to put another call out,’ she said.
Asthma attacks could be tricky. If nothing else, Sam thought, he could help calm down whoever was with the patient, so the other doctor could get on with treating the patient. He headed down to the next deck, and saw a woman wearing a yellow raincoat. She was talking to a man who was clearly panicking and wheezing, and the woman with them was wringing her hands and looking equally panicky.
‘Hello. I’m Sam Price, and I’m an emergency doctor,’ he said as he joined them. ‘Can I help?’
‘Hayley Clark—also an emergency doctor, from London,’ the woman in the yellow raincoat said.
He noticed how blue her eyes were—like an Icelandic summer sky—and her sun-streaked blonde hair was caught back at the nape of her neck, with soft tendrils framing a perfect oval face.
What the hell was he doing, noticing the colour of her eyes when there was a sick patient who needed their attention? Besides, even if he was looking for a relationship—which he wasn’t, after Lynda—she was probably already spoken for. Cross with himself for getting distracted, he paid attention to what she was saying.
‘This is Milton Adams and his wife Lulu,’ Hayley continued. ‘He doesn’t have his reliever or preventer inhaler with him, and we think the cold air probably brought on his asthma attack. He doesn’t have any other medical conditions.’
‘The guide’s putting out a second call to see if anyone on board has an inhaler with them,’ Sam said. ‘But even if there isn’t anyone, we can help you, Mr Adams.’
The man continued to wheeze, fighting for air, clearly panicked by the tightness in his chest.
Really, they needed to get him away from the cold air that had triggered the attack and into a warm place. But, given the state of his breathing right now and the fact that he was quite overweight, no way would Mr Adams be able to cope with the steep stairs to go back inside the ship. First, Sam thought, they needed to get Mr Adams stabilised so he was calm, and breathing more slowly. Anxiety released cortisol in the body, constricting the bronchial tubes even further, and panicking that you couldn’t breathe caused a vicious circle: it tightened the chest muscles, which made it harder to breathe, which in turn made the patient panic more and then the chest muscles tightened even further.
‘Mr Adams, can you sit up straight for us?’ Sam asked. ‘It’ll help you breathe more easily, because bending over constricts your breathing.’
Milton Adams continued gasping, but to Sam’s relief, he did as he was told.
‘I’m going to loosen your tie and undo the button of your collar,’ Hayley said, ‘because that’s also going to help you breathe more easily. Is that all right?’
The man nodded.
‘I told him he ought to bring his inhaler. I told him,’ Mrs Adams said, almost in tears.
Hayley reached over and squeezed her hand. ‘Mrs Adams—can we call you Lulu?’ At the woman’s nod, she continued, ‘I know how worried you are about your husband, but right now I really need you to do an important job for me and count. Can you do that for me?’
‘Yes,’ Mrs Adams said, her voice slightly quavery.
Brilliant management, Sam thought—she’d acknowledged the woman’s fears and distracted her by making her feel useful. What Hayley had just said about counting told him that she’d intended to use the same method he would’ve used.
‘Mr Adams—can we call you Milton?’ At the man’s nod, Sam continued, ‘We want you to try to take some really long, deep breaths for us. I know right now it’s scary, but I promise we can make you feel better. I want you to breathe in through your nose for a count of four and out through your mouth for a count of six. Can you do that for us?’
Mr Adams nodded, still fighting for breath.
‘Can you count for us now, Lulu?’ Hayley asked. ‘Four in, then six out. Count with me for the first set so we can get the rhythm right together. One, two, three, four...’
Mrs Adams joined in with counting.
Sam took the older man’s hand to reassure him. ‘OK. Breathe in—now out.’ Breathing to the counts would slow Milton’s breathing down, making it easier for him.
‘Purse your lips as you breathe out, Milton,’ Hayley said. ‘That helps to slow your breathing and keeps your airways open. That’s it. Keep going. You’re both doing really great.’
Mr Adams was still wheezing, but his colour was improving. ‘Can you place one hand on your stomach, Milton, just below your ribcage?’ Sam asked. ‘Then, when you breathe in, focus on pulling down into your stomach. Use your stomach muscles to help you push out,’ he said. ‘It’s called diaphragmatic breathing and it will really help you take deep, slow breaths.’
Eventually, Mr Adams’s breathing pattern settled and he seemed noticeably calmer.
Sam caught Hayley’s eye. ‘Shall we all go downstairs, so we’re away from the cold air?’
She nodded. ‘And we can ask the crew if they’ll sort out a bowl of hot water and lend us a towel.’
‘Good call,’ he said. They could make a tent with the towel and the bowl of hot water, and then Milton Adams could breathe in the moist air to help him recover.
Everyone else on board was on the upper decks by the railings, watching what sounded like a couple of whales playing in the water, so it made their passage down the stairs a bit easier—even if they were missing out on all the fun. They supported Milton Adams down the steep staircase to the inner deck, but he was wheezing badly again by the time they’d got him sitting down by a table.
‘Could you get your husband a cup of coffee from the bar, please?’ Hayley asked Mrs Adams.
‘He doesn’t like coffee,’ Mrs Adams said. ‘Or tea. Only hot chocolate.’
‘Maybe make the coffee milky and sweet?’ Hayley suggested. ‘The chemical structure of coffee is similar to theophylline, which is in most asthma medications, so a hot cup of coffee can help with wheezing, shortness of breath and chest tightness. Plus the warmth of the liquid will help break up the phlegm and mucus, making breathing easier.’
‘I’ll drink the coffee,’ Mr Adams wheezed.
‘Great. Are you OK to sit with Milton while I sort out a towel and hot water?’ Hayley asked Sam.
‘Sure,’ he said. ‘What I’d like you to do, Milton, is to sit up straight for me again, and count the number of blue things in the room.’
‘Blue things?’ Mr Adams looked nonplussed.
‘Blue things,’ Sam confirmed. ‘Count them, and keep breathing like we did upstairs. I’ll count while you breathe. In for four, out for six.’
As he’d hoped, the small task of looking round the room for blue things distracted the older man enough to help calm him further, and by the time Mr Adams had drunk the coffee and Sam and Hayley had arranged the bowl of hot water and towel as a temporary recovery tent so he could breathe in warm, moist air, he was looking in a much better condition.
When
