The Italian Effect

It wasn’t the first time that Lissa was glad of her own mixed heritage. Not only did her dark hair and the natural olive tint of her skin offer her a degree of protection against these predators, but her comprehension of Italian was easily good enough to put her on her guard. An insult spoken with an apparently admiring smile was still an insult.

She heard a group of giggling female English voices arrive nearby and opened one eye to peer in their direction. It didn’t take long to discover that they were apparently a group of girls on their first foreign holiday without their parents.

Lissa could remember that age of innocence—just left school and waiting for exam results to know whether she was going to be able to follow her dream of becoming a doctor—but it seemed so much longer than ten years ago.

She didn’t need a crystal ball to know what was going to happen next and the grim inevitability of it kept her watching.

It only took a few minutes for the local males to close in on their new quarry with swaggering walks and gleaming smiles. The girls clearly didn’t understand the crudity of the comments being made about them and their physical attributes, or the bargaining going on between the men as they apportioned the girls among themselves. Lissa could, and it turned her stomach to see them led off like lambs to the slaughter.

She closed her eyes again but what little pleasure she’d found in the day had been soured. It didn’t seem to matter that she tried to concentrate on the soothing sounds of the ocean. All she seemed to hear were the insincere compliments that had been showered on the naïve girls just a few feet away. How long would it be before their eyes were opened? Hours? Days? At least it wouldn’t be longer than the one- or two-week span of their holiday.

In her case, it had taken months for the penny to drop.

She tried to shut the sounds out and was seriously contemplating going back to the hotel when she heard a new sound added to the cacophony and every nerve switched to full alert.

‘Oh, my God,’ shrieked a voice not far away, a young and obviously frightened girl’s voice. ‘Help me, someone. He’s fallen. He’s hurt…’

Lissa was on her feet almost before she realised she was moving, her eyes scanning the far end of the beach.

Several other people had obviously heard the scream and they were all looking towards the rocks that curved round like a protective arm at the far end of the strip of sand.

Second nature had her reaching for her bag and then she was off and running.

A small crowd had started gathering, several voices calling out advice.

Lissa sent up a silent prayer of gratitude that she’d never lost her basic comprehension of Italian even though her speech might not be quite fluent. It was certainly enough to understand that the voices in the crowd were suggesting that the unseen victim should be moved into a more comfortable position.

‘Fermo! Non muoverti!’ she shouted as she pushed her way through the gathering knot of onlookers, terrified that they might move the victim and damage his spinal cord. ‘Stia attento della spina dorsale!’

Her voice must have conveyed both the urgency of the situation and the fact that she was an authority of some sort, because everyone stood back to let her through. Even the young woman who had first called the alarm grew silent, but tears still streamed down her face as an older woman wrapped her in comforting arms.

‘Chiami un’ambulanza!’ she ordered as soon as she caught sight of the scene in front of her, then dropped to her knees in the sand and concentrated on beginning her observations.

She couldn’t help thinking that the little boy lying crumpled and unconscious on the unforgiving rocks looked just like an abandoned puppet. He looked so small and fragile that she just wanted to pick him up and cradle him in her arms.

‘ABC,’ she murmured under her breath, grounding herself in the routine she’d been following ever since she’d begun her training in emergency medicine. ‘Airway, breathing, circulation.’

He was lying on his back across the rocks with his head twisted to one side, but all the while he was able to breathe it was far safer not to move his neck. His pulse was good, too…a little fast but strong and regular.

In between, she was being peppered with information about her little charge. It seemed as if almost half of the people on the beach knew little Taddeo.

A voice called something from the back of the rapidly growing crowd and the message was passed forward. With so many voices chiming in it could have been garbled, but Lissa understood enough. There had been an accident a few miles up the coast. A car had crashed into a motorcycle. It could take half an hour or even more before qualified help arrived.

‘It’s up to me, then,’ she murmured as she rested her fingers gently over the steady pulse in the fragile neck. ‘No proper equipment. Nothing except all those years of training to fall back on.’

Suddenly her brain seemed to be working at lightning speed.

‘I need a small surfboard,’ she announced, the Italian word emerging from her mouth without conscious thought. She’d been watching some of the children riding the waves into shore on them a little while ago and one of them would have to serve as a makeshift backboard. ‘And some towels and some leather belts…Oh, and some strong men with gentle hands.’

‘Wouldn’t we all?’ quipped one of the women in the crowd. There was a sudden ripple of laughter at her wry comment and Lissa couldn’t help smiling, in spite of the tense situation.

