Joanna Neil - A Consultant's Special Care

By now Kieran was showing clear signs that something was very wrong with him. His breathing was rapid and his lips were beginning to show a bluish tinge. ‘He needs oxygen,’ Abby murmured.

Quickly, she slid a Guedel airway into place, and then covered his mouth and nose with a face mask and began to squeeze the attached ventilation bag. ‘Do you think you could manage to do this?’ she asked Vicky. ‘I need to examine him again.’ As she spoke, she heard the gratifying drone of the rescue helicopter in the distance. At least help wasn’t far away.

‘Yes, I can do that.’

‘Good.’ Abby ran her stethoscope over Kieran’s chest. There were no breath sounds on his injured side and he was becoming increasingly distressed. His pulse was rapid, and the veins in his neck were becoming distended, and all that was very bad news. It meant that pressure was building up dangerously, and if she didn’t act soon, he could go into cardiac arrest.

‘Kieran,’ she said gently, ‘the injury has caused a tear in the pleural cavity around your lungs, and air is building up in there because it can’t escape. That’s why you’re having difficulty breathing. It’s caused your lung to collapse, and I need to relieve the pressure by putting in a tube. I’m going to give you an anaesthetic so that it won’t hurt as I do that.’

His situation was desperate, and she worked as fast as she could, sliding a cannula between his ribs and withdrawing the needle. There was a reassuring hiss of air as the gas escaped, and she taped the cannula in place and inserted a chest drain. In the background, she could hear the whir of the helicopter blades as it approached.

A paramedic came to stand beside her a few minutes later. ‘What’s the situation here?’

She looked up and greeted him with a feeling of relief. Briefly, Abby outlined the patient’s condition.

‘OK,’ he said when she had finished. ‘My partner and I will get him aboard the helicopter and then I’ll let the hospital know that we’re coming in.’

His partner was already preparing the stretcher. ‘I’d like to go with him,’ Abby said quickly. ‘His condition could worsen, and I want to do what I can for him. I feel responsible for monitoring him, since I’ve already been giving him treatment.’

‘That’s all right.’ The paramedic smiled and glanced at Vicky, waiting anxiously by Kieran’s side. ‘We’ve room enough for two more.’ He helped secure their patient on the stretcher. ‘It’ll take us about ten minutes to get there, but Dr Blakesley and his team will be ready for us.’

Abby felt a quiver of alarm run through her. It was beginning to look as though she was going to meet her new boss sooner than she had expected. She could only hope that the meeting would go well.

She looked on while the paramedics transferred Kieran by stretcher to the helicopter, which was waiting some distance away. When he was safely installed, the paramedic in charge helped Vicky climb in alongside Kieran, and Abby followed.

She wasn’t at all happy with her patient’s pallor, and as the helicopter took off and the journey progressed, she realised that he was showing increasing signs of distress. That was very worrying.

Vicky held his hand and murmured soothing words, while Abby inwardly fretted. If anything, he should be showing signs of his condition improving, but instead he was experiencing increased breathlessness and his pulse rate was rising. She glanced at the chest drain, and doubts crept into her mind.

If only she knew more about emergency medicine. Although she had followed what she believed was correct procedure, it wasn’t beyond the realms of possibility that she had made a mistake somewhere along the way.

‘He’s still breathless,’ the paramedic observed, and Abby nodded. Could she have pushed the tube in too far?

The paramedic quietly relayed the developments back to the hospital via his radio and listened to the response. ‘Dr Blakesley is going to meet us as soon as we land,’ he told Abby. ‘His team will be standing by.’

His words were meant to be reassuring, but Abby had mixed feelings about that. What would Mr Blakesley think of her if she had messed things up? With her patient in poor condition there was the distinct possibility that she could find herself starting off on the wrong foot with her new boss.

She glanced back at her patient. If blood was building up in his pleural cavity, he was in imminent danger…She found herself praying that they would get to the hospital very soon. It was more than likely that Kieran would need surgery to repair the wound in his chest.

‘We’ll need to send blood for cross-matching,’ she said. ‘I’ll organise that now…and we’ll start intravenous fluids.’ That should compensate in part for what Kieran was losing.

They landed a few minutes later, and Mr Blakesley was taking charge even before Abby had stepped down from the helicopter. While the paramedics were giving their report, Abby stood back and had time to observe the consultant momentarily.

Somehow, he wasn’t at all what she had expected. He was relatively young, for a start, in his mid-thirties, she guessed, long-limbed, and full of vital energy, his jet-black hair tousled by the wind from the whirling rotor blades of the helicopter. He was wearing an expensively tailored grey suit, the jacket open to reveal a dark blue shirt.

Within seconds Kieran had been transferred to a trolley and then he was being whisked off through the wide doors of the hospital and along a corridor towards A and E.

Abby hurried to keep up. ‘He’s losing too much blood,’ she said worriedly, coming alongside Mr Blakesley. ‘He must have lost two litres already.’

The consultant was giving instructions to his team as they went, ordering X-rays and tests and calling for a cardiothoracic surgeon, but he paused long enough to throw her a quick glance.

Close up, his features were even more impressive than she had at first noticed, and she was thrown completely off guard for a moment or two. He was incredibly good-looking, his face angular, strong-jawed, his compelling eyes a satisfying mixture of blue and grey. His mouth was firmly moulded…attractively masculine, she thought distractedly, and immediately berated herself. How could she allow such an irrelevant observation to creep into her thoughts at a time like this?

‘I know you must be concerned,’ he said briefly, ‘but I can assure you that we’ll take very good care of him.’ His voice was deep and resonant, his tone reassuring. His gaze shifted to take in Vicky, who had paused uncertainly alongside Abby and was looking anxious and tearful. ‘For the moment,’ he added, ‘it would probably be for the best if you let the nurse show you both to a waiting room while we look after him. We’ll let you know how he is as soon as we can.’

Unsure of herself and bewildered by events, Vicky allowed the nurse to gently lead her away, and Abby heard her asking what was happening to Kieran, and what his chances of recovery were. Abby stayed where she was, following Mr Blakesley into the emergency room. ‘You don’t understand,’ she began, and he lifted a querying brow.

‘Are you a relative?’ he asked, and she realised with a small frown of dismay that he must believe that the doctor who had treated Kieran had stayed behind at the beach. He went on, ‘I know that Miss Baxter is his girlfriend, but perhaps you would like to tell me who you are?’

He looked her over fleetingly, and she was suddenly conscious of the flimsy summer dress she was wearing, a sunny yellow cotton creation, splashed here and there with a pattern of tiny pale flowers. The bodice clung to her curves and emphasised her slender waist, leaving her shoulders bare except for two narrow straps, and the skirt draped itself around her legs, falling in gentle folds to her knees.