A Doctor Beyond Compare

by MELANIE MILBURNE

  ‘Not at all,’ Holly lied. ‘I kind of figured it was a practical joke and dismissed it as that.’

  The older woman gave her a tremulous smile. ‘You’re being very gracious about this. Thank you.’

  Holly smiled back. ‘Thank you for coming to tell me. I know it must have been very hard for you under the circumstances.’

  ‘I’d better be going…’ Mrs Shoreham got to her feet. ‘I don’t like to leave Grant on his own too much…’ She held out her hand. ‘Thank you again for being so understanding.’

  Holly took the thin hand in hers and gave it a gentle squeeze. ‘Thank you, Mrs Shoreham.’

  Cameron looked up from the paper when Holly came into the clinic kitchenette at lunch time. ‘I heard you had a visit from Lisa Shoreham. How did it go?’

  Holly pulled out a chair and flopped down into it. ‘You’re not going to believe this.’

  ‘Try me.’

  ‘Guess who broke into my house.’

  ‘You’ve got to be kidding me.’

  ‘Her husband did it to pay me back for doubting Noel Maynard’s conviction.’

  He whistled through his teeth as he absorbed the news. ‘I didn’t even know he came into town any more. I’ve heard he sits at home drinking himself into oblivion most days, not that you could blame him.’

  Holly looked at the newspaper still in his hands. ‘What does my star guide say today?’

  He gave her a teasing look. ‘You surely don’t believe in all this rubbish, do you?’

  She gave a non-committal shrug.

  He turned to the paper and flicked through until he came to the horoscope section. ‘“Sagittarius: You will be confused about your feelings on a certain issue. Trust your heart and don’t let other people’s actions sway you from what you believe to be right.”’

  She gave him a sceptical glance. ‘Now, what does yours say?’

  He looked down at the paper once more. ‘“Gemini: You will be thinking of faraway places and lost loves…”’ He let out a muttered curse as he tossed the paper to one side and got to his feet. ‘God, who the hell writes this stuff?’

  Holly swivelled in her chair to watch him as he strode out of the room, his lunch abandoned on the table. She let out a tiny defeated sigh and, turning back, reached for one of the egg sandwiches off his plate.

  CHAPTER EIGHTEEN

  HOLLY decided that since no one had booked in to see her for the remainder of the day she would go for a drive to let off some steam. It was a beautiful day; the sun was warm but not overly hot so she opened her sun-roof and let the breeze lift her hair as she took the road for the hills behind Baronga Beach.

  She was halfway along the dirt road leading to some caves she’d seen signposted a few kilometres back when she saw out of the corner of her eye a body lying on the side of the road, a crushed bicycle flung a few feet away.

  She slammed on the brakes and reversed back, her heart beginning to race in panic.

  Calm down, she mentally chanted. Think about trauma management principles. She got out of the car on shaking legs and inspected the body. There, crumpled into a broken heap, bleeding from multiple cuts and abrasions, his clothes torn and shredded, was Noel Maynard.

  ‘Noel…’ she gulped as she dropped to her knees beside him. ‘What happened?’

  Noel made some groaning sounds, but was clearly unconscious. He had a deep laceration running across his forehead from which blood was still running, his left femur was at a forty-five degree angle, his shirt was shredded, revealing multiple abrasions over the left chest, and the palms of his hands were white and, although she repeated his name several times, he made no verbal response.

  Holly carefully shifted his position so that he was more on his side, protecting his airway from aspiration of vomit and mindful of protecting his neck from movement. She then retrieved her mobile phone from her handbag back at her car but, to her shock, there was no signal. She stared at her phone in horror. How could there be no signal? She looked around at the hills behind and let out a single expletive.

  She turned and ran down the road until the signal came back. ‘Oh, thank God!’ She quickly keyed in Cameron’s mobile number.

  ‘McCarrick.’

  ‘Cameron, it’s Holly. I’m on the road out to Tolly’s Caves. I’ve just come across Noel Maynard, about ten kilometres from town, I think. He’s been knocked over and seriously injured. It looks like a hit-and-run.’

  ‘Have you called the paramedics?’

  ‘No, I called you first because I had to run down the road to pick up a signal as it is.’

