Emergency Response (11 page)

“One day the timing will be right or something will happen and I’ll know what I’m supposed to do. Until then, I’ll keep doing what I’m doing here.” He stopped abruptly, let go of her hand and turned to face her. “Enough of this depressing discussion.” He smiled at her. “Do you ever have any weekends off?”

Mackenzie raised her eyebrows in surprise at his change of tone and smiled in return. “I’m off next weekend. Three full days. Why?”

“Don’t make any plans,” he announced as he draped his arm across her shoulders and pulled her into a sideways hug. “I’m going to take you on an adventure to the real Australian Outback. And I promise it will be the best experience of your life.”

“This is Wayne,” Charlotte said, bringing a man through from triage to one of the small cubicles later the next day. “He’s a forty-four-year-old man. Lives at home.”

Mackenzie gave the man a small wave. “I’m Mackenzie, I’m working with Charlotte. We’re your nurses.”

Wayne clutched at his very considerable abdomen with an open hand and barely acknowledged her greeting. He moaned in pain and Charlotte raised her eyebrows as she turned away from him and addressed Mackenzie quietly.

“His wife just dropped him off saying he’d had a sudden onset of sharp central chest pain after eating breakfast this morning. She’s outside having a smoke.”

“Past history?” Mackenzie asked softly.

Charlotte lowered her voice further. “I’m sure you can work it out just by looking at him.” She took a few steps away and with her back to Wayne smirked at Mackenzie. “Type two diabetes, high cholesterol, smoker, hypertension, GORD.” She rattled off her suggestions, holding up one finger for each diagnosis. “Add to that a recent chest infection, peripheral vascular disease and gout.” Charlotte checked her watch and then thrust the paperwork into Mackenzie’s hands. “And now he’s all yours.” She grinned. “My shift has just finished!”

“Jeez, he’s only forty-four!” Mackenzie exclaimed as she skimmed the paperwork in her hand and then glanced at Wayne.

She entered the cubicle and pulled the curtain closed. She tried to attach the blood pressure cuff to his upper arm but his writhing and moaning made it very difficult. Both arms still clutched at his chest.

“Wayne!” Mackenzie said sharply.

He stopped for a moment and looked at her.

“How bad is your pain right now? If ten is the worst pain you’ve ever experienced in your life and one is a slight niggle, what would you rate it?”

“Oh, it’s a ten for sure,” he said, groaning again to illustrate the point. “It’s
burning
.” He clutched at his chest again as a woman whipped open the curtain and strode into the cubicle. Mackenzie’s eyes widened in astonishment. The woman who pushed past her and bent over to kiss Wayne on the cheek was the female version of him. She reeked of cigarettes.

“I’m Sharon. His wife. What’s wrong with him? He’s having a heart attack isn’t he? What are you doing about it?” The questions flew from her mouth like gunfire.

“Hi Sharon. I’m Mackenzie. I’m one of the nurses here. I haven’t been able to assess him yet. How about you take a seat and I’ll do what I need to do.”

Sharon crossed her arms and glared at Mackenzie. “But if he’s having a bloody heart attack, shouldn’t one of the doctors be seeing him instead of you?” she asked, her voice going up a notch. Wayne moaned again, as if to indicate his agreement.

Mackenzie clamped her lips closed to stop from saying what she
really
wanted to say. Ignoring the woman’s condescending tone, she wrapped the blood pressure cuff tight around the man’s meaty upper arm and attached the oxygen saturation probe to his finger. Placing her stethoscope in her ears, she was pleased when it at least drowned out some of Sharon’s muttered comments about the nursing care her husband was receiving. She listened to Wayne’s pulse as she pumped up and then deflated the cuff. His blood pressure was definitely up. One-ninety on eighty-five. Maybe pain. Maybe stress. More likely because he hadn’t taken his morning anti-hypertensive medications.

Pulling her stethoscope from her ears, she wrapped it around her neck in one fluid, well-practiced movement as she undid the cuff and looked at him.

