Bride at Bay Hospital

by Meredith Webber

  ‘We’ll have the police here any minute and any of you still here, aside from those two, will be arrested.’

  Meg doubted the water police could arrest all the people on upwards of seven boats, but the threat seemed to have some force as small motors started up and the little boats, most with one or two people in them, eased away—though only far enough to allow space around the accident site. They may not have caught many fish that evening but they’d go home big with news.

  The big trawler came alongside the coastguard vessel, and the two divers, then Meg and Sam, were transferred. The deckhand passed across some lightweight stretchers—ones from SES equipment, Meg guessed—and some first-aid packs as well, one of the coastguard crew taking charge of them, everyone working quietly and efficiently. The trawler was then sent to the other side of where the vessels had gone down, to send light towards the sunken boats.

  Meg shuddered at the ghostly white bows of the big trimaran poking up from the bottom of the bay, but there were injured people on the deck in front of her, and work came before pity.

  ‘We’re putting them into the recovery position, checking airways and major bleeding, but we’ve not had time to do much else,’ the coastguard man who’d collected the new gear explained. ‘There are a couple of bad-looking ones up front—if one of you’s a doctor, you might start there.’

  Sam picked up one of the packs and followed him, while Meg knelt beside a woman who was lying silently on the deck, on her side but barely breathing.

  ‘Can you hear me? Can you talk?’

  Eyelids lifted to reveal grey eyes but they couldn’t focus and the woman’s eyelids closed again almost immediately. Meg pressed a hand against the woman’s chest and felt the faintest movement as she breathed. Ten seconds, feel for ten seconds—the rate was fast but her breathing shallow. Meg felt for expired air next, then reached for oxygen. Air was getting in and out—straight oxygen would help.

  Meg spoke to her again and the woman coughed—gag reflex OK. A nasopharyngeal tube would carry the oxygen directly into her lungs.

  Hands moving almost without direction, Meg got the oxygen flowing then felt for the woman’s pulse.

  Racing—over one hundred beats a minute. Together with the rapid breathing it suggested pneumothorax, a condition where air was getting into the pleural space between the chest wall and the lungs but getting trapped there, unable to get out. As it built up it would not only put pressure on the lungs but on the heart and major blood vessels running through the thoracic cavity.

  Meg’s mind pictured the accident. Two boats colliding. There’d have been a jar, knocking those who were standing off their feet, those sitting off their chairs—against the table?

  She pressed gently against the woman’s chest, feeling the distortion of the rib cage at the same time the woman gasped and flinched away from her.

  Cracked ribs, possibility of one puncturing a lung, definite possibility of a pneumothorax—but tension, which could be deadly, or a simple one that could be handled later?

  The first two signs of tension pneumothorax, rapid breathing and rapid pulse, were there, and the woman’s skin was clammy, but whether from her dunking or shock, Meg couldn’t tell.

  Very gently Meg turned the woman on her back, unwrapping the blanket that had been tucked around her, needing to examine her for more signs, hearing through a stethoscope the loud sounds on the left side of her chest, seeing distended neck veins as affected vessels battled to get blood through what was like a road-block in their way. And the final clue, the woman’s trachea deviating to the right—away from the affected side.

  Tension pneumothorax. She needed to release the trapped air by needle thoracentesis—plunging a cannula through the second intercostal space and attaching a syringe so the air could escape.

  Meg found the equipment she needed, stripped back the woman’s clothing, measured the midclavicular line where the cannula should go and plunged it in. The satisfying hiss of air told her she’d done the right thing, and a movement from the woman suggested she was already feeling better.

  IV access next—internal injuries could be causing blood loss and fluid replacement was essential. It was second nature to her now—years of training and practice coming together so she had the woman hooked up to fluid and was contemplating inserting a chest drain to remove the remaining air from the chest cavity when Sam squatted at her side.

  ‘All OK?’

  ‘Apart from the fact my legs are getting too old for this kind of crouching,’ Meg told him, ‘everything’s fine.’