  ‘I’ll come out right now with the paramedics. You say you’re on the road to the caves—you must be on the back road. There’s nothing out there. You’re lucky to be in mobile range at all, so you can’t be more than a few kilometres out. Hang on and we’ll be there in ten or so minutes. Are you OK?’

  ‘Yes, yes, I’m OK. But Noel is going to be lucky to survive this. Hurry up, Cameron. I’ve got my doctor’s bag but it won’t be enough. Please hurry,’ she begged. ‘I don’t know if I can do this by myself.’

  ‘Hang on, Holly, we’re on our way.’

  Holly grabbed her doctor’s bag from the boot of her car. Even though she’d failed the practical exam of the Emergency Management of Severe Trauma course, one of the instructors had harangued the participants to take home from the course ideas on how they could apply the lessons to the situations in which they practised. He’d insisted that they all apply the EMST principles to putting together a doctor’s bag of equipment to allow them to deal with the basics of ABCDE.

  As Holly hurried back to Noel’s side she was silently grateful that she had at least taken that much on board. Now her trauma skills were going to be sorely tested and this was no practice scenario in an air-conditioned educational centre. It was the real thing, in the dirt and grime of the roadside, with no help and limited equipment.

  She pulled open her bag and put on a pair of gloves and some goggles. She then took her only adult Guedel’s airway and inserted it into Noel’s mouth. He was still breathing spontaneously but had stopped groaning, becoming more deeply unconscious. She had no oxygen supply, no bag or mask. If he stopped breathing, the best she could do was use a plastic air viva respirator tube to do protected assisted respiration. She desperately hoped it wouldn’t come to that.

  She took her stethoscope and listened to his chest. There were no breath sounds over the left chest, which was covered with abrasions, presumably from where he had been dragged along the road by whichever vehicle had knocked him down. She felt his chest and noted crepitus over the left upper chest, indicating subcutaneous emphysema. Percussion was hyper-resonant over the left chest and his trachea was shifted to the right, the hallmarks of a left tension pneumothorax. His hands were pale and sweaty, clearly signs of hypovolaemic shock, and possibly cardiogenic shock as a result of the pneumothorax.

  Holly had some large bore IV canulae in her kit. She cleared away what was left of Noel’s shirt from the front of his chest, took an alcohol swab and prepped the second left intercostal space in the midclavicular line. She punctured the skin with the canula over the top of the second rib, slowly advancing it until it suddenly gave way as she punctured the pleura. There was a distinct hiss of air as the high pressure pneumothorax decompressed. She then inserted another canula next to the first, to increase the air flow. Noel’s breathing seemed to improve and he was moaning again. Holly listened to the left chest again with her stethoscope—this time there was at least some air entry to hear.

  In her kit there was one bag of normal saline and a giving set. She connected the set to the bag of fluid and ran through some saline to flush the line. She took an elastic tourniquet and applied it to Noel’s left mid-forearm. She then took another alcohol swab and prepped over a large vein on the radial side of Noel’s left wrist, inserting her only remaining IV canula into the vein successfully. She attached the giving set, removed the tourniquet and started running in the normal sa
line full bore.

  She had a few four-inch crêpe bandages in her kit, which was now looking a little depleted. She removed the cellophane outer covering from one of the bandages and carefully applied a head bandage, trying to move Noel’s neck as little as possible, but successfully controlling the bleeding from his forehead. She then took a pair of scissors and cut open his trousers over the angled left leg. He clearly had a fractured femur. His left shoe was missing and he had no socks on. Holly felt for his dorsalis pedis pulse—it was absent and the sole of his foot appeared dusky.

  The arterial supply is blocked at the fracture site, she thought.

  As gently as she could, she straightened the thigh, causing an enhanced bout of moaning from Noel. Holly noted that the peripheral pulses in the left foot were now palpable. Looking around, she noticed a piece of pipe lying close by. She retrieved it and found a reasonably straight piece of stick. Using these as temporary splints and her remaining two crêpe bandages, she roughly splinted Noel’s left thigh, again checking that his peripheral foot pulses were intact.

  She looked in her bag. There was little else. She took a small penlight torch and checked Noel’s pupils. The left pupil was dilated and unreactive, the right normal-sized and reactive.