“Have you taken your blood pressure medications today?” She was certain he would be on more than one anti-hypertensive tablet.

“I ran out two days ago.”

Bingo! Mackenzie remained silent.

“What’s his blood pressure?” Sharon demanded. “It’s up isn’t it?” Sharon let out an expletive. “I tell you, he’s having a bloody heart attack. I know he is. You’ve got to get a doctor now!”

Charlotte pulled back the curtain and entered, pushing the ECG machine in front of her.
Perfect timing.

“Are
you
the doctor?” Sharon demanded.

“Nope, I’m Charlotte. Another one of the nurses. I’m working with Mackenzie.” Her singsong voice belied her real attitude.

“I thought you were going home,” Mackenzie hissed.

“Decided you might need some help.”

Mackenzie flashed her a grateful smile. Between them they attached the sticky dots and ECG leads to Wayne’s diaphoretic upper body and limbs, while Sharon breathed like a dragon down their necks. Wayne continued to groan theatrically.

“Lie still Wayne or we can’t get a good shot,” Charlotte said.

Wayne sat still long enough to capture a picture of his heart. While the ECG was printing, Mackenzie checked his temperature and then attached cardiac monitoring leads to his body.
White on the right. Smoke over fire. Snow over grass.
The simple phrase helped her remember which order to place the five colored leads in position on his chest, even though she had been doing it for years.

Charlotte waved the ECG in front of Mackenzie and she gave it a cursory glance. “Sinus rhythm. No ST changes. Slightly tachycardic,” Mackenzie said with a shrug. “Looks like a pretty normal ECG to me.”

“Are you going to show that to a doctor?” Sharon asked.

“I need to take some blood first and when the results are back, we will have a better idea of what’s going on,” Mackenzie said, grinding her teeth together to stop from losing it.

Sharon swore again. “He’s having a heart attack! That’s what’s going on! I’m telling you and you’re not doing a thing about it!” Sharon stood with her hand pressed against Wayne’s arm, challenging them with her eyes, nostrils flaring like a racehorse at the end of a sprint.

“Wayne, did you take
any
of your normal medications this morning? What about the tablets you take for your reflux?” Mackenzie asked, ignoring the glowering Sharon. At the rate she was going,
she
was about to have a heart attack.

“Oh I stopped taking them ages ago. They weren’t working.”

Mackenzie raised her eyebrows and stifled a groan. She spent the next few minutes asking Wayne questions and documenting everything. Sharon watched over her shoulder, legs planted wide apart with a tight expression on her face. She was thankfully smart enough to keep quiet while Mackenzie worked.

“I hate needles,” Wayne said when he saw Mackenzie pull the IV cart toward him.

“It’s a tiny little sting and it will all be over,” Mackenzie assured him. “All I’m going to do is take some blood. If we need to pop an IV line in later, we can do that. Small scratch,” she said as she inserted the tiny butterfly needle into his vein. She withdrew enough blood for three pathology tubes, pulled out the needle, wrote on the tubes and filled in all the necessary paperwork before turning back to Charlotte.

“I reckon we should give him a ‘pink lady,’” Mackenzie said.

“Good idea,” Charlotte said as she snatched up the paperwork and bloods. “I’ll call the doctor.”

“You agree with me though, don’t you? Heartburn?”

Charlotte nodded. “Absolutely! Of course we won’t know ’til we get the bloods back, but yeah, I reckon that’s highly likely.”

“Heartburn?” Sharon spluttered. “Are you kidding me? It’s not heartburn, it’s a heart
attack
! I want to speak to the doctor!”

Ten minutes later Richard, the local GP, appeared and asked Wayne and Sharon all the same questions Mackenzie had. He concurred with the nurses and suggested Wayne might like to drink a pink lady – a mix of Mylanta and a local anesthetic which would take away some of the burning sensation caused by his heartburn. He ordered them to administer Wayne’s usual medications and some paracetamol, and three minutes after the doctor left, the moaning subsided and he reported he was pain free.

