I couldn’t detect anything wrong.
‘My feet have started bloody burning,’ Dick said, panic causing his voice to go up at least an octave. He was even trying to sit up.
‘Lie still, Dick,’ I said urgently. ‘You don’t want to do yourself any more damage, do you?’
‘But my bloody feet hurt,’ he said.
‘That’s a good sign,’ I said. I ran my hand down his left leg and squeezed each side just above his knee, just like I used to squeeze the legs of my twins to make them laugh. ‘Can you feel that?’
‘I can feel something,’ he said. ‘Pressure.’
That was a very good sign.
‘Do you need anything for the pain?’ I asked him.
‘Just about OK at the moment,’ he replied. ‘Thanks, doc.’
He looked up at me and I looked back down at him.
The paramedics had collected a scoop stretcher from their vehicle and they started sliding it under him. The two-piece construction of the stretcher allowed it to be slid in from each side before being joined together, thus reducing the amount the patient had to be moved unsupported.
I turned to one of the paramedics.
‘Give him some supplementary oxygen at five litres per minute,’ I said. Added oxygen in his system would aid any recovery. ‘Or Entonox if he needs it.’ Entonox was a fifty-fifty mix of nitrous oxide and oxygen – gas and air – for relief of acute pain. Ask any mother.
‘I’ll be back in a sec.’
The horses still in the race galloped past the fence on their second circuit as I went back to Ellie Lowe. The second ambulance crew were helping her onto their stretcher.
‘You OK, Ellie?’ I asked.
‘Will be,’ she said. ‘And I managed to pull my boot off.’
Amazed, I looked down at her ankle. ‘Didn’t it hurt?’
‘Like bloody murder,’ she said with a laugh. ‘But not as much as cutting it off would have hurt my bank balance.’
She’d do, I thought. Jockeys were clearly made of stern stuff, male or female.
‘Take her to the medical room,’ I said to the paramedics. ‘We’ll arrange onward transportation from there.’ I turned back to Ellie. ‘I’ll leave you with these guys now, if that’s OK. I need to get back.’
She nodded. ‘It’s Dick McGee, isn’t it? How’s he doing?’
‘Not great,’ I said.
‘Is he paralysed?’
It was the one thing that frightened every jockey.
‘I don’t think so. It may be too early to tell but I’m hopeful he’s just jarred his back. But we can’t take any risks.’
She nodded and was carried away towards the waiting ambulance.
‘Two fallers, fence after the water,’ said the spotter into my ear. ‘One jockey still down. Doc three, are you available?’
‘Doc three on my way,’ I heard Jack Otley reply over the radio. He would have been stationed at the start and then have moved to the last fence.
I, meanwhile, went back over to Dick McGee, who was being strapped to the scoop ready to be lifted into the ambulance, which had been driven onto the track close by. In addition he was now wearing a mask attached to a portable oxygen tank.
‘You OK, Dick?’ I asked.
‘What do you think?’ he replied, his voice somewhat muffled by the mask.
I considered it a good indicator that he was still able to engage me in his usual banter. If there had been a highly critical trauma to his spinal column, such as a complete break, I might have expected him to have had difficulty breathing let alone talking.
‘How about the air ambulance?’ one of the paramedics said.
Big-call time.
I put my hands onto the toe-ends of Dick’s lightweight riding boots.
‘Dick,’ I said. ‘Wiggle your toes for me.’
I could feel the slightest of movements through the wafer-thin leather.
‘No need,’ I said to the paramedic. ‘There’s movement. If it becomes necessary we’ll transfer him to Gloucestershire Royal. They have a spinal injury assessment unit, and it would take longer to get the air ambulance up here than to go by road.’
I would have called the air ambulance if I’d thought his spinal column was severed or for a major head injury. He would then have had to go to Bristol.
‘Faller, second-last,’ said the spotter into my ear. ‘Jockey down. Any doctor available?’
There was no reply.
‘Can you cope here now?’ I asked the paramedics.
‘Sure.’
