Читать книгу Her Emergency Knight - Алисон Робертс - Страница 9

THEY just had to get through the night.

‘That red sunset meant it’ll be a nice day tomorrow, didn’t it?’

‘Should be.’ Guy wasn’t making any promises.

‘Shepherd’s delight,’ Digger said. ‘It’ll be clear.’

Clear skies with the wreck of a light plane glinting in sunshine on an exposed, rocky plateau. If they’d checked south of the great lakes already, they might well send someone looking to the north tomorrow. Maybe the locator beacon wasn’t one of the faulty ones. Rescue would come.

They just had to get through the night. Right now, that seemed an achievable goal. It was cold, certainly, but it didn’t feel dangerously so with the three of them huddled under the tarpaulin.

‘The tussocks were a good idea.’ Guy had used a pocket knife to slice off clumps of the strong mountain grass. It now provided a carpet for the floor of their shelter and insulation from the bone-chilling cold of the rocks beneath. ‘Are you warm enough, Digger?’

‘Feel like a chicken…ready for roasting.’ Digger’s breathing had a wheeze that was becoming steadily more audible, and he was still in enough respiratory distress to necessitate taking a breath after only a few words. ‘Never been wrapped…in foil before.’

‘You thirsty?’ Guy’s voice floated through the intense darkness.

‘Yes. Very.’ The sweetness of the chocolate biscuit had been wonderful, but trying to swallow had made Jennifer realise just how thirsty she was.

‘Actually, I was asking Digger. The snow I collected in this billy has finally melted.’

Jennifer bit back the automatic response that a patient awaiting surgery should be nil by mouth. It would be hours before they got Digger anywhere near an operating theatre. If they even managed to get him that far.

‘Let Jenna have it…’ Digger dragged in another breath. ‘I’m fine.’

‘Here it is, then.’ Guy sounded resigned. ‘I’ll pass it round Digger’s feet. I don’t want to spill cold water on him.’

The foil sheet encasing Digger’s legs crackled as Jennifer felt for direction. She could feel the warmth of Guy’s hand well before she touched it, and she would rather have taken hold of his fingers than the cold metal container they held. There would be more comfort to be found in the touch of another person right now than in assuaging her thirst. She passed the billy back after just a few swallows.

‘Can you pass me the torch?’

‘Why?’

‘I want to check the IV line and that bag of fluid.’

‘I can do that.’ The torch flashed briefly, running from the line in Digger’s arm up to a bag that looked ominously flat. It wasn’t quite empty, or blood would be visible, travelling back up the line, but it was going to run out pretty soon.

‘Have you got the stethoscope on your side?’

‘No.’

‘OK.’ Jennifer’s hands left the protection of the inside of her anorak again and she felt around near Digger’s head.

‘Don’t uncover him for any longer than you have to.’

‘I’m not stupid, Guy.’

‘I’m not doubting your intelligence,’ he responded calmly. ‘But I doubt that you’ve ever spent a night on a mountaintop before. It’s going to get a lot colder than this, and we want to conserve all the heat we can.’

‘Actually, I have spent a night on a mountaintop.’

‘Where? In front of some après-ski open fire? A nicely exclusive resort in the Swiss Alps perhaps?’

‘And you’re an expert?’ He wasn’t so far from the truth, but why did he have to make it sound like she’d committed some kind of crime? Jennifer’s hand curled around the stethoscope but she was now hesitant to expose Digger’s chest to listen to his breath sounds.

‘I know what I’m doing.’

‘He does at that,’ Digger said. ‘We’ve had a few…dodgy nights…here and there.’

‘Thanks to your desire to start a new gold rush.’ Guy sounded as though he was smiling. ‘We must have checked every obscure stream within tramping distance of every equally obscure airfield there is in these parts.’

‘Are you a goldminer, Digger?’

‘Just a…hobby.’

‘Digger’s a man of many talents,’ Guy said quietly. ‘Sheep shearer, rodeo king, deer hunter, top-dressing pilot, tavern manager and more recently a tour guide. He knows this country better than anyone.’

‘Wish I…knew where…the bloody hell…we are…right…now…’

The difficulty he had in speaking had increased markedly. As Digger forced out the last vehement word he made a gagging sound and was suddenly silent.

‘Digger?’ Jennifer twisted onto her knees, her head scraping the canvas above her. She had the earpieces of her stethoscope fitted and was pulling away the covering on Digger’s chest as Guy’s shadow loomed behind the bright beam of the torch.

