by Sarah Morgan
Logan turned and looked. ‘That couple? I walked past them about ten minutes ago. They’re just tourists, out for an early stroll. They had a stack of newspapers in their rucksack. Probably looking for a peaceful spot on the headland to sit and catch up on the news. I can never understand that really, can you? People come to this island to escape from the big wide world and the first thing they do is buy a newspaper.’
‘They’re waving at us.’
‘Why would they wave at us?’ Logan lifted Kirsty off his shoulders and winced. ‘She always holds onto my hair.’
‘Logan.’ Evanna caught his arm. ‘They are waving at us. He’s shouting something.’
Kirsty wriggled in Logan’s arms and he shifted her back onto his shoulders in a smooth, confident movement. ‘All right. Let’s stroll back up there and see if there’s something wrong.’
‘There is something wrong. Definitely.’ Evanna suddenly had a bad feeling. ‘The woman’s on the ground now. Has she collapsed or is she sitting down? I can’t see properly from here.’ She started to run along the path, aware that Logan was right behind her.
When she reached the couple the woman was on her knees and her hands were at her throat.
The man was right beside her. ‘It’s my wife, Alison. She’s been bitten!’ There was panic in his voice as he fumbled with his phone. ‘I need to get help. I can’t believe this has happened.’
‘Bitten?’ Evanna was already on her knees beside the woman. ‘Bitten by what? Where?’ She put a hand on the woman’s shoulder in a gesture of reassurance and then closed her fingers around her wrist and felt her pulse. It was extremely rapid.
‘It’s a hundred and twenty, Logan.’
‘Her foot. It’s her foot. She trod on the damn thing. Oh, I can’t do this.’ The man’s hands were shaking so much that he couldn’t dial the number and the woman’s breathing was becoming laboured.
She looked at her husband in blind panic and let out a sobbing breath. ‘Pete—do something. My mouth’s really dry and I feel dizzy. I didn’t see it until I put my foot on it. Do something.’
Logan had transferred Kirsty from his shoulders to his arms but he didn’t put her down because they were too close to the edge of the cliff. Instead, he held her easily and squatted down beside the woman, his voice calm and steady. ‘Alison, try not to panic. I’m a doctor and I can help you but I need to know what happened. You said that something bit you? What was it? Insect?’
Alison turned her head to look at him and there was fear and revulsion in her eyes. ‘Snake.’ She croaked the word and Evanna frowned, thinking that she must have misheard.
‘Snake? Are you sure?’ Baffled, Evanna glanced around her but Logan didn’t waste time questioning further. Instead, his fingers were on the woman’s leg, examining an area that was reddening by the minute.
‘Adder. It must have been an adder. Evanna, I want to bandage and splint the leg to stop her moving it around. What can we use?’
Still one step behind him, she stared at him blankly for a moment, tempted to answer, Fresh air. And then she saw something in his eyes—something serious—and his voice held an urgency that she didn’t often hear. Logan was always calm and relaxed. It was unlike him to show that he was worried. ‘I— You need a splint?’ She thought quickly, her eyes flitting around her. ‘Kirsty’s cardigan? That’s cotton so it would be fine as a pad. Your socks because they’re longer and we can tie them, a folded newspaper as a splint?’ Her improvisation clearly met with his approval because his blue eyes gleamed with approval.
‘Let’s do it.’ Handing Kirsty to the woman’s husband to hold, he dragged off his socks and thrust them into Evanna’s hands. ‘You’ll be relieved to know that they’ve only been on my feet for about two minutes. You were reading the Sunday papers.’ He turned to the woman’s husband. ‘Fold a section for me so that I have something rigid to use as support.’
The man dropped the phone, fumbled with the newspaper, cursing as he tried to fold it with hands made useless by nerves. Evanna reached over and took it from him, folded it neatly, placed it on the wound and they strapped the ankle.
Logan had the phone in his hand and was dialling. He made two calls—one to the air ambulance and one to Jim—and Evanna gave a swift nod of understanding. Jim owned the land they were walking on. The sheep in the field were his sheep and he owned a four-wheel-drive vehicle. Travelling cross-country, they could be in the surgery in less than five minutes.
