would never be simple. Or easy. That it could become even worse, in fact, because there might come a time when she was ready to take that enormous step into a new life only to find that Charles would never feel the same way.
‘I’d like it, too.’ He didn’t seem to have noticed that she was edging away. ‘I had some later that night and it was the most delicious thing ever. It had bacon in it.’
‘Mmm... It’s not hard.’
‘Maybe you could show me. Sometime...’
The suggestion was casual but Grace had to push an image from her mind of standing beside Charles as she taught him how to make a cheese sauce. Of being close enough to touch him whilst wrapped in the warmth and smells of a kitchen—the heart of a home. She could even feel a beat of the fear that being so close would bring and she had to swallow hard.
‘I’ll write down how to do it for you.’
Charles smiled and nodded but seemed distracted now. He was staring at the patient details board. ‘What’s going on with that patient in Curtain Six? She’s been here for a long time.’
‘We’re waiting for a paediatric psyche consult. This is her third admission in a week. Looks like a self-inflicted injury and I think there’s something going on at home that she’s trying to escape from.’
‘Oh...’ His breath was a sigh. ‘Who brought her in?’
‘Her stepfather. And he’s very reluctant to leave her alone with staff.’
‘Need any help?’
‘I think we’re getting there. I’ve told him that we need to run more tests. Might even have to keep her in overnight for observation. I know we’ve blocked up a bed for too long, but...’
‘Don’t worry about it.’ The glance Grace received was direct. Warm. ‘Do whatever you need to do. I trust you. Just let me know if you need backup.’
Feeling trusted was a powerful thing.
Knowing that you had the kind of backup that could also be trusted was even better and Grace was particularly grateful for that a couple of mornings later with the first case that arrived on her shift.
A thirteen-month-old boy, who had somehow managed to crawl out of the house at some point during the night and had been found, virtually frozen solid, in the back yard.
‘VF arrest,’ the paramedics had radioed in. ‘CPR under way. We can’t intubate—his mouth’s frozen. We’ve just got an OPA in.’
Grace had the team ready in their resuscitation area.
‘We need warmed blankets and heat packs. Warmed IV fluids. We’ll be looking at thoracic lavage or even ECMO. Have we heard back from the cardiac surgical team yet?’
‘Someone’s on their way.’
‘ECMO?’ she heard a nurse whisper. ‘What’s that?’
‘Extra corporeal membrane oxygenation,’ she told them. ‘It’s a form of cardiopulmonary bypass and we can warm the blood at the same time. Because, like we’ve all been taught, you’re not—’
‘—dead until you’re warm and dead.’
It was Charles who finished her sentence for her, as he appeared beside her, pushing his arms through the sleeves of a gown. He didn’t smile at her, but there was a crinkle at the corners of his eyes that gave her a boost of confidence.
‘Thought you might like a hand,’ he murmured. ‘We’ve done this before, remember?’
Grace tilted her head in a single nod of acknowledgement. She was focused on the gurney being wheeled rapidly towards them through the doors. Of course she remembered. It had been the only time she and Charles had worked so closely together during those long years of training. They had been left to deal with a case of severe hypothermia in an overstretched emergency department when they had been no more than senior medical students. Their patient had been an older homeless woman that nobody had seemed to want to bother with.
They had looked at each other and quietly chanted their new mantra in unison.
‘You’re not dead until you’re warm and dead.’
And they’d stayed with her, taking turns to change heat packs and blankets while keeping up continuous CPR for more than ninety minutes. Until her body temperature was high enough for defibrillation to be an effective option.
Nobody ever forgot the first time they defibrillated somebody.
Especially when it was successful.
But this was very different. This wasn’t an elderly woman who might not have even been missed if she had succumbed to her hypothermia. This was a precious child who had distraught members of his family watching their every move. A tiny body that looked, and felt, as if it was made of chilled wax as he was gently transferred to the heated mattress, where his soaked, frozen nappy was removed and heat packs were nestled under his arms and in his groin.
‘Pupils?’
‘Fixed and dilated.’
Grace caught Charles’s gaze as she answered his query and it was no surprise that she couldn’t see any hint of a suggestion that it might be too late to help this child. It was more an acknowledgement that the battle had just begun. That they’d done this before and they could do it again. And they might be surrounded by other staff members but it almost felt like it was just them again. A tight team, bonded by an enormous challenge and the determination to succeed.
Finding a vein to start infusing warmed IV fluids presented a challenge they didn’t have time for so Grace used an intraosseous needle to place a catheter inside the tibia where the bone marrow provided a reliable connection to the central circulation. It was Charles who took over the chest compressions from the paramedics and initiated the start of warmed oxygen for ventilation and then it was Elijah who stepped in to continue while Charles and Grace worked together to intubate and hook the baby up to the ventilator.
The cardiac surgical team arrived soon after that, along with the equipment that could be used for more aggressive internal warming, by direct cannulation of major veins and arteries to both warm the blood and take over the work of the heart and lungs or the procedure of infusing the chest cavity with warmed fluids and then draining it off again. If ECMO or bypass was going to be used, the decision had to be made whether to do it here in the department or move their small patient to Theatre.
‘How long has CPR been going?’
‘Seventy-five minutes.’
‘Body temperature?’
‘Twenty-two degrees Celsius. Up from twenty-one on arrival. It was under twenty on scene.’
‘Rhythm?’
‘Still ventricular fibrillation.’
‘Has he been shocked?’
‘Once. On scene.’ Again, it was Charles’s gaze that Grace sought. ‘We were waiting to get his temperature up a bit more before we tried again but maybe...’
