Emergency Response

by Nicki Edwards

  “What happened?”

  “Three car MVA.” Motor vehicle accident. “Each car loaded with people. We counted nineteen, but there may have been more than that – a couple were seen doing a runner before we arrived on the scene.”

  Nineteen people in three cars? She tried to do the math. “Why am I getting them?” she asked, trying unsuccessfully to hide the note of dread in her voice. “We’re not set up here for trauma.”

  “No choice. The seriously injured are headed out to Karratha and Perth with the flying doctors. Para and Tom Price hospitals are taking the rest, but they’re already full, which is why you’re getting these two. Looks like they have a few cuts and scratches. I’m told you’ll be able to handle it.”

  Mackenzie remembered Doc’s words. He had told her things could change in an instant, and she was beginning to realize how right he had been.

  Mackenzie barely had time to set up for the injured patients when the police arrived again. It was the same two men as before, but this time their faces wore the look of men who had seen things that couldn’t be unseen. Mackenzie didn’t want to ask. The accident scene must have been bad.

  Behind them, an indigenous woman shuffled in on bare feet, carrying a young child, probably only twelve months old, in her arms. The sleeping child was only wearing a disposable nappy and a dirty T-shirt at least four sizes too big for it. Mackenzie couldn’t see any life-threatening injuries at first glance, but she knew better than to make a judgment without performing a proper assessment first.

  “I’ve only got the two beds and I’m the only one here,” she told the police officer. “I can’t look after him as well.” She pointed to the still sleeping man.

  “That’s all right,” the older of the two policemen spoke up with the same gruff manner as before. “We’ll take him back over to the station and he can sober up there. We shouldn’t have brought him here, but because we were both needed out of town at the scene, we couldn’t leave him on his own in the lockup. They have to be constantly supervised or they hang themselves you know.”

  Mackenzie opened her mouth in shock at his tone. He had gotten under her skin and she was about to correct him when the young man groaned and clutched his stomach. With remarkable speed he rolled onto his side and vomited everywhere. Mackenzie pulled on gloves. She handed the man a plastic emesis bag to hold in case he was going to be sick again. He barely opened his eyes to register her, but took the bag in his hand. It was the most alert he’d been all night. Mackenzie threw towels on the ground and hastily cleaned up the mess as best she could. It would have to do for now. She needed to assess her other patients and a drunk man was not her priority. As the police half carried, half dragged him back out the door to their van, Mackenzie turned her attention to the woman and small child in front of her.

  *

  Half an hour later she was satisfied neither the mother nor her child were badly hurt, at least not physically. As for emotionally, it was hard to tell. Mackenzie wished the police had given her more information about the accident. It was highly likely a member of the woman’s family was one of those killed.

  Once Mackenzie had patched up a few small cuts and grazes, she sat back wondering what else to do.

  The woman’s voice interrupted her thoughts. “Nurse, can you check me sugars?”

  The food Mackenzie had placed in front of her was uneaten, while her child was tucking into the sandwiches as if she hadn’t eaten in days. The little girl was eyeing off the ice cream with large eyes, brown like pools of mud.

  “I’m a diabetic and I’m supposed to check me sugars before I eat. I don’t always remember to, but since I’m here, you can do it for me,” the woman said.

  As Mackenzie pricked the woman’s finger and squeezed the tiny drop of blood onto the glucometer strip, something heavy landed in the pit of her stomach. She barely registered what the woman’s blood glucose level was, except it was within normal ranges, before she raced to her desk. She scrolled impatiently through the list of important phone numbers until she found the one she was looking for. After ten rings, the policeman finally answered.

  “This is Mackenzie Jones,” she snapped. “Over at the hospital.”

  “Yeah? Everything okay over there?”

  “Yes, everything’s fine here. But I’m a bit worried about the patient you took back to the station.” She tried to keep the hint of fear from her voice. Sweat trickled down her back and she lifted her scrub top away from where it was stuck to her skin. Now she longed for a cool Sydney sea breeze. The storm was over, but it was stuffy inside again and she needed to open up the windows.

