She set to work, but she was only halfway through her ironing pile when the phone rang.
‘There’s been a surfing accident just a mile from where you are,’ her boss told her. ‘Darren Mayfield, a fourteen-year-old, was knocked unconscious and had to be pulled out of the water. The ambulance has been called, but you’ll probably reach him before it arrives. A nasty head injury, by all accounts.’
‘I’ll leave right away,’ she told him, unplugging the iron and heading for the door. Her medical bag was in the hall, ready for such emergencies, and the rest of her supplies were in the car.
The boy’s level of consciousness was waxing and waning by the time she arrived on the beach. ‘Do you know anything about what happened to him?’ she asked his mother, who was waiting anxiously by his side.
‘He came off his board when one of the big waves hit,’ the woman said, her voice shaky. ‘The board sort of rose up in the air and then crashed down on him. We had to drag him out of the water. There’s a gash on the back of his head and he’s bleeding... He hasn’t come round properly since we brought him to shore.’ Her lips trembled. ‘He keeps being sick, and I thought it was just concussion, but it’s more than that, isn’t it? He should have recovered by now.’
‘I’ll take a look,’ Katie murmured, kneeling down beside the boy. ‘How are you doing, Darren?’ she asked quietly. ‘Can you hear me?’ She waited, and when there was no response she added, ‘Do you know what happened to you?’
He still didn’t answer, and Katie began to make a swift but thorough examination. ‘He’s unconscious,’ she told his mother, after a while. ‘I’m going to put a tube down his throat, and give him oxygen, to help with his breathing, and then I need to stabilise his spine to prevent any more damage being done.’ She carefully put a cervical collar in place, before checking the boy’s heart rate once more. It was worryingly low, and his blood pressure was high, both signs that the pressure within his brain was rising. That didn’t bode well.
Suddenly, Darren’s whole body began to shake, and Katie reached in her medical bag for a syringe.
‘Why’s he doing that?’ his mother asked in a panicked voice. ‘What’s happening to him?’
‘He’s having a seizure,’ Katie answered. It was yet another indication that this boy was in trouble. ‘I’m going to inject him with medication that will help to stop the fit.’
By the time the paramedics arrived, she had put in place an intravenous line so that fluids and any further drugs could be administered swiftly and easily. ‘We need spinal support here,’ she told the men, keeping her voice low so as not to worry the boy’s mother any further. ‘He has a depressed skull fracture, so we need to phone ahead and tell the trauma team what to expect. They’ll most likely need to prepare him for Theatre.’
She spoke to the lead paramedic as they wheeled Darren into the ambulance a few minutes later. ‘I’ll ride along with him in case there are any more complications along the way.’
The paramedic nodded. ‘You go ahead with Mrs Mayfield and sit by him. I’ll call the emergency department and keep them up to date.’
‘Thanks.’
Katie looked at her patient. He was deathly pale and she was deeply concerned for this boy as she sat beside him in the ambulance. She had placed a temporary dressing on the wound at the back of his head, but it was bleeding still, and she was worried about the extent of the damage.
The journey to the hospital seemed to take for ever, though in reality it was probably only about fifteen minutes, and as soon as they pulled into the ambulance bay, Katie was ready to move. The paramedics wheeled Darren towards the main doors.
‘He had another seizure in the ambulance,’ she told the doctor who came out to greet them, ‘so I’ve boosted the anti-convulsive therapy. I’m afraid his blood pressure is high and it looks as though the intracranial pressure is rising.’ Again, she spoke quietly so that the boy’s mother wouldn’t be unduly alarmed, but to her relief a nurse stepped forward and gently took the woman to one side.
‘We’ll get an x-ray just as soon as we’ve managed to stabilise his blood pressure,’ a familiar voice said, and Katie was startled to see Nick appear at the side of the trolley. He was wearing green scrubs that only seemed to emphasise the muscular strength of his long, lean body. Her heart gave a strange little lurch.
He listened attentively to the paramedic’s report and was already checking the patient’s vital signs, scanning the readings on the portable heart monitor that Katie had set up. Then he looked at Katie and gave her a quick smile. ‘Hi,’ he said.
‘Oh… I… somehow I hadn’t expected to see you here.’ Katie’s response was muted, but she recovered herself enough to acknowledge him, and also the paramedics, who were ready to leave on another callout. She was troubled about her patient’s progress, but Nick’s sudden appearance had thrown her way off balance. In the heat of the moment it had completely slipped her mind that he might be on duty.
‘I’m on the late shift today,’ he told her, as if in answer to her unspoken thoughts, as they moved towards the trauma room. His glance ran quickly over her. ‘It’s great to see you again.’
‘Likewise,’ she said, and then tacked on hurriedly, ‘I’d like to stay with Darren to see how he goes, if that’s all right with you?’
‘That’ll be fine.’ By now they had arrived in the resuscitation room and from then on he concentrated his attention on his patient, examining the boy quickly and telling the nurse who was assisting, ‘We’ll monitor blood glucose, renal function, electrolytes. I’ll take blood for testing now and we need to consult urgently with the neurosurgeon. Given the boy’s condition, it’s quite likely he’ll want to put him on mannitol to reduce the intracranial pressure. Ask him to come down to look at him, will you?’
Katie watched him work. He was remarkably efficient, cool, calm, and obviously concerned for this teenager. He didn’t hesitate for an instant, but carried out the necessary procedures with effortless skill, delegating other tasks to members of the team. Then, when the neurosurgeon came to the side of the bed, he spent several minutes talking to him about the boy’s condition.
‘I’ll be ready for him in Theatre in about half an hour,’ the surgeon remarked as he prepared to leave the room. ‘Let me have the CT images as soon as they’re available.’
‘Of course.’ Nick checked Darren’s vital signs once more, and only when he was satisfied that he had done everything possible for the boy did he turn back to Katie.
‘Okay, we’ll take him along to the CT unit. Let’s find out exactly what’s going on here.’
As soon as Darren had been placed on the CT trolley, they went into the annexe to watch the images on the computer screen as the technician began the X-ray. ‘You’re right,’ Nick said, after a few minutes. ‘It’s a depressed fracture, with the bone fragments pushing down on the lining of the brain. There’s a large blood clot causing a build-up of pressure. If we don’t act soon, there’s a risk that the brain will herniate.’
He spoke to the technician. ‘Download the films to the computer in Theatre, will you? Dr Kelso will want to see them.’
The technician nodded, but Nick was already striding out of the annexe towards his patient. ‘We’ll have to get him to Theatre just as soon as we’ve cleaned the wound,’ he told Katie. ‘By that time Mr Kelso should be ready for him.’
They went back to the trauma room and Nick began the process of irrigating the wound while Katie looked on.
‘Okay, that should be clean enough now,’ he said after a while. ‘We’ll start him on antibiotics to prevent any infection,’