5 Going…
Shadows danced around on the white walls of the room and drawn curtains, distorting their shapes each time the human bodies shifted under the fluorescent lights.
The young woman, who entered the room with Thomas, gazed at a few static shadows lurking in camouflage against those moving shadows as though she saw something else.
"Has anyone called Alex's parents?" Thomas asked around as the nurses looked at each other.
"But Julia said…" Rosie trailed off when Thomas shot a stare at her.
Julia, the incompetent fool of a nursing unit manager, was more of a paper pusher than a clinical nurse. Her attitude often annoyed the crap out of Thomas. Protocols were more important to Julia than common sense.
"Fuck Julia, just call the family - so that they can come in time quickly," Thomas said. "Tell them there's a sudden change in his condition."
Rosie got the subtle hint that Alex was not long for the world and ran out to make the fateful call. In her mind, she knew the parents may not come in time, but some hope was better than nothing.
"What's the time now?" someone asked, probably to jot down on the notes.
"8.45pm," Rosie answered.
"Oh, 15 minutes before the handover to the night shift."
"Thomas here, he is the night charge nurse," she replied.
Fifteen minutes - a certain time which this young man didn't have, Thomas thought as he rubbed the veins on the patient's arm to pick the best. He could spot a few pin-sized holes from the previous attempts.
"Prepare the cut down equipment, in case I don't get the vein. The ICU team is arriving in a few seconds," Thomas told the young doctor, who stared blankly.
"First clinical posting?" Thomas recognized the look of a medical rookie, realising that the young doctor could witness the first death of a patient under his care.
The young man nodded. No bravado. Just a helpless look.
"Get used to it. Death comes and goes here. What matters is that you did your absolute best in good conscience."
That entire sequence which may lead up to Alex's death will haunt the doctor's nightmares for days or weeks, maybe months. Thomas never forgot the first patient who died on him.
A cranking noise of another metal cart, followed by footsteps, announced the resuscitation code team's arrival.
Someone drew the curtains open, revealing the cavalry in full glory - the Intensive Care Unit (ICU) registrar, his young intern, the specialist ICU nurse, hospital bed manager and the Operating Theatre anaesthesiologist who promptly took their positions.
"Dr Kapinski here and my intern, Dr Karusamy. Dr Lim, from anaesthesiology. Our ICU nurse is Andrea. I'm the registrar on call from the ICU today. So tell me this fine young gentleman's story?" Dr Kapinski asked while his blue eyes trained on the cardiac monitoring screen with keenness. The thinking wheels were already turning in his brain.
No time for greetings or niceties. Not when life is a priority.
Lisa handed him the file, rattling off every detail she had of Alex's medical history and admission, along with the events leading to his decline.
"Prepare the lignocaine for the V-tach. And prepare pads plus the AED machine - prepare to 200 joules. We need to shock him if it doesn't reverse," Dr Kapinski said as his intern started documenting his orders.
Thomas narrowed his eyes at the engorged target vein with intense concentration. With one deep breath, his hand held the prized IV cannula with a short, narrow tube leading to a three-way connector.
"Aim a little to the left - do it lightning fast," the young woman, who accompanied him, whispered. "It may stop the vein from running if pressure is on the right of the vein."
Thomas nodded his head in response.
A glint of metal, one stab into the vein and blood flowed along the tiny tube into the small chamber of the cannula as Thomas slapped on the securing surgical plaster. His other hand attached an empty syringe, and he pulled 10 ml of blood before injecting the saline in via an already prepared syringe.
"Access in. Line clear and ready. 10mls of blood good to go," Thomas said in a mangled tone of defeat and triumph.
"Good job."
Pushing the saline into the vein, Thomas felt the area with his callused index finger to check his handiwork as someone removed the leads and slapped on the classic gel defibrillator pads to the chest. No swelling seen.
"Send for urgent Trop, Ck, Ckmb, UE, full bloods - telephone the results over," Dr Kapinski ordered as someone grabbed the precious syringe filled with blood.
"Oh and leave a message for the Cardiac registrar to come up after his emergency stent procedure," he added as Dr Karusamy nodded. "IF this poor bugger can survive till then."
His realistic pessimism came with years of experience, watching the same scenarios replay year after year.
"All those not needed here, clear the room. We need space to work."
