IV access was more manageable. Hannah placed a large-bore cannula in the woman’s forearm and started fluids. She remembered to use extra tape to secure both the cannula and the IV fluid lines. The lecturer’s jocular warning was what she’d remembered most clearly about that workshop. “If it can fall out,” he’d said, ‘it will fall out.’
Mario had the expertise and strength to move the woman onto a backboard and strap her securely onto it. And then the firemen took over, inching their way up the mountainside with the help of ropes and the net.
Moving to follow them, the beam of Hannah’s light caught something that made her stoop. She picked the object up. It was a shoe. A rather well-worn sneaker with a hole in the top and what looked like a picture of a bright orange fish done in felt pen or something similar. What startled her was its size. It was small.
Very small.
A child’s shoe.
But they hadn’t come across any children in their triage, had they? Hannah had the awful thought that it could be the fatality inside the bus. But maybe the owner of this shoe was uninjured? Not seen amongst that huddle of frightened people who had been waiting for help up the slope? Hannah certainly hoped so. And if they were, they might have one bare foot and be grateful to see that shoe. Hannah stuffed it into the large pocket on the front of her overalls.
It wouldn’t have been easy for a child to climb, even with the hand-and footholds the net provided. They were wet now and very muddy. Hannah slipped, more than once, and had to save herself by grabbing the netting or a tree root or branch.
How could fifty metres seem such a long way? And how long had they been on scene? Certainly no more than an hour, but she felt as though she had just completed a full night shift in the ED and a busy one at that.
The third time she slipped, Hannah might well have fallen but she was caught by her arm in a vice-like grip.
‘Are you OK?’ Ryan asked.
It had to be her imagination that she could hear the same kind of caring in the query that she had heard in the car on the way to Wygera that morning. An aeon ago. In her current state it was enough to bring the sting of tears to her eyes. She blinked them away.
‘Yeah … thanks …’
‘Not easy, this stuff, is it?’ Ryan was climbing beside her. Just below them, the scoop stretcher containing his patient was making slow progress upwards. ‘How’s your woman?’
‘Still unconscious but breathing. A head injury but I have no idea how bad it is yet.’
‘You’ll be able to do a more thorough assessment in the ambulance. We won’t be far behind you if you run into trouble. Mike says they’re going to stage departures so we arrive at the ED at about six-minute intervals. Just pull over and keep your lights on and we’ll stop to help.’
‘Thanks,’ Hannah said again. Professional assistance but at least he was talking to her. She was almost at the top of the slope now. A fire officer had his hand out to help her onto the road and the noise level increased markedly. She could still hear Ryan’s call, though.
‘Hey, Hannah?’
‘Yeah?’
‘You’re doing a fantastic job. Well done.’
Those tears were even closer all of a sudden. They couldn’t be allowed to spill. Hannah clenched her fists as she got to her feet on the road and her hand struck her bulky pocket. She peered down at Ryan.
‘Hey, did you come across any children in the bus?’
‘No. Why?’
‘I found a shoe. A kid’s size shoe.’ She pulled it from her pocket. ‘See?’
‘Could have come from anywhere,’ Ryan said. ‘Maybe there’s a kid amongst the green tickets.’
‘Yes, I thought of that. I’ll check with Grace later.’
‘It could have come from spilled luggage as well. Or even been thrown away. Looks pretty old.’
‘Hannah?’ Mario, the paramedic, was calling. She could see the backboard supporting her patient being lifted into the back of an ambulance. ‘We’re nearly ready to roll.’
‘On my way.’ Hannah turned to give Ryan a smile of thanks for his help but he wasn’t watching. He had already turned back to his patient.
‘I’ll take over the ventilations there, Mike. You’ve done a fantastic job up the hill.’
A fantastic job. Like her. So the praise hadn’t really been personal, had it? The doors of the ambulance slammed shut behind her and someone thumped on the back to give the officer driving the signal to go. Hannah took a deep breath.
