They’d travelled in Amy’s car. Joss usually travelled with a basic medical kit but it had been pulped along with the rest of the rear of his car. So he was dependent on Amy. ‘Do we have oxygen?’ he asked, expecting the worst, but Amy was nodding, moving already back to the front door.
‘Yes. I’ll get it.’
She had more than just oxygen. She had a complete and extensive medical kit.
She was back in seconds, handing Joss a stethoscope as she hauled out the oxygen mask to attach to the cylinder by her side. Whew, Joss thought-and then reminded himself that he should have expected no less. Amy obviously acted as district nurse and was first port of call in emergency for Iluka’s elderly. Oxygen would be something she needed all the time.
So he had what he required. Now he could concentrate on the child. He needed to concentrate. Her illness was frightening.
‘I can’t…’ The little girl was frantic. She was tossing wildly on the bed-as if trying to escape some unknown demon-and her grandfather was vainly trying to restrain her. ‘My legs… I can’t move them… Oh, I want my mummy.’
‘Her mother’s in Bowra.’ Beside the bed, her grandmother was sobbing with fear. ‘Dear God, what’s wrong?’
‘Emma, you must hush and keep still while the doctor works,’ Amy told the little girl. She signalled to Harry to stand clear and sat on the bed. ‘I’m fitting a mask over your face to help you breathe. But if you fight it, it won’t help. You must keep still. Do you hear?’
The little girl nodded, but her terror was still almost palpable.
‘We don’t know what’s wrong with you yet.’ Amy was already sliding the mask over the little girl’s face. ‘But here we have Dr Braden who’s stuck in Iluka like you are, because the bridge fell down. So we have our very own Iluka doctor. Isn’t that lucky?’
Lucky? Yeah, great. Except he didn’t know what was wrong with her. Hell, he was a surgeon, not a physician.
But he had gone through basic medical training. He’d worked for two years in an emergency department of a busy city hospital before he’d specialised-but this wasn’t fitting into anything he’d ever seen.
The child was badly cyanosed. Her skin was growing more blue by the minute, which meant she still wasn’t getting enough oxygen. Her heartbeat was rating 170 beats a minute and her breathing was far too fast. Yet she wasn’t running a temperature. She was completely afebrile and both lungs sounded normal.
The oxygen didn’t seem to be making a difference.
‘What’s she eaten tonight?’ Joss asked. This wasn’t making any sense.
‘Just what we ate. Roast beef and veggies. Apple pie. Nothing else.’
‘You’re sure?’
‘Yes.’
They’d have three patients here in a minute, Joss thought grimly, and sent an unspoken message to Amy with his eyes. They had to get the pressure off the elderly couple before they collapsed.
‘We need to get Emma to hospital,’ he told them. ‘I want a chest X-ray. There must be something going on.’
But what?
‘She’s asthmatic,’ Harry told Joss. He took that on board but still it wasn’t making sense. ‘It’s only mild…’ The old man gulped and swallowed a couple of times. ‘I thought-I thought you should know.’
Asthma he could deal with, but this wasn’t asthma. Still, it was something… ‘OK. Amy, do we have salbutamol?’
‘Sure.’ Amy was already preparing it. She was a fine nurse, Joss thought. A wonderful team member. He could work alongside her any day.
‘We’ll give her salbutamol just to make sure,’ Joss said, looking at the little girl’s frantic eyes. He shook his head. ‘But asthma…it doesn’t make sense.’
Nothing did.
They drove Emma to the hospital in Amy’s wreckage-mobile with Joss cradling the child in the back seat as he held the oxygen mask in place. They’d left her grandparents collecting her night things and contacting her mother- and pulling themselves together. The old people were shocked and shaky, and Amy rang their neighbours, asking them to drive the couple in. The neighbours just happened to be Joss’s father and stepmother.
Amy didn’t refer to Joss before she rang them. Joss had enough to worry about keeping Emma alive. David and Daisy were dependable and solid; she could rely on them to look after Emma’s grandparents and she didn’t want any more casualties tonight.
One was enough-and maybe even one was too many to save. By the time they reached the hospital things were deteriorating even further.
Amy found herself making silent pleas as she drove, and as she helped Joss lift Emma out of the car her pleas grew more desperate. Were they going to lose her?
Why? This was no asthma attack. What was going on?
Joss was agreeing with her. ‘There’s no way this is just asthma,’ Joss muttered as they carried her swiftly through to X-Ray. The nursing home was settled for the night. It was darkened and at peace, and Sue-Ellen, the night nurse, emerged from the nurses’ station, shocked at the startling interruption to her night.
Sue-Ellen, like Amy, had done her training in an acute hospital and she switched to acute care without a murmur. Joss couldn’t have asked for a better team as they set up the drip, monitored the oxygen flow and organised the child for an X-ray.
Emma was still terrified. The most important thing had to be reassurance-but how to do that when they didn’t know what they were dealing with?
The X-rays told them nothing. The X-rays were normal.
Hell, what?
Joss was raking his hair as he looked helplessly down at the child on the bed. ‘We need blood tests. I don’t suppose you have the facilities here…’
Amy shook her head, knowing what he needed was beyond them. ‘We can do blood sugars and we have an oxi-meter to measure oxygen levels.’
‘I want to do blood gases.’
‘We can’t.’
Hell!
He wanted his teaching hospital, he thought desperately. He wanted a specialist paediatrician and a pathologist. He wanted some answers…
The child was slipping into unconsciousness and he’d never felt so helpless.
‘Joss?’
‘Mmm.’ He was holding the child’s wrist, feeling her racing pulse. His mind was turning over and over. What…?
‘Joss, the swab…’ Amy sounded hesitant-unsure-and she caught Joss’s attention.
What was she looking at? He followed her gaze.
He’d set up a drip before the X-ray, thinking that they might need adrenalin at any minute. The child couldn’t keep this pulse rate up for ever, and the cyanosis was at dangerous levels. So he’d inserted a drip and placed tape over the back of Emma’s hand to hold it steady. But the insertion site had bled a little. Amy had swabbed the blood away and the swab lay in a kidney dish. Sue-Ellen had lifted the dish out of the way but Amy was reaching to grip her hand.
Sue-Ellen paused, the dish with the swab held before her. The light was directly on it.
‘It’s brown,’ Amy said stupidly, and she looked up at Joss. ‘Surely that can’t be right?’
He stared. There it was. The bloodstained swab had turned to a deep, chocolate brown colour.
No, it wasn’t right, but there it was. Unmistakable.
Where had he read about that? Joss closed his eyes, his mind racing. Where…?
And there it was. An article studied for a long forgotten exam. Useless information suddenly resurrected.
‘Methaemoglobinaemia.’ Joss could hardly frame the word. He could barely remember it. But it must be. He
