Читать книгу Emergency: Christmas - Алисон Робертс - Страница 8

YES!

Penelope Baker was confident that her personal elation would be easily absorbed by the general buzz of anticipation building around her. She reached for the wall phone and punched in the required number to reach the operator.

‘Could you page the anaesthetics registrar, please?’ Please! Penelope added silently. Let Jeremy be on duty. Please, please, please!

She glanced over her shoulder as she waited, inner tension kicking in at the minor crisis erupting beside her. A student nurse, Chrissy, had been invited to join the trauma team for the incoming case and the poor girl was terrified. Having been directed to assist the circulation nurse, Chrissy was presently struggling to untangle the giving set she was attempting to prime. She had forgotten to close the line, and fluid was dribbling steadily from the end of the tubing. Droplets splashed Penelope as Chrissy shook the tubing to try and unravel the knot.

Behind Chrissy, the other team members appeared focused. Drugs were being removed from a secure cupboard, drawn up, checked and labelled. Over-head lighting was being positioned and switched on. A suction unit was being tested. Radiographers were donning lead jackets and doctors were tying on disposable gowns and pulling on gloves. Advanced airway care equipment was being assembled and checked.

Belinda Scott, the nurse responsible for the airway equipment, deflated the balloon on the endotracheal tube she had just checked, glancing up to catch Penelope’s eye just as the phone was finally answered.

‘Jeremy Lane.’

‘Hi, Jeremy.’ Penelope ignored Belinda’s meaningfully raised eyebrow. She also ignored the fact that Chrissy’s elbow had just dislodged a box of sixteen-gauge cannulae and sent them scattering over the floor at her feet. She even managed to ignore the familiar tingle the sound of Jeremy’s voice engendered. Her tone was entirely professional. ‘Penelope Baker speaking, Jeremy. Trauma Room.’

‘Penny! My day is improving.’ Jeremy’s tone was far from professional. Warm. Distinctly inviting. Penelope had to take a somewhat deeper breath.

‘We’ve got a nineteen-year-old multi-system trauma patient coming in. A paragliding accident. Apparently he has neck and head injuries and attempts to intubate in the field were unsuccessful—’

‘I’m on my way.’ There was no need for Penelope to elaborate. As she summoned his expertise to deal with a potentially life-threatening situation, any hint of flirtation evaporated instantly. Senior anaesthetics registrar Jeremy Lane was now as focused as every member of the emergency resuscitation team. Including Penelope Baker.

‘Estimated time of arrival, four minutes,’ someone called.

The bustle was subsiding as Penelope turned away from the phone. Chrissy’s latest disaster had been rectified and the young nurse now stood out of harm’s way in the corner, her cheeks still flushed scarlet. The preparations in the trauma room were now complete. Both the inner swing doors and the outside doors leading to the ambulance loading bay stood open. The trauma team stood, gowned and gloved, awaiting the arrival of their patient.

Penelope breathed in deeply, soaking in the atmosphere of calm control with the undercurrent that only high levels of adrenaline could produce. This was the part of her job she loved the most. There was no room now for any unprofessional personal reflection. She was simply a member of a highly trained medical team waiting for a chance to do what gave them all the highest level of satisfaction.

Waiting to save a life.

* * *

The ambulance backed swiftly and smoothly up to the loading bay of Wellington’s St Margaret’s Hospital. The doors opened immediately and the stretcher was lifted from the vehicle, raised and wheeled directly to the trauma room. The patient was strapped to a backboard which made the transfer to the bed a swift procedure.

‘On the count of three. One...two...three.’

Belinda unhooked the oxygen tubing from the portable cylinder and reattached it to the overhead supply outlet. Penelope lifted the bag of intravenous fluid out of the way of the approaching shears as clothing was cut away from the patient. She hung the bag on a hook near the oxygen outlet and opened the flow enough to keep the line patent then stepped to one side to make room for the staff members who were attaching the electrodes needed for a 12-lead electrocardiogram and wrapping an automatic blood-pressure cuff around their patient’s upper arm.