  “He’s still sleeping,” came the man’s offhand reply.

  “Are you sure? Can you go and try to wake him for me?”

  “Really? It’s late and I’ve got paperwork to do from the accident. I checked on him half an hour ago. Trust me, he’s still breathing. Snoring his head off. You can hear his breathing before you even open the cell door. I don’t need to check him to tell you he’s still alive.”

  Panic tore through her. She cursed aloud. How could she have been so stupid and overlooked something so simple?

  “I need you to go and wake him up right now and I need you to check his sugars. Can you do that? Do you have a blood glucose machine?” She hoped her tone indicated she did not appreciate a lazy cop stuffing her around.

  “No, we don’t have anything like that. Why?”

  No, no, no! Mackenzie screamed inwardly.

  “You have to bring him straight back here. Now! Can you do that?”

  There was a loud sigh over the phone. “Whatever. Give me ten minutes or so.”

  “He may not have ten minutes,” Mackenzie said before slamming down the phone and making another call. She prayed Richard would be available. Unfortunately, fortune was not on Mackenzie’s side, and she left a terse message on the doctor’s voicemail asking him to call her back immediately. If Mackenzie’s hunch was right and they didn’t move quickly, the young indigenous man would probably die and it would all be her fault.

  *

  Less than five minutes later the young policeman dragged the man back into the hospital, filling Mackenzie with a sense of déjà vu. Even from the doorway she heard the man’s labored breathing. Kussmaul breathing. A late symptom of diabetic ketoacidosis. She wanted to kick herself all over again. The man was obviously a diabetic, and while he’d probably been out drinking a bit too much, alcohol wasn’t the cause of his near coma-like state.

  Before the police officer settled him into the bed, she pricked his finger. While she waited ten long seconds for the reading, she checked his blood pressure, filled with alarm when she saw how much it had dropped since she’d checked it only an hour or so earlier. The machine beeped and she glanced at it. His blood glucose reading was ridiculously high, as she’d expected. Without immediate treatment he would die.

  Mackenzie had cared for patients with DKA in the controlled ICU environment, where, surrounded by doctors and equipment, she knew what to do. Here, in the middle of nowhere it was different. As Doc had predicted, she didn’t know what to do when dumped in the middle of an emergency without all her usual support mechanisms. She drew in a deep breath and pulled her shoulders back. She was just going to have to multi-task and do her best. She needed to act fast and there was no time to find the protocols on the computer.

  She inserted a large bore IV cannula into the man’s arm and hung a liter bag of normal saline fluid. Opening the clump fully, she allowed gravity to do its job of filling the man’s veins. She attached him to the monitor and noted the irregularities in his heartbeat, most probably caused from low potassium. Unfortunately she had no way of checking his venous blood gases because the machine had broken the week before and they were waiting on a part to come from Perth. Other than knowing what his blood glucose levels were, that was all she had. There was no way of knowing what his pH or electrolyte levels were – the most important things she needed to know.

  She peered ou
t the window, hoping to see headlights. Where was the bloody doctor? If he didn’t arrive soon and write up insulin orders, she would have to guess.

  Mackenzie had two choices. Follow protocol, keep her nursing registration and the man would probably die while she waited for the doctor. Or, she could take a guess, administer the drugs the man needed and he might live. She’d probably lose her job either way, but it was better than knowing her inactivity had caused a man to die.

  While she waited, she got insulin from the fridge and took another set of obs. The man’s blood pressure was stable, but still low, and his heart rate had increased, as had the ectopic, irregular heartbeats. He was rousable to her voice but was obviously in a great deal of pain, clutching his abdomen and rolling around in the bed. At least he’d stopped vomiting for now, but she expected he would start again soon and it would be the consistency of ground coffee. A very bad sign. Now the smell of vomit and alcohol wasn’t as strong, she caught a whiff of the fruity smell which should have been her first clue to his condition. His skin was dry and she checked his mouth. His tongue was also dry. The older aboriginal woman stood on the other side of the room, watching intently, and Mackenzie felt the pressure in the room increase tenfold.

