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Now was not the time to learn!

      ‘Pulse one-twenty, thready, blood pressure seventy over thirty and falling.’

      ‘Damn. Let’s get some IV lines in and fill him up a bit. Is the X-ray coming?’

      The door opened then and the radiographer came in. They worked round her, Ginny refusing to step back and continuing to put in the IV line into his left arm while the pictures were taken.

      ‘You shouldn’t do that—you’re a young woman,’ the radiographer scolded gently.

      ‘Don’t worry about me, I’m fine,’ Ginny said shortly, withdrawing some of the precious blood for cross matching. ‘Can we have the chest results quickly, please?’

      ‘Sure.’

      They were left in peace then, squeezing the plasma expander in fairly rapidly to bulk up his blood volume while they waited for cross-matching. His blood pressure picked up a little, and they inserted another line into his damaged right arm.

      ‘I don’t want to use his legs because of the femur injury and possible internals,’ she said to Ryan, ‘and the neck I want to avoid until we’re sure he hasn’t got a head injury, so is it OK to use this broken arm?’

      ‘You’ve got no choice,’ he told her absently. ‘That’s more like it. OK, aspirate, please; get the blood out of her trachea. Can you cope, Virginia?’

      ‘Yes, I think so.’

      ‘Get four units of blood into him stat—use O neg while you wait for cross-match. There should be some coming up.’

      There was, and she was glad to see it. Her patient’s pulse was very weak and thready, although they had boosted his blood volume, and she wondered how much he was losing into the thigh and how much through what she was beginning to be sure was a ruptured spleen.

      ‘Should we do a peritoneal lavage to see if he’s haemorrhaging?’ she asked Ryan.

      He shook his head. ‘No. Treat as if he is—there should be a general surgeon on his way down to check. If he’s not here in five minutes—or if the lad deteriorates—I’ll stick a needle in and see what we come up with. Better catheterise him anyway—he’s going to have to go to Theatre. Do we have any ID?’

      The sister lifted her head from the catheter she was already inserting. ‘Yes. The police are on it, apparently. They’re contacting relatives now.’

      A man came in then, tall and rangy, his white hair in sharp contrast to the bushy black brows beneath. ‘Query abdomen for me?’ he said in a soft Scottish burr.

      ‘Oh, hi, Ross. Yeah, Virginia’s got it. She’ll fill you in.’

      She met his eyes and smiled briefly. ‘Hi. I think his spleen might have gone. His ribs have penetrated his left lung low down, but he’s also got a possible head injury and his left femur and right wrist have gone.’

      Ross nodded. ‘OK. Can I have a trocar, please?’

      He scrubbed quickly while they prepared the abdomen for his incision, then Ginny watched as he carefully pushed the sharp instrument into the abdomen and pressed gently.

      Blood welled rapidly out of the little hole, far too much and too fast to be because of the incision.

      ‘Damn. Right, we’d better have him now. Have we got head and spinal X-rays?’

      ‘Just done.’ They were snapped up on the light box by the radiographer, and Ross scanned them quickly. ‘That looks OK. Right, we can assume his head injury is of secondary importance to his internal haemorrhaging. The spleen looks enlarged and the abdo contents are displaced—aye, I’m sure it’s gone. I’ll get the orthopaedic boys to sort his leg and arm out after I’ve finished with the spleen and chest. How stable is he?’

      ‘Not bad,’ Ginny replied. ‘I think he’s improving. He’s certainly not getting any worse, but his blood pressure’s still a bit low.’

      Ross nodded. ‘OK. Can you send him up as soon as he’s stable enough, please? I’ll go and scrub. How about this one?’

      Ryan grunted. ‘Smashed mandible, lacerated tongue—I’m just suturing it now to stop the bleeding. Apart from that and the coma and the leg fractures, she’s fine.’

      Ross snorted and left the room.

      Ginny’s patient’s parents arrived at that point, so he was covered with a blanket; Ginny warned them about the breathing tube and the chest drains and IV lines, and then they came in for a few moments.

      They were shocked and upset but, as Ryan said later, at least they knew he was still alive and recognisable, which was more than could be said for the girl who had been on the back of his bike. Her facial injuries were extensive and would require the intervention of a plastic surgeon—if she survived the head injury. Ryan thought her helmet must have been too big for her, as it had come off at the scene. Either that or it had been ripped off, thus damaging her jaw.

      The boy’s parents were distressed by her condition, as well as their son’s. It seemed they were going out together and had been for some time.

      ‘Do you know where the police might find her parents?’ Ryan asked them.

      ‘Possibly.’

      ‘Would you talk to them? Sister has some forms for you to sign first, then if you could talk to the police?’

      ‘Of course.’ With shaking hands they signed the consent form for surgical treatment of their son’s various injuries and, as Ginny was happy with his blood pressure and pulse, he went off to Theatre.

      Ryan’s patient, on the other hand, was still causing concern. The fragments of her fractured lower jaw had penetrated her mouth and tongue and were causing serious problems. Ryan had been unable to get an airway in and had had to do a tracheostomy to allow her to breathe because of the blood in her throat and her swollen tongue, but he had been able to suture the worst cut on the tongue to halt the outpouring of blood into the back of her throat that was threatening to drown her.

      Her parents hadn’t yet arrived, but she was at least stable now. Ginny went over to Ryan and asked if she could help.

      He grinned tiredly. ‘No, not really. You could finish off that patient you abandoned. I’ll be through here in a minute and she’ll be transferred to ITU. I’ll come with you if you hang on.’

      Ginny had quite forgotten the woman whose infected finger she had been about to lance. ‘It seems hours ago,’ she murmured.

      ‘Only half an hour.’

      He was still working. Ginny watched him as he checked the girl’s pupils again. ‘How’s her head injury?’

      ‘Not good. Her pupils are both equal and reacting, but she’s still very deep. She’s got multiple fractures in both legs and one arm, but all in all she’s got away with it lightly if the head injury isn’t anything too sinister. I think she was wrapped round a tree branch, from what I can gather. It may be just whiplash or it may be worse. She’s got a nasty cut on her leg as well. She’ll need a tetanus jab.’

      He did that as they talked, and Ginny was able to see the long, jagged cut up her thigh. ‘Are you going to stitch it?’ she asked.

      He looked horrified. ‘No. It’s dirty—we’ll pack it and leave it for a few days with antibiotics, then it can be sutured on the ward. If you close it now you trap all that road dirt in it and she’d get a nasty infected wound for sure.’

      Ginny suddenly felt the yawning void of her ignorance opening up under her feet. ‘Sorry,’ she mumbled.

      Ryan lifted his head and met her eyes over the patient, and grinned. ‘Don’t apologise. That’s why you’re working with me—to learn these things. You did really well with that lad, by the way. Well done.’

      His eyes glowed with appreciation, and Ginny felt as if the sun had

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