  She explained what she’d done, asked about his patients—both now transferred back to shore and left him to insert a chest drain with a one-way valve, while she moved on to the next patient.

  A man more concerned about whether his wife had got out safely than his obviously broken leg. Meg checked him out but found no other damage, organised oxygen, fluid, pain relief, splinted the leg, eased him onto a stretcher and tagged him to be taken to shore.

  ‘I can’t go without her,’ he protested, as two of the coastguard appeared to carry him across to one of the boats doing the shore run.

  ‘She might already have gone ashore. I did hear they had thirty people at the wharf, mostly unharmed. You can’t help her here and you’re taking up space we need as more people are brought up from the boats.’

  ‘But if they’re being brought up, they’ll be dead. They’ll have drowned. We were celebrating our wedding anniversary.’

  He began to cry, and though Meg wished with all her heart she could spare some time to comfort him, he had to go. But what comfort could she offer when the thought of people trapped and drowned filled her with such agonising sorrow herself?

  But as the two men lifted the stretcher she heard one say, ‘She could be all right. One diver’s been up. There’s an air pocket there so there’s air to breathe.’

  And though Meg felt relief, another question soon quelled it.

  How long would the air last?

  How many people would it sustain?

  CHAPTER EIGHT

  MORE VICTIMS were brought onto the coastguard vessel, blankets quickly wrapped around them then they were passed along for her or Sam to check.

  The divers had first offered oxygen from their own tanks to those trapped below, then had taken tanks down for the victims to share until they could be helped out. Some with the confidence a few gulps of oxygen had given them had even made their own way up to the surface, where willing hands had hauled them aboard.

  ‘I’m going down, there’s someone trapped.’

  Meg turned from a woman she was tending—bandaging a badly scraped shin—to see Sam struggling into a wetsuit much too small for him.

  ‘It’s a man in the galley of the trimaran. I might have to amputate his foot to get him out. You’re OK here?’

  Meg looked in horror at Sam. He was going down into the dark waters of the bay to cut off someone’s foot, and he made it sound…normal?

  Or was he speaking that way not to panic her?

  She reached out and touched his leg—well, the cold, clammy rubber of the wetsuit on his leg—and said, ‘Take care,’ hoping her voice didn’t quaver enough to give away her horror.

  He bent and pressed a hand against her hair.

  ‘I will,’ he said, and it sounded like a promise.

  But was it a promise he could keep? If the man was trapped, whatever was trapping him could fall on Sam. Trap him! And who would cut him free?

  She worked on, hoping to escape the thoughts chasing through her head, but although she worked efficiently and spoke cheerfully to all the patients as she tended them, her heart was with Sam while her mind made little bargains with uncaring fate—promising her soul for his safe return.

  At last the final passenger had been shipped back to shore—or last but one. Sam and the two divers were still down below, still trying to rescue the trapped man.

  How badly was he hurt? Would shock and lack of treatment kill him before the
y got him out?

  Meg walked into the cabin of the coastguard cabin where the captain was talking to someone on his radio.

  ‘How bad are things back on shore?’ she asked, as he turned it off and acknowledged her with a nod and an offer of coffee.

  She answered with a nod herself, and followed him to a table with an urn on it. A litter of dirty cups and teaspoons showed coffee had been much in demand all evening.

  ‘The most badly injured have been taken straight through to the city,’ he told her. ‘The Bay hospital has been treating people for shock, keeping a few for observation but on the whole sending home those people who have family or friends to watch over them.’

  ‘How many were there? Did they all survive?’

  The man made her coffee then waved his hand towards sugar in a paper bag and milk in its carton.

  ‘We have two fatalities,’ he said quietly. ‘I’m thinking they were in the speedboat that hit the trimaran. Teenagers, both of them. They were the first taken ashore—one of our blokes went with them on a trawler that was coming in from netting the shallow banks.’

