The Fling That Changed Everything
‘No,’ Ana told her. ‘We’ve got a lot of things that remote hospitals might dream of having, like a CT scanner, but a cath lab would be taking things a bit too far.’
‘So how do you treat your cardiac patients?’
‘We’ll take a twelve-lead ECG,’ Sam responded. ‘And a chest X-ray. We can check cardiac enzymes and we’ll administer thrombolysis if it’s indicated.’
The sound of a wolf-whistle made him blink but he ignored it.
‘As soon as we’ve got him stable enough, we’ll arrange a fixed-wing evacuation to a hospital on the mainland that can do angiography and angioplasty. Cardiac surgery, if that’s what’s needed.’
The wolf-whistle sounded again. Frowning, he looked up from the rhythm he was watching on the screen to see Lia reaching into the pocket of her cargo pants to pull out a mobile phone.
What the heck? Okay, she was still holding the patient’s mask in place with one hand but how inappropriate could you get? Had she even been listening to the response to her query?
She was actually texting as she stepped back to let the hospital staff position the bed and hook up the equipment they now had available. Any impression he’d had of Lia’s competence and professionalism was beginning to fade and maybe that was why he gave her the challenge of interpreting the ECG trace as soon as he’d put the chest leads on and printed it off.
He stepped close enough to hold the sheet of graph paper in front of her. ‘So what do you think?’
Lia jumped and her gaze jerked up from her phone but she still had it clutched in her hand as she turned her attention to the trace.
Her scanning was as rapid as his had been.
‘Hyperacute T waves, and there’s significant ST elevation in leads V3 to V5. Looks like a sizeable anterior infarction with lateral extension.’
He wanted to test her. ‘What about the bundle branch block?’
‘There is a left bundle branch block but the ST elevation is greater than you’d expect and we’ve got Q waves here...and here...’
He hadn’t noticed how delicate her fingers were before. Long and slim, with practical, unpainted nails and no rings. Her touch on the paper was light enough not to move it but he could feel the pressure transfer itself to his own fingertips.
‘And there’s some reciprocal changes in the inferior leads,’ Lia added. ‘It’s pretty conclusive.’
He should have been impressed. He might have even told her that except for the interruption of that damned wolf-whistle again.
Her cheeks went pink. ‘Oops, sorry. I meant to put that on silent.’
Sam glared at her. ‘Maybe you could save your personal messaging for out of work hours.’
‘I’ve got the bloods done.’ Ana had a handful of test tubes. ‘Some will have to go down to the lab but do you want me to do the benchtop cardiac biomarkers?’
‘I’ll do it.’ Sam turned away from Lia. ‘Set up the tenecteplase infusion, will you? And draw up some atropine. I’m not happy with his rate. It’s sinus but it’s too slow.’
A glance from the corner of his eye as he transferred some blood to the tiny, specialised tube that would slot into the sophisticated device he was now holding in his hand showed Sam that Lia was busy texting again. Maybe she already knew that they could measure things like troponin and creatinine kinase and myoglobin, which were all markers of whether someone was having a heart attack and how large it was, but surely she should be interested to know that she would have one of these units available in the helicopter she was about to start working in?
They hadn’t been cheap but, like a fair few other items here, they were important enough for Sam to have quietly provided them from his personal funds.
Not something he would want Lia—or others, for that matter—to know. Maybe it was better that she wasn’t showing any interest or asking awkward questions.
And at least she put her damned phone away when Jack’s pager sounded an alert.
‘Looks like we’ve got a call. Come on, Lia. I’ll show you how the radio system works.’
* * *
‘Holy heck...’ The straps of her harness tightened to hold Lia in the front seat of the helicopter as it fought the wind. ‘How far have we got to go?’
‘Only another five minutes.’ Jack’s voice was reassuringly calm inside her helmet but the sidelong glance he gave her was more concerned. ‘These are pretty marginal flying conditions. You okay?’
‘Are you kidding?’ Lia laughed aloud as they slewed sideways and rocked again. ‘I love it.’
The look she got now was impressed. ‘I’ve had a few guys in that seat who’d have white knuckles by now.’
‘How will we get to patients if it gets any worse than this? Do you think the cyclone’s going to be a direct hit?’
‘It’s looking more likely. We might well have a day or two when we can’t get airborne. If that’s the case, we use boats for the closer islands. How do you go in rough seas?’
