Intensive Care: Escape to the Country (20 page)

“You’re very welcome. It’s lovely to meet you and I’m also sorry that it’s here at the hospital,” Kate replied. “Joel’s in good hands but he’s very sick. They’re just taking him up to ICU now. Would you like to come upstairs with me? Oh, and I was just speaking to Liam on the phone – he’s on his way but he won’t get here until late tonight.”

“Good. Good. Yes, let’s go upstairs. But before we go, let’s just take a moment to stop and pray for Joel,” Sean said.

Kate was momentarily unsure what to do. Joel had never mentioned anything about his family being religious and she wasn’t sure what they wanted to do. The only time she had ever seen people openly pray was in the weekly assemblies at the Catholic school she had attended as a child. Before she knew what was happening, Emma reached for one of Kate’s hands and Lorraine reached for the other as Sean closed the circle and began to speak. His lilting Irish accent seemed to have a calming effect on all of them. He finished praying and Lorraine and Emma loudly chorused “Amen,” squeezing Kate’s hands.

“Amen,” Kate whispered in echo, wiping an unexpected tear from the corner of her eye. Clearly Joel’s family were very close and she immediately warmed to his parents.

“Right then, young lady. Lead the way to your ICU,” Sean said to Kate, reaching out and enveloping her in another quick hug.

“I’m sorry but only two people are allowed in at a time,” Kate explained as she swiped them all into the unit and led them toward the waiting room.

“Of course,” Sean replied, looking between Lorraine and his daughter.

“It’s okay, Mum and Dad. You go in first. I can sit in the waiting room.”

Accompanied by Joel’s parents, Kate approached his bed area with a sense of trepidation. She didn’t know how Sean and Lorraine were going to cope with the shock of seeing their son so unwell. Kate knew that by now he would be sedated and tubed and she knew the shock this caused many people. She wondered if she should prepare them.

As she caught sight of Joel, Lorraine’s knees slightly buckled and Sean grabbed hold of his wife before she fell. Kate pulled up a small chair beside the bed for Lorraine to sit in and she flopped into it noiselessly. Kate looked across at Amanda who smiled at everyone.

“He can hear you. Speak to him,” Amanda said.

“Joel? It’s Dad.” Sean looked uncomfortable, unsure what else to say. Kate saw him looking around the room at the unfamiliar equipment and she mentally kicked herself for not taking a few minutes to prepare them for what they were about to see.

“Hi Joel me love. I’m here too. It’s going to be okay.” Lorraine’s voice cracked. “Kate’s here.”

Joel’s face was unresponsive and Lorraine and Sean looked from Amanda to Kate for clarification. Kate took hold of one of Joel’s hands in her own and squeezed it gently.

“Hey Joel. It’s me. I’m just going to have a chat with your mum and dad okay? You’re in the ICU and you’re going to be all right. Emma is okay. She’s in the waiting room and Liam is on his way from the city. You’ve got a tube down your throat to help you breathe but it will only be there for a few days. Your lungs are really sick and we just need to help them a bit with the machine.” As she spoke, Kate stroked her fingers across the back of his hand, noting how cool and smooth it felt. She found herself wanting to entwine her fingers through his to give him some of her warmth.

She turned and addressed his parents. “He’s heavily sedated so he can’t respond but he can most likely hear everything you say to him. Right now the best thing to do is to keep offering him reassurance that he’s going to get better. Over the next twenty-four to forty-eight hours they may consider lightening up on his sedation a bit, but for now the most important thing is for his body to rest.”

“I don’t understand, though,” Sean said. “They say it’s just pneumonia.”

“Pneumonia is very serious. A lot more so than most people understand.” She didn’t want to tell him that people died from pneumonia. “Thankfully Joel is young and fit so he will recover well,” Kate explained.

“But how did he get pneumonia?”

“It’s a bug basically,” Kate replied. “He probably had the flu and it just developed into pneumonia.” She wasn’t going to try to explain the physiology of the condition.

“He’s been working very hard out on the farm,” Sean said. “Could he have overdone things?”

“Possibly,” Kate answered. She felt guilty when she thought about how hard Joel had been working at her own place. She knew he was also spending hours at Eagles Ridge Farm getting it ready to open, plus he still had the café. Maybe he had been working too hard.

“So what’s the plan?” Lorraine asked, interrupting her musing.

“To be honest I’m not sure.” Kate turned to look at Amanda. “What have the doctors said?”

