‘I’m not sure,’ Ari admitted. ‘She said she went but who knows?’
‘I’ll make sure she goes when I get back home.’
‘You won’t be doing anything to stress you out. I’ll be making sure of that.’
Peggy shifted her gaze to Kelly. ‘So, how’s my boy doing? Have you been anywhere exciting yet?’
‘No. Nowhere at all today. It’s the quietest shift I’ve ever had with the flying squad. A bit boring, to be honest.’
Except that wasn’t really true, was it? Being in Ari’s company could never be considered boring, even if there was absolutely nothing to do. Especially not after what Kelly had imagined had happened just a few days ago in that waiting room. When it had felt like he’d been about to kiss her. She had wanted him to kiss her—so badly that the disappointment of that interruption had been crushing at the time, although when she’d relived that moment later, more than once, she’d realised that it was a good thing it hadn’t happened. She wasn’t ready for anything more than a friendship. It was confusing to even imagine it. Scary. It was just as well there’d been no hint of anything like that today.
‘There is a possibility that a woman who’s pregnant with triplets and was admitted for bed rest last week might be having a Caesarean later this afternoon,’ she told Peggy. ‘If we’re still here we might be allowed to be in Theatre to observe.’
‘I’m not bored at all,’ Ari protested. ‘I’m reading up on all the protocols for handling preemie babies. We’ve got special plastic bags to put them in so they don’t get cold. What did you do, back in the day, Ma?’
‘We certainly didn’t have all the bells and whistles you’ve got these days so we just did what we could and hoped for the best. I do remember things changing after President Kennedy’s baby died. Suddenly there was more money and research being done.’
‘JFK? I didn’t know he lost a baby.’
‘Oh...poor Jackie Kennedy had a terrible time of it. She had a miscarriage and then a stillbirth before she had the two babies that survived. And then there was the preemie baby who only lived a couple of days because of respiratory distress. We were all talking about it at work. I think I remember that they put that poor wee baby into one of those chambers for people who have diving accidents.’
‘A hyperbaric chamber?’
‘That’s the one.’ Peggy shifted a little and winced but ignored any pain she was having. ‘It was to try and force oxygen into his lungs.’
Again, Ari and Kelly shared a glance. They would be talking about that soon, she thought. About how barbaric the treatment seemed now that they knew the damage that too much oxygen could do and about the improvements in managing the risks that came with undeveloped lungs—like giving the mother steroids if there was time before the birth or giving the babies artificial surfactant as protection. But that discussion was going to have to wait. Kelly’s pager sounded at the same moment she caught Ari’s gaze.
‘Ooh...what’s happening?’ Peggy tried to sit up as Kelly was reading her pager and this time the pain made her gasp.
‘Just rest,’ Ari told her. ‘And tell your nurse that you’re hurting. You’re allowed as much pain relief as you need, you know.’ He turned back to Kelly. ‘Do we need to go?’
Her nod was crisp. ‘Looks like we’re needed. Finally...’
‘I’ll be back later,’ Ari told Peggy. ‘If you’ve rested enough, I’ll tell you all about it.’
‘It sounds complicated,’ Kelly told him as they sped down a staircase and headed for the emergency department and their vehicle. ‘Premature labour but the ambulance crew can’t get to her yet—there’s a flooded stream that’s made part of a bridge collapse. Even worse, she’s trapped in her vehicle. The fire service is on its way but they’re under pressure due to this weather. We might well be on scene before them.’
The call out got even more complicated when they arrived in ED to be told that they had a driver—Bruce—but there were no obstetricians or neonatal paediatricians that were available to go with them. Apparently, the Caesarean for the woman carrying triplets had just become an emergency and all staff were needed in Theatre.
‘What do we do?’ Ari asked.
‘We’ll still go,’ Kelly said. She opened a cupboard to hand him a heavy-duty raincoat with fluorescent stripes. ‘We’ve got equipment that’s not available otherwise and I’m qualified to use it.’ She bit her lip. ‘I just prefer to be assisting the real experts.’
