Going
[Melbourne, Australia. Year: Early December 2019]
"Over the edge. Feel like I'm floating through the air. The pain I felt is paid for, all is said and done…" a young woman mouthed the lyrics of the song in silence while watching the bland walls of the hospital ward's tea room.
The established Australian hospitals were almost all the same, decrepit and falling apart. Limited public funding meant limited renovations in most second tier hospitals. The peeling wallpaper and woody smell emanated from the cupboards, first built over forty years ago.
The door to the staff room creaked open. Thomas, a senior nurse of the ward, had shuffled in for his usual cup of coffee before the night shift began.
"Another night, another paycheck," he grumbled, then he spotted a young woman curled up on the armchair wearing her headphones and reading a small paperback.
Young, Asian, in her early twenties, she is petite for her size. Her facial features resembled migrants from China, Japan, or Korea.
Probably a relative of a patient staying overnight, or an agency nurse, a common sight for the medical ward, known as the old aged care dump. He couldn't make out under her hoodie sweatshirt. Thomas didn't care.
A stiff nod. "How's it going?"
"Good and you?" She looked up, and her striking amber eyes took him by surprise. Unusual for an East Asian, Thomas thought. Perhaps of mixed heritage. Not uncommon in Australia.
"Same, need a cuppa for the night shift," he said as he started making his coffee.
He plonked down on the sofa beside her armchair with a mug full of cheap Nescafé instant coffee on the table. His nose sniffed the almost stale roasted coffee bean's aroma before the sip as his hand reached out for the newspaper on the side table.
Just when he got comfortable adjusting his bum to the aged PVC covering of the faux leather sofa, the creaking door to the staff room was flung open again. The unmistakable scent of decomposition mixed with bleach assaulted his nostrils.
Rosie, the senior nurse specialist from the afternoon shift, was at the doorway in a state of panic.
"Hey, need help for an emergency now," Rosie glanced in both their direction as another nurse rolled the crash cart past her.
The heavy AED, an automatic defibrillator, thumped against the cart's metal surface as the cart hit a minor bump on the linoleum floors. Someone's heart is about to give way and crash.
Thomas placed down his mug of coffee and hurried out, along with the young woman trailing behind.
"Fucking full moon," he muttered.
There is a baneful legend of the infamous full moon season amongst the hospital staff. Not werewolf related.
To the nursing staff, full moon was Murphy's law on extreme steroids - everything will go wrong, like three patients coding at the same time last month during the full moon. With only one crash cart to go around in the ward and the code team is on call at night, the morgue had two extra bodies by morning.
That or a patient going bat shit crazy. Explosive diarrhoea with psychosis during a full moon did not mix well, especially when a doctor and the walls were finger painted within foul watery faeces. Thomas sighed.
Towards the large end of the corridor, the pandemonium of a commotion grew louder. Pitter patter of feet running around. Phone calls made with urgency in tone. Shouts of medication and equipment to grab rang through the long, dreary corridor of the ward.
A chubby clinical assistant ran past them while panting away from his plentiful blubber jiggling beneath his white uniform and the obvious lack of stamina.
A crackling noise came from the hospital's intercom system, about to blare a call for the cavalry - the resuscitation team from the intensive care unit.
"Ah hem. Code blue. Ward 13, Room 12, bed no. 24. Code blue. Ward 13, Room 12, bed no. 24," the most unenthusiastic voice announced in monotony over the hospital-wide intercom system.
"PAGE THE REGISTRAR!" A voice was hollering from the room down the corridor, causing Thomas, Rosie, and the accompanying young woman to break into a quick run into room 12 to see the staff running around grabbing items or on the phone.
The noise was immense. Several commands over others. A scene of chaos was unfurling before them.
"Get IV epinephrine 1mg prepped."
"Standby amiodarone too, if he flatlined."
"Where is the IV line?"
Thomas yanked opened the curtain, revealing the patient, a young man laying flat on the bed, surrounded by a young doctor and five nurses in a tiny space.
"Doctor is on it."
"Grab a bag of 500 ml saline and two bags of 100 ml saline for later."
