‘You think he’ll be okay?’ Adams asked the doctor.
‘Who knows?’ Colonel Nick replied with a shrug of his shoulders. ‘We’ve done our bit,’ he said, nodding at the medical team who were swarming around Perry. ‘Now it’s their turn.’
12
He watched, invisible, as the medical team got the patient ready for the slide over to the trolley. They would all be concentrating on their task for the next few seconds, so this was his moment of opportunity. He fingered the ampoule in his pocket, getting ready to swap it over for one of the ampoules that had been laid out ready for the resuscitation. Glancing at the medics to make sure that they were all concentrating on their patient, he turned his back on them to shield the cardboard tray with a saline ampoule and syringe laid out on it.
In one swift movement, he picked up the ampoule in the tray and substituted it with the one that had been in his pocket. The only difference between the two ampoules was that the one in his pocket was warm, but he was sure that no one would notice. Right then, he thought. Let’s go fishing and see if we catch anything. His heart raced as he walked towards the back of the tent to join the staff who were watching the medical team working. He couldn’t wait to see what happened next.
13
All Lizzie wanted to do was get to the TRT tent and have a shower, but she had to get the Land Rover unloaded first. She knew that all of them felt just as uncomfortable, but she was feeling particularly sorry for herself. Her shoulder still ached from carrying the stretcher earlier, but there was no way that she would admit that to any of the others. Lizzie knew full well that if she did then Ronald would get all protective and masculine, and Adams would just take the piss. But as the only woman working on the TRT, she wasn’t going to give any of them the opportunity to treat her any differently. She stepped up onto the ramp and walked back into the helicopter to join Ronald who was just doing a final sweep.
‘There’s a bit of blood on the floor just here,’ Ronald said, pointing at a dark red stain near to where the patient had been lying. ‘Nothing drastic though. I’ll come back down later with a spill kit and sort it out.’
‘Okay, mate,’ Lizzie replied. ‘Let me know if you want me to come with you.’
‘What, so you can sit there and watch me work? That’s what you did last time.’
‘Yeah, whatever,’ Lizzie laughed. ‘Come on, let’s do one. They should have made the tea by now. But if the bloody Colonel’s made it like he did last time, I swear, I won’t be happy.’
‘He’s just using the cooking trick,’ Ronald said.
‘What do you mean?’
‘Like when you cook something so badly that you never get asked to do it again.’
Lizzie rolled her eyes at Ronald and walked back down the helicopter into the heat. She stepped off the helicopter and saw the pilot and the loadmaster having an intense discussion by the side of the helicopter. As he saw Lizzie step down from the ramp, the pilot beckoned her over to them.
‘You okay, sir?’ Lizzie said as she walked up to them. A few seconds later, Ronald joined them.
‘Hi chaps,’ the pilot said. ‘You know Kinkers, don’t you?’ He gestured at the loadmaster standing next to him, and for the first time, Lizzie realised that he wasn’t wearing a British uniform. The pattern on his camouflage uniform was slightly different to theirs, and on the top of his shoulder was a small Australian flag. ‘Kinkers, this is Lizzie and Ronald.’
‘G’day,’ the loadmaster said, his eyes fixed firmly on Lizzie, before starting to laugh. ‘Sorry, I know it’s a cliché, but I can’t help it.’
‘Blimey, you’re a long way from home,’ Lizzie replied, admiring his blonde hair and triangular shoulders. He would look very good on the beach, she suspected.
‘Yeah, well,’ the loadmaster said, leaning back on the side of the helicopter, winking at Ronald before giving Lizzie a lazy grin. ‘I heard the women in the British military were way better looking than in ours.’
‘Jesus, Kinkers,’ Davies said, shoving Kinkers in the side. ‘You’re so full of shit, you know that? If your wife heard you say that, she’d beat you senseless.’
‘Bloody right there, mate,’ Kinkers replied, his blue eyes twinkling at Lizzie.
‘Well, I’m pleased to meet you, anyway,’ Lizzie said, returning his smile as she wished more British men had teeth like the Australian’s. ‘It’s normally a bit noisy when we’re working together, so it’s nice to have a proper conversation.’
‘I don’t think he knows what a proper conversation is,’ Davies laughed.
