Her Emergency Knight

by Alison Roberts

  The question of why she felt so proud of herself was still unanswerable by the time she reached the verge of freedom, but at least it provided a distraction from the feel of Guy Knight’s hands as they held her legs, then her hips, as she wriggled past a mangled door and shredded metal to find herself standing on solid ground.

  Well, almost standing. Her legs felt like jelly and the light was bright enough to make her eyes water furiously so Jennifer kept them tightly closed. She clutched the red bag to her chest and didn’t protest as she felt herself being eased into a sitting position.

  ‘Were you knocked out?’ Strong fingers were palpating her head and neck.

  ‘I must have been, I guess. I remember waking up.’

  ‘Can you remember what day it is?’

  ‘Sunday. And it must be around 5:00 p.m.’ Jennifer was quite confident that her level of consciousness was not impaired despite her mild headache. ‘We got on the plane at four o’clock and that pilot reckoned it would take over an hour to get anywhere near Fox Glacier.’

  ‘It’s just after 5:00 p.m. now. Are you having any trouble breathing?’

  ‘Not anymore.’

  ‘Can you open your eyes?’

  Jennifer complied, blinking and squinting as she tried to adjust to the glare of sunlight. The GP’s face was very close to her own. Dark eyes fringed with long, black lashes were assessing her from beneath a flop of equally dark hair. A minor laceration on his temple had stopped bleeding but had left a smear of blood now mixed with grime over rather angular features. A strong face, Jennifer thought distractedly. And not a particularly friendly one.

  ‘Does anything hurt?’

  Jennifer felt as though she’d been run over by a train. Things ached and stung in all sorts of places but no single pain stood out as being unbearable. Even the arm she knew she had broken was just a dull throb now that she’d stopped putting stress on it. The man in front of her looked in worse shape. A nasty abrasion covered the side of one arm and bloodstains covered large areas of his white shirt and faded denim jeans.

  ‘I’m OK.’ Jennifer was still staring at Guy Knight’s legs. ‘Whose blood is that?’

  ‘Probably Bill’s.’ Guy didn’t bother to look down. He gave a brief nod instead. ‘You look OK.’ A hand reached out. ‘I’ll take that bag, then. Digger needs some help.’

  Jennifer released the bag she’d forgotten she was clutching. ‘Who’s Digger?’

  ‘The pilot.’

  ‘Oh.’

  ‘This wasn’t his fault.’ The swift reaction to any implied criticism in Jennifer’s tone was sharp. ‘If Digger hadn’t coped with that engine failure as well as he did, we’d all be dead.’ Turning abruptly, Dr Knight walked away.

  Jennifer pushed herself to her feet, pleased to find her legs working far more normally. She was standing in the space between a wing that had broken completely free and the bulk of the Cessna. The propeller blades of the single engine were crumpled almost beyond recognition and the front window and part of the plane’s roof had been torn away.

  Lettering on the other end of the fuselage was distorted. B…P…L. No. An echo of Jennifer’s dream sounded in her head. That last letter was a T.

  ‘Bravo Papa Tango…Mayday…Mayday…’

  Jennifer’s gaze slid involuntarily to her fellow passengers now lying beside the wreckage. She should check that they were, indeed, beyond any help a doctor could provide, but she didn’t move. Nobody could survive the kind of head injury Bill had clearly sustained and she had been in close enough contact with Shirley for long enough to know that she, also, was dead. Taking the time to confirm what she already knew was pointless. Turning her back on the fatalities, Jennifer picked her way over rocks and tussocks, following her new companion to where the sharply bent, sheared-off wing had created a kind of wall. The man with tufty grey hair lay behind the wing tip. Guy was standing beside him.

  ‘Digger? Can you hear me, mate?’

  The response was incoherent and Jennifer’s view of the other survivor was blocked as Guy crouched in front of her. It was tempting to focus on the injured man herself but Jennifer needed a moment or two to orient herself first. This was no well-equipped emergency department with extra staff and facilities available automatically.

  How ironic, to find herself in a situation like this, having travelled the length of the country to give GPs her expert advice on how to handle emergencies in precisely such situations. Now she was about to find out, at first-hand, what it was like to depend on limited resources and personal skills. Already she was listening for the sound of an engine. A buzz that would evolve into the chop of rotors as a rescue helicopter arrived to break the barrier of isolation.

  No sound broke the overwhelming silence around them, however, and Jennifer’s gaze was drawn as involuntarily towards the horizon as it had been to the bodies beside the plane. She knew she would see a reality she would rather not confront. She also knew that it had to be confronted before she could move on. Scanning the clear blue of the sky in the hope of seeing a sign of movement offered no reassurance, but what she did see took her breath away.

