'This is Kim Earl, twenty-two years of age, passenger in bus number one. She was up the front end of the vehicle, which took most of the impact. When we got to her she was conscious, trapped by her left leg.'
The paramedic gave Alice a wide-eyed look and glanced down at the affected limb. Alice's gaze followed his. The leg was heavily splinted and covered in drapes, but Alice could see from the hideous angle at which the foot was lying and the colour of the toes the reason for the paramedic's concerned expression.
'She's also complaining of some abdominal pain, but her leg seems to be the main source of pain. She's had gas on the way with some relief.'
'Thanks very much.' Alice said when they had carefully moved Kim onto the hospital gurney. 'Are there many more to come?'
The lead paramedic gave a grim nod. 'Yep, we'd better get back to it. Oh, one thing we didn't tell you. Kim's due to get married on Saturday, aren't you, Kim?' He gave the terrified woman a friendly wink. 'They'll look after you now, Kim. Good luck. I'll come and see how you got on later.'
Alice was always impressed by the paramedics. The scene they had just attended and were going back to would have been horrific, yet despite it all they had found the time to make the patient feel more than a number, to treat her as a young woman with a life and problems of her own, not just a nasty leg and abdo injury. It was a lesson Alice always tried to remember.
They had already established intravenous access, and as the nurses were all tied up Alice did a swift set of observations, trying to quell the mounting panic within her as she examined her patient. An accurate assessment was especially vital, given the fact that the senior staff were involved elsewhere. Kim's leg, the most obvious injury, was for the moment safely covered and secured, so there was no point concentrating on that if she had more dire injuries. Her neurological status was sound, Alice noted, with no apparent head injury apart from a few abrasions. Moving to her chest, Alice was satisfied her air intake was adequate with no breathing difficulty, though her respiration rate was high. Her abdomen, though, was distended and tender.
Alice felt a surge of anxiety. This young woman was seriously injured. Inserting another IV cannula, Alice took some baseline bloods and an urgent group and cross-match then attached a plasma expander drip. There were supplies of O-negative blood kept in the emergency department but these would already be sorely depleted. Samuel Donovan would have to ration that valuable commodity.
Alice rechecked Kim's blood pressure, which was markedly lower with her pulse-rate increasing, a sign of large blood loss. What would Jeremy do next? That was how she'd play it.
Peritoneal lavage. It was a relatively simple procedure which involved making a small incision into the abdominal cavity and allowing in a bag of warmed saline. If when the saline flowed back there was blood in it, it meant the patient needed to go to Theatre. Although a straightforward procedure, it was not one Alice had done before but, realising the seriousness of the situation, she prepared all the equipment that would be needed before rushing out.
'Mr Donovan?'
He made his way over swiftly. 'What have you got?'
'Twenty-two-year-old female with a serious leg injury, which I haven't looked at yet. It's her abdomen I'm more concerned about, though. I think she's bleeding out. I've set up for a peritoneal lavage.'
'Good.' He came straight to the gurney and, after briefly introducing himself, performed the procedure. 'She needs Theatre. OK, I'll get Jeremy. Fay...'
In a matter of ten minutes Kim was about to be taken up to Theatre. All planned ops had been cancelled to leave room for the urgent cases, and Kim couldn't wait.
'I'll see you on the ward.' Alice squeezed the young woman's hand. 'Mr Foster is going to operate.'
'What about my leg?'
It was Samuel Donovan who answered as the orthopods examined her leg.
'Kim, it's a very serious leg wound you have. We'll have a better idea in Theatre once you're anaesthetised. We'll do the X-rays up there.'
'It has to be right for Saturday.'
'She's getting married,' Alice said to the consultant.
Despite the chaos, despite the tragedies unfolding in all directions, Samuel took the time to explain to this beautiful young woman as he took her through the consent form that, although they would do everything to save her leg, it might not be possible.
'No!' The scream that emerged from Kim's lips was blood-curdling. 'I won't consent to that. You can't cut it off.'