‘You know what?’ Ari raised his voice against the sound of the heavy rain as he followed Kelly outside.
‘What?’
‘I’ve seen you in action and I know how amazing you are. You can handle anything.’
‘I don’t know about that.’ Kelly automatically dismissed the compliment, although a part of her brain—or perhaps it was actually a part of her heart—registered and liked the fact that Ari thought she was amazing, even if it wasn’t true. ‘Let’s hope we can both handle anything. You’re being thrown in at the deep end, that’s for sure. Your first callout and you certainly won’t be just an observer.’
* * *
This was way more exciting than Ari had expected. Not only was it the first time he’d been in an ambulance under lights and sirens but they were heading into a situation that could be life-threatening for both a mother and baby. That they had the weather against them as well added another degree of difficulty and the fact that he was with Kelly, who’d been dispatched as the lead medic for this advanced back-up in an emergency, made it all the more thrilling.
He’d meant what he’d said about her being able to handle anything but he could sense that she was nervous and he was going to give her whatever assistance he could. And maybe it was just a side effect of so much adrenaline in his system but Ari had the feeling that the two of them could make a perfect team. That, together, they could both achieve way more than if either of them was working alone.
Twenty minutes later, when they turned down a side road, having cleared one of London’s outer suburbs and arrived on the scene of this emergency, it was Ari’s turn to feel a beat of nervousness. He’d never had to deal with anything like this in his life. A police car was blocking the road that led to a narrow bridge. An ambulance was parked just beyond that but its crew was simply standing beside their vehicle. The beacons of both emergency vehicles flashed brightly against the driving rain and were reflected in the tumbling water of the swollen stream.
The far bank had collapsed, presumably due to the pressure of water combined with already saturated ground, and a car had come off the road and was tilted down at the bottom of the bank and seemed to be wedged on the driver’s side amongst low-lying branches of a weeping willow. The water was flowing swiftly around the front tyres of the car and Ari could see a police officer on the bridge.
‘Stay here, Bruce,’ Kelly instructed their driver. ‘Keep the engine running and the heat up as high as you can. We’ll go and find out what’s happening here.’ She caught Ari’s gaze as she handed him a heavy-duty torch. ‘Ready?’
Ari took the torch, having slipped his arms into the straps of the portable kit. ‘Ready,’ he confirmed.
And he was. Any nervousness evaporated at that instant, replaced by adrenaline and backed up by catching some of that determination he could see in Kelly’s eyes.
It was noisier than Ari might have expected. The rain and wind and the rushing water of the stream was a background to the sound of radios crackling, voices shouting, the faint sound of a siren in the distance, which could be more emergency vehicles coming their way and...more disturbingly, a cry that sounded like that of a terrified woman. He was right beside Kelly as they went past the police car blocking the road and got to the ambulance.
‘We’ve been told not to go any further yet.’ One of the young paramedics looked frustrated. ‘The fire service is on its way but the car needs to be secured. There’s
a danger it’ll get washed out from where it is and could roll. That stream is getting deeper in the middle. Plus, they don’t know how stable the rest of the bridge is and they don’t want any more weight on it.’
‘But you know there’s a pregnant woman in the car? In labour?’
‘We’re going on what’s been relayed by the police officer on the bridge. Her name’s Zoe and she’s thirty-six weeks along. Her contractions had started before she went off the bridge. Her foot’s caught under the pedals or something and she can’t get out, even though the doors on the other side are open.’
‘How far away are the firefighters?’
‘Don’t know. Feels like we’ve been waiting for ever.’
Ari turned to catch Kelly’s gaze. They’d only been on scene for a matter of minutes but it already felt like far too long a delay to being with their patient. He raised his eyebrows in a silent question that Kelly seemed to understand instantly and she apparently agreed with his summing up of the situation so far—that they weren’t necessarily going to comply with orders from the police officers on site if they were not in the best interests of their patient. He and Kelly could weigh up the risks and make their own decisions about what could or could not be done for the woman trapped in her car.
