LITMIR.BIZ

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She started medical school with me but she hated it. Too much pressure.’

      ‘You must be quite different.’

      ‘Personality-wise, definitely. To look at, no. We’re identical.’

      ‘Wow! Do you have, like, that twin thing?’

      ‘Which “twin thing” is that?’ They were near the central desk now. Ryan had disappeared, presumably into the only cubicle with a drawn curtain. The nurse on triage duty, Wayne, was sitting, drumming his fingers on the counter.

      ‘You know, when one twin sprains her ankle, say, here in Auckland and the other twin falls over in a supermarket in central London.’

      Hannah laughed, dismissing the suggestion with a shake of her sleek head. But was it so ridiculous? Was it just that she was missing a sister who had always also been her best friend or did those niggling doubts about how happy Susie was have a basis in some form of telepathic communication? Was the urge to travel thousands of miles at a very inconvenient time to attend the wedding of two people she only knew through Susie’s emails just an excuse?

      ‘Apparently this wedding is going to be great fun.’ Hannah tried to find a more rational explanation for the urge she hadn’t been able to resist. ‘The groom, Mike, is Greek and his parents own a boutique hotel right in the cove. Susie reckons it’ll be the biggest party the Creek has ever seen.’

      Jennifer’s peal of laughter made several heads turn.

      ‘What’s so funny?’ Hannah’s eye was caught by the light on the radio receiver that linked the department with the ambulance service. It was blinking.

      Jennifer could hardly get the words out clearly. ‘You’re going to My Big Fat Creek Wedding!’

      Grinning, Hannah still managed to beat Wayne to the microphone. ‘Emergency Department.’

      ‘Auckland four eight here. How do you receive?’

      ‘Loud and clear,’ Hannah responded, her grin fading rapidly. ‘Go ahead.’

      ‘We’re coming to you from the scene of a high-speed multiple MVA. The chopper’s just landing to collect a second seriously injured patient who’s currently trapped, but we’re coming to you with a status-one seven-year-old boy.’

      The grin had long gone. Status one was as serious as it could get. Under CPR, not breathing or uncontrollable haemorrhage were all possibilities for the priority designation. This ambulance would be coming towards the hospital under lights and sirens.

      ‘Injuries?’

      ‘Head and facial trauma. Partially unrestrained front-seat passenger—the safety belt wasn’t latched securely.’

      This wasn’t the time to feel angry at someone failing to strap a child into a car seat properly. Or to wonder why they were travelling at 2 a.m. in the first place.

      ‘Vital signs?’

      ‘GCS of 3.’

      The child was profoundly unconscious. Quite possibly due to bleeding around his brain.

      ‘Airway?’

      ‘Unsecured.’ The paramedic raised his voice as the siren came on in the background. The vehicle must be in heavier traffic now. At night, just having the beacons flashing could be enough warning of the urgency of their mission. ‘There’s severe facial trauma and swelling. We’ve got an OP airway in but that’s all.’

      The boy needed intubation. Securing an airway and optimising oxygen levels were a priority in a head injury. Especially in a child because they had a greater chance of neurological recovery than an adult after a head injury and therefore warranted aggressive treatment in the early stages. If the paramedics had been unable to intubate due to the level of trauma, it could mean that this was going to be a challenging case.

      Hannah could feel her adrenaline levels rising and the tension was spreading. Nearby staff were all listening avidly and the curtain on cubicle 4 flicked back to reveal that Ryan was also aware of what was happening. Hannah’s heightened awareness registered the interest and at some subconscious level something like satisfaction was added to the emotional mix. She was taking this call.

      This would be her case, not Ryan’s. Just the kind of case she needed to showcase the skills that would be a major consideration in choosing the new consultant for the department.

      ‘What’s the oxygen saturation level?’ she queried briskly.

      ‘Ninety-four percent.’

      Too low. ‘Blood pressure?’

      ‘One-thirty over sixty-five. Up from one-twenty five minutes ago.’

      Too high for a seven-year-old. And rising. It could well be a sign of increasing intracranial pressure.

      ‘Heart rate?’

      ‘One hundred. Down from about one-thirty.’

      Too slow for Hannah’s peace of mind. And dropping. It could also be a worrying sign. ‘What’s your ETA?’

      ‘Approximately five minutes.’

      ‘We’ll be ready for you.’ Casting a glance over her shoulder, Hannah could see Ryan moving towards the resuscitation area she and Jennifer had just checked. Not that she was about to decline any assistance for dealing with the incoming case but she didn’t want Ryan taking over. It wasn’t as though there was only one victim arriving, was it? She pushed the button on the microphone again.

      ‘Do you know the ETA for the chopper?’

      ‘Negative. Fire service is on scene, though.’

      It shouldn’t take them long to cut the second victim clear of the wreckage, then. ‘And that’s also a status-one patient?’

      ‘Affirmative. Chest trauma. It’s the mother of our patient.’

      Ryan would be able to lead the team on that case. In resus 2. Or they could share the main trauma room if necessary. Hannah’s plan of action was forming rapidly as she replaced the microphone.

      ‘Put out a call for an anaesthetist, please, Wayne,’ she directed. ‘And let’s get a neurosurgical consult down here. Sounds like we might need someone from Plastics, too. Jenny, you’re on the trauma team tonight, aren’t you?’

      ‘Yes.’

      ‘And you, Wayne?’

      ‘Yes. Resus 1?’

      Hannah nodded, already moving towards the area. She pulled one of the protective plastic aprons from the large box on the wall. Ryan was already tying his behind his back.

      ‘Could be a tricky airway management,’ he said.

      ‘Mmm. I’ve called for some anaesthetic back-up but I’ll see how I go.’ The direct look Hannah gave Ryan could leave him in no doubt that she intended to lead this resuscitation effort. The subtle twitch of an eyebrow let her know the message had been received and understood. It also hinted at amusement rather than intimidation.

      ‘I’ll stay until the mother gets here,’ he said calmly. ‘In case you need a hand.’

      ‘Thanks.’ The acknowledgement was perfectly sincere. There was a child’s life at stake here and Hannah would never let any personal considerations affect her performance. She would stand back in a flash if she thought Ryan’s skills would improve the management. Never mind that he would get the credit for managing a difficult case.

      It was just annoying that people that mattered were keeping a count of those credits at present. And disappointing that a competitive edge of any kind had crept into Hannah’s working environment when one of the things she loved best about her work was the way a team of people could work together and the only kudos that really mattered was a successful outcome to that work.

      The decision on the consultant’s position

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