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She followed him numbly, still praying for that elusive miracle as they went into the staff rest-room and collected two cups of coffee and then out again, back down the corridor to the consultant’s room—his room.
On the way her mind ran over their conversation in the car park. One thing in particular sprang to mind. ‘If you knew the first thing about Accident and Emergency—’ Oh, Lord, let me be dreaming …
He opened the door for her, closed it behind him and indicated the chair, then lounged against the window sill and grinned. ‘Would you like to go first?’
Oh, sure—and say what? She almost laughed. ‘Not really—I’m still trying to swallow the rest of my feet,’ she confessed ruefully.
He chuckled, a wickedly delicious little chuckle that sent a shiver down her spine. She set her coffee down before she slopped it all and met his eyes defiantly.
‘Why didn’t you say something?’
He smiled slowly. ‘Such as?’
‘Well—I don’t know—anything. “I’m your new boss” would have done nicely. You just stood there and made a complete fool of me—’
He shook his head. ‘Oh, no, Irish, you did that all by yourself.’
She blushed again. ‘You could have said something,’ she repeated stubbornly.
‘Yes, I could, you’re quite right. It was unkind of me. I apologise.’
She shot him a keen look, quite sure he was laughing at her, but his face was sober and his eyes were gentle now.
‘You didn’t look like a consultant.’
‘No.’
‘You should have said—’
‘I should. You didn’t really give me much chance—’
‘Rubbish! You had every opportunity!’
He shrugged and grinned. ‘I suppose so, but it just seemed like a bit of harmless fun—and you know, Irish, you’re beautiful when you’re angry.’
She was speechless.
The phone rang, and he reached out a long arm and hooked it up. ‘Lawrence.’
He listened for a moment, a slow smile spreading over his face, and then held the phone out to her.
‘Security for you—something about a motorbike in the car park …’
Kathleen supposed there was some comfort to be gained from knowing that nobody had ever died of humiliation. Doubtless in later years she would be glad of that, but for now she was too embarrassed to care.
It wouldn’t have been so bad, of course, if it had only been him, but there was that second-year nurse whom she had accused of loitering with him in the corridor—that was going to take some fancy footwork to get out of without loss of face. Oh, well, at least she wasn’t Japanese. Good job too, as there wasn’t a handy sword to fall on. She didn’t somehow think a stitch cutter would do the trick quite so well!
In the end she screwed up her courage, took the girl into her office and apologised. ‘I made a mistake,’ she admitted. ‘I didn’t realise who he was, and with the security problems hospitals have been having recently, you can’t be too careful.’
The nurse smiled. ‘I didn’t know who he was, either, but he asked me where he could find you, and I told him I didn’t know, and he said “Are you new too?” and then you arrived and …’ She trailed to a halt. ‘He didn’t look—well—like a consultant, did he?’
Bless her, Kath thought. ‘No, Nurse, he didn’t, but he is.’ She glanced at her name badge. ‘Amy, have you done any work on Surgical?’
She nodded. ‘I did some time with Sister Lovejoy last year, and I’ve done some orthopaedics.’
‘And how did you get on?’
She nibbled her bottom lip. ‘OK. I had a bit of a problem with Mr Hamilton when he first arrived—I did something rather stupid and he was furious, but the patient was OK and he was great after that. Sister Lovejoy was ever so kind to me over it.’
Kathleen groaned inwardly. That was all she needed, a nurse who made mistakes.
‘Well, Amy, if you aren’t sure about anything, you ask, OK? We can’t afford to make mistakes down here. I think you’d better work with me for the next few days, or if I’m not here, then with one of my staff nurses. Right. Do you know what triage is?’
‘Um—is that putting patients in order of priority as they come in so that you don’t leave people to bleed to death because they’re at the end of the queue?’
Kathleen winced and grinned. ‘Sort of. You’re on the right lines. It really comes into its own when there’s a big emergency involving lots of people. Then the triage nurse is perhaps the most important member of the team. It’s a tremendous responsibility, and challenges all your skills and training, but it also depends a lot on gut instinct. OK, now we’re going to go and have a look in the waiting-room and at the notes, and do a bit of triage there. If they’re all on a par, we take them on a first come, first served basis. Anyone with a suspected heart condition or serious bleeding or a major fracture or head injury comes first, though, and every time an ambulance brings someone, they get seen immediately in the trolley area.’
