Another nurse appeared at the door. ‘We’ve another four trauma cases—two paediatric, two adult and about twelve walking wounded.’
Avery glanced down at his now blood-splattered shirt. At some point he should really change. The radiographer walked back in and stuck the X-ray straight up on the light box, flicking the switch.
It didn’t take a genius to see what was wrong. Both of Mahito’s lungs were deflated. Oxygen wasn’t circulating properly because of the penetrating chest injury. If there was no other choice, he could try to insert chest drains but it was unlikely the lungs could reinflate with the spear still in place. It would be foolish to attempt anything like that now—particularly when he had a theatre and surgeon at his disposal. Avery shook his head. ‘Let’s go, folks. We’re never going to get these lungs to reinflate until we get this spear out of his chest. Someone point me in the direction of the theatre.’
‘Let’s go, people!’ shouted Katsuko. For someone small and perfectly formed her voice had a real air of command. Everyone moved. Monitors were detached from the wall, oxygen canisters pushed under the trolley, a space blanket placed over the patient. Avery kept his eyes on the patient but after a second he looked up. They were all watching him expectantly.
There was something so reassuring about this. And he’d experienced it time and time again in the military. These people didn’t know him. He’d walked into an emergency situation with only a wave of his ID. That was all he’d needed.
From that point on—early or not—he’d been expected to do his job. At first he’d been a bit concerned about the chaos. Now he realised everyone had known what to do, but the rush of blood and age of the child had fazed them all.
‘Everyone ready?’
Eight heads nodded at him. ‘Then, let’s go.’
Hands remained pressed to a variety of areas on the little body. The move along the corridor was rapid. The theatre was on the same floor. The porter at the front of the procession swiped his card and held the doors open. A surgeon strode over and nodded at Avery, not even blinking that they didn’t know each other.
Avery handed over the X-ray. ‘Explosion at a local factory. This is Mahito. I don’t have an age. Penetrating wound to the chest, two collapsed lungs, intubated but sats are poor.’ He nodded at the monitor. ‘Two IV lines, tachycardic at one-sixty and hypotensive. BP seventy over forty-five.’
He frowned. ‘Sorry, didn’t have time to catheterise.’
The surgeon shook his head. ‘My staff will get to that. We’ll take it from here.’
Theatre staff dressed in scrubs surrounded them, one set of hands replacing the others and a stern-looking woman taking over bagging duties from Katsuko. She moved away swiftly. It was the first time he’d actually seen her relinquish control to someone else.
The trolley moved forward, being pushed through another set of swing doors as the surgeon shouted orders.
Just like that.
Mahito was someone else’s responsibility.
Avery looked down at his hands, smeared with blood. The rest of the staff turned and headed back out of the doors.
Katsuko folded her arms and glared at his hands.
‘If you ever come into my ER again and touch a patient without washing your hands and putting on gloves, I will make sure you live to regret it.’
Her accent was odd. It had a lilt. A twang. Part Japanese, part American. Her English was completely and utterly fluent.
‘And as for this...’ She lifted her hand and picked his fedora off his head. He’d completely forgotten about it. ‘Who do you think you are, Indiana Jones?’
He let out a laugh. ‘It’s a pleasure to meet you too. And who said this was your ER?’ He glanced over his shoulder. ‘I was planning on making it mine.’
A spark flashed across her eyes. It was almost as if he’d issued a challenge.
There was a potent silence for a few seconds. Things had been chaotic before. Mahito had been the priority. Now the only noise around them was that of the swinging doors.
She was looking at him. Sizing him up. Did he meet the grade? His curiosity was sparked. What was the grade for the firecracker?
He couldn’t help but start to smile. The air around them had a distinct sense of sizzle.
Despite the chaos of earlier her poker-straight hair had fallen back into place, framing her face perfectly. Those brown eyes could get him into a whole load of trouble. They hadn’t even had a proper introduction yet, but Katsuko was one of the most gorgeous women he’d ever set eyes on. She might be small but she had curves in all the right places. One thing was for sure—if she was only six inches taller she would be on the catwalk.
It was odd. Avery had always gone for blondes—usually leggy. But all of a sudden leggy blondes had flown straight out of his mind.
She crossed her arms over her chest and met his inquisitive gaze. From the determined tilt of her chin it was clear she knew he’d been checking her out.
She plonked his hat back on his head, then turned and walked away, giving him a clear view of her tight, perfectly formed ass. The pale green scrubs looked good on her.
He couldn’t help but laugh.
Shaking his head, he walked after her, stopping at the nearest sink to wash his hands. He didn’t even have time to catch his breath. The siren sounded again and another trolley crashed through the doors from an ambulance outside. This time the patient was an adult. His colour was poor and he was rasping.
The ambulance crew spoke rapidly in Japanese. Katsuko didn’t even blink, she just translated. ‘Thirty-five-year-old also injured in the factory explosion. Bruising across his torso already visible. No penetration wounds. They suspect broken ribs. Poor oxygen saturation. He’s complained of chest pain and he’s tachycardic. Probably tension pneumothorax.’ She bit her lip. ‘First the kid, now the adult.’
She was mirroring his exact thoughts. Two cases of pneuomothorax, each requiring different management.
In their absence, someone had cleared the resus room. Both bays were empty again. Avery grabbed the pink stethoscope that was hanging around Katsuko’s neck. ‘Hey!’ she shouted.
‘Needs must. Haven’t been able to find mine yet.’
As the trolley eased to a halt he listened carefully to both sides of the man’s chest. He waved his hand. ‘Sit him forward so I can check his back.’ Two nursing assistants responded instantly, helping to sit the man forward. The back was clear. No sign of any wounds. The patient was eased back. The shift in the trachea was evident. There was no need for anything else. A pneumothorax was air in the chest cavity. This had probably resulted from a fractured rib puncturing his lung and releasing air into the pleural space. A pneumothorax wasn’t usually life-threatening unless it progressed to a tension pneumothorax, causing compression of the vena cava, reducing cardiac blood flow to the heart and decreasing cardiac output—and that was exactly what had happened here.
A tension pneumothorax could be life-threatening and needed prompt action. The military had collected vast amounts of data regarding tension pneumothorax and subsequent treatment. In a combat setting, tension pneumothorax was the second leading cause of death, and was often preventable. Today Avery was going to make sure it was preventable.
‘Tension pneumothorax.’
Two words were all it took. Packs opened around him. Surgical gloves appeared. He pulled them on and swabbed the skin. Katsuko was speaking into the man’s ear in a low voice. She waved Avery on with a nod of her head.
‘Let’s