Intensive Care: Escape to the Country (11 page)

Until the next time.

“Well Mr. Cartwright, I’m sure we can work something out.”

When Kate returned to the nurses’ station she dialed the co-ordinator. Before she even had a chance to speak, the other nurse answered and said, “Don’t say it, Kate. Just accept that sometimes this is how it happens here in Birrangulla.”

Kate hung up the phone and shook her head. She pushed two Panadol from the foil sleeve and popped them into her mouth before taking a big gulp of water from her bottle. While she appreciated the importance of helping patients with their mental illness, this was intensive care, not a mental health assessment unit. She tried not to be frustrated with the situation, but found she was failing miserably.

She replayed the words of the co-ordinator in her head.
Welcome to living in the country.

Later that afternoon Kate went down the street to do some shopping. She caught sight of Hugh Cartwright parking his large black late model Mercedes SUV near the Performing Arts Center. A couple that looked to be around his age greeted him as he stepped out of his car. Kate watched from a distance as an older woman air-kissed both of his cheeks. These people looked like they all belonged back in Sydney. As Cartwright returned the woman’s kiss, he must have sensed Kate’s scrutiny. He turned and caught her eye. When he saw her, he put his finger to his lips, and she knew he was reminding her to keep his secret safe. He spoke for a brief moment to the other couple before striding across the street toward her. Kate stood riveted to the spot, wondering what he wanted.

“Kate isn’t it?” he said as he came closer.

You just met me! Of course you know my name!

“Yes?”

“I’m told you’re a bit of a runner.” His booming, commanding voice was back, no evidence of the fearful man she had only recently witnessed at the hospital.

The statement surprised Kate.
How on earth does he know that?
“Yes, I guess you could say that.”

“Then we’ll be seeing you at the fun run of course.”

Kate had no idea what he was referring to. She shrugged her shoulders. “What fun run?”

“Every year the Birrangulla Rotary Club hosts the hospital fun run two weeks before Christmas. It’s a fundraiser. I’m the president of the Rotary Club this year.” He puffed out his chest and Kate stifled a smirk. “It’s a community run, open to everyone, but
all
hospital staff are highly encouraged to join in. And obviously, given your position at the hospital, it would be assumed that you will participate.” It was clear he wasn’t giving her a choice.

“That sounds great. How far is the run?”

“It’s up to you but the most you can run is twenty-one kilometers.”

“Oh god, that’s a half marathon!” Kate exclaimed.

“Yes, I’m aware of that. But some people don’t run anywhere close to that distance. The way it works is you pay the entrance fee and then you get folks to sponsor you per kilometer. Obviously the farther you run, the more money you raise. Naturally all proceeds go straight back to the hospital. This year we’re fundraising for new cribs for the special care nursery.”

Kate was genuinely pleased with the whole idea when she replied, “That sounds awesome. Definitely count me in. Although I’m not sure I could run a half marathon! I guess I’d better start training. Lucky it’s still nearly six months away.”

“I’m sure young Joel O’Connor would be more than happy to be your training buddy.”

Kate flushed with heat. How on earth did he know about her and Joel? They’d only run together once!

He must have seen her startled expression. “It’s a small town, Kate. Don’t ever forget that.” With that he turned on his heel and headed back across the street, not even glancing either way for oncoming traffic.

Kate shook her head, unable to come back with an appropriate reply. She was surprised he hadn’t wagged a finger in her face.

It was Norman’s fourth day in the unit, and according to the brief handover from night staff, the plan was that he would be weaned from his sedation and extubated later that morning. Norman was a normally fit and active seventy-year-old who had visited his GP complaining of some discomfort when urinating. Subsequent tests indicated a mass on his right kidney and within a few days he had gone for surgery to have a nephrectomy, or a removal of one of his kidneys. The procedure was uneventful and he was expected to make a full recovery.

