by Sue MacKay
‘Come and lie down somewhere.’ The sound of the siren was fading rapidly as Ari put a supporting arm around her shoulders. ‘Couch or bed—whatever’s easier. We need to find out what’s going on.’
A very short time later, he ended his phone call, hoping that he would be hearing another siren from an emergency vehicle in the very near future—from the ambulance he had just summoned.
* * *
Paramedic Kelly Reynolds shut down the lights and siren on the rapid response vehicle she was driving as she approached the suburban address she’d been dispatched to. Parking directly behind a large motorbike, she jumped out of the driver’s seat to go to the back hatch of the SUV to collect the gear she might need, slipping her arms through the straps of the backpack that contained an extensive first-aid kit. One hand was then free to carry the life pack with its monitoring and defibrillation capabilities and Kelly took a deep breath as she took her first step across the road.
As a rapid response paramedic it was her job to either arrive first to assess and stabilise what could be a serious case, or back up an ambulance crew that needed expert assistance. Sending an officer that worked alone—especially a female officer—into a potentially volatile situation was not ideal but when a call like this came in, it had to be the closest available vehicle that got dispatched and, this time, that had been Kelly.
She wasn’t about to stand back and wait for the back-up of the ambulance that she had heard being dispatched at the same time she had received the Code Red, urgent priority callout, on her radio. Not when there was a pregnant woman and a midwife on scene who needed assistance. She just needed to remember her training. To keep a clear escape route behind her at all times and to carry a heavy bit of kit like the defibrillator in front of her so that, in the worst-case scenario, she could throw it at someone to make her escape easier.
There was a woman leaning on an iron railing fence that separated her property from the house they’d been dispatched to.
‘’Bout time someone got here,’ she told Kelly, with satisfaction. ‘He’s kicking off again.’
Kelly acknowledged the greeting with no more than a nod. She could hear a raised voice coming from inside the house so she walked past the neighbour and rapped on the open door.
‘Ambulance,’ she called loudly.
The hallway was empty. The man’s angry voice was coming from a room to one side.
‘It’s her own bloody fault. I reckon she got pregnant on purpose. How do I even know the kid’s mine?’
It was the cry of pain from a woman that made Kelly move, her hackles rising as she got closer to what turned out to be a living room. She held the heavy life pack in front of her body as she’d been trained to do—poised to hurl it if she found herself under attack. The angry man wasn’t making an assault on anyone, however. He had a can of beer in his hand and he was simply standing in the doorway to a kitchen. The woman who sounded as if she was in severe pain was lying on a couch and there was another man crouched beside her.
An extraordinary-looking man, with olive brown skin and his hair pulled up into a bun that was a lot higher than the one Kelly always used to tidy her own hair for work. A lot messier, too. He was wearing jeans and a leather jacket of all things but he had what looked like a professional medical kit open on the floor beside him with a stethoscope and blood-pressure cuff visible. And he was placing his hands on the woman’s pregnant belly. Large, capable-looking hands, she noticed, but even from this distance she could see—or sense—how gentle his touch was. Kelly wasn’t the only one watching.
‘Get ya hands off her,’ the man yelled. ‘Nobody touches my wife without my say so.’
He lunged towards the couch but Kelly was faster as she stepped into the room at the same moment to get between him and the pregnant woman. He stopped in his tracks and swore vehemently but then backed off a little. He was a bully, Kelly realised, lowering the defibrillator. He might thrive on making threats but he was actually unlikely to follow through on them. Not that that made the abuse or interference with medical care any more acceptable, of course.
‘It’s not my fault,’ he muttered as he stepped back. ‘It’s that cow next door. She’s the one who’s causing all the trouble round here—not me. So we were having a bit of a barney...so what? Who doesn’t?’
‘What is happening here?’ Kelly only took her gaze off him for an instant because, while she thought she had the measure of this man, he was still clearly posing a threat. Her swift glance over her shoulder was long enough to see that the woman on the couch was looking distressed and far too pale. It was also long enough for the man who was crouched beside her to look up and meet her gaze.
Dark, dark eyes. A serious expression on a very intelligent-looking face.
‘I’m Kelly,’ she introduced herself. ‘From the ambulance service.’ She was still a little confused about who this man was. ‘And you are...?’
‘He’s a midwife,’ the man in front of her sneered. ‘A boy midwife. And you’re a girly medic. Who let you out to play all by yourself? If you ask me, the world’s gone bloody mad...’ He crumpled his beer can, hurled it towards the corner of the room and then turned back towards the kitchen. ‘I need another drink...’
Kelly ignored him, her gaze fixed on the midwife. She could sense that, beneath that calm expression, he was worried about his patient. Seriously worried.
‘I often work with the obstetric and neonatal flying squad,’ she told him. ‘Do we need to call them?’
The flying squad was a specialised team with a dedicated ambulance that was mainly used for transport of premature or sick babies to a hospital like the Kensington, which had a neonatal intensive-care unit, but it could also cater for any obstetric emergency like a home birth going wrong or a complication like a post-partum haemorrhage or obstructed labour. The team could include an obstetrician and/or a neonatal specialist, midwives and paramedics and had an incubator as part of their equipment in case an out-of-hospital birth or transport was needed for a fragile infant.