Hours later they discharged Wayne home with advice to stop smoking, lose weight and remember to take all his medications every day. Mackenzie highly doubted he would be compliant with any of their counsel. He and Sharon walked out of the department without as much as a thank you or a backward glance.

“Patients like that make my blood boil,” Charlotte said a few minutes later after they’d tidied everything.

Mackenzie shrugged. “Not much we can do about it. Are you heading home now?”

“Yeah. I hope the rest of your shift goes well. You’re off this weekend aren’t you?”

Mackenzie felt her cheeks heat. “Yes, I am.”

“Ah, that’s right,” Charlotte drawled. “I remember now. You and Nathan Kennedy are going camping aren’t you?”

“News travels fast around here.” Mackenzie turned away so she could hide her flushed face.

“You have no idea how fast. I heard all about you beating him at pool the other night at the pub within ten minutes of it happening. The guys there said the air was very steamy and you only had eyes for each other. I also heard you walked out of there hand in hand, headed back to his place. So has he kissed you yet?”

“No!”

“But you want him to?” Charlotte asked.

Mackenzie’s silence and red face was answer enough.

“Ooh, a fly-in fly-out romance. Just what you need to spice things up while you’re here,” Charlotte said. When Mackenzie frowned, Charlotte continued. “They’re the best kind of relationships. If it doesn’t work out, you can just fly back out at the end of your contract and never have to see the guy again.”

“Oh, I’m not like that,” Mackenzie said with a quick shake of her head. “I’m not interested in the one-night stand thing.”

“Oh, that’s so sweet,” Charlotte teased. “Let me guess, you want the whole ‘horse and carriage, love and marriage’ thing don’t you?”

“Maybe.” She wasn’t about to admit Charlotte had hit the nail squarely on the head.

“Well I’d have to say he’s perfect marriage material. He’s not my type – too clean cut for me – but I’ve often wondered why he’s still single. I reckon he’d be a great catch.”

“Have you known him long?” Mackenzie asked. “Has he gone out with anyone here?”

Charlotte shook her head. “I’ve only been here six months and he hasn’t been out with anyone in that time as far as I know. I heard he had a serious relationship with a girl in England. Ellie someone.” She shrugged. “Maybe she broke his heart and he’s still getting over her.”

“Hm. Possibly.”

Why had he never mentioned Ellie before?

“So you’re pretty keen on him then?” Charlotte asked, breaking into her thoughts.

“He’s a great guy and we get along well.” She sounded evasive, even to her own ears.

“And?”

“And he’s incredibly sexy,” Mackenzie said with a laugh, “and I’ll be the first to admit I’d be crazy if I wasn’t interested in him. Problem is I’m not sure why he’d be interested in
me
?”

It was Mackenzie’s final shift before her well-earned weekend off. She hadn’t left Iron Ridge except to go to Paraburdoo or Tom Price for shopping and she couldn’t wait to explore further afield. At the rate time was flying, her three months in the Pilbara would be over in a flash.

Nathan had promised to take her to see what he described as “the most magnificent gorges and waterfalls in the world” and she could hardly wait. As much as she was dying to see the “real” Australian Outback, as Nathan had called it, she was also secretly looking forward to spending two full days alone with him. She hadn’t seen him all week, but they’d talked every day and she’d received numerous text messages from him as he arranged all the details of their overnight camping trip. She was getting more excited with every conversation.

She eyed the darkening sky and hoped the weather would hold. She didn’t want to have to cancel their trip because of a storm. For some reason she felt unusually antsy and she didn’t think it was simply due to the weather. She pulled her hair up into a knot on top of her head and pinned the wispy pieces back from her forehead and headed out the front door to work, wincing at the sudden blast of hot northerly wind against her skin. In the distance, thick clouds were building on the horizon, bringing with them humidity and the hopeful promise of rain. Since she’d arrived, it hadn’t rained once.

