Intensive Care: Escape to the Country (9 page)

“What are your plans for the rest of today then?” Kate asked as their cars came into sight and she slowed her pace slightly.

“Work today. I’m open in the morning ’til midday unless it’s quiet, then I close up a bit earlier and head out to the farm.”

“Farm?”

“Ah, I suppose that will have to be a conversation for our next run, City Chick,” Joel teased. “If you’re not going to tell me anything about yourself, I’ll have to keep boring you with all the details of my life.”

Kate knew she’d been caught out, but didn’t want to admit that Joel was right.

“Well I’m off to work this morning too. I’ve got so much paperwork to catch up on I thought I might head in there on my day off. But I’ll have to stop and grab a coffee first.” She paused for effect and then teased back, “You don’t happen to know anywhere I could get a decent one do you?”

By the time they had finished stretching, the sun had broken through and the fog was almost gone. Kate half expected Joel to make plans for another run together. She was disappointed when he stepped into his car and, with a wave out the open window, drove off, leaving her alone, surrounded by black fumes from his diesel engine.

An hour later Kate had showered and was dressed in her favorite denim jeans, a long-sleeved blue and white striped T-shirt and a navy blue cable knit cardigan. She was wearing a brand new coat and had wrapped a thick scarf around her neck. Checking herself in the mirror, she was pleased with the casual ensemble. She left her hair loose and the ends curled slightly with a natural wave. It felt nice not having to tie it up for a change.

She had to circle the block twice before she eventually found a park close by the laneway that led to the Bean Counter. It was a busy morning in town with people filling the streets. There was a buzz Kate hadn’t noticed during the weekdays. It was as though everyone came out to shop on Saturday mornings. After only a short time living in Birrangulla, Kate finally understood what the locals meant when they said their Sydney cousins were missing out. She had to agree with them.

With a spring in her step Kate headed inside to get her coffee. The café was packed. She noticed the same young woman working alongside Joel behind the machine. They looked comfortable standing together and there was a familiarity about the way their arms occasionally brushed against each other as they worked.
Surely she’s too young to be his girlfriend.
Kate shook her head. Where were these thoughts coming from? Joel O’Connor might be cute, but she wasn’t interested in another relationship. And she certainly didn’t want to get things confused and start thinking of him as anything other than a friend. If Joel was going out with someone, that would make things so much easier for her. She enjoyed their daily chats and had enjoyed running with him that morning, but she didn’t want to read anything into it that wasn’t there. He certainly wasn’t sending off any signals that he was interested in
her
. After all, he hadn’t even made another time to catch up.

Her thoughts spun around her.

Although the café was busy, Joel looked as relaxed as usual. When he saw Kate he smiled and waved in her direction. She stood patiently in line, waiting for an older couple to make their decision and place their order. When it was her turn she was pleasantly surprised when Joel handed her a freshly made coffee in a brand new reusable cup.

“This one’s on the house, City Chick,” he said. “Keep the cup for next time. And thanks for the run this morning. We’ll have to do it again.”

Out of the corner of her eye Kate was sure she saw the young woman frown in her direction. With a “thanks” to Joel and what she hoped was a casual wave, Kate left the café and headed toward the hospital.

By the time Kate arrived home from work later that afternoon, heavy, dark clouds filled the sky, threatening rain and she stumbled around in the shadows trying to fit her key into the front door lock. While she wasn’t usually spooked by stormy weather, living in such an isolated area had caused her to become a little more jumpy than usual. She seemed to have an increased sensitivity to every sound or change in the environment, especially at night. Although she wasn’t scared, she made a mental note to call April the next morning and arrange for an outdoor light with a sensor to be installed. When the lock finally turned and the door opened, Matilda greeted Kate with her usual exuberance as only a Burmese cat can, winding between Kate’s legs, reminding Kate that her company had been missed all day. She stooped down and picked the cat up in one fluid movement, rubbing her chin on the cat’s head, comforted by her purr.

“Did you miss me, Till?”

Flicking on the light switch with her elbow, Kate answered her ringing phone with her spare hand, not recognizing the number displayed on the screen.