"IV Amiodarone needs a prescription here. Only ICU nurses can take the order."
"Fuck that shit. Just deck amiodarone out with the necessaries, label on the kidney dish and code team will be on it."
"Doctor needs to get the vein for the IV in first. Priorities. No access. No IV drugs."
"SATS 70%, 65%… Mary, Joseph, Jesus, he is in respiratory arrest."
"Prep ETT intubation gear for later. We will need it when the code team arrives."
On the patient's chest were three white stickers with wires attached to the protesting, shrill-pitched cardiac monitor. The display of the monitor was flashing the fading vital signs in the red. Hands were moving everywhere in a blur.
An over-breather mask covered the lower part of his face, secured at its ends by the hand of the nurse assisting in his ventilation. The tip of a ghastly orange plastic oropharyngeal airway peeped out of his mouth under the mask.
They could hear the whistling sound of oxygen rushing through the plastic tubing into the mask as a small bag expanded. A nurse was busy bagging him, inflating his chest with oxygen. Without oxygen for two minutes, he would be dead and gone.
"SLAP ON THE AED PADS!" someone yelled. "NEED IT SOON!"
The patient's dull green eyes fixed on the wall, unmoving, bore the resemblance to dead fish eyes. Pallor in his complexion, cyanotic lips which looked a goth- like blue and purplish, was enough to warn of his impending demise.
Beads of sweat were breaking out on the doctor's forehead as the cannula needle trembled in his gloved fingers, holding the patient's hand steady from the compressions by a panting nurse.
Another nurse waited behind with a ready prepped syringe of saline and another was busy tagging the prepped medication.
With one deep breath, the young doctor tried pushing the intravenous cannula with its introducer needles into the collapsing vein of the young man lying on the bed. Blood wasn't flowing back into the tiny chamber. He was trying to manoeuvre the needle a few times in different directions.
"Lisa, what's his history?" Thomas asked the charge nurse as he rubbed his hands with a squirt from the bottle of alcohol sanitizer and gloved up. Among the panic, calm was necessary.
"25 years old, male. Name is Alex Fu-Tales. No cardiac history or major trauma. No chronic diseases, too. He came in for a septic shock of unknown cause. Chest x-ray clear. Went into grand mal, no epilepsy in the history too. Then he just went dead in the water. And we have no fucking access because his IV cannula fell out while he was seizing," Lisa rambled.
"So young… anything about the infection?" Thomas looked at the patient and noticed his athletic built.
"We did two panels - even for respiratory infection. Negative for HIV/AIDS. White cell counts off the roof. Nothing popped. Blood culture, nothing too." The doctor answered with a grimace while rubbing the patient's hand with another alcohol swab frantically.
"Strange… wait what's that on his palm?" Thomas pointed at the strange shaped, pinkish raised keloid scar on the open right palm which looked like a recent injury.
"Injury in Japan a few months ago. He was on exchange there…," the charge nurse said as her eyes poured over the notes. "As an exchange postgraduate student. Archaeological dig. The Japanese hospital faxed the information. He was fine when they discharged him from outpatient. Tetanus shot given."
"That's why we also ran the tests for anthrax and any possible soil pathogen, in case some snuck into his system. Heck, even small pox and all known fungal infections. All negative. His parents are fine, so not some easily transmittable disease - spoke to them on admission. So we ran toxicology and came up blank for toxins, now waiting for the approval to do the more intensive work up," the doctor added with a frustrated look.
"SATS 45%. Heart rate 156 and in full v-tach. Pupils unequal but reacting."
Thomas glanced at the monitor and asked, "how long is the v-tach now?"
Ventricular tachycardia could kill the poor guy anytime, Thomas thought. There was almost so much the heart can take.
"3 minutes. He's fighting but…"
"Not good. Another seven and he is dead."
"His veins are all collapsing… I can't… get the iv in," muttered the young doctor as he pulled out the bent intravenous cannula in frustration.
With no intravenous line, direct delivery of the life saving medication into Alex's veins was impossible. Death would be imminent.
"Let me try," Thomas said.