‘We’ve lost any breath sounds on the left.’

‘Digger?’ Guy was unable to elicit any response. He swore under his breath.

‘Help me unbandage this arm,’ Jennifer directed. ‘And then find a needle. I think that pneumothorax has finally tensioned.’

‘I don’t have a chest decompression needle in this kit.’

‘A 12-gauge cannula will do. And a syringe.’

Unwrapping Digger’s arm from where it was splinting his broken ribs was awkward enough in the cramped conditions. Shifting their patient so he was lying flat took precious seconds and finding the equipment she needed was frustratingly slow.

‘I said a 12-gauge.’

‘Fourteen’s the best I’ve got.’

‘I can’t see a damn thing.’

‘That’s because you’ve got your head in the way.’

The canvas roof moved and Jennifer could hear a rock or two rolling away from anchoring their shelter as Guy moved further towards Digger’s head and pointed the torch straight down.

Jennifer felt the ridges of Digger’s ribs, counting to find the second intercostal space. Then she moved sideways until the needle tip was under the midpoint of the clavicle.

‘OK, here we go.’ She let the needle scrape over the top of the lower rib to avoid the bundle of nerves and veins beneath the higher rib. The pop as the tip pierced tissue over the air space could be heard as well as felt. Escaping air that had been trapped in the chest cavity, crushing the lung, came out in a hiss. ‘Got it,’ Jennifer said in relief. ‘Let me have that syringe and I’ll make sure I aspirate any more air or blood that’s trapped.’

‘What are you going to do with the needle?’

‘I’ll take it out and leave the catheter in situ. We’ll cover it with an occlusive dressing but it may need aspirating again. He needs a tube thoracostomy as soon as possible.’ Jennifer reached for the stethoscope but she could see that the lung was starting to function. The window of broken ribs was showing the disconcerting paradoxical movement again.

‘We’d better get his arm splinting that again.’

‘Hang on just a second.’ Jennifer was positioning the disc of the stethoscope below Digger’s clavicle. ‘I’ll listen to his chest and check his abdomen quickly first. How’s his LOC looking?’’

‘He’s coming round.’

Digger was conscious again by the time they had him propped back up, leaning towards his injured side. He was also in pain.

‘I’ll draw up another dose of morphine,’ Guy decided. ‘Your turn to hold the torch, Jenna.’

‘Sure.’ Jennifer flicked the beam upwards. ‘We need to hang another bag of saline as well.’

Except it wasn’t just another bag. It was the last bag, and it was going to be totally inadequate to replace the blood volume being lost internally if the increasing tension of Digger’s abdomen was anything to go by. With the added stress of lacking oxygen due to respiratory distress, the shocked state Digger was already in would rapidly worsen. It was highly likely to become irreversible. And there wasn’t a damned thing either of them could do about it.

The morphine made Digger a lot more comfortable, but his level of consciousness gradually decreased over the next hour or so. He could speak a little more freely now, but his thoughts were wandering and after a time of bitter self-recrimination for the accident and fatalities Digger seemed to forget where he was.

‘I’ll have a whisky, thanks, Di…Bloody cold tonight, eh?’

‘Sure is.’ Jennifer pulled the folds of the pale blue anorak more tightly around her and drew her knees up to her stomach. ‘What time do you think it is, Guy?’

‘I’ve no idea. I’ll check my watch the next time we use the torch.’

‘Ah…Diana,’ Digger murmured. ‘The goddess.’

‘Who’s he talking about?’ Jennifer whispered.

‘The woman he was in love with for years.’

‘Oh?’ Something in Guy’s tone left a question unanswered.

‘She was also my mother.’

‘Oh.’ Jennifer frowned in the darkness. ‘So, is Digger your father, then?’

‘Closest thing I ever had to one, anyway.’

‘Stepfather?’

‘No.’ The conversation was clearly over and silence fell until Digger’s voice startled them both.

‘Oi! What the hell…do you think you’re doing? Come here, you little bugger…and bring that back!’

‘It’s only us, Digger. Guy…and Jenna. We’re here with you.’ Guy’s voice was reassuring but Digger seemed oblivious.

‘I have to get up at sparrow’s fart…I don’t need some thieving kid…taking off with my smokes…’

‘Smoking’s bad for you, mate. You knew it was time to stop.’

‘Don’t need a snotty-nosed kid…telling me what to do…Just wait till I talk to…your mother…’

‘Did you steal Digger’s cigarettes?’ Jennifer found herself smiling. ‘Were you on a crusade or trying a life of crime?’

