A Forever Family For The Army Doc. Meredith Webber
trauma centre.
‘No obvious skull fracture,’ the paramedic reported, ‘but the GCS was three.’
So, some brain damage! A subdural haematoma with blood collecting inside the skull and causing pressure on the brain?
A CT scan would assess head injury, but would moving him for the scan cause more complications?
This was a patient with spine and head secured and moving on to a major hospital.
Leave the CT scan to them!
Intubation?
Definitely!
A young woman, presumably the paramedic, was using a manual resuscitator to help his breathing.
‘The paramedic is intubation trained,’ Izzy explained, somehow picking up on his thoughts once again, ‘and I know the literature is divided about whether or not to intubate at the scene, but if we’re doing the main stabilisation here, the paramedics tend not to intubate as that way they get the patients to us faster.’
Mac nodded. The patient’s worst enemy, with severe trauma, was time. The sooner he or she had specialised help, the better the outcome.
So, intubation first, Izzy already checking for any obstruction in the mouth, before passing Mac what he needed for rapid sequence intubation. While he checked the tube was in place, she attached it to the ventilator.
The medical personnel from the helicopter were assisting, one taking blood for testing, the other setting up for an ECG.
‘We coordinate our rosters,’ Izzy explained as she set up the portable X-ray machine. ‘Ambulance, helicopter and hospital, so we always have emergency-trained personnel to assist in a crisis. These two both work at Braxton Hospital when they’re not rostered on ambulance or helicopter duty. The helicopter is based at Braxton, an hour and a half away, but the patient was brought here for stabilisation because we’re closer.’
Mac wanted to ask why the helicopter pilot was in Wetherby if he was on call, but the screen was in place, the picture showing a shadow that suggested a subdural haematoma and, anyway, he had other things to worry about.
Do a CT scan to be sure?
It meant moving the patient to the radiography room, maybe doing further damage to his spine—
No time!
Mac had already decided he’d have to drill a small hole into the patient’s skull and insert a catheter to drain off some blood to relieve the pressure before he could be sent on.
Apparently Izzy had also read the situation correctly and had already shaved and prepped the area of scalp the shadow indicated.
The two paramedics—Mac had decided that’s what they must be—had been making notes of all the findings, although all the information would also go directly into the computer. Mac knew the notes would travel with the patient in case of computer glitches.
‘Are you okay in helicopters? Did Hallie ask you that?’ The gold-flecked eyes were fixed on his face as Izzy asked the questions.
‘Practically never out of one,’ he told her as he carefully drilled through the patient’s skull. ‘Why?’
He sounded confident but Izzy was sure he’d gone pale and sweaty when the helicopter had come in.
‘Well,’ she said, ‘another statistic shows better outcomes for serious trauma patients if a physician travels with them. I can stay here and Roger—have you even met our other resident doctor, Roger Grey?—he’ll come if I need him. Would you be okay with going along?’
She paused, watching for any hint of a reaction, but Mac’s attention was on the delicate job of inserting a catheter into the wound he’d created.
That done, he looked up at her, his eyes fixed on a point somewhere above her head so she couldn’t read any reaction in them.
‘Of course,’ he said, but so shortly, so abruptly she guessed he’d rather poke a needle in his eye. ‘We’ll start a drip, and make sure there’s saline, swabs and dressings available on the chopper. I’ll look at his leg on the way.’
She went off to check, returning in time for Mac to give the order to return the patient to the chopper. However, a grim set to the new doctor’s face made her wonder just what horrors he had seen in the helicopters that were used to ferry casualties in war zones.
A wailing ambulance siren recalled her to the other casualties coming in. Megan, the most experienced of the two paramedics, had given up her place in the helicopter for Mac and stayed at the hospital to help with the incoming patients.
There were three, none too serious, but two needing limbs set and the other slightly concussed. Izzy and Megan began the initial assessment, GCS and ECG, palpated skulls for signs of injury, set up drips with analgesia. One by one they were wheeled through to the radiography room for X-rays, and for the concussion patient a CT scan, Izzy blessing the radiography course she’d completed.
It was painstaking work, but needed to be completed swiftly in case some major problem showed up, so time passed without them realising that dawn was breaking outside the hospital, the sun rising majestically out of the ocean.
They were studying the films of the second of the limb injuries, a compound fracture of the ankle, when they heard the helicopter returning.
‘That’s your lift home,’ Izzy told Megan. ‘And I think you should take Mr Anderson back to Braxton with you. That ankle will need pins and plating, and you’ve got an orthopod on tap up there.’
‘Good idea. Of course we’ll take him. I’ll get Marty and Pete in to give a hand loading him.’
Izzy started on the paperwork for admitting the other two patients, one for observation, the other to have further X-rays then a temporary cast fitted on his leg, which would keep the bone stable until the swelling went down and a firmer cast could be used.
‘And now we’re all done, here comes the cavalry.’ Megan nodded to the door where Roger Grey had appeared, accompanied by two of the day-shift nurses.
‘Big night, do you need a hug?’ Roger said, heading for Izzy with every intention of providing one.
She ducked away. Not that there was anything remotely sexual or untoward in Roger’s hugs—he was just a touchy-feely kind of man, and there were often times when a member of the staff appreciated a quick hug.
But ducking away had her backing into someone else—someone who’d come in through the patient entrance, someone with a rock-solid body who steadied her with his hands, holding her in such a way she could see those dark silky hairs...
Moving hurriedly—escaping, really—she made the introductions, gave Roger a brief précis of what they’d already done for the two new patients, explained the third would go to Braxton, then, as exhaustion suddenly struck her, she turned towards the cloakroom. There’d be a bikini, shirt, shoes and socks in her locker. She would run off the tension of the night, then swim, before heading home to sleep.
She peeled off the scrubs she’d been wearing since the ambulances had come in and threw them into the bin by the door—the opening door.
Mac’s head poked around it.
‘Sorry,’ he said, though in bra and pants she was quite respectable. ‘I wondered if you were going for a run. It’s definitely what I need and we’d look silly running separately along the path.’
She’d have liked to say she was taking the path south but that would sound petty; besides, she wanted to collect the sleeping bag.
So she nodded, in spite of knowing that she was making a rash decision.
‘I imagine you’ll have to go home and change. I’ll wait by your gate.’
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