Okay. She could work with this. Even in semi-darkness she had what she needed to assess an airway, breathing and circulation and to do her best to handle whatever emergencies needed to be treated to stabilise a critically injured patient. And she wasn’t alone. As the shadowy figures of paramedics surrounding a gurney came rapidly towards them, Charles was already standing at the head of the bed, ready to take on the most important role of managing an airway.
‘Male approximately forty years old,’ one of the paramedics told them. He was wearing wet weather gear but his hair was soaked and he had to wipe away the water that was still trickling into his eyes. ‘Hit by a truck and thrown about thirty feet to land on the hood of an approaching car. GCS of twelve, blood pressure ninety on palp, tachycardic at one-thirty. Major trauma to left arm and leg.’
The man was semi-conscious and clearly in pain. Despite wearing a neck collar and being strapped to a back board, he was trying to move and groaning loudly.
‘On my count,’ Charles directed. ‘One, two...three...’
The patient was smoothly transferred to the bed.
‘I need light here, please,’ Charles said. He leaned close to their patient’s head as someone shone a beam of light in his direction. ‘Can you hear me?’ He seemed to understand the muffled change to the groan coming from beneath an oxygen mask. ‘You’re in hospital, buddy. We’re going to take care of you.’
A nurse was cutting away clothing. Another was wrapping a blood pressure cuff around an arm and a young, resident doctor was swapping the leads from an ambulance monitor to their own. Grace was watching, assessing the injuries that were becoming apparent. A mangled right arm and a huge wound on the left thigh where a snapped femur had probably gone through the skin and then been pulled back again. The heavy blood loss was an immediate priority. She grabbed a wad of dressing material and put it on the wound to apply direct pressure.
‘We need to get back out there,’ the lead paramedic told them. ‘It’s gone crazy. Raining cats and dogs and visibility is almost zero.’
‘How widespread is the power cut?’
‘At least sixteen blocks from what we’ve heard. Lightning strike on a power station, apparently. Nobody knows how long it’s gonna be before it’s back on.’
Charles nodded. ‘Thanks, guys.’ But his attention was on assessing his patient’s breathing. He had crouched to put his line of sight just over head level and Grace knew he was watching the rise and fall of the man’s chest to see whether it was symmetrical. If it wasn’t, it could indicate a collapsed lung or another problem affecting his breathing.
She was also in a direct line for the steady glance and she saw the shift, when Charles was satisfied with chest movement and had taken on board what she was doing to control haemorrhage and his gaze flicked up to meet her own. For a split second, he held the eye contact and there was something in his gaze that made her feel...what? That he had confidence in her abilities? That she was already a part of the team?
That he was pleased to see her again?
Behind that emotional frisson, there was something else, too. An awareness of how different Charles looked. It shouldn’t be a surprise. Thirteen years was a very long time and, even then, they had been young people who were products of their very different backgrounds. But everyone had known that Charles Davenport had the perfect life mapped out for him so why did Grace get the fleeting impression that he looked older than she would have expected? That he had lines in his face that suggested a profound weariness. Sadness, even...
‘Blood pressure eighty on forty.’ The resident looked up at the overhead monitor. ‘And heart rate is one-thirty. Oxygen saturation ninety-four percent.’
‘Is that bleeding under control, Grace?’
‘Almost. I’d like to get a traction splint on asap for definitive control. It’s a mid-shaft femoral fracture.’
Another nod from Charles. ‘As soon as you’ve done that, we need a second line in and more fluids running. And I want an abdominal ultrasound as soon as I’ve intubated. Can someone ring through to Theatre and see what the situation is up there?’
The buzz of activity around the patient picked up pace and the noise level rose so much that Grace barely noticed the arrival of more paramedics and another patient being delivered to the adjoining trauma room, separated only by curtains. Working conditions were difficult, especially when some of the staff members were directed to the new arrival, but they were by no means impossible. Even with the murky half-light when a torch wasn’t being directed at the arm she was working on, Grace managed to get a wide-bore IV line inserted and secured, attaching more fluids to try and stabilise this patient’s blood pressure.
With the airway and breathing secured by intubation and ventilation, Charles was able to step back and oversee everything else being done here. He could also watch what was happening on the neighbouring bed, as the curtain had been pulled halfway open. As Grace picked up the ultrasound transducer and squeezed some jelly onto her patient’s abdomen, she got a glimpse of what was happening next door.
Judging by the spinal board and the neck collar immobilising the Spanish-looking woman, this was the ‘fall down stairs’ patient they had been alerted to. What was more of a surprise was that Charles was already in position at the head of this new patient. And he looked...fresher, somehow. Younger...?
No... Grace blinked. It wasn’t Charles.
And then she remembered. He’d had a twin brother who’d gone to a different medical school. Elijah? And hadn’t their father been the chief of emergency services at a prestigious New York hospital?
This hospital. Of course it was.
Waiting for the image to become readable on her screen as she angled the transducer, Grace allowed herself a moment to think about that. The dynasty was clearly continuing with the Davenport family front and centre in Manhattan Mercy’s ER. Hadn’t there been a younger sister who was expected to go into medicine as well? It wouldn’t surprise her if there was yet another Davenport on the staff here. That was how rich and powerful families worked, wasn’t it—sticking together to become even more powerful?
A beat of something like resentment appeared. Or was it an old disappointment that she’d been so insignificant compared to the importance of family for Charles? That she’d become instantly invisible the moment that scandal had erupted?
Whatever. It was easy to push aside. Part of a past that had absolutely nothing to do with the present. Or the future.
‘We’ve got free fluid in the abdomen and pelvis,’ she announced. ‘Looks like it’s coming from the spleen.’
‘Let’s get him to Theatre,’ Charles ordered. ‘They’ve got power and they’ve been cleared to only take emergencies. He’s stable enough for transfer but he needs a medical escort. Grace, can you go with him, please?’
The metallic sounds of brakes being released and sidebars being raised and locked were almost instant. Grace only had time to ensure that IV lines were safe from snagging before the bed began moving. This was an efficient team who were well used to working together and following the directions of their chief. Even in the thick of what had to be an unusually stressful shift for this department, Grace could feel the respect with which Charles was regarded.
Behind her, as she stayed close to the head of the bed to monitor her patient’s airway and breathing en route to Theatre, Grace could hear Charles moving onto a new task without missing a beat.
‘Any signs of spinal injury, Elijah? Want me to see if the CT lab is clear?’
And then she heard his voice change. ‘Oh, my God... Maria?’
He