Spring had arrived in the Pilbara, but it felt hotter than any summer Mackenzie had ever experienced. Only days after she’d arrived in August, the temperatures had soared from pleasant mid-twenties to high thirties every day. They were now up to their sixth day in a row of temperatures above thirty-five degrees. The bureau of meteorology simply altered the forecast day to day from “hot with plenty of sunshine” to “partly sunny and very warm.” The days were unbearably hot, and without air-conditioning everywhere, Mackenzie would have melted into a pool of sweat. The only positive aspect of the heat was she wasn’t eating as much and already her scrub pants felt a little less snug around her thighs, which was something that brought a smile to her face. The hot weather normally didn’t bother her, but after six days with no sign of a reprieve, she wondered how much longer she could cope with the heat.

Mackenzie arrived at work to find Charlotte and Amy in the resus bay with a young girl sitting up on the bed between them, gasping for breath. Mackenzie’s heart sank. She had treated the same little girl the week earlier.

“Hey Mackenzie,” Charlotte greeted her, worry evident in her eyes. “This is little Georgia. She’s nine. Known asthmatic. Multiple presentations. And that’s her mum, Donna.” She pointed to the woman leaning disinterestedly against a doorframe.

“We’ve met.” Mackenzie heard Georgia’s wheeze from where she stood without needing a stethoscope. She glanced at Donna again before turning her attention back to Georgia.

“We’ve done hour of power and she’s improved, but still struggling,” Charlotte said.

Mackenzie had given the same thing to Georgia on her last admission. Ventolin and Atrovent at regular intervals, along with Prednisolone. It had worked well then and with luck, it would do the same this time.

“Hi Donna,” she said. “I looked after Georgia the other day.”

The woman looked up from her phone and nodded. “Yeah I remember. You took over from Doc. Charlotte said you have an ICU background. I’m glad, because Georgia’s already had two ICU admissions with her asthma in the past twelve months. I forgot to tell you that last week.”

In the back of Mackenzie’s mind, an alarm pinged. Georgia could deteriorate very quickly and they weren’t set up to intubate if they couldn’t get her airways open with bronchodilators.

Mackenzie smiled warmly at Georgia. “Hi. I’m Mackenzie. Do you remember me? How are you feeling, sweetie?”

“Better,” Georgia wheezed, glancing at her mother. She was clearly lying.

“It’s the change of weather,” Donna said with a wave of her hand. “Happens all the time. I had her home all day yesterday. She’s had a bit of a cold and wasn’t well this morning when she woke up. I knew her asthma would flare today as soon as I saw those storm clouds building. Is she all right here with you? I’m just gonna pop outside for a quick smoke.” Without waiting for an answer she headed to the glass doors which led outside.

Mackenzie tried to ignore the annoying niggle of frustration which was building. Didn’t Donna care about her daughter? She turned to Georgia, smiling again. “Do you mind if I lift up your T-shirt and have a listen to your chest, sweetie?”

Georgia stared bleakly at Mackenzie as she lifted the shirt up and onto the little girl’s shoulders.

“Tracheal tug, use of accessory muscles,” Mackenzie said quietly. “Has her respiratory rate dropped at all since she got here?”

Amy nodded. “Yeah, heaps actually. She was barely speaking one or two words when Donna brought her in and that was after her usual Ventolin at home. Rate was almost sixty. Back down to forty now. She mightn’t look it, but she’s heaps better.”

“And her oxygen levels?”

“She’s maintaining sats of ninety-three percent on room air now,” Charlotte answered.

Mackenzie listened to Georgia’s chest, noting the high-pitched squeal at the end of each expiratory breath. “Have you been using your puffers at school?”

Georgia hesitated before nodding vigorously. Once again Mackenzie didn’t believe her for a second.

“Still a considerable wheeze. When is she due for the next dose?”

