checked the few patients in the waiting-room, and Kathleen got Amy to sort them into priority, talking through the decision-making process as she did so.
‘Fine,’ she said when Amy had finished. ‘No problems there. But don’t worry, you wouldn’t be asked to do it alone yet. The triage nurse is always qualified and experienced, but it doesn’t hurt you to see how it’s done.’
It was, in fact, a ridiculously quiet day with a steady trickle of bits and pieces, an ideal day to find one’s feet.
Unfortunately it meant that there wasn’t enough for the consultant to do to keep him out of her way, and every time she turned round she almost fell over him.
‘Are you checking up on me?’ she demanded half way through the afternoon.
‘Now, Irish, you know better than that,’ he said with a cheeky grin, and left her alone for a few minutes.
Then there was a call on the red phone.
‘OK,’ Kathleen said. ‘We’ve got someone coming in on a blue light, a young man who’s fallen under a train. Could be an attempted suicide, we don’t know. Anyway, there’s considerable loss of blood, massive lower limb and pelvic damage and some chest injuries. We’ll need plasma expander, and samples immediately for cross matching. Better have some O neg. sent up for immediate use as well. Right, let’s move.’
They prepared the resus. room, and when all was ready they informed the patients still waiting that they might have a slight delay due to an emergency that was being brought in. There were the usual grumbles, but they faded instantly as the ambulance backed up to the entrance, doors already opening.
He was screaming, the high-pitched, nerve-grating scream of agony that always turned Kathleen’s blood to stone, and the waiting-room fell into shocked silence.
They wheeled him rapidly into Resus., Kathleen snapping out instructions right, left and centre, but as they peeled back the blanket to examine him, even Kathleen after all the years she had been working in A and E was shocked at the extent of his injuries. Both his legs were severed completely, the right one mid-thigh, the left up at the hip. His head was cut and bleeding, and his jacket was torn and damaged, indicating possible chest injuries. His right arm was also lying at a funny angle and was probably dislocated or fractured.
Amy Winship took one look at him and disappeared quietly through the door, and Ben Bradshaw winced. Only Jack Lawrence appeared quite unmoved, glancing dispassionately at the damage that Kath revealed with her scissors. There was blood everywhere, more of it by the second, and nothing they did seemed to stop it. His left leg was particularly bad, the vessels refusing to co-operate. They slowed it to a steady well, but it wouldn’t stop, and through it all there was the awful screaming.
‘For Christ’s sake get an anaesthetist down here and shut him up,’ Jack Lawrence grunted, and moved to his head, checking his pupils automatically. ‘Have we got any ID?’
Kathleen shook her head. ‘No, nothing. The ambulance men checked his clothes.’
‘Damn. We need to get his relatives in fast.’
She raised an eyebrow. ‘You don’t say?’
He grinned ruefully. ‘Any sign of a surgeon? And we need cardiothoracic and orthopaedics, too.’
‘Before or after the mortuary technician?’ Ben said under his breath.
Kath glared at him, and he shrugged.
‘Just being realistic, old thing.’
‘Well, don’t bother—and don’t call me old thing. Just do your job, please. Have you stopped that bleeding yet?’
He shook his head. ‘It’s leaking from the abdomen—I think he needs a bit of surgical attention.’
Kath shot him a dry look. ‘You guys are really sharp today, aren’t you?’
Jack was inspecting the young man’s chest dispassionately, watching the ragged rise and fall of the ribs as he dragged in a breath between screams, and he shook his head thoughtfully. While he ran thorough hands and eyes over his shattered body, Kathleen started cleaning up the chest area ready for the heart monitor after checking the IV line that was running in Haemacel and taking blood for cross-matching, dodging round the radiographer who had brought the portable in and was taking X-rays.
When his chest was clear, she put on the pads for the heart monitor, frowning slightly as she did so at the feel of the chest wall under her hands. As she watched his breath jerked in, and a large section of his chest wall moved in instead of out.
‘Flail chest,’ she said quietly, and Jack nodded, drawing her to one side.
The lung’s collapsed, I think. Probably where he was hit by the train. His pelvis is shot to hell, too, and judging by the feel of the abdomen, he’s got massive haemorrhaging.’
Kath nodded. ‘So why is he still alive?’
‘God knows.’ Their eyes met and tracked together to the heart monitor. ‘He’s not doing too well, is he? I think we need an echocardiograph. Can you get the cardiographer?’
Not that there’s a great deal of point, Kathleen thought to herself, but we may as well go through the motions.
While she phoned the switchboard and requested that they page the cardiographer, Michael Barrington the orthopaedic SR arrived and glanced at the shattered stubs of the young man’s femurs.
He swore, softly and succinctly. ‘Got any X-rays yet?’
Jack nodded. ‘Yes, they’re just being developed.’
Michael pursed his lips. ‘Done a real job on himself, hasn’t he? Anyone know why?’
‘No. We don’t even know if it was an accident yet.’
Their eyes flicked to the monitor. Their patient was still alive but his condition was deteriorating visibly. The anaesthetist, Peter Graham, had arrived and managed to dull his pain. Now he merely lay and moaned, but at least he was no longer screaming.
Amy popped her head round the door to tell Kathleen that they had found some ID on the track and the police had brought his parents in.
‘His name’s Steven Blowers. They want to see him.’
Kathleen exchanged glances with Jack, and he shook his head.
‘Put them in the interview-room and give them a cup of tea. One of us will be out in a minute,’ she told the young nurse. ‘Oh, and Amy? Say nothing.’
Amy nodded gratefully and retreated.
The X-rays appeared and Michael ran a critical eye over them.
‘Ouch. Do you want me to interpret, or is it academic?’ he said quietly.
Jack’s mouth lifted in a wry smile. ‘Probably. We’ll see what the cardiothoracic guy has to say.’
When he arrived moments later, he took one look at the X-rays and shook his head.
‘You