  He could have intracranial haemorrhage, Holly thought. But there’s nothing I can do about that here.

  Just then a familiar city sound wafted in from the distance—the sound of a wailing siren. Holly breathed a sigh of relief. Thank God, the cavalry had arrived and Noel was still alive.

  Within a few seconds a red-and-white country ambulance pulled in front of Holly’s car, Cameron the first to jump out.

  Cameron quickly took in Noel Maynard’s shattered form, but with tubes and bandages attached and a white-faced Holly beside him, her doctor’s bag looking almost empty.

  ‘You OK?’ he asked.

  She gave a quick nod.

  ‘What’s your assessment of his injuries?’

  ‘He’s got a GCS about seven or eight, responding with groans to pain. There’s a bleeding laceration on his forehead, which I’ve controlled with a bandage. His airway’s clear and he’s breathing spontaneously. He’s got a dilated non-reacting left pupil—my worry is an intracranial haemorrhage. He’s got left fractured ribs and subcutaneous emphysema, and had no breath sounds on the left and a deviated trachea to the right, so he had a left tension. I decompressed that with a couple of large-bore IV needles, but he’s going to need a definitive chest drain. I started my only bag of saline through the largest bore IV canula I had, about a fourteen gauge, I think. I’m running it in full bore and it’s almost finished. And he’s got a fractured left femur, which I’ve roughly splinted. It had been angled and there were no peripheral foot pulses; they’ve come back since I’ve straightened the leg and splinted it the best way I could.’

  ‘That’s the most impressive roadside resuscitation I’ve ever seen,’ said Cameron, directing the paramedics with their trolley to the patient. ‘I have to say I am very impressed. Well done. Listen, can you stabilize his neck while I get a hard collar on?’

  ‘Sure.’ Holly could feel a warm inward glow at his praise. She’d been so worried she wouldn’t cope and yet here he was telling her what a good job she’d done.

  Soon the collar was applied, some oxygen was running via a mask, more IV fluids were attached and Noel was log-rolled and carefully placed on to a spine board.

  ‘I’ll go back in the ambulance with him, Holly. You follow in your car. We’ll radio through for a retrieval team from St George by air ambulance. Will you be OK to drive?’

  ‘Sure. I’m fine,’ she said, doing her best to disguise her shaking limbs as the stress of her encounter started to hit home.

  Within seconds the back of the ambulance was closed and it moved off down the road, lights flicking red and siren wailing.

  Holly slumped into the driver’s seat of her car and stared straight ahead, taking several deep breaths before turning the ignition and starting her engine.

  Once the airlift team had taken Noel Maynard to the nearest trauma centre, Cameron turned to Rob Aldridge, who had not long come back from the accident site to talk to Holly.

  ‘Any idea who’s responsible?’ Rob asked.

  ‘No idea at all,’ Holly said. ‘I didn’t see a single vehicle on my drive out there.’

  ‘With the sort of injuries he’s got, the car that hit him must have some sort of damage,’ Cameron pointed out. ‘Noel’s bike is a mess.’

  ‘Yes…’ Rob rubbed his chin thoughtfully. ‘I wonder if it’s the same person who trashed your cottage.’

  Holly exchanged a quick glance with Cameron.

  ‘The person responsible for that has already come forward and apologised,’ she said. ‘I don’t want to take it any further.’

  ‘Who did it?’

  ‘I don’t think that’s—’

  ‘Grant Shoreham,’ Cameron said, earning a caustic look from Holly.

  Rob rolled his lips inward. ‘I’d better go and have a chat with him after I’ve spoken to Maynard’s mother.’

  ‘I can go and see her if you like,’ Holly offered.

  ‘No,’ Rob said. ‘I need to get a statement from her about Noel’s exacts movements.’

  Holly waited until the police officer had left before turning on Cameron. ‘I promised Mrs Shoreham I wouldn’t report that stupid chicken incident—now you’ve gone and blabbed.’

  Cameron looked down at her. ‘You’ve got dust on your nose.’

  ‘I’ve got…what?’ She put her hand up to her face.

  ‘And you need to go home and have a shower and take the rest of the day off.’

