Their Own Little Miracle

CHAPTER TEN (#litres_trial_promo)

Extract (#litres_trial_promo)

About the Publisher (#litres_trial_promo)

CHAPTER ONE (#u7f5466cc-0f2c-5cbf-9a9d-7f478e52ed6f)

‘ED TRAUMA CALL, ten minutes.’

Iona’s heart sank. Another one? The previous trauma patient had only just arrived, and they were seriously short-staffed. Andy Gallagher was on holiday, Sam Ryder had gone for lunch five minutes ago at three thirty, they were rushed off their feet and she was virtually on her own because James Slater, the clinical lead, was already up to his eyes in Resus with the trauma patient who’d just arrived, a construction worker with severe crush injuries to his chest who from what she could gather was resisting all attempts to resuscitate him.

Which made her, a brand new registrar, the most senior doctor available, so it wasn’t a surprise when she was called into Resus. James didn’t pause what he was doing. ‘Iona, can you take the trauma call, please? I can’t leave my patient but I’ll be right here, so you can run things by me if you need to.’

‘Sure.’

She went back to her patient, handed her over to the F2 junior doctor she was with, found out as much detail as possible about the incoming casualty, went into Resus and put on a lead apron. Their patient had been hit by a car and had suspected pelvic injuries, which she really hadn’t wanted to hear, so he’d need X-rays to check for fractures. She hoped they wouldn’t be too serious because James was still tied up and looking at him she was fairly sure he would be for some time, because he and his team were now opening the patient’s chest and it wasn’t looking pretty.

Around her a new team was assembling: Tim, an F1 junior doctor fresh out of medical school who was totally out of his depth, Jenny, thankfully a highly competent nurse, Sue, a radiographer she trusted, ready with the portable X-ray and ultrasound, another nurse who she’d worked with in the past and who seemed OK, and a recently qualified health care assistant as the scribe.

Well, she just hoped the patient wasn’t too bad, because as teams went, this one was inadequate on several fronts. Not Sue, though, who was already surrounding the bay with lead screens, and not Jenny. Just her, Tim and the HCA, then. It was a good job James was right beside them, even if he was up to his eyes.

She briefed them quickly on what little she knew, allocated them their positions in the team and made sure they were ready. ‘Right, lead and plastic aprons, please, everyone, and you all know what you’re doing?’ she checked, then it was too late to worry because the patient was being wheeled in and they were given the handover by the paramedics.

‘This is Jim Brown, age fifty-six, hit on his right-hand side by a large van about forty minutes ago, suspected pelvic injury. We put a pelvic binder on and secured his spine at the scene. BP one-twenty over eighty, sats ninety-eight per cent, we’ve given him ten of morphine and started him on saline. No apparent head or chest trauma but he’s complaining of pain in the right wrist so we’ve splinted it.’

The pelvic injury wasn’t good news, but at least his blood pressure was all right so hopefully he could be transferred to Orthopaedics shortly. ‘OK, everybody, can we get these clothes off so I can do a primary survey, please? Sue, we need a FAST scan, and somebody book an urgent CT? Jenny, take bloods, cross match for four units, and we’ll have packed cells and FFP on standby, please. Sue, after the FAST scan I’d like X-rays of C-spine, chest and pelvis. And make a note of the time. Fifteen forty-six.’

The team went into action and she bent over the patient so she was in his line of sight; he was conscious but in obvious pain and distress, and she smiled reassuringly at him. ‘Hello, Jim. My name is Iona, I’m a doctor and I’m going to be looking after you. Can you tell me where it hurts?’

‘All down there—don’t know, it’s all blurred together.’

‘Anything else? Head? Chest?’

‘No, they’re fine. My right wrist hurts, that’s all.’

‘OK.’ She looked up at the monitor to check his blood pressure. One-ten over seventy, slightly down. She’d need to keep a close eye on it. ‘How’s the FAST scan, Sue?’

‘Some free fluid in the abdomen,’ Sue murmured softly. Which was highly suggestive of a pelvic fracture. And his blood pressure had dropped since the paramedics had reported it.