The monitoring machine begun screaming a warning about the abnormal heart rhythm, as the pitter patter of feet signalled the leaving of some staff. Thomas slammed his hand on the silent button. The defibrillator machine was now in charge of generating the electrocardiograph, which was flowing out in a bright green pattern.
"Lignocaine infusion bolus, 50 mg and standby another 50mg," came the expected order as Andrea yanked the clanking metal drawer to get the emergency drug while another dropped a sterile 100mls saline bag on its top.
"Prepare an intubation tray on standby… let's see… 7.5 size," Dr Lim had snuck in between the moving bodies and examined the oropharyngeal tube beneath the semi translucent mask.
"His airway looks clear for now. SATS are moving up to the 90s. The v-tach has turned into AF, but good to prepare," Dr Lim suggested.
"I will take atrial fibrillation over v-tach any day. Better his chances," Dr Kapinski said.
"Cutdown needed, if that iv access fails. I would suggest medically sedating him with Midaz for now, then in ICU, pump the phenobarbital for a medical induced coma before intubation," Dr Lim added.
"Agreed. Go ahead."
"Do we have spare beds in the ICU?"
"Yes," the bed manager answered with her mobile in hand. "Two spare."
"One spare now. This young gentleman is coming to us once we can stabilise him for a quick transfer," the ICU registrar replied.
"Eh hmm, Code Grey, Emergency Department, Resuscitation Bay 1, Code Grey, Emergency Department, Resuscitation Bay 1," the voice spoke over the hospital-wide announcement system.
"Ah hem, Code Grey, Emergency Department, Triage area, Code Grey, Emergency Department, Triage Area," the voice spoke right after again.
"Mad house in the Emergency Department today? Two Code Greys in a row? The guards must be busy," Dr Kapinski raised his eyebrow at the bed manager, who palmed her forehead in frustration.
"Full moon and we have three meth junkies off the planet. A couple of drunks. One LSD user surfing the waves on a bed. I better call the ICU to hold the space for this young man first," the bed manager pulled out her mobile with a thumbs up from Dr Kapinski, and walked out of the room.
"The cardiac registrar, Dr Larouche, will be up soon. He is scrubbing out," Rosie popped in with the news as Dr Kapinski signed off on a few more drugs destined to flow in Alex's veins, while Dr Karusamy begun a clinical assessment of his condition.
"Good. We are having a better time than the ED for now. What are we going to do with you, Alex?" Dr Kapinski sighed as he read the medical notes with interest.
"The mobile Chest X-ray machine is coming soon."
"My dear Dr Karusamy, better try to get the CVC in before the machine comes and we can hit two birds with a stone."
"Yes, sir."
"That's weird. It's summer yet it is so cold in this room," a nurse shivered as she went to pull the already prepared trolley waiting outside the room.
On top of the trolley was a sterile green pre-prepared package inside the clear sealed plastic wrap, labelled with the ostentatious words 'Central Venous Cannulation'.
The bed was bloody enough with all the previous failed attempts of the young doctor, who was now updating Dr Kapinski. That venous cutdown was going to drench the bedsheets with a deeper shade of crimson red. Along with some yellowish-brown from the large bottle of Povidone iodine on below the top tray of the trolley.
"Air conditioning on full blast?" Dr Karusamy looked around while pulling the trolley with the package to proceed with central venous cannulation.
"Having fun, Kanghui?"
The young woman narrowed her eyes at the unseen questioner addressing her in the ward and raised a finger to her lips.
"The humans can't hear us when we are behind the veil," the voice replied.
Kanghui shook her head as she moved to the back of the crowd and vanished, while Thomas looked around with his eyebrows furrowed.
"What is it?" Rosie asked him as she passed a syringe to Andrea.
She noticed a strange look on his face, as though searching for someone in the room.
"I thought there was one more person in the room but…" Thomas trailed off.
"Just us. Don't frighten me. Your shift is starting soon, and it's full moon. Strange shit happens."
"Must be my imagination," Thomas said as he frowned with his arms folded. "Full moon and ghosts, the perfect combo."
Despite his self-reassuring words, Thomas felt uneasy. He could have sworn that he heard another woman's voice a moment ago while he was cannulating Alex's hand.
He remembered amber eyes on a someone but he could not recall how the person looked like.
It simply made little sense unless he was so stressed out and overworked. Thomas could barely remember his last holiday because of the constant staff shortage and double shifts pulled. It's time for a mental health holiday, he reminded himself.