‘Let’s get some oxygen on, Mario. A non-rebreather mask at ten litres a minute. And I want a slight head tilt on the stretcher. Can we do that with a backboard in the way?’
‘Sure, we’ll just use a pillow under this end.’
‘Let’s get some definitive baseline measurements, too. Blood pressure, heart rate and rhythm, oxygen saturation.’ She pulled a stethoscope from the kit. ‘I’m going to check her breathing again.’
It felt good to be on the move towards a fully equipped emergency department and hospital. Hannah would feel far more in control then. Far less likely to be thrown off balance by overly emotional reactions to someone else’s words or the way they looked at her. Or didn’t look at her.
It helped to know that Ryan would be on the road within minutes, though. Travelling in the same direction she was. Sharing the same experiences and goals that had arrived in their lives so unexpectedly. To get through this ordeal and help as many people as possible.
They were on the same page now, weren’t they?
What a shame it was just too late.
CHAPTER NINE
THE contrast couldn’t have been greater.
The Poulos wedding had been a happy circus. Crocodile Creek Base Hospital was hosting a miserable one.
Injured, bewildered people filled the cubicles and sat on chairs. A moving sea of professional staff was doing everything necessary. Doctors, nurses, clerks, radiographers and orderlies were doing their jobs. And more. The fact that it was late at night and the majority of people here were not rostered on duty meant nothing. A disaster response had been activated and there was nobody associated with this medical community who wasn’t prepared to do whatever they could to help.
There was a lot to be done. Hannah’s case was the first serious one to arrive so she had the initial advantage of all the staff she could possibly need to assist.
Luke hadn’t yet gone to the receiving ward where he would be available on the surgical team, along with Cal and Alistair. Emily was still in the department as well, because minor cases needing surgery were going to have to wait until all the majors had been dealt with. They both came to assist Hannah. Charles wasn’t far behind.
‘You should get changed out of those wet overalls,’ he told Hannah. ‘There’s plenty of people here to take over. Susie can show you where the scrubs are kept.’
‘Soon,’ Hannah promised. ‘I just want to make sure she’s stable.’ Having come this far with the injured woman, Hannah was reluctant to hand over. ‘If that’s OK with you, Dr Wetherby?’
Ryan might be registered to work in Australia but Hannah wasn’t. It was Charles who could give her permission. It was up to him whether he trusted that she was competent enough not to cause problems he would have to take ultimate responsibility for.
The look she received was assessing but Charles had obviously seen enough to make a decision.
‘Go ahead,’ he said.
Mario and a male nurse had moved the woman, still strapped to her backboard, onto the bed.
‘Right.’ Hannah nodded, tucking away the pleasure that someone like Charles Wetherby was prepared to trust her. ‘This woman was apparently thrown clear of the bus and was found unconscious. There’s been some response on the way in but nothing coherent. I’d put her GCS at seven. She was initially tachycardic at 120 but that’s dropped in the last fifteen minutes to a rate of 90, respirations are shallow but air entry is equal and the oxygen saturation has been steady on 97 per cent on 10 litres.’
Standard monitoring equipment was being attached to the woman, like ECG leads, a blood-pressure cuff and an oxygen saturation monitor. Someone was hanging the fluids from a ceiling hook and another nurse was taking the woman’s temperature.
‘Thirty-five point six degrees centigrade,’ she reported.
‘Not hypothermic, then,’ Emily commented.
‘Blood pressure was initially one-twenty on eighty. Last measurement was one-thirty on seventy.’
‘Widening pulse pressure,’ Luke said. ‘Rising intracranial pressure?’
‘Quite possible. She has an abrasion and haematoma in the occipital area. No obvious skull fracture. Pupils were equal and reactive.’
‘They’re not now.’ Emily was at the head end of the bed, shining a bright torch into the woman’s eyes. ‘Right pupil is two millimetres larger and sluggish.’
‘Do we know her name?’ Luke asked.
‘No.’ Hannah glanced at one of the nurses. ‘Perhaps you could check her pockets? She may have some ID.’
