The Doctor's Rebel Knight Page 10

  ‘We’ve got a serious head injury and a leg fracture,’ the woman in her sixties said. ‘He’s barely breathing. Mick’s trying to give him some oxygen now.’

  Fran took a steadying breath and, approaching the victim, quickly assessed the situation. The man was about fifty, one of his thighs at an acute angle, dark blood seeping onto the road from a head injury. And as the volunteer had said, he was hardly breathing.

  ‘Can you get me a cervical collar?’ she asked the woman who had introduced herself as Karen.

  Once she had the collar on, Fran asked for the portable sucker to be set up. She quickly donned gloves and goggles and suggested Jacob do the same. He was looking down at the victim, his expression inscrutable.

  ‘Sergeant Hawke?’ she prompted, frowning at him.

  He appeared to give himself a mental shake. ‘Sorry?’

  ‘You’d better glove up,’ she repeated. ‘And goggles, too, in case there are blood splashes. You also, Karen, and Mick, is it?’

  ‘Yeah.’ The man nodded.

  Fran used the sucker on the victim’s mouth before she inserted a Guedel’s airway and administered oxygen. There was no response from the victim to voice or pain. Although the airway was clear, he had stopped breathing.

  ‘Can you pull on his leg to straighten it?’ she asked Mick, and once he had done so, with Jacob and Karen’s help they log-rolled the man onto the spinal board while Fran controlled the neck.

  As soon as Fran had the patient on his back she could see the front of the neck had been in an impact with whatever had hit him and that the larynx was probably crushed, which meant the likelihood of intubating would be remote.

  ‘I’m going to have to put in a surgical airway,’ she said, reaching for a disposable scalpel, forcing her hand to stay steady and controlled while inside she felt doubt nip at her nerves with sharp pointed teeth as she made the incision.

  ‘Mick, you ventilate him while I listen to his chest,’ she directed.

  ‘Er…this is my first time,’ Mick said, a fire-engine blush running over his cheeks. ‘I’m not sure I can do it properly.’

  Fran swung her gaze to the female officer. ‘Karen?’

  ‘Sergeant Hawke had better do it,’ Karen said with a grimace. ‘Mick and I are not very experienced. Jack’s on leave this week and Hamish is out of town. We were the only two available.’

  ‘Right, Sergeant,’ Fran said, but before she could instruct him on what to do he had already taken over with the sort of competence she had come to expect from him. His cool, calm composure helped her. It suddenly occurred to her how automatic her responses to the scene had been so far. It helped her shattered confidence somewhat, good enough to keep going for now.

  ‘OK…’ She took another deep breath and, reaching for a stethoscope, addressed Karen. ‘Can you cut the patient’s shirt off his chest?’

  Karen did as she was directed and Fran leant down to listen to the man’s chest. There was no air on entry to the right side. All the signs pointed to a tension pneumonthorax, which was rapidly fatal if not treated immediately.

  Before early management of severe trauma courses had been conducted in Australia, giving doctors the skills to recognise and deal with injuries such as this, many patients had died because of the failure of those attending them to prioritise their assessment and treatment. ABCDE—airway, breathing, circulation, disability, exposure/environment—and treat each injury as it was found.

  Fran mentally rehearsed the stages of primary survey as she located a large-bore IV needle. After wiping it with an alcohol swab, she inserted the needle a few millimetres at a time over the top border of the third rib and into the second intercostal space on the right, sensing a ‘pop’ as the needle punctured the pleura. There was an immediate hiss of air out of the needle. Quickly glancing at Jacob, Fran could see the ventilation of the victim had become easier.

  ‘So far so good,’ she said, more to herself than to the others, thrilled that she had got this far without falling apart.

  ‘You certainly know what you’re doing,’ Karen remarked. ‘Thank God you’re in town right now, otherwise this guy wouldn’t have a chance.’

  Fran acknowledged Karen’s comment with a strained smile, although deep inside she felt another link of confidence snap into place as she inserted a canula into a large vein in each of the patient’s arms, rapidly infusing normal saline.

  ‘Mick, can you take his pulse and BP?’ she asked, glancing up as another police car with two officers arrived, one of them the young officer she had met before, Constable Jeffrey.