Mr Khan, the orthopaedic consultant, came to the head of the gurney. 'Now, please, my dear, believe me when I say I'm going to do my utmost to save it, but it doesn't look good. I cannot and will not let you die from your leg wound. And that could be the reality. I'm not going to amputate unless I have no other choice.'
Kim looked pleadingly at Alice. 'Is that it? I'm going to lose my leg? Can't I get a second opinion? I've got private cover...'
For some reason, perhaps because she had been the first doctor present, perhaps because she was a woman or near her age, Kim needed Alice's opinion.
'Kim, when the doctors say they'll do everything, they mean it. You really need to go Theatre. I know how hard this must be.'
'No, you don't.'
Alice knew she was right. 'I'm sorry. I can only imagine—'
'Will I die?'
Alice squeezed her hand. 'We're not in the business of letting young women die. Our job is to do everything to save you, and that means you have to go to Theatre now.'
Kim's eyelids were starting to close and she struggled to open them.
'Ted, my fiancé...'
'I'll talk to him as soon as he gets here. He'll be waiting for you when you come out.'
Watching the pale, shaking hand as Kim signed the consent form, it took a superhuman effort for Alice to stay professional. Kim should be signing a marriage certificate in a few days, not a damned consent form that might render her an amputee.
Although the situation had intensified, with a seemingly never-ending stream of casualties still arriving at an alarming rate, the department seemed a lot more controlled. More staff were now present, many of them senior and able to make swift assessments and prioritise the patients. Up on the wards all patients who had arrived for planned surgery or were well enough to be discharged were being seen by doctors and sent home to free up beds for those that needed them. The overnight stay ward in the emergency department had become a makeshift mortuary.
Stunned, Alice still couldn't take in what she was a part of. The precarious line that held everyone inside a safe normality could change in an instant. Life that day had changed for all present.
'How's your stitching, Alice?' Fay grabbed her as she walked past. 'Do you mind making a start?'
And so she played her part. OK, so she wasn't up in Theatre saving a life or in the resuscitation room on the front line. But over the next five hours Alice knew that she was doing a good job. Painstakingly she picked out the never-ending lumps of shattered glass, applied local anaesthetic and cleaned aligned edges, doing her small bit to make sure the external scars people bore to remind them of this black day were as minimal as possible. Her soft voice was gentle, reassuring patients and their relatives. And sometimes when there was no need for words, when the patients just wanted to lie still and let her get on, Alice's mind drifted to Jeremy up in Theatre, doing his best to save a young woman's life. Jeremy, who had always done his best for her and later Maisy, too.
'Alice, when you finish this one, Kim Earl's parents and fiancé have arrived. I've done my best to talk to them but I was wondering if you might have a word. Samuel's not going to get there for ages and she's still in Theatre.'
'Sure, Fay,' Alice replied, placing a dressing over the hand she had just sutured. 'I'll come now.'
'A word of warning—the fiancé isn't taking it all too well.'
'Can you blame him?' Alice said sadly. 'It must be an awful shock.'
But Fay shook her head. 'His greatest concern is the fact she might lose he
r leg. Look, I'll let you judge for yourself. Just tread carefully.'
Bill and Sheila Earl looked every bit as devastated as any parents would, confronting the events that had been thrust upon them. Bill sat staring at the wall ahead, his heavily tattooed arm around his wife's shoulders. Sheila was gently rocking, not making a sound as tears coursed down her cheeks. A younger man, dressed in a trendy single-breasted charcoal-grey suit, his dark wavy hair cut closely to his head and slicked back with gel, introduced by Fay as Ted Caversham, paced relentlessly up and down the tiny room.
Alice pulled a chair up and sat down opposite the parents, and as gently as possible took them through her dealings with Kim.
'The sister said her injuries were serious.' Bill cleared his throat. 'How serious? She's not going to...?'
'She was bleeding internally, I'm not sure from where. Rather than wait for further investigations which would have taken up a lot of time, particularly due to the demand on equipment this morning, it was considered far safer to take her directly to Theatre. I'm sorry I can't be more specific, but I really don't know much more than that. However, what I can tell you is that she was taken to Theatre very quickly, and the surgeons that are operating are first class. She was conscious throughout. I spoke with her and she told me all about the wedding.'