‘Keep your truck as warm as possible,’ Kelly told the paramedics. ‘If we can get her out, we might need to deliver a baby in there.’
And if they couldn’t get her out, what then? Would they be delivering a baby in a car under threat of either being washed away or submerged in flood waters? This was dangerous but it didn’t feel like Ari had a choice. That Kelly was brave enough to be prepared to go with him made him feel proud to be with her. Proud of her. He lengthened his stride. There wasn’t a minute to lose and the police officer on the bridge must have sensed that neither he nor Kelly were going to be put off getting to the accident victim.
‘Be careful,’ was all he said. ‘That ground’s unstable and so is the car. The bridge is still falling apart as well. The firefighters have had to go around the long way to get to this side of the bridge. If you wait another ten minutes, they could be able to secure the vehicle.’
‘Help...’ The cry came from the car beneath them. ‘Please...someone, help...’
‘Can’t wait, mate,’ Ari told the police officer. ‘I think we’re needed.’ But he turned back to Kelly before stepping onto the rubble between the bridge and the bank. The urge to protect her from danger was too difficult to suppress completely. ‘Maybe you should stay up here?’
Kelly simply shook her head, dismissing the suggestion.
Ari was tall enough to reach a tree branch to use as an anchor as he started to pick his way down the slippery mud on the bank. He held his other arm out as a safety barrier for Kelly and it was needed almost immediately as she began a slide that only stopped as she grabbed hold of his arm.
‘Hold on tight,’ he told her. ‘I’ve got this.’
It got easier as they got further down because the branches were lower. They could see the open, crumpled doors of the passenger side of the car. They could also see the pale face of the terrified driver.
‘Oh, thank God...you’re here. Please... I can’t get out and I’m having... Ahh...’ She screwed her eyes shut as she cried out in pain.
Ari was almost at the side of the car.
‘You want to be in the front or the back?’ he asked Kelly.
He expected her to want to get in the front passenger side to be able to get to the woman more easily. She was in charge here after all and he was only supposed to be an observer. But Kelly said she would get into the back seat.
‘You’ve got way more experience than me in assessing how close someone is to giving birth. Put the kit in the back seat as well. There’ll be more room for me to open it there.’
‘Okay.’ Part of Ari still wasn’t happy with the idea of Kelly getting into the car at all but he couldn’t ask her to stand back and watch and he wasn’t about to suggest that she stay somewhere safe because he admired her courage and he wanted to work with her. He needed that extra dimension that the two of them could make as a team. But he touched her arm.
‘Don’t get in until after me, okay? If there’s any danger that changing the balance is going to push the car into the current, it’s best if it’s only one of us in there.’
It was already darker than normal for this time of day due to the weather conditions. Now they were beneath a veil of leafy branches and the interior of the car made it feel like night-time. Ari flicked on his torch.
‘Hey...’ He eased himself carefully onto the front passenger seat of the car, praying that it wouldn’t be enough of a change to give the current the power to do more damage. ‘It’s Zoe, right? I’m Ari. I’m a midwife.’
The pain from Zoe’s contraction was clearly easing and her expression changed from pain to something more like horror. It wasn’t because of his gender, however—simply his specialty. ‘A midwife? Oh...no...there’s no way I’m having a baby in here. I can’t... Oh... God...’
‘We’re here to look after you,’ Ari told her. ‘You and the baby.’ The car wasn’t showing any sign that it was going to start moving so he gave Kelly a nod. ‘That’s Kelly getting into the back seat now,’ he told Zoe. ‘She’s an awesome paramedic and she’s part of the obstetric flying squad so you’re in good hands, okay?’
But Zoe had a hand covering her eyes. ‘I just want to get out,’ she sobbed. ‘I want to go home...’
‘Is anything hurting?’ Kelly asked. ‘Apart from your contractions?’
‘My foot. Ankle. Or it was... It’s kind of numb now but I can’t get it out.’