‘We need some radiography,’ Luke said. ‘Preferably a CT scan. And where’s Alistair? If we’ve got a neurosurgeon available, this is where he should be.’
Charles pivoted his wheelchair. ‘I’ll find him.’
The movement of the woman on the bed was unexpected. Restrained, due to the straps still holding her to the backboard, but unmistakable.
‘She’s going to vomit,’ Emily warned.
‘Let’s turn her side on,’ Hannah ordered. ‘I’ll need suction.’
It was easy to turn the woman onto her side and keep her spine protected, thanks to the backboard, but it was another sign that the pressure could be building dangerously inside her head.
The nurse checking her pockets had easier access with the patient tipped to one side. ‘I’ve found something,’ she said. ‘It’s a passport. An Australian one.’
‘Great. At least she’ll understand the language. And we’ll be able to use her name.’ Hannah glanced up at the monitor, to see what was happening with the blood pressure. ‘What is it?’
‘Janey Stafford.’
‘What?’ The startled query came from Luke. ‘Did you say Janey Stafford?’
‘Do you know her?’ Hannah asked. It could be helpful for an unconscious person to hear the voice of someone she knew.
‘I … I’m not sure.’ Luke was looking stunned. He reached over and lifted the oxygen mask the woman had on. Was he looking for a feature he might recognise? Hannah wondered. Like that small mole at the corner of her top lip?
Luke was backing away. Shaking his head.
‘You don’t know her, then?’
‘Not really. It was her sister I knew.’ The tone was dismissive. An ‘I don’t want to talk about this’ sort of tone. ‘It was a long time ago.’
Emily was staring at Luke. Then she blinked and refocussed. ‘Do you want me to intubate?’ she asked Hannah.
Alistair walked into the resus bay at that moment.
‘I’ll hand over to an expert,’ Hannah said. Having given Alistair a rundown on their findings so far, she found herself stepping back. Luke did more than step back. He left the resus bay completely.
But then a new emergency was coming in. Luke hadn’t pulled the curtain closed behind him and Hannah could see Ryan arriving with his multi-trauma case from the interior of the bus. They were still using a bag mask to ventilate this patient. There were two IV lines in place and Ryan looked worried.
‘Bilateral fractured femurs,’ Hannah heard him tell Charles. ‘Rib fractures and a flail chest. GCS of nine.’
Charles directed them to resus 2 and Luke disappeared behind the curtain along with them.
The picture of Ryan’s face was not so quick to disappear for Hannah. She had seen him work under duress before. Seen him tired and even not a hundred per cent well himself, but she had never seen an expression like the one he had walked in with.
So grim. Determined. So … lacking in humour.
Instinct told her that it wasn’t just the grim situation that was making Ryan look like that. He was the one who always made an effort to defuse just such an atmosphere. He seemed like a different person. Gone completely was that sparkle. The laid-back, golden-boy aura that had always seemed to cling enough to be easily resurrected.
It didn’t look like Ryan intended smiling for a long time to come and Hannah didn’t like it. He was being professional and she knew he would have the skills to match anything he had to face, but something was wrong. Something big was missing. The real Ryan seemed shut off. Distant.
Was it sheer arrogance to wonder if his anger at her had something to do with his demeanour?
Hannah shivered and wasn’t even surprised to hear Charles’s voice from close by.
‘Go and get out of those overalls. Get some dry scrubs on and get a hot drink. I don’t want to see you back in here for at least ten minutes.’
It did feel better, being in dry clothes. And the hot chocolate and a sandwich she found in the staffroom were wonderful.
‘At least you’re getting a bit of the wedding breakfast.’
Hannah smiled back at the plump woman. Susie would be surprised to see that Dora had taken off her hat. ‘It’s delicious,’ she said. ‘Thank you so much.’
‘You’re all doing such a wonderful job. Those poor people out there. There are a lot that are badly hurt, aren’t there?’
Hannah nodded, her mouth full of the first food she had eaten since a hurried lunch too many hours ago. She had taken a moment to check on Janey’s progress, to find she’d gone for a CT scan and that Alistair was planning to take her to Theatre immediately afterwards, if necessary, to relieve any pressure building from a bleed inside her skull. Emily had gone to get ready to administer an anaesthetic.