‘I was only twelve. A life of crime seemed a good idea at the time.’

Guy was probably in his mid-thirties now, so he had known Digger for a very long time. A father figure. Jennifer remembered the glimpse of anguish she had seen on Guy’s face when he’d first confronted the extent of Digger’s injuries. Now he was lying close to someone he loved, and that person was dying. As if to emphasise her bleak thoughts, Digger mumbled something completely incoherent and lapsed into silence. Jennifer swallowed hard.

‘I’m sorry,’ she said quietly into the darkness a minute or two later.

‘What for?’

‘That I can’t do more to help Digger.’

There was a long hesitation before the response came. ‘Not half as sorry as I am.’

Jennifer shrank a little further into the folds of her anorak as the depth of feeling in his words echoed in her head. Had that been a personal slight? Did he expect a consultant in emergency medicine to be able to perform some kind of miracle? She shook her head, dispelling the faintly paranoid notion. Given the bond that existed between these men, it was far more likely that the comment was a bitter reflection on his own inability to provide assistance.

The sounds of Digger’s breathing filled the tiny tent. How long would his injured lungs manage to struggle on, trying to provide enough oxygen to keep cells alive? Jennifer looked upwards. She couldn’t see the bag of saline in the darkness but she could picture the steady drip of fluid entering Digger’s veins. It was such inadequate treatment for the condition he was in.

If the internal bleeding continued, he would enter irreversible shock within the next few hours. Lack of oxygen-carrying red cells would cause the major organs like kidneys and heart and brain to fail. If they had been in an emergency department, it would be so easy to do what was needed. X-rays and ultrasound. Aggressive fluid replacement. A proper chest decompression. A quick trip to Theatre to have the source of the abdominal blood loss fixed.

The isolation of their situation was suddenly overwhelming because it was going to cause someone’s death, and there was absolutely nothing Jennifer could do about it. Her sigh was heartfelt.

‘What’s the matter?’

‘Nothing.’ Nothing new, anyway. Jennifer sighed again. ‘Everything,’ she corrected herself. ‘This is so frustrating. I know what should be done and there’s no way of doing it. It’s…just awful.’

‘You must be pretty used to awful things. How many cases a day would you put through your ED? Dozens? Hundreds?’

‘Somewhere in between. But that’s different. Sure, we lose patients and it’s awful sometimes, but at least we’ve done everything we could and we get to save people who wouldn’t make it without us. People like Digger.’

The silence suggested that Guy didn’t want to discuss Digger’s obviously bleak prognosis. When he spoke, he almost sounded as though he was having a conversation at a cocktail party.

‘So, what’s the most awful case you’ve ever had to deal with?’

‘It’s never nice to lose a patient. You must know that.’

‘It’s different for me. I know most of my patients on a personal basis. Even something as mundane as a cardiac arrest is awful, but it doesn’t happen too often fortunately. You’d get far more interesting things to deal with. So what’s the worst you can think of?’

‘This isn’t exactly a happy topic of conversation.’

‘Maybe I don’t feel happy,’ Guy responded. ‘Or maybe I need to think about other people who are even less fortunate than me. I’m curious anyway. You have a very different perspective on medicine than I do these days, so it must take something pretty major to stand out as being memorably awful. Humour me. What constitutes really awful for you?’

This, Jennifer wanted to say. Lying beside someone who could be saved and isn’t going to be. Having the person who probably loves him more than any other lying on the other side. Being connected by their physical proximity and the enormity of their predicament. Knowing that when there was absolutely nothing more they could do for Digger, the distraction of caring for someone else would be lost and she would have to face the fear of her own chances of survival.

Instead, she drew in a deep breath and spoke quietly. ‘There was this woman a couple of years ago. Lucy, her name was. She was thirty-five and she and her husband had been desperate to have a baby for years. It took about six attempts but IVF finally worked and she became pregnant with twins. Seven and a half months pregnant. They went out shopping for a double buggy and while they were walking along a path, Lucy spotted this puppy in a pet-shop window. She stopped abruptly and turned to have a look, but this kid had been coming up behind on a skateboard and he barrelled into her.’

Jennifer paused to take another breath. Digger mumbled something and jerked his head but then lay still again.

‘And?’ Guy prompted. ‘What happened? Did she miscarry?’

‘No. She stumbled and fell sideways into the path of a car. Severe head injury but she was still alive when she arrived in ED. She arrested shortly after arrival so I decided to do an emergency Caesarean to try and save the babies. Her husband, Matt, was right outside the door of the resus room.’