“Exactly what you just said, Kate. Rest his lungs and throw antibiotics at the bug. I’ve just got to keep him well sedated.” Amanda pointed to the white liquid dripping from the bottle at the head of the bed. “Also he’s got the chest drain in now.” Amanda indicated the small square container placed on the floor attached to the suction tubing that snaked its way to a dial on the wall. The machine was bubbling and it was clear there was blood collecting in the canister.

Lorraine saw it and frowned. “But he’s been on antibiotics for weeks now,” she said.

“The ones we give him here will be much stronger and also specific to the actual bug he’s contracted. Once they get a sample from his lungs they will be able to send it off to pathology and the infectious diseases doctors will work out the exact antibiotic to kill the bug,” Amanda explained.

Lorraine stood up and stepped up to the bed. Kate moved out of her way so that she could get in closer to her son. She stroked the side of his head, brushing the hair away from his ears, being careful to avoid the tube down his throat that was taped to the side of his face.

“My darling boy. You’re going to be okay. Kate’s going to make sure of it.”

“I’ll go and get Emma,” Sean said, his voice breaking slightly. He touched Lorraine gently on the arm. “You stay here with him.”

Lorraine nodded her head, not taking her eyes off her son.

Kate stood to one side, speaking quietly to Amanda as Emma came into the room. Emma went straight to her brother’s side, tears falling down her face. She hugged her mother tightly and the two women stood side by side, their faces expressing the shock they were feeling. Kate felt like an intruder watching the special moment between mother and daughter. She quietly excused herself to Amanda and left Joel’s bedside, unnoticed by either Emma or Lorraine.

Joel’s condition hardly changed during the course of the day and by eight o’clock that night Kate finally convinced his family to go home to rest. There was little they could do sitting by his bed while he was so heavily sedated. After they left Kate sat with Joel, holding his hand, listening to the hypnotic sound of the ventilator pumping oxygen into his lungs. Its rhythmic sound made her feel sleepy and she yawned. She needed to get home herself but something compelled her to stay and sit with him. It was the first chance she’d had in the frantic busyness of her day to spend a few moments with him alone. She chatted quietly to him, babbling away about insignificant things, hoping he could hear her voice. Finally when the night staff arrived, Kate realized she had to leave. She would be back at work in a few short hours and she knew the staff would contact her if Joel’s condition deteriorated overnight.

“I’m going home now, Joel.” She stroked his arm, feeling the heat radiating from his body as the fever raged. There was no response from him. She reached for a face washer from the pile of linen on the shelf and dipped it under the tap. Laying the cool cloth across his head she spoke again. “It’s getting late – almost ten o’clock. Your family have headed home and we’ll all be back in the morning. You’re doing great, Joel. Don’t fight the machine, just rest and let your body heal itself.” She hoped her words sounded positive and encouraging.

Amanda and Stephanie entered the room together so that Amanda could give Stephanie the report on Joel’s condition.

“I’ll look after him for ya, mate,” Stephanie spoke kindly, her dark eyes full of compassion.

“Thank you, Steph. And you too, Amanda. You’ve done a great job today.”

Kate sighed as she took one last look at Joel in the dimmed lights. She knew in her mind he was going to be okay but her heart was still struggling to catch up. It had been a big day and she was emotionally exhausted. Joel was much sicker than she had imagined him to be, and seeing him wheeled in by the paramedics had shocked her. It was also obvious to her now that her feelings for him ran much deeper than she had first thought. If only she knew if he felt the same way about her. At least he was going to be okay – of that she was certain.

“Is Joel your …” Stephanie didn’t finish the question before Kate interrupted her.

“No – we’re just friends. Good friends.”

“Could have fooled me!” Amanda winked at Stephanie. “I’ve watched Kate with him all day and I can assure you, I don’t look that way at
my
friends!”

“Ooh a romance!” Stephanie laughed and rubbed her hands together. “You’ve kept this pretty quiet, Kate.”

Kate blushed. “Really, there’s nothing between us. We’re just good friends. Both of us have just come out of long-term relationships so we’re not ready to jump into something new. And anyway, I’m pretty sure he’s not interested in me in that way.”

Kate bit her lip, annoyed with herself for having shared so much private information. She had managed to keep her personal life separate from her work life and she had no right to share Joel’s own story with someone else. She saw the look that passed between Amanda and Stephanie.

“Is that why you moved here,” Amanda asked, “because of a break-up?”

“Partly. Yes.”

“I’m sorry. I didn’t mean to pry. I hope I didn’t upset you,” Amanda said.