A trembling smile wobbled on Sheila's lips, then as the realisation dawned again it vanished and she gave way to hysterical tears.
'But what about her leg?' Ted turned an angry stare on Alice. 'We've been told she might lose it.'
Alice swallowed. 'It does look a real possibility. Her leg was partially severed below the knee. I personally didn't see it but the orthopaedic consultant said that it was a very serious injury, though I must reiterate that everything will be done to save it.'
'Rubbish. They'll be rushing to get the next case in. I tell you now that if everything, and I mean everything, isn't done this hospital is going to have the biggest lawsuit—'
'Mr Caversham, I understand you're distressed—'
'You bet I'm distressed. You calmly walk in here and tell us that Kim's probably going to lose her leg—'
'The important thing,' Alice interjected, 'is that she gets out of Theatre. Once we know the extent of her injuries, the doctors can give more definitive answers to your questions. At the moment it's pure speculation.'
'If Kim loses her leg, she might as well die.' Alice fought to hold her tongue as Ted Caversham continued, 'You might think I sound harsh, but you don't know her. She's a model, for heaven's sake. She simply won't cope.'
Privately Alice rather thought it was Ted that wouldn't be able to cope with the loss. Standing up, she picked up her stethoscope from the coffee-table. 'As soon as we hear anything further, we'll let you know.' She wanted to stress that at the moment Kim's leg, although a tragedy in itself, was really the least of her problems, but bringing Ted down a peg or two could only exacerbate Bill's and Sheila's pain. 'I'm sorry I can't give you any more answers.'
Fay was waiting for her as she came out. 'A charmer, isn't he?'
'He's probably just upset. People react strangely.'
Fay gave her a knowing look. 'Yes, people react strangely, but I can't help but think he's more worried about his image than poor Kim. How all this is going to affect him.' Taking Alice's arm, she led her to the staff room. The canteen has sent down some refreshments.' With a final glance back towards the interview room Fay shook her head. 'Tell me, Alice, where have all the good guys gone?'
'Here's where you're hiding.'
Alice smiled as Josh entered, then flushed as she realised Jeremy was directly behind him. There was the answer to Fay's question. Jeremy looked terrible, his grim face set with tension. He had been operating without a break since eight-thirty that morning, and Alice couldn't help but wonder how he was coping with his back. Alice poured the two men coffee while Fay piled a couple of plates with sandwiches.
'I needed that.' Never had a cup of coffee and a cheese and Vegemite sandwich been more welcome.
Fay grinned. 'Me, too.'
Finally a sense of normality was emerging. Though A and E was still full, no case now was particularly urgent and a welcome break was most definitely in order. Glancing at her watch, Alice gave a yelp. 'Heavens, it's three o'clock! What time are you due to finish, Fay?'
'Seven hours ago' came the rueful reply.
'You were on last night? Oh, Fay, you must be exhausted.'
'Actually, no. I'm quite sure if I went to bed now I wouldn't be able to sleep. If you knew how much time I've spent in meetings and mock-ups, preparing for this day, hoping it would never happen but trying to be sure that if it did we'd be able to cope. I think we did well.'
'I don't think we could have done any better,' Josh agreed. 'Everyone was marvellous, pitching in. What was the final casualty count?'
'Fifty. We saw twenty-eight, the rest went on to the Women's and Children's or were flown to the trauma centre.'
'How many fatalities?'
Fay let out a long breath. 'Eighteen. Unbelievable, isn't it? People like you or I just setting off to work or school. How's it going up in Theatre?'
Josh didn't answer until he had demolished a couple of sandwiches. 'Bloody awful—literally. There's a couple down here for Theatre still, aren't there, Fay?'
'Yep. When do you think you'll be able to do them?'
Jeremy stood up, speaking for the first time. 'Now. Theatre four was just finishing up.' He turned to Josh. 'You finish off your food. I'll go and see them then meet you in Theatre, say in half an hour.'
