then to palpate.
“I don’t see any wounds,” he said. “Do you?”
Krissie immediately stepped in and began to check the small body from head to toe. “Head gash,” she said. “Already stopped bleeding. Maybe two stitches, nothing major.”
“Got it.”
She kept working her way downward, checking limbs, searching every inch of skin. “Nothing else. Either he bled heavily for a while or it’s someone else’s blood.”
David finished putting two sutures in the scalp wound. “Check BP again, make sure it’s not falling.”
She pressed the button on the automatic blood pressure machine and watched the cuff inflate then release. “Good BP,” she said, scanning the readout.
“Good. Send him on to X-ray. No way to tell what’s broken, but make sure they do a good job on the head.”
But before they could take him away, David stopped them and looked at the boy’s abdomen again. What he saw made him pause. “Seat belt.”
Krissie stepped closer and watched David trace the faint outline of an emerging bruise. As soon as she saw it, she turned back to the BP monitor and took another reading. “Steady,” she said. But as she turned back to David, she saw the worry in his eyes. They both knew what a seat belt could do in an accident: ruptured spleen, other organ damage from sudden pressure. The damage might be small right now, too small to detect with palpation, but if allowed to go untreated, it could become a death sentence.
“You go with him,” David told her. “Monitor constantly. But we need those X-rays.”
“Yes, doctor.”
So, keeping the child hooked up to his IV, and with the blood pressure monitor tucked onto the bed with him, Krissie helped push the gurney to X-ray. “What’s his name?” she called over her shoulder.
David shook his head. “No names yet.”
“Tell the cops I need to know.”
“I will.” He was already moving on to the next patient. A woman suddenly screamed, but not even that woke the boy.
“Poor little tyke,” said the orderly helping her to push the gurney. For the first time, Krissie looked up and saw Charlie Waters.
“Oh, hi, Charlie. Sorry, I was focused on the boy.”
He nodded. “Everyone is focused right now.”
Two X-ray technicians were already waiting. Krissie insisted on remaining at the boy’s bedside, so she donned a lead apron. As they moved his little body around so they could get an unobstructed view of every bone in his body, she found herself grateful that, for now at least, he remained unconscious. If any of those bones were broken, this would have been hell on earth for him, and he’d already been through quite enough.
A radiologist had been called in, and he began examining the X-rays as they developed, before the entire set was even taken. Krissie kept checking the blood pressure, and every few minutes, palpated the child’s abdomen. No sign that it was hardening, even though the seat-belt bruise was becoming more apparent.
The radiologist joined her before they were even done. “He needs to be transported,” he said. “There’s a compression fracture in his left skull. It’s not deep, not something you’d probably find by touch, but he needs an MRI stat.”
That was all Krissie needed to hear. Small hospital, no MRI available. It was one of those things you dealt with here. “Call down to E.R. and tell Dr. Marcus, will you? We’ll get him out as fast as we can.”
The radiologist nodded and waved them on their way. Another gurney, holding a moaning man, was already waiting in line.
By the time they returned to the emergency room, another helicopter was landing, this one from a neighboring county. The boy was rushed on board, along with a woman who seemed to be wavering in and out of consciousness. Instructions were given, then Krissie, Charlie and David stood back as the helicopter lifted to the sky.
“God,” said David, “some days I hate being at a small hospital.”
“Yeah.” Krissie could understand his frustration. With something like this, every minute counted, and because they didn’t have all the bells and whistles, the minutes were stacking up.
Then she looked into David’s eyes, and saw the same ghosts that must be in her own. He visibly shook himself and started back to the E.R. She and Charlie followed.
“Maybe,” she heard David mutter, “we need to start a fund-raising drive for some new equipment.”
“I’ll help,” Krissie said promptly.
He looked at her, appearing slightly embarrassed. “That wasn’t meant for general distribution.”
“I know. But it’s still true.”
“Stabilize and transport usually works.”
“I know.” And she did. That’s mostly what they’d had to do in field hospitals. Even in major metropolitan areas, only one or two hospitals were equipped as trauma centers. Stabilize and transport was a medical dictum in many places, because it was the only efficient way to use resources.
An hour later, they’d cleared the accident victims. Two had gone to surgery, two had been moved to the general ward, the rest had been transported. Krissie hurried to take a shower and change into clean scrubs before going up to relieve the day-shift charge nurse.
Denise Albright greeted her like a savior. A small woman with surprisingly broad shoulders, she had pretty gray eyes and a huge smile. “Girl, am I glad to see you! My feet are screaming.”
“Been busy?”
“You wouldn’t believe. I guess the last week was the calm before the storm. In addition to the two accident victims you already know about, we got four more.”
“What’s going on?”
Denise grinned. “The usual. Accidents. You shouldn’t stand on the edge of the bathtub to change a light bulb.”
Krissie compressed her lips to stifle a laugh. “New rule.”
“Definitely. Lucky it was only a broken arm and a concussion. Then we have Mr. I-got-careless-with-the-farm-equipment. He needed twenty-nine stitches, a unit of blood and is on IV antibiotics. We have a first-degree burn case which is highly painful and resulted from splashing grease. New rule: watch it when you dump those frozen fries into a big pot of very hot grease. She’ll be okay, she was lucky to be standing back far enough for the grease to cool some, but the pain is enough that she’s on some powerful meds, so she needs watching. Also, they said she seemed a little shocky when she came in.”
“Got it. And the last one?”
“Now this is my very favorite.” Denise paused for effect.
“Another new rule?”
“Yup. When you get mad at your husband, don’t punch your arm through
