Josie Metcalfe is joining us today with an excerpt – if you missed Josie’s blog last week you can find it here and ‘Forgotten Pain’ is available now from Amazon. Welcome again Josie, and over to you…
I know personally that not all injuries and disabilities are immediately visible and that sufferers will often find ways to hide their problems when they have no other options. If they’re lucky they’ll find someone like Sally with the intuition to recognise that hidden pain, no matter how fraught the circumstances.
In spite of her best intentions, Sally had just been dropping off to sleep in the corner of her big squashy armchair when the phone rang, jerking her back to full wakefulness.
‘Doctor Webster?’ the voice in her ear seemed to reach her from a long way away.
‘Yes. I’m sorry,’ she blinked rapidly and shook her head to clear away the cobwebs of sleep. ‘Dr Webster here. What is it?’
‘Accident at the gravel pits out at Abbey Meads,’ the woman said tersely.
‘How many involved and what’s the nearest access?’ Sally’s feet hit the floor and she bent forward to search around with her free hand to find the trainers she’d kicked off when she’d sat down to have a much delayed lunch. She forced her feet into them hurriedly as she stood up, belatedly reaching out for her bag.
‘Two mountain bikers racing downhill. Came off a ledge. Probable spinal injuries. You’ll have to go out past Priory Park towards open countryside. I’ll give you an accurate GPS as soon as I get it but there’s a turning on the left signposted Abbey Meads and a track almost immediately on the right taking you towards the gravel pits.’
‘Emergency services alerted?’ The surge of adrenaline meant she was firing on all cylinders now, her brain clear, her pulse rate elevated and her whole body ready to race into action.
‘Ambulance already on their way with a paramedic on board,’ the calm voice confirmed, ‘but they have to come across town. You’re closest.’
‘On my way,’ Sally dropped the phone into her pocket, swung her pack up on one shoulder and took off across a room cluttered with half-unpacked boxes, barely slowing her stride as she grabbed her jacket off the convenient hook beside the door the fluorescent word ‘doctor’ emblazoned across the back.
She reached back to grasp the handle to pull it shut but paused for the rapid scrabble of claws on the polished wooden floor as an eager canine nose followed her out onto the step.
‘Come on, then, girl,’ she invited, just missing the long-plumed tail as the catch clicked shut.
Within seconds she was turning the key in the ignition, her free hand reaching for her seat belt. ‘Down, Amber,’ she ordered, and her companion subsided obediently into the footwell on the passenger’s side.
She glanced at the map that had automatically displayed on her sat nav to confirm that she was going to be taking the most direct route and set the vehicle in motion, a flick of a newly-installed switch on the dashboard activating the flashing blue light on the roof. This was her first call-out since she’d joined the group practice at Abbey surgery and she needed to do well; she needed to prove that she’d made the right decision in coming here, if only to herself…
The GPS directions came through seconds later, before she’d even exited the driveway, and she was soon heading well away from the town through all-but deserted lanes before the automated voice sent her bumping along a rough track leading around the edge of the abandoned quarry, grateful for the superb suspension of the car provided by the practice.
‘Come on. Come on. Where are they, then?’ she muttered, the chilly wind tugging at loose strands of hair through the half-open window as she pushed her speed as hard as she dared over the unfamiliar terrain.
‘Shoot!’ She braked and swerved as a young man leapt out of no-where, his arms flailing like windmills.
Her tyres slithered to a stop on the loose gravel and she thrust her head out of the window, barely waiting for it to open fully.
‘What on earth do you think you’re…’
‘Down there!’ the youth broke in, pointing frantically at a faint track she’d almost missed. ‘They’re down there. Hurry!’ He whirled away from her and disappeared over the lip of the quarry as quickly as he’d appeared.
‘Right,’ Sally turned the wheel and moved forward gingerly until she could see the state of the track then increased her speed when she found it was an old access route to the floor of the quarry, wending its potholed way down the side.
By the time she reached the bottom she’d spotted the small knot of people grouped round the victims, the buckled remains of their brightly coloured bikes mute testimony to the event.
‘Stay!’ she ordered as she flung herself out of the vehicle, grabbed the smallest pack off the back seat, hooked it over one shoulder and took off at a run.
By the time she reached the injured boys, both of them were conscious but one was lying very pale and still, his shattered crash helmet evidence of the severity of the accident.
‘There’s an ambulance coming,’ she announced. ‘Can someone run to the top to direct them down here, please?’ then she knelt down on the gravel-strewn quarry floor shifting awkwardly as the cold dampness and small sharp stones cut through the sturdy denim covering her knees.