  Holly wanted to argue with him on principle but the truth was she didn’t have the energy to do it. ‘Fine. I’ll go home. I don’t have any patients, anyway.’

  Cameron watched her stalk off, a small frown beginning to pull his brows together as some thoughts shifted around in his head. He turned around after a moment and reached for the phone and dialled Accident and Emergency at St George and asked to be put through to the doctor on duty. After he’d introduced himself, he asked the doctor to conduct several blood tests on Noel Maynard, who was due to arrive shortly.

  ‘Wilson’s disease?’ the registrar asked. ‘What’s that got to do with his trauma? I’ve never seen a case.’

  ‘It is rare. But it could be important in this case. How soon can you get the results?’

  ‘God, I don’t know. I’ve never ordered the test. Listen, Biochem here is pretty good. I’d be surprised if it would take more than a few hours. I’ll see if I can fast-track it.’

  ‘Good, thanks for that. Can you fax the results to our clinic here as soon as you get them through? Here’s the number…’

  CHAPTER NINETEEN

  HOLLY had not long showered and changed when she heard a tentative knock on her front door. She peered through the curtains to see who it was before opening the door to Jacinta Jensen.

  ‘Dr Saxby…can I talk to you?’

  ‘Sure.’ Holly closed the door once she was inside. ‘How are you?’

  Jacinta lowered her eyes. ‘I’m fine…’

  ‘Would you like a glass of juice or something?’ Holly asked. ‘I was just about to have one.’

  ‘No…no, I just want to get this over with…’ She twisted her hands together.

  Holly frowned. ‘Why don’t you sit down and tell me what’s on your mind?’ She led the way to the sofa and watched as Jacinta perched on the edge of it while she took the chair opposite.

  ‘Do your mother and stepfather know you are here?’

  The young girl shook her head, her eyes downcast.

  ‘Have you changed your mind about pressing charges?’ Holly asked after a long silence.

  Jacinta looked up at her. ‘He didn’t do it.’

  Holly stared at her for a moment. ‘What do you mean?’

  ‘Noel Maynard didn’t do it,’ Jacinta said. ‘I only said he did because I…I…’ She
began to cry.

  Holly left her chair to sit on the sofa by the young girl’s side, taking her hand in hers and stroking it. ‘If he didn’t do it to you, then who did?’

  Jacinta looked at her with red-rimmed eyes. ‘My stepbrother, Martin.’

  Holly tried to hide her shock but it was almost impossible.

  ‘It’s not really his fault,’ Jacinta continued. ‘I’ve been awful to him for ages. He ignores me most of the time but this time I…I…made him so angry he grabbed me and gave me a little shake. I bumped my eye on his wardrobe.’

  ‘What were you doing in his bedroom?’ Holly asked after another little silence.

  Jacinta’s face coloured up. ‘I know you’re going to think this is terrible of me, but I wanted him to sleep with me. I tried to get him to kiss me but he wouldn’t…That’s why I came to you for the pill. I think I’m in love with him.’ She gave Holly an agonised look. ‘Is that against the law or something?’

  Holly let out a little sigh. ‘It won’t be against the law when you’re a little older but right now you’re under age.’

  ‘My mother will be so ashamed of me,’ Jacinta sobbed. ‘I’ll be sent away to boarding school for this, I just know it. I hate myself. I don’t know why I behave the way I do…It’s just I still really miss my Dad and I can’t quite forgive my Mum for finding someone else so soon. Do you think I’m bad?’

  ‘Of course I don’t. I know it’s a little different, but when my parents separated they both had new partners within a few short weeks. I was furious with both of them.’

  Jacinta dabbed at her eyes with the tissue Holly had handed her. ‘I hated changing schools and I have no friends. No one likes me here.’

  You and me, too, honey, Holly thought. ‘It takes time to make friends in a new place,’ she said. ‘You have to build up trust, but also you have to learn to like yourself more. That way others will see the real you instead of the façade you put up. Give it more time; you’ll settle in eventually.’

  ‘Thanks,’ Jacinta said. ‘I just had to tell someone. Martin will be furious; he made me promise but I heard Mr Maynard got hit by a car…I was so frightened that…that…someone might have done that to him because of what I’d said.’