Still holding Kirsty on one arm, Logan made the calls while Evanna glanced nervously around her. She’d lived on the island virtually all her life and she’d never seen a snake.
‘What if it bites someone else? Should we look for it?’
‘It will have gone. Adders are shy. They’ve been spotted on the island occasionally but they don’t normally bother people. They feel the vibration of approaching walkers and slide away.’
‘I think it must have been lying in the sun, warming itself,’ the man muttered, dropping to his knees beside his wife. ‘She trod on it and she was wearing sandals. It’s summer. We didn’t even bother with walking boots. We heard this terrific hiss and then she felt a really sharp stinging in her leg.’
‘Can’t breathe properly,’ the woman gasped, lifting her hands to her throat, and Logan glanced across the fields.
‘We’re going to have you in the surgery in a couple of minutes,’ he said easily, standing up and shielding his eyes from the sun. ‘There’s Jim now. I’m going to help you up, Alison, and we’re going to get you into the car.’
Evanna looked at the woman’s face, saw her increasing struggle for breath and wondered if they’d make it. Panic, with its sharp, deadly claws, stabbed through her and she looked at Logan, taking reassurance from the fact that he was so calm.
He was watching Alison and clearly working out a plan in his head. As Jim pulled up in his four-wheel-drive vehicle, Logan handed Kirsty to Evanna and lifted Alison inside. The rest of them clambered into the vehicle and Logan slammed the door shut.
‘Drive,’ he said to Jim, without wasting time on conversation or niceties and, to his credit, Jim rose to the challenge, covering the distance to the surgery in record time.
‘I’ll keep Kirsty with me,’ Jim volunteered, and Logan gave a brief nod of thanks as he and Pete helped Alison out of the car.
Evanna unlocked the door and sprinted through to the consulting room. Without hesitating, she unlocked the drug cupboard and removed the adrenaline.
‘Can you do a pulse and blood pressure, please? And let’s give her some oxygen.’
Without hesitation, Logan helped Alison onto the couch, jabbed the injection straight into the muscle and depressed the plunger. ‘Her pulse is a hundred and forty. I’m going to need more adrenaline, Evanna, and I want to do an ECG.’
‘Her blood pressure is ninety over fifty.’ Evanna quickly fastened a mask over the woman’s mouth and nose and adjusted the flow of oxygen. Then she reached for the ECG machine and swiftly attached the leads.
‘Ninety over fifty? That’s low, isn’t it? Is she going to be OK?’ The woman’s husband was pacing the floor, his hands clasping his head. ‘I can’t believe this has happened. I didn’t even know that we had poisonous snakes in the UK. If I’d known, I wouldn’t have let her walk in sandals. But it was hot and—’
‘They rarely show themselves and the bite doesn’t always cause such an extreme reaction. She was unlucky.’ Logan took the second syringe from Evanna and injected the contents into his patient. ‘Let’s give her some antihistamine and hydrocortisone and I’m going to put a line in, just as a precaution.’
Evanna reached for the IV tray that she kept ready. ‘Do you think she needs antivenin?’ She knew nothing about antivenin but she knew that it existed.
‘Possibly. She’s obviously absorbed some venom.’
Evanna watched the ECG trace carefully but could see nothing amiss. ‘That seems all right. What exactly are you looking for?’
‘Non
specific changes—ST depression or T-wave inversion.’ Logan frowned and leaned closer. ‘That seems all right. Leave it on until we transfer her to the helicopter. I want to keep an eye on it.’
‘You’re sending her to the mainland?’ Evanna knew that Logan never requested a helicopter transfer unless he was absolutely confident that the patient needed hospital help fast. In his years as the island GP, he’d shown himself to have an uncanny instinct for exactly when to call in the air ambulance.
‘Yes.’ His eyes were still on the ECG trace. ‘Can you get the poisons unit on the phone for me? I want to talk to them.’
‘Her blood pressure is coming up,’ Evanna said, recording the reading and then reaching for the phone. She looked up the number and dialled swiftly, aware that Logan was examining his patient.
