‘Sorry, sweets, I know this is a bit personal but it could be important. Would you rather just talk to Emily?’
Megan shook her head emphatically but Emily wasn’t offended. Given the choice, Mike would win as far as she was concerned as well.
‘OK. Do you use tampons?’
Emily almost nodded at the line she could see Mike following. Septic shock from ill-advised tampon use was a real possibility here. Appendicitis was also amongst a raft of conditions that could produce severe abdominal symptoms. A ruptured ectopic pregnancy was unlikely to cause the fever but Emily was running through every possibility she could think of. She had a strong impression that they were missing something important.
‘Sharp scratch, Megan, I’m sorry.’ The cannula slid into a vein on the back of the girl’s hand and Emily secured the line and attached a bag of saline as Mike continued his examination and assessment.
Emily held the bag of saline towards Honey. ‘Would you mind holding that for the moment, please?’
‘She’s really sick, isn’t she?’ They could all see that another shivering spell was gripping Megan. She had to stop answering Mike’s questions because her teeth were chattering hard enough to make speech impossible.
‘She’s certainly going to need to go into hospital,’ Emily said carefully. The anxiety levels around this place were quite high enough, without her adding too much. ‘Would you like to come in with her?’
Honey opened her mouth, closed it again and then shook her head in distress. ‘I can’t! We can’t afford to have the cattle loose again.’ With a quick glance at her daughter she lowered her voice. ‘Jim can’t manage by himself and there’s been enough trouble…’
Emily remembered Wetherby Downs’ station manager’s disgust at the state of the shared fence line between the properties. And she remembered something else. A comment about ‘one of the lads’. She also threw a quick glance in Megan’s direction. Wayne had implied that the ‘trouble’ had been some time ago. Around Christmas, which was eight months ago now. Too long for a ruptured ectopic pregnancy to cause the current symptoms. But what about a miscarriage? Maybe Megan’s relationship was ongoing. The girl’s weight was certainly enough to easily conceal a pregnancy for some time.
If her parents were unaware of the possibility then perhaps Megan had reason to want it kept confidential. Perhaps taking her to the hospital unaccompanied by any family members would actually be preferable.
Except that Jim clearly needed some kind of evaluation himself. Mike had had the same thought. He approached Megan’s father after she was settled on the stretcher in the back of the helicopter, having been carried there, single-handedly and rather heroically in Emily’s opinion, by Mike.
‘When did you last see a doctor, Jim?’ he queried casually.
‘He won’t.’ Honey ignored the warning look from her husband. ‘It’s too far for us to try and get into town and the only clinic in the area is held at Gunyamurra.’
That was very close to Wetherby Downs and the station’s population would provide the majority of any patients. The short silence spoke volumes about bad blood between neighbours. Emily broke the uncomfortable pause.
‘Maybe you’ll be able to get in to bring Megan home,’ she suggested. ‘It would be easy to set up an appointment to suit. We’ve got a really good cardiologist who’s just joined the staff and I could help by—’
‘We don’t need your help,’ Jim interrupted gruffly. ‘I’m fine. We can manage by ourselves, thanks. Just look after Megan for us, eh?’
Monitoring the sick teenager kept Emily too occupied to worry about being airborne again in a craft that lacked wings. Her faith in Mike’s ability to get them all back to base safely was absolute, and working with a patient in a helicopter was not so different to being in a fixed-wing aircraft. She still had to deal with engine noise while trying to talk to her patient or listen to breath sounds or get a blood-pressure reading, and to cope with unexpected fluctuations in her balance while reaching for equipment or trying to record observations on the patient record chart.
The first litre of fluid had run through with no improvement in blood pressure. Emily started another bag of normal saline and took another set of vital sign measurements. Megan’s heart and respiration rates were way above normal and her temperature was 39.6 degrees Centigrade, which was worryingly high.
Conversation proved difficult and not just because of the engine noise. Megan seemed even more miserable and withdrawn, possibly because Mike was no longer there to coax or charm. Emily did her best to keep her comfortable and maintained a cheerful, reassuring manner, but trying to win the girl’s confidence and talk to her properly might have to wait until she didn’t have to shout. And when they had more diagnostic tools and tests for assistance.
Charles was waiting in the emergency department of Crocodile Creek Base Hospital as Mike and Emily rolled the stretcher through the doors. Jill Shaw, their director of nursing, stood beside his chair.
‘I’ve set up the resuscitation area,’ she told Emily. ‘Charles offered to stay so I’ve held off calling any other staff in, but they’re only over at the house.’ She smiled. ‘Apart from Cal and Gina, that is. I think they’re still sitting on the beach somewhere.’
‘I’ll stick around,’ Mike offered. ‘I could be useful.’ Mike’s strength was vital, in fact, as they transferred Megan from the stretcher to the bed. The girl’s level of consciousness appeared to have dropped and she groaned loudly and rolled her head from side to side but said nothing in response to Jill’s greeting as the nurse readjusted her oxygen mask and started to remove clothing to change her into a hospital gown.
Charles raised an eyebrow questioningly at Emily.
‘I think we can rule out meningitis,’ Emily told him, ‘and her chest is clear. It’s more than a viral illness, though. Something’s going on abdominally and I’m worried about sepsis. We need to rule out peritonitis or maybe pyelonephritis or pancreatitis. Or possibly an incomplete miscarriage.’
Both of the rather bushy eyebrows that topped Charles’s craggy features rose at the last suggestion.
‘Plan of action?’
‘I’ll get bloods for chemistries. A complete count and coagulation studies from two separate sites. We’ll get a catheter in, get an analysis, do a pregnancy test and start monitoring urine output. I’ll do a pelvic exam and an ultrasound.’ She glanced at the monitor above Megan’s bed which was settling to give continuous readings of her ECG, blood pressure and pulse oximetry. ‘I want to get her blood pressure up a bit as well. I’ll start a dopamine infusion. And we’ll get her on full antibiotic cover as soon as we’ve taken the first bloods.’
‘I can take care of the samples,’ Charles offered. ‘I know my way round a few of those machines in the lab and I’m sure Alix won’t mind if we don’t haul her in at this time of night.’
Megan muttered incoherently and groaned frequently as Mike helped Emily collect the blood samples required. Jill was charting a new set of vital signs and looked up as the tympanic thermometer beeped.
‘Temp’s up to 40.2.’
Emily nodded. ‘We’ll need to cool her down.’ The blood pressure showing on the monitor was also a concern, having dropped a little to 90 over 45. ‘I’ll get that dopamine infusion started.’
Within twenty minutes the medical care Megan was receiving seemed to be helping. Her level of consciousness improved with a drug-induced rise in blood pressure and reduction in her body temperature, and by the time Emily was ready to do a pelvic examination Megan was alert and orientated. She understood Emily’s explanation of what she was about to do.
And she was not happy about it.
‘Why do you want