Anne Fraser - Top-Notch Men!

With the help of Danielle and the nursing staff, he replaced Allegra’s previously inserted central line over a guide-wire and ensured it was running rapidly.

‘Danielle, increase the noradrenaline infusion to three now, please, to help maintain blood pressure. I’m starting a vasopressin infusion to reduce venous pressure in the pelvis,’ Joel instructed.

‘Dr Addison, she’s bleeding from every puncture site,’ Danielle observed with growing alarm.

Despite massive transfusion, it was clear to Joel that coagulopathy was developing, and his inner tension went up another notch. Gaile’s young daughters’ faces swam before his eyes and his stomach clenched uncomfortably at the thought of having to face them with the worst news in the world.

‘Unless we get this blood loss stopped now, no amount of intensive care is going to help her,’ he said. Turning to the nurse at his side, he instructed, ‘Get me four packs of FFP and I’ll call the blood bank myself to retrieve ten packs of platelets.’

The ICTU nurse left to retrieve the packs of fresh-frozen plasma, which were stored in the ICTU blood fridge, as Joel reached for the nearest telephone.

A few minutes later a courier came in with the thawed platelets and Joel stabilised the patient to the point where she could be transferred to the operating theatre for a further attempt at pelvic packing and possible embolisation.

In Theatre, Allegra had set up the anesthetic machine, arterial line and monitoring equipment, and Harry and the scrub team were already scrubbed and waiting.

‘She’s extremely unstable, Dr Tallis—I’m just keeping up with fluids and she’s coagulopathic. She’s on norad at three and a vasopressin infusion. I’ve got FFP and platelets running and we’re onto unit ten of fresh B blood, with ten left to go. Blood bank is scouring for more,’ Joel said as the patient was transferred to the operating table.

Allegra gave him a worried look. ‘I’ve really got my hands full here. Once we open up, her BP is going to hit the floor again.’

‘I know that. I’ll stay here and help with fluid and coag management while you manage the anesthesia,’ he offered.

‘That’s a first,’ Harry said, as the scrub nurse handed him scissors to open the previous incision. ‘You don’t often see an intensivist in Theatre.’

‘That’s the whole point of this new unit,’ Joel said, as he assisted Allegra to attach the arterial line and monitor. ‘Overlap of skills to break down the rigid barriers between specialties.’

While Allegra concentrated on anesthesia, Joel juggled fluid input, coagulation factors, consultation with the haematologists and blood bank, and provided general support to Allegra during the procedure. After rapid prepping and draping of the abdomen, Harry opened the previous incision to be greeted by welling up of venous blood from the pelvis.

‘Her blood pressure’s 60, Dr Addison,’ Allegra said with concern, as she pumped in blood through two lines.

‘Harry, we’re not winning up this end. Can you control anything down there?’ Joel asked over the drapes.

‘I’m doing my best, guys, but there’s no one bleeding point,’ Harry rasped back, beads of sweat appearing on his brow above his mask.

Harry rapidly removed the old packs and repacked the pelvis, this time using multiple thumbtack-shaped staples to pin down every obvious bleeding vein to the pelvic walls before compressing with packs. In addition he ligated both internal iliac arteries. Although a drastic step, the bleeding finally slowed then stopped with repacking the pelvis.

‘I can see clotting. You must have improved her coag profile significantly,’ Harry said with obvious relief in his eyes as they connected briefly with Joel and Allegra’s.

‘She’s just about used up the entire supply of platelets and FFP. I think she’ll run into ARDS after all of this,’ Joel said.

‘Her ventilation pressures are up, she’s got pulmonary oedema—she’s already in respiratory distress. I appreciate your help in Theatre, Dr Addison, but I’ll be fine in here now. I’m sure you’ve got other concerns in the unit apart from this one patient,’ Allegra said with brisk formality.

Joel gave her an indecipherable look before shifting his gaze towards the surgeon. ‘See you later, Harry. Good luck with the rest of the procedure.’

‘Yeah, thanks, Joel. I think I like this cross-over idea, ICU, anaesthesia and Theatre all in one for this sort of case. I just hope this poor lady makes it. She’s put up one hell of a fight so far.’

‘It’s not over till it’s over,’ Joel said as he shed his theatre overgear and dropped it into the bins as he went. ‘I’ll speak to the relatives if you want me to, and then I’ll do a quick changeover round with Tony Ringer before I leave.’

‘No, don’t worry, Joel, I’ll see them. It’s my responsibility,’ Harry replied.

Joel nodded and left the theatre.

Harry looked at Allegra once Joel had left. ‘I know I’ve said it before, but you two work well as a team,’ he remarked. ‘Are the rumours true, then?’

Allegra gave him a quelling look. ‘I thought it was only the nursing staff who indulged in such a useless pastime as gossip.’

‘In spite of your little formal act just then, anyone can see you and he have something going on.’

‘Yes—an argument,’ she said.

‘He’s a nice chap,’ Harry said, as the nurse handed him another pack. ‘I’ve worked under a lot of directors in the past but I can tell Joel Addison is switched on.’

‘He’s highly skilled, yes,’ Allegra agreed, not quite able to disguise a little scowl.

Harry gave her another quick glance before he positioned another pack in the patient’s abdomen. ‘Are you still worried he’s going to stop your project?’

‘He’s not keen on me working with the Lowe boy, especially now.’

‘That’s to be expected, I guess,’ Harry said. ‘God, it was a shock to think someone could waltz in and interfere with equipment like that on the mother. Have the police got any idea of who did it?’

‘Not that I know of.’

‘What about the father?’ Harry asked. ‘He’s certainly got a motive, I would think.’

‘He’s also got an alibi,’ Allegra pointed out.

Harry gave a grunt as he began to close the abdomen. ‘How very convenient for him.’

‘I don’t think he did it,’ she said, hoping her gut feeling was right.

‘Not personally, but perhaps he had someone do it for him,’ Harry said.

Allegra frowned as she checked the anaesthetic monitors. The same thought had crossed her own mind. Had Keith organised someone to get rid of his wife? It was clear he hated her for what she’d done to their son and if Tommy’s injuries proved to be permanent, how much more would he want to avenge his son’s life?

‘What if he was the one who drugged her up and sent her off in that car in the first place?’ Harry said into the silence.

Allegra swung back to look at him. ‘With his own son sitting in the back seat? Come on, Harry. Keith might not win the husband-of-the-year award, but he loves his son. Besides, he wants me to do what I can to get Tommy to wake from his coma. If he was involved in any way with his wife’s accident, I hardly think he’d want a seven-year-old witness on hand to testify against him.’

‘Yeah, I guess you’re right,’ Harry said. ‘But it pays to look at it from all angles.’

‘That’s what the police are for. There’s already been too much gossip and innuendo as it is.’

‘Speaking of gossip, Patrick Naylor was crowing about you and him having a drink later this evening,’ he said as he finished closing the wound.

Allegra let out a frustrated breath as she began to reverse the anaesthetic. ‘I’m only having a drink with him because he’s been supportive of my project, although he’s wavering on it in the Lowe boy case. It seems he’s joined the Addison camp.’