“It’s fine.” Kate sighed again. “It’s no big secret anyway. I broke up with my boyfriend and decided one big change wasn’t enough so I took the job here to get away from him and start over. Call it an escape, whatever, but let me assure you, finding love again is not part of the plan – not yet anyway.” There was no way she was going to tell them why she’d left Marcus and she definitely wasn’t going to tell them about her real feelings for Joel.

Kate glanced at Joel, certain she had seen his arm lift spontaneously off the bed at the mention of the word “love.” Amanda and Stephanie followed her gaze but Joel remained lying supine in the bed, the head of his bed at the obligatory thirty-degree angle. His arms remained propped on the pillows by his side, unmoving. Perhaps she had just imagined it.

“Well if you
were
looking for love again, he’d be a bit of all right wouldn’t he?” Stephanie whispered. “He’s hot!”

“And apparently he’s Irish,” Amanda said, her voice also low. “I can’t wait to hear if he’s got an accent when he wakes up.”

Turning away from her colleagues, Kate spoke over her shoulder as she walked down the hallway. “You’re right, girls. He is pretty hot.” She saw the surprised expression on their faces and grinned to herself. “Oh, and his accent is divine.”

That’ll get the Birrangulla rumor mill working overtime!

She wondered if Joel had heard her, even in his sedated state. She hoped so.

When Kate returned to work the next morning, she dragged herself up the stairs, already exhausted both physically and emotionally. Having slept poorly, worrying about Joel, she had woken earlier than usual and headed straight into work. Hoping Joel’s condition had improved overnight, Kate frowned when she saw the gathering of people at his bedside. Without stopping to dump her bag in her office, she pushed through the crowd of people to get to him.

“What’s going on? What’s happened?” She looked around, trying to get her bearings.

Stephanie’s face was flushed and she had a worried look in her eyes, making them appear like black buttons in her brown face. She didn’t answer Kate’s question. Kate glanced over and saw that Joel was still lying sedated and intubated, the ventilator keeping its own beat, pushing air into his lungs. Nothing appeared to have changed with his ventilation or oxygenation. There was a slight sheen of sweat on his face and a fan was oscillating, blowing air around the small area, causing the curtains to billow. She surveyed the monitor, saw the fluids running and was still confused.

“Dr. Powell? Bruce. What’s going on?” She tried to gain his attention but he was focused on looking over Joel’s charts.

“We need to filter this young man.”

Kate’s heart plummeted as though she had just been dropped from a great height.

No one had moved when the doctor spoke.

Without acknowledging Kate, he spoke again, frustration clearly heard in his gruff manner. “Now!”

Still no one moved, not even Kate. Her legs were lumps of concrete and she felt like her feet had been glued in place. Time seemed to slow down.

“His urea and creatinine have gone through the roof. We’ve got to get his pH down and the only way is to connect him up to the filter.” Still not acknowledging her, Bruce looked around the room at Stephanie and the others gathered in the small space, his voice gaining strength. He sounded angry. “Unfortunately, Kate, your staff don’t seem to know what they’re doing.”

Kate could hear the sarcastic tone in his voice and wondered what on earth was going on.

“Okay,” she said, trying to assess the situation. Her mind was spinning. This was Joel, her friend, not just any patient. Her own anger began to grow and she looked around for someone on whom to cast blame. “What’s going on? And why didn’t someone call me and let me know Joel wasn’t doing well?”

“Because I’ve only just been shown his blood results when I arrived,” Bruce snapped. “I didn’t know how sick he was when they called me in.”

“Isn’t this your week off, Bruce? I thought it was Simon’s week on duty.” Kate frowned in confusion. Her brain was sluggish. It seemed to be in slow motion.
I haven’t even had a cup of coffee yet,
she remembered.

The two doctors rotated, working one week on, one week off. At the mention of his name, the younger doctor walked in, dumping his backpack at the end of the bed. His shirt sleeves were rolled up and the back of his shirt was untucked from his pants. The collar of his shirt was still damp from his wet hair. He looked like he’d rushed in. Kate hoped
he’d
had his morning coffee.

“Good morning, Bruce.” He spoke to the older doctor and then nodded once in Kate’s direction. “Kate.”

What is happening here?
“Simon? What’s going on? Why are you both here?”

“Relax, Kate. It’s okay. Pippa wasn’t able to get hold of me this morning – I was out riding – so she left a message on my phone and then obviously called Bruce in to cover until I arrived.”

“I’m finding it a bit hard to relax. Joel is my friend. I want to know what’s going on.” Kate’s voice cracked slightly as she looked from one doctor to the other, seeking answers.

