Doctors at Risk

by Alison Roberts

  ‘Over my dead body.’

  ‘I don’t think he heard that.’ Debbie was leaning over the counter near the noticeboard. Her expression was curious. ‘Who is he, anyway?’

  ‘He was on the USAR course and he was a pain right from day one. He should never have been able to get in here like that. Have you any idea how slack security is around here?’

  ‘It’s difficult,’ Debbie reminded her. ‘A lot of patients have family members wandering around. We can’t challenge everybody.’

  ‘Maybe they should wear a visitor’s pass or something.’

  Debbie was still looking curious. ‘If you keep scowling that hard you’ll get wrinkles. What did he do to annoy you so much?’

  Wendy just scowled harder. She had no desire to refresh her own memory by telling Debbie about the infatuation Kyle had with her, and she was relieved when Debbie was distracted by having to answer the phone. The conversation was brief.

  ‘Paddy’s looking for you, Wendy. He’s in his office.’

  ‘On my way.’ Wendy was pleased to have an excuse to push the whole episode with Kyle firmly out of her mind and concentrate on her job again.

  ‘That bloke seemed to like you.’ Debbie’s voice floated after her. ‘Hey, maybe he’s the secret admirer!’

  Patrick Miller had summoned Wendy to let her know the results of the X-ray examination Martin had just undergone.

  ‘There’s no significant reduction,’ he reported. ‘We’re going to take him to Theatre as soon as it’s free. We’ll try manipulation and reduction under general anaesthesia but it’s quite likely we’ll have to go on to an open reduction and plating. Martin’s asleep at the moment and Gemma is taking a break. She wants some time to get to grips with this before we talk to him. And it could be a while before we get to Theatre. There’s been a couple of hiccups with Cecily Barnett’s surgery and it’ll be at least an hour before they finish.’

  ‘It’ll have to be Gemma that signs the consent form, anyway, won’t it?’

  ‘Yes, but it’s Martin that needs to make the decision.’

  ‘There’s not much choice if his condition is deteriorating.’

  ‘No.’ Patrick looked grim but then his expression lightened. ‘How’s Ross today? I haven’t had the chance to go and say hello yet.’

  ‘I think he’s a bit down.’ Wendy couldn’t confess the real problem, no matter how approachable her boss might be. Not when she hadn’t yet accepted that Ross was seriously intending to dump her.

  ‘Facing this kind of challenge is a long haul. Things will improve, though. I have great hopes that Ross will walk out of this place—at least with crutches.’

  ‘I’m not sure that’s going to be good enough for Ross.’

  ‘It’s certainly a body image that he’ll need time to adjust to. At least you’re in a perfect position to help him.’

  ‘I hope so.’ Only Wendy knew the statement was ambiguous. She did hope she could help but she hoped even more that she could regain the perfect position from which to try. Ross had never been as close to anyone as he had to her. He had said as much on more than one occasion. Who would be there for him the way she could be if he insisted on trying to break that bond?

  Peter had stayed with Martin during Wendy’s absence. He looked up from the notes he was writing as she returned.

  ‘How’s Ross? Sally said the level of sensation in his legs seems to be improving.’

  ‘Still no signs of any movement. I don’t think he wants to accept that a wheelchair is a real possibility.’

  Peter closed the folder of patient notes. ‘It’s ironic, isn’t it, that those are often the people that end up in here? The horse riders and rugby players and paragliders. They have the most to lose, and doing what they love is what puts them at risk of losing it.’

  ‘I don’t think an avoidable accident in an urban search and rescue scenario would count as doing something Ross loved.’

  ‘Wouldn’t it? Wasn’t he heavily involved in a mountain search and rescue team?’

  Wendy had to nod. ‘He saw the USAR course as an extension of that training. Ross wanted to be the best rescuer he could be—in any situation.’

  ‘Who’s Ross?’ The sleepy mumble indicated that Martin had woken.

  ‘Wendy’s boyfriend,’ Peter told him. ‘She’s just been to visit him in the ward while you were asleep.’

  ‘Is he a doctor?’

  ‘He is,’ Wendy confirmed. She was watching the monitors as Martin’s heart and respiration rates increased. The oxygen saturation level dropped slightly and then picked up. ‘But he doesn’t work here. He’s a patient at the moment.’

