Alison Roberts - Surgeon On Call

‘I’ve found some sandbags.’

‘Good for you, Tommo.’ The men made way for him.

‘Excellent,’ Joe added. ‘Well done.’ Felicity noticed the pleased expression on the young man’s face as Joe rose swiftly from his crouched position. Joe clearly had the ability to lead people. Tommo’s face became eager.

‘Where would you like me to put the bags?’

‘Give them to me,’ Joe ordered. ‘I need to put them in exactly the right place.’

Felicity saw the disappointment that accompanied the handover of the sandbags. Joe Petersen might have leadership qualities but he would never hold the loyalty of the people he led if he dismissed their potential so abruptly. There wasn’t anything highly technical about the placement of support materials for a neck and head. Tommo could easily have been directed to accomplish the task. He would have had the satisfaction of knowing he was really helping and Joe would have had a loyal assistant for anything else he might require. The sandbags were cold against Felicity’s hands as Joe snuggled them along the side of Jeff’s head.

‘Don’t let go of his head,’ Joe instructed her firmly. ‘These supports will help but they’re not enough. You’re doing a great job,’ he added.

It was the first direct eye contact Felicity had had with this man. It was also the first appreciative comment. She noted that the dark brown eyes were rather attractive but she couldn’t detect any hint of personal warmth being directed at her. In fact, in the few minutes so far of his management of this incident, Felicity had not seen even a hint of a smile. Joe was focused on this task with an intensity that was definitely grim. The people around him were merely tools. His praise of Felicity’s ability to stabilise his patient’s head and his appreciation of Tommo’s success in locating sandbags was automatic, an acknowledgment that they had both performed as he had expected. How totally ridiculous that she should feel as pleased by the acknowledgement as Tommo had been.

Felicity gave herself a mental shake. She could hear the wail of the approaching siren advertising the imminent arrival of the ambulance service. The emergency vehicle was likely to be crewed by paramedics who would know who she was. It was going to be extremely interesting to see how Joe reacted to finding out her qualifications. Felicity was also curious to observe how he would relate to the ambulance officers. Doctors who had no direct contact with the service were sometimes inclined towards an arrogant assumption that the paramedics were no more than drivers. Given Joe’s treatment of the people around him so far, Felicity would be surprised if he gave the paramedics any credit for the skills she knew they possessed.

The first surprise came when Joe stood up to greet Stanley Ferris, the paramedic leading the crew.

‘I’m Joe Petersen. I’m a neurosurgeon,’ Joe told Stanley crisply. ‘This is Jeff. He’s nineteen years old and has fallen approximately fifteen metres from this scaffolding.’

Stanley glanced up at the platform well above them as he took in the mechanism of injury.

‘He hit a rail about halfway down which caught his back in the lumbar region. Then he landed on his head, causing a distraction injury to his neck. He wasn’t KO’d and his GCS has remained at 15.’ Joe cast a brief glance at the second ambulance officer. ‘Can you get a cervical collar on Jeff? Thanks. And some oxygen. A high-concentration mask.’ His attention turned back to Stanley.

‘Jeff has pain at C5 to C7 and I’d query an increased interspinous gap. He has a moderate contusion in the occipital area. He has paralysis to both legs and paraesthesia and paresis in both arms and hands. Chest and abdomen are clear, breathing is diaphragmatic. He’s bradycardic at 55 and I’m concerned about hypothermia. This ground is frozen solid and it’s been nearly ten minutes since the accident.’

Felicity watched as Stanley nodded to show he had absorbed the information. She was impressed at Joe’s professional summary of their patient’s condition, but she was even more impressed at his attitude towards Stanley. Assuming he now had assistance of medical merit, Joe was treating the paramedic as a colleague and an intelligent one at that.

‘We need some blankets,’ Joe continued. ‘A foil sheet if you have one. Jeff will be poikilothermic with a spinal injury.’

Felicity’s raised eyebrow mirrored Stanley’s expression. Perhaps Joe wasn’t treating Stanley as a colleague after all. Did the paramedic know that poikilothermic meant that a body would assume the temperature of the environment? Maybe Joe was deliberately using terms even medical staff might not recognise easily in order to show superiority and demonstrate his command of the situation.

‘We need to get him off the ground as quickly as possible,’ Joe continued. ‘Do you carry backboards or scoop stretchers?’

‘Both.’ Stanley’s glance at Jeff’s position made him notice Felicity for the first time. His eyes widened dramatically. Felicity’s smile was intended to indicate that this wasn’t the moment for Stanley to be distracted by her presence, and the paramedic took the hint with his customary astuteness. ‘A scoop stretcher will let us pick him up with minimal disruption but they are cold. If we log-roll him onto a backboard it would also give you the chance to check his lower back.’

‘What’s going to be quicker?’

‘Probably the scoop.’

‘We’ll do that, then.’ Joe watched as Stanley and his partner, Ray, introduced themselves to Jeff and explained what they were about to do. They moved the sandbags and eased a cervical collar into place.

‘Grab a towel,’ Stanley directed Ray. ‘We want that under his head to maintain neutral alignment. You can get the scoop out as well. I’ll take some vitals while you set it up.’

Stanley wrapped a blood-pressure cuff around Jeff’s arm. Ray brought the metal scoop stretcher from the back of the ambulance. When Joe moved to take over unfolding and setting out the stretcher, Stanley caught Felicity’s gaze.

‘Does he have any idea who you are?’

‘No.’ Felicity couldn’t help a quick grin. ‘I haven’t exactly had the opportunity to introduce myself.’

‘Hmm.’ Stanley’s noncommittal grunt acknowledged the level of authority Joe had assumed. ‘At least he seems to know what he’s talking about.’

Felicity nodded. She rubbed her hands together. They were cold and stiff after the long minutes of stabilising Jeff’s head and neck. ‘I think I’ll leave you guys to it,’ she told Stanley. ‘I’m late for a meeting and I’m sure Mr Petersen can give you any medical assistance you need.’

Stanley was taking some IV supplies from his kit. He had the line in Jeff’s hand within seconds. Joe frowned as he noticed the action that had been taken without his direction. He laid down the half of the scoop stretcher he was carrying.

‘Blood pressure’s 85 over 60,’ Stanley told him. ‘I won’t run any IV fluids unless the systolic drops below 80.’

Joe nodded and Felicity could sense his satisfaction. The low blood pressure with a spinal injury was likely to be due to vasodilation below the level of injury rather than blood loss. As long as the systolic blood pressure remained above renal filtration pressure of 80 mm mercury it was not advisable to give extra IV fluids, which could cause complications from over-hydration.

Joe was eyeing the drug supplies in Stanley’s kit. ‘Are you able to give a loading dose of methyl prednisolone?’

‘No.’ Stanley shook his head. ‘That’s not in our procedures.’

‘We do it in some parts of the States.’ Joe frowned again. ‘Have you got a specialist spinal unit we can transfer him to directly?’