Even now, the memory was enough to create a painful lump in her throat. What had she been thinking of, agreeing to tell such an awful story? Jennifer blinked hard and doggedly carried on.

‘It was a circus. We had dozens of people rushing in and out. We had to tube Lucy and keep CPR going. We had obstetric and paediatric and neurology staff arriving, and every time the door swung open Matt got a glimpse of what was going on. He saw his wife being cut open and his babies being resuscitated. And then…then I had to go and tell him that we had failed. He’d lost everyone—his whole family. His whole reason for living.’

Long seconds ticked by before Guy broke the new silence. ‘That’s worse than awful,’ he said finally. ‘It’s a truly heartbreaking story.’

‘You did ask,’ Jennifer reminded him.

‘OK, so tell me about the best case you’ve ever had,’ he commanded.

‘There’s been lots of those as well.’ Jennifer was thankful to turn her thoughts to something positive. Maybe the reminder of just how dreadful events could be for others hadn’t been such a bad thing after all. ‘One of my favourites was a three-year-old girl who came in under CPR. She had fallen into a river but we weren’t sure whether she’d arrested because of drowning or hypothermia. It was the middle of winter and she was unbelievably cold.’

‘A “not dead until you’re warm and dead” case?’ Guy suggested.

‘Absolutely. It took thirty minutes to get her core temperature above 30 degrees Celsius and she was still in asystole. Her parents were quite convinced she was dead. We defibrillated her finally. It took three goes but we got her back.’

‘Brain damaged?’

‘No.’ Jennifer was smiling into the darkness. ‘She came into the department a week later with her parents, carrying a big bunch of flowers for me.’

‘Have you got kids of your own?’

‘No.’

‘Planning on some?’

‘That’s a rather personal question. Why—are you?’ ‘Definitely not.’

‘You sound very sure about that.’

‘I am. I like my life just the way it is. There’s no space for kids in it.’

‘So what makes you assume I want a family?’ Jennifer was frowning. Did she want a family? It wasn’t something that had been more than a fleeting thought over the years. A thought that was easy to shove on the back burner due to the precedence her career had always taken. ‘Not all women are born with the desperate need to reproduce. Maybe I’m just as sure about it as you are.’

‘You just gave me the impression that you’re fond of kids, that’s all.’

‘How on earth did you reach a conclusion like that?’

‘Both your worst and best cases involved babies and children.’

‘I guess those cases can be more memorable. Maybe it’s more of a tragedy to lose babies and children than older people who have had a chance to live life.’

‘Like Digger, you mean?’

‘No, I didn’t mean that.’ Jennifer’s tone softened. ‘Digger’s obviously special. He reminds me of my dad.’

‘Because he called you Jenna?’

‘Not just that. There’s something else there. An independence maybe. Or courage, or a sense of humour. An ability to face whatever has to be faced without making a big fuss about it.’

Guy grunted. ‘You’re not a bad judge of character.’ Jennifer could hear him moving. ‘Hey, Digger? Did you hear the nice things Dr Allen was saying about you?’

There was no response from Digger. Jennifer moved as well, to wriggle her hand inside the coverings and find Digger’s wrist.

‘His radial pulse isn’t palpable,’ she said quietly. ‘Blood pressure’s dropping.’

‘He’s not responsive,’ Guy added. ‘And I don’t like how shallow and rapid his breathing’s getting.’

Digger was tilted towards Guy’s side of the tent and as Jennifer was tucking his arm back under the leather jacket and foil sheet she found him tilting even further. Startled, Jennifer opened her mouth to say something but then realised what was happening. Guy was taking the older man into his arms.

‘It’s OK, mate,’ he was saying softly. ‘I’m here, Digger. I’m not going anywhere.’

This time tears formed that rolled down Jennifer’s face. Would someone hold her like that when she was dying? And speak softly in such a loving tone? There was a gap beside her now, where Digger’s back had been.

‘Come a bit closer,’ Guy instructed. ‘We need to keep as much body heat in one place as we can. Pull the tarp in around us if you can.’

So Jennifer found herself pressed against Digger’s back again. She could feel his uneven breathing beneath her cheek. She could feel the erratic heartbeat a long time later when his breathing settled into a rhythm that suggested the end wasn’t far away. They huddled together as the minutes, then hours passed. The cold was numbing and attempts at conversation gradually faded into simply waiting.