Peter James: Dead Man's Grip

‘Pulse?’ he asked.

‘Faint radial,’ she replied. A radial pulse meant that he had enough blood pressure to maintain some of his organs.

‘ Stay and play ,’ he mouthed back, knowing they had no option, as they couldn’t move him because his leg was trapped in the wheel. ‘I’ll get the kit.’

Stay and play was one step above Scoop and run . It meant that although the victim’s chances were slim, they would do all they could – try their best until he was dead and they could stop. Going through the motions, if nothing else.

She was aware of the scream of an approaching siren getting louder. Then she heard Phil radioing for the fire brigade to bring lifting gear. She squeezed the young man’s hand. ‘Hang on in,’ she said. ‘Can you hear me? What’s your name?’

There was no response. The pulse was weakening. The siren was getting louder still. She looked at the stump of his severed leg. Almost no blood. That was the only positive at this moment. Human bodies were good at dealing with trauma. Capillaries shut down. It was like the accident she had attended two years ago, when one of the young lads was dying but was hardly bleeding at all. The body goes into shock. If they could get a tourniquet applied, and if she was careful with his intestines, then maybe there was a chance.

She kept her fingers pressed hard on his radial artery. It was weakening by the second.

‘Hang in there,’ she said. ‘Just hang in there.’ She looked at his face. He was a good-looking kid. But he was turning increasingly paler by the second. ‘Please stay with me. You’re going to be OK.’

The pulse was continuing to weaken.

She moved her fingers, desperately searching for a beat. ‘You can make it,’ she whispered. ‘You can! Go for it! Go on, go for it!’

It was personal now.

For Phil he might be a Fubar Bundy , but for her he was a challenge. She wanted to visit him in hospital in two weeks’ time and see him sitting up, surrounded by cards and flowers. ‘Come on!’ she urged, glancing up at the dark underbelly of the lorry, at the mud-encrusted wheel arch, at the grimy girders of the chassis. ‘Hang on in there!’

Phil was crawling back under the lorry with his red bag and his critical haemorrhage kit. Between them, they covered everything that modern medical technology could throw at a trauma victim. But even as Phil tugged the red bag open, displaying pockets filled with vials of life-saving drugs, apparatus and monitoring equipment, Vicky realized, in this particular situation, it was mere cosmetics. Window-dressing.

The young man’s pulse was barely detectable now.

She heard the whine of the EZ-10 bone drill, the fastest way to get the emergency cannula in. Every second was critical. She assisted Phil, locating the bone inside the flesh of the good leg, just below the knee, the professional in her kicking in, pushing all emotion aside. They had to keep trying. They would keep trying.

‘Stay with us!’ she urged.

It was clear that the poor young man had been dragged right around the wheel arch after the wheel had gone over his midriff, crushing him and splitting him open. Phil Davidson was calculating the likely damage to his internal organs and bones as he worked. It looked as if one of the wheels had shattered his pelvis, which in itself was usually sufficient to cause massive internal bleeding and almost certain death – on top of everything else that was probably going on in there.

This lad’s best hope, he thought grimly as he worked on, would be to die quickly.

Roy Grace was shocked to see how pale Cleo looked. She lay in a high bed, in a room with pale blue walls that was cluttered with electrical sockets and apparatus. A tall man in his early thirties, with short, thinning brown hair, dressed in blue medical pyjamas and plimsolls, was standing beside her, writing a measurement on a graph on his pad as Roy entered.

She was wearing a blue hospital gown, and her blonde hair, cascading round her face, had lost some of its usual lustre. She gave Roy a wan, hesitant smile, as if she was happy he had come, but at the same time embarrassed that he was seeing her like this. A forest of electrode pads were attached to her chest and a monitor, like a thimble, covered her thumb.

‘I’m sorry,’ she said meekly, as he took her free hand and squeezed it. She gave him a weak squeeze back.

He felt a terrible panic rising inside him. Had she lost the baby? The man turned towards him. Grace could see from his badge that he was a registrar.

‘You are this lady’s husband?’

‘Fiancé.’ He was so choked he could barely get the word out. ‘Roy Grace.’

‘Ah, yes, of course.’ The registrar glanced down at her engagement ring. ‘Well, Mr Grace, Cleo is all right, but she’s lost a lot of blood.’

‘What’s happened?’ he asked.

Cleo’s voice was weak as she explained, ‘I’d just got to work – I was about to start preparing a body for post-mortem and I suddenly started bleeding, really heavily, as if something had exploded inside me. I thought I was losing the baby. Then I felt terrible pain, like cramps in my stomach – and the next thing I remember I was lying on the floor with Darren standing over me. He put me in his car and drove me here.’

Darren was her assistant in the mortuary.

Grace stared at Cleo, relief mingled with uncertainty. ‘And the baby?’ His eyes shot to the registrar.

‘Cleo’s just had an ultrasound scan,’ he replied. ‘She has a condition that’s called placenta praevia. Her placenta is abnormally low down.’

‘What – what does that mean – in terms of our baby?’ Grace asked, filled with dread.

‘There are complications, but your baby is fine at the moment,’ the registrar said, pleasantly enough but with foreboding in his voice. Then he turned towards the door and nodded a greeting.

Grace saw a solidly built, bespectacled man enter. He had dark hair shorn to stubble, a balding pate, and was dressed in an open-necked blue shirt, grey suit trousers and black brogues. He had the air of a benign bank manager.

‘Mr Holbein, this is Cleo’s fiancé.’

‘How do you do?’ He shook Grace’s hand. ‘I’m Des Holbein, the consultant gynaecologist.’

‘Thank you for coming in.’

‘Not at all, that’s what I’m here for. But I’m very glad you’ve arrived. We’re going to have to make some decisions.’

Roy felt a sudden stab of anxiety. But the consultant’s businesslike attitude at least gave him some confidence. He waited for him to continue.

The consultant sat down on the bed. Then he looked up at Roy.

‘Cleo came in for a routine ultrasound scan five weeks ago, at twenty-one weeks. At that time the placenta was very low but the baby was normal-sized.’

He turned to Cleo. ‘Today’s scan shows your baby has hardly grown at all. This is unusual and cause for concern, to be honest with you. It signifies that the placenta is not working well. It’s doing its job just about enough to keep the baby alive, but not enough to enable it to grow. And I’m afraid there’s a further complication that I don’t like the look of. It’s a very rare condition known as placenta percreta – the placenta is growing much further into the wall of the uterus than it should.’

From feeling a fraction upbeat seconds ago, Roy’s heart plunged again. ‘What does that mean?’

Des Holbein smiled at him – like a bank manager approving a loan, but with tough strings attached. ‘Well, one option would be to deliver the baby now.’

‘Now?’ Grace said, astounded.

‘Yes. But I would really not be happy to do this. Although 50 per cent of normal babies would live if delivered at this time – and probably a little more than that – the survival rate for one that has not grown since twenty-one weeks is much, much lower. In another month that would increase substantially – if we can get your baby’s growth normalized, we’d be looking at above 90 per cent. If we could get to thirty-four weeks, that would rise to 98 per cent.’