‘Maybe.’ There was a hint of a smile on his face as the midwife spoke to Kelly for the first time but it was ironic rather than amused. ‘For now, it’s good that you’re a “girly” paramedic. Between us, we might be able to properly assess how much blood Vicky’s actually losing.’
Any hint of that smile had faded but his glance still communicated the fact that this man was well aware of the threat that Vicky’s husband posed and that his attitude to a male midwife being here was exacerbating that threat. He wasn’t about to let it stop him doing his job, which deserved serious respect as far as Kelly was concerned. That simple reference to her being “girly” conveyed both an understanding of the kind of prejudice that could come with crossing perceived career boundaries or trying to assert authority and the kind of humour that meant he’d learned long ago how to deal with it. That earned more than respect from Kelly.
She liked this man.
As an advanced paramedic whose expertise had been requested, Kelly was theoretically now in charge of this scene but she wasn’t about to ask this midwife to step back if it wasn’t necessary. He had looked as though he knew exactly what he was doing when he’d been checking both the position of the baby and how tender or rigid Vicky’s abdomen was, and now he was about to move her clothing to check on her blood loss—something they both needed to assess as rapidly as possible.
A split second later, however, he reared back as an open beer can, spewing froth, whistled through the air to narrowly miss his head. Vicky cried out in fear and shrank back against the couch, even as the midwife moved to shield her, and it was in that instant that Kelly knew this woman had been struck in the past.
Maybe they should have waited until they could have taken Vicky out of there and into an ambulance before starting any assessment or treatment but this was most definitely not the time to start thinking about how she could have improved
her management of this scene. Abuse of any kind was totally unacceptable and the midwife—who’d come into this situation alone with the sole intention of looking after a vulnerable woman—could have been seriously injured by that can.
With anger driving her muscles, it only took Kelly three steps to get to the other side of the room, although it was long enough for a hole to get punched into a wall. Not that that slowed Kelly down. If anything, she was even more furious as she faced up to the violent thug that Vicky was unfortunately married to.
‘Get in there,’ she shouted, jabbing her finger in the direction of the kitchen. ‘If you so much as put a foot back in this room while we’re looking after your wife, I’ll have the police here so fast you won’t know what’s hit you. And, believe me, they’ll make sure you don’t get to cause any more trouble for anyone for a very, very long time. Now...move...’
* * *
Wow...
Ari had his stethoscope in his ears because, having seen the alarming amount of blood Vicky had already lost, it was a matter of urgency to check on the baby’s status, but there was no missing the absolute authority in that voice. This paramedic—Kelly—might be blonde, pretty and as “girly” as they came, but she was not about to get messed with and that was exactly the kind of medical back-up he had hoped would arrive. He moved the rounded bell side of his stethoscope to pick up the baby’s heartbeat, which was reassuringly rapid and steady...for now.
‘Have you been feeling the baby move today, Vicky?’
‘Yes.’
‘How long ago did the pain start?’
‘I dunno. Maybe an hour. Or maybe a bit longer. The fight started because Brendan didn’t like what I was making for lunch and he...he...’
Ari lowered his voice, even though the kitchen door had been slammed behind Brendan. He knew that Kelly was coming back to this side of the room and would be able to hear him.
‘Did he hit you, Vicky? Is that how the pain started?’
‘N-no...he just...shook me a bit, that’s all.’
Again, his gaze met that of the paramedic for a heartbeat. He could see that Kelly, as a frontline member of the emergency services, had seen it all before. He could also see a fierce determination to help a vulnerable mother-to-be. He recognised that determination easily because it was something Ari had lived with himself for almost as long as he could remember. A need to protect and care for those more vulnerable than himself. Especially babies. Including babies that hadn’t been born yet and had no idea how tough life could be.
Kelly had her fingers on Vicky’s wrist but Ari knew she wouldn’t be able to locate a radial pulse because that had been the first thing he’d tried to assess. The tiny frown that appeared between her eyes was confirmation that she’d taken on board the warning that they needed to move fast. An absent radial pulse was an indication that the blood pressure was far too low.
‘Vicky?’ Kelly’s tone was reassuring. ‘I’m going to put a mask on you so that we can give you some oxygen. And I’m going to put an IV line into your arm, love. You’ve lost a bit of blood and we need to give you some fluids to get your blood pressure back up again. Then we’re going to get you into hospital. Is that okay with you?’
Vicky nodded wearily, lying back as she closed her eyes, her response no more than a mumbled assent. Kelly must have noticed that Ari was watching her rather intently because she flicked him a sideways glance. One that acknowledged what they both suspected—that Vicky’s placenta could be separating from the uterine wall and the amount of blood she was losing could put her into haemorrhagic shock that could be life threatening—both for this young mother and her baby.
There was a question in Kelly’s eyes. ‘You okay with staying here?’ she asked quietly as she opened her backpack and took out an equipment roll. ‘Want me to call for police back-up? There’s an ambulance on its way but we could try and get Vicky next door in the meantime.’