  ‘Did you know them?’ Meg asked gently, hoping the pain in his voice was for a different reason. He turned away but not before she saw him swallow hard.

  ‘One young bloke’s a neighbour,’ he said. ‘His mother’s had a rough time as it is. Her husband left her a couple of years ago—just took off without a thought for how she’d cope with four young kids. We’ve all helped out but Josh—the one who died—he…I guess he resented his dad leaving him like that and he’s taken it out on the whole world. Angry—that’s how he was, all the time. He’d have been speeding across the water, probably with no lights. All that anger…’

  Meg hadn’t thought her heart could ache so much for someone else, but right now it was aching for Josh’s mother.

  As much as it had ached for Lucy.

  And suddenly she was fiercely glad she’d told Sam she wouldn’t marry him. Marriage was too hard. There were too many stresses and strains and bad stuff that could happen—too many heartaches waiting to strike when you least expected them.

  Sam! Was Sam all right?

  She sipped her coffee and went back to worrying, although her chest still throbbed with the referred pain of a woman she didn’t know.

  Sam breathed in and out, checking from time to time the dial that showed how much oxygen he had left in his tank.

  The two divers were working with pinch bars to try to prise the refrigerated cold room off the man’s foot, but the weightlessness of water meant they couldn’t get the leverage they needed, and steel plating used in the decking of the trimaran meant they couldn’t bash away the deck to free him that way.

  Sam held the oxygen mask to the man’s nose and supported him, but he guessed there was injury to the foot already, for the man’s pallor suggested he was losing blood, though the shadowy water didn’t show it.

  Unable to communicate apart from basic hand signals, he had no idea of knowing if the divers’ work was meeting with success. He hoped so—the idea of amputating the man’s foot in such circumstances was making him feel physically ill. Although in his head he was rehearsing it. The first thing the divers had done had been cut away the man’s slip-on shoe, thinking to pull his foot out of it, but the foot wouldn’t move.

  The ankle was clear, which was good, and he thought the tarsal bones, the ones closest to the ankle, could probably be saved. But with the metatarsals and the phalanges trapped by such a weight, the chances were they were crushed and worthless anyway.

  But cutting through? Getting through the bones. No, around the bones—cut through the sinews and ligaments of the joints but keep as much skin as possible so the wound can be closed over neatly.

  Would half a foot ever be neat?

  No, think positive. The man had already been given a sedating injection—just enough to relax him—and Sam had put a nerve block in his leg so he was feeling nothing below the knee. Everything was ready—should it be necessary.

  Pray it would not be!

  The divers straightened and gave the signal he’d been dreading. No can do!

  OK, it was up to him. Up to him, and speed was essential. Hard to bandage a cut-off foot underwater!

  He signalled to the divers to hold the patient and slid lower in the water, first securing a ligature around the man’s leg, just above the ankle, hoping it would stop enough blood flow to save the man bleeding to death while he operated. Then with concentrated effort he unsheathed the first of the scalpels he’d tucked into his weight-belt and more by feel than from the feeble light penetrating the churned-up water, he began to cut, starting right against the steel container that pressed against the foot, delving deeper as he felt each bone, using his hands to find the joints before pressing hard between them, remembering as he pressed just how tough nerves and sinews and ligaments were.

  It was taking for ever.

  The man would surely die.

  He was running out of oxygen.

  They all must be.

  Then a movement—an involuntary spasm of the man’s calf or thigh muscle—and the foot moved. Sam wrapped a sodden towel around it and held on tightly, signalling to the divers at the same time to take them up.

  They rose swiftly, not deep enough to be concerned about the bends, willing hands reaching out to take his patient. Sam tore away his own mask to yell at Meg, whose pale face hung above him.

  ‘Pad and bind his foot then loosen the ligature just slightly, give him oxygen and start fluid IV.’

  The man was already gone, and so was Meg. Now all Sam had to do was haul his weary body aboard the vessel and tend his patient.