It was impossible to work with him and not admire him, she thought as she waited for someone on the other end to pick up the phone. In all the years that he’d been the doctor on Glenmore Island, she’d never seen him panic. Even that awful night with Catherine, he’d been in control. He was incredibly skilled and his confidence had a soothing effect on patients who were often anxious at finding themselves ill or injured so far from what they considered to be civilisation.
Logan removed the ad hoc dressing that they’d applied. ‘Her leg is swelling up,’ he said quietly, ‘and I can see fang marks on her foot. So it was definitely a venomous bite. Do you know if her tetanus is up to date?’
‘I have the poisons unit on the phone for you.’ Evanna held out the phone and Logan stepped towards her and took the receiver.
‘Can you clean and dress it, Evanna?’ He lifted the phone to his ear. ‘It’s Logan MacNeil here.’ His voice deep and steady, he swiftly outlined what had happened and discussed the best management with the person on the other end.
‘Her colour looks better,’ Pete said, and Evanna nodded as she checked her pulse again.
‘Her breathing seems easier. We haven’t even had a chance to take details from you. What’s her surname?’
‘Winchester. Alison Winchester. I’m Peter. We’re staying at the Glenmore Arms. We only arrived yesterday.’
Evanna scribbled down the details and then checked the woman’s pulse again and gave a nod. ‘It’s ninety-five now. Better. I’m just going to clean the wound and splint that leg properly.’ She washed her hands, laid up a trolley and quickly cleaned and dressed the wound.
Logan replaced the phone. ‘The air ambulance will be here any minute and we’re going to transfer her to the mainland. They’re expecting her in the hospital. I’ll just write a quick letter so that they know what we’ve given.’
‘I feel better.’ Still pale, Alison lifted a hand to try and move the mask but Logan stopped her.
‘Keep that on for the time being. The drugs I’ve given you are obviously taking effect and that’s good, but we’re going to fly you to the hospital on the mainland just in case you need some more treatment.’
‘Will they keep me in?’
‘It’s likely, at least in the short term.’
‘Are you going to go with her?’ Evanna glanced out of the window as she heard the approaching helicopter.
‘I ought to.’ Logan’s eyes were on the computer screen as he quickly drafted the referral letter. Then he pressed the print key and turned to look at her, and she read his mind.
Kirsty.
‘I was just planning to have a quiet day so I’d be happy to have her,’ she said softly, and he let out a long breath and ran his hand over the back of his neck.
‘I feel guilty asking.’
‘Don’t. I love her, you know that. We’ll have fun.’ Evanna checked Alison’s blood pressure again. ‘That’s much better. You go and talk to them, Logan.’
‘Will I be able to go with her?’ Pete glanced between the two of them and Logan nodded.
‘That shouldn’t be a problem. Unless you’d rather take your car over on the ferry and drive. That way, you could pack a few things.’
‘Yes, do that.’ Alison shifted the mask slightly. ‘I need you to bring me my night things and my bag from the bathroom. And I left my jewellery in the drawer by the bed. Better bring that, too.’
Evanna helped them transfer Alison to the helicopter and then went to check Kirsty.
‘You might have warned me that she likes to pull hair. I’ve taught her to drive.’ Jim grinned and Kirsty laughed with delight and held out her arms for a cuddle from Evanna.
‘You and I are having a girls’ day at home, Kirsty.’ Evanna slid into the car. ‘Jim, do you mind giving Pete a lift back to the Glenmore Arms? He’s going to pack a few things, pick up the car and take the ferry to the mainland to be with his wife in hospital.’
‘No problem. I’m due at work in half an hour anyway. Do you want to be dropped home?’
Evanna thought of all the preparation she’d planned to do on her bathroom and then dismissed it as unimportant. She could do it later. Her head ached and she didn’t want to think about how tired she was. ‘No, I’ll spend the day here at Logan’s. All Kirsty’s toys are here. It will be easier to keep her occupied.’
It was mid-afternoon by the time Logan arrived home and Evanna and Kirsty were in the middle of an extremely messy painting session in the kitchen. She’d opened the sliding doors that led to the garden and a breeze cooled the stifling air.
