LITMIR.BIZ

      Chapter Two

      TUESDAY went without incident in Minors, but on Wednesday Louisa was called in to help in Resus.

      ‘Essie tells me you’re very experienced, so I’d like you to work with me, please, Nurse Practitioner Austin,’ Dominic said.

      She noticed again that he’d addressed her by her title rather than by her name. Was he just being like that with her because she was new, or was he like that with everyone? Then she remembered that Essie had called him by his first name. Better get things straight now, then. ‘OK, but can we spend thirty seconds now to save us a lot of time when our patients arrive?’ she asked.

      He frowned. ‘How do you mean?’

      ‘It goes without saying that I respect your seniority, but I’m used to working on first-name terms. It’s quicker, easier, and less of a mouthful. Would you mind?’

      He blinked. ‘OK, Nu—Louisa.’

      ‘Thank you, Dominic.’ She used his name deliberately. ‘So what’s happened?’

      ‘Car crash. Three casualties,’ Dominic explained. ‘Both drivers are coming in with suspected whiplash, and the passenger has suspected multiple fractures. Ronnie and Sasha are going to treat the drivers, and I need you with me as lead nurse to treat the passenger—Sally will assist us.’

      She nodded. ‘How long have we got to prepare?’

      ‘Five minutes. I’m going down to the ambulance bay now.’

      She busied herself getting the trolley ready; when Dominic came back with the paramedic and their patient, the team swung into action.

      ‘Rhiannon, this is my team, Louisa and Sally,’ Dominic said calmly. ‘They’re going to help me look after you.’

      ‘Hurts,’ Rhiannon mumbled. ‘Where’s Gary?’

      ‘Your husband’s right here,’ he reassured her. ‘Ronnie’s looking after him, and as soon as she’s checked him over and made him comfortable, he’ll be able to come and see you. And we’re going to give something to help with the pain,’ he said. ‘I’m going to put an oxygen mask on you to help you breathe better, and then we’re going to have a proper look at you, OK?’

      On Dominic’s direction, Sally gently cut through Rhiannon’s clothes so he could do a full body assessment, top to toe. Meanwhile, Louisa hooked Rhiannon up to a cardiac monitor, put in a second line and started taking obs.

      ‘Heart rate 135, respirations twenty-six, blood pressure 82/54,’ she said. Tachycardia and low blood pressure pointed to major loss of blood—probably caused by internal injuries, Louisa thought.

      ‘We need to get some fluids in. Start with a litre of Hartmann’s, and get six units cross-matched for me,’ Dominic said—and looked approving when he saw that she already had the saline solution in her hand.

      Dominic had given Rhiannon painkillers to make her more comfortable; but when her blood pressure didn’t respond to the fluids and her sats started dropping, he glanced at Louisa. ‘Can you do ABGs for me, please, Louisa? And, Sally, I need X-rays.’ He listened to Rhiannon’s chest.

      From the bruising on Rhiannon’s skin, it looked as if she had several broken ribs. No doubt Dominic wanted to check for pulmonary contusions. There were a lot of problems that could be caused by blunt trauma at high velocity, Louisa knew; with damage in Rhiannon’s chest area, there could be trauma to the heart as well as the lungs.

      ‘I think we need to intubate.’ He held Rhiannon’s hand as he explained to her what they were doing. ‘You’re struggling to breathe, sweetheart, so we need to help you with that and make sure you get enough oxygen. I’m going to put a tube down your throat so you won’t be able to speak, but I’m going to give you some medication first so you won’t feel it and it won’t hurt—it’ll make you more comfortable. I know you’re feeling tired and it’s hard to talk, so just squeeze my hand if you’re OK with that—once for yes and twice for no.’ He paused. ‘That’s a yes—that’s my girl. We’ll get you comfortable as soon as we can.’

      Louisa was just drawing up the ampoules of anaesthetic when one of the drivers who’d been brought in came over to them, his face ashen. ‘Oh, my God, Rhi! I’m so sorry. I couldn’t avoid him—he just pulled out on me and there was nothing I could do.’ He looked distraught as he stared wildly at Dominic and Louisa. ‘I can’t believe I’ve come out with just bruises, and Rhi’s so…so…’ His voice caught.

      ‘Gary, isn’t it?’ Dominic said, somehow managing to divide his attention and eye contact between his patient and her husband.

      ‘Yes.’

      ‘She was asking for you.’

      ‘Can I hold her hand?’ At Dominic’s brief nod, Gary curled his fingers round his wife. ‘Honey, I’m here, and I love you, and I’m so sorry.’ He dragged in a breath and looked pleadingly at Dominic. ‘Is she going to die?’

      ‘Not on my shift,’ Dominic said, ‘though it might be easier on you if you wait outside. There’s a vending machine just round the corner. I promise we’ll come and find you as soon as we’ve got her stable and let you know what’s going on, but for now we need to concentrate on Rhiannon here and treat her.’

      Gary shook his head. ‘No. I need to stay with her.’

      ‘Unless you’re a trained medic, it can look very worrying in here,’ Dominic said gently. ‘Especially as we’re just about to intubate her to help her breathe. Trust me, we’re going to do everything we can for your wife, but it will be much better on your nerves if you go and get yourself a hot drink and leave us to it for the next few minutes.’

      ‘I’ll come and get you as soon as there’s any news,’ Louisa promised. But she noticed that Gary was staring at his wife, looking stunned. In shock, she thought—not the medical kind, but the emotional kind. They needed to get him out of here. ‘Do I have two minutes, Dominic, to show Gary where everything is?’

      ‘Two minutes,’ Dominic confirmed; the expression in his eyes told Louisa that he knew exactly what she was doing and approved. Which was a huge relief: he was much easier to work with than she’d expected. And he was sensitive with patients and relatives. Maybe she’d just caught him on a bad day on Monday.

      ‘Come on, I’ll show you where the drinks machine is,’ Louisa said, slipping her arm through Gary’s and guiding him out of Resus.

      ‘I was coming down the hill. I wasn’t speeding. I could see the other car approaching the junction, but he wasn’t even indicating! And then he just pulled out in front of me. It was as if it all happened in slow motion. I could see

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