Author's Note: My contribution to the Holby City Hospital Scrub-In project which has been a lot of fun and a huge pleasure to be a part of so massive thanks to the organisers. My story assumes that the events beginning with Bea leaving never happened because let's face it, we all wish that she had never left (you're lying if you say otherwise!). I am now wishing even harder for her to come back safely.
Oh well, on with the story!
Her bare feet were agonisingly sore and were covered in blisters from several days of walking. Her body was weak and her breathing was becoming more and more difficult with every step she took but she knew that she could not stop. The chaos of the street around her was becoming too much. She could see everything, she could feel everything but the world around her was silent. All of a sudden, a group of boys not much older than herself ran into her, making her jump but did not acknowledge that they had done so. It felt like everything around her was getting closer, too close. She felt as if she was suffocating. Unable to bear the chaos of the busy street no more, she fell to her knees, put her hands over her ears and she screamed and screamed and screamed, though she was barely aware that she was doing so. Her heart felt as if it would burst from her chest, which became so tight that she was frantically snatching at breaths, the street began to spin uncontrollably and then, everything went black.
"Can someone tell us what happened please?" Iain called firmly as the paramedics forced their way through the crowd of people gathered round the unconscious young girl. "Hiya darling." He started as he and Sam knelt down either side of her and began carrying out the usual observations. "We're just going to take a look at you, alright?"
"She just started screaming and then collapsed." An elderly gentleman told them.
"Alright, thanks mate." Iain replied.
"Does anyone know her name or know where her parents are?" Sam questioned. Several mumbles of the word 'no' and shaken heads rippled through the crowd. "Okay, Iain, her heart is racing, she's freezing cold and cyanosed. Let's get her wrapped up, hooked up to a monitor, get some oxygen into her and get her to the ED." She instructed. "Oh and take her bag with you." She added, referring to the canvas rucksack with a print of Moana on the front. Iain nodded obligingly and picked up the bag, returned to the ambulance to get the required equipment and brought it back to the scene in a matter of seconds. "Alright sweetheart, we're just going to put these stickers on your chest so that we can monitor your heart and give you some oxygen to help you breathe better, okay?" Sam continued, talking soothingly to the girl as she busied about attaching her to the various pieces of equipment and placing the oxygen mask over the girl's face. The girl was so small and thin that Sam could easily lift her onto the trolley without the help of a stretcher. The two paramedics ensured that the girl was wrapped up as snugly as possible in foil and blue blankets to maintain the very little heat left in her body, strapped her securely onto the trolley and lifted her into the ambulance. Sam remained in the back of the ambulance with the girl whilst Iain got them to the hospital as quickly as he possibly could, more than aware of the situation's severity.
The doors to the ED flew open as Sam and Iain entered with their patient.
"Doctor Munroe, Doctor Kinsella, with me please." Elle ordered, rushing over to the arrival. "What have we got?" She asked the paramedics as Alicia and Bea joined her, following them swiftly to resus.
"We have an unknown female, aged four or five years old at a guess, collapsed in Holby high street and has been unconscious and unresponsive throughout. Heart rate through the roof at 233 beats per minute, resps 51, she's cyanosed, hypothermic and severely undernourished. No medical history but she does have a surgery scar down her chest and extremely blistered feet. Nobody knew her and no sign of the parents." Iain informed the team. "All she had with her was this rucksack containing an iPad but the iPad is out of juice so no help at all." He finished, placing the girl's bag on a trolley next to the bed.
"Thank you Iain." Elle said. "On my count. One, two, three." In one swift movement, the team transferred the girl from the trolley to the bed. "Charlie, can you get a line in? Doctor Kinsella get onto the police please and see if there have been any recent reports of missing children matching her description and Alicia, carry out a physical examination whilst I try and slow her heart down." She ordered. Before she had even finished her sentence, Bea left the room to contact the police and the other two instantly began doing as they had been asked.
"Noel, can I use the phone please?" Bea asked, her expression serious.
"Of course." The receptionist replied. "What's going on in there?" He enquired, being careful to lower his voice.