Pippa had been working the twenty-four-hour shift and Kate figured she must have been concerned enough to call the more senior, experienced doctors to come in and assess Joel’s condition. Kate looked across at Pippa and saw her standing to the side, looking uncertain. Kate had never seen her looking anything less than confident and it made Kate worry about how sick Joel really was.

The three doctors conferred at the desk and Kate heard them discussing multisystem organ failure as well as confirming their decision to put Joel on dialysis using the hemofilter, the machine that would remove blood from his body, filtering it through a series of tubes where waste products and toxins would be removed, before returning the cleaned blood back to his body.

“Are you saying he’s in septic shock?” Kate interrupted the doctors, worry and stress causing her to forget her manners.

“Yes.”

“So the antis haven’t worked?” She twisted the ring on her finger as she did whenever she was uncertain.

“Not at this stage.”

“How’s his breathing then?”

“So far his lungs are doing okay and I’m pretty sure the antis are working but I’m mostly concerned about his kidneys right now. Renal function’s totally off. Creatinine’s over four hundred and urea is sitting at thirty-five,” Simon replied.

Kate raised her eyebrows in surprise at the exceptionally high figures. Acute renal failure.
This isn’t good.
Why wasn’t anybody moving?

“Have you got the filter ready, Steph?” Kate turned to her, wondering why she wasn’t doing anything.

“No.”

“Why not? It takes at least twenty minutes to get it set up.” Kate’s voice was terse – a combination of worry and anger.

“I don’t know how to use it, mate,” Stephanie said in a voice so quiet Kate could hardly hear her.

“What do you mean? Why not?”

“No one here knows how to connect up the filter. We haven’t used this one before – most of the staff only know how to use the old one. And the last time we filtered anyone was ages ago. That’s why Pip called Simon. After I took gases and got the bloods sent off around five I showed her the numbers. Then pathology rang with the results and Pip was pretty sure he needed filtering but because we don’t know how to use the machine she wanted a second opinion in case we could get away with not needing to filter him. She waited ’til six to call Simon and when she couldn’t get hold of him she called Bruce in.” Her long explanation did nothing to appease Kate’s frustration.

“Why didn’t you just call me?”

Stephanie shrugged her shoulders. “I didn’t think to. We’ve never called the NUM in emergencies, always the doctor.”

Kate let out an expletive which was unusual for her. “That’s bloody ridiculous! What are Bruce or Simon going to know about operating the filter? It’s a nursing responsibility!”

“I don’t know, mate.” Stephanie’s answer was not what Kate wanted to hear and she struggled to keep her temper in check and her frustration from spilling out. She knew Stephanie was an excellent nurse, but she was staggered that no one in the unit knew how to operate the equipment. Joel was deteriorating while he was lying there and no one was doing anything about it!

“I can’t believe this! Hasn’t the educator gone through the new filter with everyone?”

“Kate, can you deal with that later? We need to get that filter on,” Simon said, cutting off her tirade. “And I suggest you get onto it quickly. This is one very sick young man,” he said as he left the room.

Kate looked at the doctor and her heart began to race at his words. He was usually very calm but she sensed the urgency in his voice, causing fear to course through her body and coil itself in the pit of her stomach. Was she too emotionally involved to be able to care for Joel? She tried to mentally take a step back but her thoughts were in turmoil, spinning in a vortex.

“What filter have you been using?” Kate asked, trying to refocus her attention on the job in front of her.

“The old Aquarius. We only got the new Prismaflex a few months ago and we haven’t had to use it yet. We don’t get many filtered patients here in the
country
,
” Stephanie emphasized. Kate felt the sting of her words but chose to ignore what she was implying.

“Well where’s the Aquarius then? Why haven’t you just connected that up if you all know how to use it?”

“That was the first thing I suggested to Pip but we can’t use the old machine because all the stock is out of date and the software needs updating or something.”

Kate’s eyes widened as she stared at Stephanie. She was so angry she was speechless but she managed to hold her temper in check. Losing it wasn’t going to make Joel better.

“Kate? Have you sorted the filter situation out yet?” Simon came back into the room, pushing the metal trolley that contained the equipment he needed for the insertion of the catheter into Joel’s groin. He was frowning at her.

“Steph, go and get the Prismaflex and bring it in here.” Kate knew she sounded rude but she was still staggered by what Stephanie had told her.

A few moments later Stephanie wheeled the bulky green machine into the bed area. “Have you used the Prismaflex before?” she asked Kate.

