‘I am a doctor; Miss Cabot is a nurse, yes. Is there a problem?’
‘There is a great problem.’ Jean-Claude had been schooled not to show emotion, so it was all the more shocking to see the fear and anger on his face.
‘The weather, the snowfall, it is most, most unusual. And so … we have had avalanches. I do not know what will become of this hotel, but the road below us is cut off. The new bridge — it has been swept away. And further up the valley, the village of Vallere, it has been almost destroyed. There has been no avalanche like this for hundreds of years. Many homes destroyed, people killed or lost, many are injured. And we cannot get help in by road because of the destroyed bridge. And we cannot fly help in because of the visibility.’
‘You need medical help?’ David asked.
‘We need it urgently. We need all kinds of help. You will come?’
‘Arrange transport. We'll be downstairs in fifteen minutes.’
Chapter Nine
‘One minute,’ David said. He knelt in front of Jane, opened her robe and wrapped his arms round her waist. Then he kissed each of her breasts. The emotions, the feelings of ten minutes before flashed back instantly, but both knew there was nothing they could do, just enjoy the one minute he had allowed them. It was soon past.
‘Come on,’ she said, pulling him to his feet, ‘we've got work to do. Shall I pack something?’
‘Bring your bad weather gear. And anything that you won't mind getting blood or dirt on. There'll be no uniform up there.’
‘Great,’ she said sadly, surveying the wardrobe full of her newest and most treasured clothes.
‘Better bring a toothbrush, too. I don't think we're going to be back here all that quickly.’
The enormity of what had happened was just getting through to her. ‘What about medical supplies? We've got nothing. Well, I've got a bag with aspirins and plaster and so on, but that's all.’
‘There should be some kind of medical station up there. We'll just have to hope.’
They were quickly dressed, and packed a bag each. Downstairs the lobby looked completely different. Instead of the well-dressed guests at the bar there were worried locals in their climbing gear. Jean-Claude came over to meet them. ‘We must set off at once. It is possible that the road between here and Vallere will soon be blocked, there are no snow ploughs here. We must get there in time.’
He shepherded them out and they climbed up into some kind of four-wheel-drive vehicle. Its engine was already running. Jean-Claude slid behind the wheel, and with a noisy clashing of gears they set off. ‘Bit different from the vehicle we arrived in,’ David murmured.
Jane stared over Jean-Claude's shoulder. The headlights were of little use – all that could be seen was the swirling of snowflakes. The ride was rough. Sometimes they bumped over unseen obstacles, at other times the vehicle would skid madly. She appreciated how good a driver Jean-Claude was. If anything, they were too hot. But no one suggested taming the heat down.
‘I want to know what to expect,’ she said, quietly. ‘Have you ever worked in this kind of operation before?’
‘Once many years ago, just after I'd qualified. There was a bus crash miles from anywhere in Scotland, and I helped the local GP. This is different from ordinary medicine. You don't try to treat anyone. Basically you start with triage, sorting out those who desperately need attention, those who will need it soon and those who can wait. Then you aim solely to stabilise, to make sure people don't get worse. And you arrange for people to go to hospital by ambulance, in the proper order.’ His voice was doubtful. ‘But if what Jean-Claude says is true, there'll be no chance of getting people out.’
‘Who will be in charge? You?’
‘I hope not. It's important that there's someone in overall control who looks after the communications and the transport as well as the medical care. If we can't get people evacuated inside twenty-four hours, there'll be the problem of feeding people and finding them somewhere to sleep as well. This is ultimately a logistical problem — it has to be run like a military operation.’
‘So I tell people what I'm good for, and then do as I'm told?’
He put his arm round her and squeezed her. ‘Have you ever done as you were told?’
They were silent for a while, then she said, ‘Not half an hour ago we were ready for bed. We've had a long day. But now I feel ready for action. I'm not tired at all.’
‘Adrenaline,’ he told her. ‘I suspect you're going to be running on it for some time. Incidentally, do you know about the golden hour?’