"We've got a young girl potentially with a heart problem, no-one knows who she is or where her parents are. It looks like she's been on the streets for weeks. She's in a really bad way." Bea explained, doing her best to control the rising anger in her voice. Noel could only shake his head. Bea picked up the phone and punched in the number for the local police.
Back in resus, after numerous attempts in both arms and hands, Charlie had finally managed to insert a line and Elle had fluids pumping into the child as quickly as was safe. One of the hardest parts of the job was knowing that you had done all you could and could do nothing more than to simply wait and pray that you had done enough. Steadily, the rapid beeping of the heart monitor began to get slower and slower until it was stable and rhythmic.
"Heart rate down to 102. Still a little high but assuming she has a heart problem I'm happy with that." Elle said, clearly relieved. "Alicia, anything?" She asked.
"No obvious physical injuries other that the blistered feet and undernourishment as the paramedics reported. She's just so thin." Alicia replied with a sigh. Elle nodded in acknowledgement.
"Thank you Doctor Munroe." She smiled. "Charlie, can you get onto Paeds and Cardio and see if they have a spare bed between them?" Before she could finish her sentence, Charlie had already picked up the phone. He had been in the job long enough by now to pre-empt what the doctors would request and more often than not, he was right.
Bea returned a few minutes later with the news that there were no children matching their mystery girl's description reported as missing and without a name for the child, her medical records could not be attained. To make matters worse, Charlie broke the news that both Paediatrics and Cardiothoracic were on the brink of overflow and already had multiple patients waiting for beds. Cardio had, however, promised to send down a doctor to fully assess the extent of the girl's cardiac condition.
As good as their word, Doctor Frieda Petrenko arrived no more than forty minutes later. "Her Tricuspid valve is not properly developed." She told the ED team matter-of-factly after carrying out a myriad of further tests. "It is called Tricuspid Atresia and she is already in heart failure. My guess is that one of the corrective surgeries failed and left permanent damage to her heart. I will talk to Ms. Naylor and see how soon we can get your girl a bed but I would not hold my breath if I were you – it may not be for a couple of days yet and her condition is too fragile to transfer her to another hospital. My advice is to keep her comfortable and I will fast-track the medications she needs to maintain her heart. Make sure that you watch her like a hawk and call me if anything changes." Her tone was stern yet informative. It was not that Frieda did not care. In fact, she cared very much but had learned very early on in her training that if you showed emotion for every patient that came through the door, you were constantly drained both emotionally and physically and in the field of medicine, you needed all the energy you could get. With words of thanks from the ED team, Frieda left the department in the same stylish sweep she had entered it in.
"I thought your shift finished two hours ago?" Charlie said, checking his watch. Alicia looked up from the chair in which she was curled up in and smiled groggily. She had only closed her eyes for a few moments but before she knew it, had dozed off for nearly an hour before Charlie had entered the room. She uncurled herself and stretched out.
"It did. Doctor Petrenko said we needed to keep a close eye on her so I thought I'd do it." She told him, nodding towards the child in the bed surrounded by a numerous different monitors. "Anyway, why are you still here?" She continued.
"Pulling a double. We're short-staffed." He told her in reply.
"Aren't we always?" Alicia smiled.
"Don't I know it! Anyway, when Doctor Petrenko said that this little girl needed watching closely I don't think she meant for you to stay on and watch her. You're back on shift in nine hours. Go home and get some sleep." Charlie ordered. "Proper sleep." He added as she opened her mouth to point out that she had just done so.
"I can't, Charlie, I'd rather be here. She's got nobody." She told him sadly.
"There is nothing you can do for her now. She's stable and is being well looked-after. She will still be here in the morning. Trust me, with Ms. Naylor in charge of Cardio we daren't not do as we've been told." Alicia gave an almost-laugh. "She's got us. Go home, Alicia." He insisted gently.
"Are you sure?" She asked, uncertainty in her voice.
"Yes. Go on, we'll see you in the morning." With a grateful word of thanks, Alicia left the room and took herself off home just as Charlie had instructed her to do.