“Hello, Kate Kennedy speaking.”

“Kate, we need to talk.”

The voice on the other end was quiet and deliberate. It was a voice Kate knew and loved well. A voice she had managed to avoid up to this point. Immediately she felt her body tense and her heart felt like a knife had been twisted deep inside. Kate unceremoniously dumped Matilda on the couch. “I have nothing to say to you and I don’t believe there are any words I want to hear you speak to me,” Kate answered, her voice wavering slightly as she began to pace through the house. She flicked lights on in each room as though hoping the light would push away the darkness that was rapidly closing in on her heart.

“Katie!”

“Don’t ‘Katie’ me, Marcus. How did you even find me? Who gave you this number?” Kate was furious.

“I called and asked one of your colleagues. Or should I say one of your
former
colleagues. Mackenzie Jones I think her name was. I had to drag it out of her. Have you seriously left your job and moved to the country? That’s what she was saying. Or is this some temporary thing? You’ve never mentioned wanting to change jobs. And where the hell is Birrangulla?”

“I’ve already told you, I don’t want to have this conversation with you.”

“Kate, you have to at least tell me what I’ve done wrong. Why did you leave? You haven’t answered a single one of my messages. Have you even listened to your voicemail?”

Kate scoffed. “Oh you have to be kidding me, Marcus. Are you serious? If you even try to deny it I’ll hang up right now.”

“Kate. Honestly. Honey, I have no idea what you’re talking about. All I know is that I came home from work one night and you were gone. You haven’t returned my texts or calls. I’ve been frantic with worry. You obviously weren’t at your parents’ house because I drove past and your car wasn’t there. Your brother refuses to speak to me when I call him. Then yesterday I find out you’ve got a new phone number. I just want to know where you are, why you ran away and when you are coming back home. We can work this out, Kate. Whatever
this
is.”

The problem with trying to have an argument with a lawyer is that you never win. Kate had learned that fact early on in her relationship with Marcus. If they ever got into a disagreement, whether it was a major issue or something trivial, things always worked out better if she kept her mouth shut and her head pulled in. Marcus wasn’t a bad person, he just liked to be the alpha male. It didn’t usually bother her, unless they got into an argument. Trying to keep her voice controlled, Kate matched his quiet intensity as she deliberately considered her next words.

“Marcus. I will say this once and only once so please listen to me without interrupting. It’s over between us. You have broken my heart and I am doing whatever it takes to find peace and healing in a new place. Yes, I resigned from my job and yes, I have taken another position at the hospital in Birrangulla. But of course you already know that. Please just leave me alone. Don’t call me again. Don’t text. And do
not
try to find me,” Kate stated emphatically. She knew her face was flushed and she was glad he couldn’t see her – she would have been in tears. Inside, her stomach was churning. She hated confrontation.

There was silence at the other end for so long that she began to wonder if the call had been accidentally disconnected. Finally she heard Marcus sigh. It wasn’t his usual sigh of exasperation when things didn’t go his way, but more a sigh of defeat and Kate wasn’t sure how to interpret it.

“Katie, I can’t fix this unless you tell me what I did wrong.” Marcus’s words were a plea for understanding but Kate was confused and still angry.

“Marcus,” Kate sighed in exasperation, “why don’t you just ask Cindy? I’m sure she can tell you that it’s something that just can’t be fixed.”

Kate hit the end button on her phone and burst into tears. She felt her body go limp as a wave of fatigue that she hadn’t felt in months overwhelmed her. She thought she had been doing so well in moving on and forgetting Marcus, but all it had taken was one phone call and the memories came flooding back. She barely had time to wipe the tears when the phone rang again.

“I just told you not to call me again!”

“Kate?” It was a female voice.

“Yes? I’m sorry. Who is this?”

“It’s Debbie. From work.”
The unit receptionist.

“Oh Debbie I’m sorry. What can I do for you?” Kate tried to gather her thoughts and hoped she sounded apologetic. Debbie must think she was incredibly rude but she didn’t want to have to try to explain.

“There’s been an emergency. I know it’s Saturday and you’re not rostered on, but we can’t get any staff and we’re getting an unexpected admission.”