She'd heard the expression. ‘It's about what you do after an accident, isn't it?’
‘It's the time between trauma taking place and the definitive treatment of it. If there's only an hour between an accident and the patient being in Theatre, he or she has a good chance. Any delay longer than an hour and the patient's chances go down. Now we're going to have to stretch that hour into hours or even days. It's going to be hard.’
They arrived at Vallere. Ahead of them they saw someone waving a torch, who directed the vehicle to the back of a large wooden building. ‘Village hall,’ Jean-Claude said. ‘Fortunately well out of the path of the avalanche. We'll use it as our emergency centre. It was designed for this purpose.’
They scrambled out of the vehicle and rushed for the door. Inside was a sports hall with great overarching wooden beams. Sitting at the side of the room clustered in groups, there were people, oddly quiet except for those who moaned or cried. They were in shock. Some lay strangely still on the floor. There were two or three young people carrying round trays of warm drinks.
Jane saw a woman clutching her arm in obvious pain. It seemed to be dislocated. She made to go over to the woman but David pulled her back. ‘Do as you're asked,’ he said. ‘That woman will have been assessed. If we all do what we feel like, the result will be chaos.’
‘I don't like passing someone in pain if I can help.’
‘You're going to help people in pain. Now, didn't you once tell me you had training on a burns unit?’
‘Yes. Why? I won't say I liked it, but I think I was good at it.’ The work on the burns unit had been hard, often horrifying, but ultimately satisfying.
‘Surprisingly, there are often a lot of burns after an avalanche. People get swept onto stoves, pushed against cookers. It's odd but it's true.’
Jean-Claude led them behind a set of screens and whispered quickly to a young, fit-looking man, looking rather lost in a white coat obviously not his. The young man looked up, delight spreading across his face. In accented English he said, ‘Welcome, David and Jane. I am Maurice. I am a doctor now for nearly a year. If you will help us, we will be glad.’
Jane's heart went out to him. This obviously unsure young man could have been her brother Peter.
Another, much older man came through, calmer than Maurice and with better English. ‘I am Dr Berfay,’ he said. ‘I am in charge here. And you are?’
Quickly David ran through his qualifications and Jane's as well, mentioning her experience as a burns nurse.
Dr Berfay allowed himself a small smile. ‘I doubt we will have need of an anaesthetist, but your skills as a doctor will be most valuable. Nurse Cabot, we have eight people suffering from burns. Will you do what you can for them? Dr Leclerc will show you where our materials are stored. Then, please, report to me.’
Maurice — presumably Dr Leclerc — pulled her sleeve and led her to a little cloakroom where she could scrub up, and showed her a cupboard with everything she might need for the emergency treatment. For the smallest of burns there was cream but she knew that for anything more serious cream was the last thing she would need. There were sterile dressings and cling film for the worst cases.
‘Dr Berfay seems very organised,’ she said to Maurice.
‘Dr Berfay was once a soldier. He has seen action in many parts of the world. His skills here are very good.’
She remembered what David had said about the golden hour. It was ti
me to start work. ‘I can manage now, Maurice,’ she said, and he led her to the screened off area where the burns cases were lying.
She walked round and glanced quickly at every injury, being careful to keep her features calm. Then she made her choice.
There were two children, one with extensive burns to the arms, the other to the chest. They had been brought in together, apparently caught and scalded by a pot of soup on a stove. They were in considerable pain. She examined them quickly, and decided that the injuries weren't life-threatening. They were superficial partial thickness burns. The skin was red and moist, with a granular appearance. Cream would do, and the comfort of their mother, who was sitting by them still terrified. Jane tried to reassure her, and then went on to the next case.
This one was bad. It was a woman with a deep burn over the abdomen. She had been pressed against a stove. Jane assessed the damaged area as just under fifteen per cent, and noted with dismay that the woman wasn't complaining of too much pain. That was a bad sign. Jane knew there would have been massive plasma loss, so she set up a giving set and arranged for an infusion of Hartmann's solution. That should expand the plasma. But Jane knew that the woman needed expert medical care, preferably in a dedicated burns unit. Here she would just have to take her chance.
