‘Thanks, Greg.’ Greg was the consultant in charge of the A&E unit where she worked, and her patient would most likely be taken into his care, unless the situation was worse than it first appeared, in which case he might have to be transferred to Inverness. ‘You’re right. I’m about a mile away from the gorge. I’ll head straight over there.’
Izzy drove as fast as she dared, barely able to take in the wonderful scenery in this part of the Highlands. She had left Lorna back in the A&E unit. It suited Izzy to work this way—spending some of the week in the hospital setting, and the rest out and about as a first responder.
This whole area was one of outstanding natural beauty, with hills and mountains all around, thickly wooded with natural species of rowan, alder, hazel and birch. To her left, she caught glimpses of the river as it flowed downhill, disappearing every now and then as woodland obscured the view.
Before too long she came across the road junction where she had to turn off towards the falls—a place of wonder for everyone who came to visit the area. There was a narrow road leading to a car park, and from there she hoped she would be able to find the injured man without too much difficulty.
She parked the car as close as she could to the bridge, a viewpoint where people could stand and marvel at the chasm that had been carved out by glacial melt-water aeons before, and where a majestic waterfall surged downwards to the valley below. From there the water cascaded over boulders and tumbled on its course towards the sea.
The man had been carried to a small viewing platform, Izzy discovered, and as she approached she could see straight away that he was in a lot of pain and discomfort.
‘Hello, Jim…and Frances,’ she said, introducing herself to the patient and his wife. ‘I’m Dr McKinnon.’ She knelt down beside the man, who was sitting propped up against the metal guard-rail. ‘The ambulance is on its way, but I’ll take a look at you and see what I can do to make you more comfortable in the meantime, if I may?’
Jim nodded. He tried to speak, but he was struggling to get his breath, and Izzy could see that there was a film of sweat on his brow. He looked anxious, his features strained and desperate, as was the case with many seriously ill people that Izzy had come across.
‘I can see that your ankle is swollen and your shoulder appears to be dislocated,’ she said. ‘Do you have pain anywhere else?’
Jim used his good arm to slope a finger towards his chest. ‘Hurts to…breathe,’ he said.
‘The pain came on before he fell,’ his wife put in. ‘He started to cough, and then it seemed as though he was going to pass out. Is it his heart, do you think?’
‘I’ll listen to his chest and see if I can find out what’s going on,’ Izzy said. ‘Have you had any heart problems before this, Jim?’
He shook his head and she gave her patient a reassuring smile. ‘Try not to worry,’ she said. ‘We’ll sort it all out. For now, I’m going to give you oxygen to help you to breathe, and I’ll give you an injection to ease the pain.’
Izzy placed the oxygen mask over his mouth and nose and checked that the flow of oxygen was adequate. Then she listened carefully to his chest.
‘Did you have any other symptoms before the chest pain?’ she asked. ‘Even up to a day or so before?’
Jim frowned, trying to think about that, but his pain was obviously getting the better of him, and as he started to shake his head once more his wife put in, ‘He said his leg was sore. Apart from that he was fine. We’ve just come back from a trip to New Zealand. This was a final weekend break before we go back home and start getting ready for Christmas.’
‘Hmm.’ Izzy was thoughtful. ‘We need to do tests to be certain what’s causing your problems, Jim, but it could be that a blood clot is blocking the circulation to your lungs. I’m going to give you medication to stop any clots forming and ease the blood flow, and then we’ll concentrate on getting you to hospital as soon as possible.’
Izzy set up an intravenous line so that she could give him anticoagulant and painkilling medication as necessary. Then she moved away from the couple momentarily, to use her mobile phone and call the ambulance services.
‘How long is the ambulance likely to be?’ she asked. ‘I need to have this patient transported urgently to hospital. I think he may be suffering from a pulmonary embolism, and I don’t believe we have any time to lose.’
‘Okay. Leave it with us,’ the controller said. ‘There’s a problem with the ambulance, but we’ll get someone to you as soon as possible.’
Izzy turned back to her patient and contemplated his other injuries. ‘I’m pretty sure your ankle is broken,’ she told him, ‘so I’ll immobilise that in a splint. As to the shoulder, the same thing applies. I’ll secure it for you in the most comfortable position, and then the hospital team will put it back in place for you while you’re under anaesthetic.’
She worked quickly to do that, all the while looking out for the ambulance. Her patient was most likely suffering from a blood clot that had passed from his leg to his lung, and she was conscious that if it was not treated quickly his life could be at risk.
‘How are you feeling now?’ she asked him.
‘It’s better now that the pain has gone,’ he said, but she could see that he was still struggling to breathe. She glanced around, but there was still no sign of the ambulance. Her gaze rested momentarily on the majestic scenery of the gorge. Trees and ferns sprang from clefts and fissures in the rock, and above everything was the gentle sound of rushing water. It was such a glorious, peaceful scene that it seemed incongruous that she was here trying to save someone’s life.
Then came a humming sound from overhead, like the drone of insects coming ever closer, until at last the noise was all around and an air ambulance helicopter hovered, preparing to land, its rotors spinning, fanning the air like giant flapping wings.
‘Is that for us?’ Frances asked, and Izzy nodded. ‘It looks that way.’ She glanced at Jim. ‘They’ll take you to Inverness,’ she told him. ‘At least with the helicopter you should be there within minutes.’
The helicopter came to rest some distance away, on a flat stretch of ground near to the car park, and a medic jumped down, followed by a paramedic. Between them they wheeled a trolley towards Izzy and her patient, and as she watched them draw near she made a sudden, swift intake of breath.
Surely that was Ross in the medic’s uniform? What was he doing here? Of course she knew that he had trained as a doctor, but his work had always been in the Lake District. This had to be new, this job working with the air ambulance.
As he approached she did her best to get over the shock and try to recover her professionalism. Her patient must come first. Any questions she might want to fire at him could surely be answered later?
‘Hello, how are you doing?’ Ross said, coming over to the group assembled on the viewing platform and checking on the patient. He glanced at Izzy. ‘Hi,’ he said. ‘Ambulance control told me you were the doctor on call.’ Then he concentrated his attention on the patient once more. ‘You collapsed, I understand, and injured yourself?’
Jim nodded, unable to speak just then, and Izzy began to explain the situation. ‘He has severe chest pain and difficulty breathing, as well as a broken ankle and dislocated shoulder.’ She went on to outline her diagnosis and explain what medication she had given him. ‘He’ll need to go for an urgent angiography, and I suspect he’ll require thrombolytic therapy in order to break down any clot that’s formed.’
He nodded. ‘I’ll alert Radiology back at Inverness. They have all the facilities there. And I’ll notify the cardiovascular surgeon to be on hand to perform the surgery if necessary.’
All the time they were talking, they were breaking off to reassure Jim that