ready to go again. ‘Catch you later, Amy. Looks like there’s some work to be done out here.’

A new stretcher was coming through the automatic double doors from the ambulance bay. The bed arriving from the other end of the corridor that led into the hospital was returning Mrs Benny to the emergency department. Amy caught up with her patient.

‘That was nice and quick. How are you feeling, Mrs Benny?’

‘Dreadful. They moved my leg and the pain is ever so much worse.’

‘Is is?’ Amy helped the orderly position the bed back in cubicle 4. ‘I’ll get one of the doctors to come and organise some more pain relief for you.’

Amy’s route to notify one of the registrars of Mrs Benny’s need for more analgesia took her past Jennifer, who was helping a woman towards the toilet. The smile that the two nurses exchanged was fleeting but it was enough to reassure Amy that Jennifer was not really bothered by her persistent efforts over the last week directed at getting her to accept the party invitation.

The difference of opinion concerning Amy’s dating of orthopaedic surgeon Nigel Wesley hadn’t been enough to seriously compromise their friendship. Yet. Amy’s spirits sank a little further. That was something that could well change after tonight, and Amy dreaded that possibility. Somehow she had to warn Jennifer of developments and ensure that their friendship wasn’t going to suffer irreparably. Persuading her to attend the party and then making sure she enjoyed herself was the only plan Amy had, so far, been able to concoct.

Perhaps she should just come straight out with it and tell Jennifer the truth. If she was really confident that she was doing the right thing, then it shouldn’t be a problem, but confidence was an emotion that Amy generally associated only with her professional abilities. Anything else was too risky to be confident about, but this was a risk she was happy enough to take. It was the right thing to do. It had to be. Time was running out in more ways than one.

Maybe the doubts that were troubling her were due to the sneaking suspicion that a friendship might have to be sacrificed. Not just any friendship either. The one and only really close relationship that Amy had ever had with another person. Nobody else had ever come close. Not her school friends and definitely not her parents. Not even Nigel. Maybe especially Nigel. Jen was the one person in the world who loved Amy for who she really was. Jen made her feel good about herself and had always supported her wholeheartedly. Well, almost always. At least until Nigel Wesley had surprisingly shown an interest in Senior Nurse Amy Brooks.

Gladys Benny was transferred to a ward half an hour later. Due to her patient’s reluctance to let go of her hand, Amy accompanied the bed as far as the lift. It was on her return that she spotted the man for the third time. He was now in the emergency observation area—a mini-ward, adjacent to Emergency, that could hold non-urgent patients for up to twenty-four hours until a decision was made regarding their need for admission. Amy didn’t give him the chance to look in her direction this time. She sped on and didn’t stop until she found Jennifer. She followed her friend into the sluice room.

‘Who is that man in the leather jacket?’ Amy demanded. ‘He’s been hanging around Emergency all day.’

‘So have I,’ Jennifer groaned. She dropped the container she was carrying into the infectious waste disposal unit and stripped off her gloves. ‘My feet hurt.’ She gave Amy a concerned glance. ‘How’s your leg?’

‘Fine.’ Amy wasn’t going to be distracted. ‘You must have noticed him,’ she persisted.

‘Why? Is he cute?’

‘I suppose,’ Amy admitted grudgingly. ‘He’s tall with straight black hair. Kind of spiky.’ She eyed Jennifer’s tufts of short blonde hair. ‘A bit like yours, only longer.’

‘I like him already,’ Jennifer declared. ‘Who’s he in here to see?’

‘That’s what I was trying to find out.’ Amy shook her head. ‘He looks too happy to be a relative.’