minutes later Nick was ready—well, as ready as he would ever be. Although the town had grown, Willowby Hospital was still little more than a large country health centre. No specialist resuscitation area here, no emergency trauma surgeon on standby, just him and whatever nurses could be spared from the usual stream of patients on a Sunday night.
Him and Bill!
Right now she was setting up a series of trays on trolleys, IV and blood-drawing supplies, chest tubes, ventilator, defibrillator, medications, and was checking the supply of oxygen, the suction tubes, not fussing but moving with swift confidence and precision. Just watching her gave him added confidence about whatever lay ahead.
‘The baler they spoke of—it’s one of those things that rolls hay into huge round bales?’ he asked, and she looked up from what she was doing to nod.
‘Though what the lad was doing, putting his arm anywhere near the machine, is beyond me,’ she said, before adding thoughtfully, ‘I suppose if the string got caught you might think you could pull it loose and give it a tug. I’ve always thought night-harvesting had an element of danger because, unless you’re used to night shifts, your mind might not be as sharp as it should be.’
Images of the damage such a machine could do to a human arm and shoulder flashed through Nick’s mind, and he had to agree with Bill’s opinion, but further speculation was brought to an end by the arrival of the ambulance and their patient, unstable from blood loss, his right arm loosely wrapped in now-bloody dressings, a tourniquet having been unable to stop the bleeding completely.
Nick listened as the paramedic explained what had been done so far—the patient intubated, fluid running into him, morphine to ease the pain, conscious but not really with them, so shocked it was clear the first-response team doubted he could be saved.
Hypovolaemic shock from loss of blood. The young man’s heart would be racing, his hands and feet cold and clammy, his pulse weak—
‘All we need to do is stabilise him enough for him to be airlifted down to Brisbane,’ Bill reminded Nick, as if she’d heard the same thing in the paramedic’s tone and had the same symptoms racing through her head.
So it began, the flurry of activity to keep the young man alive long enough for surgeons down south to save him. The paramedics had fluid flowing into him through his radial artery but he needed more.
While Bill hooked the patient up to the hospital’s oxygen supply and monitors, taking blood to send to the lab for typing, Nick prepared to put a catheter into the left subclavian vein, anaesthetising the site, then advancing a needle carefully down beneath the clavicle, a guide wire following it when blood flowed freely into the needle’s syringe.
Removing the needle, he made a small incision, his hands working mechanically while his mind raced ahead. Once the catheter, guided by the wire, was in place and more fluid was flowing in, he could examine the torn arm and shoulder in order to find the source of the blood loss.
‘The tourniquet is holding back blood loss from the brachial artery,’ Bill said, making Nick wonder if their childhood ability to follow each other’s thoughts was still alive and well.
He looked across to where she was gently probing the damaged arm, flushing debris and carefully tweezing out bits of dirt and straw—the work a surgical assistant would be doing in a major trauma centre.
‘I’ve been releasing the tourniquet and can see where the artery is damaged but he’s so shocked I doubt that’s the only source of blood loss.’
They were definitely following each other’s thoughts!
He moved round the table, leaving another nurse to control the fluid while a third watched the monitors. He’d have liked to have an anaesthetist present, but that, too, was for city trauma centres, so he used a nerve block to anaesthetise the arm before examining it.
‘There,’ Bill said, passing him a loupe so he could see the torn artery more clearly.
Two tiny sutures and the tear was closed, but the nurse watching the monitors reported falling blood pressure.
Drastically falling blood pressure …
‘V-tach,’ the nurse said quietly.
The words were barely spoken before Bill had the defibrillator pushed up against the trolley and was already attaching leads to the paddles. Nick set the voltage, gave the order to clear, placed the paddles above and below the heart and watched as the patient’s body jerked on the table.
He looked at the monitor and saw the nurse shake her head.
He upped the voltage, cleared again and felt the tension in the room as the body jerked and stilled, then the green line on the monitor showed the heartbeat had stabilised.
A release of held breath, nothing more than a sigh, but he knew everyone had been willing the lad to live.
For now!
‘He’s had three litres of fluid—he’s definitely losing blood somewhere else,’ he muttered, then turned to Bill. ‘We need full blood—has he been cross-matched?’
‘It’s on its way,’ she said quietly, then nodded towards the door where a young man in a white coat had appeared, stethoscope around his neck and, thank heavens, two blood packs in his hands.
‘Rob Darwin, I’m one of two doctors on duty upstairs but Bill said you needed help down here, and when Bill calls, I obey. Her slightest wish is my command.’
He was joking, teasing Bill, but Nick had no time for jokes.
‘Get that blood into him—it’s warmed?’
Rob nodded and took up a position at the head of the table, fiddling with the fluid lines as he prepared to give the patient the transfusion.
‘The bleeding has to be internal, but how? Where?’
Nick was talking to himself as he looked at the swollen, badly dislocated shoulder, picturing how the machine must have caught the arm and twisted it, trying to imagine where internal damage would have occurred.
‘A tear to the axillary artery?’ Bill suggested quietly, looking up from where she was putting clean dressings on the damaged arm.
‘That or the subclavian,’ Nick agreed. ‘I’m going to have to go in and have a look.’
He glanced up at Rob.
‘You okay with anaesthesia?’
Rob grinned.
‘I haven’t been here long but as Bill told me soon after I arrived, country doctors do the lot,’ he said. ‘How long would you want him out to it?’
‘Hopefully twenty minutes, but double it—make it forty to be on the safe side. He’s due to be flown out if we can get him stable.’
‘The plane will wait,’ Rob assured him, already checking the available drugs and drawing up what he’d need.
Bill prepared the area beneath where the young man’s shoulder should be, quickly shaving the hair and swabbing antiseptic all around then stepping back as Nick made
