Leo said, and she heard his voice break.
Carla’s eyes were open but she wasn’t seeing.
‘I don’t think it’s her heart.’ Anna said it intentionally loudly, making her voice clipped and professional. Leo and this woman must be friends. She’d heard Leo’s instinctive distress, but she needed a doctor here, not someone emotionally involved.
And he got it. She felt the moment he hauled himself together. The moment he became one of a medical team.
‘Fall?’
‘Collapse,’ she told him. She glanced up at Maria, and Maria anticipated her needs by handing down a towel. Two. She used one to sweep the mess away from Carla’s head, the other to help clear her face. ‘She looked like her head hurt. She put her hand to her head like there was intense pain and then she passed out.’
‘The headache… Hell…’ He had his hand on her wrist.
‘It’s still strong,’ Anna told him.
They were squashed together. Maria started working around them, shoving the bed back, heaving the bedside table onto the bed to give them more room.
‘Defibrillator?’ Maria asked.
‘No.’ Leo was moving to the next stage. He checked her eyes, and Anna saw the slight sag of his shoulders, relief that he’d seen a corneal reflex. He’d seen her clear Carla’s mouth. He’d seen the gag reflex as well.
She wasn’t comatose, then, but the speed of the drop from alert to where she was now implied she soon would be.
‘It’s okay, Carla, we’ve got you,’ Leo said, loudly and firmly. ‘Relax, love, don’t fight it.’
That made Anna blink. He was assuming Carla could hear. It was good medicine, the assumption, unlikely as it was, that Carla would comprehend what was going on. But not all doctors did it, especially under the stress of an emergency like this one.
‘We need to stabilise your airway and get a scan,’ Leo said. ‘Carla, have you had a head injury? Banged your head?’ She didn’t respond—how could she?—but once again Anna knew the words had been said to reassure Carla that she was included in this conversation. ‘Carla didn’t say anything about an injury, Anna? Maria?’
‘Nothing,’ Maria said, and Anna heard her distress, too.
‘Just a headache,’ Anna said. ‘Leo, this looks like an internal bleed.’
‘You must have had a bump.’ Leo was back to speaking to Carla. ‘You told me you took aspirin last night.’
‘She has been taking aspirin,’ Maria ventured. ‘She’s been getting it from the hospital pharmacy. I saw her take a couple of boxes last week. She said she has a bit of arthritis. We were busy and I didn’t follow it up.’
‘Aspirin won’t have done this, though it might have made it worse,’ Leo said. ‘But if there’s a bleed it won’t help now. Carla, we’re going to have to have a look-see. Get a trolley, Maria. We’ll take her through for scans. Now.’
‘What can I do?’ Anna asked.
‘You’re a patient,’ Leo said roughly. ‘Thanks for your help, Anna. You should be right to go.’
The scan showed a bleed.
A big one.
The hairline skull fracture was bad enough. What was worse was the dark shadow underneath the fracture. A subdural haemorrhage. Blood vessels near the surface of the brain had obviously ruptured.
How the hell…?
But the cause of the injury was the least of his concerns. What was crucial was time. Blood had collected immediately beneath the three-layer protective covering of the brain. The brain was being compressed.
In young people a bleed like this was usually triggered by a significant impact. Older people could bleed after only a minor trauma.
Carla was hardly elderly but she’d been taking aspirin. The aspirin would have been thinning the blood.
The greater the pressure on the brain, the worse the bleeding would become. For her to lose consciousness so quickly…
‘I’m going in.’ He was talking to Carla, and to the nurse beside him. Maria was looking as terrified as he felt. ‘Carla, there’s a bleed under the surface. We need to get the pressure off.’ He needed to say no more. If Carla was aware enough to take it in then she’d know, and Maria had been a nurse long enough to realise the ramifications of a cranial bleed. Pressure on the brain caused brain damage, and it caused it fast. They had to get the pressure off now.
‘Leo, I’m asking again. What can I do?’
The voice came from the doorway. Anna still looked very much the patient. She was dressed in jeans and a T-shirt, but the white dressing showed starkly against her burnt-red hair.
‘You need to leave, Anna.’ It was an instinctive response.
‘I’m a doctor, Leo,’ she snapped. ‘Get over yourself. Let me help.’
‘You’re injured.’
‘I have stitches from a bump on my head. I imagine Carla’s haemorrhaging. Am I right?’
‘You’re not well. I can’t—’
‘Do you have another doctor on staff? An anaesthetist?’
He needed headspace and she was messing with it. He opened his mouth to snap back but sense prevailed.
His instinctive reaction to Anna had been that of a doctor to a patient. The internal war, how he was feeling about Carla’s illness, physician versus friend, could allow no other distractions.
Anna’s question, though, had cut through.
There was no other doctor within hours of travel. Carla collapsing so dramatically meant that the bleed was sudden and severe. The pool of blood under the dura must be causing damage.
Carla usually assumed the role of anaesthetist if he needed to operate. What now?
‘There’s no other doctor,’ he admitted.
‘Evacuation?’
‘It’ll take hours.’
‘Then she needs emergency craniotomy and drainage,’ Anna said. Her curt, professional tone helped. ‘If there’s no one else… Leo, can you operate if I do the anaesthetic? I’ve done additional anaesthetic training. The village where I work isn’t big enough to support medical specialists and there’s occasional urgent need.’
She had anaesthetic training? It was like a gift from the heavens. A colleague with anaesthetic skills…
‘You have a head injury
