someone go up to the house and tell Joan to ask them to divert here now. There’s every chance this is going to be a fatality unless we can pull off a miracle here,’ Matt said. Turning to Kellie, he went on, ‘He’s in shock and unconscious. Put on gloves and goggles and come round to the side and stabilise his neck while I intubate him.’
Kellie held the neck steady, while Matt, now also with gloves and goggles on, gathered the laryngoscope and size 7 endotracheal tube. There was no suction, and the sun was bright, flooding out the light of the laryngoscope.
‘Jack, hold this space-blanket over his head to make it darker so I can see down his throat,’ Matt instructed with a calm confidence Kellie couldn’t help admiring.
Under the cover of the blanket, Matt inserted the endotracheal tube, inflated the cuff and attached the respirator bag. There was no oxygen, only air to ventilate with.
‘OK, I’ll ventilate while you fit a hard cervical collar, Kellie. They’re in the airway section,’ Matt instructed.
Kellie retrieved and fitted the collar, then under Matt’s instruction took over ventilation with the bag. Matt listened to the chest with his stethoscope, and then percussed the chest.
‘There’s very little air entry on the right and it’s dull to percussion. I’d say he’s got a haemothorax. He’s also losing a lot of blood from the abdominal wound.’
Taking a pair of scissors, Matt cut away the front of the patient’s shirt to reveal a ragged gash in the right upper quadrant of the abdomen, with a loop of bowel protruding and dark blood oozing out. Taking a pack of gauze dressings and a few ampoules of saline, Matt covered the bowel and compressed it back into the abdomen, then covered the whole wound with several large dressing packs and taped them down. He then inserted a 14-gauge cannula into a vein in the arm, and attached it to a litre bag of normal saline.
‘Jack, here, squeeze this bag firmly to push the fluid in,’ Matt directed, handing over the IV set to the cattle farmer.
One of the station hands came back down from the house to inform them, ‘The flying doctor’s diverting here. They should be overhead in about ten minutes.’
‘Good,’ Matt said, and inserted a second IV line into the other arm, and got the station hand to hold up the IV fluid bag.
Matt knew he had two more bags of saline in the kit which would hopefully be enough till help arrived. The flow of blood had now stopped, at least externally.
‘OK, all we can do now is hold the fort and support his airway and circulation till we get more gear,’ Matt said. ‘I’ll take over ventilation, Kellie. Can you do his obs?’
‘Sure,’ Kellie answered, becoming even more impressed at Matt’s level-headedness under intense pressure and circumstances that were far from ideal. The dust and heat was bad enough but with the stickiness of blood the bush flies were starting to swarm around. ‘Pulse is 120, BP 80 systolic,’ she said. ‘The first bag’s through. I’ll put up the next one.’
Seemingly from nowhere, the roar of a plane at low altitude passed directly overhead, en route to the airstrip on the other side of the homestead.
‘Thank God.’ Matt breathed a sigh of relief. ‘We might just pull this off yet.’
The final bag of saline was almost through when one of the station’s four-wheel-drive vehicles arrived with the air ambulance crew in the back, together with a stretcher and several emergency kits. One of the ambulance crew jumped out, carrying two packs of equipment.
‘Hi, I’m Marty Davis. We haven’t got a doctor—he’s in Roma with a placenta praevia. They’ve got things under control there but we’re on our own here. What have you got?’
‘Brayden Harrison, one of the jackaroos, has been gored by a bull and is in very bad shape,’ Matt informed him. ‘He’s in haemorhagic shock, he’s got a haemothorax and an open abdominal wound. Have you got any plasma expander? We’ve just exhausted our normal saline and we’re still way behind.’
Kellie connected both of the bottles Marty produced to the IV lines while Matt instructed Marty and his partner, Helen, to position the stretcher beside the patient. While Kellie took over ventilation, Matt supervised the transfer onto the trolley and into the back of the four-wheel drive.
‘He’s still bleeding internally. I want to get him to the plane and put in a right intercostal catheter to re-expand his right lung. Have you got underwater drainage?’ Matt asked.
‘Yes, we’ve got a full set of stuff for chest wounds on the aircraft,’ Helen said.
‘Let’s go, then,’ Matt said. Exchanging a quick glance with Kellie, he asked, ‘Are you OK to fly with me to Brisbane? I’ll need you to ventilate him while I manage his IV fluids and abdominal wound.’
‘Of course,’ she said, although she could feel her stomach already beginning to tighten in apprehension.
Once they reached the aircraft, the two ambulance personnel loaded the patient, while Kellie and Matt set up the intercostal tray.
Kellie helped Matt wash his hands with some sterile water and surgical scrub solution.
‘Thanks,’ he said, locking gazes with her momentarily before he donned sterile gloves.
She watched as Matt prepped the right side of the chest before performing the necessary procedure that would stem the flow of blood. Some tense minutes later when he unclamped the tube, about 300 ml of blood drained into the bottle, with a small ongoing leak of blood after that.
‘Hopefully his chest bleed will stop,’ Matt said as he fixed the tube to the skin with a heavy suture and sticky plaster.
‘You did an amazing job back there,’ Kellie said, meeting his eyes across the now relatively stable patient. ‘You stayed so calm and in control.’
Matt gave her a quick movement of his lips that could have almost passed for a smile. ‘You were a damned good assistant,’ he said. ‘It makes a huge difference when everyone knows what to do and when to do it.’
‘Thanks,’ she said, feeling a blush spreading over her cheeks. ‘But I was glad you were the one in charge.’
‘I’m sure you would have coped just as well,’ he said, checking the patient’s condition again. ‘Come on, Brayden, hold it together, mate. Not long now.’
Kellie heard the slight note of desperation in Matt’s voice. ‘Do you know him personally?’ she asked softly.
His eyes connected with hers before looking away again to focus on the young man lying between them. ‘I met him a few months ago. He came to see me about a plantar wart on his foot.’ His frown deepened as he continued, ‘He’s nineteen years old. He was a little undecided about what to do after he finished school, so rather than waste his parents’ money at university doing a course he might never use he came out to the bush for a gap year.’ He let out a ragged sigh as his eyes came back to hers. ‘He’s just a kid …’
Kellie put her hand on his arm. ‘He’ll make it, Matt,’ she said. ‘You’ve done everything possible to get him this far. He has to make it.’
Matt looked down at her smooth hand resting against