‘Hey Lizzie,’ Kinkers replied. ‘Just ignore the taxi driver in the baby-grow and look at this.’ He pointed to a small hole in the fuselage of the helicopter. ‘See that hole?’
‘Er, yes,’ Lizzie replied. Ronald leaned in for a closer look at the area that the loadmaster was pointing at.
‘Well, that’s not supposed to be there. And it wasn’t there when we took off. Nor was this one, or this one, or this one.’ Kinkers pointed out a line of similar holes. He knelt and looked under the helicopter. ‘There’s more here. These are the entry holes here, and the ones on the side are the exit ones. You can tell by the way the metal edges go.’
‘Fuck,’ Ronald whispered. ‘Sorry, I mean–’
‘No, no. You’re right.’ Davies cut Ronald off with a wave of his hand. ‘That’s what I said when I saw them. There must have been someone in those trees after all, and they’ve had a pop as we took off and banked. That would fit. It’s not like we could have heard them, and there was no-one left on the ground.’ The pilot patted the side of the helicopter. ‘We’ll have to ground her. And I’ll get the engineers to take a look and patch her up. I don’t think there’s much in this area to get damaged though, so she should be okay. In the meantime, if we get another shout, we’ll have to take Thunderbird 2.’ Davies pointed in the direction of another Chinook sitting on the pan a few hundred yards away. He turned to Ronald and Lizzie. ‘Have you got any idea how much paperwork this means?’
Ronald and Lizzie said goodbye to the aircrew and climbed into the Land Rover. Lizzie sat in the driver’s seat, looking across at Davies and Kinkers who were still looking at the underside of the Chinook. She jumped as Ronald slapped her thigh.
‘Jesus wept, Lizzie,’ he said. ‘Would you stop staring at the Australian bloke. Did you see those bloody holes?’
‘Er, yes,’ she replied, turning to look at him. ‘I did. I was standing next to you.’
‘For fuck’s sake. Those rounds could have gone anywhere.’
‘I know,’ Lizzie said. ‘I know.’
‘Ok, everyone ready? One, two, three.’ Corporal Emma Wardle looked at Squadron Leader Webb as he counted down to coordinate moving the casualty from the canvas stretcher to the trolley in the emergency department.
On ‘three’, the medical team smoothly dragged Perry from the stretcher and onto the trolley. Emma had one hand grabbing his left shoulder, and the other clutching his belt. She tried not to look at the shattered stump of his left leg as he was moved across to the trolley. Emma looked up at the anaesthetist next to her to see if there was anything that he needed her to do. He looked up at her and gave her a quick thumbs up to let her know that all was good.
Emma reached across Perry and picked up the intravenous bag that had been put in between his legs during the transfer from the helicopter. Hanging it up on the stand attached to the trolley, she opened the valve on the line to get the fluid flowing. She frowned as she realised that there were no drips in the plastic chamber just below the bag. Looking down at the cannula in Perry’s arm, she squeezed the rubber plug to try to clear whatever was blocking the line. Emma looked back up at the drip chamber, but there was still no sign of any movement.
She turned to her left and saw Major Clarke standing next to her. Without a word, he pulled a pen out his pocket and started to wind the tubing of the intravenous drip around the pen.
‘Bit of an old trick this one,’ he said. �
��It pushes fluid down towards the cannula, sometimes clears it without the need for a flush.’ He unwound the tubing from the pen and they both looked up at the chamber. Nothing. ‘Just flush it would you, Corporal?’ Squadron Leader Webb barked, making Emma jump.
Fingers trembling, she picked up the plastic ampoule from the pulpwood tray on the work table next to her, along with a syringe. She squinted slightly to read the minute text written on the side.
‘Could you check this for me, sir?’ she said to Major Clarke. Holding the ampoule so that they could both read the text, she continued, ‘Normal saline, still in date.’
‘Yep, got that,’ he replied, before continuing in a quiet whisper. ‘Just ignore Webb. You’re doing fine.’
