Her Emergency Knight. Alison Roberts
Jennifer gave no sign of being impressed at such rapid recognition of a life-threatening situation. ‘Paradoxical chest-wall motion.’
As Digger breathed in and his chest wall moved outward, an area on the left side sank inwards. With an inward breath, it bulged outwards. The movement was subtle because of the shallow respirations but that did nothing to diminish its significance. Several ribs had been broken in two or more places, resulting in a section floating free that would seriously compromise breathing.
Jennifer’s hand had gone straight to the area and she elicited a heavy groan from Digger as she stabilised the flail segment in an inward position.
‘We need some towels, or sandbags, or a pillow. And a wide bandage.’ Jennifer looked up to catch Guy’s raised eyebrow and an almost patient expression on his face. OK, so she wasn’t in her emergency department or even the back of a well-equipped ambulance. She could cope.
‘We’ll just use his arm as a splint, then. You do have some bandages, don’t you?’
Having the arm bound to the chest wall to keep the floating ribs in place made the rest of the assessment of Digger’s breathing more awkward, but his respiratory distress seemed to be easing slowly. A faint pink tinge crept back into his skin and his level of consciousness was improving. Opening his eyes, Digger tried to cough but the attempt was weak and broken by an agonised groan.
‘Let’s position him on his injured side,’ Jennifer directed, lifting the stethoscope from Digger’s chest. ‘He’s moving air but breath sounds are definitely reduced on the left side. We want to keep his uninjured lung functioning as well as possible.’ She sighed. ‘I wish we had some oxygen. Or at least a bag mask.’
‘Welcome to the world of front-line emergency care,’ Guy responded. He gently eased an arm beneath the older man as he spoke, tilting him single-handedly towards his left side. Digger groaned again. ‘Sorry, mate,’ Guy said. ‘We’re just trying to look after you. We’ll get something for that pain as soon as we can.’
‘You’ve got morphine?’ Jennifer was pleasantly surprised.
‘Only a few ampoules, but it should help for a while.’
‘Should be more than enough.’ Jennifer nodded. ‘How long will it take for a rescue helicopter to get to us?’
She didn’t wait for a response. Her patient’s airway and breathing were under as much control as they could achieve for the moment, and she wanted an assessment of his circulation. Picking up Digger’s wrist, Jennifer felt for a radial pulse. Frowning, she shifted her grip and tried again.
‘Barely palpable,’ she announced. ‘Have you got a BP cuff in that kit?’
‘No. We don’t have a defibrillator or a 12-lead ECG either.’ Guy was pulling his fleece-lined leather jacket back over Digger’s chest. ‘I’m afraid you’ll have to make do with good old-fashioned estimates. If the radial pulse is palpable, his systolic is at least 80, which is adequate for renal perfusion.’
‘Hardly adequate to administer morphine,’ Jennifer countered sharply. ‘And it wasn’t an unreasonable request. Sphygmomanometers hardly cost the earth these days, and many are quite small enough for any first-aid kit. I would have thought you’d use one often enough to make it an essential item even in a remote practice.’
‘My first-aid kit happens to be in the back of my four-wheel-drive vehicle and it’s perfectly well equipped, thank you. I keep one in Digger’s plane as backup simply because I often fly with him. The morphine’s not exactly legal with it not being under lock and key, but we needed it once and didn’t have it so we bent the rules.’
‘Oh.’ Jennifer didn’t bother to apologise for the incorrect assumption regarding Guy’s medical practice. ‘He’s a friend of yours, then?’
The smile was fleeting enough to be no more than a ghost. ‘You could say that.’
‘Has he got any medical conditions I should know about?’ Jennifer was running her hands over Digger’s body in a sweep for any obvious bleeding. ‘How old is he?’
‘Seventy-two.’
‘And he’s still flying?’
‘Any reason why he shouldn’t be?’
Jennifer met the angry stare without flinching. Only the obvious, she wanted to say. This flight hadn’t exactly been a huge success, had it? The steely glare from those dark eyes silenced her, however. If the pilot had any major physical problems like a cardiac condition, the civil aviation authority wouldn’t have renewed his licence. Assuming that Digger was still licensed, of course, but Jennifer wasn’t about to go there.
‘Any allergies that you know of?’
‘No. He had a hip replacement about ten years ago but he’s as fit as a fiddle otherwise. Not that he’d tell me in a hurry if he wasn’t.’ Guy was smiling down at the man lying between them. ‘He’s as tough as an old boot is Digger. He’s probably broken every bone in his body at least once, thanks to his early days as a rodeo rider. He cut his leg badly with a chainsaw once and sewed himself up with dental floss before driving fifty miles to come and find me.’
Jennifer’s grunt indicated either a lack of interest in anecdotes or concentration on her current task of palpating Digger’s abdomen. When she got to the upper left quadrant, Digger groaned and opened his eyes.
‘Hurts…’
‘OK, I’ll stop pushing.’ Jennifer was pleased to see her patient looking more alert. ‘You’ve had a nasty knock on your left side. You’ve got broken ribs and may have some internal injuries. How does your breathing feel now?’
‘Bit…better…’
‘You need some fluids,’ Jennifer told him. ‘Dr Knight here is going to put a needle in your hand now.’ She glanced up swiftly, having heard what sounded like a faintly incredulous snort. ‘Is that a problem?’ she asked evenly. ‘You have fluids in that kit. I was assuming you also had the IV gear to make use of them.’
‘Oh, I do,’ Guy responded.
‘Then what’s the problem?’
‘No problem.’ Guy clearly wasn’t going to be the first to break eye contact. ‘It was just your other assumption that I found kind of amusing.’ An eyebrow rose. ‘You’re used to being in charge, aren’t you, Dr Allen?’
Jennifer felt muscles in her jaw tighten as she watched Guy pull a tie on a package from the kit, unrolling it to reveal a good supply of cannulae, swabs, luer plugs and occlusive dressings. He had asked for her help, hadn’t he? As the most highly qualified person present, of course she had assumed command of the scene.
‘And you must be used to being a big fish in a little pond.’ Her smile lacked any hint of warmth. ‘Why don’t I put the IV line in?’
‘Works for me.’ Guy’s smile was just as chilly as hers had been. ‘I’ll go and see if I can find what we need to get Digger a bit more comfortable and keep him warm.’
‘Try the radio while you’re there,’ Jennifer instructed. ‘I’d like to know how far away rescue is.’
The arm she was encircling with a tourniquet moved as Digger raised his hand.
‘Stuffed,’ he said succinctly. ‘Radio’s…shot.’
‘I’m sure Dr Knight is responsible enough to carry a cell phone. If he isn’t, then mine is in my bag…wherever that is.’
The snort from Guy was unmistakable this time. ‘And how many transmitter towers did you spot on the way, Dr Allen?’
The sound from Digger could have been a groan. Or a growl.
‘Cut it…out,’ he said clearly. ‘You’re behaving…like children.’ Despite having to take short gasps of air every few words, he continued speaking. ‘My fault