Ari leaned closer, stretching one arm into the footwell and keeping the torch in his other hand to try and see what he was doing. The driver’s door was badly crumpled inwards and the accelerator and brake pedals were bent and pressed onto Zoe’s foot. A brief attempt was all it took for Ari to realise that specialised equipment would be needed to free Zoe. And it was needed soon. There was icy water swirling around those pedals as well. The passenger side doors were well above water level at the moment but it was seeping in on the lower side.
Kelly had the kit open on the back seat beside her. She pushed a blood-pressure cuff and a stethoscope between the front seats.
‘Can you get a blood pressure?’
‘Sure.’ Ari already had his hand on Zoe’s wrist. ‘Heart rate’s one hundred and five. And the pulse is strong so she’s not hypotensive. I’ll get an accurate blood pressure in a minute. There’s a Doppler in that kit, too, isn’t there? I’d like to check on baby’s heart rate.’
‘I’ll get it.’
‘Tell me about your pregnancy, Zoe,’ Ari said. ‘Is it your first? Have you had any problems?’
But Zoe didn’t answer. She reached out and clutched his hand as she screwed up her face again and cried out. ‘This hurts so much...’
‘We’ll get you some pain relief,’ Kelly said. ‘How long since that last contraction, Ari?’
‘Between two and three minutes at a guess.’ He glanced at his watch. ‘I’ll keep time for the frequency and duration.’
‘Here...’ Kelly handed a methoxyflurane inhaler between the seats moments later. ‘It’s got the activated carbon chamber inserted and the cap off. Put the loop over Zoe’s wrist so it doesn’t get dropped.’
There was no point in checking for contra-indications or trying to coach Zoe into using the inhaled analgesic until her contraction was over. Ari also needed to examine Zoe to see if delivery was imminent. With a bit of luck, they might be able to get her into the ambulance before that happened. Above them, from the direction of the road on the broken side of the bridge, he could see more flashing lights and hear people shouting. It seemed the fire service was now on scene with their heavy vehicles and ability to not only stabilise a car in a precarious situation but to cut throu
gh and bend metal to make extrication possible.
Ari was able to get a blood-pressure reading as Zoe’s pain ebbed. ‘One-forty on ninety,’ he relayed to Kelly. They both knew it was the high end of normal but that was hardly surprising given the circumstances and level of anxiety. ‘Can you try and release the lever on the other side of Zoe’s seat? If we could tilt her back a bit, it’ll make it much easier for me to find out what this baby’s up to.’
‘I’m not having this baby here,’ Zoe said. ‘I can’t... What if...? Ahh...’ This time it was a cry of fear rather than pain and Ari thought he heard an echo of the same sound from Kelly as the car suddenly shifted, scraping over boulders on the creek bed beneath them and tilting down more sharply on the driver’s side.
‘It’s okay,’ Ari told them. ‘Look...the firefighters are putting a hook on the back of the car. It’s only moved because they’re making sure it’s secure and it can’t float away. We’re safe... I’m not going to let anything bad happen, okay?’
His words were intended as reassurance for their patient but he knew they were still in a very dangerous situation—even more so, if that hook didn’t have a good grip on the chassis of the car. Kelly had to know that as well but, when Ari turned his head to check that she was all right, he could see that she was also hanging onto his words so he held her gaze for a heartbeat longer. So that she would know he meant what he said and that Kelly was included in his protection.
He wasn’t going to let anything bad happen to her—not if there was any way he could possibly prevent it. The urge to protect Kelly was so strong, in fact, that Ari could feel it snatch his own breath for a moment. Had he made a mistake in encouraging her to get to Zoe before the vehicle had been stabilised? Taken advantage of that extraordinary courage she displayed because he wanted her by his side in this challenge? No...she’d been just as determined as he’d been, hadn’t she? That determination to help others was one of the traits they had in common. One that, right from the start, had created that connection but right now it felt like more than simply being members of the same team. It felt like a bond that was soul-deep. They were in this together and it just felt...right...
The Paramedic's Unexpected Hero Page 9