Handover finished and the staff went to their allocated patients while Kate continued with a more in-depth handover with Stephanie. Stephanie was another local girl who seemed to know something about everyone. Her black hair and tanned skin hinted at Aboriginal descent but Kate didn’t know how to ask without coming across as nosy. Stephanie’s down to earth, bubbly personality was clearly a winner with everyone. So far she’d been polite to Kate, but like all the other staff, not overly friendly or welcoming.

As they were finishing handover, Kate heard a voice call out and there was a commotion in the hallway. Nurses had gathered at Norman’s bed and by the time Kate arrived and pushed her way through the staff who were milling around, Laura and Ewan were on either side of the bed, holding his arms down, trying to stop them from flailing around.

“What happened?” Kate asked, tilting her head to the side as she asked the obvious question.

“He tried to pull the tube out,” Greg replied.

Greg was working his fourth night shift in a row and looked tired. His wire-framed glasses had slipped down his nose and a thin sheen of perspiration had gathered on his forehead. Laura Kelleher had just finished receiving handover from Greg. Her blonde bob swung as she moved. Vivid green eyes were framed with dark black mascara and charcoal eye shadow. Laura was known for her blunt, forthright manner and while all the other staff seemed to like her, Kate had yet to warm to her. She was a similar age to Kate but so far the two women had yet to find any common ground, and any hint of friendship seemed a long way off. If anything, Laura’s attitude toward Kate bordered on rudeness. It had been evident right from the beginning when they met in the staff room on Kate’s first day and was still as apparent now, two months later.

“Greg’s had the sedation off, trying to wean him,” Laura explained. She didn’t look at Kate as she spoke. “Ewan wants us to re-sedate him. Just give him a bolus of propofol now,” she demanded.

Kate glanced at the small glass bottle of milk-like solution hanging at the head of the bed. She pressed buttons on one of the triple IV pumps hanging on a pole, ignoring the way Laura’s words had stung.

“Are you okay if I go, Kate?” Greg asked. He flicked his rubber gloves off his hands, then pushed his glasses back up his nose with the back of his hand.

“We’ll be fine now, thanks Greg,” Kate replied, smiling at him. “Sleep well.” She was disappointed when he ignored her cheerful farewell.

 Norman was still thrashing his legs around, as much as he was able to with the calf compressors wrapped around his legs. He was moving his head from side to side like a clown in a sideshow alley, making it difficult for Ewan to hold the tube in place as well as one of Norman’s arms at the same time. Ewan was speaking loudly, trying to calm him down but with no effect.

“What other sedation is he on?” Kate asked Laura.

“Greg’s been running precedex and morphine all night. As per protocol,” Laura responded brusquely.

“Then what the heck caused him to go off so quickly?”

“He was calm and settled, but I could see he was trying to get into a different position. Once Greg and I helped him move, he was obviously in heaps of pain. He grabbed at his abdomen and then went straight for the tube,” Laura answered.

By now the sedation Kate had administered had taken its effect and Ewan and Laura were able to step away from the bed, releasing his arms.

“Did he pull it out, do you think?” Kate leaned in closer and peered at the clear plastic tube in his mouth, squinting as she tried to read the small numbers printed in black at two-centimeter intervals along the tubing. “What was it sitting at the lip before?”

Laura didn’t answer for a moment as she consulted the notes in front of her. “Twenty-four centimeters,” she replied.

“It’s reading twenty-seven centimeters now,” Kate said. “I’ll call x-ray to come up and check the tube placement.”

“Is it really worth it?” Laura turned to Kate. “I mean, if he’s about to have the tube pulled out anyway?”

Kate felt her face flush as Laura second-guessed her decision. Kate ignored her and spoke in measured words to Ewan. “What do you want to do?”

“Better get x-ray. Bruce isn’t here for another hour and he won’t want us to extubate until he’s here and has reviewed the patient,” Ewan agreed, shrugging his shoulders and avoiding looking at Laura.

Kate was annoyed Laura had tried to undermine her. She didn’t want to have to confront her but she knew she couldn’t let things continue this way much longer. Kate left the room to call the radiographer to come and take a portable x-ray of Norman’s chest so that they could check that the endo-tracheal tube was still in the correct position.

