Page 1 of The Night Shift
Violet
Monday night
24th December– Christmas Eve
It was nearing midnight on Christmas Eve when the crash bleep first went off and Dr Violet Winters was so shocked that she almost dropped it down the toilet. In a panic she darted out of the cubicle without remembering to tie up her scrub trousers which promptly slid down her legs, wrapped themselves around her ankles, and sent her hurtling into the wash basin. Thankfully nobody else was in the ward twelve staff toilet area to witness the festive sight of a junior doctor sliding arse over tit into a big heap on the floor. Neither was anyone there to observe her look of abject horror as the crash bleep continued to broadcast its uncompromising message. ‘Cardiac arrest. Ward seven. Cardiac arrest. Ward seven.’
Violet clipped the small but terrifying device back into the top pocket of her scrubs, gave her hands a cursory run under the tap, and emerged onto the open ward a few seconds later, the bleep still crackling static and squawking like an alarmed parrot. The noise lent a justifiable air of urgency to her situation, and she didn’t turn it off until she had sprinted past at least three staff nurses and one of the orderlies cleaning the floor. The more people witnessing her emergency dash, the fewer there would be bleeping her in the next couple of minutes with the combination of alternately mundane and horrific tasks currently weighting her to-do list. If word got out that Dr Winters was attending a resuscitation then it was much less likely she would be called upon to take blood from the lady with the collapsible veins or write up the discharge drugs for the man in bed nineteen, a task deemed urgent at this hour by nobody other than the temporary ward clerk.
Once out of sight of the nursing staff, Violet slowed her sprint to a manageable jog, both to preserve her lung function and to delay her inevitable arrival. As the most junior member of the medical crash team, one definitely did not want to be first on the scene of an arrest and the sign for ward seven was only a short way down the corridor, its peeling plastic numeral looming ominously from the wire hangers in the ceiling. Thankfully the sound of another set of trainers squeaking along the linoleum began to chime with the rhythm of hers, and a flash of blue cotton disappearing around the corner indicated that at least one other health care professional had beaten her to it. She felt able to step up the pace and followed the blue cotton through the double swing doors, narrowly avoiding a collision with a precariously balanced synthetic fibre Christmas tree that had seen better days. From the ward corridor she was directed towards a curtained area already bulging and humming with raised voices.
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.
‘Violet Winters,’ she said breathlessly. ‘I’m just the F1.’
With those words the rest of the crash team were instantly alerted to the fact that Violet was a foundation year doctor, only a few months out of medical school– they would also doubtless be aware that five years of diligent attendance at lectures and hours spent trawling through textbooks rarely translated to clinical competence on the wards. Theory was no substitute for practice, and a straight-A medical student was worlds apart from a good, effective, confident doctor. Violet was living proof of this fact. She was as green as her crumpled scrubs and it was safer for everyone, including the patient, if they knew this immediately. She wasn’t one for pretending.
The nearest nurse looked a little disappointed at this declaration of Violet’s junior ranking, although Violet had never been very good at interpreting facial expressions, particularly when they were fleeting– the nurse could just as easily be suffering with a bit of indigestion. She turned her attention to the man occupied at the head of the bed. He was hunched over the prone body and, like Violet, was wearing cotton scrubs except his stretched taut against the muscle of his shoulders where Violet’s billowed and flapped around her angular body like a sail in the breeze. He looked attractive, if any judgement could truly be made by glancing at the top of someone’s tousled head. And the clothing, along with the fact that he was confidently advancing a plastic tube into the mouth of the prone patient, indicated that he was likely to be a doctor. It was also likely that he was significantly more important than her, not that this was hard given that she felt about as senior and capable as a blancmange. Even the orderly mopping the ward corridor had more hospital experience than her.
‘Hello, Violet,’ the probably handsome probable doctor said, raising his eyes briefly from his bent position where he was dealing with the patient’s airway.
Yes, from a purely objective point of view he was definitively gorgeous. His features were symmetrical, his jaw was just the correct degree of angulation to be neither pointy, nor breezeblock, his skin was smooth except for the areas where an acceptable amount of stubble was present, his smile was broad, and his dark brown eyes crinkled attractively at the corners. Violet knew that these were all considered to be ‘good things’ but what was most pleasing was that he had one of those expressions that shecouldread easily– a cheerful open countenance that made her feel relaxed. True, her knees went a little wobbly when he smiled at her– but that might have been from the running. She was wary of handsome faces as a rule, had been ever since a nasty incident at school, and she didn’t tend to come over all giggly and weird when confronted by them. Not normally anyway.
‘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 legendDr 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.’
