St Piran's: The Brooding Heart Surgeon

The crash that came from somewhere in the kitchens behind the food counters was astonishingly loud. Metallic. Jarring enough for every head in the cafeteria to swivel sharply in that direction and for conversation to cease abruptly.

And in that second or two of startled silence a scream rang out. And then a cry for help.

Jaws dropped as staff members looked at each other as though trying to confirm the reality of what was happening. Anna heard Charlotte’s gasp behind her but she was watching something else. Weirdly, her instinct had been to look away from the source of the sound so she had seen the first movement in the crowd. A reaction time so fast it was hard to process.

Luke Davenport was on his feet. His chair tipped backwards and he pushed at the table in front of him rather than stepping around it. The table also tipped, the tray sliding off to send china and cutlery crashing to the floor but Luke didn’t even spare it a glance. He was heading straight for the kitchen.

Access was blocked by the tall, glass-fronted cabinets apart from the space where Anna was, beside the tills and the fruit baskets. There was a flap in the counter beside the last till where kitchen staff could go in and out with the trolleys of used dishes but Luke didn’t bother to stop and lift it. Or maybe he didn’t see it. He swept the baskets clear to send apples and oranges bouncing around the feet of those still standing motionless and then he vaulted the space, making the action seem effortless.

Kitchen staff were backing away hurriedly, but not quickly enough for Luke.

‘Move!’ he barked. ‘Clear the way. What’s happened?’

‘Over here,’ someone shouted. ‘Oh, my God … I think he’s dead.’

Luke took several steps forward. Between the tills, Anna could see the blue uniforms of kitchen staff moving. Clearing a space near the stoves in front of which a large man in a white jacket lay very still.

Luke took in the scene. He turned his head with a single, rapid motion.

‘Anna!’ he shouted. ‘Get in here. I need you.’

Someone had raised the flap now but, if they hadn’t, it occurred to Anna that she might have tried to leap over it, too. Luke needed her?

The man was obviously one of the chefs. His white hat had come off when he’d collapsed and was lying amongst the pots and pans of an overturned rack.

Luke kicked one of them aside as Anna raced into the kitchen. ‘Get rid of those,’ he ordered. ‘Someone help me turn him. Did anyone see what happened?’

‘He just fell,’ a frightened woman offered. ‘One minute he was cleaning down the cooker and then he toppled sideways.’

‘What’s his name?’

‘Roger.’

The man had been rolled onto his back now. Luke gripped his shoulder and shook it firmly, hunched down so that he could lean close and shout.

‘Roger? Can you hear me? Open your eyes!’

He barely waited for the response that didn’t come. His hands on Roger’s chin and forehead, he tilted the head back to open his airway.

‘Does anyone know him?’ he demanded. ‘Medical history?’

‘He takes pills,’ someone said. ‘For his blood pressure, I think.’

‘No, it’s his heart,’ another voice added.

The few seconds that Luke had kept his fingertips on the side of Roger’s neck and his cheek close to his face had been enough to let him know that there was no pulse or respiration to be felt or seen. Anna crouched on the other side of the collapsed man as Luke raised his fist and brought it down squarely in the centre of the man’s chest. A precordial thump that was unlikely to be successful but was worth a try.

Ready to start CPR, Anna was thinking fast, compiling a mental list of what they would need. Luke was way ahead of her.

‘Get a crash trolley in here. Find a cardiac arrest button. Send for someone in ED or wherever’s closest. Anna, start compressions.’ He looked up at the silent, horrified onlookers. ‘Move!’

They backed away. Anna heard someone yelling into the canteen for the cardiac arrest button to be pushed. If there wasn’t one in there, it wouldn’t be too far away. She positioned her hands, locked her elbows and started pushing on Roger’s chest. He was a big man and it was hard work to compress the sternum enough to be effective.

Ten … twenty … thirty compressions. At least someone would arrive with a bag-mask unit very soon so she didn’t have to worry about the implications of unprotected mouth-to-mouth respirations on a stranger.

The faint possibility of contracting something like hepatitis didn’t seem to occur to Luke. Or it didn’t bother him.

‘Hold it,’ he ordered Anna, pinching Roger’s nose and tilting his head back as he spoke. Then he sealed the man’s mouth with his own. One slow breath … and then another.

Anna started compressions again, the image of Luke’s lips pressed to someone’s face emblazoned in her mind. The kiss of life … She’d seen it before, though it was a rarity in a medical setting. Was that why it was so disturbing this time? Shocking, in fact. She had to concentrate on her silent counting until it was time to warn Luke.

‘Twenty-seven, twenty-eight, twenty-nine, thirty …’

By the time they had completed another set of compressions and breaths, there were new voices nearby and the rattle of a trolley.

‘Crash team,’ someone announced. ‘We’ll take over now.’

‘I’ve got it, thanks,’ Luke growled. ‘But it’s what we—’

‘We just need the gear,’ the surgeon interrupted. ‘And some assistance.’

Anna could feel the resentment at not being allowed to do what they thought they had been summoned for, but a life pack was lifted from the trolley and put on the floor along with an IV roll, a bag mask and a portable oxygen tank.

She carried on with the chest compressions, pausing only to let Luke rip the chef’s jacket and the singlet underneath open to expose the chest and stick the pads in place. On direction, one of the doctors in the crash team secured his airway and attached oxygen to the bag mask, holding it in place until Anna paused again.

Could she ask to hand over compressions to someone else? This was enough of a physical effort to make her aware of perspiration dampening her shirt. No, she wouldn’t ask. She was with Luke on this.

He had been the one to respond and identify the crisis, which made this man his patient until he chose to hand him over. And he’d asked for Anna’s help. Roger was their patient and they could do this as well, probably better, than the junior doctors assigned to crash-team duties for the day.

‘Stop compressions.’ Luke was watching the screen of the life pack, waiting for a readable trace to appear. ‘V fib,’ he announced moments later. ‘Charging to three hundred joules. Everyone stand clear.’

The junior doctors inched back, exchanging glances.

‘Who is this guy?’ Anna heard one of them ask another.

‘Luke Davenport,’ came the response. ‘You know, the surgeon who’s just got back from Iraq?’

‘Oh …’

In the short space of time it had taken for three stacked shocks to be delivered, the atmosphere in this inner circle around the victim changed. The crash team, who had been busy resenting not being allowed to showcase their skills in managing an arrest, suddenly couldn’t do enough to help their leader.

‘Do you want an intubation kit, Mr Davenport?’

‘Shall I draw up some adrenaline? Atropine?’

‘Here’s a sixteen-gauge cannula. And a flush.’

‘Dr Bartlett? Do you need a break?’