The Director of Nursing smiles and shakes my hand in welcome. She’s younger than I, taller and wider. I’m drawn to her bucktoothed grin and her informal look. ‘You’ve arrived at a sensitive time’, she says. ‘The body of a young woman who died a few months ago returned on the same plane as yours. She was very young, eighteen years, and she died here, suddenly, of unsuspected heart disease. It was a coroner’s case of course. Now she’s back, the community will all view the body this afternoon. Some here – only a few – blame the hospital. Best keep well clear of the mortuary today.’ The boss sweeps her hand, indicating the morgue. It stands directly on the path between my quarters and the hospital. On arrival I noted with distaste the sturdy steel mesh that encloses the doctors’ house. Protection of that order speaks of past violence.
I start work in Emergency. ‘Hello, my name’s Howard. What’s yours?’
The woman looks up from her phone. She gives me that information without warmth.
‘How can I help you?’
‘He’s sick.’ The woman indicates the chubby baby stretched out on her shoulder, asleep.
I ask for details.
‘He’s been sick for a week, coughing.’
I touch the child. His face burns.
I lift the shirt: the round tummy rises and falls fast, with rib muscles sucked in with every inbreath.
Nurses attach a metallic clasp to a little finger. Numbers appear on a screen: his oxygen saturation is normal at 98 percent, but he’s working hard to maintain it.
‘Has he been drinking normally today?’
‘What?’ – head bent over the phone.
‘Has he taken fluids normally?’
‘Can you give me an idea how much?’
‘He doesn’t want to drink.’ – defiantly.
‘Has he had any medicine for the fever?’
A shrug: ‘We ran out.’
‘Has he wet nappies normally today?
I suppose so – somewhat grumpily, as if questions were accusations.
I ask a nurse to give the baby some Panadol.
I pull out my stethoscope and retreat to the baby’s chest. I can’t hear much, none of the squeaking or rattling that might give answers.
I draw a breath.
More figures appear on the screen. The baby – I learn from his chart his name’s Oscar and he’s fifteen months old – breathes too fast and his heart is beating too fast. I don’t know how long he’s battled like this or how long he can keep it up. And I don’t know what’s wrong. I don’t have enough information. Oscar and I have been together for fifteen minutes and I’ve haven’t heard a cough. A cough itself would be information. Mother is a woman in her thirties. Her manner is combative, she doesn’t waste her smiles, she’s thrifty with eye contact.
‘Has Oscar ever had breathing problems before?’
‘Has he ever been treated for bronchiolitis? Or croup?’
‘He always gets bronchiolitis. He was flown out just a month ago. Still not better.’
‘Flown out’ would have been to the regional hospital, six hours drive and eight thousand dollars’ flight away. If this is bronchiolitis again, why can’t I hear the fine rustling crepitations in his chest? I decide to treat Oscar with a steroid, which can be helpful in his age group. But the steroid won’t work quickly and Oscar needs help now. We set up an asthma pump to deliver a mist of molecules that might open up narrowed breathing tubes.
We apply a mask to Oscar’s face.
‘No!’ – says Mum, pulling it away – ‘He doesn’t like it.’
Instead Oscar’s mother holds the mask at a close remove. The mist drifts to his face and he breathes surrounded by a white cloud of medicated mist that drifts uselessly away.
At this distance any benefit he’ll receive will vary inversely as the square of the distance between mask and face. In other words, the treatment is sabotaged and I’m worried. I know this, but to share this knowledge will require a collision of wills, a struggle for authority. Wondering what experience with doctors or hospitals has created Oscar’s mother’s mistrust, I apply the stethoscope again. This time I’m able to hear sounds, moist sounds at the base of Oscar’s left lung. We have an answer: Oscar has pneumonia, dangerous enough in any person, especially so in an Aboriginal child. I order a powerful antibiotic.
An hour passes, two, and Oscar’s breathing remains fast. But his temperature has fallen and his racing heart has slowed. We give him some formula and he drinks it greedily.
I ask Mum would she like a cup of tea.
‘What?’ She looks up from the phone. She’s been playing Patience.
She takes the drink from my hand without words. Oscar remains in his perch, sitting up now and looking around. His hair is dark and wavy, quite beautiful. He has the face of a cherub. But still his chest heaves as he breathes.
The hour is late in the Emergency Department. Baby Oscar sleeps on his mother.
‘I think we should keep you both in hospital until Oscar’s better.’
‘You said he was better an hour ago.’
‘Yes, he is better than he was, but he’s still not breathing easily.’
‘Why didn’t you say so an hour ago?’
A sigh escapes my pursed lips.
Mother accepts our hospitality.
Next morning I’m in the ward checking on Oscar at 6.00. He sleeps and he breathes, lying in the arc of his mother who enfolds him in her sleep. It’s a comforting sight.
I return at 10.00. Both mother and infant sleep on.
At noon mother is up and restless: ‘We’re going home now.’
Oscar sits astride their bed, his face buried in a Vegemite sandwich, an upturned bottle, drained of formula, rests on the bed beside him. Before him on a dish lie the remains of mince and mashed potato. I gather from the cutlery these were his mother’s lunch.
Eating well and drinking well are unspoken testimony. You can’t suck and swallow, chew and swallow, if you’re a baby and you’re too short of breath. Oscar’s temperature and oxygen levels and heart rate have remained normal and stable. But he still breathes fast and still I hear the rustling sound of air moving through infected mucus.
‘We need to wait for an x-ray’, I say.
‘When will that be?’
‘Why not now?’ – belligerently.
