Friday 5th March 2010

Gestation: 23 weeks

One year ago.

 

I rise before dawn, and leave the bedroom on tiptoe.  As I walk the hall, I step where I have learnt that I can;  through summer the boards have begun to creak, the noisiest of all directly under foot, right at the doorstep of the bedroom.

I perform my morning ablutions before I leave, sending an air-kiss to Suse, my overnight bag in tow.  As I walk down the street, the sun beginning to rise, I spot a sweater on the footpath;  arms tied, as if slipped from someone’s waist while running.  It’s not my kind of thing – the jumper or the habit – but for whatever reason, I pick it up and take it with me.

Like a good luck charm for the day.

* * * * *

I sit at Southern Cross Station, waiting to board.  Fifty other disgruntled passengers stand with me, all waiting for the early morning train, now twenty minutes delayed.  V/Line workers stand there as well, walkie talkies at the ready, some on mobile phones.  All waiting for approval to allow us on board.  A train, willing workers and passengers all stand stationary, silently fuming, herded sheep like a John Brack painting, ready to start the day.  No one, not least the employees, quite understands the hold up.

Ninety minutes later, I walk through the doors of the hospital, familiar from previous locums.  I drop my bag in the staff room, and hurry upstairs to meet the ward round, already thirty minutes late.

“Welcome, Nethers,” calls out one of the Consultants.  “Glad you could make it.”

“Are you here this morning?” says Peg, one of the other Registrars.  “We didn’t think you were going to arrive until this arvo.”

My mouth moves into shape, but nothing comes out.

* * * * *

The day whizzes by, a flurry of action.  There are jobs constantly on the go, always something to keep me busy.  I enjoy locuming, working in other hospitals, being the go-to guy to fill the holes in the roster.  I enjoy the challenge of a new place:  new staff, new corridors, new systems, new protocols.  Most people would hate it, but for whatever reason, I kind of enjoy having things shaken up, keeping me on my toes, dealing with totally new scenarios.

I know, I know.  I’m weird.

I knew it was going to be a long day, but by 10pm, there is no end in sight.   Kids continue to roll into Emergency on this Friday night;  a 22-monther with a febrile convulsion, a three-monther with a breath-holding episode, another with a temperature, this time a six-weeker.

Then, I’m called back upstairs to look at another newborn with a temperature, and then to the ward to review a 13-day-old child with a fever that just won’t subside.  Back up to special care nursery to examine a kid dropping her oxygen saturations, and then back down to look again at the 13-day-old.  She’s been awake for eighteen hours, and just won’t settle.  Kind of like me.

My head hits the pillow at 3.30am, for an entire hour, long enough to fall into a deep, deep sleep, only to be woken at 4.30am about blood results for the hypoxic kid, and and then again at 5.30am.

Eventually I rise at 6.30am, my twenty-four hours on call almost up.  Due to be finished in just on ninety minutes.  This has been a nasty on call.  It’s not usual to be quite this busy.  Just a few more things to check before I’ve earnt two days off.

* * * * *

I stand there, at 7.45am, dazed and foggy, counting down the clock until Peg arrives.  Fifteen minutes to go.  Thoughts float slowly, synapses sluggish, not quite stabilised from my two, hour-long catnaps just before.

I check the computer for an X-ray, one of the baby with the low saturations.  I move the cursor round the screen, changing the saturation of the X-ray.  It does so, but with delay;  a second passing between the cursor movement and the effect occurrin.  As if to copy my own slowed thoughts.

“Paed in delivery!  Now!” comes the call from down the hall.  Right from the Delivery Suite.

“What is it?” someone barks back.

“A twenty-eight weeker.  Crowning!”

I grab my phone, looking for Peg’s number.  I ring it quickly, knowing that I need help.  This is not something for my tired brain alone.

I need back up.

There is a flurry of action, as people rush about, getting things together.  I stand there, willing my phone to work.  Just as it picks up, it drops out.  I try again for the number, my phone stalling like a petulant child.  I power it down and reboot it.  All the time, as people rush about me, I feel the pressure in my vessels building.  I wait for it to start up, groaningly slow.  The name comes up, and this time I use a landline.  Just as it picks up, there is another urgent call:

“We need the Paed in here.  Right now!”

I hand the phone to a nurse by my side, someone I’ve not met, who only arrived forty-five minutes ago.

“This is Peg, the Registrar.  Just tell her she needs to get up here.  I need back up.”

I jog over to Labour ward.  Primal groans come out of Room One, initially muffled, then startlingly clear, as the door is opened, and a nurse runs out.

I walk through the open door, and into the scene.  The resuscitation cot sits there in the centre;  still, while all around is action and movement.  It is lit from above, the white wraps already laid out;  an electric manger.  The scene is framed on all sides by bodies, those of the staff.  I approach the cot, grabbing at gloves from the  box on the wall.  As I do, I see a woman, lying on a bed, a man at her side.  They are both dark – in lighting, skin tone, and mood.  He grips her hand as she sucks on the nitrous, riding through another contraction.  Her belly is stretched, but less than you like to see in childbirth.

This is a small child.

I wrestle the gloves, trying to pull them on.

“What do we know?”

“Walked in of the street.  Thirty-one weeks…”

“Thirty-one now?  Well, that’s a start.”

The nurse leans in.  “On the Methadone program, Hepatitis C positive.”

“Yep.  Keep going.”  The time for subtlety has gone.  That boat sailed when we walked in off the street with a head on view.

“Coorie background.  Oligohydramnios.  Pulmonary hypoplasia.”

“What?  How bad?”

“I don’t know.”  It’s like Chinese whispers.

“Well, we’ve got about five minutes.  She what you can find out.”

I check the Resuscitation Cot, getting things in place.  I pull out the enotracheal tubes, and the laryngoscope for placement.  The oxygen is running, the suction tube is ready to go.  We search for the lines, for access to help give adrenaline when we need it.  Because we will need it.  We’ve got more than enough for ourselves; lack of sleep is little more than a memory now.

With that, Peg bursts through.  She is panting, eyes wide, that urgent look when you first arrive at a terrible accident.

“What do we know?”

“Very little.”

“Twenty-eight weeks?”

“Thirty-one, now.”

“Well, that’s better,” she says, sighing a little.

“But pulmonary hypoplasia.”

She stiffens up again, right back to where she was when she first came in.

It’s even worse than she thought.

* * * * *

to be continued…