Chapter 7
7
There was no such thing as a routine shift in the emergency department, but sometimes things came in patterns, and just lately it seemed to Danni that every other patient being brought in was a child. She’d never been someone who could take a completely businesslike approach to being a doctor, but she could usually bury her feelings deep enough for her to keep the kind of professional distance that was necessary for her to do her job. Except, these days, when it came to children, she was struggling with that much more than she ever had before. When a call came through on the red phone to alert them that ambulances were on the way in with a toddler and his sixty-three-year-old grandmother, both of whom had been hit by a car, goose pimples had broken out all over her skin. The likelihood of the injuries being minor – particularly for such a small child – was tiny. He was going to be frightened and in pain, and Danni couldn’t help hugging her bump tightly as they waited for the first of the two ambulances to turn up.
The adrenaline seemed to flow all the faster once the paramedics arrived, briefing the team on the details of the accident and the pain-killing medication both patients had been given. The little boy’s grandmother, Tania, had taken the force of the impact when the car had mounted the pavement, with eye witnesses saying she’d thrown herself between the vehicle and his pushchair. She’d initially been unconscious at the scene, and there’d been an obvious open break in both her left leg and arm. Tania had been sedated and intubated, so that the open fracture could be realigned sufficiently to maintain blood flow to her hand and foot, and she’d been given ketamine to manage the pain.
As a result of the sedation, it was difficult to determine the impact of any head trauma. The paramedics had also described severe bruising and suspected broken ribs on her left-hand side, but thankfully her heart rate and blood pressure had remained stable, so there didn’t appear to be any risk of internal bleeding. Danni had only got a brief glimpse of the little boy, who one of the ambulance technicians had said was called Barney, and whose curly blond hair was matted with blood. He was conscious at least, sobbing and calling out, which Danni was hoping would turn out to be a good sign. The sound of him crying for his grandmother made something in her chest constrict. But all she could do was to help the woman he so desperately wanted to be with, while her colleague, Zahir, took charge of treating the little boy.
‘We’re going to need the trauma surgeons and an anaesthetist down here as soon as possible, but we need a CT first. With so much blunt force trauma on the left-hand side, there’s a good chance she could have damaged her spleen.’ Danni gave the instruction to Esther, once they were through to resus with the patient and the handover from the paramedics was complete. Aidan, Amy and Isla were already attaching the monitors to ensure that Tania’s condition remained stable. She’d been given a GCS of six, due to the fact she hadn’t regained consciousness prior to sedation, but there was some response to pain, in both her reflexes and her eyes, which meant there was hope. Although with a score in that range, Danni would have estimated her chances of survival at being less than 50 per cent. And her chances of a full recovery were even lower.
‘She’s got a heart rate of 130 bpm, and her blood pressure is dropping.’ Aidan gave the update on Tania’s condition and Danni’s heart sank. Both of these changes in her vital signs were indications of internal bleeding.
‘Her abdomen is rigid, and it looks like her spleen has ruptured. She needs IV fluids, and we need to prepare for the major haemorrhage protocol.’ She’d barely got the words out before Esther headed off, only too aware of how urgent it was to put in the call. They were going to need staff from a range of specialisms available during the CT scan. If Tania’s blood pressure dropped again due to further bleeding, specialists would need to administer blood clotting medication, to try and slow down the bleeding until the scan had been completed and she could go into surgery. Amy, Aidan and Isla leapt into action, each of them knowing their roles. And within minutes they’d set up the machine to facilitate the transfusion, despite them not being able to identify where the suspected blood loss was coming from.
‘How’s her heart rate?’ Danni connected the IV to the cannula that the paramedics had put in, hearing Aidan’s sharp intake of breath before he responded.
‘Still rising. She’s at 135 bpm now.’
