The Night Shift

Violet

Monday night

Beyond the curtain three bodies moved urgently around a fourth lying prone upon the bed. Three faces turned expectantly in her direction. The fourth face, that of the patient, remained staring blankly at the ceiling, registering little of the frantic activity occurring around it.

‘We could do with a bit more access if you can get a venflon in?’

The nurse who had previously been either disappointed or had heartburn was now peeling the adhesive strips from the defibrillator pads and she indicated a nearby trolley where an array of needles and cannulas were scattered.

‘He’ll need at least a green if you can,’ she said kindly, pointing to the wide- bore cannulas. ‘He’s only got a pink in the other arm and his veins are pretty shut down.’

Violet knew that pink venflons were the narrower variety of cannula, easier to put in but less useful for getting drugs and fluids into a patient quickly.

Green, brown and grey venflons were the big boys, ideal for delivering emergency medication straight into a vein.

Unfortunately, trying to site one of these javelins in an elderly patient whose peripheries were shutting down was like hitting a treble twenty when the dart you were using was actually a harpoon and the dartboard was located in the next county.

‘I tried my best to flush this one, Carol,’ said the nurse on the other side of the bed who was busy pumping the patient’s chest. ‘But I think it’s blocked.

’ This nurse was wearing a set of Rudolph antlers, a novelty snow-angel jumper and a tinsel bow that kept getting tangled around his arms. ‘Really bloody stupid idea to go for the Christmas fancy dress option,’ he muttered to himself as he paused the chest compressions and shook out his wrists, a bracelet of sleighbells jingling loudly.

Handsome Doctor squeezed a bagful of oxygenated air into the patient’s lungs and Heartburn Carol secured the pads to his torso.

Violet reached for a green venflon from the trolley and slid a tourniquet around the patient’s wrist, hoping to make his veins more prominent and therefore accessible.

Her own hands were trembling slightly as the curtains behind her gusted open and the reassuring sight of her senior colleague Anjali appeared.

‘Sorry,’ Anjali said, also pausing to catch her breath.

‘I was on MAU.’ The rest of the team made what sounded like sympathetic noises; the medical assessment unit was at the furthest end of the hospital, two floors down.

‘What’s the story?’ Anjali said, eyeing the patient critically from the foot of the bed.

‘Albert Thirkettle,’ said Handsome Doctor.

For one moment Violet thought he was introducing himself.

But he really didn’t look like an Albert.

Five decades too young for a start, and those Slavic high cheekbones gave him an exotic edge that didn’t correlate with the robustly Anglo-Saxon surname.

She leaned forward an inch and squinted at his name-badge which bore the legend Dr Gus Jovic– Anaesthetics .

That was a better fit. And his being an anaesthetist also explained the practised confidence in dealing with Mr Thirkettle’s airway.

‘Eighty-nine years old,’ Gus continued. ‘Known heart disease, two previous strokes, admitted with pneumonia. Staff noticed him becoming agitated just before midnight, checked his observations, poor respiratory effort and rapid thready pulse. Is that right, Carol?’

Carol was checking the dial on the oxygen as it hissed through the tube to the mask on the patient’s face.

‘Yep,’ she said, using a totally different type of smile with Gus to the one she’d used with Violet.

‘We put the call out straight away, started compressions.’ She looked at her watch.

‘He’s been down for about four minutes now. ’

‘Looks like a shockable rhythm.’ Anjali directed her comment to Gus, and they both peered at the cardiac monitor now connected to the patient’s chest.

‘Agreed,’ said Gus, adjusting the power setting on the defibrillator.

‘Stand back, everyone.’ He moved away from the bag and mask he was holding over the patient’s face as the defibrillator beeped its countdown.

‘Everyone clear?’ he asked, checking around the bed.

‘You! Move!’ He pointed to where Violet’s trousers were still in contact with the blankets and she stepped back with a shriek just as the defibrillator kicked in.

The patient’s chest jolted upwards in a second of suspended animation before returning to the bed with a thud.

Everyone returned their attention to the screen which revealed little change.

‘On we go,’ said Gus grimly. He looked to his left.

‘You happy to keep doing compressions, Dean?’

The nurse in antlers had now succeeded in removing one of his sleighbell bracelets. He cracked his knuckles and glanced at the others. ‘Reckon I’m man enough for the job,’ he said. ‘No offence, girls.’

‘Just try not to break any more of his ribs, Dean,’ muttered Carol as they all returned to their previous positions.

‘And have we got access?’ Anjali looked to where Violet was flicking the back of the patient’s wrist desperately hoping for a vein to miraculously appear.

‘Uhm, I can’t quite…’ Violet grimaced at Anjali.

‘We’ve got a pink over here where his antibiotics were going in, but I think it’s had it,’ said Dean.

Anjali nodded and returned her attention to the arm Violet was holding.

‘I’ll have a look,’ she said, gently pushing her aside and expertly sliding a wide-bore grey venflon into a vein that Violet was certain hadn’t existed moments earlier.

‘There,’ she said. ‘Let’s get some adrenaline into this old boy. ’

* * *

Ten minutes later the patient had a passable heart rhythm but was still not breathing for himself.

The anaesthetics registrar Dr Stringer had agreed to admit him to the high dependency unit and the resuscitation was being written up in the patient’s notes.

Violet loitered near the nurses’ station feeling useless.