  If I don’t save this man’s life … She couldn’t even continue

  the thought.

  She glanced from the woman to the man to the drugs sitting on the bench in front of her. Without knowing his potassium levels or the amount of insulin to give him, she could kill him, but if she didn’t give him insulin he would die anyway. She knew she should wait for the doctor but she had no choice. In between panicking and getting out the appropriate fluids and medications, she’d tried calling Richard again but now his phone was switched off. The flying doctors were caught up with transferring all the patients after the accident and would call her back shortly. She’d also tried calling her nursing colleagues and it was only after the third time their phones went to voicemail she remembered they’d driven to Tom Price to go to the movies for the night. For a second she almost considered calling Melissa, her unit manager in Sydney, or even her friend Kate in Birrangulla, but in the end she didn’t have time. She had never felt so alone.

  She eyed the man again and guessed his weight to be around seventy kilograms. He was probably heavier, but she was erring on the side of caution. She drew up the insulin to make it up to point one of a unit per kilogram. As she was about to administer it, she sent a silent prayer heavenward. Once she’d administered the first dose of insulin she changed the bag of fluid from normal saline to one containing potassium. She had to assume his potassium levels were low. Everything she was doing was unorthodox, but she didn’t know what else to do. She rechecked his sugars and they’d come down slightly.

  For the next half an hour she administered fluids into the man’s body as speedily as she dared, alternating between normal saline and bags with potassium added to them. Empty intravenous fluid bags littered the floor. She made a quick count and saw she had filled him with nearly six liters so far. In between, she gave insulin and checked his sugars. To her amazement, he seemed more settled. He was awake, although still very drowsy, but his breathing was sounding more normal. He thankfully hadn’t vomited again and when she’d asked, he’d said the pain in his abdomen wasn’t as bad. His blood pressure was stabilizing and there were less random beats seen on the monitor. Overall, against the odds, he seemed to be improving. She allowed herself a slight reprieve from berating herself for being so dumb and not considering DKA when the police had first brought him in.

  On the bed on the other side of the room the aboriginal woman was sound asleep on her side, her legs tucked beneath her and her child wrapped in the crook of her arm. At the beginning of the night she’d watched Mackenzie like a hawk, worry written across her face. Either she was overcome with tiredness, or had decided Mackenzie wasn’t going to kill one of her people and fallen asleep.

  Mackenzie checked the clock on the wall. There was no way she would be getting out of there on time. She debated texting Nathan and cancelling their trip, but in the end, after documenting everything that had happened, she handed over to Debbie and dragged herself home.

  She collapsed into bed, falling asleep the moment her head hit the pillow. It was the wrong side of midnight.

  Chapter 15

  She should have trusted him. Just as Nathan had promised, the sun was already rising into a bright blue sky devoid of any clouds when she got up the next day. She was waiting on her front step for him to arrive. Although she was still tired from the previous night’s excitement, surprisingly she had slept soundly.

  She took a deep breath. The air had the crisp freshness she loved at this time of day and the grass was still damp from the previous night’s rain. She rubbed her arms, glad she had a thick jumper on. The streets were empty with no movement except for the neighbor’s tortoiseshell cat sitting on a nearby fence post. The cat was carefully washing its face with its paws while keeping one very wary eye on her. After a few minutes when it sensed Mackenzie wasn’t going to approach it, the cat jumped down from its perch and sprawled out on the path in the sun, luxuriously stretching and rubbing itself on the cold concrete. Mackenzie smiled, knowing exactly how the cat felt.

  When she’d left the indigenous boy in Debbie’s capable hands the night before, his sugar levels were almost back to normal limits and her colleague had assured Mackenzie the rest of the paperwork could wait until the following Monday. Debbie gave Mackenzie strict instructions not to worry, and commanded her to go out and enjoy the weekend with Nathan. Mackenzie fully intended to do exactly that.