She took Amy down the corridor. ‘Here we have the cubicles for the walking wounded or minor cases, then the trolley area for the major cases, and then the resus. room for the crisis cases. Then down here we have a couple of day beds for patients who need to rest under observation for the day following treatment but who don’t really justify admission, and then over here we’ve got the two theatres for major suturing and cleaning up, and then down there at the end the X-ray and plaster rooms.’
Amy nodded, her eyes like saucers, and Kathleen remembered the first time she had worked in A and E.
‘Don’t worry, you’ll be fine. I’ll look after you.’
They checked the few patients in the waiting-room, and Kathleen got Amy to sort them into priority, talking through the decision-making process as she did so.
‘Fine,’ she said when Amy had finished. ‘No problems there. But don’t worry, you wouldn’t be asked to do it alone yet. The triage nurse is always qualified and experienced, but it doesn’t hurt you to see how it’s done.’
It was, in fact, a ridiculously quiet day with a steady trickle of bits and pieces, an ideal day to find one’s feet.
Unfortunately it meant that there wasn’t enough for the consultant to do to keep him out of her way, and every time she turned round she almost fell over him.
‘Are you checking up on me?’ she demanded half way through the afternoon.
‘Now, Irish, you know better than that,’ he said with a cheeky grin, and left her alone for a few minutes.
Then there was a call on the red phone.
‘OK,’ Kathleen said. ‘We’ve got someone coming in on a blue light, a young man who’s fallen under a train. Could be an attempted suicide, we don’t know. Anyway, there’s considerable loss of blood, massive lower limb and pelvic damage and some chest injuries. We’ll need plasma expander, and samples immediately for cross matching. Better have some O neg. sent up for immediate use as well. Right, let’s move.’
They prepared the resus. room, and when all was ready they informed the patients still waiting that they might have a slight delay due to an emergency that was being brought in. There were the usual grumbles, but they faded instantly as the ambulance backed up to the entrance, doors already opening.
He was screaming, the high-pitched, nerve-grating scream of agony that always turned Kathleen’s blood to stone, and the waiting-room fell into shocked silence.
They wheeled him rapidly into Resus., Kathleen snapping out instructions right, left and centre, but as they peeled back the blanket to examine him, even Kathleen after all the years she had been working in A and E was shocked at the extent of his injuries. Both his legs were severed completely, the right one mid-thigh, the left up at the hip. His head was cut and bleeding, and his jacket was torn and damaged, indicating possible chest injuries. His right arm was also lying at a funny angle and was probably dislocated or fractured.
Amy Winship took one look at him and disappeared quietly through the door, and Ben Bradshaw winced. Only Jack Lawrence appeared quite unmoved, glancing dispassionately at the damage that Kath revealed with her scissors. There was blood everywhere, more of it by the second, and nothing they did seemed to stop it. His left leg was particularly bad, the vessels refusing to co-operate. They slowed it to a steady well, but it wouldn’t stop, and through it all there was the awful screaming.
‘For Christ’s sake get an anaesthetist down here and shut him up,’ Jack Lawrence grunted, and moved to his head, checking his pupils automatically. ‘Have we got any ID?’
Kathleen shook her head. ‘No, nothing. The ambulance men checked his clothes.’
‘Damn. We need to get his relatives in fast.’
She raised an eyebrow. ‘You don’t say?’
He grinned ruefully. ‘Any sign of a surgeon? And we need cardiothoracic and orthopaedics, too.’
‘Before or after the mortuary technician?’ Ben said under his breath.
Kath glared at him, and he shrugged.
‘Just being realistic, old thing.’
‘Well, don’t bother—and don’t call me old thing. Just do your job, please. Have you stopped that bleeding yet?’
He shook his head. ‘It’s leaking from the abdomen—I think he needs a bit of surgical attention.’
Kath shot him a dry look. ‘You guys are really sharp today, aren’t you?’
Jack was inspecting the young man’s chest dispassionately, watching the ragged rise and fall of the ribs as he dragged in a breath between screams, and he shook his head thoughtfully. While he ran thorough hands and eyes over his shattered body, Kathleen started cleaning up the chest area ready for the heart monitor after checking the IV line that was running in Haemacel and taking blood for cross-matching, dodging round the radiographer who had brought the portable in and was taking X-rays.
