General was crying miserably. So was the mother who was holding her as the nurse, Sue, helped to settle her on the bed. The young father was hovering on the other side of the bed, looking stressed and helpless.
‘We thought it was just a cold,’ he told Luke. ‘But now she’s got this horrible cough and it sounds like she can’t breathe...’
‘Has anyone else in the family been unwell?’ Luke was looking carefully at the baby as Sue undressed her. The baby looked dehydrated but not feverish and, thankfully, there were no signs of a rash that could be meningococcal.
‘I’ve had a bit of a cough,’ the father said. ‘Nothing major. Just one of those irritating dry coughs that won’t go away. I heard someone call it the “Hundred Day” cough.’
Luke’s heart sank as he met Sue’s glance as she helped position the baby so that he could put his stethoscope on the tiny chest. For adults or immunised people, the ‘Hundred Day’ cough was an irritating bug. For babies like this, it could be the life-threatening bacterial infection of whooping cough.
And, sure enough, the baby started coughing. It was too young to have the strength to produce the characteristic ‘whooping’ sound of gasping for air between the coughing spasms but they were severe enough to be causing a dangerous lack of oxygen and both Luke and Sue watched with deepening concern as the blue tinge to the baby’s face advertised a degree of cyanosis that was going to need urgent management.
‘See if we’ve got an oxygen hood in the department,’ Luke said to Sue. ‘And put out a call for an urgent paediatric consult.’
‘I’m going to take a swab,’ he told the mother, ‘and some blood tests but it looks very likely that she has pertussis—whooping cough. We’re going to need to admit her and keep her in isolation.’
‘Whooping cough?’ The mother looked terrified. ‘But that’s impossible. I had the booster vaccination that they recommend when you’re pregnant. They said that would help keep her safe until she gets her first shot next week.’
‘And it does help. You did exactly the right thing.’ Luke nodded. ‘Did everybody in your extended family get boosters, too?’
‘My mother did. I told Gerry that he should get one but...’ The woman glanced up at her husband, who was looking stricken. ‘I guess we kind of forgot...’
‘Work’s been crazy,’ he muttered. ‘And what with Serena having to give up her job, I’ve had to take all the overtime I could get.’ He turned away, putting his hand over his eyes. ‘Oh... God...is this my fault?’
‘The important thing is looking after little Grace, here.’ Luke was pulling supplies from the containers on the bench in this resuscitation area. A tourniquet, the smallest cannula available for IV access, tape and the connecting plug that would enable him to set up a drip. ‘We’re going to start her on antibiotics without waiting for the test results. And we’re going to try and improve her oxygen levels. You must have noticed the way she’s going blue with the coughing fits? That means she’s not getting enough oxygen and that can be dangerous.’
Another nurse came in with the oxygen hood that Luke had requested.
‘We’ll get you to put Grace on the bed by herself, now,’ Luke said gently. ‘This looks scary but it’s just a plastic dome that will go over her head on the bed. It’s an easier way to provide extra oxygen than taping prongs into her nose.’
It was clearly hard for the mother to hand her baby into the care of others and step back, out of touching range. Her husband put his arms around her as she sobbed.
‘Can we stay?’ he asked. ‘Is that all right?’
‘Of course,’ Luke said. ‘And I’ll tell you what we’re doing every step of the way. The first thing we need to do is to put a tiny needle into one of Grace’s veins. Given how small she is, it might need to go into a vein in her scalp, or her foot, but don’t be alarmed. It’s just the same as putting one in an adult’s arm.’
The new nurse was staying to help Sue hold the baby as Luke began to work on starting treatment that would, hopefully, save this baby from the potentially life-threatening complications from whooping cough that were running through his head right now. Luke had seen babies develop pneumonia and encephalitis from this disease. He’d once looked after a baby in Intensive Care who had needed extracorporeal membrane oxygenation, even, where the blood was removed from the body to do the work of the lungs in the same way a heart-lung bypass machine worked.
The sad thing was that this was a preventable disease but he could understand how the idea of having a booster vaccination had seemed unimportant to the father of this baby.
With the cannula safely secured into a scalp vein, Luke had a moment of distraction with the automatic process of attaching the IV line and setting the drip rate of the fluids.
Had Ellie had a booster vaccination while she was pregnant? How many visitors was little Jamie getting and was he in close enough contact with any of them to be in danger of having something like this passed on? A sideways glance at Sue, who was positioning the plastic dome of the oxygen hood over Grace’s head, prompted Luke to make a mental note to talk to her about it. Ellie had told him that Sue was a good friend of hers. She could, at least, pass on the warning that they’d had a serious case here.
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