Emma twisted the top off the ampoule and transferred the clear liquid inside to a syringe. She flipped the small cap on top of the cannula and inserted the top of the syringe into it before pushing down on the plunger, watching the area around the cannula carefully for any signs that the small plastic tube inside Perry’s vein had become dislodged while he was being transferred. There was no swelling around the cannula, so she emptied the syringe and disconnected it from the cannula. A quick glance at the chamber underneath the intravenous fluid bag showed the liquid dripping as it was supposed to.
Major Clarke walked back to his vantage point in the corner of the Emergency Room. As he passed the combat medical technician who was acting as scribe for the day, he paused.
‘Did you get that? 10ml saline flush, left antecubital fossa,’ Emma heard him say to the medic, who dutifully wrote it down on the chart.
Adams and Colonel Nick stood in the corner of the Emergency Room, both sipping water from plastic bottles as Major Clarke walked back across to join them.
‘She’s a bit green, that one.’ he said, nodding towards Emma. ‘But she’s doing okay.’ Adams looked across at Emma. He’d never say anything, but the young nurse was very attractive. Adams's thoughts were interrupted as the casualty on the trolley sat bolt upright and started shouting. He saw Emma jump back as Perry sat up before recovering and grabbing his hand with one of hers as she gently started to push him back towards the trolley. On the other side of the trolley, one of the other nurses was doing the same thing.
Adams couldn’t make out what Perry was saying, but he was becoming increasingly agitated and thrashing around.
‘For fuck’s sake,’ Major Clarke said, setting off toward the trolley. ‘Come on, let’s give them a hand.’
‘What’s going on?’ Colonel Nick said, to no one in particular as they spread out around the trolley. ‘My God, he’s white as a sheet,’ he continued. Adams was standing next to Emma, whose hands were shaking as she tried to hold onto Perry’s arm.
‘Here,’ Adams said to her. ‘Let me help.’ He took Perry’s arm to keep it steady. Adams nodded towards the monitor, saying to Emma, ‘Get some up to date vitals. He’s going off by the looks of it.’ Emma reached up to the monitor and pressed the button that would measure Perry’s blood pressure.
‘Pulse, one seventy-five,’ she said, loudly enough for the scribe and the rest of the team to hear. ‘Sats, er, not sure.’ Emma scrabbled around the trolley to find the oxygen saturation probe which had detached itself as Perry thrashed around.
‘They were in the high nineties,’ Adams heard the anaesthetist say as they both looked at the oxygen flow meter to make sure that there was still plenty of gas. The monitor bleeped to signify that it had finished taking Perry’s blood pressure.
‘Fucking hell,’ Major Clarke said. ‘Two forty over one ninety-five. That can’t be right.’ Adams saw Major Clarke look at Squadron Leader Webb and Colonel Nick in quick succession before turning back to Emma. ‘Take it again.’ She pressed the button again on the monitor, and the team all looked towards it, waiting to see what the new reading would be.
While they waited, Adams moved across to the resuscitation trolley and opened a drawer marked ‘Blood Gases’. He picked the plastic ampoule and syringe that Emma had used to flush the cannula and put them both into the sharps bin that was attached to the trolley, replacing them instead with the arterial blood gas syringe he knew was about to be asked for. Adams tapped Emma on the elbow and nodded toward the syringe on the trolley.
‘Oh, thanks sir,’ she said with a very brief smile.
The new reading was just as high. Knowing that this meant it was unlikely to have been caused by the patient thrashing around on the trolley, Adams started to run through a mental checklist. Perry’s symptoms just didn’t make sense. The quick heart rate could be a loss in blood volume, but then the blood pressure wouldn’t be through the roof. It would be going in the other direction. He glanced up towards the screen, just in time to see an unusually large heartbeat register on the electrocardiograph screen.
‘He’s throwing off ectopics,’ Colonel Nick said, pointing at the screen. Webb looked at the screen, concern creasing his brow. ‘There’s another one,’ Colonel Nick continued as the line on the screen lurched again.
‘Shit, shit, shit,’ Webb muttered. ‘Right, get me a blood gas set,’ he said, looking at Emma who already had the tray in her hands.
‘There you go, sir,’ she said, offering him the tray, her hands still shaking. Adams caught Emma’s eye. She might look terrified, he thought, but as Major Clarke had said, she was doing okay. While Webb put the needle onto the end of the syringe for the blood gases, Adams whispered in Emma’s ear.
