a moment beside the central triage desk.
‘Doris has gone to X-Ray so we’ve got an empty cubicle for a while. Could you find me a bed, please, Suzie? I think I should take a look at that little boy over there.’
‘Oh, would you?’ Suzie sounded relieved. ‘That would be great. I was just going to upgrade him for an urgent assessment. He’s looking a lot worse than he did when he came in.’ She sent a nurse aide to find a bed in the storage area off the main corridor to the hospital. ‘Put it in cubicle 3. Hopefully we’ll have another free space by the time Doris comes back.’
A stretcher was coming through the double doors from the ambulance bay. Another one was lined up behind that.
‘What’s the history?’ Pip queried briskly, before Suzie could get distracted by the new arrivals.
‘Just became unwell today. Running a temperature, off his food. Family’s new in town so they didn’t have a GP to go to.’
‘Cough? Runny nose?’
‘Apparently not. Temp’s well up, though—39.6 when we took it on arrival.’ Suzie was moving to intercept the first stretcher. ‘His name’s Dylan Harris. Turns two next month.’
Pip smiled at a mother who was probably her own age. What would life be like for herself, she wondered briefly, if she had a two-year-old instead of a twelve-year-old? She certainly wouldn’t be doing what she was doing now—a job she loved with a passion.
‘Mrs Harris?’
‘Yes…Jenny.’
‘I’m Dr Murdoch.’ The thrill of saying those words had never worn off. Worth all those long years of hard work and heartache. ‘Follow me. We’re just finding a bed so I can check Dylan for you.’
‘Oh, thank goodness! I think he’s getting sicker.’
The bed wasn’t needed immediately. Pip carried the chair Jenny had been sitting on as she led the way to cubicle 3.
‘Keep Dylan sitting on your lap for the moment, Jenny. It’ll keep him happier and help his breathing as well.’
‘He’s started making funny noises.’
‘Mmm.’ Pip was listening to the soft stridor on expiration and a gurgle on inspiration with mounting alarm. ‘And how long has he been dribbling like that?’
‘Is he?’ Jenny looked down at her son. ‘I hadn’t noticed. It must have started just now.’
Something that could compromise a child’s airway this quickly was extremely serious and Pip already had a fair idea of what she might be dealing with. She signalled Suzie to indicate the need for assistance but the senior nurse was still occupied with a patient on an ambulance stretcher. Her apologetic wave and nod let Pip know she would do something as soon as she could. Pip reached for an oxygen mask.
‘Hold this as close as you can to Dylan’s face without upsetting him,’ she instructed Jenny.
Pip could see the way the skin at the base of his neck was being tugged in as Dylan struggled to breathe and the retraction of his rib-cage when she lifted his T-shirt to place the disc of her stethoscope on the small chest.
An empty bed was being pushed into the cubicle behind her.
‘Get me a nurse, please,’ Pip told the orderly. ‘Preferably Suzie, if she’s available.’ She took another glance at Dylan’s face. ‘You’re being such a good boy. You’re not feeling too good, are you, sweetheart?’
She got no response. Not even eye contact from the toddler. Pip looked up at Jenny.
‘Has he been talking much today?’
‘He hasn’t said anything since we got here. He’s not even crying, which is weird. He usually cries a lot. Does that mean it’s not that serious?’
‘Not necessarily.’ Pip wasn’t going to alarm Jenny by telling her that it was the quiet children that were usually most at risk. With the oxygen mask held close to his face, Dylan was leaning back on his mother’s shoulder, his chin raised. The ‘sniffing the air’ position that indicated an instinctive method of maximising airway calibre.
‘And he hasn’t been coughing at all?’
‘No. This came on really suddenly. He seemed fine except he wouldn’t eat his toast this morning. I wondered if he might have a sore throat.’ She cast a worried glance at her son. ‘It’s getting worse, isn’t it?’
It was. Dylan’s eyes drifted shut and his head drooped. Pip touched his face.
‘Dylan? Wake up, love. Open your eyes.’ She got a response but it wasn’t enough. ‘I’ll be back in a second,’ she told Jenny. Slipping through the curtain, Pip nearly collided with Suzie.
‘Any of the consultants free at the moment?’
The nurse shook her head. ‘One of the trauma cases has arrested. It’s a circus in Resus.’
‘I need a paediatric anaesthetist here,’ Pip said. ‘And we need to get Dylan to Theatre. I’m pretty sure he’s got epiglottitis and his level of consciousness is dropping.’
Suzie’s eyes widened. ‘I’ll find someone.’
‘Get me an airway trolley in the meantime?’
‘Sure.’
Pip could only hope that intervention could be avoided until Dylan was safely under the care of an expert anaesthetist.
‘I think Dylan has something called epiglottitis,’ she told Jenny a moment later. ‘It’s a nasty bacterial infection of the epiglottis, which is at the back of the throat. If it gets inflamed it can interfere with breathing, which is why Dylan has started making these noises.’
‘What will you do?’
‘We treat it with antibiotics but we have to protect the airway in the meantime. I’m going to get Dylan taken to an operating theatre if possible to have a tube put down his throat.’
‘He needs an operation? Oh, my God!’
‘Not an operation,’ Pip said reassuringly. ‘Not unless it’s difficult to get a tube in place. In that case, it might be necessary to create a temporary external airway by—’
Suzie was back with a trolley. ‘Someone’s on the way,’ she interrupted Pip. ‘Shouldn’t be long.’
It was going to be too long for Dylan. The small boy’s eyes suddenly rolled and then closed. Jenny felt him go even floppier and when she moved the oxygen mask to look at her son, they could all see the blue tinge to his lips.
‘Dylan?’ Pip rubbed his sternum. ‘Wake up!’
There was no movement to be seen. Including the chest wall. The toddler was in respiratory arrest. Pip plucked him from his mother’s arms and laid him on the bed.
‘Oh….God,’ Jenny gasped. ‘He’s not breathing,
