‘Where does this one come in the priority list?’ Nick asked, jerking his head towards the Fiesta.
The top at the moment. The other guy’s grim but, like I said we’re holding him for the minute, and we’ve got two fatalities, but this lady’s going to join them if you can’t do something soon.’
‘I’ll go in,’ Sally said. ‘You can pass me the things I need.’
She hated small spaces, but there were times when you just had to forget about things like that. She squirmed through the narrow opening left by the bent roof, and laid her hand on the lady’s shoulder.
She moaned and turned her head towards Sally, but she couldn’t speak.
‘It’s all right, I’m going to help you,’ Sally said with a quick squeeze to her shoulder. Talking softly to reassure her patient, she rapidly checked her symptoms.
The woman had distended jugular veins, which meant that the blood vessels in her chest were being compressed and causing a build-up of pressure. Her chest seemed distended on the left side, although it moved less when she breathed in and out, and she was restless and her pulse was rapid. The picture was consistent with a lung leaking air into the chest and collapsing the lungs—rapidly fatal if left untreated.
Sally turned her head and reported to Nick. ‘I think it is a tension pneumothorax,’ she said. ‘The signs all fit. She’s looking pretty rough.’ She ran through the symptoms and he nodded.
‘Certainly sounds like it. Can you get enough access to do a decompression?’
She looked at the woman’s chest. The simple answer was no, but the simple answer meant that she’d die. ‘Yes, I can do it,’ she said firmly. If she could just get the needle in at the right angle …
‘OK. I’ll talk you through it. Find the second or fourth intercostal space, and insert the needle along the upper border of the rib. Don’t go below it, you’ll get the artery and nerve. I’ll hand you the needle and a wipe now.’
‘Pass me scissors first, her blouse is in the way,’ she said, and, taking them, she sliced away the clothes over the woman’s collar-bone and then handed them back. ‘Right, let’s have a wipe and the needle.’
He talked her through it, and seconds later there was a little pop, and a rush of air through the end of the cannula.
‘OK, can you slide the catheter in now and take the needle out?’ he asked, and when she’d done that and had checked it was still venting, she taped it in place and wriggled back out.
‘She’s looking better,’ she said, ‘but she needs to come out of there fast. I don’t think I can do anything else in there, the space is too tight.’
Nick nodded, and hailed the fire brigade officer who was in charge of freeing the casualties. ‘We need to get this lady out fast.’
‘Give me ten more minutes and we’ll be with you. Can she last that long?’
Sally shrugged. ‘I hope so.’
‘We need to reassess the others,’ Nick said briskly. ‘Status can change very rapidly under these conditions.’
Just then they were hailed by the paramedic working on the person with the trapped and bleeding leg, and they had no choice but to leave their lady with the pneumothorax. With a last glance over her shoulder, Sally followed Nick and found herself down in the passenger footwell of the BMW, applying a compression bandage to the lacerated limb to try and prevent any further blood loss while the fire brigade worked on the bulkhead with the air cutters.
It was only a few moments before he was released, and then Nick left the other casualties he was treating and came over to supervise his extraction from the car and make sure he was stable before he was whisked away to hospital.
Most of the casualties were suffering from cuts and bruises, and some were dealt with on the spot by the ambulance staff and taken to hospital for a routine check-up; others went straight off in the ambulances for treatment of fractures and stitching of lacerations once their condition was known to be stable.
Once the critical patients were dealt with, Nick and Sally turned their attention to the noisy ones—anyone who could make a fuss was going to live at least a few more minutes, and they worked their way through them as rapidly as possible.
The lady with the pneumothorax was freed after half an hour, and they broke off to supervise her removal and dispatch before going back to the less seriously injured.
Finally everyone had been dealt with, and Nick straightened up and stripped off his gloves, scrubbing his face on his shoulder in a weary gesture that tugged at Sally’s heartstrings.
‘Well, at least we didn’t lose anyone else,’ she said softly, and he nodded.
‘I know. Right, we need to get back to the unit. No doubt they’ll be in chaos.’
They stripped off their yellow coats and stashed them in the boot, along with the depleted bags of emergency supplies, and then Nick reversed back out of the wreckage that surrounded them and they drove slowly away, leaving the police to clear the crumpled cars away and get the road open.
‘It’s nearly five again,’ he said to her as they pulled up outside the hospital a short while later.
Sally sighed. ‘I know. Maybe one day I’ll knock off on time.’
‘I shouldn’t hold your breath,’ he said with a chuckle, and she smiled wryly.
‘Don’t worry, I’m not. I wonder if they still need me, or if I can get away?’
Nick cut the engine and looked across at her, then reached out and brushed his knuckles across her cheek. ‘Nobody’s indispensable, Sal,’ he said softly. ‘Why don’t you go home? You look all in.’
She dragged her eyes from his and turned away, reaching blindly for the doorhandle. ‘I’m fine. I want to make sure my pneumothorax lady is OK before I go, if I do nothing else.’
‘OK, but then you go,’ he said firmly.
She made a noncommittal noise and opened the door, climbing out and looking towards the doors. The waiting room was full, no doubt with people who’d been delayed because of the crash and put to the back of the queue. If she stayed, she could help them get through the backlog quicker—
‘No.’
He’d appeared beside her; she glanced up into his face and saw his eyes were filled with gentle understanding. ‘No, what?’ she asked defensively. ‘I’m my own boss, Nick.’
‘You always were,’ he reminded her, and there was a thread of reproach in his voice.
She felt a twinge of guilt, and then reminded herself of the facts. ‘I only refused to move to Manchester with you because our relationship was going nowhere.’
‘Was it? I didn’t know where it was going. I wanted to find out. It was you who didn’t care.’
‘I cared!’ she exclaimed. ‘You told me to forget it, because I wouldn’t drop everything and go with you to the other end of the country! And then, when I tried to contact you, you didn’t bother to ring.’
He paused, his eyes searching. ‘I did try and ring,’ he said quietly. ‘I tried that number you gave me several times. Nobody had ever heard of a Staff Nurse Clarke. I assumed, in the end, that you must have been working for an agency, so I rang all the agencies I could get hold of. None of them had a Sally Clarke registered with them. I didn’t understand. I thought, if it was important enough, you’d ring me again—but you didn’t.’
She looked away, her heart pounding. She didn’t need this conversation—not now, when she was tired and