‘You put your hand flat, like that,’ Evanna was saying as she planted Kirsty’s hand in the middle of the paper and rocked it from side to side. ‘Great!’
Logan stood in the doorway and watched. He loved the fact that Evanna wasn’t bothered about the mess. She’d spread newspaper over the kitchen floor to protect it and then squeezed paint into saucers so that Kirsty could use her hands and feet, and Kirsty was bright-eyed with excitement. ‘Whatever happened to reading a book or dressing a doll? I can’t leave you two alone for a moment.’
Evanna glanced up, saw him there and scrambled to her feet, her cheeks flushed. She was still wearing the shorts and T-shirt that she’d been running in that morning, but she’d removed her trainers and her feet were bare. ‘You know she loves painting. It’s her favourite thing and I can’t bring myself to say no. I’ve used plenty of newspaper so I’m hoping you won’t be needing a new kitchen.’
‘You spoil her,’ Logan said softly, dropping his bag onto the nearest chair and removing his jacket. ‘Amy used to hate doing anything messy because it meant clearing up, and she was always worried that Kirsty would splatter her with paint.’
‘Well, I’m in my ancient running gear and I don’t mind clearing up.’ Evanna carefully lifted the paintings and put them outside on the table to dry in the sun, anchored by jam jars. ‘How did it go with Alison?’
‘I think they might give her antivenin. I’ve left her in their hands. She’s in quite a bit of pain but her pulse and blood pressure have stabilised and her breathing has settled down. Hopefully she’ll be all right now but they’re going to keep her in for a bit just to check on her. Everyone is crowded around her, of course, because it’s such an unusual thing to see.’
‘I couldn’t believe it was really a snake bite. I mean—’ Kirsty was still planting her chubby little hands in the paint and Evanna stooped to adjust the newspaper on the floor ‘—we see a variety of accidents and illnesses on this island, but that was a first.’
‘It’s pretty rare.’ Logan pulled open the fridge and removed a bottle of chilled water. ‘And not often fatal in humans, although there are reports of severe allergic reactions and I thought Alison might have been one of those. Frustrating, actually, because you know I always carry adrenaline with me in the summer, ever since that wasp episode a few years ago. But Kirsty and I had only left the house for a quiet stroll so I didn’t think of it. I had a nasty moment back there.’
‘It didn’t show. I think the fact that you were so incredibly calm helped to reassure Alison. Have you finished, sweetheart? That’s a lovely painting. Clever girl.’ Evanna lifted Kirsty
, unconcerned about the volume of paint that was now attached to the child. ‘I’m usually quite confident with emergencies, but not that one. I didn’t want to speak in case I looked like a complete idiot. I had to stop myself from asking you stupid questions about first aid. I’m sure I read somewhere that you’re meant to suck the venom out or something. Or cut the leg and let the blood flow.’
Logan drank the water straight from the bottle and then lowered his arm and smiled at her. ‘You’ve been watching too much TV.’
‘Actually, I never get to watch TV because I’m always working,’ Evanna said with a pointed look. ‘But there’s so much myth and you hardly get copious amounts of experience in this country.’
She was so generous with Kirsty, Logan thought as he watched her. So patient. ‘Well, these days more and more people keep dangerous snakes as pets and there’s still some argument over best management and it does actually depend on the type of snake. But there is a body of medical evidence now and sucking and slashing isn’t generally recommended.’ Logan lifted the bottle and drank again. ‘If you want to know about snake bites, Ethan is your man. He dealt with a few when he was working in Africa.’
Still holding Kirsty, Evanna glanced towards him. ‘Really? I don’t know how I feel about snakes. Sort of repelled and fascinated at the same time. I think if I’d met an adder on the path, I might have frozen with fright. I’m not surprised Alison felt a bit freaked out. Ugh.’ She gave a shudder and Logan smiled, trying to imagine steady, practical Evanna freaking out about anything.
‘It probably would have run away long before you saw it. To be honest, adders aren’t generally a problem. They’re shy.’
‘But not this time.’
‘She must have surprised it.’
‘Well, she was lucky you were there.’ Evanna wiped the worse of the paint from Kirsty’s hands with kitchen roll and dropped it into the bin.