The noise level in the trauma room rose as equipment was manoeuvred and the team focused on gathering the observations and information they required immediately.

Penelope moved swiftly back to her position at the drugs trolley. Extra drugs that might be required needed drawing up and labelling. Despite the level of concentration the task entailed, Penelope was still able to assimilate most of what was happening around her.

‘The patient’s name is Richard Milne. He’s nineteen years old.’ Information previously relayed by radio needed repetition and clarification by the ambulance staff. ‘He got blown off course while paragliding and landed in a tree.’

‘BP’s 140 over 80.’ Belinda was able to keep an eye on the monitor screens from her position at the head of the bed.

‘What gauge IV access do we have?’ Emergency Department registrar Mark Wallace was checking the patency of the cannulation done by the paramedics.

‘Fourteen.’

‘Let’s get another line in.’

Penelope watched the circulation nurse collect and deliver the supplies Mark would need. Chrissy was also watching carefully as another bag of IV fluid was set up and the giving set attached and primed with no hint of any tangles in the tubing.

‘He tried to get himself out of his harness to climb down, slipped and was caught around the neck by the harness as he fell.’ A paramedic was speaking to the consultant leading the medical team, Jack Hennessey. ‘He hung long enough to lose consciousness, then the branch broke and he fell approximately six metres. The fall was broken to some extent by lower branches and he landed on a grassed area.’

‘Was he wearing a helmet?’

The helmet was in the hands of a second ambulance officer. ‘It’s damaged at the back,’ he reported. ‘Witnesses didn’t think he was KO’d.’

‘He was conscious on our arrival,’ the paramedic continued. ‘Glasgow Coma Score 14. No neurological deficit. Fractured mid-shaft femur on the left side and a fractured right wrist. GCS dropped en route to 10 with increasing respiratory distress.’

Penelope glanced towards the patient’s head. The level of consciousness was still well down. The teenager’s eyes remained closed and his verbal responses were limited to an occasional moan. The neck collar had now been removed and Belinda Scott was providing manual stabilisation while Jeremy assessed the injury to the neck and the patency of the patient’s airway. Air movement was not good. Penelope could hear the girl’s harsh inhalations clearly through the general noise level. She could also hear Jeremy Lane speaking to the consultant.

‘We’ve got some major oedema here. Trachea’s still midline and there’s no subcutaneous emphysema on the neck but I can’t rule out a tracheal rupture.’

‘Oxygen saturation is down to 85 per cent.’

Jack Hennessey turned to Mark Wallace. ‘See if you can get an arterial blood gas off after you’ve secured that IV line.’ He looked back at Jeremy. ‘Are you going to intubate?’

‘I’ll have a go. Could do with fibreoptic endoscopy, judging by the oedema present, but it won’t be the first time I’ve done it blind.’ Jeremy sounded confident. ‘Could I have someone ready for cricoid pressure? Thanks.’

Penelope looked at the registrar standing beside her at the drugs trolley. Labelled syringes were spread out in front of them, including sedation and paralysis agents and cardiac drugs in case prolonged laryngoscopy led to a deterioration in heart function. Duplicate ampoules were readily available. The registrar acknowledged their readiness with a nod.

‘You do it, Penny. I’m all set.’

Belinda was still holding the patient’s head in a position to protect his neck. A cervical spine injury had not yet been ruled out. Jeremy was hyperventilating their patient with rapid squeezes on the bag mask unit. A neuromuscular blocking agent was administered and then Penelope positioned her fingers on the young man’s neck to press on the cricoid cartilage. With the amount of soft tissue swelling this wasn’t as easy as Penelope would have liked but she was confident she had located the correct spot. She knew that pressure on this part of the Adam’s apple reduced the risk of vomiting and aspiration during the procedure. It also displaced the larynx and aided visualisation for Jeremy.