“Yes, I have. I’m very familiar with it.” Kate knew she sounded arrogant but she was under pressure from Simon and increasingly worried about Joel. By now the other nurses had gathered around Joel’s bed and were watching Kate.

“So none of you have had any training on this machine,” Kate confirmed as she turned it on.

“No.”

“None.”

“Nope.”

Kate shook her head. “Later this morning I want someone to call the educator.”

Greg spoke up, “I actually did think about calling him in earlier, but by then Pippa had already called Simon and Bruce.”

“Okay, well I’m not going to take the time to explain how to set the machine up right now because we need it done immediately, but feel free to watch. I’ll make sure the educator does a full training session on the filter over the next few days.”

Kate began loading the tubing that Stephanie handed her, feeding it into the correct places on the front of the machine. The others watched her in silence, handing her the large bags of fluid when she asked for them. Within a short amount of time the machine was ready for use.

“Well done, Kate,” Simon applauded her as together they connected Joel up to the machine and waited while the wheels began spinning, extracting the blood from his body.

The other nurses finished putting excess stock away and Kate composed herself enough to spend time explaining the operation of the machine to Amanda who was going to look after Joel for that day.

As she left the room she found the doctors and spoke quietly to them. “Sorry Dr. Powell. Simon. I had no idea the staff hadn’t used this filter before,” Kate apologized, “and I’m sorry for my anger. Joel is a friend and I probably overreacted.”

“Well at least it’s all sorted now,” Simon said, smiling reassuringly at her. “As long as they know to come and get one of us urgently if it blocks or if they’re unsure of anything.”

“Of course,” Kate replied. “I’ll make sure they all know.”

During rest period that afternoon when the lights had been turned down and all the visitors had left the unit, Kate finally had a chance to check on Joel. She was aware that Sean and Lorraine had sat with him all morning and she knew Emma had visited. She had yet to meet Liam.

“How’s he doing?”

“Great. He’s responding really quickly to the filter.”

Kate glanced over at Joel and then looked at the numbers on the chart on Amanda’s desk. She was pleased to see everything trending in the right direction. Relief pushed her exhaustion aside and dulled the tension that had been gripping her tighter than a tourniquet over the past couple of days.
Thank you, God.
Maybe Sean’s prayers were going to be answered and Joel was going to be okay.

“Go and have your lunch, Amanda – I’m covering for you.”

“Oh thanks, Kate. That would be great. I’ve actually got a shocking headache.”

“You okay?”

“Oh I’ll be fine – you know what it’s like – one of those headaches you get when you’re learning something new and it’s a stressful day.”

“How are you finding the filter?”

“Surprisingly easy.”

“Has the educator spent any time with you?”

“He was here all morning. He’s been great.”

“Well he should have trained you all
before
a patient needed to be filtered.”

“Don’t blame him, Kate. There’s been a lot of changes here lately and that’s just something that got missed.”

“Well it could have had catastrophic consequences if Joel had died while we were waiting to work out how to turn a machine on.”

“But he didn’t die, Kate. No use thrashing it out with Ian – or any of us for that matter. The fact is, Joel is okay.”

Kate sighed. She knew Amanda was right, but the pressure she was feeling was immense. She had allowed fatigue and worry to weaken her to the point that she was finding it difficult to think clearly.

“You’re right. Anyway, enjoy your lunch and take your time. I’m happy to sit here as long as you need. Take an hour, okay? And grab a couple of Panadol.”

Kate looked over the chart and paperwork on the desk, and seeing everything was in order, she pulled up a chair and sat beside Joel. Her back was stiff and knots had formed in her neck from all the stress. She tilted her head from side to side and raised her shoulders to meet her ears, but it did little to ease the tension that was there.

“Hey you,” Kate said softly as she squeezed Joel’s hand.

Beneath his closed eyelids she saw slight movement as he struggled to open his lids. She knew the amount of sedation he was receiving was enough to keep him relaxed and to prevent him from pulling out the tube, but she desperately wanted to lighten the level of sedation to let him know she was there with him. Pushing buttons on the IV pump, she waited a few minutes for the decreased dose to have an effect. She squeezed his hand again.

“Can you hear me, Joel? Open your eyes. Squeeze my hand.” Slowly he squeezed her hand in return and opened his eyes slightly. She could see he was trying to focus on her through his lashes. “You’re doing great, Joel,” Kate reassured him. “You’re still in the ICU and you were pretty unwell this morning but you’re getting better, I promise. You’ve still got that tube in your mouth helping you breathe. Just try to relax and we’ll keep you nicely sedated and comfortable.”