An hour later Bruce Powell arrived and made the decision to turn off the sedation and get Norman extubated as quickly as possible. Kate sent Laura on her morning tea break while she stayed in the room, keeping close watch on him as the sedation began to wear off. Within minutes it was her turn to call out for help. Amanda was looking after the patient in the adjacent bed and she quickly came to her aid.

 “He needs to be extubated now or he’s going to go for the tube again,” Kate said.

While Amanda used the syringe to deflate the balloon that kept the tube in place, Kate suctioned and pulled the tube out in one swift movement. Norman gave a small cough and Amanda placed the oxygen mask over his face. The ventilator alarmed and Laura walked back in as Kate pressed the button to turn the machine off.

“Why didn’t you wait for me to do it?”

Kate heard the anger in Laura’s voice.
Jeez, what’s the big deal?

“We had to do it, Laura. He was about to pull it out himself again,” Amanda explained.

Kate heard Laura grunt in reply. She continued writing in the chart when Amanda called out.

“Watch out!”

Kate turned to see Norman grabbing at his naso-gastric tube, the thin tube that was passed down his nose, through the back of his throat and into his stomach. In one swift movement he yanked the tube straight out. As he did, bright yellow fluid splashed across the bed and hit the wall, barely missing Kate. Once it was out, he began searching for other things to remove from his body. His hands were roaming everywhere, searching first for the indwelling catheter that drained urine from his bladder. He was unable to find it under the sheets and Kate grabbed his arm just in time before he reached up to his neck to pull at the central venous catheter. Unfortunately Kate wasn’t strong enough and he used his other hand to grab her arm and pull her toward him in the bed. Amanda reached over and tugged his arm with his arterial line and held it firmly down on the bed.

“Kate, has he got any sedation orders?” Amanda yelled, surprising Kate, who had never heard her raise her voice or lose her calm. Her red glasses matched the flush in her cheeks.

“I’ll grab some haloperidol and ask Simon to write it up,” Laura replied as she hurriedly left the room.

By now Amanda and Kate were each holding his arms down and Norman was glaring up at Kate. In a croaky voice typical of patients who had just been extubated, he finally spoke.

“You silly buggers. I know what you’re up to you know!”

Kate tried not to laugh as the hilarity of the situation hit her. She looked across to see whether Amanda was as amused as she was, but was unable to catch the other woman’s eye. “Norman, my name is Kate and this is Amanda. We are your nurses. Do you know where you are?”

“I know where I am and I know what you’re trying to do.”

“You’re in the ICU, Norm,” Amanda spoke calmly, trying to reason with him. “You’ve had surgery and we are here to help you.”

“I
have not
had surgery,” he shouted at them.

Before Kate had a chance to move, he lifted his leg up and angled it across the bed in an attempt to kick at her. She jumped aside just as his leg made contact with her stomach. She looked up at Amanda again and laughed in surprise, but Amanda’s face remained expressionless.

“Well, I didn’t see that coming!” Kate said.

Laura came back into the room and showed Amanda the two small brown glass vials of haloperidol. Amanda confirmed the dose and date were correct on the vials and checked them against the written order in the drug chart Laura proffered to her.

“Just don’t let him see you do it!” Kate said.

Laura rolled her eyes. “I
do
know what I’m doing,” she replied. Kate’s eyes widened at her tone but she chose not to react. Now wasn’t the time or place.

“Don’t you dare drug me or I’m going to call the police!” Norman yelled out as he began thrashing around again.

Laura quickly administered the drug. It started to work slowly, and soon his arms began to relax under their grip. Fifteen minutes later Laura administered another dose of the drug and he drifted off to sleep.

“If he wakes and becomes aggressive again, you’ll have to get out the restraints, Laura,” Kate said, referring to the soft Velcro bands that were sometimes attached to the sides of the bed and wrapped around a patient’s wrists. Restraints were always an issue of controversy and could only be administered under the direction of a doctor.