In this instance it wasn’t enough of an aid. Jeremy had two attempts to pass the intubation tube into the trachea.

‘This is hopeless,’ he pronounced. ‘Bag him, will you, Penny? The suxamethonium won’t wear off for a while yet. We might have to go for a tracheostomy here.’

Penelope fitted the face mask securely and squeezed the bag to provide oxygen to the now paralysed teenager.

‘What about a needle cricothyroidotomy?’ Jack Hennessey suggested. ‘The injury seems to be above the level of the larynx.’

‘That would only give us thirty to forty minutes’ effective ventilation. This lad’s going to need CT scanning to rule out a skull fracture and C-spine injury before he even gets near the operating theatre.’

‘Heart rate’s dropping. Down to 90,’ a nurse warned.

‘And pulse pressure’s widening. One-fifty over 95.’

Tension in the trauma room went up a notch. The signs could be a warning of rising intracranial pressure from an as yet undiagnosed injury. Airway control and adequate ventilation had to be instigated as quickly as possible.

‘Surgical cricothyroidotomy should be enough.’ Mark joined the discussion between Jack and Jeremy. ‘Fewer complications than a tracheostomy, which could be done later in Theatre if it’s needed.’

‘Are you happy to do it?’

Mark nodded. He glanced at Jeremy. ‘Unless you want to?’

Jeremy shrugged. ‘Go for it, mate. I’ll look after the bag mask and Penny can assist you.’

Penelope relinquished the ventilation equipment, taking a quick glance at Jeremy as she did so. Was he bothered by his unusual failure to intubate a patient? Less than happy to hand over the imminent procedure to a newcomer? If so, he didn’t show it. Jeremy smiled at Penelope.

‘Seen one of these done before, Penny?’

‘No, but I know where the kit is. I’ll find it.’

She opened the roll of sterile drape on top of a fresh trolley to reveal the sterilised equipment that would be needed.

‘Clean the whole area over the cricoid and thyroid cartilage,’ Mark directed her. ‘Then we’ll infiltrate with one per cent plain lignocaine.’

Penelope swabbed the young man’s neck.

‘I’m going to stabilise the thyroid cartilage here,’ Mark told the onlookers. ‘Then I make a horizontal incision over the cricothyroid membrane. Scalpel, please.’

Everyone in the trauma room was crowding in for a closer look. This wasn’t an everyday occurrence. Mark appeared confident as he cut carefully into their patient’s throat. He reversed his hold on the scalpel and inserted the handle.

‘It’s helpful to rotate it through ninety degrees to open the airway,’ he explained. ‘Can I have a size 9 endotracheal tube, now, please?’

The tube that Penelope handed him was carefully inserted and the cuff inflated. Penelope had the sutures ready to hand over next. She watched as Mark stitched the tube into place.

‘I’ll get us hooked up.’ Jeremy was adjusting controls on the ventilator. ‘Let’s see if we can get some better-looking oxygen saturation figures.’ He nodded at Mark. ‘Well done.’

‘Thanks.’ With the airway and breathing for their patient now under control, Mark’s attention was diverted. He was examining Richard’s chest for injuries and had his stethoscope in his ears to recheck breathing.

‘Let’s have another neurological check,’ Jack requested. ‘What are the pupils like?’

‘Equal and reactive. Bit more sluggish than they were.’

‘Let’s run off a C-spine, chest and pelvic set of films,’ Jack directed. ‘Then we’ll send him for a CT scan of his head and neck.’ He was watching Mark as the registrar took a moment to re-examine their patient’s abdomen. He glanced at Penelope. ‘Give Neurology a call and get someone down for a consult, will you, please? Don’t worry about Orthopaedics just yet. That femur and wrist can wait.’

The doctors moved back as the radiographers positioned equipment.

‘Chest and abdomen look OK,’ Mark informed Jack. ‘I’d say he’s pretty stable for the moment.’

‘Now that we’ve got that airway sorted out, he is. Nice job, there, Mark.’