“Give me twenty minutes,” Kate replied. “I’ll be there as quickly as I can.”

By the time Kate arrived at work fifteen minutes later, she had almost forgotten about the phone call from Marcus. The unit had been quiet for most of the day until Debbie had taken the phone call from the emergency department. A twenty-four-year-old man had been involved in a quad bike accident on the family farm. Knocked unconscious, he had sustained severe head injuries. His condition was critical and he wasn’t expected to live. He was being sent to the unit for monitoring and management.

Amanda Collins and Mitch Wood were the only two nurses on duty and Kate was glad Debbie had decided to call her in. Although Amanda was a senior nurse with years of ICU experience, Mitch was only two years since graduating and he had a tendency to be a bit gung ho during emergency situations. She hoped he didn’t know the patient personally, but figured it was likely that he did, given the size of the town.
Great
,
she thought sarcastically,
that’s all I need.

Kate guessed Amanda was in her early forties but it was difficult to tell. She wore bright red-framed glasses that matched her lipstick. She was an excellent nurse and patients and staff alike all loved her.

At twenty-six, Mitch had a shock of red hair and the obligatory freckles that most redheads have. He wore the freckles well, and despite his naturally pale skin, he had somehow managed to acquire a tan in the middle of winter. 

By the time Kate arrived, Amanda and Mitch had prepared the room and all they could do was wait for the emergency department staff to bring the patient up to the unit. Kate wondered what the delay was. Two orderlies were quietly standing outside the room, one of them holding the pat slide that would be used to transfer the patient from the trolley onto the ICU bed. No one was saying much and there was a somber mood in the air.

Simon Barclay, one of the other intensive care consultants, arrived shortly after Kate. He began conversing with Ewan as they all waited. In the short time Kate had worked at the hospital she already loved working alongside Simon. He was young, tall and exceptionally good-looking. He wore his clothes well, usually brand names, and always the latest fashion. He was clearly intelligent and it was obvious by the way he spoke and carried himself that he was privately educated. Although he had a hint of over-confidence about him, he was an exceptional doctor with a great bedside manner.

Just before five o’clock Pete Anderson arrived. As he was wheeled into the unit, Kate’s adrenaline kicked in and she felt her heart begin to race. Pete’s large-framed muscular body was covered with a mix of dried and fresh blood. Most of his clothes had been cut from his body and Kate caught a glimpse of a tattoo sleeve on his right arm. His right foot angled off to the side and it was obvious his right leg had sustained multiple fractures. There was a large laceration on the back of his head where much of the blood was pooling and becoming matted in his hair, but it was the swelling on the left side of his head that Kate knew was the reason Pete was unlikely to survive.

A CT scan in the ED had confirmed a subdural hematoma on his brain. The pressure caused by the large and increasing volume of blood pushing against his skull meant that he would likely die unless the pressure could be relieved. The doctors in emergency had already intubated him, inserting an endo-tracheal tube into his mouth and down his throat. This tube was attached to a small transport ventilator, and the machine was breathing on Pete’s behalf. The white tracheostomy tape that held the tube in position and prevented it from coming out was already stained a bright red color from the laceration at the back of his head. Kate’s nose wrinkled at the metallic smell of blood.

“Crap,” Mitch exclaimed and Kate caught sight of his shocked expression. She felt a sour taste in her mouth.

“Do you know him?”

“Yeah. Not all that well though. We went to school together. He was the year below me.”

“Will you be okay?”

“Should be.”

His usual jovial manner was noticeably absent. Kate knew she was going to have to keep an eye on him. As well as teach him the basics of trauma response and management, she would probably have to help him deal with the stress this case was going to bring when it was all over.

“Why haven’t they got the ICP monitoring set up for us already?” Amanda asked, referring to the intra-cranial pressure monitoring that Kate too had expected to see attached via thin wires to Pete’s skull. It was the first time Kate had seen her without a smile on her face.

“Let’s wait to hear the handover and we’ll work out what’s going on,” Kate replied tersely.