  Mick nodded. ‘Yep, onto it now.’

  ‘Karen, if you can use those scissors on his jeans now, please,’ Fran said. ‘I need to check that foot pulse and get a blow-up splint on.’

  ‘Pulse is 140 and BP 80 over 50,’ Mick informed her.

  Once the splint was in place, Fran carefully examined the head wound. There was no bony fracture underlying the laceration but she noted the unequal pupils as she lifted each eyelid. She bandaged the bleeding scalp wound and once she had the patient as stable as she could, she supervised his loading into the ambulance with the assistance of the two police officers who had just arrived.

  One of them had called for helicopter evacuation at Jacob’s command and informed Fran it would be landing on the cricket oval near the clinic within the next half-hour.

  Jacob had handed over the ventilation to Karen, who seemed more confident once she had been shown how to do it. He moved around the accident site, crouching down at one point to inspect the gravel, Fran supposed for skid or swerve marks. He still had that inscrutable expression on his face, but she could sense something in his stance that made her wonder what was going on behind the screen of those ice-blue eyes of his.

  He caught her looking at him and, stripping off his blood-stained gloves, put them in the bin in the back of the ambulance. ‘Whoever hit him did a good job of it,’ he said. ‘If you hadn’t been on hand he wouldn’t have lasted long enough to get him in the chopper.’

  Fran felt her cheeks begin to glow at his compliment. From the moment she had met him he hadn’t struck her as the type to throw words around just to people-please. What he said, when he said it, was genuine. ‘How could someone run into another person and just drive off like that?’ she asked.

  He looked back at the victim lying on the stretcher for a moment. He turned back to meet her frowning gaze. ‘It takes all types, Dr Nin.’ He let out a sigh that seemed to be somewhere between resignation at the state of the world and relief that he was no longer needed as roadside assistant. ‘It takes all types.’

  After loading the patient into the ambulance, Fran inserted an intercostal chest drain to better manage the pneumothorax, and on the way to the clinic she catheterised the patient and inserted a nasogastric tube. By the time they arrived, she had completed her secondary survey, noting several additional injuries. The patient was still deeply unconscious but his blood pressure was nearly back to normal.

  She communicated by mobile phone to the receiving hospital, giving them a rundown of the patient’s injuries and how she had managed them to this point. The words rolled off her tongue as they had done so many times in the past, and she wondered if this was another limping step forward on the long, twisting road to recovery.

  The blades of the helicopter created a wind that lifted Fran’s hair about her face as the victim was finally loaded. The Careflight team was trauma trained and took over the management of the patient, congratulating her for the job she had done.

  Fran brushed her hair back off her face and stood watching as the helicopter lifted off, hoping the man made it in spite of his life-threatening injuries.

  Constable Jeffrey came over to where she was standing. ‘Sergeant Hawke instructed me to give you a lift home,’ he said.

  Fran glanced around. ‘Where is he? I thought he followed the ambulance back to town.’

  ‘He’s back at the accident site,’ he said. ‘I’ve got to go back th
ere once I take you home to do further investigations.’

  ‘Do you know who the victim is?’ she asked as Constable Jeffrey drove to her sister’s house.

  ‘He didn’t have any ID on him but apparently he’s a fairly new resident to the bay. Wade Smith’s his name, or so Sergeant Hawke said. Comes from Sydney originally—he knew him back there.’

  Fran lifted her brows as she glanced at him. ‘In a personal or professional sense?’

  Constable Jeffrey gave her a mask-like look which reminded her of every cop she had ever met, in particular Jacob Hawke. ‘He’s got a record, if that’s what you mean. Car theft, aggravated assault, domestic violence, you name it, he’s been there and done it. He’s supposed to be on the straight and narrow now but how long that will last is anyone’s guess.’

  Fran chewed her lip. Patients were patients, no matter what they did or who they were. She would not have treated Mr Smith any differently if she had known he was a well-known criminal. As far as she was concerned, he was a fellow human being who had needed her expertise. But thinking back to those first few minutes at the scene of the accident, she recalled Jacob Hawke’s silent scrutiny of the victim.

  ‘Does Mr Smith have family that need to be contacted?’ she asked.