‘Thanks.’ Mark was looking at Penelope. ‘Thanks for your help. Penny, isn’t it?’

‘Penelope Baker.’ Penelope wanted to add her compliments about the surgical intervention but, while Mark smiled at her briefly, his attention was obviously still on their patient. He reached for a lead jacket so he could move back while the X-rays were being taken.

‘How bad is that femur?’

‘Feels like a clean break. Minimal swelling thanks to the traction splint. There’s a Colles’ fracture of the right wrist but everything else is superficial. With a bit of luck we might even keep him out of Theatre.’

‘What’s wrong with Theatre?’ Jeremy appeared relaxed as he joined the other doctors. He winked at Penelope as Mark moved away. ‘I’m quite happy in there myself.’ A glance at the wall clock prompted a frown. ‘In fact, I should be in there right now.’

Jack nodded. ‘Mark can take over monitoring the ventilation. Thanks for your help, Jeremy.’

Penelope watched the senior anaesthetics registrar leave the room. An Australian, Jeremy Lane had only taken up his new position at St Margaret’s a couple of months ago but Penelope had noticed him the first time he had come into the emergency department. Tall, blond and lean, Jeremy looked as though he’d spent a lot of his time on Australian beaches to acquire that tan. Maybe a lot of time surfing or swimming as well to gain the muscular build that Penelope hadn’t been the only one to notice. Neither had she been the only one to notice the fact that the anaesthetist wore no wedding ring.

Penelope swallowed a small sigh. Jeremy was undeniably good-looking and she didn’t mind that he had left the trauma room now without a backward glance. The wink had been sufficient for the moment. Jeremy had also made sure that she’d had front-line involvement in the unusual procedure. Penelope was rapt. This had been an exciting resuscitation and it looked as though their young patient was not only going to survive: he might even come through relatively unscathed.

‘We’ve finished here,’ a radiographer called. ‘We’ll have the films through on screen in a minute.’

‘Right. We’ll tidy up our secondary survey and get things moving,’ Jack directed. ‘Let’s have a few extra hands here for a log roll.’

* * *

‘Wasn’t that awesome? Imagine just cutting into someone’s throat like that.’

‘Mmm.’ Penelope dropped the bloodied scalpel into the sharps disposal container and put the holder with the other instruments destined for resterilisation. ‘You’d better put the mask from the bag mask unit in with this lot, Bindy.’

Belinda Scott pulled the mask free from the unit. ‘He’s good, isn’t he?’

‘Who?’

‘Mark Wallace. Our new registrar.’

‘Mmm.’ Penelope turned her attention to the suction unit. She stripped off the disposable tubing, coiling it up as she reached for the biohazard rubbish bag. ‘I wonder why Jeremy didn’t do the cricothy-roidotomy?’

‘Maybe he didn’t know how,’ Belinda suggested wickedly. Penelope’s dismissive snort made her grin. ‘Come on, that’s your cue for telling me how wonderful Dr Lane is...yet again!’

Penelope remained silent. She rolled up soiled drapes and stuffed them into the contaminated linen holder. The two nurses were alone as they cleared up the trauma room. The highly equipped area needed to be made completely ready for any new incoming emergency. If Richard Milne returned to the emergency department after his CT scan he would go into another area, but it was more likely that he would be transferred directly to the intensive care unit.

Belinda watched Penelope for a moment before returning to her task of restocking the drug cupboard. Then she shook her head with an expression of fond exasperation.

‘For goodness sake, Pen. If you feel this strongly about the man, then do something about it.’

‘Like what?’

‘Ask him out.’

Penelope’s jaw dropped. ‘Are you kidding? I couldn’t do that!’

‘Why not? I would.’

‘You would, too.’ Penelope eyed her friend enviously. ‘Why can’t I be more like you?’ The frustrated shake of her head made the shoulder-length tumble of black curls bounce.