It took very little time for her strange shopping list to arrive and then it was a case of demonstrating exactly what she needed her untrained assistants to do.

It seemed as if it took for ever before she had five-year-old Taddeo positioned to her satisfaction, his head braced by rolled-up towels on either side to prevent his neck from moving and held still by several strips of adhesive tape from the first-aid kit in her bag. The rest of his body was cushioned by more towels and stabilised by the borrowed belts wrapped around the board.

He was still unconscious and there was a large knot on the back of his head that was bleeding sluggishly. It didn’t look as if he’d broken any limbs, but only an X-ray would tell. As for any further injuries…

‘Carry him carefully,’ she encouraged the men who took either end of the board. ‘Don’t slip or you’ll jolt him. We don’t want to risk paralysing him.’

She raced back across the narrow beach to grab the rest of her belongings before rejoining the small cavalcade, sparing a brief reassuring smile for the young woman being comforted by the matriarch of the boisterous family.

It was a precarious trek up the winding pathway to the road at the top. She’d taken the much steeper steps on the way down, but even this route seemed almost as precipitous as Mount Everest now that she wanted to cover the distance quickly.

She knew that the first hour after an accident—the so-called ‘golden’ hour—could be the most crucial in deciding the survival of a patient. It would have been impossible not to be conscious that time was ticking by at an alarming rate.

‘La macchina,’ announced one of the volunteer porters as they came to a halt beside a luxurious car.

While she supervised the loading of her little charge across the back seat she subdued a brief pang of worry at abandoning her own hired vehicle. It could be awkward if she was left stranded at the hospital without transport, but it was far more important that she should be close at hand to watch over Taddeo.

Lissa perched herself on the edge of the seat, bracing her hip against the edge of the makeshift backboard to ensure it didn’t shift as the engine roared into life. She tightened one hand over the luxurious leather upholstery, the other probing gently around the wedged towels to check on her charge’s pulse.

Still strong and steady, thank goodness, although his continued unconsciousness was worrying. Supposing he had sustained something more than concussion? A haemorrhage? Brain damage? Was he in a coma, dying even as she counted his pulse and monitored his breathing?

‘Don’t be stupid,’ she muttered, giving herself a mental shake. ‘Just because you aren’t surrounded by the usual equipment in the emergency department doesn’t mean that your brain isn’t functioning the way it usually does.’ She checked the size of the child’s pupils, having to peer closely because the irises were so dark a brown that they almost merged with the pupil.

‘Still even,’ she whispered, relieved that they also seemed to be equally responsive to changes in light levels.

‘Uno minuto,’ her unofficial ambulance driver called over his shoulder, announcing their imminent arrival at the hospital. Lissa sighed with relief, then started to brace herself for the task of dredging up enough of her rusty Italian to try to explain the situation and her observations.

She marshalled her thoughts into some semblance of order and spared a brief thought for the paramedics who had to do this on a daily basis. She’d always appreciated the ones who managed to give the maximum of pertinent detail in the minimum of words but had never realised how difficult it could be to do it.

‘Può aiutarmi?’ she called, beckoning two gentlemen in uniform standing near the entrance to the small regional hospital’s emergency entrance. They certainly looked strong enough to help to lift the makeshift stretcher out of the car.

‘There’s been an accident. He’s hit his head. He’s unconscious,’ she said, relieved that the hastily collected phrases had the desired effect.

Her redundant driver waved off her expressions of gratitude and called his good wishes after her as she hurried away. In no time at all she was following the child into the department, relieved to have arrived so swiftly.

Once inside the doors she was stopped by a wall of bodies and sound, unable to believe her eyes.

The whole place seemed to be completely crowded with a multitude of people wailing in misery, and for a moment she wondered how on earth she was going to get her little charge the attention he urgently needed.

Her press-ganged porters obviously knew their way around, as there was no hesitation in their passage through the unit. She followed closely behind, her eyes darting around in the hopes of spotting someone in authority as soon as possible.

One of her willing companions called out urgently to a harried nurse who pointed towards a curtained cubicle. The woman’s reply was totally incomprehensible to Lissa, the words lost in the volume of misery surrounding them.

Lissa supervised as they gently deposited their burden onto an examining table then checked the little figure again. There was still no sign that he was returning to consciousness and she was growing increasingly frustrated that there was absolutely nothing she could do about the delay in getting someone to look at him.

If this had been the accident and emergency department she’d been working in for the last year, she wouldn’t even have had to raise her voice to have at least a nurse in attendance. What kind of place was this to have the reception area filled with such a noisy rabble and not a member of medical staff in evidence? Was there anyone in charge?