Amy consulted the chart. “Another five minutes.”

“Okay. Make sure we listen to her breathing before and after the next neb, then I’ll call the RFDS if I need to.”

“Oh, we’re not giving nebs, we’re only using the spacer,” Amy said. “That’s what her mum said she’s used to at home.”

“Are you using it properly though?” Mackenzie asked Georgia. “The way I showed you last time?”

There was a long pause. “Sometimes.”

“Her mum said she doesn’t like taking it to school. She said it’s too bulky and the kids make fun of her when she uses it, so she only makes her use the spacer at home,” Amy said.

Mackenzie frowned, debating whether it was worth having an argument with Georgia’s mother when she returned about the risks of not using the inhaler properly. Donna’s apparent disinterest in her daughter’s asthma meant it would probably fall on deaf ears.

“How about the next one we try using a neb,” Mackenzie said. “I know best practice says use the spacer but if she’s having difficulty breathing it in properly, she might not be getting the full benefit of the drug.”

“Okay,” Amy replied. “It’s certainly worth a try.”

Mackenzie grabbed an oxygen mask with a canister from the container at the back of the bed and tore the packaging open. Charlotte handed her two small plastic ampoules. She snapped the lids off. Squirting the liquid into the container, she screwed the connections together and attached the tubing to the oxygen on the wall. She fitted the mask over Georgia’s face and tightened the orange elastic, securing the mask in position. Georgia continued to struggle to catch her breath. Amy turned the oxygen flow up high and immediately the nebulizer steamed as the oxygen mixed with the drugs, bubbling away while steam emitted from the mask.

Mackenzie stood back to observe Georgia. She was a skinny girl and with every strained breath her whole upper body moved. A strand of blonde hair was plastered across her forehead, falling into her right eye. Mackenzie brushed it back. Donna had returned but her head was down, tapping away on her phone, not even watching her daughter. Mackenzie wanted to pick up the phone and throw it across the room. Did the woman not realize how sick her daughter was?

“You’re doing great, Georgia,” Mackenzie reassured her. “Keep taking nice deep breaths. Try to slow your breathing down.” She turned to Charlotte and Amy and spoke quietly. “I think we should get a drip in just in case.”

Amy pointed to Georgia’s arms. Local anesthetic, referred to as “angel” cream, covered in occlusive dressings was on the back of her hands and the inside of Georgia's elbows to numb those places in case she needed to have a cannula inserted. Clear plastic dressings covered the cream. “One step ahead of you sister,” she said with a smile.

*

Half an hour later, Georgia had visibly improved. Charlotte and Amy finished their shift and headed home. Georgia was chatting to Mackenzie about her new puppy and no longer struggling for each breath. Her chest sounded clear and both her respiratory rate and heart rate had reduced. Once again the drugs had worked their magic.

Mackenzie’s own heart rate returned to normal as she watched Georgia. She kept her in the hospital for another hour to observe her, but eventually Georgia’s boredom at being cooped up inside was more than either Mackenzie or Donna could stand. Mackenzie discharged them both home after attempting to explain the severity of Georgia’s asthma to Donna. She then went and made herself an early dinner. If the past three Friday nights in Iron Ridge were any indication, it would be wise to eat early before it got busy and she missed out on a meal altogether.

Outside, heavy drops of rain had begun to fall and they landed like golf balls on the tin roof. A cool breeze had sprung up and Mackenzie walked around the small hospital closing up windows. The temperature had dropped considerably and Mackenzie sighed in disappointment as she glanced out at the dark sky. It looked like they would have to cancel their trip.

She stood in front of the microwave waiting for her dinner to reheat when the sound of the phone made her jump. She rushed back to the front desk to answer it. It was the police, on their way with a young man they’d picked up outside Hendo’s pub. He was drunk and they needed somewhere to dump him. It was too late to tell them a hospital was not the place for people to come while they sobered up – they were already on their way. It looked like dinner would have to wait.

