grimly as he turned to Beth Humphreys, the senior radiologist.
‘Both legs need doing as well as the usual—lateral cervical spine and anteroposterior views of the chest and pelvis. And can you send a copy through to the orthopaedic department so they know what they’ll be dealing with?’
He moved away after Beth had assured him that she would get straight onto it and went to see how Suzanne was faring. Although the registrar was extremely capable, she tended to doubt her own ability and needed a bit of gentle encouragement at times.
‘So what have we got here?’ he asked, standing beside Suzanne because it meant that he had his back to Rose Tremayne. The less he saw of her the better, he thought darkly, then deliberately erased the thought from his mind. If she’d hoped to upset him by turning up here then she was going to be disappointed.
‘Jane Robinson, aged fifty-five, presented with severe chest pain. She was a rear-seat passenger in the second vehicle that crashed.’ Suzanne frowned as she looped her stethoscope around her neck. ‘GCS fifteen on admission. Blood gases normal for both oxygenation and acid-base status, and both lungs are clear. There’s no history of cardiac problems, but there’s extensive bruising down the centre of her chest.’
‘Right.’ Owen turned to the woman. ‘I’m Owen Gallagher, the consultant in charge of the trauma unit. Were you wearing a seat belt when the accident happened?’
‘Yes. My daughter insisted I should wear it…Where is she? Has she been brought in yet? I want to see her…!’
‘I’ll get one of the nurses to check,’ he said soothingly. He looked around but everyone appeared to be busy at that moment apart from Rose. He steeled himself and beckoned her over. ‘Can you find out if this lady’s daughter has been admitted yet?’
‘Of course.’ She turned to the woman and smiled, and Owen felt his breath catch. Rose Tremayne had the most beautiful smile he’d ever seen, so warm and caring that it felt as though it could melt away any problems one might have had. It obviously had a comforting effect on Mrs Robinson because she immediately calmed down.
‘Can you tell me your daughter’s name?’ Rose asked quietly, but he’d prepared himself and the sound of her voice caused only the most minimal reaction this time.
‘Shelley…Michelle, I mean. Michelle Robinson.’
‘I’ll see what I can find out for you.’
Rose gave the woman’s hand a gentle squeeze then hurried away. Owen breathed a sigh of relief as she left the resuscitation room. Now that she’d gone he should be able to function on all cylinders again.
It was alarming to realise the effect she had on him. He tried not to think about it as he turned to the patient. ‘I need to examine you, so try not to worry. I’m sure there will be news of your daughter very shortly.’
Mrs Robinson didn’t demur as he set about the familiar routine. He frowned when he saw the full extent of the bruising down the centre of her chest. ‘How did this happen? I can see the marks from your seat belt, but I can’t understand where you got these bruises from.’
‘It was my own fault,’ Jane Robinson admitted guiltily. ‘Shelley told me to put it in the boot but I didn’t want it getting damaged.’
‘Were you holding something on your knee?’ he guessed, gently exploring the area. The bruising extended from just below her collar-bones right down to her waist—following the line of her sternum, in fact. It was possible that she’d broken a rib or two but he wasn’t convinced it was that which was causing her so much pain.
‘Well, not on my knee, exactly. It was too heavy for that. I had it propped in the footwell in front of me.’ She sighed. ‘It was a table, you see, with a marble top, and I didn’t want it getting chipped.’
‘And when the car crashed you slammed into it?’ Owen said, rapidly putting two and two together.
‘Yes. There wasn’t much room with the table in front of me, so even though I was wearing my seat belt, it still rammed right into my chest…’
She broke off and gulped. Owen frowned when he saw her start struggling for breath. ‘Can you tell me how severe the pain is at this moment?’
‘It’s really bad, Doctor, and I can’t seem to breathe properly…’ She suddenly stopped talking and her eyes rolled up into her head. The cardiac monitor started beeping to warn them that there was no output from her heart.
‘She’s in VF.’ Owen turned to his registrar. ‘I think it’s a cardiac tamponade—the heart is being compressed because blood is collecting in the pericardium. I’ll need to draw it off to relieve the pressure.’
‘You think it’s a fractured rib that’s caused it?’ Suzanne queried, hurrying round the bed.
‘More likely to be the sternum. That would explain the severe pain she’s been in. If the sternum has fractured, it could have pierced the pericardium, which is why there’s blood collecting around her heart. She’ll need to go straight to Theatre once we’ve finished. Shock her and give her a shot of adrenaline, but don’t apply external cardiac compression—it will only make matters worse.’
He left it to Suzanne to resuscitate the woman, knowing that the registrar was perfectly capable of following his instructions. His main concern was to deal with the cause of the patient’s arrest. It took him just a few moments to insert a hollow needle into the woman’s chest and he nodded as he watched the blood gush back into the syringe.
‘Just as I thought—cardiac tamponade. The sternum will need wiring up and the pericardium will need repairing, so the cardio team will have to crack open her chest.’
He drew off another syringe full of blood before Suzanne told him the patient’s heart was beating and they had established sinus rhythm. ‘Good. Get onto the cardio reg and tell him what’s happened,’ he instructed, peeling off his gloves. ‘Make sure he understands how urgent it is. This is one occasion when queue-jumping is absolutely essential.’
Suzanne made the call, then came back to him. ‘I wouldn’t have known what to do if you hadn’t been here. It never occurred to me that it could be a tamponade. I always associate that with a penetrating chest injury. I never considered the possibility that the sternum had fractured and pierced the pericardium even though I could see all that bruising.’
‘Don’t be so hard on yourself, Suzanne. There’s a dozen different reasons why she could have arrested. You know that as well as I do.’
‘Maybe. But you still managed to come up with the correct diagnosis.’
Suzanne looked downhearted as she went to meet the paramedics who’d arrived with another casualty. Owen made a note to have a word with her later and went to check on the young man with the leg injuries. Beth had the X-rays on the computer screen and he sighed when he saw the extent of the damage that had been done to the man’s ankle.
‘That’s going to take some sorting out. It will be a while before he’ll be able to walk on it. It causes a major problem when ligaments are torn like that.’
‘What about his leg?’ Rob queried, coming over to have a look. ‘It’s a real mess.’
‘That’s going to take time, too, and it will need external fixation