“I’ll be fine now,” Laura answered curtly, not looking at Kate. She then addressed Amanda with a smile and her tone was instantly changed. “Thanks for all your help, Amanda. I appreciate it.”

Kate clenched her jaw and her eyes darted between the two nurses. She definitely wasn’t being paranoid
–
Laura clearly didn’t like her. She sighed heavily. What was she going to have to do to be accepted?

“Just call me if you need anything, Laura,” Kate said as she left the room. She wasn’t surprised when they both ignored her.

Later that day Kate was taking a break in the staff room. She sat slumped in one of the chairs, staring into her half-drunk cup of tea, thinking back over her earlier altercation with Laura and Amanda. The television was blaring in the background and the voice of someone trying to encourage her to buy a new vacuum cleaner barely registered.

On the table in front of her lay a pile of pamphlets for the Rotary Club fun run. She glanced at them, knowing she should have already signed up and started her training, but at that moment she lacked any motivation. The only place she wanted to run was back to Sydney. With her tail between her legs.

She had been living in Birrangulla for two months and other than Joel, she hadn’t made a single friend. No one had reached out and made her feel welcome and she desperately missed the camaraderie she had enjoyed with her previous work colleagues. She missed being invited to hang out, or go to dinner or the movies with her friends. Although Kate didn’t know how, she was going to have to make some friends outside of work.

The brochure caught her eye again and she absentmindedly pulled it toward her and scanned the details. Maybe a fun run was the perfect opportunity. Surely if she registered, it would encourage other staff to sign up. Maybe she could even organize a running group. Her heart leaped at the idea that began to form and then she sighed. It just seemed too big of a task to take on.

Unexpectedly she found herself sniffing and wiping her eyes. At that moment Amanda came into the room and Kate turned her head away, wiping at the tears that had formed and hoping that she hadn’t just smeared mascara across her face. She didn’t want Amanda to see she had been crying. She straightened her back and drank the last of the cold tea, her nose wrinkling in distaste.

“Mind if I join you?” Amanda asked, indicating the empty chair opposite Kate.

“Sure,” Kate said, and forced a smile on her face.

Amanda reached for the remote and turned the television off, plunging the room into silence before settling into the chair, leaning back and crossing one leg over the other. She took her red glasses off and placed them in front of her on the table.

“How’s it all going then?”

“I’m getting there,” Kate replied cautiously, wondering what this change of attitude was all about.

Amanda arched her eyebrows. “You sure about that?”

“Yeah,” Kate said, wiping at her eyes again. This was ridiculous.
Why am I always crying these days?

“Seems like you’re doing it a bit tough. Want to talk about it?”

“Nah. Not really. It’s nothing.” Kate shrugged her shoulders and avoided making any eye contact. She knew Amanda was staring at her but the other woman remained silent. The longer she stared, the more Kate felt obliged to talk and open up to her. Perhaps if she trusted Amanda and shared some of her concerns, she might have someone on her side. Amanda seemed friendly enough, so it was worth a try.

“All right,” she relented, “I’m finding it hard to make friends. Everyone seems genuinely very nice – but not toward me. You saw what Laura was like just now. I feel as though I’m being judged for everything I do and say. It’s as if people are just waiting for me to screw up and quit. I want to enjoy coming to work but I feel really lost.” Kate sighed and slumped back in the chair again, knowing she was whining. “I just don’t feel like I’m fitting in and don’t know what to do to fix it. Is it something I’m doing wrong? Is it just because I’m the newbie? Or is it more than that?”

“Hmm. Yeah, I saw how Laura was, and I’ve noticed a few of the others giving you a bit of the cold shoulder treatment too. And I guess I haven’t been all that friendly either. Sorry about that.”

Kate raised her eyebrows. At least she wasn’t imagining it. It was nice that Amanda was apologizing, but she still hadn’t answered Kate’s questions.

“Why though? Is it because I’m from the city?”