Two kids—a girl and a boy—in their mid-teens were lying on the road. Horns were blaring. Sirens were screaming and lights were flashing. People were screaming and shouting. The police were doing their best to control the scene, but it was nothing short of mayhem given it was smack-bang in the middle of peak hour.
‘Dr Cargill,’ said Jake, calmly but with unmistakable authority. ‘Take Cathy and Tanya and do a primary survey on the girl and tell me what equipment you need. Lei, take Lara and Tim and get started on the boy.’
Kitty started her assessment of the girl who was unconscious. ‘AVPU is P,’ she said. ‘I don’t have an airway.’
‘Get the neck stable and get her intubated,’ Jake ordered.
Kitty felt a flutter of panic rush through her stomach like a rapidly shuffled deck of cards. ‘I can maintain her airway without intubating her out here.’
‘You need to secure the airway and get the rest of the primary survey done now,’ Jake said. ‘We’re not moving her until she’s assessed. Do you want me to intubate her?’
‘No,’ Kitty said, mentally crossing her fingers and her toes. ‘I can manage.’
‘Good,’ he said. ‘Get it done and then give me the primary survey.’ He turned to the registrar. ‘Lei, what’s your assessment?’
‘GCS thirteen, Dr Chandler,’ Lei said. ‘Airway patent, multiple fractured right ribs and a flail segment. Probably right pneumothorax. Pulse one-twenty, BP one hundred on sixty. No external bleeding.’
Kitty kept working on her patient, wishing she were half as confident as the registrar appeared to be.
She tried to focus.
To keep calm.
This was not the time to doubt her skills. She had been trained for this. She had worked on similar cases inside A&E.
Come on, she gave herself a little pep talk. You’ve intubated loads of patients before. Why should this one be any different?
‘Good work, Lei,’ Jake was saying. ‘Is it a tension pneumothorax?’
‘No tension, Dr Chandler,’ Lei said. ‘Fair air entry and no mediastinal shift.’
‘Brilliant,’ Jake said. ‘Get a collar on and do a quick secondary survey. Log roll and check the spine. If that’s all, pack him up onto the spinal board, get in a cannula, get him inside and continue in there.’
‘Will do.’
Kitty could feel the sweat pouring down between her shoulderblades as she tried again to intubate the girl. The sun was burning down like a blowtorch on the top of her scalp. Panic was no longer fluttering in the pit of her stomach; it was flapping like a bedsheet in a hurricane-force wind.
This was not a dummy patient.
This was someone’s daughter, someone’s little girl, someone’s sister and someone’s friend. If this young girl died someone’s life—many people’s lives—would be shattered.
The sun burned even more fiercely and the trickle of sweat down between the straps of her bra became a torrent. Her head started to pound as if a construction site had taken up residence inside. The sunlight was so bright her vision blurred. She blinked and white flashes floated past her eyes like silverfish.
‘What’s the problem?’ Jake asked as he came over.
‘This is not the ideal environment to do an intubation,’ Kitty muttered in frustration. ‘It’s too bright and I can’t see the cords.’
‘Accidents don’t happen in ideal environments, Dr Cargill,’ he said. ‘We’re not moving her until the airway and neck is secured. You stabilise her neck while I intubate.’
Kitty moved aside as Jake came around to the head of the patient and took over the laryngoscope. ‘Hold the head from below,’ he ordered.
She did as he directed and watched as he inserted the laryngoscope. It was genuinely a difficult task, which should have made Kitty feel less of a failure, but it was pretty obvious Jake had had extensive training and was far more experienced at resuscitating on site. Everything he did he did with cool and calm confidence. He kept his emotions in check. Not a muscle on his face showed any sign of personal distress or crisis. He was simply getting on with the job.
‘Listen to the chest, Dr Cargill,’ he said. ‘What’s the air entry?’
Kitty listened to the patient’s chest. ‘There’s no air entry on the right and mediastinal shift to the left.’
‘Get a needle in the chest,’ he said. ‘We can put a chest tube in inside.’ He called out to the nurse. ‘Kate—here. Ventilate the patient while I get the collar back on and get a drip in.’
Finally the patients were transferred inside and taken to ICU once stabilised.
‘Good work, everyone,’ Jake said, stripping off his gloves and tossing them in the bin.
Kitty couldn’t help feeling she didn’t deserve to be included in that statement. She concentrated on washing her hands at the basin, hanging her aching head down, feeling the sweat still sticky beneath her clothes.
‘You too, Dr Cargill,’ Jake said as he reached for some paper towels alongside her basin. ‘That was a tough call.’
Kitty looked up at him. ‘I was out of my depth and you know it,’ she said.
‘You’ll get better once you do EMST,’ he said. ‘It’s all a matter of confidence. The same skills apply inside here or outside there.’
‘I was nearly roasted alive out there,’ she said. ‘It looked like you didn’t even break a sweat.’
His dark blue gaze scanned her flushed face. ‘You look like you caught the sun,’ he said. ‘Your nose is a little pink.’
‘Great,’ she said with a rueful grimace. ‘More freckles.’
‘Kisses from the sun,’ he said. ‘Or so my mother called them when I was a kid.’
‘But you don’t have any freckles.’
The corner of his mouth tipped up and a glint appeared in his eyes. ‘None that you can see.’
Kitty flushed to the roots of her hair but stalwartly held his gaze. ‘I’ll pass on the guided tour, thanks very much,’ she said.
‘I wasn’t offering one.’
His blue eyes played tug-of-war with hers in a moment that vibrated with palpable tension.
‘Sorry to interrupt, Jake,’ Gwen said as she approached. ‘Your brother is here to see you. He’s waiting in Reception. He told me to tell you it’s important.’
Jake’s expression tightened, and then locked down to a blank impenetrable mask. ‘Call me on my mobile if anything urgent comes in,’ he said gruffly to Kitty. ‘I’ll be ten minutes.’
Gwen let out a sigh as Jake disappeared through the entrance to A&E. ‘I wish Jake would tell me what’s going on.’
Kitty frowned. ‘Going on?’
‘With Robbie,’ Gwen said. ‘I can tell Jake’s worried sick about him but he won’t talk about it. I guess he’s used to dealing with his family on his own. God knows he’s been doing it long enough.’
‘What do you mean?’ Kitty asked.
‘Jake’s mother was killed in a car accident when he was sixteen,’ Gwen said. ‘And that’s another thing he won’t talk about. I only heard about it because one of the paramedics who attended the accident worked with my husband in the fire department. A drunk driver hit Jake’s mother head-on. She made it to hospital but died a few hours