  The twin motors of the coastguard vessel roared as the driver took off, heading back to shore the moment he had Sam and the divers on board.

  ‘He’s being well looked after,’ one of the crew told Sam as he lifted the oxygen tank from his back, taking its weight while he undid the straps and eased it off his shoulders.

  How long had it been since he’d last dived?

  He’d certainly been fitter then. His shoulders ached with strain, and getting out of the wetsuit and into his dry trousers and shirt all but exhausted him.

  ‘Hot sweet coffee, mate.’

  Another crewman handed him the cup and wrapped a blanket around his shoulders. Just how many blankets did the coastguard carry?

  Then, still sipping, he made his way to where Meg had his patient, also blanket-wrapped. The damaged foot was already padded and Meg was tightening the ligature again.

  ‘He’s too cold. The crew are heating a fluid bag in their kitchen, but he’s shaking with shock and hypothermia.’

  ‘Body heat—it’s not for long,’ Sam suggested, whipping off his blanket to lie on the deck beside the man. Meg understood and lay down on the other side, cuddling up to the cold, unresponsive body.

  But he was breathing, and that, Sam knew, was as good as it would get, until they got him ashore where warming pads in the ambulance would start the process of bringing him back to normal.

  Or his temperature back to normal.

  Any other normal would be difficult for him for a while.

  A crewman approached, a bag of fluid held tentatively aloft. Meg spotted him as well and sprang up.

  ‘You lie here,’ she told the crewman, taking the fluid, feeling the temperature of it against her cheek and reaching for the bag already hooked up to the IV access.

  She double-checked the label then switched bags. Another crewman came with more blankets.

  ‘Put these on the bilge pump—they mightn’t be clean but they’re warm. And I haven’t been in the water, so my body’s warmer than yours.’

  He took Sam’s place beside the man, while Meg spread the blankets over their patient, tucking them tight across all three of them to trap the two men’s body heat around their patient.

  The motors revved then stopped. They were back at the wharf. Sam sat back and let the ambulance attendants who scrambled on board
shift the man onto a stretcher, then carry him away.

  ‘I’ll go with them—you take my car home,’ he said to Meg, whose T-shirt was wet and stained with blood and grease.

  ‘No, you go with him but I’ll follow,’ she said, taking the keys. ‘Whatever staff’s on duty will need to be relieved—there’ll be work for both of us.’

  Sam was too tired to argue—too tired even to think about where they’d been when all of this had begun, but he saw the strain in Meg’s white face and the bluish shadows beneath her eyes and though he wanted to argue—to order her home to bed—he knew he wouldn’t.

  She wouldn’t be Meg if she didn’t insist on being at the hospital.

  ‘How are you feeling? Up to an hour or so in Theatre?’

  Meg was settling the woman with the collapsed lung into a single room where she could be monitored when Sam came through the door.

  ‘The man with the foot?’

  Sam nodded.

  ‘I can’t send him anywhere until he’s stable, and that won’t happen until we’ve done something with his foot. I’ve got him in Theatre. Kristianne will assist but I’ll need a couple of nurses.’

  ‘I’ll come, and I’ll grab someone else with theatre experience off a ward. I don’t particularly want to call in any off-duty staff as we’ll be just as busy tomorrow with the patients we’ve kept here.’

  The man’s body had been gradually warmed back to within acceptable limits, but he was shocked and had fluid in his lungs—not an ideal patient for surgery, but until the blood vessels in his foot were tied off, he was in danger of haemorrhaging to death.

  Meg was glad to see Andy, their most experienced anaesthetist, already in Theatre, watching over the man, checking his sedation, keeping an eye on his breathing and heart rate while Sam and Kristianne worked on his foot.

  ‘We’ve got to make sure the sutures will hold,’ Sam was telling Kristianne, as one by one they tied off bleeding vessels, cauterising the smaller ones so the smell of burning hung in the air. The theatre was quiet, apart from the clatter of instruments and the demands of the two surgeons.