“I guess you’re used to seeing patients like this in the city,” Amanda snapped, “but we’re not.” Kate was momentarily stung by the barb in Amanda’s comment. At the Royal Sydney she
had
been used to dealing with trauma patients, but each time Kate received a patient like Pete she still felt totally unprepared. A wave of emotions washed over her. The room felt cramped and she could already feel the sweat running between her shoulder blades. She decided to ignore Amanda’s remark, figuring she was probably feeling as stressed as Kate was.

Kate made certain everyone was ready and they lined the trolley up alongside the ICU bed. Kate disconnected Pete from the transport ventilator and attached the tubing to the bag-valve-mask. This allowed her to push air into his lungs via the tube until they swapped him across to the ventilator that had been set up in the room.

“On my count,” Kate instructed the other staff. On the count of three they slid him across the slippery slide sheets laid across the large plastic board used to transfer patients from one bed to another. No one spoke as the next few minutes were spent re-connecting him to the ventilator that would continue breathing on his behalf, untangling lines and ensuring his fluids, sedation and pain relief were adequate.

“Is there any talk of doing a crainy?” Mitch asked. Kate could hear from the tone of his voice that he was now pumped and ready for action.

“It’s not like television, Mitch. Real life situations aren’t always as action-packed and fast-paced as you might think. In this case, there’s no rush,” Kate told him.

 As soon as she saw the look that Mitch gave Amanda, she instantly regretted her words. She’d come across sounding stuck up and exactly like the city girl they clearly thought she was.

“There’s probably no point,” Simon added quietly. “We’re waiting on the neurosurgeon. He’s on his way back from a conference in Adelaide. He should be here in a few hours.”

She turned to Simon and softly asked, “What are his chances?”

Meeting her gaze, Simon replied, “It’s not looking good. He’s not going to last long.”

As soon as he spoke, a painful lump formed in the back of her throat and her shoulders slumped. She knew all the signs were pointing to brain death but Simon had confirmed her worst fears. She continued working on the spaghetti-like tangle of leads and lines that was inevitably caused when a patient was transferred. It was going to be a long night and everything within her wanted to be as far away from this tragedy as possible. She wanted to flee from the room and be alone, but she knew she had a job to do. She just wished Pete had been airlifted straight to Sydney.

She moved to stand at the large desk at the end of Pete’s bed and unfolded the critical care flow sheet that was used to record all patient observations. She began filling the details in. Time of arrival, vital signs, medications, results of neurological checks, lab results. While she duly recorded all these figures, Amanda and Mitch were left with the unenviable task of cleaning up the blood and making Pete look presentable for when his parents arrived.

“So you think he’s brain dead?” Mitch asked incredulously, causing Kate to look at him closely.
Is he going to be able to deal with this?

“Yes. Possibly,” Kate replied cautiously.

“Oh.” Mitch sounded completely deflated and Kate’s heart went out to him. His tan seemed to have faded by several shades, and Kate could see he was clearly affected by the young man’s dire prognosis. An image of the small cross on the side of the road came to Kate’s mind. Another local life lost in tragic circumstances.

 Simon spoke quietly, “There’s no need to go all out. At this stage it’s mostly comfort measures until we can get his parents here. Then we’re going to need to discuss organ retrieval.”

“Really? You can do that here? This far away from the city?”

Simon nodded. “Yes. We’re not out in the sticks here, Kate. All the systems are in place for organ donation the same as they would be in the city. We just have to get his parents’ consent.”

Once again she’d put her foot in it, coming across all wrong. “Do we even know what his wishes are?” she asked.

“According to the card in his wallet, yes, he wants to be an organ donor,” Ewan answered from where he was standing, writing notes. Kate had almost forgotten he was still in the room.

“But you know as well as I do that as he can’t speak for himself, his parents still make the final call,” Simon added.

“Let’s hope it’s the right one,” Kate replied.

Pete’s parents arrived half an hour later and their eyes held the look Kate had seen many times before. It was a look people have when they are trying desperately to hold themselves together and are blindly clinging to hope. Kate met them at the door of the ICU and introduced herself.