  Nathan pulled up promptly at seven o’clock and got out of the car. Mackenzie’s heart sped up at the sight of him in his khaki shorts and navy blue polo top and she had to work overtime to stuff down the sudden surge of desire that swept through her before he noticed her weird behavior. He was insanely good-looking and had no idea the effect he was having on her dormant hormones. She was certain if she remembered even half of her dreams when she woke every morning, he would be the starring feature in every one of them.

  He strode toward her, his long tanned legs ending in thick socks and well-worn leather boots. His Akubra sat low on his head, almost touching the upturned collar of his polo shirt. Beneath the brim, warm brown eyes and his ever-present warm smile greeted her. He was freshly shaven, his cheeks red from his razor. As he hugged her in greeting she was enveloped in the aroma of his aftershave and deodorant. She breathed deeply, inhaling his scent. He smelled good too. She hugged him tightly in return.

  “I hear you had a bit of a rough night last night?” he said, looking down at her, his eyes full of compassion. He still held her in his arms and she had to work hard to steady her racing heart. She nestled closer. She could get used to this.

  “How did you hear that?” she asked, looking up into his face.

  “News travels fast.”

  Mackenzie shook her head in wonder. How many people already knew what had happened?

  “I hear you did very well, Mackenzie,” Nathan said, looking directly into her eyes. “That young man is alive today because of you. His family will be grateful. What you did means a lot to the people around here. They won’t forget what you’ve done.” He squeezed her tight again before releasing his hold.

  “Thank you. That means a lot.”

  “Nice boots,” he said, changing the subject.

  His eyes skimmed down her bare legs to her feet. Mackenzie shuffled on the spot, feeling slightly uncomfortable under his open scrutiny. Charlotte had loaned her some shorts as well as the hiking boots, and they were shorter than what Mackenzie would have usually worn. She pulled down at the hem, looking somewhat self-consciously at her pale skin. Her legs weren’t long like his and they hadn’t seen much sun, so they looked lily white and short in comparison. Even so, she was amused to see Nathan was still checking out her legs and she was happy to note the look on his face was anything but revulsion. In fact, if she was reading
him right, he approved of what he was seeing, which sent fireworks exploding in her brain.

  Nathan’s head snapped up as though he realized he was staring. He reached down and grabbed her backpack, spun on his heel and headed to his car. Mackenzie followed, watching the way the fabric of his shorts hugged the contours of his backside. Argh! This has to stop. Then again, maybe it didn’t. If the sparks kept flying between them, this could be a very interesting camping trip.

  Nathan tossed her bag into the back of the car and they took off. He drove with confidence and Mackenzie quickly relaxed, everything at work forgotten. They traveled for hours past low mountain ranges and then through open space with nothingness on either side of the car. The constantly changing landscape around her was astounding. She had heard Western Australia was renowned for its natural beauty and abundance of spring wildflowers and she wasn’t disappointed. Mother Nature treated her to a visual smorgasbord with hundreds of shrubs bursting in blossom. Groupings of mauve, pink, purple, white, yellow and orange blooms were offset by dark red soil, gray-green spinifex and white-barked ghost gums. She’d never seen anything like it on the east coast.

  After hours of driving Nathan pulled over and found a suitable place to set up their camp for the night. Once the engine was off, thick silence blanketed them. A flock of pink and white corellas flew overhead, screeching as they disappeared into the distance.

  “Here, I bought you something.” Nathan reached behind him, pulling a package from the backseat. He handed it to her and she noted the slight blush on his cheeks.

  She untied the ribbon and ripped the packaging apart. Inside was a plain brown box. Nothing about it gave her any clue as to what was inside. She turned it around in her hands, and then stared at him expectantly.

  “Go on, open it,” he urged.

  She did so and let out a cry of surprise. Inside was a brand new Akubra. She lifted it almost reverently from the box and put it on her head. Nathan leaned over and, holding it by the brim with two hands, he gently tugged it down. It was a perfect fit.