LITMIR.BIZ

       CHAPTER ONE

      ‘HAS ANYONE HEARD what’s happening?’ Laura McKenzie slowed down as she pushed an IV trolley past the central desk of Wellington’s Royal Hospital’s emergency department and then she stopped. ‘Has the baby arrived yet?’

      One of the department’s consultants, Fizz Wilson, was in front of a computer screen, studying the lab results on blood samples. ‘Last I heard, it’s not far away. Maggie was almost fully dilated. When Cooper brings Harley in for his feed later, I’m hoping we can use my break to go and meet the new arrival.’

      ‘Yes... I’m due for my break at the same time.’ Laura nodded. ‘I’ll come with you.’ Maggie was a close friend and ex-flatmate and Laura couldn’t wait to meet her baby.

      ‘Where are you off to?’ Tom Chapman, the senior consultant in this emergency department, dropped a patient file on the desk.

      ‘To see Joe and Maggie’s baby.’

      Tom’s eyebrows rose. ‘Maggie’s in labour?’ He was already scanning the board that provided the update of all the patients currently in the department, whose care they were under and at what stage of their assessment or treatment they were. ‘I was working with Joe at the rescue base yesterday and he thought it was still a week or two away.’

      ‘Nope. Today’s the day. They headed into Maternity at about four this morning.’

      But Tom didn’t seem to be remotely excited and Laura could feel a slightly puzzled frown line appearing between her eyebrows as she let her gaze rest on his profile for a moment longer. She’d worked with this man for more than two years now but sometimes she had absolutely no idea what was going on in his head. He was a brilliant doctor, was warm and kind and completely trustworthy but, at the same time, he could be oddly reserved. Like now, when you might expect him to share at least some of the excitement of imminent parenthood to people he knew well.

      Maybe he just had other things on his mind. Like how his emergency department was coping with the patient numbers and the levels of attention they needed. Laura brushed off an urge to reassure him in some way that, as always, he had everything as under control as it was possible to have it but a couple of seconds later she thought that it had been just as well that she hadn’t said anything because someone would have blamed her for tempting fate as potential chaos broke out. An ambulance crew was rushing through the automatic doors leading to the vehicle bay, someone was calling for assistance from one of the cubicles and a cardiac arrest alarm was sounding.

      Tom was the first person to put his hands on the trolley that contained a lifepack, airway and IV equipment and the drugs that could be needed to manage a major cardiac event.

      ‘Where’s the arrest?’ he demanded.

      ‘Waiting room,’ someone responded.

      Tom started moving. ‘Fizz, take over here for a minute. Laura? Come with me. We can get there before the arrest team arrives.’

      Abandoning the IV trolley, Laura was almost running to keep up with Tom’s long stride. Expecting to see an elderly patient who had collapsed in the waiting room, it was a shock to find that the cardiac arrest button had been pushed for someone who looked like a child.

      ‘Help...please...she’s not breathing...’ The distraught woman who had her arms around the young girl had to be her mother and Laura’s heart immediately went out to her. She’d be this terrified, as well, if she was holding her son, Harrison, and he’d just stopped breathing.

      ‘What’s happened?’ Tom eased the girl from her mother’s arms to lay her flat on the floor and then he tilted her head back to open the airway. He put his fingers on the side of her neck as he leaned closer.

      Laura was peeling open the pack that contained the defibrillator pads. She cut the neck of the girl’s T-shirt and ripped it open to give her access to the point below her right collarbone and then lifted the hem to press the second pad on her left side. She noted the dramatic rash on the child’s skin and caught Tom’s gaze to make sure he was aware of it, as well. He was. Of course he was.

      ‘She’s allergic,’ the mother was saying. ‘To dairy. She was eating chips in the car and I thought they were the plain ones and they were safe but they weren’t...someone had given her some flavoured ones. Ketchup. She thought that was fine but we could already see the hives starting to come up.’

      ‘We’ve got a pulse,’ Tom told Laura. ‘But she’s bradycardic. Not breathing.’

      He reached for a bag mask, fitted the mask over the girl’s face and delivered a breath. And then another. But he was frowning and Laura knew why. This had to be an anaphylactic reaction to an allergen and the child’s airways were swelling up and making it harder to deliver oxygen. They needed to move fast or it could become impossible to intubate and secure the airway. The fact that the heart rate was already too slow meant that they could be dealing with a cardiac arrest as well as a respiratory arrest in a very short time.

      Tom glanced up and this time it was him who was catching Laura’s gaze. It was another moment of silent communication and something they were both so used to now it took only a split second to have a question asked and answered. This was a critical situation and every second counted. They would be losing quite a few of those seconds to take the girl into one of the resuscitation areas on the other side of the swing doors but it was entirely possible that they would need more equipment than they had in this trolley—like a surgical kit to perform a cricothyroidotomy if a tracheal intubation proved impossible.

      With no more than a subtle nod, Tom broke the glance, scooped the child into his arms and took off.

      ‘Follow us,’ Laura told the mother. She had picked up the lifepack as Tom had started moving and she really was running this time to keep up with him and not break the connection between the pads and the defibrillator.

      People in the emergency department stepped hurriedly out of their way. Laura saw the startled expression on Fizz’s face and the way she signalled junior doctors to take over what she was doing. She was right on their heels by the time Tom put the girl down on the bed.

      ‘Respiratory arrest,’ he told Fizz. ‘Anaphylaxis. Known allergy to dairy.’

      ‘Has she had any adrenaline?’

      ‘Yes...’ The girl’s mother was near the foot of the bed, her arms held tightly across her body as if she needed physical support. ‘We used her auto-injector but...but it didn’t seem to be working. When she started getting wheezy I just drove straight here.’

      She was used to coping, Laura thought. Used to providing her own support. Was she a single parent, like herself?

      ‘Laura? Draw up some adrenaline, please.’

      ‘Onto it.’ The personal connection Laura was feeling to this patient and her mother had to be put firmly aside as she focused on what she needed to do.

      Other staff members were arriving now, including the two medic arrest team. Laura was pleased to see a new nurse beside their patient’s mother, easing her to one side of the room, out of the

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