GCS of fifteen meant that the victim was conscious and alert. Okay, he might have a chest injury but he was breathing well enough for the moment. Part of her job in charge of this department was to make sure she used potentially limited extra resources as wisely as possible.
‘Not yet. I’ll take a look at him first. How far away are they?’
‘About five minutes.’
Emma couldn’t help glancing up at the clock as she walked into Resus One and pulled on a disposable gown and some gloves.
Twenty-two thirty. It would probably be twenty-two thirty-five as they rolled the stretcher in.
Breathe, she reminded herself again, as she heard the whoosh of the ambulance bay doors.
Alistair came in and grabbed a gown, closely followed by a nurse. And then the stretcher arrived. Nothing could have prompted Emma to take a breath when she saw who was on the stretcher. The opposite happened as her body and brain both froze. There was just enough breath left to utter a single, horrified word.
‘Jack...?’
THE JOY CAME from nowhere.
It caught her in that moment when Jack opened his eyes and his startled gaze met her own. When she saw the flare of recognition and something more... Relief that he was in a place he knew he’d be cared for? Or was it because he wanted to see her? Was it the reason he’d finally come back?
It only lasted a heartbeat, that joy, but in that instant, every cell in Emma’s body was singing.
He’s come back...
Jack’s here...
But following so closely on the heels of joy that it morphed with it and then took over was fear.
He’s hurt...
Maybe badly hurt...
She could see the lines of pain etched on his face and in the way he was pressing his lips together as he closed his eyes again.
This might be the biggest challenge of her career so far in not allowing emotional involvement to interfere with delivering clinical excellence but, to her surprise, Emma found she was up for it.
It was a relief, even, to turn away from such overpowering feelings to something she knew she could handle. The paramedic who was giving a rapid but thorough handover had her full attention.
‘High-speed collision. Mr Reynolds got cut off by someone coming into his lane. He swerved, apparently, but lost control of the bike. GCS is fifteen but he may have been KO’d briefly. I suspect the bike landed on his left leg. We’ve splinted the possible tib/fib fracture there. The chest injury may have come from contact with the handlebars. One sleeve of his jacket got ripped so there’s road rash and a potential fracture on his left forearm.’
‘Got his helmet?’
‘Yes. Superficial damage but it’s not broken.’
Emma nodded. She listened to the quick summary of the most recent vital signs and glanced at the monitor, which was showing a rapid but normal heart rhythm. His oxygen saturation level was also good.
‘Let’s get him on the bed.’
As lead physician, it was Emma’s job to be at the head end of their patient. The ambulance crew had put a neck collar on Jack, quite correctly assuming that the mechanism of injury could mean he had a spinal injury, so she had to ensure that the transfer from stretcher to bed did not do anything to risk making it worse. Having the paramedics here was helpful in having enough people to do the job well.
‘Three on each side, please. On my count...’ Emma put her hands on either side of Jack’s head. Mostly, all she could feel was the plastic collar but at the base of her hands she could feel the warmth of his scalp. The softness of that shaggy black hair...
‘One...two...three...’
A smooth transfer. Emma had a moment to scan her patient and assess his airway as her colleagues went into a well-rehearsed routine.
Alistair was unhooking the leads of the ambulance monitor to replace them with their own. A nurse had a pair of shears in her hands.
‘I’m sorry, sir, but I’m going to have to cut the rest of your leathers...’
Jack nodded, but didn’t say anything. His eyes were still shut.
‘Keep your head still,’ Emma reminded him. ‘We haven’t cleared your neck, yet. Your sats are good but are you having any trouble breathing?’
‘No.’
She hadn’t expected the effect that hearing his voice again would have. She had to swallow past the lump that appeared suddenly in her throat and felt like a rock.
‘Sinus tachycardia,’ Alistair said. ‘Blood pressure’s one-thirty on eighty.’
Probably higher than normal for Jack.
‘What’s your pain score?’ she queried. The paramedics had already given him some morphine but maybe it hadn’t been enough. She didn’t need to give Jack the usual range of zero to ten to pick from, with zero being no pain and ten the worst ever. He knew.
‘About five, I guess. Maybe six.’
‘Let’s top up the morphine,’ she directed Alistair, as she hooked her stethoscope into her ears. ‘I’m going to have a listen to your chest,’ she told Jack.
His chest was bare. The leather jacket had been unzipped and the black T-shirt beneath had been cut. His skin was far more tanned than Emma had ever seen but that whorl of dark hair was exactly the same. And she knew exactly what it would feel like against the silk of his skin, if it had been her fingers rather than the disc of her stethoscope she was pressing against it.
Oh, help... Maybe she should stand back and let Alistair take over here? Or call in part of the trauma team? They were probably going to need at least an orthopaedic consult but that should probably wait until the necessary X-rays and other tests had been done.
Alistair was drawing up the morphine. He held the ampoule so that Emma could do the drug check. Her nod was brisk. Happy with Jack’s breath sounds, she wanted to start a neurological check. The potential head injury was high on her list of concerns.
‘You know where you are, Jack?’
One side of his mouth curled into that ironic smile she remembered so well.
‘Oh, yeah... Unless the Eastern got shifted recently?’
‘And can you tell me what date it is today?’
The smile vanished and Emma knew, with what felt like a kick in her gut, that the pain in his eyes had nothing to do with his injuries. It was a standard question but how insensitive was it, given these particular circumstances?
‘It’s
