I slipped my darkblue jacket off, shoved it into the narrow locker and snapped the latch shut. The staff room smelled of cheap washing powder and a hint of bleach drifting in from the next bathroom. My shift was due to start at nine oclock, but Id arrived a little early so I could change without hurrying and take a sip of the strong black tea Id brought in a thermos. The bitter aftertaste told me the night would be long. I smoothed the white blouse under my coat, slipped a pair of rubber gloves into my pocket and stepped out into the corridor of the highdependency ward.
The hallway was lit by a dim glow from the overhead lamps, the soft clatter of a portering trolley echoing off the walls. Beyond the long window, the lateautumn darkness pressed in; a few street lamps flickered over a crust of frozen snow on the courtyard. I nodded to the dayshift nurse, who handed me a folder of patient orders, the contact details of the oncall anaesthetist and an oldfashioned pager. Three patients for the night, all critical: check blood pressure, monitor IV lines, listen to lungs and, above all, keep everyone stable.
In Bay 6 lay Andrew Egerton, seventyeight, with terminal stomach cancer, an opioid pump, his face waxen. The monitor traced a fragile pulse, oxygen saturation hovering around eightyfour percent. I moistened his lips, adjusted his pillow and checked the timing of his next morphine dose the pain had to stay under control even through the night. His breaths grew a touch softer, though a harsh wheeze still rattled between his ribs.
A bay down the corridor, the cardiac monitor of a young man Nick Pritchard, twentyfive flickered. Hed been brought in after a roadtraffic collision. Pelvic fractures, a bruised lung and internal fixation. A catheter was attached to a drainage bag, colloids sat on the bedside tray. I made sure his urine container wasnt full and heard him whisper:
How long have I been here?
Two days now. Everythings proceeding as planned, just keep breathing calmly, I replied evenly. He closed his eyes and the dayshift nurse moved on.
Next was Sarah Whitby, fortythree, who had just survived a suicide attempt a packet of sleeping pills and deep despair. Her stomach was washed out, consciousness hazy, fresh pink bruises on her wrists. She thrashed beneath the blanket, trying to pull it off.
Sarah, Im right here, I said, offering a cotton ball damp with water. Your mouth must be dry; lets moisten it. Her glassy stare stared at the ceiling, a flash of how much pain shed endured to reach for those tablets passing through my mind.
It was twentythree past fifteen minutes past the hour. I logged the first observations: temperature, blood pressure, drip rate. A cough grew louder from the old mans bay. I raised the head of his bed, connected an aspirator and then fitted oxygen spectacles. The wheeze lessened, but his fingers stayed cold and bluish.
I hadnt stepped out before Nicks monitor shrieked: saturation seventynine, blood pressure dropping. He had rolled onto his side and kinked his oxygen tube; the drainage line had tugged, leaving a dark stain on the sheet. I repositioned him, pressed gauze to the leak, swapped the fluid bottle and reset the parameters. The frontline alarms blared on three monitors, while the hallway outside stayed quiet.
Midnight found me still writing Sarahs chart: two children, a divorce in August, no prior attempts. She asked to use the bathroom and then began to sob quietly. I helped her, gave her diazepam and dimmed the lights. The deep part of the shift was starting thoughts stretched, my legs felt like lead.
At one oclock the radiators gave off a thin metallic hum, frost edging the windowsill. The night nurse made her rounds old man trauma suicide changing urine containers, wetting lips, checking dosages. The oncall doctor dropped by once, glanced at the charts, then went back upstairs: a stroke on another floor. The ward ran on the green lines of the monitors and the occasional sip of cooled tea.
Three fortytwo brought a simultaneous storm: Sarahs hoarse cry, a VTAC alarm on Nicks monitor, a deep moan from the old man. I slammed the general call button, the pager sprang to life. Time narrowed to a thin slit that had to hold three lives at once.
Rushing to Nick, I found his pulse at oneforty and his blood pressure collapsing. Defibrillation was on standby, but I chose medication first. In the corridor a cupboard toppled Sarah had jerked her IV line loose. The old mans wheeze grew fainter. I pressed the red emergency button, the wards lights flashed, and, clutching the keycard for the drug cupboard, I realised there was no going back to the calm before.
The alarm still pulsed when two members of the resuscitation team an anaesthetist and a paramedic with a kit sprinted to my post. I gave a brief rundown and followed them to Nick, already drawing a dopamine ampoule.
Inside, the monitor danced red and green, but the rhythm remained organized. While the paramedic placed an extra catheter, I pressed gauze to the leak and handed the doctor a syringe. Onefifty on forty, I reported. Within a minute the jagged lines on the screen smoothed out. He would pull through.
The pager vibrated: the porter was struggling with Sarah. I handed the observation over to the paramedic and hurried to the third bay. The woman stood barefoot by the window, clutching a cracked bottle of saline.
Sarah, look at me, I said, moving slowly, no sudden gestures. Youre safe here, no ones judging you. The plastic bottle dropped onto the linoleum, and Sarah broke down in tears. I helped her lie down, applied fresh soft dressings, gave a minimal dose of diazepam and called the oncall psychiatrist: an inperson assessment in the morning and continuous observation.
Only then did I return to Andrew Egerton. His wheeze thickened, saturation fell to sixtythree. Morphine was still working, but the furrowed brow told me pain lingered. I gave a bolus, sat on a stool and felt his cold hand. The corridor siren had already faded, replaced by hushed commands, and a heavy quiet settled over the ward. The old man took two interrupted breaths and then was still. Time of death four zero five. I switched off the oxygen and pulled the sheet up to his chin.
The paramedic entered, helped disconnect the equipment and left to complete the paperwork. Patient stabilized, patient retained, patient passed without a scream, I thought, summarising the night in my mind.
Almost five oclock, the pale sky began to glow with the first blue of dawn. I collected used gloves, flushed Nicks drain, changed the bloodstained sheet. He was breathing more evenly.
Stable. Well get a scan in the morning and, if all looks good, transfer him to the general ward, I told him. He gave a barely perceptible nod.
Sarahs breathing steadied. I placed a folding chair by her bedside the porter would stay on duty. I entered in the notes: High risk of selfharm, 24hour observation, psychologist consult, safety plan in place.
Half past six, the oncall doctor descended again, this time without rush. I handed over the oral report and the procedure log. He checked the timeofdeath entry, nodded and signed the forms.
At eight, the dayshift nurse and the cleaning attendant arrived. I showed them the fresh bandages on Nick, the analgesic schedule and the monitoring plan for Sarah. Then they cleared the old mans bay, closed his eyes and prepared the body for transfer.
The computer rows filled with trembling fingers: Sarah Whitby conscious, denies negative thoughts; Nick Pritchard haemodynamics stabilised; Andrew Egerton deceased, pain managed. I added at the end: Nursing observation fully provided and clicked Save.
The staff room still smelled of the same powder, but now it buzzed with morning chatter. The night nurse slipped off her coat, fastened her jacket and set the pager on its charger the long beep sounded like a farewell.
Outside, a light dusting of snow filled the gaps between the cobbles. I inhaled the chilly air, feeling the breath escape my lungs, and smiled despite myself. In my pocket a spare tea bag rustled for the next shift. Cars hurried past, and I allowed myself a halfminute of peace before stepping toward the bus stop. The night was over, and I had made it through.