‘Take him to the jockeys’ medical room for further assessment. Check his blood pressure and call me immediately on the radio if he deteriorates.’
‘Will do.’
‘Doc two. On my way,’ I said into the radio as I ran back to the Land Rover. It wasn’t ideal, I’d have liked to remain with Dick McGee, even travelled with him all the way to hospital if that was required, but it would leave us short-handed.
I jumped into the Land Rover.
‘Second-last fence,’ I said to the driver. ‘Quick as you can.’
We set off at breakneck speed along the vehicle track.
‘Doc two to medical room,’ I said into the radio as we bounded along.
‘Medical room. Go ahead.’
I gave the two nurses there a very brief account of both Ellie Lowe’s and Dick McGee’s condition and that both were on their way to them for further assessment.
‘Doc one here,’ Adrian said over the radio. ‘On my way back to the medical room now.’
I arrived at the second-last fence and was quickly out of the Land Rover and running.
The jockey who was down was being tended to by two paramedics from one of the remaining ambulances. I joined them.
‘Jason Conway,’ one of the paramedics said to me as I approached. ‘Claims he’s all right but he can’t stand up properly.’
First Dick McGee. Now Jason Conway.
Who would believe that was a coincidence?
I went over to him.
‘Hello, Jason, what seems to be the problem?’
He looked at me but seemingly without any recognition.
‘No problem,’ he said, trying to get up.
But his words were slightly slurred.
Concussion. I knew. I’d been there.
‘Just lie down and let me examine you,’ I said.
I could tell that he wasn’t keen. ‘I’m OK,’ he insisted.
‘Jason,’ I said firmly, ‘I will need to examine you and if you refuse I will have to stand you down from riding anyway.’
I wasn’t sure that his brain was in a position to work out the logic but he stopped trying to get to his feet and lay back on the grass.
‘Which horse were you riding?’ I asked as I knelt down beside him.
He looked up at me blankly without answering.
‘Where are you?’ I asked.
‘At the races,’ he said confidently.
‘Which racecourse?’
Again there was no answer.
I turned to the paramedics. ‘Put a neck collar on him and we’ll take him on a stretcher to the medical room. We’ll decide there but I strongly suspect he’ll need to go to hospital for a scan.’
While the paramedics collected their stretcher I examined Jason for any other injuries but there were none I could see. That didn’t mean there weren’t any. Unseen injuries were often the most dangerous.
To say that there was pandemonium in the medical room when I arrived back would not be an exaggeration. The two beds plus the physiotherapist’s table were already occupied by injured jockeys, hidden from view by the blue privacy curtains, and Jason Conway was still outside in the ambulance being cared for by the paramedics.
‘Bloody hell,’ Adrian said. ‘It’s like Piccadilly Circus in the rush hour. Speak to me.’
‘Ellie Lowe has a suspected broken fibula,’ I said. ‘Dick McGee took a blow to his back and initially couldn’t feel his legs but some sensation and
movement returned while I was with him. I’ve also got Jason Conway outside in the ambulance with suspected concussion. He couldn’t stand properly and didn’t know where he was or which horse he’d been riding. I think he should go for a scan.’
‘OK,’ Adrian said, taking a deep breath. ‘Ellie Lowe is having a support bandage fitted but will have to go to hospital, so will Jason Conway. Both to Cheltenham General. Dick McGee says he’s now fine and all sensation and movement have returned to normal and he should be able to ride in the fourth race. It’s as much as I can do to keep him lying down. I’ve told him if he gets up, I’ll sign him off riding for a month.’
‘I still think he should go for a scan, to be on the safe side,’ I said. ‘Who’s in the other one?’ I nodded towards the blue curtains nearest the door.
‘Mike Sheraton,’ Adrian said. ‘Gashed his right knee. The nurse is just putting in a few stitches. He’ll be fine.’
I stared at him in disbelief.
Dick McGee, Jason Conway and Mike Sheraton, the three jockeys I had vowed to have nothing to do with, were all here, and all injured.