  ‘What happened to him?’

  ‘He had a bad fall.’

  ‘You might have read about him in the newspaper,’ Peter added. ‘Or seen him on TV. He’s famous now. Ross and Wendy were part of the rescue team during the Westgate Mall disaster.’

  ‘Really?’ Martin sounded much more awake now. ‘Wow! You know, when I first heard about that I thought someone was pulling my leg. I couldn’t believe something that awful was happening in New Zealand. It was unreal.’

  ‘We thought that at first, too,’ Wendy admitted. ‘We’d just finished our three-week training course on urban search and rescue and we got loaded into a bus for a callout. We thought we were being taken to a pub to celebrate and instead we found ourselves in the middle of the biggest disaster this country’s ever had.’

  ‘I was amazed that we even had people training to do that kind of rescue work.’

  ‘New Zealand’s been part of an international search and rescue advisory group for more than ten years,’ Wendy told him. ‘Up until recently there’s only been two task forces in the north island. Our course was held to boost numbers and make a full-response team available in the south island.’

  ‘You must have had to learn a lot.’

  Wendy nodded. ‘Heaps.’

  ‘Like what?’ Martin sounded genuinely interested and Wendy was happy to respond. Conversation that wasn’t centred on a patient’s own situation was often beneficial.

  ‘We learned how to do a reconnaissance and survey of an incident. What sort of equipment would be used and the gear we needed to keep ourselves safe. We learned how to identify hazards and how to deal with them and how to do a rubble crawl and a line-and-hail search to find people buried under debris.’ Wendy smiled. ‘We had a practice session of that in a huge rubbish tip. I got buried and the rest of the class had to find and rescue me.’

  ‘Sounds like fun,’ Martin observed.

  ‘Kind of,’ Wendy agreed. ‘It was pretty cold and dirty.’

  ‘What else did you do?’

  ‘We had quite a lot of medical training for people who didn’t come from health-related jobs.’

  ‘What sort of jobs did they come from?’

  ‘We had a couple of doctors, more nurses, like me, and some paramedics. There were lots of fire officers and other people who were involved in organisations like the Red Cross and Civil Defence.’

  ‘Any builders like me? I’d love to do something like that.’

  ‘Actually, builders would be very useful,’ Wendy told him. ‘We had to learn how to shore up unstable structures and that seemed to involve a lot of hammering bits of wood together.’

  Martin was quiet for a moment but Peter seemed to have caught his interest in their conversation.

  ‘They couldn’t have been anticipating something like a shopping mall blowing up,’ he commented. ‘It seems quite a coincidence that it happened right as you finished the course.’

  ‘The course had been planned ages ago. There are a lot of other reasons to have USAR personnel available. We get plenty of earthquakes in New Zealand and they always have the potential to make a lot of buildings collapse. Besides, the teams can be used for any kind of long-duration special incidents.’

  ‘Like what?’

  ‘Major terrorist activities aren’t so far-fetched any more. Manmade situations could be bombi
ngs or hazardous material release. Natural events like hurricanes or floods happen often enough, too. People with just this sort of training were needed, say, in that tidal wave in Papua New Guinea not so long ago. And that awful mud slide at Thredbo in Australia in ’97. Personnel trained here can theoretically be deployed anywhere in the world.’

  ‘So you could get sent off if there was a huge earthquake in Mexico or somewhere?’

  ‘That’s the idea.’ Wendy nodded. ‘Most of the people in my class were quite prepared to go anywhere they might be needed.’

  ‘Did you know the guy that got trapped trying to rescue that kid?’ Martin queried.

  ‘That was Joe.’ Wendy nodded again. ‘He’s a good friend. And the little boy that was rescued is the son of one of my other best friends, Jessica. She was in our class as well. Her mother was killed in the collapse.’

  ‘And your boyfriend got hurt. I remember reading about him now. He’s going to end up in a wheelchair, isn’t he? Like me?’

  It seemed tactless to tell Martin how much better off Ross was. Peter spoke as he noticed her hesitation. ‘His injury’s a bit different. His arms and hands are still OK.’

  ‘He’s lucky, then.’