It was difficult to take a case history as she spoke very little French, but somehow she managed. The rest of her patients appeared at first not to be too seriously ill, and she was able to act as a normal nurse, treating injuries and offering care and sympathy. For pain relief there were two intravenous injections of nalbuphine.
There was one last thing she was worried about. She knew that inhalation injury was now the commonest cause of death in burns. She'd examined all of her patients for burns round the lips and singed nasal hair, and checked breathing constantly. Wheezing, excessive coughing, signs of respiratory distress – all were danger signs. But this time she appeared to be in luck.
Only on the third inspection did she come to suspect it. It was a man with superficial burns on his back, showing a long crooked red line. Jane carefully cut the shirt and sweater away from the burn, then placed clean cold-water compresses over the charred cloth. The man was lying, of course, on his chest.
When she stooped to look at his face she found his pupils dilated, and he had cyanosis of the lips. He seemed to have lapsed into a coma. Jane tried to take a history from those around her, asking just how had the man been injured. It was hard, speaking in broken French and broken English, but eventually she picked up the words 'car exhaust', and gathered what had happened.
A car, with its engine running, had been turned on its side by the avalanche. A further fall had pressed the victim against the exhaust pipe – the engine had still been running – hence the long crooked burn. However, it had been some, time before the man had been dug out – he'd been completely covered by snow. She guessed then what was wrong. The man was suffering from carbon monoxide poisoning, having inhaled the exhaust fumes.
Quickly, she fetched the cylinder, fixed on the mask and gave him one hundred per cent oxygen. He also needed to be transferred to a specialist unit, but he'd have to take his chances.
For the moment there was little more she could do with her little group. In hospital she would never have dreamed of leaving them, but this was still an emergency situation.
She found Maurice outside her little area and told him she thought she could be free for half an hour so should she report to Dr Berfay?
‘Dr Berfay and your Dr David, they are setting a leg. The bone is … how you say … ? It has damaged the flesh, there is more than one piece broken.’
‘A comminuted fracture,’ Jane said, wincing.
‘Dr Berfay is very glad that David can give the anaesthetic and perhaps help. The patient is an old man. With two doctors perhaps he will be lucky. But now perhaps you will help me? There are some ladies I have to examine, and perhaps I will need some help with bandaging.’
They worked through the night. They had three doctors and an abundance of willing but unskilled helpers. She was the only trained nurse. After a while she found that she was supervising the helpers, rather than nursing. It wasn't ideal but it was the only thing to do.
Once or twice she saw David. They smiled at each other, but didn't stop to talk. There was work to be done.
Dawn came, just a gradual lightening of the dark. The snowstorm was as heavy as ever. Jean-Claude came to find her. Apparently, he was supervising the cooking of food and the sleeping arrangements. ‘I think you should sleep now,’ he said.
‘I'm all right, Jean-Claude. Good for a few hours yet.’
He shook his head. ‘It is not enough to be good for a few more hours. This situation may last for days. There is no way of getting our patients down the road. The bridge is down and the army is trying to erect another one. No helicopters dare try to land. We are … I think the word is marooned.’
‘Just a couple of hours, then.’
‘I have a meal for you by your bed. Soup, bread, cheese.’ He shuddered. ‘What a way to feed my guests! But it is fuel, not food.’
In fact, it was marvellous. She was to sleep in a camp bed in yet another corner of the main room, partitioned off by screens. This was the doctors' quarters. There were three camp beds there. She took off the trainers she'd been wearing instead of boots and lay on the bed fully dressed. Within seconds she was asleep.
Jane became aware that someone was leaning over her, and she woke to find it was David. He looked tired. His hair was in a mess, he needed a shave and he smelled, half of man, half of hospital. And she thought she'd never seen him look more lovable. She reached up and pulled him down to her.
