Bonita Beach Community Hospital
"Right then," Patrick began enthusiastically, "we're to meet Dr Dale in Reception at half past nine. Nick gave me a decent description so I think I'll be able to recognise him. They don't cross paths often at the university, but they have served on a few committees together."
Shelagh nodded in agreement and watched her husband drum his fingers impatiently on the steering wheel, waiting for the traffic light to change. Reaching into her handbag, she withdrew an envelope, "His letter says we can expect a tour of Labor and Delivery as well as the Maternity Ward. But of course the main reason for our visit is to learn about the toolkits. I hope there won't be a need for us to see them in use but he does say we will have an opportunity to observe one of their practise drills."
The light turned green and Patrick eased the car forward. "Shelagh, if they are truly experiencing the success they've reported, the impact could be profound! Maternal haemorrhages account for far too many postpartum deaths."
"Quite." Her eyes sparkled with anticipation, "It's thrilling to be part of something like this, Patrick!"
He beamed at her and reached for her hand, "Isn't it? I'm so glad you're here to experience it with me."
Squeezing his hand in return, she continued her task as navigator, but as she directed him along their course, her thoughts drifted back to the children. "Are you certain they'll be alright today on their own?"
He laughed, "They're hardly on their own, Shelagh! Timothy is with them, and Mrs Bartlett, as well as half the neighbourhood children."
"I suppose you're right," she murmured. "The girls mentioned organising a performance of some kind."
"You see? I doubt they will even notice we've gone," Patrick mused. "In fact once we're back home you'll probably find them missing all the attention."
"Timothy won't be," she giggled. "Oh, there it is! Turn left here."
Patrick pulled into the wide drive that fronted the hospital. It circled around for patient drop off, a tiered Spanish fountain at its center. Double doors, topped by an arched window, announced the wide two-storeyed entrance. Two long wings, complete with Spanish tile roofs, ran perpendicular to the front wing on either side.
After turning right and leaving the sedan in the car park, they made their way toward Reception with ten minutes to spare.
Shelagh couldn't resist, "California Patrick is pleasingly punctual," she teased.
He replied with a chuckle and a wink. "Mind your cheek, Mrs Turner," he murmured as he ushered her through the double doors and into the entrance hall.
A red tiled floor stretched out in either direction and a long wooden desk, closer to the back of the room, stood central. Windows along the rear of the hall opened the view to a fourth stretch of building in the distance, connecting the long side wings and creating an enclosed courtyard. Paved with the same red tiles they were standing on, it was beautifully landscaped with small palm trees and bougainvillea vines boasting bright pink, paper-like flowers. A smaller version of the fountain from out front was surrounded by garden benches and short walking paths.
"Dr and Mrs Turner!" Patrick and Shelagh looked up as a deep voice echoed through the hall. The doctor approached them, his hand outstretched in the familiar greeting. He looked to be about Patrick's age, although shorter and with broader shoulders. His eyes were a kind and intelligent blue, his hair a mixture of light and darker grey. He wore a clinical coat over trousers, dress shirt and, Shelagh noticed with amusement, a very well-chosen tie.
"Welcome to our little hospital," Dr Dale enthused.
"Thank you," Patrick replied, "we're glad to be here."
"I thought we could get better acquainted in my office before you have your tour," he explained while leading them out the back doors and through the courtyard to the rear wing. The medical staff offices were situated in this part of the hospital with doors opening to small rooms on either side of the corridor. Dr Dale's was compact and cramped with overflowing bookshelves, but his desk was neat; two chairs were available opposite the desk for the Turner's visit. The window overlooking the courtyard garden more than made up for the tiny space.
Dr Dale asked several questions about their international journey and was interested to know how they had spent their time thus far before getting down to business. "I know you are most interested in seeing the haemorrhage carts, so let me start with some background. The system began with a Dr Lagrew, who came out to southern California for a medical fellowship. Researching how to lower maternal death rates, he and his team found that one of the most common, yet preventable, causes was obstetrical haemorrhage."
"And the most prevalent reason for that is uterine atony," Patrick remarked.
Shelagh nodded in agreement, "Adding to the complication, a significant percentage of women have no known risk factors."
"Hence, the haemorrhage carts," said Dr Dale. "The idea came from the readily accessible code blue carts many hospitals are now using in cases of cardiopulmonary arrest. In the event of a haemorrhage, the clinical team has everything at its fingertips: the medications, the instruments, the tools for technical procedures."
"There is such time sensitivity involved with a haemorrhage, these trolleys-sorry, carts-would be invaluable." Shelagh marveled.
Patrick leaned forward, "Are they mainly part of the equipment in delivery suites," he wondered, "or are they made available on ante- and postpartum wards as well?"
Dr Dale answered, "We started with just one in labor and delivery, but as more funding has come through we have been able to increase that number."
A nurse rapped on the open door of the office; her brown hair featured a short pixie cut and she was dressed in a uniform of white, including dress, stockings, shoes and cap. Dr Dale greeted her and introduced her to the Turners, "This is Nurse Jones, she's here to give you a tour of the maternity ward followed by our labor and delivery rooms. Afterwards, I'll join you while you observe one of our drills."
Patrick and Shelagh bid farewell to Dr Dale and followed Nurse Jones down the corridor toward the north wing. Here the maternity ward was housed, with a small nursery and the nurses' station in the center. Semi-private rooms with two beds each were located on either side of the corridor. Shelagh noted that the hospital was equipped with much more modern features and furniture than the maternity home and even their local hospitals; she would certainly have enjoyed one of the push-button adjustable beds during her time at St Cuthbert's.
The nurse explained that the general female patients were housed just upstairs and the male patients on the second floor of the south wing, above labor and delivery and general surgery. Once in the south wing, she took them into an empty delivery room where they had their first look at one of the haemorrhage trolleys; off-white with four red drawers, it stood on wheels and was about a meter in height.