‘Mum!’ The doors of resus suddenly flew open as a man, who looked to be in his mid-thirties, charged into the room; the panic in his eyes was obvious before he even spotted his mother lying on the bed. ‘Oh my God, is she…’
He stood there with his mouth open, unable to finish the sentence, and Danni stepped in. ‘She’s sustained some serious injuries, but she’s in the right place and the best thing you can do for her now is to go and wait somewhere until we can come and give you an update.’
‘I’m not leaving her.’
‘I know it’s hard.’ Danni kept her tone even. ‘But you need to let us get on with our jobs. So we can try to make your mother better.’
‘ Try ?’ The man had seized on the one word that Danni probably shouldn’t have used, but her natural instinct was to be as honest as possible. And she jumped as he hammered his fist down on the top of trolley. ‘I need you to do more than try .’
‘We’ll do everything possible.’ Even in the wake of the man’s obvious anger, she wasn’t going to make a promise she knew could easily turn into a lie. ‘I’m Danni, one of the doctors and if you go and wait in the relatives’ room, I promise I’ll come and find you as soon as there’s more news. But right now, we need to stabilise your mum so that she can go for a scan, and we can work out the best way to treat her. What’s your name?’
‘Max.’ The anger seemed to drain out of him as he spoke, and he suddenly looked so much smaller and far less threatening. ‘Mum was looking after my nephew. My sister phoned her when they were on the way home from the park and she heard the accident happen. She was hysterical when she called me. I’m sorry, I know I’m not supposed to be in here, but I just need to know she’s going to be all right.’
‘It’s okay, Max, I’m going to get Isla to take you to the relatives’ room now, and I’ll come and find you as soon as I can.’
‘Please don’t let her die, will you? We lost Dad last year and I can’t…’ For the second time Max was unable to finish his sentence, and Danni’s only option was to repeat herself too.
‘I promise we’ll do everything we can.’ As she turned back to Aidan and their eyes met, all she could do was silently pray that everything they could do would be enough to save Max’s mother.
Danni’s only focus was to keep Tania safe until she was taken up to surgery. It meant that being forced to spend time with Lucas Newman, one of the trauma surgeons, who also happened to be Esther’s ex-fiancé, barely registered on the list of things she was worried about.
‘You’ve done your bit and kept her alive; you can let the experts take over now.’ Lucas had given her a tight smile. With any of the other surgeons, she might have assumed they were joking; a bit of inter-departmental rivalry that the different teams would often exchange to take the edge off high-pressure situations. But this wasn’t a joke, this was a way of putting Danni in her place, and letting her know exactly what he thought of the job her department did. That type of comment wouldn’t have bothered her, even if it hadn’t come from a slimeball like Lucas, because she knew how vital her team’s work was, and just how good they were at it. They’d kept Tania as stable as possible, until the scan had revealed that the bleeding was coming from a ruptured spleen. After the handover with Lucas, Tania had been rushed up to theatre for a splenectomy, and to pin unstable fractures in both her leg and arm. She was going to survive, and would make as full a recovery as possible, because of what the team in A it’s instinctive, isn’t it?’
‘I’m sure most people would.’ Danni’s attempt to return his smile made her cheeks ache. Nicola couldn’t even make time to meet up with Danni when she’d suggested travelling down to Bristol to meet her mother for lunch. She’d wanted to share the pictures from the twenty-week scan, and she’d even found a place close to her mother where they could go for a 4D scan together, now that she was past the twenty-four-week stage. She’d hoped if her mother saw the baby that she might somehow develop a bond with her grandson. It was stupid really, when she barely had a bond with the children she’d given birth to, but somehow Danni still couldn’t quite bear to let go of that hope. Tania had put her life on the line without a moment’s hesitation, and Barney had a grandmother who loved him more than life itself. Danni and Charlie’s baby would have that kind of love from his parents, but she couldn’t help feeling sad for him that he’d never have that from his maternal grandmother. Buried far deeper than that was the pain that Danni carried from never having that kind of love from her own mother. It still mattered, even after all this time, and she had a horrible feeling she’d never stop grieving for the one thing she was never going to have.