‘Rick? Mate, can you hear me?’ Kaspar shook the memories off and called out with deliberate cheerfulness as he approached the figure lying on the ground, one eye half-closed and bloodied.
The extent of the blast damage made it almost impossible to recognise the man as Rick, but the man’s build and clothing fitted. There was one way to tell for certain, though. Carefully, Kaspar ripped the man’s shirt sleeve.
A clipper ship stared boldly back.
Rick. But he wasn’t conscious. Pinching the man’s side, Kaspar began a quick examination, surprised when Archie came running up not far behind him. Her intake of breath was the only acknowledgement that the dark shadow was indeed a person.
‘Is it your friend Rick?’
‘Yes. Get a medical crew,’ he instructed.
‘He might have a mobile,’ she suggested hopefully, but Kaspar shook his head.
‘He doesn’t. Claims to hate them. So you’ll just have to hoof it. Can you do that?’
‘Yes.’
‘Good. Tell them to alert the air ambulance and say we’ve got an unresponsive adult male, around fifty, with severe maxillofacial blast injury, including tissue loss of the right eye and nose and unstable maxilla. GCS three and his airway is going to need to be secured immediately.’
She recited it back clearly and competently despite the slight quake in her voice then left. Kaspar turned back to Rick. By the looks of it, the man was mercifully beginning to regain some degree of consciousness.
‘Rick? It’s Kaspar. Can you hear me?’
At least the older guy was making vague groaning noises now, even if he didn’t appear to recognise Kaspar at all. He certainly couldn’t seem to speak, although that was hardly a surprise. Keeping up light, breezy conversation, Kaspar concentrated on the injuries and the potential damage to the man’s airway. If that collapsed, things would spiral downwards pretty damned fast.
Occupied, it felt like it was only minutes later when the helicopter landed and the on-board trauma doctor came racing over.
‘Kaspar Athari.’ The doctor nodded in deference. ‘Your partner said it was you. I’m Tom. What have we got?’
‘Adult male, around fifty years old. Name is Rick.’
‘Rick the food truck guy? You’re sure?’
‘Sure enough.’ Briefly, Kaspar tapped a bold, unusual tattoo on the man’s upper arm. ‘Approximately fifteen minutes ago he was changing a gas bottle on his food truck when it exploded, no witnesses except myself and my skydiving partner but we were too far away to see clearly. He appears to have been projected by the force and hit his face and neck on something, I would guess the vehicle bracket. There’s tissue loss of the right eye and of the nose, unstable maxilla and suspected crushed larynx. Initially unresponsive, he’s now producing sounds in response to verbal stimuli. GCS was three, now four.’
‘And he’s breathing?’
‘For now,’ Kaspar said quietly. ‘But with the soft tissue swelling and oedema there’s still a risk of delayed airway compromise, while haemorrhage from vessels in the open wounds or severe nasal bleeding from complex blood supply could contribute to airway obstruction.’
‘Okay, so the mask is out, given the damage to his face, supraglottic devices are out because of his jaw, and intubation is out because if the blast caused trauma to the larynx and trachea, any further swelling could potentially displace the epiglottis, the vocal cords and the arytenoid cartilage.’
The trauma doctor ran through the list quickly, efficiently. He was pretty good—something Kaspar always liked to see.
‘One more thing,’ Kaspar noted. ‘There’s a possible cervical injury.’
‘One p.m. So we’ve got a high risk of a full stomach after lunch, which means increased risk of regurgitation and aspiration of gastric contents. I could insert a nasogastric tube or I could apply cricoid pressure, but either of those procedures could worsen his larynx and airway injuries.’
At least the guy was thinking.
‘Yes,’ Kaspar agreed slowly, not wanting to step on anyone’s toes. Ultimately, this was the trauma doctor’s scene. He himself might be a surgeon, but today he was a skydiver on his day off. ‘Still, I’m not confident that his airway will hold without intervention.’
‘Can’t intubate, can’t ventilate,’ Tom mused. ‘Which leaves a surgical airway option. Tracheotomy or cricothyroidotomy.’
‘I’d say so,’ Kaspar concurred, thrusting his hands in his pockets to keep from taking over. The doctor was actually good, but Kaspar knew he’d be faster, sharper. It was, after all, his field of expertise.
It was the one thing that gave him value in this world. Every patient. Every procedure. They mattered. As though a part of him imagined that each successful outcome could somehow make up for his unthinking actions that one night with a couple of drunken idiots. As though it could somehow redress the balance. A hundred good deeds, a thousand of them, to make up for that one stupid, costly error of judgement.
But it never would.
Because it hadn’t been merely a mistake. It had been a loss of control. The kind that was all too reminiscent of his volatile father.
The kind that Peter Coates had tried to teach him never to lose.
The memories burned brightly—too brightly—in his head. It must be why he was feeling so disorientated. He’d thought the jump would help, but jumping with that woman had somehow heightened it all.
A familiar anger wound its way inside him. Even now, all these years later. All his awards, his battlefield medals, the way the media lauded him meant nothing.
In many respects he was glad that Archie woman was gone. She was, for some inexplicable reason, far too unsettling. The way she’d looked at him on that plane. As though seeing past the playboy front and believing he would do the right thing and help her.
He couldn’t explain it, but she didn’t look at him the way almost everyone else in his life looked at him. She didn’t look at him as though calculating what being with him would do for her career, or reputation, or fame. In fact, she’d looked at him with eyes so heavy with meaning he hadn’t been able to stop himself from wondering what it was she’d seen. Why she made him feel more exposed than anyone had in long, long time.
It made no sense. And Kaspar hated things not making sense.
Just as he hated the part of him that had wondered whether, when this was over and the patient was safely on board the air ambulance, he might head back to the fete or the hangar and perhaps buy her a coffee. Or a celebratory drink that night.
For the first time in a long time the idea of a date actually made him feel...alive.
‘Want to do the honours?’
Tom’s voice broke into his thoughts.
‘You’re the on-duty trauma doctor.’ Kaspar hesitated, fighting the compulsion to jump straight in, needing to be sure. Not to protect himself but to protect the hospital. He owed them that much. ‘And you’re good.’
‘I am.’ There was nothing boastful about the way the doctor said it. Simply factual. Exactly as Kaspar might have said it. ‘But you’re the oral and maxillofacial specialist, it’s right up your street and this is a particularly