He shook his head, his eyes staying on the monitor to read blood results. ‘No. Caroline thought that as it’s your first day back you could do with some support.’
He said it bluntly, though Caroline, she suspected, wouldn’t have wanted her to know this. In truth, she’d probably told Nathan to find a plausible reason for staying the extra hours. He could have said it was Friday night, the place was heaving and he could spare the time. But Nathan Bell didn’t do deception well. He was blunt and he was truthful.
She was about to tell him there was no need to stay when a high-pitched screech from the transceiver blasted the air.
‘I’m right behind you,’ he said. ‘Just give me two minutes.’
Fiona Woods was at the control base with the transceiver in one hand and a pen in the other as she prepared to take down the details from the paramedic. Her colleagues around her were hushed so that she could hear her caller more clearly, and some of the patients and visitors stopped in their tracks so that they, too, could listen in.
‘Emergency department receiving,’ Fiona said calmly and clearly. Her new hairstyle looked torturous; in a French braid too tightly woven, it pulled the skin at her temples. Her naturally frizzy hair was something she constantly battled with, and Alex could bet she’d have a headache at the end of the shift with this new attempt.
‘We have a young female, unresponsive at the scene. Glasgow Coma Score, now 12. Systolic pressure 85. Heart rate 110. Resps 26. Sats 99 per cent. She has a bleed through her jeans, either rectal or vaginal. Over.’
Fiona pressed the transmit button. ‘Do we know if she’s pregnant? Over.’
‘Undetermined. We have verbal response, but incoherent. We have no status on history. Over.’
‘What’s your ETA? Over.’
‘Four minutes. We’re in the hospital grounds. She made it this far.’
‘Thank you crew 534. Emergency department standing by.’
Alex headed straight to ‘resus’, with Fiona on her tail. As they entered the resuscitation area, Fiona briefed the nurses on what was coming in. Alex was glad she was on duty; Fiona was a brilliant practitioner and, after seven years in this area of nursing, there was very little she didn’t know about emergency medicine. Alex automatically gloved up, donned a green plastic apron and went into bay 2 to check the equipment. It was the nearest bay for an ambulance crew and consequently the most used. Therefore it was essential that before and after each patient the stock was checked.
On the wall behind the patient trolley there was a board holding equipment. At a glance she saw everything was in place, but she went through each item anyway. She did the checks in less than a minute and then moved on to other equipment: oxygen supply and resuscitator bag, used to assist ventilation, with a snugly fitted facemask. She pressed buttons and flipped switches, and cardiac monitor screens lit up with alarms beeping as they searched for a source.
Over at the divider unit, which separated the bays, Nathan was pulling out syringes and placing them on the counter; some he filled with saline, others he kept ready for drawing blood. Fiona Woods and another nurse hung two one-litre bags of warmed fluids. On a priority 2 alert, X-ray and path lab were standing by. It was all in the preparation. Be ready, be waiting, and be prepared for the unexpected.
*
Her blood had seeped through the white blanket, turning a large patch a deep red. It had dripped down the side of the trolley, onto the wheels, and was now wetting the floor. Her face was a stark white beneath the oxygen mask. Her eyelids were flickering and she was making small murmuring cries. In the few minutes it had taken for them to get her here she had seriously deteriorated. She was bleeding out with every passing second.
Even while they were positioning her, Nathan Bell had hold of her left arm, had a tourniquet in place and was inserting a needle. The fluid was attached and a pressure bag put round the litre of fluid to rush it through faster.
‘Have we any history at all? A trauma? Anything?’ Alex asked quickly, while casting her eyes over the woman’s body for immediate assessments. The blood loss was great, and the ashen face and white fingers were alarming.
‘It was a 999 call,’ the paramedic replied. ‘She was found just inside the hospital grounds, clearly trying to find help. The couple who found her said she was groaning and then she slumped on them. Unresponsive initially with us, and then in the back of the ambulance we’ve had a few moaning sounds.’
‘Do we have a name?’
‘Haven’t checked pockets. She didn’t have a bag with her, but there might be something in her jacket.’
The woman was making sounds from the back of her throat, a deep humming, and Alex didn’t like it. It was too internal, and her Glasgow Coma Score, the tool for evaluating neurological function and patient’s level of consciousness, was dropping.
Fiona Woods pulled out her shears as the other nurse removed the blood-soaked blanket. The woman’s blue jeans were drenched at the groin and down to as far as the knees, and more blood was being soaked up by her pale green shirt.
With ease, Fiona cut away the clothing. ‘She’s flooding,’ she said urgently. ‘I’m not going to get a catheter in here. And there’re clots in her pants.’
Alex moved away from the head end of the trolley and inspected the find. Dark congealed blood was mixed with tendrils of white. ‘It looks like foetal matter. Put it in a kidney bowl. Put the trauma call out and state urgent need for obs and gynae.’ The call would also bring other doctors – an anaesthetist and a general surgeon. ‘We have a Class III moving rapidly to Class IV blood loss. I want more people in here now.’
Over the next twenty minutes fluids and blood were pumped into the young woman, and theatre was standing by. The urgently summoned help had arrived, and in a controlled rush of precise activity, everything possible was done to stabilise and to facilitate aggressive treatment.
The anaesthetist was preparing to put the woman to sleep. Every person attending the scene was tense with the need to get the woman out of A & E quickly so that the bleeding could be explored, vessels clamped, whatever was causing it stopped.
Alex was standing to one side at the head of the trolley getting the respiratory ventilator ready when she saw the woman’s lips moving beneath the oxygen mask. She leaned close to her patient’s face and, over the hiss of oxygen, she spoke calmly, using similar words to the ones that Caroline had used with her. ‘Hello, sweetheart. My name is Alex and I’m a doctor. You’re in hospital and you’re safe. I’m going to help you now. Can you tell me your name?’