Five minutes later two police officers in blue uniforms stumbled through the front door, their arms hooked around the upper torso of a skinny indigenous man. His dragging feet left a dirty trail of mud along the floor. The three of them were soaking wet. The wind caused the front door to slam shut behind them and Mackenzie jumped as though slapped. Her senses were on overdrive. She loved storms, but for some reason tonight’s weather had put her on edge.

“Gotta dump him and run,” the older of the two policemen said when they’d hoisted the man onto the narrow bed. At first glance Mackenzie thought he looked like an old man, but on closer inspection she realized he wasn’t much older than a teenage boy. “There’s been a rollover out near one of the black fella communities outside of Para.” He must have seen the apprehension in Mackenzie’s eyes. “Don’t worry, love, we’ll take any of the survivors over to Para or Tom Price – closer than here. We were heading out that way when someone called this in.” He pointed to the man on the bed. “He was found lying in the rain outside the pub covered in his own piss. People were tripping over him.” The cop laughed without mirth and Mackenzie felt an instant dislike toward him. “He was ruining everyone’s good night out.” He chuckled again. “Anyway, good luck. He’s all yours, love.”

The police left and Mackenzie began her assessment. As hard as she tried, she was unable to rouse the young man. She yelled at him, squeezed his trapezius muscles and even resorted to pressing the edge of a pen hard against his fingernail. At least that elicited a grunt from him. She checked his blood pressure, which was on the low side of normal and checked his heart rate, which was fast, but wasn’t what she considered was tachycardia. She took his temperature and it was low, but not surprising depending on how long he had been lying outside in the rain. Covered in dried vomit and urine, he smelled of alcohol. Mackenzie tried not to grimace as she peeled off his T-shirt and jeans, covering him in a hospital gown and crisp white sheet. Dumping his clothes in a plastic garbage bag, she knotted the top and then threw it beneath the bed. She then pulled both the rails up on either side of the bed. He might as well sleep off his hangover.

While she waited for him to stir she ate her reheated dinner and rang Nathan. “Will we have to cancel tomorrow?” she asked when he finally answered on the fifth ring. She heard loud cheers in the background. “Where are you?”

“I’m at the pub,” came his shouted reply. “A few of the guys are leaving for Perth in the morning and I’m watching them play a game of pool. Macka just pocketed four balls with one shot.” There was more shouting. “What did you say about tomorrow?” he asked, still shouting. It was clear he was having difficulty hearing her over all the cheering and laughter.

“Will we have to cancel the trip?” she repeated slowly.

She heard muffled sounds and the noise in the background faded. “Sorry Mackenzie, I couldn’t hear you. I’ve stepped outside now. What did you ask?”

“Oh, I’m sorry. I don’t want to take you away from your friends.”

“They’re just the guys I work with. You met some of them last week. It’s no big deal. Now, what did you ask?”

Mackenzie hesitated. “I was a bit worried the storm would mean we’d have to cancel our trip tomorrow.”

“Not at all. In fact, the rain will mean all the waterfalls and gorges are full. We may not be able to swim and there will be some parts we won’t be able to cross if the river is up, but we’ll still go.”

“But what if it’s still raining tomorrow?”

“I can assure you the sun will be out and the skies will be royal blue again by seven o’clock tomorrow morning when I pick you up. You can trust me on that one.”

“Oh, okay.” Mackenzie regretted calling him. She probably sounded like a whining city girl and she certainly didn’t want him to get that opinion of her.

“I forgot to check with you. Do you have any hiking boots? Or at least some good quality runners with heavy soles?” he asked.

“I don’t, but Charlotte does. She’s already warned me I’ll need good shoes and thick socks so I’m borrowing hers. I just hope I can keep up with you.” Mackenzie pictured Nathan’s long, lean legs effortlessly climbing over rocks while her own shorter legs struggled to keep up with him. “What else do I need to bring?”