  Alongside and above for as far as she could see were the sharp peaks and valleys of the Southern Alps—a mountain range that provided a spine for the south island of New Zealand. Sunlight turned patches of snow into the blinding glare of mirrors and shadowed surrounding grey rock into inky darkness. Barren heights became the kind of tussock-covered terrain she was stranded on at present and bush-covered slopes fanned out below, a thick, green blanket softening variations in the terrain that were probably as sharp as those created by the towering peaks.

  Jennifer had grown up in this country. New Zealand was home and it had always offered the security of being small and relatively isolated from the evils the rest of the world had to endure, but there was nothing remotely small about this landscape. The vast emptiness made her feel astonishingly insignificant.

  No wonder people—and planes—got lost out here, never to be recovered. Even with a beacon sending out a distress call, Jennifer had no idea how long it might take for their exact location to be pinpointed. Maybe you had to fly within range to pick it up in the first place, and there were thousands of square miles to cover out there.

  She was alone.

  No. They were alone.

  Jennifer swallowed past the constriction in her throat as she dragged her gaze back to the crouching man in front of her. She found herself the object of a speculative glance.

  ‘If you’ve finished admiring the view,’ Guy Knight said mildly, ‘I could use some help here.’

  CHAPTER TWO

  ANSWERING a call to duty was automatic.

  Absorbing the reality of what had happened and where they were had taken only seconds, but the effect was an anchorage from which Jennifer could now function without distraction. Locking into the practice of what she was most competent to perform was a relief. A way of taking back control in the midst of catastrophe.

  ‘Airway?’

  ‘Clear.’ Guy Knight was opening the red sports bag. Jennifer could see neatly rolled packages and caught a glimpse of cardboard splints lining the base of the bag as some items were pulled clear. She should take the time to use one to splint her forearm, but it didn’t actually hurt too badly anymore and she could wriggle her fingers and even make a fist without causing more than fairly tolerable discomfort. It was a minor injury compared to what the man on the ground had suffered and, as such, it could wait.

  ‘Has he been conscious at all?’ Jennifer stepped around Guy’s feet to get to the other side of their patient. The two-inch heel of her shoe caught between two rocks but she ignored the discomfort the lurching movement provoked. She had obviously collected quite a few sprains and bruises, but hopefully the only broken bone was in her arm. ‘What’s his name?’

  ‘He was alert enough to get out of the plane by himself. He was obviously short of breath and said his ribs hurt, but it took a bit of convincing to get him to sit down while
I went back to see about the rest of you. It wasn’t until I’d got Bill out and went back to check that I found him less responsive.’

  He’d still gone back to help Jennifer out of the wreckage, however. She owed both these men the best she had to offer right now.

  ‘Name?’

  ‘Jim Spade. But he hasn’t willingly answered to anything other than “Digger” for as long as I’ve known him.’

  Jennifer leaned close and rubbed a knuckle on the older man’s sternum. ‘Digger! Can you hear me? Open your eyes.’

  The man groaned and his eyes opened briefly. He jerked his head and his hands moved, but any struggle to speak was clearly too much of an effort.

  ‘Breathing’s inadequate,’ Jennifer stated. ‘Do you carry an oxygen cylinder in that bag?’

  ‘No.’

  ‘Bag mask?’

  ‘No.’

  ‘Stethoscope?’

  ‘Yes.’

  ‘Good.’ Jennifer’s tone implied that he had, at last, provided an acceptable answer. She took the item from Guy’s hands and flicked off the leather jacket draped over Digger’s chest. It was only then that she realised why Guy seemed so inappropriately clothed for the cold temperature. He had been wearing this jacket over his polo-type shirt when he had boarded the small plane.

  Digger had a woollen plaid bush shirt on, the buttons of which only opened a short distance.

  ‘Got some shears?’ Jennifer queried.

  ‘Don’t think so.’

  ‘We need this shirt off. I can’t see what’s going on.’

  Guy leaned forward. He gripped the shirt at the base of the neck opening and ripped the heavy fabric apart as easily as if it had been a light cotton.

  ‘Sorry, Digger. It’s about time you treated yourself to a new one anyway.’

  The T-shirt beneath was ripped from the hem upwards and they both stared at the exposed, skinny chest for a moment as they assessed the chest-wall movement. Breathing was rapid and shallow. Then Guy pointed.

  ‘Look at that.’

  ‘Mmm.’ 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 we’re here…Going to be a while…Rather not listen to…squabbling.’

  Squabbling? She was never that unprofessional, especially when dealing with less qualified subordinates. And just how long was ‘a while’? An hour? Two, maybe? The puff of air around her lower legs as she moved was icy, and Jennifer realised that the chill was why her fingers seemed to be lacking their usual dexterity as she snapped the cap off a cannula.

  It was ridiculous to be engaging in some sort of power play with a rural GP who apparently wasn’t impressed by her position or personality. Or maybe he was still in a huff because she hadn’t recognised him from yesterday’s question-and-answer session. None of that mattered a damn right now because none of them were safe yet. Not by a long shot. She bit her lip as she glanced up to see Guy turning back towards the wreckage of the plane.