Not only had she been unable to gain venous access, literally the only task she’d been assigned, she’d nearly got herself electrocuted in the process of failing at it.

She scrolled through her list of interminable and fairly pointless things to do on the wards (not that she’d labelled it thus on screen) searching for any jobs that needing doing on ward seven, given that she was here already.

‘Sorry about that,’ said a friendly voice behind her. She turned and met the dark caramel eyes of the doctor who’d led the arrest. Gus.

‘Sorry about what?’ Her tone was more brusque than she’d intended but she was still feeling harassed and couldn’t imagine what this Adonis might have to apologise for, other than being so outrageously handsome and medically competent, in sharp contrast to herself.

Perhaps that was what he was about to say?

Sorry for being so devastatingly good-looking and making you feel like an inferior human being simply by being in the presence of my physical magnificence and clinical expertise. It was possible.

‘Sorry for forgetting your name when I shouted at you to get out of the way,’ he said. ‘You know– when you were…’

‘About to receive five hundred volts through my trouser leg?’ Violet said seriously. ‘I don’t think you need to apologise for that. In fact, I’m rather glad you saved my life.’

‘It probably wouldn’t have actually killed you,’ he said.

‘The embarrassment might have though.’ Her face was impassive. ‘Anyway, a paper in the Cleveland Clinic Journal of Medicine concluded that accidental caregiver shock from defibrillator use during resuscitation is likely to be grossly underreported.’

Gus raised his eyebrows. ‘Is that so?’

‘Far more common than we realise apparently.’

‘O-kay,’ he said. ‘Thanks for the heads up.’

She glanced at him, checking he wasn’t making fun of her. ‘You’re very welcome.’

‘Well, anyway,’ Gus said. ‘Sorry about the generic, “Oi, you, get out of the way” earlier. I’m usually good with names, but halfway through a midnight cardiac arrest I’m probably not on my best form.’

‘You seemed on perfectly good form to me,’ said Violet, cross with herself for the unexpected flush in her cheeks and hoping it could be attributed to the decidedly unseasonal temperature of the ward.

‘After all, you saved him– the patient.’ She was reluctant to be too cavalier with her compliments, after all, this Gus was probably used to receiving praise for simply existing, but she also wanted to give credit where it was due.

‘It was a successful resuscitation at least. I haven’t been to many of those. ’

Gus grimaced, ‘I’m not sure as I’d call it wildly successful,’ he said. ‘That guy’s got at least four fractured ribs, no respiratory effort and likely no brain function left. He might have a heartbeat but that’s about all we managed to save.’

‘Do you think we shouldn’t have resuscitated him then?

’ As she said the words she wondered whether this was what her friend Dev would have called a classic Violet question– blunt as a thumb in your eye was how he usually described it– but how else were you supposed to discover what people meant when they gave you a load of subtext?

‘I don’t know.’ Gus gave a little shrug while Violet tried to concentrate on his words and not become too distracted by the neck and shoulders actively involved in the shrugging.

‘There was no mention of a Do Not Resuscitate in his notes. Anyway, it’s too late now, you can’t make those sorts of decisions retrospectively.

But I do wonder what would’ve happened if the nurses hadn’t been checking his observations at that moment.

You know, what if an eighty-nine-year-old man with multiple medical problems had just slipped away peacefully in his sleep?

Would that have been the end of the world? ’

He sighed and tapped his fingers against the desk for a moment while Violet tried and failed to think of the right thing to say.

Usually it was just the first thing that popped into her head; a surprising fact, a statistical anomaly or a reference to a recent randomised controlled study, but she knew that sometimes other people didn’t find that kind of response as interesting or appropriate as she did.

There was, it seemed, a fine line between funny ha-ha and funny peculiar that she occasionally fell on the wrong side of, and for some reason the opinion of the Adonis mattered to her; this was clearly one of the concomitant benefits of having a handsome face– people wanted to impress you.

She was still mulling over a few phrases that might sound clever and insightful, something about death and the human condition, when Gus spoke again.

‘Ignore me,’ he said, smiles restored. ‘I always have an existential crisis on my first night shift of the week. I’ll go and give them a hand getting him up to HDU now, who knows, he might make a miraculous recovery and be sprinting out of the door in a few days’ time.’

‘Hmm… I’ll keep an eye out for him vaulting over the bollards in the ambulance bay.’

‘That’s just a warm-up for his four laps of the outpatients’ car park,’ he said.

‘Followed by a quick jog down to the docks.’

‘Would he be taking in a short tour of the SS Great Britain while he’s there?’ Gus’s eyebrow was raised.

‘Of course he would– crazy not to. And then he’d probably want to check out the—’ She stopped abruptly. Gus’s bleep had gone off and she was also slightly shocked at herself for this burst of conversational enthusiasm.

Gus looked down and checked the number flashing on his pager.

‘Oh well,’ he said. ‘No rest for the wicked. Still, I’ll keep you posted as to whether our patient makes it out of here in time to sign up for the next Marathon des Sable.

I’m sure I’ll see you around.’ The smile he flashed in her direction was wide and warm.

He seemed to have a lot of teeth, thought Violet, which was ridiculous because clearly he’d have the same number as anybody else– maybe he just showed more of them off at any given time?

‘Oh, and Happy Christmas,’ he said as he sauntered off, taking his easy manner, multiple teeth and perfectly chiselled face with him.