Ari kept his voice just as low—no more than a murmur that Vicky probably couldn’t catch. ‘I’d prefer to get her stable before we move her. Her GCS is dropping already. I reckon we can handle this between us...’ He tilted his head towards the kitchen door. ‘In fact, I think you could handle it all by yourself.’
A brief curl of one side of Kelly’s mouth acknowledged the compliment but her nod was an agreement with his preference to stay put and get some fluid resuscitation started. Movement could make the loss of blood more rapid and Vicky’s condition could deteriorate rapidly, tipping her into a possibly irreversible state of shock. Kelly had the tourniquet and the foil packet containing an alcohol wipe in her hands, ready to start establishing an intravenous line.
Ari reached for a cannula, peeling back the plastic cover before holding it out for Kelly to take as soon as she cleaned the skin over the vein she’d chosen in Vicky’s forearm. In that moment, they became even more of a team than they had when they’d agreed to stay here and try to stabilise their patient’s condition.
‘Vicky? Sharp scratch, love, but it’s only for a second.’ She slid the needle in, slid the cannula into place and released the catch on the tourniquet so swiftly and smoothly it looked like a single action.
Impressive.
‘There’s a bag of zero point nine percent saline in the kit. Top pocket.’
Ari pulled it out. Then he read out the expiry date for her.
‘Thanks...’ Kelly paused, a finger pressed onto the vein above the small, plastic tube in Vicky’s vein as she reached for the Luer plug he’d left beside her knee. ‘Sorry... I didn’t catch your name.’
‘We didn’t exactly get the chance for introductions.’ Ari was unwinding the giving set to poke the spike into the bag and then run enough fluid through the tubing to remove any air bubbles. ‘I’m Ari. Ari Lawson. I’m a midwife attached to Kensington Hospital.’ He held the end of the tubing out to Kelly who took it to attach to the Luer plug. With the IV line securely taped, she worked just as swiftly and smoothly to attach ECG electrodes to Vicky’s chest and flick the defibrillator into monitoring mode. Almost immediately, an alarm started sounding.
‘She’s tachycardic,’ Kelly noted. ‘And look...’ She pointed at the screen, where the bizarre shapes of ectopic beats were interrupting a trace that was rapid enough to have tripped the alarm. She silenced the alarm but it seemed like it had triggered a new wave of tension. Chaos, even?
The kitchen door was flung open behind them.
Ari could feel the surge of adrenaline that made every muscle in his body tense as he started to get to his feet. He could sense the same reaction from Kelly as she gathered her inner resources to face whatever new threat might be coming. After what he’d seen earlier, Ari had every confidence that she could deal with it but, this time, he was going to be the one in front. Protecting her.
Or maybe he didn’t need to. He could hear a commotion coming from the hallway of this small house. Loud shouting that told him that the police had apparently responded to the neighbour’s call—perhaps because they knew an ambulance officer had been dispatched and might be in need of back-up?
He could also tell that the arriving officers were both male because it felt like the wave of testosterone arrived in this room before they burst in, and although their equipment like telescopic batons, pepper spray and handcuffs were still attached to their belts or stab-proof vests, it felt like they were demanding attention and advertising their ability to enforce authority. Ari found himself turning his glance towards Kelly again. She’d had the authority to command respect without any kind of weapon, hadn’t she?
Except...
She looked different now that these male officers had arrived. Okay, her head was probably dipped because she leaning in to try and calm Vicky, who was trying to sit up and pull her oxygen mask off at the same time, but, for a split second, it almost seemed to Ari that Kelly was ducking her head for another reason. Trying not to be seen, even?
Ari moved to help Kelly keep Vicky still. The last thing they wanted was an increase in the rate at which she was losing blood.
‘It’s really important that you keep still, sweetheart,’ he said. ‘We’ve got this, okay?’
Even if Brendan hadn’t been drunk enough to make it difficult to stand up straight, he would have been incapacitated within seconds by the two police officers.
Ari wondered if one of them, in particular, was enjoying the opportunity to use physical force to restrain someone a little too much as he flourished his baton and raised his voice. He was a big man with buzz-cut blond hair that accentuated uncompromising features, including a very square jaw. Kelly was watching as well as the officer twisted Brendan’s arm behind him with enough force to make him cry out in pain.
Kelly’s expression made Ari suspect that she shared his opinion that too much force was being used here. It certainly looked like her desire to protect an underdog was automatically overriding any desire to remain in the background. She jumped to her feet, although her words were almost tentative.
‘H-he hasn’t hurt anybody,’ she told the police officers. ‘He’s drunk, that’s all. Noisy. He was just...making some verbal threats.’
She was being ignored as the officer issued a rapid, almost bored-sounding caution.
‘You do not have to say anything. But it may harm your defence if you do not mention when questioned something which you later rely on in court...’
What Kelly had said wasn’t exactly true, Ari thought as he reached for Vicky’s wrist to feel for her pulse again. Throwing a full beer can as a weapon was definitely assault. But ambulance staff often got to know local police officers pretty well when they were working in the same area of a city. Was she minimising what had happened here as a form of protection because she knew what this officer might be capable of in the heat of the moment?