‘Kieran. I’m Vicky. We just came down here for the weekend. We thought Cornwall would be so romantic…’ Her voice trailed off in despair.
Abby tried to reassure her patient. ‘Kieran,’ she murmured gently, ‘I’m Dr Curtis—Abby. I’m going to take care of you, but I just need to examine you for a moment. Is that all right with you?’
Kieran nodded, almost imperceptibly, as though the effort was too great, and Abby quickly checked his pulse. His breathing was laboured, and she looked carefully down at the grazed area of his chest. She watched as he tried to breathe and discovered that there was a part of his rib cage that wasn’t rising and falling as it should. Instead of expanding as he breathed in, that section moved inwards, and when he tried to expel the air from his chest, it shifted outwards.
‘I think you have what we call a flail chest,’ Abby explained to him quietly. ‘It means that you’ve probably broken several of your ribs in a couple of places, so that part of the rib cage is moving independently and interfering with your breathing. I’ll do what I can to make you feel more comfortable, and then we’ll get you moved to hospital for a proper check-up.’
She lifted her gaze to Vicky. ‘I’ll need to go and get my medical bag from my car,’ she said softly. ‘I’ll be just a couple of minutes…it isn’t too far away. Will you watch him carefully while I’m gone? Don’t move him at all, just make sure that he’s comfortable and try to keep him warm. If he should stop breathing, tilt his head back slightly and blow into his mouth. Do you think you can do that?’
Vicky looked at her with frightened eyes, but she nodded all the same.
‘OK, then.’ Abby looked around and saw that there was a beach towel spread out on the sand nearby. ‘We’ll cover him with this, shall we?’
She carefully tucked the towel around Kieran, and then got to her feet, reaching into her bag for her phone to call for an ambulance as she headed towards the cliff. Her car was parked on a standing space on the clifftop, and she was thankful that she was strong and healthy and could manage the climb at a reasonable pace. She wasn’t so sure that the ambulance crew would cope as well in this terrain with a patient on a stretcher, though, and when the operator suggested sending the rescue helicopter, Abby agreed readily enough.
Going back down to the beach was more difficult when she was carrying her medical kit, but she made as much haste as was possible, knowing that Kieran’s condition could deteriorate at any moment. He was already having problems with his breathing, and if he had punctured a lung or a blood vessel, he could be in deep trouble.
‘He’s getting worse.’ Vicky’s agitated words greeted Abby as she came to kneel down beside her patient once more. ‘What’s the matter with him? Can you help him?’
By now Kieran was showing clear signs that something was very wrong with him. His breathing was rapid and his lips were beginning to show a bluish tinge. ‘He needs oxygen,’ Abby murmured.
Quickly, she slid a Guedel airway into place, and then covered his mouth and nose with a face mask and began to squeeze the attached ventilation bag. ‘Do you think you could manage to do this?’ she asked Vicky. ‘I need to examine him again.’ As she spoke, she heard the gratifying drone of the rescue helicopter in the distance. At least help wasn’t far away.
‘Yes, I can do that.’
‘Good.’ Abby ran her stethoscope over Kieran’s chest. There were no breath sounds on his injured side and he was becoming increasingly distressed. His pulse was rapid, and the veins in his neck were becoming distended, and all that was very bad news. It meant that pressure was building up dangerously, and if she didn’t act soon, he could go into cardiac arrest.
‘Kieran,’ she said gently, ‘the injury has caused a tear in the pleural cavity around your lungs, and air is building up in there because it can’t escape. That’s why you’re having difficulty breathing. It’s caused your lung to collapse, and I need to relieve the pressure by putting in a tube. I’m going to give you an anaesthetic so that it won’t hurt as I do that.’
His situation was desperate, and she worked as fast as she could, sliding a cannula between his ribs and withdrawing the needle. There was a reassuring hiss of air as the gas escaped, and she taped the cannula in place and inserted a chest drain. In the background, she could hear the whir of the helicopter blades as it approached.
A paramedic came to stand beside her a few minutes later. ‘What’s the situation here?’
She looked up and greeted him with a feeling of relief. Briefly, Abby outlined the patient’s condition.
‘OK,’ he said when she had finished. ‘My partner and I will get him aboard the helicopter and then I’ll let the hospital know that we’re coming in.’
His partner was already preparing the stretcher. ‘I’d like to go with him,’ Abby said quickly. ‘His condition could worsen, and I want to do what I can for him. I feel responsible for monitoring him, since I’ve already been giving him treatment.’
‘That’s all right.’ The paramedic smiled and glanced at Vicky, waiting anxiously by Kieran’s side. ‘We’ve room enough for two more.’ He helped secure their patient on the stretcher. ‘It’ll take us about ten minutes to get there, but Dr Blakesley and his team will be ready for us.’
Abby felt a quiver of alarm run through her. It was beginning to look as though she was going to meet her new boss sooner than she had expected. She could only hope that the meeting would go well.
She looked on while the paramedics transferred Kieran by stretcher to the helicopter, which was waiting some distance away. When he was safely installed, the paramedic in charge helped Vicky climb in alongside Kieran, and Abby followed.
She wasn’t at all happy with her patient’s pallor, and as the helicopter took off and the journey progressed, she realised that he was showing increasing signs of distress. That was very worrying.
Vicky held his hand and murmured soothing words, while Abby inwardly fretted. If anything, he should be showing signs of his condition improving, but instead he was experiencing increased breathlessness and his pulse rate was rising. She glanced at the chest drain, and doubts crept into her mind.
If only she knew more about emergency medicine. Although she had followed what she believed was correct procedure, it wasn’t beyond the realms of possibility that she had made a mistake somewhere along the way.
‘He’s still breathless,’ the paramedic observed, and Abby nodded. Could she have pushed the tube in too far?
The paramedic quietly relayed the developments back to the hospital via his radio and listened to the response. ‘Dr Blakesley is going to meet us as soon as we land,’ he told Abby. ‘His team will be standing by.’
His words were meant to be reassuring, but Abby had mixed feelings about that. What would Mr Blakesley think of her if she had messed things up? With her patient in poor condition there was the distinct possibility that she could find herself starting off on the wrong foot with her new boss.
She glanced back at her patient. If blood was building up in his pleural cavity, he was in imminent danger…She found herself praying that they would get to the hospital very soon. It was more than likely that Kieran would need surgery to repair the wound in his chest.
‘We’ll need to send blood for cross-matching,’