‘This isn't quite the holiday I'd planned,’ he said.
‘It's not quite the holiday I expected. But I'm with you – well, some of the time – and I'm happy. David, you look all in.’
‘I'm going to get into your bed. Unfortunately, you're going to get out of it. Are you still up to this, Jane?’
‘Watch it, matey! I'm a nurse. We carry on when all around us doctors falter and fail. Yes, I'm up to this.’ She wriggled out of bed. ‘I need five minutes in the bathroom then I'm ready for work.’ She looked sadly at the once good shirt and trousers she was wearing. ‘I don't think they've got a clean uniform for me, though.’
He kissed her, and she hugged him. ‘Love you, sweetheart,’ he said. She went to pick up her bag. When she turned to look at him he was already asleep.
Jean-Claude found her a piece of bread and a cup of coffee. He told her that the weather was still as bad and there was still no hope of relief. She reported to Dr Berfay for duty. He asked her to go with Maurice, look first at those with burns and then help with the rest of the patients.
‘This is now becoming a nursing not a medical situation,’ he told her. ‘A few more injured were brought in while you were asleep, but I doubt there will be more. Those not yet discovered will be dead. We must hold out as best we can until we are relieved.’
He did make it sound like a military operation, but she realised that this attitude was necessary. It prevented chaos, helped save lives.
There were only seven now in the little burns section. The man with the burn to his back, with possible carbon-monoxide poisoning, had gone. She looked at Maurice questioningly.
He shrugged and spread his hands. ‘In hospital, perhaps with the right equipment, he might have lived. You – we – did all that was possible. It was not enough.’
She didn't have the energy to spare to grieve. ‘The rest look reasonable,’ she said. ‘I'll change dressings and so on, and then come to find you.’
There had been some changes made while she'd been asleep. Those who were only mildly injured, or suffering from shock, had been moved to another building. There was no longer the background noise of screams or sobbing so it came as a bit of a shock to hear shouting, and then the sound of a scream. She looked over, and saw that someone new had been brought in.
Dr Berf
ay had at long last gone to sleep. Only she and Maurice were on duty. And she could tell from a distance that Maurice wasn't happy. She knew she shouldn't interfere until asked, but something about the woman's screams made her incapable of keeping away.
The patient was a woman of about twenty-five. And her distended abdomen made it obvious she was about to give birth. Maurice was bent over, listening with a Pinard's stethoscope for foetal distress, but Jane knew what was wrong. Emmy's was a women's hospital, and she had seen a vast number of pregnant women brought into Theatre. The signs were obvious.
‘How long has she been in labour?’ she asked Maurice.
‘Twenty-four hours. This is her first child, but …’
Maurice had witnessed perhaps a couple of dozen births, while she had helped with literally hundreds. Here she was the expert. She conducted a swift internal examination and realised what was wrong at once – a deep transverse arrest. Quite simply, the baby was stuck. ‘This woman needs a Caesarean section — quickly. Shall I wake up David and ask him to do it?’
Maurice would be good in time. ‘Certainly,’ he said. ‘I do not now feel quite competent. I will have her carried to where we can operate.’
David looked so peaceful asleep. She looked at him once, then leaned over and shook him vigorously. Bewildered, he opened his eyes. He had been asleep an hour.
‘David, there's a woman who needs a C-section right now. You'll have to do it.’
His eyes focussed and she saw him take in the message. He swung his feet off the bed. ‘I'll wash my face and be with you in two minutes,’ he said. ‘Be a good scrub nurse and lay out what I'll need.’
Caesarean sections were often performed quickly. There wasn't the full equipment necessary for swift anaesthesia so David gave a spinal block. It was tricky, but somehow he managed it. Then Jane rushed through the necessary procedures before the operation began. She winced as she cut corners, missed precautions that, in a hospital, would have been second nature. But this wasn't a hospital. It was a battlefield.
The Time is Now Page 14