‘The x-ray person won’t be here until then’ – placatingly.
At 3.00 the chest x-ray shows opacity where mucus is filling a corner of the lungfield. I show the film to Oscar’s mother: ‘Germs have got into Oscar’s chest there. We’re giving him antibiotics by mouth to kill those germs. He’ll need that medicine twice a day for five days, maybe longer. His next dose is due at 7.00 this evening’.
‘We’re going home.’
‘We can’t make you stay here, but if you go, please be sure to give Oscar his medicine at seven tonight and seven in the morning. It’s very important.’
It occurs to me I haven’t seen Oscar’s mother give him Panadol or his antibiotic. She hasn’t given him bottles or changed a nappy. She stands back and nurses act. This is a mother who has waged war on the nurses who care for Oscar, and against the doctor. Clearly militant towards us, she keeps herself distant from him. Do we make her feel self-conscious? Does she lack confidence? A clever nurse asks, ‘Would you like us to give the medicine this evening?’
Mother nods. She’ll leave the medicine with us for safekeeping.
Seven o’clock comes, but no mother, no Oscar.
At 7.00 next morning, no show. We don’t know Oscar’s whereabouts. His medicine remains uselessly here with us.
We phone mother’s mobile, but there’s no answer.
No answer that evening, none the next morning.
A nurse asks me, ‘Do you think Oscar is at risk?’
As I speak these words I know what they mean. From the time of Oscar’s first, belated arrival three evenings ago I’ve felt a heaviness, a sinking. In advance of any decision I might make, I’ve felt a self-accusation. It falls to me to make Oscar safe, and the legal means is to refer the family to Child Protection. Child Protection is, of course, a heavy instrument and a blunt one. Child protection is the present incarnation of State, the lineal descendant of governments that stole children ‘for their own good.’ That same state massacred people in this district during the 19th and 20th centuries. There’s a weight of history here. Additionally, I realise I don’t like Oscar’s mother. I know those are the reasons I’ve delayed taking action.
I tuck a note beneath the door of my bucktoothed boss: I’m worried about Oscar. I don’t think he’s safe. Can we talk about local resources to help his family? Some informal arrangement?
I return home and prepare for the day, the second-last of this week-long locum placement. Around mid-morning I come across Oscar and his mother in the waiting area. The Police have located her and asked her to come in. I see Mother before she sees me. She’s talking on her phone, while Oscar toddles at free range. I note he’s managing to walk without gasping.
I stand before Oscar’s mother, waiting for her conversation to finish. She looks up and continues talking. I stand quietly for some minutes while the conversation continues. From time to time Mother’s eyes registers me in her face. She speaks to her interlocutor: ‘OK, see you later.’
My turn to speak: ‘Hello, it’s good to see you both.’
A stare, no response.
‘How’s Oscar today?’
‘Alright. He’s still coughing.’
I examine Oscar. He is indeed alright. He’s not hot, his breathing is comfortable and the moist sounds of his pneumonia are quieter.
‘Oscar’s much better, isn’t he?’
‘That’s what I said.’
‘Have you given him his antibiotic medicine this morning?’
‘No. How could I? You had it here.’
‘That’s a worry. We’ve been worried about Oscar. He’s missed all his treatments. That’s not safe.’
‘He’s better. You said so yourself.’
‘Yes, he is better. That’s good… You know we couldn’t find you. We had to send the Police.’
‘No you never. He’s been safe with me.’
‘I’m really happy to see how much better he is. But you promised to bring him back two nights ago and you didn’t.’
‘Not my fault… Family things.’
While a nurse gives Oscar his antibiotic, mother returns to her phone.
The Director of Nursing describes an informal service in the community which provides support to families. A nurse shows parents how to give medicines and how to use a thermometer. The nurse visits in the days after discharge from hospital, and contacts the family every week to chat and quietly keep an eye on a child’s wellbeing.
I like the sound of support and tactful surveillance. I look past the Boss and out her window, out towards the mortuary. The girl who arrived back here when I did, one week ago, died of unsuspected heart disease. Her sorry business continues. The hospital didn’t know how ill she was, the community nurse didn’t know, social supports never knew. My mind comes back to Oscar. He’s making a remarkable recovery on the strength of a single dose of antibiotic, but he’s not yet cured. He’ll need a further X-ray, he’ll need to see specialists at the regional hospital, he’ll need lung scans and breathing tests. He’s likely to need close medical surveillance through his childhood, possibly life-long.
I make my decision. I return to my office and call Child Protection. We speak for a long time. I complete the forms and return to Oscar and his mother. She’s engaged with the phone. I reckon she’s spent most of our numerous hours together face-down and screen-bent. The face rises to me, tightly closed. I speak: ‘I’ve been thinking about Oscar and how to make sure he gets better and he stays better. I think it’s too hard for you and us together to keep him safe. We need help so I’ve notified Child Protection.’
Mother sits up straight: ‘What?’
‘I told them he has breathing problems and it’s too hard for his family to keep him safe without help.’
Mother looks shocked. She summons strength, looks defiant: ‘I’ll talk to Child protection. Don’t you worry. I’ll tell them.’
Her long hard stare seems intended to threaten.
It’s time for me to leave the hospital. I’ll only just manage to catch the plane out. Before we part, I need to join with Oscar’s mother. I tell her my simple truth: ‘You and I want the same thing for Oscar: we both want him to be healthy.’ My simple truth leaves no impression on the wrathful mother. I leave and I fly away, and I cannot know whether I have done Oscar good or ill.