after a single vehicle accident. Seems their car went off the side of the road and ended up in the river. A car travelling behind stopped and the driver managed to get the mother and the kid in the car free, but both were unconscious and spent a bit of time in the cold water until the rescue team arrived to haul them out. The kid is still unconscious and still hypothermic and bradycardic. The mother has been rewarmed, but she has head injuries, a flail chest and blunt abdo trauma. We need your help on the boy—he was tubed at the scene but the airway’s not great and he’ll need to go up to CT soon. Joel Addison is heading the team getting the mother under control—she’s going to CT now. They’ll both need ICTU after we’ve finished here.’
‘Right,’ Allegra said, heading for bay one, where the small child was contained.
Tony Ringer, one of the A and E staff consultants, who was directing the care there, looked up in obvious relief when Allegra appeared at the foot of the bed.
‘Allegra, listen—this tube’s in too far, it’s too small and there are anterior neck injuries from the air bag. We need to change it but I’d be grateful if you would do it. I’ll help.’
Allegra moved to the head of the bed and, taking the airway bag and checking the tube and connectors, she listened to the chest with her stethoscope. ‘Yes, you’re right, Tony. The left side’s not inflating, the tube is too small and probably down the right main bronchus. We’ll change it for a six point five but we need to be ready for a surgical airway if his larynx is oedematous. I’ll change the tube over an introducer to maintain access.’
Tony took over bagging the child while Allegra, with the help of one of the nursing staff, arranged all the equipment she needed, setting it out for easy access.
‘Right, Tony, let’s do it,’ Allegra said, taking a breath to steady herself.
She took a long flexible plastic introducer and, after disconnecting the endotracheal tube from the bag, passed the introducer into the ETT and the right main bronchus. She then deflated the ETT cuff and pulled the tube out of the airway and over the introducer. She rapidly passed a cuffed 6.5 ETT back over the introducer and into the trachea with not much difficulty, positioning the tube this time in the trachea so that both lungs would be inflated, and blew up the cuff. She checked the insufflation of both lungs with her stethoscope and, satisfied that the tube was in the correct position, secured it with tape.
‘Good job, Allegra,’ Tony said. ‘It’s a godsend, having someone with increased airway skills for this sort of situation.’
‘Thanks, Tony. I guess that’s a benefit of the anaesthetic rotation through ICTU.’
‘True,’ Tony replied. ‘Listen, this kid’s still hypothermic. We’re running in warmed intraperitoneal saline now, and as soon as his temperature is up we’ll need to get him next door for a head CT. Can you manage the airway for his transfer and then settle him into ICTU for us? I want to look over the second team treating the mother. And word’s just through that the husband and father has just been located. He’s on his way in.’
‘What’s the boy’s name?’ Allegra asked.
‘Tommy Lowe,’ Tony answered. ‘I don’t know his age, his father was too distressed to talk. What do you think?’
Allegra looked at the tiny body on the bed with tubes running out of him, her stomach clenching in distress that someone so young had had to suffer so much. ‘I reckon he’s about six or seven.’
‘Too young for this sort of caper,’ Tony said, stripping off his gloves and tossing them in the bin.
‘Tell me about it,’ Allegra said. Stripping off her own gloves, she reached out with a gentle hand and touched the little boy on his arm, her fingers soft and warm on his cold pale limb.
Joel was in ICTU, finishing setting the mother up on a ventilator, when Allegra brought the little boy Tommy round from CT.
‘CT on the mother shows some contusion, but no intracranial haemorrhage,’ he said, glancing at her briefly, his expression coolly professional, showing no trace of his anger of the night before. ‘She’s got a flail chest on the right and underlying contusion. She had an intercostal tube put in before they transferred her. I’ve just had to retape the connectors, otherwise that’s OK. Her abdo CT shows a liver contusion, but no free blood, so the surgeons are treating it expectantly at this stage. She’ll have another CT tomorrow. Her bloods were pretty normal, the Hb down as expected. But there was one unexpected finding, about which we’ll have to inform the police.’
‘What’s that?’ she asked, as she supervised the transfer of Tommy from the trolley to the ICTU bed.
‘Her blood alcohol is through the roof—point one. No wonder she ran off the road.’
‘That’s unbelievable!’ Allegra said. ‘How could a mother drive along a winding mountainous road with a child in the car, having drunk herself stupid?’
‘I’m sending off a drug test as well,’ he said with a grim set to his mouth. ‘I have a bad gut feeling about this scenario. Something else is going on, maybe suicide—actually, a murder-suicide.’
Allegra felt a cold shiver of unease pass through her as she looked at the woman hooked up to the ventilator. What circumstances in her life would cause her to take that drastic step?
‘What about the boy?’ Joel asked. ‘Any results from the CT?’
‘No detectable macro brain injury. He could have general minor contusion, maybe slight cerebral oedema. His core temp’s up to 37 now. No other major injuries. We ran the scanner over his neck, chest and abdo—all clear,’ Allegra reported.
Danielle Capper appeared. ‘Dr Addison? Dr Tallis? Mrs Lowe’s husband is here. Perhaps you should speak to him before he comes in. He’s very agitated. I’ve made him a cup of tea and he’s in conference room two.’
Joel helped Allegra set Tommy up on the ventilator then while Allegra set up the IV lines with the nursing staff, Joel removed the intraperitoneal catheter, which had been used to rewarm the patient, stripped off his gloves and exchanged a quick glance with Allegra. ‘We’d better talk to the father together.’
‘Right,’ she agreed, mentally bracing herself. How would the father of the little boy cope with hearing his wife had been driving under the influence, let alone if what Joel suspected was true—that she’d done so deliberately in an attempt to kill herself and her child?
Joel opened the conference-room door to find a man in his mid to late thirties pacing the floor, his face haggard, his clothes looking as if he’d just thrown them on haphazardly. His tie was hanging loosely and his shirt buttons were done up crookedly.
‘I want to see my son! Where is he?’
‘Mr Lowe, I’m Dr Joel Addison and this Dr Allegra Tallis. Your son is in ICTU—we’ve just stabilised him.’
‘And my wife?’ Mr Lowe asked, his hands tightening by his sides.
‘She’s also in the unit,’ Joel said. ‘Both she and your son are being ventilated with a machine to help with breathing. They both have head injuries. We’re not sure yet about how severe those injuries are. The neurosurgical team is coming down now, and will almost certainly want to do a minor procedure on each to insert a pressure monitor. We’ll have a lot better idea when that’s in, and also with a period of observation.’
