The department was busy enough to keep her completely focussed. Fetching and carrying supplies, taking patients to the toilet or supplying bedpans, dealing with vomit containers and spills on the floor. She’d worked here often enough to be familiar with everything she needed to know. Many of the staff recognised her. One nurse looked particularly pleased to see her when she took a fresh linen bag to hang in the main resuscitation area.
‘Kelly! Just the person I need. You know where everything is around here, don’t you?’
‘Pretty much.’
‘Help me sort out this mess?’ The wave indicated a benchtop littered with supplies that hadn’t been put away. ‘We’ve got an MVA victim coming in, and if it’s still looking like this when they arrive, my guts will be someone’s garters.’
It was fun, working under pressure. Handling syringes and bags of saline and packages containing endotracheal tubes. Things that had once been so familiar. Part of the dream Kelly had been well on her way to attaining.
‘Want any sizes smaller than a seven on the tray?’ she asked the nurse. ‘Do you know what’s coming in?’
‘Something major.’
More staff were beginning to assemble in the room.
‘Where’s Radiology?’ someone called. ‘And the surgical reg—is she on her way?’
‘I’d better get out of here,’ Kelly said.
‘No! Look!’
Kelly looked. Cupboard doors were open below the bench, with supplies spilling into a heap on the floor. They encroached over the red line on the floor that was there to keep unnecessary personnel from the area around a patient. Right at the head of the bed, too, where the person responsible for the patient’s airway would be in danger of tripping over them.
Swiftly, Kelly crouched and began to stack the awkward packages back into the cupboards, so focussed on doing it as quickly as possible she barely registered the increasing level of activity behind her.
And then suddenly the double doors were pushed open and controlled chaos ensued.
‘Seventeen-year-old, pushbike versus truck,’ a paramedic informed the receiving doctor. ‘Handlebar of the bike penetrated the left side of his chest. Intubated on scene and decompression attempted for a tension pneumothorax. Oxygen saturation’s currently—’
Kelly was rising slowly to her feet, her back to the bench, and she slid sideways to get out of the way, horrified at being somewhere she had no right to be. Her gaze was none the less fixed on the scene so close to her. The transfer of the patient from the ambulance stretcher to the bed.
‘On the count of three. One…two…three!’
There was a reassessment of all the vital signs, like heart-rate and blood pressure and respiration rate. None of them was looking good. Monitors were being hooked up and requests being called for more equipment and extra personnel. No one had time to notice Kelly, still standing in the corner.
She knew she had to leave. There was no way a nurse’s aide could be any use at all in the kind of life-and-death drama about to be played out in here.
Bags of intravenous fluids were being clipped to overhead hooks. The doctor in charge of the airway was bag-masking the teenage boy, his eyes on the monitor screen that was showing him how much oxygen they were getting into his circulation. He didn’t look happy with the figures he could see.
‘Saturation’s dropping. We’re below ninety percent. And what the hell’s happened to that ECG?’
An electrode had been displaced while moving the boy from the stretcher to the bed. Nursing staff were busy cutting away clothing and hadn’t noticed the lead dangling uselessly, tangled up with the curly cord of the blood pressure cuff.
Without thinking, Kelly stepped forward into a gap, untangled the lead, and clipped the end back to the sticky pad attached beneath the patient’s right collarbone.
‘Thanks.’ The doctor hadn’t taken his eyes off the monitor, and Kelly could see why. The trace now travelling across the screen was erratic, and the unusual shapes of the spiky complexes suggested that this young boy was in imminent danger of a cardiac arrest.
Another doctor had his stethoscope on the less injured side of the chest. Was it proving too hard for one lung to function well enough to sustain life? Was the heart itself badly injured? Or was this boy simply bleeding too badly from internal injuries to make saving his life an impossibility?
Kelly was back in her corner. Transfixed. She could feel the tension rising with every second that ticked relentlessly past. With every command from the emergency department specialists, who were finding it difficult to gain extra IV access and infuse the blood volume that was so desperately needed, judging by the way the blood pressure was continuing to fall.
‘Didn’t someone page Cardiothoracic?’ a doctor snapped. ‘Where the hell are they?’
‘Right here,’ a calm voice responded. ‘What are we dealing with?’
Kelly actually gasped aloud as Tony Grimshaw stepped closer to the bed, pulling on a pair of gloves. Not that there was the slightest danger of being noticed. At the precise moment the surgeon finished speaking, an alarm sounded on a monitor. And then another.
‘VF,’ someone called.
‘No pulse,’ another added.
‘Start CPR.’ The order came from the head of the bed. ‘And charge the defibrillator to three-sixty.’
‘Wait!’ Tony’s hands were on the patient’s chest, lifting a blood-soaked dressing to examine the wound. ‘Have you got a thoracotomy trolley set up?’
‘Yes, I’ll get it.’ An ED registrar leaned closer. ‘You’re thinking tamponade? What about a needle pericardiocentesis first?’
‘Wasting time,’ Tony decreed. ‘We’re either dealing with a cardiac injury or major thoracic blood loss that needs controlling. Can I have some rapid skin preparation, please? We’re not going to attempt full asepsis and draping, but I want everyone in here wearing a mask. And let’s see if we can get a central line in while I’m scrubbing.’
Masks were tugged from the boxes attached to the wall as trolleys were moved and rapid preparation for the major intervention of opening the boy’s chest continued. Kelly grabbed a mask for herself. A perfect disguise—just in case she got noticed when she made her move towards the exit.
Except she couldn’t move. A thoracotomy for penetrating chest trauma topped the list for emergency department drama, and staff who had no more reason to be here than she were now finding excuses to slip into the back of the room to observe. House surgeons, registrars and nursing staff were squeezed into the space behind the red lines, and Kelly was trapped at the back. Able to hear everything, and even find a small window between the shoulders of the people directly in front of her, that afforded a good view of the surgeon if not the procedure.
He now had a hat and mask and gown over the Theatre scrubs he had been wearing on arrival. He seemed unconcerned by his audience. Ready to use an incredibly tense situation as a teaching tool, in fact.
‘I’ll use a “clam shell” approach,’ he told the closest doctors. ‘The one you guys would be using if I wasn’t here.’
‘Yeah…right,’ someone near Kelly muttered. An over-awed medical student, perhaps?
She saw the flash of a scalpel being lifted from the sterile cover of the trolley.
‘Bilateral incisions,’ Tony said. ‘About four centimetres in length, in the fifth intercostal space, mid-axillary line.’
Blood