  ‘Yes, he is,’ Wendy agreed simply. And maybe Ross would realise that himself soon. Especially if he had someone like Martin to compare himself to. If he could talk to Martin, he might realise just how negative his own attitude was. The idea that Martin could be moved into Room 2 alongside Ross seemed an inspiration and Wendy felt a surge of optimism as she resolved to speak to Patrick about it later. They would get through this. Together. And their love would end up stronger than ever.

  ‘Martin’s due for a turn,’ Peter observed. ‘Shall I round up the team?’

  ‘Thanks, Pete. I’d appreciate that.’

  Turning a paralysed patient at regular intervals was essential to avoid pressure problems and maintain limbs and joints in functional positions. To change between a left or right lateral and a supine position required a team of at least four trained staff members. The team leader held the head and the others controlled the rest of the spinal alignment. Martin was returned to lying on his back after a spell on his left side. Peter stayed to help Wendy reposition the pillows after the turn. Martin had a pillow under each arm, others beneath his back, between his legs and two at the foot of the bed to prevent foot drop. Wendy looked up as she pushed the last pillow back into place between her patient’s foot and the board to make a solid bed end.

  ‘OK, Martin?’

  ‘I don’t feel so good.’

  Wendy straightened swiftly. Peter was watching the cardiac monitor and her eyes flew to the screen. Changing the position of a patient with a high spinal fracture could precipitate an irregularity in heart rhythm and she was as disturbed as Peter to see the spikes drifting far more slowly across the screen.

  ‘I feel sick,’ Martin told them. His skin colour had faded to a nasty pallor and Wendy could see beads of perspiration on his forehead.

  An alarm sounded on the monitor and Peter pressed a button to silence it. ‘Rate’s down to thirty,’ he warned Wendy. ‘I’ll get Paddy.’

  Patrick Miller was at the bedside within seconds. ‘Draw up some atropine,’ he instructed Wendy. ‘And adrenaline.’

  Wendy drew up the drugs, which were administered in small increments. She held her breath as the fifth dose of adrenaline was injected, watching the screen and willing the heart rate to start picking up.

  The rate did increase but not in the way any of them had hoped. The slow spikes changed to rapid, smooth-capped mountains.

  ‘Ventricular tachycardia,’ Wendy observed aloud.

  ‘He’s unconscious,’ Peter announced tersely. He had already positioned the crash cart. He slapped gel pads onto Martin’s chest as Wendy reached for the paddles from the defibrillator. She held them in position on Martin’s chest as the charge accumulated.

  ‘Stand clear,’ she directed. ‘Shocking at two hundred joules.’

  They all watched the line on the screen settle back to the same pattern. Wendy pushed the charge button on one of the paddles, still holding them firmly in position.

  ‘Is everyone clear?’ Wendy waited a second for affirmative responses. ‘OK, shocking now. Two hundred joules.’

  This time the spikes reappeared and they all breathed a sigh of relief. The rate was fast but the rhythm was normal. Patrick had a hand on Martin’s wrist. ‘Output’s good,’ he nodded.

  Martin’s colour was improving. His eyelids flickered and he groaned. He was starting to wake up. Wendy slotted the paddles back into the life pack. She reached to peel the gel pads from their patient’s chest but Patrick was frowning.

  ‘Hang on, Wendy.’

  In dismay, Wendy watched the irregular beats that were now disrupting Martin’s heart rhythm at frequent intervals. This time the change to ventricular tachycardia progressed to ventricular fibrillation and three further shocks did nothing to alter the ominous rhythm. More staff members arrived in response to the cardiac arrest alarm that Peter had activated.

  ‘I’ll intubate,’ Patrick informed them. ‘Bag him, Wendy.’ He reached for the laryngoscope on the crash trolley. ‘Pete, I’ll need a 9-mm endotracheal tube and a 10-ml syringe.’

  Wendy held the mask over Martin’s face and squeezed the bag, forcing his level of oxygenation up prior to the procedure of securing his airway. Then she kept up the ventilations as another staff member started chest compressions and Patrick continued the drug therapy. More adrenaline was administered. Then amiodarone. Further shocks were delivered in an attempt to convert the fatal rhythm of ventricular fibrillation until the flat line on the screen advertised the lack of any rhythm to try and convert. They abandoned the paddles. There were now plenty of trained staff to take turns with the CPR.

