if we can get you to extend your secondment and stay past Christmas, don’t you?’
He smiled. ‘Not a problem. And maybe I can persuade some of the non-singers into forming a choir.’
‘I have a feeling you might just manage that.’ She smiled at him. ‘Come on, let me show you round and introduce you to everyone.’
He’d met half the team when a trolley came round the corner, a paramedic on one side and Sydney on the other; clearly they were heading towards Resus.
He caught snippets of their conversation as the handover continued. ‘Knocked off his bike … helmet saved him … broken arm … ribs …’
Given the situation, there was a very high chance that the cyclist would have a pneumothorax. And he’d dealt with enough cycling accidents in his time to be useful here. He glanced at Ellen. ‘Mind if I …?’
‘I was going to put you on Cubicles, to ease you in gently.’ She spread her hands. ‘But if you want to hit the ground running, that’s fine by me. And you’ve already met Syd, so I don’t have to introduce you. Go for it.’
‘Thank you.’ He quickened his pace slightly and caught Sydney up. ‘Hey. Would another pair of hands be useful right now?’
‘Considering that the driver of the car’s due in the next ambulance, yes, please,’ she said.
Within seconds Marco had swapped his suit jacket for a white coat. Although technically he was the senior doctor, he knew that Sydney had been part of the team for longer and knew her way round. ‘I’ll follow your lead.’
She looked surprised, and then pleased. ‘OK. Thank you.’ She turned to their patient. ‘Colin, this is Dr Ranieri, our registrar. He’s going to help me treat you. We’re going to sort your pain relief first and make you more comfortable, then we can assess you properly.’
He noticed that she didn’t use Entonox; clearly she suspected a pneumothorax as well, so she was using a painkiller that wouldn’t make the condition worse.
‘Where does it hurt most, Colin?’ she asked.
‘My arm. And my ribs.’
Colin was definitely getting more breathless, Marco noticed, and finding it harder to speak.
Sydney listened to his chest. ‘Decreased air entry,’ she mouthed to Marco.
‘Needle decompression?’ he mouthed back.
She nodded.
His first instinct was to offer to do it, but he wanted to see how she worked; besides, given her throwaway comment about being a better doctor than abseiler, he had a feeling she needed to do this—that she needed to prove to him that she was good at her job and not some weak lightweight who couldn’t cope. And he could always step in if she needed help.
‘I’ll hand you the stuff and keep an eye on the monitors,’ he said.
‘Thanks. Colin, I know you’re finding it hard to breathe, so I’m going to put an oxygen mask on you to make it easier for you.’ Gently, she put the mask on. ‘At the moment, you’ve got air moving into the space around your lungs and it’s causing pressure. I need to take it off; that means I’m going to have to put a needle in, but it’s not going to hurt. Is that OK?’
Colin gave a weary nod.
Marco handed her a cannula.
‘Thanks, Marco.’ She smiled in acknowledgement, and for a second Marco was lost in a mad memory about what her mouth had felt like against his.
But this wasn’t the time or the place to think about that. They had a seriously ill patient who needed their help.
She inserted the cannula in the second intercostal space, withdrew the needle and listened for the hiss of gas. ‘Great, that’s it,’ she said. ‘Colin, now I need to put a chest drain in, to take off any fluid and gases that shouldn’t be there and keep you comfortable.’ She explained the procedure swiftly to him. ‘I’m going to give you extra pain relief so you’re not going to feel anything, but I need your consent for me to treat you.’
Colin lifted the mask away. ‘Do whatever you have to. I’m in your hands,’ he mumbled.
‘OK, sweetheart. I promise I’m going to be as gentle as I can.’
Stella, one of the senior nurses, cleaned Colin’s skin and covered it with sterile drapes. Marco handed Sydney the syringe and she injected local anaesthetic, prepared the chest drain and then inserted it. He was impressed by how smoothly and confidently she did it; Ellen had been spot on in her assessment of the younger doctor’s skills.
He kept an eye on the monitors. ‘Heart and BP are both fine. Do you want me to write up the notes as you do the assessment?’
‘That’d be good. Thanks.’
She checked Colin over very gently and Marco wrote up the notes as she went. ‘Suspected multiple rib fractures,’ she said, ‘but no sign of a flail segment. That’s good news, Colin.’ She checked the distal pulses and the sensation in his broken arm. ‘I think you’ve fractured your elbow, so I’m going to refer you to our orthopaedic surgeon to fix that for you.’ Finally, she took a sample for blood gases.
‘OK, Colin, I’m all done here. I’m going to send you for chest X-ray so we can check out your ribs; I think you’ve broken several, but hopefully they’re not complicated breaks. I also want to check out your arm properly for the surgeon. Is there anyone we can call for you while you’re in X-Ray?’
‘My wife, Janey.’ He rattled off a number, which Marco wrote down.
‘I’ll call her,’ Sydney promised.
‘And I’ll take you to X-Ray,’ Marco said.
‘Do you know where it is?’ Sydney mouthed, so Colin couldn’t see.
‘I can read the signs,’ Marco mouthed back with a grin.
She gave him the cheekiest wink he’d ever seen, and he was still smiling by the time he got to the X-ray department.
She was working on the driver of the car when he got back to Resus, and sent him off for observation for possible concussion. By the time she’d finished, Colin’s X-rays were ready on the system for review.
‘Want to look at these with me?’ she asked.
‘Sure.’
She peered closely at the screen. ‘Hmm. Not all fractures show up on a chest X-ray, but it looks as if I’m right and it’s not flail chest, so that’s a good start.’ She grimaced at the X-ray of Colin’s elbow. ‘That’s a mess. It’s going to need fixators. I’ll refer him to the orthopods and warn them that he’s already had a pneumothorax.’
She went back over to Colin. ‘I’ve had a look at the X-rays. The good news is that your ribs will heal by themselves, though it’s going to be a bit painful for you over the next few days. But your elbow’s going to need pinning, so I’m going to take you out to one of the cubicles to wait for the orthopaedic surgeon,
