Worth The Risk

Sean nodded, his mouth a grim line. ‘Could be. He’s certainly broken some ribs.’

And one of those ribs could have punctured a lung.

‘What’s happening?’ Jack was frowning and Sean rose to his feet in an easy movement, talking to Jack in low tones while Ally sat with Pete, monitoring his condition and reassuring him while he struggled with his breathing.

Gently she unzipped the top of his jacket and examined his neck, her heart sinking as she recognised the cardinal sign of pneumothorax. Giving Pete a quick smile, she stood up and joined Sean who was discussing the options with Jack.

She touched his arm, feeling the rock-hard muscle under his jacket. ‘He’s got tracheal deviation. We need to get him off this mountain fast.’

Sean shook his head, bracing himself against a sudden gust of wind. ‘No way. It’s compromising his breathing. If we could arrange an air evacuation then maybe we could risk leaving it, but as it is—’ He broke off and gave a shrug. ‘It’s going to be a long and difficult carry off, and he’s not going to make it unless we sort his breathing out.’

Jack frowned. ‘So what do you suggest?’

‘We’ll have to put in a chest drain.’ Sean gestured to the team members carrying the medical equipment.

‘We carry a disposable chest drain,’ Jack informed him quickly. ‘It’s just that we’ve never seen it used before.’

Sean gave a humourless laugh. ‘Well, stick around—this is your lucky day.’

‘What else do you need?’ Jack was the epitome of professionalism, demonstrating with his quiet calm just how he’d managed to mastermind so many successful rescues over the years.

‘Local anaesthetic and scalpel.’

Ally caught Sean’s arm again, her expression urgent. ‘Sean, you can’t! It’s too risky to put in a chest drain here.’

‘You have a better suggestion?’ Sean removed his thick protective gloves and flexed long, strong fingers.

‘Not really.’ Ally bit her lip and glanced anxiously at Pete, who was lying with his eyes closed, a bluish tinge surrounding his lips. ‘But we’re half way up a mountain—he might die…’

Sean moved her to one side and took some anaesthetic from one of the team. ‘And if we do nothing he will almost certainly die. His breathing is becoming more compromised by the minute. Look at him.’

‘But it’s an emergency technique.’

Sean gave her a half-smile and unsheathed the needle. ‘And this is an emergency.’

Ally watched him stride confidently over to Pete and tried to squash her anxiety. Maybe Sean was right. Maybe they had no choice.

She walked back to Pete and knelt beside him, smiling with a confidence she was far from feeling. Would Sean be able to do this?

‘Leave him as much clothing as you can,’ Sean ordered in an undertone. ‘He’s already colder than he should be.’

Carefully Ally removed Pete’s jacket, watching Sean out of the corner of her eye as he snapped on sterile gloves.

‘Jack, have you got strong scissors?’

They were slapped into her hand without question and as quickly as she could she cut through the fabric of Pete’s jumper and shirt, exposing a small area of his ribs.

‘Good thinking.’ Sean was next to her, positioning himself to give the local anaesthetic. ‘He’ll stay warmer that way. Jack, I need high-flow oxygen here.’

‘On its way.’ Jack handed the mask to Sean and hovered, watching over his shoulder. ‘Do you want Entonox?’

Ally shook her head quickly and shifted to give Sean elbow room. ‘No. Never in this sort of chest injury. It can turn a pneumothorax into a tension pneumothorax. What else have you got?’

‘I’ll look.’ Jack vanished and returned in less than a minute with a syringe which he slapped into her rapidly freezing fingers. ‘Any good?’

Ally scanned the label. ‘Fine.’

‘Tell us what you’re doing, will you, Sean?’ Jack stood behind Sean, squinting down at the younger man. ‘We haven’t seen this done before.’

Neither had Ally. At least, not since her casualty days years before, and never halfway up a mountain in a howling gale. She was a GP, for goodness’ sake, not a trauma doctor. And what was Sean’s specialty? He didn’t seem at all nervous but, then, he didn’t seem to be the sort of man who would ever be nervous about anything. His hands were rock steady and his manner totally relaxed, although Ally wasn’t fooled. The man was working fast and with a skill that left her open-mouthed with awe.

‘OK, he’s had pain relief.’ Ally handed the empty syringe to one of the team and flexed her fingers quickly to warm them. ‘I’ll get a line in while the anaesthetic works.’

Sean nodded approval and Ally reached out a hand for a venflon. Her fingers were stiff with cold and she seriously doubted she’d find a vein with Pete this cold. Still, maybe… She frowned down at his arm.

‘Squeeze there for me, Jack.’

Jack’s hands closed like a vice and she flicked the skin and mentally crossed her fingers. The cannula slid into the vein and she released her breath. Thank goodness.

Sean gave her a brief smile. ‘Well done. Now get your gloves back on before your hands freeze. OK, I’ve given local anaesthetic and I’ve prepared a sterile field. God, it’s cold! I’m going to make a small incision here. You’re doing well, Pete—this will help you breathe.’

Ally watched as he used the scalpel with quick precision and then inserted his gloved finger into the incision.

Jack hunkered down next to her, his voice soft. ‘What’s he doing that for?’

‘To check that part of the lung isn’t stuck to the chest wall,’ Ally replied in an undertone, squeezing Pete’s hand gently.

‘That’s fine,’ Sean said quietly, and pushed the tube with just the required amount of force. ‘I’m in. That should do it.’

Ally released the clamp.

‘Cough for us, Pete,’ Ally instructed gently, watching as air bubbled up through the fluid in the bottom of the drain.

‘Bingo,’ Sean muttered softly, rising to his feet in an easy movement and gesturing to Jack. ‘That drain must be kept below the level of the lungs. If it goes any higher then the fluid drains back into his lungs and we’re in trouble.’

Jack gave a brief nod, his expression grim. ‘No problem. One of the lads can carry the drip and the other can carry the drain. Good work, Sean.’

Ally finished taping the drain securely and listened to Pete’s chest, smiling with satisfaction at what she heard. Jack was right—Sean had done good work. And judging from his quiet confidence, he’d done the procedure many times before, but surely not in circumstances as difficult as these?

He caught her glance and raised an eyebrow. ‘What?’

Her eyes teased him with a mixture of humour and admiration. ‘I don’t know what sort of doctor you are but I’d hazard a guess that you’re not an obstetrician.’

‘You don’t think I can deliver a baby?’

Ally had to admit that the man would probably succeed at anything he set his hand to. ‘Well, that was pretty impressive, Dr Nicholson.’

‘For a macho idiot, you mean?’ His teasing drawl made her blush.