When his chest was clear, she put on the pads for the heart monitor, frowning slightly as she did so at the feel of the chest wall under her hands. As she watched his breath jerked in, and a large section of his chest wall moved in instead of out.
‘Flail chest,’ she said quietly, and Jack nodded, drawing her to one side.
The lung’s collapsed, I think. Probably where he was hit by the train. His pelvis is shot to hell, too, and judging by the feel of the abdomen, he’s got massive haemorrhaging.’
Kath nodded. ‘So why is he still alive?’
‘God knows.’ Their eyes met and tracked together to the heart monitor. ‘He’s not doing too well, is he? I think we need an echocardiograph. Can you get the cardiographer?’
Not that there’s a great deal of point, Kathleen thought to herself, but we may as well go through the motions.
While she phoned the switchboard and requested that they page the cardiographer, Michael Barrington the orthopaedic SR arrived and glanced at the shattered stubs of the young man’s femurs.
He swore, softly and succinctly. ‘Got any X-rays yet?’
Jack nodded. ‘Yes, they’re just being developed.’
Michael pursed his lips. ‘Done a real job on himself, hasn’t he? Anyone know why?’
‘No. We don’t even know if it was an accident yet.’
Their eyes flicked to the monitor. Their patient was still alive but his condition was deteriorating visibly. The anaesthetist, Peter Graham, had arrived and managed to dull his pain. Now he merely lay and moaned, but at least he was no longer screaming.
Amy popped her head round the door to tell Kathleen that they had found some ID on the track and the police had brought his parents in.
‘His name’s Steven Blowers. They want to see him.’
Kathleen exchanged glances with Jack, and he shook his head.
‘Put them in the interview-room and give them a cup of tea. One of us will be out in a minute,’ she told the young nurse. ‘Oh, and Amy? Say nothing.’
Amy nodded gratefully and retreated.
The X-rays appeared and Michael ran a critical eye over them.
‘Ouch. Do you want me to interpret, or is it academic?’ he said quietly.
Jack’s mouth lifted in a wry smile. ‘Probably. We’ll see what the cardiothoracic guy has to say.’
When he arrived moments later, he took one look at the X-rays and shook his head.
‘You jest, of course?’ he said drily. ‘Look at this shadow here—probably a bulge in the heart or the aorta behind it—the kid’s a goner. He’ll never make the anaesthetic, and even if he did, who wants to be a bloody cripple? Oh, well, we can only fail. Let’s have him up in Theatre.’
He sauntered out, whistling, and Kathleen met Michael Barrington’s eyes. They were like chips of blue ice, his lips compressed into a thin line.
‘Call me if you need me in Theatre—but I’d just as soon Tim Mayhew did it—I don’t trust myself near that bastard.’
And he turned on his heel and stalked away, his limp almost imperceptible.
Jack raised an eyebrow. ‘What’s eating him?’
‘He’s a bloody cripple,’ she said succinctly.
‘What?’
‘He has an artificial leg. He went to assist at a passenger train derailment last year and got trapped in the wreckage. We had to amputate part of his leg to free him.’
‘Ah …’
Just then their patient moaned and opened his eyes. Kathleen was there instantly.
‘Steven? It’s all right, you’re in hospital. Can you hear me?’
He licked his lips and nodded slightly. ‘Messed it up, didn’t I?’ His voice was a mere thread. ‘I thought it would be quick,’ he went on painfully. ‘Let me go—please, let me go. You don’t know what this is all about.’
She squeezed his hand. ‘Do you want to tell me?’
‘Danny,’ he whispered. ‘My fault … gave Danny—HIV.’
‘Oh, Christ,’ someone muttered behind her. Kathleen closed her eyes. The room was a bloodbath, all of them were covered, and their patient was HIV positive.
Great. Oh, well, it had happened before, doubtless it would happen again. As far as she was aware, no one had cut themselves or pricked themselves with a needle.
Behind her she could hear Jack calmly telling everyone to go and shower and change and come back in full barrier gear.
She could see blood on Jack’s cheek and on his arm above the gloves. God knows where it was on her.