They stepped back briefly so Sue could X-ray his pelvis for confirmation, then Iona shut her mind to everything else and concentrated on Jim. Pupils equal and reactive, airway clear, good bilateral breath sounds, no significant pain when she felt his chest, no obvious bumps on his head, but his right wrist was almost certainly fractured.

And so was his pelvis. The X-ray showed multiple fractures of the pelvic ring, some displaced. No wonder he was bleeding, but hopefully his neck and chest were clear and he still had circulation to both feet. Small mercies, she thought.

‘Right, Jenny, can we start the PRBC and FFP, and can someone page Orthopaedics please? Multiple pelvic fractures. Sue, can you get the neck and chest shots, please.’

‘If he’s got pelvic fractures you need to page IR,’ James said over his shoulder, and she took a breath and nodded. At least he was listening and keeping her on track. She could do this.

‘OK. Can someone page Interventional Radiology as well, please? How about CT, James?’

‘No, wait for IR. They’ll probably take him straight to the IR suite to embolise the damaged arteries.’

If she was lucky...

She was scanning the X-rays when she heard the swish of the door opening and closing behind her. She glanced round to see who it was, and her heart did a funny little hitch. The interventional radiologist? He didn’t look old enough to be a consultant, but he had the firm tread of someone who knew what he was doing. She could only hope—

‘Hi. I’m Joe Baker, IR Specialist Registrar. You’ve got a pelvic fracture for me?’

She met his eyes and her head emptied. Framed by the longest, darkest lashes, they were very pale blue, almost azure, with a dark rim. Utterly gorgeous and curiously penetrating. Mesmerising, in fact...

She gave herself a mental kick and tried to focus. ‘Yes. Hi. I’m Iona Murray, Registrar. This is Jim Brown, fifty-six years old, hit by a car on the right, BP one-twenty over eighty on admission, now...’ her eyes flicked to the monitor, and her heart sank ‘...ninety-five over sixty. Sats were ninety-eight per cent, now ninety-six. FAST scan shows free fluid, X-ray confirms multiple fractures of the pelvic ring. I think the chest and neck are clear but they haven’t been checked by a radiologist.’

He nodded and held out his hand. ‘May I?’ He took the tablet from her, scrolled through the images and frowned. ‘Right, they are clear but the pelvis is a mess and I’ll need to embolise him. Has he had a CT yet?’

‘No. We haven’t had time.’

‘How’s his airway? Any obvious chest trauma or signs of head injury? Cardiac tamponade? Pleural effusion?’

‘No.’

‘Are you leading?’ he asked, and she nodded.

‘Right, I’ll take over from here. Go on.’

She didn’t know whether to be relieved or furious, because frankly it was a close-run thing. She went for relieved.

‘He’s also got a query fracture of right radius and ulna, but good cap refill and sensation.’

‘OK, that can wait, then, so can the CT. Can you cancel the slot, please, if you’ve booked it, and alert IR?’

Joe reached for his neck, then frowned. ‘Stethoscope?’ he said briskly, holding out his hand, and she lifted her stethoscope over her head and handed it to him reluctantly.

‘You’re dead meat if anything happens to it, it was a graduation present from my sister,’ she muttered darkly, and he rolled his eyes, introduced himself to Jim and checked his chest.

‘OK, his chest’s clear so I’ll take him straight to IR—’

‘BP falling. Sixty-five over forty.’

Jim was crashing. He groaned, and Iona took his hand.

‘It’s OK, Jim, we’re here, we’ve got you,’ she said, squeezing his hand for reassurance. But it was cold and lifeless, clammy now as well, and she felt her pulse spike.

‘Right, can we have the REBOA kit, please, we need to do this now,’ Joe said. ‘And get me an arterial kit before we lose the femoral artery.’

He was going to insert a balloon into his aorta in Resus? Her eyes widened. She’d never seen it done, far less assisted, and she felt a moment of panic.

‘I can page Sam,’ Iona said hopefully. Sam, who was an ex-army medic, had done it dozens of times in the field and would know exactly what to do, but Joe Baker wasn’t waiting.

‘No time. Can I have a pair of scissors? The first thing we need to do is cut a chunk out of the pelvic binder to give me access.’