As she cast a rapid eye over the more seriously injured of the two she realised that she would need help with his care. The lower part of his face and neck had taken part of the force of his fall and she would need another pair of expert hands to stabilise his head while she put a cervical collar on him and maintained his breathing.
At least his pulse and respiration were within reasonable bounds, considering the state he was in.
The distant sound of a siren was drawing rapidly closer as she turned towards the second victim, hoping to have him ready to move by the time assistance arrived for his friend.
‘What’s your name?’ she looked up at the carroty-haired gangly youth hovering over her.
‘Andy,’ his voice wavered between tenor and soprano and his cheeks flamed with embarrassment.
‘Right, Andy,’ later she’d have time to smile at his adolescent trauma, but for now… ‘I’m going to need your help.’ Immediately, his shoulders straightened importantly. ‘Take one of your friends and bring out the two zipped bags behind the driver’s seat. Carry them carefully…’
He’d grabbed a husky dark haired lad by the elbow and they were sprinting towards her car almost before she’d finished speaking.
As they opened the door of the vehicle there was a low warning growl from Amber.
‘It’s all right, girl,’ Sally called, barely looking up from her task. She hardly had time to confirm her diagnosis of a broken leg before the two of them returned and she opened the bags to select the equipment she’d need.
A shadow fell over her as the surrounding group of lads pushed forward and she looked up at them. The concern they felt for their friends was so clear on their faces that it prevented her from snapping at them to stand further back.
‘Has any of you done any first aid?’ Most of them shook their heads as she glanced round at them but two raised their hands as if answering a question in school.
‘Right,’ she continued, her voice decisive. ‘The ambulance is on its way and we need to get your friends ready to go to hospital. This young man,’ she put her hand on his arm…
‘That’s Jimmy,’ Andy volunteered quickly.
‘Thank you,’ she nodded, ‘Jimmy has broken his leg. He needs to have both his legs splinted together…’
‘I can do that,’ one of the lads who’d raised his hand broke in eagerly. ‘We had that in our test.’
‘Good,’ Sally praised. ‘Take it slowly. Move him as little as possible. Ask me if you need help.’ She turned towards the second still form beside her, steadying herself with a mental reminder to check A, B and C again. She could hear her long-ago instructor drumming it into them. ‘Airway, breathing and circulation…’
‘What’s wrong with Wayne?’ Andy demanded.
‘He’s hurt his face and I think he’s hurt his back,’ she said quietly as she leant over him and carefully took hold of one hand.
‘Wayne?’ her voice was soft but carried clearly in the still air. ‘Can you hear me?’
‘…ss…’ she heard and tightened her hand gently.
‘Good,’ she encouraged. ‘Keep very still but can you squeeze my fingers?’ She waited for a response while she noted down the figures for his respiration and pulse and was rewarded by a deliberate pressure. ‘Well done. What about the other one?’
She was just taping the IV line to the back of his hand when her concentration was broken by the hurried arrival of two large pairs of feet topped by dark navy trousers at the edge of her vision.
‘Where do you want us, Doc?’ one voice panted as he lowered the stretcher he was carrying to the ground. ‘We had to leave the vehicle up on top.’
She looked across at the blond owner of the cheerful voice, his eyes as blue as the shirt of his uniform showing between the edges of his brightly flashed jacket.
It took very few words to direct him towards loading Jimmy and carrying him back up the hill with the willing assistance of his friends but before Sally had time to turn her attention back to Waynethe second paramedic knelt down swiftly on the opposite side.
‘He needs a neck brace,’ the deep voice was accompanied by a searing gaze from tawny eyes and for just a moment Sally was unable to look away. His breathing seemed unaffected by his rapid descent to the quarry floor, the only sign of his exertion the rumpled state of his dark hair.
When he looked back down at the young man between them on the ground she was left with a strange feeling of breathlessness before his forceful words finally sank in.
‘Of course…’ she began speaking, then stopped. There was no point telling him that she fully intended to protect young Wayne’s neck because he’d already taken a cervical collar out of his kit and was preparing to position it.
‘Hold his head without touching his jaw,’ he instructed, his deep voice curt as he concentrated on his task. ‘He’s bleeding from his nose so we can’t do a blind nasotracheal intubation and he’s partially conscious so we can’t do an œsophogeal…’
Sally subdued the momentary surge of resentment at his high-handedness with the silent reminder that it was the patient who mattered, not her pride.
A little imp of mischief had her watching his technique critically, but his procedure was faultless, as was his management of the boy’s transferral to the scoop.
‘When we’ve got him strapped down, we’ll load him into your vehicle,’ he said decisively, barely glancing in her direction as his hands moved competently about their business. ‘It’ll save time carrying him up the quarry track and your four-wheel-drive will smooth out some of the bumps.’