‘Hold his hand still, palm up so that the Squadron Leader can do the gases.’ Emma nodded in agreement and, by the time Webb turned back with the fully assembled syringe, she had Perry’s arm in exactly the right position for the blood gases.
Webb pushed the needle into Perry’s wrist, trying to find the radial artery.
‘Come on, come on,’ he whispered. Adams looked at the screen above their heads.
‘He’s firing off salvos of ectopics now,’ Colonel Nick said. ‘Major Clarke, can you grab the crash trolley, please? I think he’s going to arrest.’ Clarke hurried away to get the emergency trolley with the defibrillator and the drugs that would be needed for a cardiac arrest.
‘Yes,’ Webb said with relief a second later as the needle punctured the radial artery and the syringe attached to it filled with bright red, frothy blood. When the syringe was full, he pulled it out and pushed a gauze pad onto the puncture site. ‘Press here,’ he snapped at Emma. ‘Hard.’
‘Yes sir,’ Emma replied. Clutching the syringe, Webb rushed across to the blood gas machine in the corner of the tent.
As Major Clarke arrived with the crash trolley, Adams could see longer runs of ventricular tachycardia on the monitor.
‘What is going on?’ Adams said to both Colonel Nick and the anaesthetist as they all watched the irregular jagged beats continue across the small screen. Adams heard a gurgle and looked down at Perry at the same time as the anaesthetist. There was pink, frothy sputum at the corners of Perry’s mouth.
‘Shit,’ the anaesthetist said. ‘Pulmonary oedema. I’m going to have to tube him.’ He turned to Major Clarke. ‘Can you get the kit ready for a rapid sequence….’
‘Nope, he’s in VF,’ Colonel Nick said, eyes fixed on the flat line on the screen. ‘Webb?’ he called across the room to the other doctor who was standing by the blood gas machine, waiting for the results. ‘He’s arrested.’
‘Bollocks,’ Webb said, running back across to join them. ‘Get those results when they come out,’ he ordered one of the medical technicians standing near the machine. Webb stared for a second at the wavy line on the monitor.
‘Fuck,’ Webb repeated. ‘Oh fuck.’
14
Lizzie put the Land Rover into gear and set off towards the hospital at the other end of the camp. She turned to Ronald in the passenger seat.
‘That’s really shaken me, mate, to be honest.’
‘Me too, Lizzie,’ Ronald replied. ‘Like you said, those rounds could have gone anywhere.’
‘I didn’t hear an
ything though. Did you?’
‘Nope, not a thing. Must have been when we were landing or taking off, do you think? I know the FP boys were getting a bit excited about some movement in the trees near the HLS. The captain was talking about it over the radio.’
‘That explains the cheeky take off then,’ Lizzie said. ‘I thought the Colonel was going to fall over when we banked around.’ Lizzie looked at Ronald and smiled. ‘Now, that would have been funny,’ she said, laughing.
They drove on in silence. Lizzie thought about whether to put what had happened today into her diary. She’d been keeping one religiously since she’d arrived in Afghanistan but was careful what she wrote in it, knowing full well that if anything did happen to her, her family would be reading it at some point. She’d have a chat with Adams at some point, she thought. See what he thought. As they drove past the main camp headquarters, Ronald turned to her.
‘Nice and slowly here, Lizzie. Best not upset the grown-ups.’ She laughed at his comment and slowed right down as they went past the HQ of the main base. They both stared dead ahead as the Land Rover crept past. Lizzie tried to see out of the corner of her eye whether the Garrison Sergeant Major was looking out of one of the windows of the HQ building, but she couldn’t see anything. Just as well, she thought. She’d probably burst out laughing, which he probably wouldn’t find funny in the slightest.
‘Is he watching?’ Ronald asked.
‘Can’t see him,’ Lizzie said, trying to keep a straight face just in case the GSM was hiding somewhere, waiting to catch them. As they passed the HQ, she sped back up again.
They arrived at the parking bay at the back of the TRT tent, and Lizzie reversed the Land Rover into its allocated space. She would have preferred just to drive straight in — reversing wasn’t her strongest skill as Adams never failed to point out — but the camp rules were that all vehicles were to be reversed into their spaces.
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