“Hello. My name is Kate Kennedy. I’m the nurse in charge. I’m terribly sorry about your son’s accident.” Kate tried to maintain eye contact with them as she ushered them gently into the unit.

“John and Heather.” The man’s voice matched his craggy face as he introduced himself and his equally weather-beaten wife. Clearly straight off the farm, they both looked exhausted, scared and out of place in the hospital environment. John was still wearing his work gear and the smell of cow dung clung to him. Heather had dirt under her fingernails and although Kate knew the importance of hand hygiene, now wasn’t the time or place to reinforce the rules.

“How’s he doin’?” Heather was forthright in her question. “Can we see him?”

“Yes, of course you can.”

They followed Kate as she walked toward Pete’s room and she stopped at the doorway before letting them enter. “Do you want me to explain what all the machines are for?”

It appeared they hadn’t heard her and Kate watched as they caught sight of their son for the first time. He was positioned on his back and his tall muscular body lay immobile. A white sheet was folded neatly across his chest and his arms lay propped on pillows at his side. Amanda and Mitch had done a great job tidying him up and Kate made a mental note to thank them. John and Heather went to either side of the bed and each held one of his hands, almost oblivious to the tubes coming from his mouth and nose and the various leads and lines attached to his body.

Kate surreptitiously watched Pete’s parents. There were no tears, no hysterics and no words. She stayed in the room, there for them if they needed her.

Finally John spoke up. “He’s our only son you know. Wanted to be a farmer just like me. He’s been off at Marcus Oldham College in Geelong studying farm management. Almost finished. I was going to hand him the running of the farm next year. I’m getting a bit long in the tooth for it now. Time for the young blood to take over.”

He didn’t look at Kate while he spoke, never taking his eyes off his son’s hands. Kate kept silent, feeling her pulse in her throat keeping time with the machines in the room.

“How long?” Heather spoke up after a long pause.

Kate was unsure what Heather was really asking her.
How long until what
?
Until the neurosurgeon arrives? Until we know what’s going on? Until he dies?
Kate looked at Heather. It was as though the woman had a mother’s intuition that her son wasn’t going to make it. Before Kate had a chance to answer Heather’s question, the ventilator alarm screeched, signaling a change in Pete’s oxygenation levels. Kate silenced the alarm and adjusted some settings on the machine. Pulling a yankauer catheter out of its position attached to the ventilator, she suctioned his tube. He didn’t cough or respond in any way. His parents remained silent, watching her work.

“How long before he dies?” Heather addressed the question to Kate again.

“There’s no way of really knowing just yet,” Kate replied hesitantly, shrugging her shoulders slightly.

She hated squashing their hope but she was a realist and there was no sense in giving them false encouragement. She wasn’t trying to put Heather off, she really
didn’t
know. Although Kate knew it was most likely that Pete was brain dead, it wasn’t her place to inform his parents.

“The neurosurgeon is on his way back from a conference in Adelaide. I’m sure when he arrives he can answer all your questions. There are protocols to follow.”

Kate was avoiding the inevitable, but she had no other words to offer Heather and John.
What words can anyone offer a mother about to lose her only child?

She already knew the answer to that question. There were no appropriate words.

John remained silent, not taking his eyes off his son, but he was clearly listening to everything Kate was saying. He nodded absently while she spoke.

Heather reached into her bag and pulled out her wallet. She opened it and removed a photo which she wordlessly handed to Kate. As Kate took it she looked and saw a very different face staring back at her. Pete. Tall and handsome, he had a wide grin and beautiful eyes. The man in the photo looked nothing like the figure in the bed with his puffy eyes and bloodstained hair. The tube coming out of his mouth had caused Pete’s mouth to form into an unnatural grimace, reminding Kate of the Joker character with his pale face and blood-red lips. Kate smiled sadly at Heather as she handed back the photo. There was nothing she could say that would ease the grief that was about to enfold the whole family.

When Kate finally turned the key in her front door, it was almost four o’clock on Sunday morning. Her body clock was confused and she felt as though she was on autopilot. Her early morning run with Joel seemed like weeks earlier rather than just the day before.