Surgeon On Call. Alison Roberts
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building. He could see the ice coating the scaffolding. Cold job, being a builder at this time of year. He wondered idly what the young chap was doing, scrambling up the side of the steel skeleton. He seemed to be in rather a hurry.
The toot from behind indicated that Joe’s attention should be back on the traffic. He slid the car back into gear but the movement he caught in his peripheral vision jerked his gaze back to the left. Had the lad’s foot slipped on that wooden platform? He’d managed to catch hold of one of the steel pipes but the grip held only momentarily. Joe watched the fall with horror. He could almost feel the impact as the victim’s back contacted the next steel bar several feet below before the graceful arc that completed the fall.
The sensation of horror was dismissed instantly and replaced with a clinical detachment. The impact mid-fall had been enough to cause a lumbar spinal injury. The distraction to the cervical vertebrae which the impact of landing on his head might have caused was even more serious. Joe pulled his steering-wheel decisively and put his foot down on the accelerator to gain just enough momentum for the wheels to mount the kerb. He pushed the hazard light control on the dashboard.
* * *
Seven thirty-eight a.m.
Felicity Munroe shaded her eyes from the glare of the sun. It was hard to see what was going on ahead but the traffic appeared to be even slower than normal for this time of day. At least she wasn’t too far from the hospital now. With a bit of luck she could still make the 8 a.m. meeting with members of the cardiology department. The interface between Cardiology and Emergency needed some urgent attention. Only yesterday they’d had a patient with a major heart attack taking an unacceptable length of time to clear the emergency department.
Her scrutiny revealed the cause of the hold-up. A car had pulled off the road onto the footpath but was still creating enough of an obstacle to cause problems. The vehicle’s hazard lights were flashing and a man was attempting to get out on the driver’s side. Passing traffic was making this difficult, however, and the man was being subjected to irate blasts of car horns as he tried to open his door.
Traffic ground to a complete halt again with one car close enough to provide an impassable barrier to the man in the stalled vehicle. Felicity could see him moving to exit from the passenger side with some urgency. Her own car was still well away from the disruption, level with the entrance to a building site on her left. Felicity glanced sideways briefly, hoping to distract herself from a mounting irritation with the delay. She’d been watching the huge apartment block take shape for months now and the site looked busy again this morning. Extraordinarily busy, in fact. There were people running from all directions. Felicity’s casual glance focused on the scene sharply. On the supine figure that the men were running towards.
The wisdom gleaned from years of experience was not needed to let Felicity know that a significant incident had occurred. It took only a second to ease her vehicle from the line of traffic and cruise onto the building site. A few seconds more and she was at the side of the victim. She could see that the young man was conscious and breathing. She picked up his wrist to check the radial pulse as she crouched down beside him.
‘Can anyone tell me what’s happened?’
‘Don’t touch that man! Stand back!’
The command was vehement enough to distract Felicity from her visual examination of her patient. The sharp tone made the man crouching beside her stand up hurriedly, stunning him into silence, though he had barely begun to answer Felicity’s query.
‘I’m sure you all have the best intentions,’ the man told the group. ‘But people who don’t know what they’re doing can actually do more harm than good in a situation like this. I’m a doctor,’ he continued. ‘And I witnessed the accident.’ He glared at Felicity, his gaze flicking over her well-dressed slight figure dismissively. ‘You haven’t tried to move him, have you?’
‘Of course not.’ Felicity might not have witnessed the accident at first hand but it didn’t take much common sense to realise that someone lying motionless beneath scaffolding could well have suffered a significant fall. And it didn’t take anything like her training to suggest that such a fall carried a high index of suspicion of a spinal injury. Felicity opened her mouth to inform this man that as an emergency department consultant she was hardly likely to risk an exacerbation of such an injury by moving an unstabilised patient. She was also tempted to say something snappy regarding the assumptions this man had clearly made based on what she looked like. What did he think she did for a job? Work as a beauty therapist perhaps? Not that she was given a chance to say anything at all.
‘Move over here.’ The stranger draped the stethoscope he was holding around his neck with a casual movement that suggested long familiarity. ‘You can do something useful and hold this chap’s head still. It’s very important that he doesn’t move his neck.’
Felicity surprised herself by doing as she was asked. Or, rather, told. There was something about this man’s attitude that indicated it wouldn’t be in anyone’s best interests to get in his way right now and it certainly wasn’t an appropriate time to voice her resentment at the way he was treating her. Felicity took a mental step backwards. She would only intervene if she needed to and so far she had no complaints.
The doctor had gently moved the young man’s head and neck into a neutral position. As soon as Felicity’s hands took over providing support he conducted a rapid examination of the head and neck. Felicity relaxed a little as she noted that his movements appeared to indicate that he knew what he was doing. From the gentle palpation of the front of the neck he was clearly checking for tracheal deviation. As he carefully felt the back of the victim’s neck, the young man groaned and Felicity watched the doctor’s face register a focused concern.
‘I need some sandbags,’ he stated. ‘Or cushions. Or some rolled-up clothing. Anything. We need to pad the neck to protect it. And someone call an ambulance.’ He leaned over his patient, seemingly oblivious to how close this brought his face to Felicity’s. ‘What’s your name?’ he queried briskly.
‘Jeff.’
‘I’m Joe. Joe Petersen. I’m a neurosurgeon.’
Felicity blinked. Perhaps the stranger was more qualified to deal with a spinal injury than she was. The fact that she’d never heard the name associated with the specialised spinal injuries unit on the other side of town didn’t mean he wasn’t an expert. He could be visiting from overseas. His deep voice did have the hint of an unusual accent.
‘I can’t feel my legs.’ Jeff’s words held an edge of panic. ‘Am I going to be paralysed?’
‘Are you having any trouble breathing?’
‘No.’
Felicity tightened her grip at the attempt to shake his head. ‘Keep very still, Jeff,’ she told him. ‘It’s important.’
‘He hasn’t told me.’ Jeff caught Felicity’s gaze. ‘I want to know how bad this is.’
‘We don’t know yet.’ Joe placed the earpieces of his stethoscope into position. He pulled up the thick jersey Jeff was wearing. ‘I’m just going to listen to your chest.’
Felicity could feel the slower than normal heart rate under her fingertips. She considered suggesting that neurogenic shock could be producing a bradycardia as she watched Joe conduct a rapid assessment of Jeff’s chest, abdomen and pelvic area. He pressed his hands on each side of Jeff’s hips to check the stability of the pelvis. Glancing up, he noticed Felicity’s studied gaze.
‘I’m looking for what we call ‘‘silent’’ lesions,’ he informed her. ‘Injuries, that is.’
Felicity kept her face neutral. She was perfectly well aware what lesions were. It was quite interesting, being treated as a layperson. Or it would have been if this man’s tone didn’t suggest that her level of intelligence might not be up to scratch. She decided not to raise the subject of neurogenic shock.
‘If there’s a significant level of paralysis then injuries could