By now Sally was gritting her teeth but there was little she could do in front of their avid audience. But, she promised herself, once their patient was safely delivered…
The stretcher was locked securely in position behind the driver’s seat in the specially adapted vehicle and Sally was stowing her bags underneath it when there was a warning growl from Amber.
Glancing over the head restraint of the front passenger seat she was treated to the unusual sight of her one-woman dog sniffing at a lean male hand and she straightened up in time to see his head disappear into the vehicle.
‘What do you think you’re doing?’ she snapped as she wrenched her own door open, resenting this further evidence of his intrusion into her territory, both physical and professional. ‘Travelling with you to monitor the patient – unless you intend me to do it while I run along behind.’ Sarcasm filled his voice as he swung his long legs round and tucked his feet carefully beside Amber, his reassuring words to the dog spoken in a totally different tone to the one he’d used with her.
‘Of course,’ Sally muttered under her breath and bit the inside of her lip as colour surged up her face at her own stupidity. What on earth was it about this man that seemed to rub her up the wrong way?
Admittedly, her recent heartbreak meant that she was less than happy with the male half of the human race at the moment, but she’d managed to keep her antipathy under control in a work situation until she’d met him – or was there another reason for the sparks flying between them?
The journey up the winding track called for all her attention, the gravel loosened by a recent winter of rain and storms causing the wheels to spit stones in all directions as she guided the vehicle steadily upwards.
From the corner of her eye she was conscious of her passenger turning towards her and tensed, expecting him to make the same sort of chauvinistic comment most men made about women drivers. When he remained silent she glanced across quickly to find that instead of watching her driving, he’d reached one hand back to offer silent reassurance to their patient.
They lurched their way to the top of the quarry to find that the ambulance had already left for the hospital and it wasn’t long before Sally had reached the metalled road and was pointing the vehicle back towards the town.
Beside her, the silent paramedic was one-handedly noting his findings on the checklist clipped to his board, his pen moving swiftly to fill in the columns of sequential observations. Once they reached the hospital, the duplicate copy would be handed over with the patient to form the start of his case notes.
The sharp command broke into her concentration and she automatically put her foot hard on the brake.
‘What…? Why?’ but her words were spoken to his back as he flung himself out of the vehicle and wrenched the back door open.
By the time Sally reached him he was crouched over Wayne’s unconscious body probing the base of his throat, a fresh pair of gloves covering his long-fingered hands.
‘What…?’ Sally began.
‘Apnoea,’ his voice was distracted for a moment as he concentrated on what he was doing, giving Sally time to register that Wayne had stopped breathing. ‘Either his larynx has swollen or the rough track has shifted something to press on his trachea…’ he paused to reach into the opening of one of her bags and withdrew a familiar instrument.
The blade was exposed and the incision performed in less time than it took to blink and he was inserting the tracheostomy tube in the neat hole he’d made into Wayne’s trachea before the significance of what he’d done dawned on her.
‘Dammit, you’re a paramedic,’ she snapped. ‘You’re not allowed to do a cricothyrotomy.’
There was a frozen second before his eyes snapped up to meet hers, blazing.
‘He’s alive, isn’t he?’ he looked back down to tape the tube into position and dispose of the used scalpel blade.
‘That’s not the point,’ Sally argued. ‘Paramedics aren’t allowed to do that. What you did was illegal without certification.’
‘But essential,’ he broke in, his voice hard, ‘like getting him to hospital, preferably without brain damage due to oxygen starvation.’ Pointedly, he looked back down at Wayne, his hands moving surely over him as he checked his vital signs again.
Her teeth gritted angrily together, Sally backed out of the vehicle and climbed behind the wheel, reaching across to pull the passenger door shut before she put the engine into gear. In her rear-view mirror she could see him change position so that he could travel safely beside their patient for the rest of the journey.
Sally had activated the siren and flashing lights as soon as they’d encountered the start of the town traffic, the ululating sound only slightly muted when she closed her window up tight as she radioed their position through.
They had nearly reached the hospital when the thought that had been going round and round in her brain surfaced – the life-saving manoeuvre he’d done had been text-book perfect and he’d performed it as if it was second nature to him.
‘Where were you taught to do a cricothyrotomy?’ the words emerged unannounced into the intimate space of the vehicle, clearly audible in spite of the noise of the siren.
Her eyes flicked up to the mirror and caught the fleeting reflection of a bitter expression on his face before it was wiped smooth.
‘I watch a lot of television.’ His deep voice was as mocking as the twist to his mouth but there was no time for Sally to challenge him as she drew up outside the hospital emergency entrance.