  ‘Our people will deal with that,’ he said as he parked in the driveway, with the engine still running. ‘Thanks for helping out this evening, Dr Nin.’

  ‘No problem,’ she said, and got out of the car. She gave him a wave as he drove off, her smile fading as soon as he’d disappeared from sight.

  She was tired, filthy and more than a little annoyed that Jacob was occupying her thoughts far more than she wanted him to.

  Fran had showered and was just thinking about whether to eat something or not when Rufus pricked up his ears as a car came up the driveway. She pulled the edges of her wrap tighter around her waist, releasing her hair from the neck of it as she went to the door.

  Jacob too had showered and changed. He was dressed in blue denim jeans and a white T-shirt, the close-fitting fabric clinging to his muscular form. Every muscle was highlighted, making her want to run her hands over him and feel their taut perfection under her fingertips.

  ‘Sorry to bother you so late,’ he said, his gaze swiftly but thoroughly taking in her attire.

  ‘It’s fine,’ Fran said, opening the door for him to come in, holding the edges of her wrap with the other hand. ‘I’m not on my way to bed. I was actually trying to decide whether to have dinner or to give it a miss.’

  ‘You’ve had a tough day, you should eat something.’

  ‘What about you?’ she asked. ‘Have you had dinner?’

  ‘I had a lukewarm cup of coffee about an hour ago.’

  Fran tucked a damp strand of hair behind her ear. ‘I could rustle up something for us both…I mean, if you don’t mind…It won’t be fancy but…’

  ‘That would be great,’ he said with a hint of a smile.

  She took a steadying breath and led the way to the kitchen, conscious of him a couple of steps behind. ‘Would you like a glass of wine or a beer or something?’ she asked as she rummaged in the fridge for ingredients. ‘Nick has light beer here if you’d prefer it.’

  ‘Light beer would be perfect,’ he said, pulling out one of the kitchen stools. ‘I’m off duty now but I don’t like to indulge too much in case there’s an emergency.’

  Fran handed him a bottle of beer before pouring herself a glass of white wine from the bottle that had been open for a couple of days. ‘How did Mr Smith’s family take the news of his accident?’ she asked as she began cracking eggs for an omelette.

  ‘He doesn’t have any family down here,’ he said. ‘He has a brother somewhere, in Wagga, I think.’

  She looked up from cracking the third egg. ‘So you know him?’

  Something shifted in his gaze. ‘Not personally.’

  She broke another egg and picked up the whisk, her teeth sinking into her bottom lip for a moment. ‘I’ve been thinking about his injuries…’

  ‘Oh?’

  She met his gaze across the counter. ‘The trauma to his throat was pretty unusual for a hit and run. The broken leg is standard, but the neck…’ She lowered her eyes and began to whisk the eggs. ‘I don’t know…’

  ‘You don’t think it was a hit and run?’ he asked.

  She glanced back at him. ‘What do you think?’

  He held her look for a beat or two. ‘There were no skid marks to indicate a car trying to avoid a collision,’ he said. ‘There were tyre marks, though, where a car had appeared to stop and taken off again at speed.’

  Fran gnawed at her lip again. ‘So you think there’s a possibility he had been injured somewhere else and dumped there to make it look like a hit and run?’

  He ran the pad of his thumb over the lip of his beer bottle, the set to his mouth grim. ‘Looks like it.’

  She let out a breath without realising she had been holding it. ‘Do you have any idea of what sort of motive someone would have for doing such a thing?’ she asked. ‘Does Mr Smith have enemies down here?’

  His expression turned cynical. ‘People like Wade Smith have enemies everywhere—they’d follow him like a bad smell.’

  ‘Who reported the accident?’ she asked as she put the omelette on the cooktop.

  ‘It was an anonymous call from a mobile phone. We should have the information on who it was by tomorrow.’

  ‘Do you think it was the same person responsible for the accident?’ she asked with a frown.

  ‘Not likely,’ he said. ‘Why would someone who wanted him dead call for help? It’s more likely a local found him and didn’t want to get involved, called it in once they’d left the scene. There were other tyre tracks—it’s a matter of working out which ones belong to which vehicles.’