27
‘Jockeys, five minutes,’ came the call through the changing room loudspeaker system.
The next race.
‘Can we cope?’ Jack Otley said to Adrian.
‘We’ll have to,’ he said. ‘There are only eight runners in this one. Jack, you and I will be out on the course. Chris, you stay here to monitor our guests but listen out on the radio in case you’re needed. With one ambulance stuck outside with Jason Conway, we still have three available. That’s more than enough. Let’s just hope we have no fallers this time.’
Adrian knew fully well that we needed to act according to our clinical decisions and not allow financial or racing operational considerations to override our judgement. But, equally, we wouldn’t be thanked if we cancelled racing for no good reason.
‘We do need to send Lowe, McGee and Conway to hospital,’ I said.
‘Could one ambulance take all three at once?’ Adrian asked.
I shook my head. ‘I think both Jason Conway and Dick McGee should be kept horizontal. Ellie Lowe could sit on a seat as long as her left leg is up.’
‘Then call for an off-course ambulance,’ Adrian said, picking up his red doctor’s bag. ‘Use that and the one outside.’
‘I’d really like to go with them,’ I said. ‘I don’t trust either McGee or Conway not to simply walk away at the other end.’
‘Threaten them with a long suspension if they do.’
He started for the door but was blocked by Rupert Forrester coming in.
‘Everything all right in here?’ he asked, standing in the doorway. ‘I hear we’ve had several injuries after that race.’
‘Yes, Rupert, we have,’ Adrian replied. ‘But we’re coping.’ He sounded a lot more confident than I was.
‘So racing can continue?’
‘Absolutely,’ Adrian replied. ‘We meet the minimum requirement.’
‘Good,’ Rupert said. He started to leave but turned back. ‘Who’s actually in here?’ he asked, indicating towards the blue curtains.
‘Mike Sheraton, Dick McGee and Ellie Lowe. Jason Conway is being treated outside in an ambulance.’
‘Any of them serious?’
‘Serious but not critical,’ Adrian said. ‘One possible fractured fibula, one back spasm, one likely concussion and some stitches in a split knee. Nothing we can’t deal with easily. Dr Rankin, here, is going to call an off-course ambulance to assist with a transfer of a couple to the local hospital.’
In my opinion, Adrian was downplaying the magnitude of the problem.
‘Jockeys out,’ was called over the speakers.
‘I must go,’ Adrian said. ‘I have to get down to the start or the race will be off late.’
The regulations stated that racing was unable to proceed until the doctor at the start had confirmed to the official starter that at least the minimum required medical provision was in place.
Rupert Forrester stepped aside to let Adrian and Jack out but came back into the doorway.
‘Dr Rankin,’ he said, ‘are you happy that you can cope here on your own? Would you like me to stay? I’m no doctor but I could surely do something to help?’
‘I’m fine, thank you,’ I said. ‘I have the nurses to help me and everything is under control.’ If Adrian wanted to talk down the seriousness of the injuries, I could do the same. I also decided not to point out to him that non-medical staff were not permitted to be in there anyway, not when we had patients present, due to compromising their medical confidentiality.
He nodded, took one more long look around the room and then departed.
‘OK,’ I said almost to myself. ‘Where do I begin?’
First, I went outside to check on Jason Conway in the ambulance. He was still lying on the stretcher with one of the paramedics sitting next to him. He had been wired up to a heart monitor and had a blood-pressure cuff on his arm, but he had recovered somewhat, at least to the extent that he knew who I was and he wasn’t happy about it.
‘I want another doctor,’ he said belligerently.
The paramedic gave me a sideways questioning glance, which I ignored.
‘There isn’t another doctor available,’ I replied calmly. ‘Now, Jason, can you answer some questions?’
‘Not more bloody questions,’ he said, lying back on the stretcher and closing his eyes.
Not those questions, I thought. I needed to ask him the Turner concussion questions.
He did slightly better this time insofar as he could remember both that he was at Cheltenham Racecourse and the name of the horse he’d been riding. But as for who was the current champion jockey or the winner of the Grand National, which had only been run the previous Saturday, he wasn’t even close.
