Consultant In Crisis. Alison Roberts
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consciousness.’
Obligingly, Owen made a gagging sound and his chin dropped to his chest.
‘Excellent!’ Kelly’s grin was broader this time. ‘What’s happening now?’
‘He’s snoring,’ Roger observed.
‘As usual,’ added Gerry.
‘He’s obstructed his airway,’ Jessica informed them.
‘And if he’s unconscious he won’t be able to correct it.’ Kelly nodded. ‘It could lead to a respiratory arrest and death, despite imminent rescue and non-life-threatening injuries. So—we get into the space. There’s no response. What do we do?’ Kelly pointed at Owen’s mouth. ‘We’d do a rapid finger sweep just to check that his false teeth haven’t fallen out and then…’ She took Owen’s chin with one hand and his forehead with the other and as she tilted his head back to open the airway the snoring sound stopped. ‘Now we can assess his breathing.’
Safety, level of consciousness, airway, breathing and circulation were covered within twenty minutes. Assessing the level of disability and exposing the chest and abdomen to assess injuries took another fifteen minutes. Kelly was relaxed now and enjoying herself. She teamed the non-medical members of the class with partners who could coach them when she directed a practice of the skills she had covered. Amidst the lack of confidence some people had to overcome and the humour that lightened the more serious aspects of the subject was a willingness to learn and a new respect for someone who had been one of the quieter members of the class up till now.
‘Kelly, my patient reckons he’s bleeding to death from a ruptured artery. Do I fix that before the airway?’
‘If he’s telling you he’s bleeding to death, his airway’s fine. You can’t talk if you’re not breathing. You’re onto circulation straight up in this case. Get some direct pressure onto the bleed.’ Kelly looked up to address everyone in the room.
‘Remember we’re trying to identify the life-threatening problems in order to deal with them quickly. Don’t move on to the next item on the agenda until you’ve managed whatever problem you find.’
‘What if they stop breathing when you’ve finished the checklist?’ Kyle was kneeling beside June with his hand gripping her wrist.
‘Then go back to the beginning and start again. There are three things that are going to kill people very quickly—respiratory arrest, cardiac arrest and severe haemorrhage. We have to identify and try to rectify those situations.’
Dave called a halt to the session. ‘That was fantastic, Kelly. Thanks.’
The spontaneous applause from her students made Kelly blush but she looked happy. Somehow, that irritated Fletch. Or was it that Roger’s appreciation was so noticeable that was the annoying factor?
‘We’ve spent over an hour learning some very important skills but don’t forget what Kelly said. A primary survey should only take thirty to sixty seconds.’ Dave paused for a moment as a few people made some last-minute notes. ‘Ross is going to run us through what vital signs are and how to measure and record them. Then we’ll have a break for morning tea.’
The break was welcome. Fletch had not enjoyed the morning so far. He felt out of sorts. The unwelcome memories Kelly had stirred surely weren’t entirely responsible for his mood. He had learned to deal with those memories long ago and he couldn’t care less if the attraction that Roger the fireman was advertising was reciprocated. The irritation was augmented by a faint touch of nausea that Fletch knew he couldn’t blame on the odd beer or two he’d had with a mate the night before. He knew what the cause was likely to be and he headed for the men’s toilet with a decisive stride as soon as Dave signalled the timetable break.
The small pouch fitted into the back pocket of his jeans as neatly as a wallet. Fletch unzipped the pouch and removed the contents. He was so focused on his task that it wasn’t until the door swung open behind him that Fletch realised his mistake.
‘Damn!’ The drop of blood fell from the end of his finger and splattered the side of the ceramic handbasin.
‘Fletch!’ Ross Turnball sounded shocked. ‘What are you doing, mate?’ He stepped closer. ‘Oh…I had no idea.’
Fletch had a new drop of blood on his finger now. He touched the end of the test strip to the drop and watched the blood travel up the central line. The beep signified that the device had started its measurement. The result was only thirty seconds away. Fletch rinsed his finger, still cursing inwardly that he’d forgotten to shut himself into the privacy of a cubicle.
‘It’s not something I advertise,’ he told Ross curtly.
‘Are you insulin dependent?’
‘No.’ Fletch smiled wryly. ‘Quite the opposite.’
Ross raised an eyebrow. ‘That sounds unusual.’
Fletch pulled the test strip from the device and threw it away. ‘Four point one,’ he murmured. ‘I just need a bit of morning tea.’ He glanced at Ross as he packed away his kit. ‘It’s a long story,’ he said casually. ‘Remind me to bore you with it some time.’
Low blood sugar was not the culprit as far as Fletch’s mood was concerned. Maybe it was being close to Kelly that was disturbing his equilibrium after all. With a cup of coffee in one hand and two biscuits in the other, Fletch moved away from the class group. He found a seat around the side of the building that had the advantage of being in full sunshine, but the pleasant solitary respite didn’t last long.
‘OK, I’m dead curious.’ Ross sat down beside Fletch. ‘You can tell me it’s none of my business but my professional instincts are making me nosy. How long have you been a diabetic?’
‘Two years.’
‘And you get hypoglycaemic even though you don’t take insulin?’
‘Not too often these days, fortunately,’ Fletch responded. ‘I still need to keep a close eye on my levels, though, especially if I’m not well or under stress or miss a meal or something.’ He bit into a biscuit. ‘I just don’t usually make it public.’
Ross nodded. He sipped his own coffee before breaking a thoughtful silence. ‘How were you diagnosed?’
‘Hypoglycaemic crisis,’ Fletch said quietly. ‘Rather a dramatic one, apparently. A taxi driver left me in the middle of the road. Someone called an ambulance and said I was so drunk I was a danger to myself. I was having a grand mal seizure by the time I got delivered to the emergency department and went into a coma after that.’
‘Good grief! Sounds like a major crisis.’ Ross stared at his companion. ‘Did you have some kind of insulin-secreting tumour?’
Fletch looked impressed. ‘You’re more clued up that my doctors were. I was in the intensive care unit for three days before they came up with a definitive diagnosis.’
Ross was nodding. ‘An insulin-secreting islet cell carcinoma. Not malignant, I guess, or you wouldn’t be looking like you do now two years down the track.’
‘No. I’d be dead,’ Fletch agreed. He grinned. ‘Never a good look.’ His smile faded. ‘Waiting to find out whether it was malignant or not wasn’t much of a joke.’
‘I’ll bet it wasn’t.’
‘It was a rough ride all round, actually. I had a partial pancreatectomy. When I got through the complications of pancreatitis and amazed the specialists by surviving, it was decided that my prognosis wasn’t so bad after all. I was in hospital for ten weeks altogether and I came out looking like I’d spent time in a concentration camp. It was another three months before I was back at work.’
Ross shook his head. ‘Amazing story, Fletch.’
‘Not one that I want spread around, mate. I don’t let it interfere with my life but some people would be inclined to regard it as an obstacle