  Fran picked up her wine, unable to suppress a faint shiver. ‘It creeps me out to think of someone wandering around town who would think nothing of maiming someone so severely.’

  ‘Do you think he will survive?’

  ‘I think so, his body anyway,’ she said, turning to check on the omelette. ‘But the brain injury…that could be severe or maybe he’ll just wake up with a headache and amnesia for the whole episode. We’ll know after he comes off the ventilator.’

  Jacob drummed two of his fingers on the side of his beer bottle. ‘You did a fantastic job out there, Dr Nin. That was a tough call but you handled it brilliantly. I have to confess I had my doubts about you before, but you took control as if on autopilot or something.’

  She met his eyes again, twisting her mouth ruefully. ‘Can we quit the Doctor and Sergeant routine?’

  ‘Sure,’ he said, smiling that half-smile. ‘Fran, then.’

  ‘Thanks,’ she said. ‘But I have to tell you I was terrified out there.’

  ‘You didn’t show it.’

  She bit her lip. ‘I can see how this place really needs a full-time doctor.’

  ‘Are you reconsidering taking it on?’ he asked. ‘Linda told me she has a clinic already fully booked for Friday.’

  Fran picked up her wine again, twirling the glass rather than drinking from it. ‘I know,’ she said. ‘I got her message on my voicemail. But I’m an emergency medicine physician. I spent years training to be the best I could be, but…’ Her teeth savaged her lip again. ‘I’m not a GP.’

  ‘It seems to me cops are a little like doctors,’ he said. ‘We have to keep fairly general in our knowledge and experience. I’ve worked in traffic and the drug squad and even a stint in covert operations, but a cop is a cop, much the same as a doctor is a doctor. The training is almost hardwired into us. It seemed like that out there today when you took charge as if you’d been doing it every day of your life.’

  Fran’s hand trembled as she put down her wineglass. She frowned as she dished up the omelette, wondering where to begin, wondering why she wanted to tell him when she had refused to talk about it with anyone else. Maybe it was because she felt he would understa
nd. After all, he had suffered because of what a criminal had done to his father. He carried that pain; she saw it in him, the way he held part of himself back, the way he rationed his smiles.

  She handed him a plate with a large serving of salad and fluffy cheese omelette on it before she sat on the stool opposite, with some food for herself. ‘Jacob, there’s something you should know about me…’

  His eyes centred on hers, not a muscle on his face moving as he silently watched her.

  Fran moistened her lips and began again, ‘I know you think I’m a city chick with an attitude problem, and to some degree I’ve encouraged that view. It was easier than offering an explanation for my behaviour just about every time we’ve met up.’

  Still he remained silent.

  Fran looked down at her plate, shifting her food for a moment before returning her gaze to his unwavering one. ‘It was a busy Friday night,’ she said. ‘I’ve had hundreds of them during my career. There were patients lined up on trolleys and chairs, waiting for beds on the wards. I guess you know how rundown the public health-care system is. Security had been called to deal with a drunk who was shouting abuse at the staff. I was called to deal with a new admission, another young man who had come in with lacerations to both his arms…’ She stopped and swallowed.

  ‘Go on,’ Jacob said in a low deep tone.

  She looked at him, her voice sounding hollow as she continued. ’It was like someone had turned a switch on him somewhere. He was agitated when he came in certainly, but I thought that was because of his injury. But suddenly he became uncontrollably violent. He threw me up against the wall. I screamed for help but he slammed his fist into my face. I think I might have lost consciousness briefly but I came to and found him stomping on my leg. The pain…’ She grimaced and went on, ‘I tried to get away but he hauled me up again and the last thing I remember is his fist coming towards me again…’

  Jacob felt his insides churn. For all his years as a police officer he still couldn’t stomach violence, particularly violence against women and children. He had attended briefings on dealing with drug-fuelled assailants and he had experienced it firsthand in Sydney too many times to count. The level of violence was astonishing. People affected by crystal meth—ice, as it was known on the street—developed bursts of superhuman strength. Once the effects of the drug wore off, most were not even aware of what they had done or the havoc they had caused. Even excess alcohol had a similar effect on some people, and that was a problem that was worsening with binge drinking.