  The resuscitation attempt lasted forty-five minutes. Awareness of their failure came in stages, though the agreement to cease their efforts was inevitably unanimous, but the horror of what had occurred lingered much longer. Peter stayed to help Wendy in the grim task of tidying up.

  ‘This is just so awful.’ Wendy had crouched to pick up discarded packaging. She remained crouched as she bowed her head in an effort to regain her composure.

  ‘I know.’ Peter’s hand rested on her shoulder for a moment. ‘But it happens. Fortunately not very often.’

  ‘He had such a great attitude.’ Wendy pushed herself to her feet. Peter had removed the tube from Martin’s mouth and cleaned his face, and the young man looked as though he was sleeping peacefully. ‘He was determined to beat this injury,’ Wendy said sadly.

  ‘He wouldn’t have, though,’ Peter reminded her gently. ‘We both know that.’

  ‘But he didn’t,’ Wendy whispered. ‘And even if he’d known, he would still have tried. He was a real fighter.’

  ‘Are you OK?’ Peter led her away from the curtained corner of the ICU. ‘We’re both due to go off duty. Can I take you somewhere for a drink or something?’

  ‘No. Thanks, anyway, Pete, but I think I’ll go and spend some time with Ross.’

  ‘Of course.’ Peter’s smile was understanding. ‘He’s the person you need to be with right now.’

  Wendy nodded. She needed comfort and there was only one person she needed it from. So much for hoping that Martin might help Ross. His positive attitude was simply a memory now, and how could that influence someone who had never met him? At least she could tell Ross about it and maybe make him understand how lucky she felt that he had survived. How much she still wanted to be with him—no matter what the outcome of his physical injuries.

  The curtains were still drawn around the bed by the window. Debbie was busy near the door, arranging a vase of flowers on Sam’s locker. She abandoned the red roses and moved swiftly when she saw Wendy enter the room, intercepting her well before she got near the curtained corner.

  ‘Ross is asleep,’ Debbie informed her colleague. ‘And he’s asked not to be disturbed.’

&nbs
p; ‘I won’t disturb him,’ Wendy promised. ‘I’ll just sit and wait till he wakes up.’

  ‘He’s asked not to have any visitors.’

  ‘He didn’t mean me, Debs. He would have said that because of that guy you saw by the noticeboard earlier. The one that sneaked in outside visiting hours. I’m sure Ross just wants to make sure that Kyle doesn’t bother him again.’

  Debbie was avoiding her gaze. ‘Sorry, Wendy. I know you guys are having a bit of a rough time. I think he just wants a bit of space.’

  ‘What did he say exactly?’

  ‘That he didn’t want to see anybody.’ Debbie looked very apologetic as she finally gave Wendy a direct look.

  ‘Even me?’ The pause was long enough to warn Wendy that she wasn’t going to like the answer.

  ‘Especially you.’

  CHAPTER FOUR

  IT WAS nearly a week overdue.

  ‘Oh, no!’ Wendy stared at the due date for the account from the power company with dismay. The mail had been accumulating in a pile on top of the breadbin for nearly three weeks now. Filed as being of little importance compared to everything else she was having to deal with. The housework had gone the same way and Wendy had dragged herself out of bed this morning trying to summon the motivation to use her two days off to sort out her home and, hopefully, her life.

  The phone account needed paying as well. And her credit card. The disturbing amount the credit company requested made Wendy blink. Remembering how she had spent so much more than usual made her wish she’d stayed in bed after all. It had been an extravagant hour in an outdoor adventure shop, snatched one day when the USAR class sessions had finished early. The age of Wendy’s climbing gear had been of concern to Ross. He had encouraged her to replace it and he had been there to help her try on the upmarket harness with the ergonomic gear loops and doubleback buckle for adjusting the leg loops. She could almost feel the touch of his fingers now—the way she had when he’d tested it for size in the shop. She could also remember all too vividly the look that had passed between them as they’d struggled to disguise both their desire and the mirth engendered by the expression on the sales assistant’s face as he’d observed them from the shop’s counter.