"The purpose of the drills are threefold," Nurse Jones informed them. "We review our procedures, identify and correct any problems within our system, and practice the necessary skills. The carts won't be effective without a practised plan alongside them."
"Well said, Nurse," commented Dr Dale, as he walked into the room followed by three other members of the medical staff. He introduced Patrick and Shelagh to Dr Thompson, a young resident physician; Nurse Cooper, the oldest and most experienced of the group; and Nurse Burns, a newer member of the team who looked determined to prove herself. "Alright," the doctor announced, rubbing his hands together, "let's get started."
Patrick and Shelagh stepped to the back of the room with Dr Dale as Nurse Jones took the lead, "Step One: Review the checklist and verify that every item is in the cart." Nurse Cooper called out the items on the list while the other two located them, including medical supplies used both infrequently and in routine cases.
"Step Two:" she continued, "Nurse Burns, as the junior member of this team, your responsibility includes contacting the pharmacy and blood bank if the need arises. Remind yourself now of those telephone numbers."
The young nurse recited, "Pharmacy, extension 1473; Blood bank, extension 6750."
Next Nurse Jones gave the group a chart detailing the attributes of their imaginary patient. The staff members studied the information before handing it off to Nurse Cooper. She read aloud, "Patient is a female primigravida, 39.2 weeks along, 26 years old, blood type O+, no complications during the pregnancy," then placed the file in a chart rack on the wall.
The group arranged themselves around the delivery bed and awaited Nurse Jones' instructions. She began to narrate the simulation, "First stage passes normally; second stage, healthy baby is born." Nurse Cooper moved to the cot as she would to clean and care for any new infant. Nurse Jones went on, "Third stage, placenta delivered." Nurse Burns collected a paper mat, which would have held the placenta, and set it on a nearby surface for inspection, but was redirected by Nurse Jones' next words, "Haemorrhage!"
Shelagh felt her adrenaline surge, even though she knew she was merely observing a drill. Aware of the immediate tension in Patrick's stance, she understood his professional instincts were triggered as well.
Nurse Cooper quickly returned to the bed as Nurse Burns handed her a calibrated bowl from the trolley. Dr Thompson called for an injection of oxytocin and the younger nurse reached for the telephone to make the pharmacy request.
"I notice he's ordering oxytocin instead of ergometrine," Patrick whispered to Dr Dale.
"We've found oxytocin to have less side effects of vomiting, nausea or high blood pressure than ergometrine;" Dr Dale replied, "although the combination drug of ergometrine-oxytocin has been proven the most effective in some cases."
Patrick nodded his understanding.
"I'm comfortable with our doctors using either drug," Dr Dale concluded.
An orderly arrived with the delivery of the artificial medication, for the purposes of such drills, just as Nurse Jones announced the amount of blood loss. Dr Thompson ordered a blood transfusion sending Nurse Burns back to the phone to call for the pint of O+. Nurse Cooper reported she was commencing with uterine massage to further encourage the uterus to contract at the same time as Nurse Burns turned to the doorway to receive the requested mock supply of blood.
As she took the bag to the bedside and began the simulated transfusion, Nurse Jones announced the all clear, "Haemorrhage has ceased, patient is stable." A collective sigh escaped from all those present in the room.
Nurse Jones joined the rest of the clinical staff and they began to assess the recent drill, focusing on what went smoothly and what could be improved upon in a real situation.
Dr Dale turned to Patrick and Shelagh, "The team will use this time to address any issues in our system that need correction as well as to review the use of the intrauterine balloon and compression sutures. We don't have a need for them on a regular basis so it's important to be sure our staff is up to date on their usage."
"How often do you hold these practise sessions?" asked Patrick.
"We'll run two more drills today," the doctor answered, "with teams from each of our other two shifts, and we schedule these sessions once a quarter. When new guidelines are released we add an additional drill to ensure we are up to speed with the changes."
Shelagh spoke up, "The efficiency is impressive; with such a standardised, straightforward procedure not a moment of precious time is lost."
"Indeed," Dr Dale agreed, "Our goal is an expert response team with good communication to ensure a positive outcome."
Patrick and Shelagh shared a look of hopeful anticipation.
"I wonder," Patrick asked, "if I might bring my son back tomorrow to photograph the toolkits?"
"I think that can definitely be arranged," Dr Dale said with a smile. "Now let's get some lunch and we can go over the details of how best you can share this information with your National Health System," the doctor gestured to the door and led them out of the delivery room and up the corridor in the direction of the hospital cafeteria.
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Later that afternoon, Patrick pulled up to the kerb in front of the Bartlett's house as Timothy came down off the stoop to greet them, looking a bit strained. Seeing their excited faces as he approached the Chevrolet, he opened Shelagh's door for her.
"Hello Timothy! We've had the most thrilling day," she began, hurrying past him to find Teddy and Angela inside. "Your father will tell you all about it!"
Patrick stepped out of the car and quickly briefed Tim on the day's activity. "And tomorrow," he continued, "I'm taking you with me to photograph the trolleys and their contents so we can take the information home visually."
Tim looked relieved, "That's brilliant! To tell you the truth, it's getting exhausting being around here."
"Exhausting?" Patrick was confused.
"The older girls are completely obsessed with The Beatles," Tim explained, rolling his eyes, "they're constantly asking me questions about them and then giggling over my accent." Tim shook his head.
"It's the burden of the Turner charm, son," Patrick laughed, reaching out to ruffle the boy's hair.
Tim, however, was too fast for him and ducked out of the way. As he ran up the steps and into the house he warned, "Just don't tell them you're from Liverpool, Dad. You'll never make it out alive!"