‘You’ll just have to try harder.’ Belinda raised her eyebrows. ‘Remember our New Year’s resolution? It was you, after all, who proposed we swear off men for life. ‘‘Who needs them?’’ you said. With great conviction, I seem to remember.’

‘I’d had rather a lot to drink,’ Penelope reminded her. ‘And it was only a month after Greg had gone back to what’s-her-name.’

‘Sharon,’ Belinda supplied helpfully. ‘Greg dumped you and took off with his old girlfriend and you were unbearably miserable.’

‘I wasn’t!’

Belinda smiled at the scowl she was receiving. ‘I should know. I was the one who had to live with you.’ She turned to lock the drug cupboard. ‘He’d ruined your life, you said.’

‘I’ve recovered.’

‘Yes. With the help of our New Year’s resolution. You’ve been doing rather well so far. Don’t weaken.’

‘It is November, Bindy.’

‘Almost Christmas,’ Belinda agreed. ‘And then it’ll be New Year again.’ She grinned widely. ‘We can renew our vows.’

Penelope sighed. ‘How do you do it? You act like you don’t give a damn, and men can’t stay away from you.’

‘It’s because I’m not acting. I don’t give a damn and neither should you, Pen. Love ’em and leave ’em—like they do to us. No strings.’

‘Maybe I want strings. I’m thirty, Bindy. I’m an aunt five times over. Five and a half times actually, and now it’s my baby sister who’s expecting a baby.’

‘How is Rachael?’ Belinda seemed eager to be diverted from the depressing direction of Penelope’s thoughts. ‘She hasn’t been around to the flat for ages.’

‘I haven’t seen much of her since she got pregnant.’ Penelope bit her lip. ‘Maybe I’m jealous,’ she confessed. ‘Rachael’s three years younger than me and she has everything I’ve always wanted. A fantastic husband, a great job, a baby on the way and...and blonde hair.’

Belinda laughed. ‘So—bleach your hair!’

‘Tried that when I was fifteen.’ Penelope snorted. ‘It looked totally disgusting.’ She shook her head. ‘That was half a lifetime ago. Do you know, my mother had four children all going to school by the time she was my age?’

‘Fate worse than death,’ Belinda stated cheerfully. ‘I should know. Been there, done that.’

‘You didn’t have any kids.’

‘No, thank goodness.’ Belinda reached to switch off the overhead lights. ‘Look, Pen, you can have a baby when you’re in your forties these days. You’ve got another whole decade of freedom.’

‘I don’t want freedom,’ Penelope responded with conviction. ‘I want...’ She sighed heavily. ‘I want Jeremy Lane.’

‘Fine.’ Belinda sounded decisive. ‘You can have him.’

Penelope grinned, pausing as she headed for the doors pushing a linen bag. ‘How?’

‘Leave it with me. I’ll think of something.’ Belinda followed Penelope out of the trauma room. ‘Just don’t marry the man.’

‘Why not?’

‘Well, are you planning to change your name when you get married?’

‘Probably.’ Penelope skirted the ambulance stretcher waiting by the sorting desk. A middle-aged man was holding a blood-soaked towel under his nose. ‘Why?’

‘Have you considered what your name would be if you married Jeremy?’

‘Shh!’ Penelope’s glance around them was anxious but the emergency department staff were all gainfully employed at enough of a distance not to overhear Belinda’s indiscreet query. Still, Penelope kept her voice well down, unable to resist a response. ‘Penelope Lane,’ she whispered. ‘What’s wrong with that?’

‘‘‘Penny Lane’’? You know—the Beatles’ song?’ Belinda began humming loudly.

‘Go away, Bindy.’ Penelope couldn’t help laughing. ‘I’ve got work to do.’

Penelope was still smiling as she moved back to the sorting desk. Her name was on the whiteboard to take the next patient and it looked like she had a nosebleed to sort out. She had to concede that Penny Lane might be a name that could cause some amusement but Penelope Lane had a much more dignified ring to it.

In fact, it had a very nice ring to it indeed.