‘Double-glove before you do anything,’ he said tossing an unopened pack of latex gloves onto her lap before reaching into the back for his medical bag. ‘Let’s go,’ he ordered, and, without waiting for a response, was out of the car. Hastily, Kirsty pulled on the gloves and followed.
It all felt surreal to her. The music emanating from the vehicle’s unbroken stereo system was a blast of happy sounds, a sharp, eerie contrast to the moaning and crying voices and the still-spinning wheels of the tilted minibus. Bodies spilled out and lay around, arms and legs twisted at unnatural angles. Still others were slowly extracting themselves from their seats and stumbling, zombie-like, away from the disaster.
Despite the warmth of the African sun on her bare arms, she shivered. For God’s sake, she thought, I’ve been in the country less than four hours and a doctor for not much longer. This can’t possibly be happening.
‘Dr Boucher—Kirsty.’ She became aware of a hand on her arm and looked up into calm blue eyes. ‘I have to phone for help. In the meantime you have to start triaging the casualties.’ He turned from her and opened the boot of his car. He shoved a pile of lines and bags into her unwilling arms. ‘Take this. Once you’ve finished triaging, put in lines where you need to.’ She looked at him, still in shock. He shook her arm impatiently. ‘Look, you can do this. I need you to help me.’ He held her eyes for a few moments, and then with a final shake of her arm he was gone.
Out of the corner of her eye, Kirsty became aware of a small figure stumbling away from the wreck. A child, no older than two, toddled purposefully up the side of the ditch towards the road. It was the impetus she needed to shake her loose from the paralysis that had gripped her in the first dreadful minutes since the crash. ‘Stop! Come back!’ she called out. Tossing the equipment Greg had given her onto the passenger seat, she lunged for the child, grabbing the small bundle seconds before he reached the road. The frightened and bewildered child squirmed in her arms. She looked around at the passengers and, finding a woman who seemed uninjured, thrust her small charge into the woman’s arms.
‘Hold onto him. Don’t let him go. Not even for a second.’ She wasn’t sure if the woman understood her words, but she must have understood her meaning as she engulfed the child in her embrace.
‘Move away from the bus,’ Kirsty instructed her. Still unclear whether the woman understood, she indicated a stretch of ground away from the bus and the road. ‘Bus could explode,’ she added miming an explosion with her arms. Thankfully the woman seemed to grasp enough of the exchange and moved away with her charge.
Kirsty retrieved the equipment Greg had given her and scrambled down the slope to the bus, oblivious to the small stones that scraped her bare legs and feet. The vehicle had come to rest at the bottom of the ditch, its front badly crumpled. The wheels on the driver’s side had mounted a small hillock and the bus tilted precariously over to the left. The driver had been thrown through the windscreen and hung there like a casually tossed rag doll. Kirsty reached up and felt for a carotid pulse. As she suspected, the driver was dead.
Moving around the front of the bus, she attempted to open the passenger door. Unfortunately the angle of the bus prevented her from opening it more than a few inches. Through the narrow gap, she could see that there were two more people in the front seat—an elderly man, who was conscious and moaning with pain, and a young woman, who was crying but seemed uninjured. She recalled her training. It’s the quiet ones you have to worry about. With these words ringing in her head, she decided that both casualties could wait until she had assessed the rest. ‘You are going to be fine,’ she said softly. ‘I’ll be back as soon as I can. In the meantime, try not to move.’ With a final reassuring smile she left them and went to check up on the remainder of the passengers. Despite her initial impression, most of them seemed relatively unhurt, apart from possible fractures, lacerations and shock. They too could wait. ‘I’ll be back in a minute,’ she promised the frightened and shocked figures. ‘Those that can, move away from the bus. The rest of you, keep as still as you can.’
Leaving them she found Greg bent over a young man in his early twenties, doing chest compressions. He had been joined by a middle-aged woman who, apart from a few cuts and bruises, seemed to have escaped from the minibus unscathed.
‘This is Sister Matabele,’ Dr du Toit said tersely, barely glancing at Kirsty ‘She was on her way to work in a taxi when the accident happened. She’ll help me here. You carry on treating the rest of the casualties. The paramedics should be here shortly.’
Before Kirsty had a chance to move, a voice called urgently. ‘Help! Over here!’
She hurried over to where a man was cradling a woman on the ground a short distance from the wreckage. She bent over the woman who was lying pale and unconscious. ‘My wife—she needs help. She was awake until just now. Now she is asleep. She is bleeding very badly from her leg, I think.’
Kirsty checked that the woman’s breathing was unrestricted before examining her. Her pulse was rapid and weak. The heart was still beating, but only just. Swallowing her fear, she removed the T-shirt the woman’s husband had laid over the wound. Gently lifting the fabric, she revealed a hole the side of a child’s fist at the top of her leg. Bright red femoral blood pulsed onto the ground.
Once again Kirsty felt the rising paralysis of her fear. Keep calm, she told herself. You’ve dealt with worse than this before. But that had been in the controlled environment of a large inner-city A and E department with the latest equipment and a team of experienced doctors and nurses. Nothing could have prepared her for this. She looked over for Dr du Toit, but he was still bent over his patient. For the time being she was on her own. These two people were depending on her. She needed to stop the bleeding, and soon. She placed her hand over the wound and pressed down hard. Her hand wasn’t enough to stem the gushing flow of blood. She needed something bigger. A quick glance around told her there was only one option. Taking a deep breath to calm her shaking hands and to steady her voice, she slipped off her linen blouse, placing it onto the hole in the woman’s leg. ‘Hold this. Press down hard,’ she instructed the frightened man, taking his hand in hers to demonstrate exactly what she wanted him to do. Kirsty knew if the woman were to stand a chance, she would have to replace the blood she had lost with fluid as quickly as possible. Kirsty used one of the lines she had been given and, ripping off the protective cover from the needle with her teeth, slipped the needle into a vein in the arm. Bingo! she thought with some satisfaction as she hit the vein first time. ‘What’s your wife’s name?’ she asked the distraught man.
‘Maria. Is she going to be all right?’ Kirsty heard the fear in his voice. She smiled and kept her voice low and calm. ‘I’m sure she will be,’ she said, although she wasn’t sure at all. ‘Talk to her. Let you know that you’re here. Reassure her.’
As she worked on her patient, she felt a shadow fall on her shoulders. She glanced up to find Greg looking down at her. ‘Are you OK?’ he asked from what seemed to be a great distance. ‘Do you need any help? My patient is breathing by himself now. Thank God Sister Matabele was here to help. She’ll stay with him until the ambulances arrive.’
‘This is Maria. She has a ruptured femoral artery. I’ve applied pressure and got a drip going. Her pulse and blood pressure are up, but we need to get her to hospital stat.’
Greg examined the woman briefly but expertly. ‘She’s doing fine for the time being. Good work,’ he said warmly. ‘I’ll carry on assessing the rest. I’ll let you know if I need you. But first…’
Kirsty felt him wrap something around her shoulders. ‘Apart from the obvious distractions of a half-naked woman, you’ll get sunburnt unless you cover up.’ He smiled down at her and despite the situation, Kirsty could have sworn she saw a wicked twinkle in his eyes. Suddenly very aware that she was dressed only in her bra and skirt, the colour rose in her cheeks. Quickly she slipped her arms into the shirt. She needed to roll up the sleeves several times and it came well below the hem of her skirt. Her day was going from bad to worse. Now she was dressed