Ryan was still busy stabilising his patient, ready for the surgery Luke would have to perform to deal with the major fractures sustained.
More cases were coming in, prearranged to arrive at a steady but not overwhelming rate. Susie had hopped past on her crutches, a sheaf of papers scrunched in one hand.
‘I’ve got to locate a new supply of O-negative blood,’ she told Hannah. ‘And there’s so many other things to do. We’re still trying to discharge people to one of the rest homes and find accommodation for everyone from the bus. You OK?’
She was, surprisingly, more than OK, thanks to the food and hot drink.
In the corner of the staffroom sat two tired-looking children. Lily was still in her flower girl’s dress and CJ hadn’t changed out of his small suit.
‘Can we go now?’ CJ asked Dora.
‘We’re supposed to stay here,’ she replied. ‘You know what they said about my house. It’s not fit to be in when the cyclone comes.’
‘Is it definitely coming, then?’ Hannah’s appetite faded and she swallowed with difficulty.
‘They reckon it’s going to hit us by morning. Susie’s arranged some beds for the children to stay in here overnight. Dr Wetherby and CJ’s parents are going to be busy all night by the look of things.’
‘But you said—’ CJ’s lip wobbled ominously ‘—you said we could go and see if the puppies have arrived before we have to go to bed.’
‘My dog’s due to whelp again,’ Dora explained to Hannah. ‘Goodness knows why Grubby keeps letting her get in pup. It’s me who ends up doing all the work.’
‘Ple-ease?’ begged CJ.
Dora looked at the clock. ‘I guess we’ve got a fair few hours before the weather gets dangerous. If we went home quick and then came back again, I guess Dr Wetherby won’t notice we’ve gone.’
‘Don’t tell,’ CJ ordered Hannah. ‘Will you?’
‘I’m sure nobody will ask me,’ Hannah responded. She watched as Dora took a small hand in each of hers and led the children away. A very capable woman, Dora. Hannah was sure no harm would come to the children.
And that reminded her of the shoe.
Over the next hour, as Hannah assisted in the treatment of se
veral people, she had two things on her mind. One of them was watching for glimpses of Ryan, to see whether he was still looking so distant and miserable.
He was. More than once he passed Hannah with barely more than a glance. Never a smile. Or a comment that might have lifted her spirits. To imagine him telling a joke seemed ridiculous. He had changed into scrubs as well so he looked like the Ryan she had always known.
She just wished she could see a flash of him behaving the way he always had.
The other thing on her mind was the shoe. At every opportunity she asked different members of the staff whether they had come across a small child amongst the patients. Someone advised her to check with one of the clerks and, sure enough, when she did, she struck gold.
‘There was a kid. A little blonde girl,’ she was told. ‘Chloe, I think her name was. She had a broken arm.’
‘How old was she?’
‘I can’t remember. Four or five.’
The right sort of age to fit a shoe the size of the one Hannah had found.
‘Where would she be now?’
‘I have no idea, sorry. Maybe the plaster room? It was ages ago, though. She might have been sent home.’
Except that she had no home to go to, did she?
The thoughtful frown on Hannah’s face must have looked like fatigue to Charles. He rolled towards her.
‘You’ve been on duty for more than four hours,’ he said. ‘It’s time you took a break. At least two hours’ standdown before I see you back in here, please. It’s going to be a long night and it might be just the beginning of what we need you for with the way Willie’s decided to behave.’
Hannah nodded. A break was exactly what she needed right now, wasn’t it?
The soaked pair of overalls lay where she had left them, in the corner of the women’s locker room. Nobody had had time to tidy yet. Hannah fished the shoe out of the pocket and went looking for the child she now knew existed.
The Australian's Proposal (Mills & Boon By Request): The Doctor's Marriage Wish / The Playboy Doctor's Proposal / The Nurse He's Been Waiting For Page 31
