At that moment, she was saved by the bell. Literally. The sharp insistent peal of the red telephone on Sister’s desk shrilled into their ears.
The emergency telephone: the one which never rang except in critical and life-threatening situations.
Nurse Higgs sped off, Lord Rousay temporarily forgotten, and Kelly followed her, her long and sleepless night shift banished by the rush of adrenalin which always accompanied a crisis. Life in the accident and emergency department was one long series of crises.
When she reached Sister’s office, Nurse Higgs was just replacing the receiver. ‘There’s a child coming in,’ she said succinctly. ‘Aged two. Been savaged on face by a Rottweiler dog. Injuries extend to neck—the ambulance men are querying tissue damage to her airway. They’re trying to intubate her, but there’s swelling, apparently.’
‘Bleep the duty anaesthetist,’ said Kelly quickly. ‘And can you send an experienced nurse into the resuscitation room to make sure the paediatric airway set is open? Did they say how bad the wound is?’
‘No.’
‘Well, when they arrive — ’ But Kelly’s sentence was never finished because at that moment they heard the insistent sound of the ambulance’s siren as it sped to the back entrance of the department.
‘That’s them!’ said Kelly. ‘Come on!’
Kelly ran out to greet it, Nurse Higgs hot on her heels. As soon as the back door was opened, Kelly climbed in, the blood draining from her face as she saw the extent of the child’s injuries. No matter how experienced you were, it never left you—that feeling of helplessness when you saw someone who was terribly injured, especially when you were dealing with a toddler like this one.
The little girl was barely conscious. Shock, Kelly decided. Her breathing was stertorous but steady, and there was an airway in situ.
‘We couldn’t manage to intubate her,’ said the driver, as he helped unhook the intravenous fluid bag from the drip stand before rushing the stretcher into A & E. ‘You’ll need an anaesthetist for that—the tissue is swollen.’
‘He’s on his way,’ said Kelly briefly.
All the way into the department and along the short corridor to the resuscitation cubicle, she quizzed the drivers.
‘What’s her name?’
‘Gemma Jenkins.’
Kelly bent her head and said softly into the child’s ear, ‘Hello, Gemma—I’m Dr Kelly. You’re here in hospital and you’re safe.’
Gemma remained unresponsive. Kelly turned worried eyes to the second ambulance man. ‘When did this happen?’
‘Only a few minutes ago, thank God.’
‘Do we know how?’
The driver’s mouth twisted with distaste. ‘The dog belongs to the mother’s boyfriend. He brought it round after a lunchtime session up the pub, rather the worse for wear. He disappeared into the bedroom with the mother, leaving the child to “play” with the dog.’
Kelly nodded. ‘I see. Do we know where the mother is now?’
‘She’s following behind in a taxi. With the boyfriend.’
Kelly raised her eyebrows. ‘But surely the mother wanted to accompany Gemma?’
‘She’s hysterical.’
‘As well she might be,’ said Kelly grimly.
‘What she wanted,’ said the ambulance driver, in the kind of weary voice which indicated that he had seen too much of the dross of life not to have become a cynic, ‘was to comfort the boyfriend. He’s worried that she’ll press charges.’
Kelly, too, had grown used to the vagaries of human nature: these days she was rarely shocked, but this comment left her momentarily speechless. She shook her head in despair. ‘Come on—let’s get her on to the trolley.’
To Kelly’s intense relief, the anaesthetist arrived and began to intubate the little girl. If he’d been delayed, Kelly could have done it at a pinch but, unless you’d had specialist training, trying to get an airway down a child’s tiny trachea was notoriously difficult, particularly if the area was as swollen as this child’s. The most common mistake was to insert the airway into the oesophagus instead of the trachea.
While the anaesthetist was extending the neck, Nurse Higgs began taking pulse, respiration and blood-pressure recordings, while Kelly gently wiped the blood away from Gemma’s face so that she could see how bad the wound was.
It was bad enough. A great gaping gash which extended jaggedly down the left side of her face, but which had fortunately just missed the eye.
Kelly glanced up at the anaesthetist. ‘How’s her breathing?’
‘Stable. And she’s coming round.’
At least with the child’s condition stabilised the danger of respiratory arrest had been allayed for the time being, thought Kelly, and she turned to Nurse Higgs. ‘She needs suturing. Can you bleep the plastics surgeon?’
‘The plastics?’ queried Nurse Higgs, and the hostility which she had been showing towards Kelly since she had started three weeks ago finally bubbled over. ‘Aren’t you going to do it yourself?’
Kelly frowned with anger at the implied criticism. ‘Nurse Higgs,’ she said quietly, ‘I’m adequate enough at stitching, but not arrogant enough to play God. I’m not sufficiently experienced to do delicate work of this nature—a botch-up here could cost a young child her looks and leave her with an unsightly scar. Now, are you going to bleep the plastics man for me, or am I going to have to do it myself?’
Nurse Higgs’s eyes sparked malicious fire, but she bustled out without another word.
The anaesthetist raised an eyebrow. He was a tall, pale man, infinitely calm like most of his profession. ‘Trouble?’ he queried mildly.
‘Nothing that I can’t deal with,’ Kelly answered resolutely, as she dipped another piece of cotton wool into the saline solution and very gently wiped some dried blood away.
‘Report her,’ he suggested.
Kelly shook her head. ‘I’ll manage,’ she said, and dropped the used piece of cotton wool into the paper bag which hung on the side of the trolley.
They worked in silence, until the glimpse of a blinding white coat out of the corner of her eye told Kelly that the plastics man had arrived, but before she could get a proper look at him, she heard a horribly familiar laconic voice.
‘I’m here to suture.’
Kelly looked up briefly, her eyes flicking to his name-badge. ‘Randall Seton, Surgical Registrar’. His title, Lord Rousay—his still living father holding the title of Lord Seton, which Randall would one day inherit—was of course absent.
She swallowed, and looked down at the child again. ‘I asked for someone from plastics,’ she said. ‘Not a general surgeon.’
He was already taking off his white coat and removing the gold cuff-links from his pristine pinstriped shirt. ‘And there isn’t anyone from plastics available,’ he drawled, ‘so you’ve got the next best thing. Me. Get me a pair of size nine gloves, would you, Staff?’
Staff Nurse Higgs had miraculously appeared by his side, like the genie from the lamp, and was staring up at him like an eager puppy. There was none of her delayed hearing problem in evidence