‘Jason,’ I said, ‘I consider that there is evidence of concussion and I will be making a Red Entry to that effect. You will not be able to ride for a minimum of seven days and, even then, you will need clearance from the Chief Medical Adviser before racing again. Do you understand?’
He looked at me somewhat vaguely. Fortunately we had a pre-prepared printed sheet to give to concussed riders that set out the rules and the procedure for obtaining clearance to ride, along with a voucher to help them purchase a new helmet. I gave him a copy.
‘You are now going to go to hospital,’ I said to him, ‘for a scan.’
‘No need,’ he said, trying to sit up but having difficulty doing so.
There was every need, I thought. I turned to the paramedic.
‘Vitals?’
‘All good,’ he said.
‘Never mind. Cheltenham General and now,’ I said. ‘I’ll call ahead to warn them he’s coming. I want an urgent head CT to check for any bleeds.’
I turned back to the patient.
‘Jason,’ I said, ‘you are going to hospital now. I will talk to your valet and get your stuff sent on.’
‘No need,’ he said again, but he lay back on the stretcher and closed his eyes.
I was suddenly quite worried about him.
‘Quick as you can,’ I said to the paramedic.
‘No problem.’
I climbed out of the ambulance and it set off with its blue lights flashing. I watched it go. Perhaps I should have gone with him, but I had more patients to deal with. I went back into the medical room.
The blue screen curtains had been pulled back and the three jockeys were all watching the current race on the television attached to the opposite wall. I glanced up at the screen as I made a call to A&E at Cheltenham General.
‘I have three customers for you,’ I said. ‘One on his way now, two more to follow.’
Jeremy Cook was the consultant on duty and I spoke directly with him, filling him in on the details of each expected patient.
‘Thanks, Chris,’ he said when I’d finished. ‘We’ll look after them.’
Next I called the ambulance service requesting
an ambulance.
‘Thirty minutes OK?’ said the operator. ‘There’s been a big accident on the motorway and we’re a bit stretched at present.’
‘Thirty minutes will be fine,’ I said, and wondered if the ambulance I’d just dispatched might be back sooner than that.
‘Get out the fucking way,’ Mike Sheraton shouted at the nurse. She had just finished stitching his knee and had inadvertently stepped into his line of sight to the TV while fetching a dressing.
I turned and stared at him. ‘That’s no way to speak to a lady.’
He didn’t reply. He didn’t even look at me.
As Dave Leigh had said, Mike Sheraton was not a nice person. All the medical staff had their favourites among the jockeys but he wasn’t on anyone’s list.
I checked his RIMANI entry on the computer. Adrian had not stood him down from riding.
‘Let me have a look at that knee before you cover it,’ I said to the nurse.
She had done a fine job. There was a tidy row of four small knotted stitches across the front of Sheraton’s right knee. I studied the wound closely as the owner of the leg concentrated only on the televised finale of the race.
Simple suturing alone did not warrant a Red Entry and was hence not a reason to prevent someone from riding, but this injury was over a joint.
As the nurse applied the dressing, I filled out some paperwork and handed a sheet of paper to Mike Sheraton.
‘What’s this?’ he demanded angrily.
‘Notification of Red Entry form,’ I said. ‘You must have seen one before.’
It gave the details of the injury and the reasons for the Red Entry.
‘I know what it is,’ he said loudly, ‘but why are you giving it to me? This is nothing more than a scratch.’
‘It’s a laceration that required four stitches, and it’s over a joint. If you bend the knee too much you will split it open again. Hence I’ve made a Red Entry on the computer. You will need to give the form to a racecourse doctor and get clearance before you can ride again, and that won’t be today.’
‘I’m not accepting that,’ he said, throwing the paper down angrily onto the bed.
He may have been furious, but I remained unmoved.
‘You will,’ I said. ‘You’ll not be cleared to ride again without it – or would you rather I reported you to the stewards?’
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