‘My name’s Katrina,’ she said, ‘and, although I don’t look like one right now, I’m a doctor, just like Rhys. I’m going to help you feel better, sweetheart. Is that OK?’
He nodded, clearly not having the breath or the energy to speak. Not a good sign, she thought.
‘Now, I’m going to undo the button on your collar to make you feel a bit more comfortable, and then I’m going to tell you a story. Do you like pirates?’
He nodded, and she quickly undid the button, checked his pulse and counted his breathing rate, and palpated his neck muscles to check whether he was using them to help him breathe—which would mean he was really struggling.
‘Rhys, his resps are forty and his pulse is one-thirty,’ she said quietly. ‘Using neck muscles.’
He nodded and she knew he’d got the message. Ben was having a severe asthma attack; his heart rate and breathing rate were both faster than they should be, as she’d expected, but she’d be more worried if his heart rate suddenly dropped.
She began telling a story to Ben while she kept an eye on his respiration and pulse.
‘So how often does Ben take the preventer inhaler, the brown one?’ Rhys asked Ben’s father.
‘I don’t know. Three or four times a week.’
‘And does he have many attacks like this?’ Rhys asked.
‘Not really—once every few months, but not as bad as this. We try to keep him away from cats and pollen, because we know they set his asthma off.’
‘Any other triggers?’
Ben’s father shook his head. ‘Not that we know of.’
‘OK.’ Rhys touched Katrina’s hand and mouthed, ‘Pulse and resps?’
‘Still one-thirty and forty,’ she mouthed back.
But at least her story was keeping the little boy calm, Rhys thought with relief.
The waitress came back with a polystyrene cup and a knife. ‘Is this all right, Dr Morgan?’
‘It’s perfect. Thank you,’ Rhys said.
‘And the ambulance is on its way. It should be here in fifteen minutes.’
‘That’s great. Thanks.’ Rhys smiled at her. ‘Now, what I’m going to do is make a hole in the bottom of this,’ he explained to Ben’s father. ‘It’ll make the medication more effective because he’ll get more medicine into his lungs than he would if he just takes the inhaler on its own.’
A moment later, Ben’s mother hurried across the room to him with the inhaler. Swiftly, Rhys made a hole in the end of the polystyrene cup that was just enough to fit the opening of the inhaler, shook the inhaler and fitted it in place. ‘Ben, bach, I’m going to put the end of the cup over your face and I’m going to ask you to breathe while I count. Can you do that for me?’ he asked.
The little boy nodded.
Rhys gave him one puff of the medication. ‘That’s great, Ben. Slow, deep breath in—that’s it—and out.’ He counted four more slow breaths for the little boy.
‘Shouldn’t you give him more, to get it into him more quickly?’ Ben’s father asked anxiously.
‘No, if you do more than one at a time the droplets of the spray stick together and coat the sides of the spacer, so Ben would get less medicine, not more,’ Katrina explained.
Rhys removed the inhaler, shook it again, fitted it back into the makeshift spacer and repeated the dose of medication.
‘Has he been in hospital before with his asthma?’ Katrina asked.
‘No,’ Ben’s mother replied.
‘So this must be pretty scary for you. They’ll put him on oxygen in the ambulance, and they’ll put a little cap on his finger so they can measure the amount of oxygen in his blood—it won’t hurt him at all, but if you’ve not seen it before it’s worrying to see your child attached to monitors,’ she said. ‘They might need to give him some additional medication, depending on how quickly he responds to this—and they’ll give you an asthma review. If he’s using a reliever inhaler three times a week, as you said, his asthma isn’t properly controlled, and they’ll need to think about giving Ben something different for a preventer inhaler.’
While Katrina talked, she was checking Ben’s pulse. It was still too fast.
‘So you see this thing a lot?’ Ben’s father asked.
Katrina nodded. ‘We both work on the children’s ward. We’ve seen little ones much worse than this pull round, so try not to worry.’
Rhys was still administering medication, though, as Ben wasn’t yet responding, Katrina was very glad he’d called an ambulance.
‘Are you staying here,’ she asked, ‘or are you local?’
‘On holiday—it’s half-term,’ Ben’s mother explained.