'How did Kim Earl do?' Alice called as he made to leave. She watched as his departing back stiffened. Turning only slightly, not meeting her eyes, he replied curtly, 'Perforated bowel, lacerated liver. She had to spend an age in Recovery but she should be transferred to the ward soon. Really she needs to be in Intensive Care, but those beds were snapped up long ago.'
'What about her leg?' Alice persisted. 'How did it go?'
'It didn't.' And without any further explanation he left the room. Fay raised an eyebrow.
'How's Jeremy? He went as white as a sheet when the call came in—it must have brought all the memories of his accident back.'
Josh didn't look convinced. 'He's seen enough trauma since he's been back, but maybe you're right. There's definitely something wrong.' He shot a look in Alice's direction. 'He's not exactly been sociable the past few weeks, but today he's far worse. There's something up—not that it's stopped him performing miracles I hasten to add. That guy's a brilliant surgeon; he's like a machine down there.'
'And Linda?' Fay asked, smiling as she anticipated a smart crack from Josh.
'Loving every moment. It's the most excitement she's had in years.' He gave a lewd grin before adding, 'Of any kind. First time I've seen her wearing lipstick. She's hoping to make it onto the news. Oh, well, back to it.'
The short interlude over. They all stood up, marginally refreshed, ready to do battle again.
Fi looked as immaculately in control as ever, her soft voice relaying instructions and answering queries as the ward struggled to cope with a mass of acutely injured patients as well as the usual workload.
'I'm not even going to ask if you've got anything for me, Fi. But thanks for holding off on the pager; I've been suturing down in A and E.'
'I knew you wouldn't be hiding. First things first—have you eaten?'
'I have. How about you? And what are you doing here anyway? Aren't you supposed to be on nights again?'
'I still am. I came in when I heard the news on the radio. Luckily I'm coming back after days off so I'm pretty fresh. I'm heading off for a few hours' sleep and then I'll come on about eleven. Rowena is going to stay back late for me.'
'Sounds wonderful,' Alice said enviously. 'Maisy kept me up most of last night. Cripes! The one thing I haven't done is check up on Maisy. I'm just going to make the quickest call in history and then I'm all yours.'
Maisy, of course, was fine. 'We've been watching it
on the news,' Mavis said. 'Jeremy rang as soon as he got to work, frantically asking what bus you would be on.'
'Oh.' It had never even entered her head that Jeremy would have been concerned she might have been involved, but there hadn't exactly been much time for introspection. 'I took the tram, Mavis. Have you spoken to him since?'
'No, but I didn't really expect to unless, of course, he hadn't seen you. I'm sure he's too busy to ring his old mum for a gossip.'
Alice laughed. 'You're hardly that, Mavis. He has been really busy. He's been great,' she added, not even bothering to keep the note of admiration out of her voice.
'Well, if you see him, make sure he eats something. An army marches on its stomach.'
'I will,' Alice assured her, though with the breakfast Mavis had served him she was sure Jeremy had enough in reserve to last the month out.
Replacing the receiver, she turned to a waiting Fi. 'I'm all yours now.'
The experience Alice gained during that on call was like a condensed version of her full three months and would stand her in good stead for years to come. With the more senior doctors unavailable and tied up in Theatre, Alice made more decisions and judgements that day and felt the weight of a doctor's responsibility more heavily than she ever had before. And yet, far from being fazed by it, she actually revelled in it—well, most of it.
Doing a post-op check on Kim Earl, Alice felt an overwhelming sadness as she looked at the bed cradle holding the sheets and blankets away from the newly fashioned stump. Kim was too out of it to understand what had happened in Theatre but her red-eyed parents sitting stunned by the bedside told the whole story.
'How is she doing, Doctor?'
Alice looked up from the charts. 'She's stable. Her observations have been good since she returned to the ward. I've just got her haemoglobin level back from the lab and it's still low, despite the transfusion in Theatre, so I'm going to order her a further two units of packed cells. Has she spoken at all?'
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