Lia grinned. ‘I quite like them, too.’
Jack shook his head, silent for a moment as he focused on controlling his helicopter. The main island of Atangi was within sight now and Lia could see that it was far more populated than Wildfire. Somewhere in that cluster of buildings was the medical centre they were heading for after getting a call from the nurse who was working there.
‘I used to ride horses way back,’ Lia said. ‘What I loved most was a good cross-country course. Boats and aircraft in a bit of rough stuff is like competing in cross-country when you never know where the next jump is or how big it’s going to be.’
‘You still ride?’
‘No. It’s not exactly an affordable hobby. Besides...’ Lia let out a whoop as they were buffeted by some particularly big turbulence. ‘I get all the excitement I need these days from my job.’
‘Yeah...’ Jack was clearly in complete agreement. ‘Let’s get this baby on the ground and hope that our patient doesn’t get airsick on the way back. If she does, it’s your job to clean up.’
‘Don’t think so, mate.’ Lia was still grinning. ‘It’s your helicopter.’
CHAPTER THREE
THE MEDICAL CLINIC on Atangi was staffed by an older local nurse, Marnie, who met them at the door after Jack had landed the helicopter on the football field across the road. He shut the chopper down and came with her in case he needed to go back for a stretcher.
‘Try not to scare her,’ Marnie warned. ‘I had a hard job persuading her to come in at all and she might try and do a runner. Not that she’ll get very far, mind you...’
‘What’s her name?’ Lia asked. ‘And what’s the story?’
‘Her name’s Sefina. She lives out past the edge of the village and keeps to herself, of course...’
Of course? A warning bell rang for Lia. She wanted to ask why it was expected that this Sefina would keep to herself but the nurse was still speaking quietly.
‘I went out there on my way home for lunch because she missed her appointment for Joni’s fifteen-month vaccinations last week and I wanted to remind her how important it was that she brings him in.’
‘Joni?’
‘Her kid. Anyway, when she finally answered the door, it was obvious something bad had happened. She said she had a fall on the rocks at the beach yesterday but...’
Lia touched her arm to slow their progress towards the consulting room. She needed to ask this time.
‘But what?’
‘Everyone knows what her husband, Louis, can be like after a few drinks,’ Jack muttered. ‘Is that what you’re thinking, Marnie?’
The older woman shrugged and looked away. ‘It’s none of my business,’ she said. ‘I only went there because of Joni...’
Lia raised her eyebrows at Jack. What on earth was going on here? This was a village and surely everybody knew everybody else’s business—and looked out for them?
‘It’s a long story,’ Jack said quietly. ‘I’ll fill you in later.’
Sitting in the middle of the consulting-room floor was a small boy with coffee-coloured skin and a mop of wild curls. At the sight of strangers entering the room, his face crumpled and he let out a wail of fear and made a beeline for his mother’s legs for something to cling to.
The boy’s mother couldn’t help, however, because she was currently vomiting into the handbasin at one side of the room.
Lia went swiftly to her side.
‘Sefina? I’m Lia. I’ve come to help you.’
Her patient looked up as she turned the tap on and Lia was shocked by the injury to her face. One eye was so swollen it was closed and there was a cut above it that needed suturing. And even on Sefina’s dark skin the bruising around the cut was obvious. She was also shocked at how young she was. Barely more than a teenager, by the look of it, and she was a mother already.
‘I’m fine. I didn’t want to come in here... Marnie shouldn’t have called you.’
‘I know.’ Lia kept her smile as reassuring as her tone. ‘But we’re here now so let me give you a check-up? I’m new in this job so I have to make sure everything’s done properly. You’re my first patient, even.’
She wanted to let Sefina know that she didn’t know anything about whatever it was that was keeping this young woman isolated from her community and that she was offering treatment without any kind of judgement. She wasn’t going to be fobbed off, however. She’d seen more than a tinge of blood in that basin before the tap had been turned on and that was a red flag for injuries that could be internal.
‘Marnie shouldn’t have called you. I’m fine.’
The repetition of something that had just been said rang another warning bell for Lia. The head injury was clearly enough to have caused concussion or possibly a more serious brain injury.
‘Do you know what day it is today, Sefina?’
‘Marnie shouldn’t have called you.’ Sefina had turned away from the basin. ‘Joni... Come on...we’re going home...’
She started to bend over to pick up her son, who was still clinging to her legs, but then she clutched her abdomen and doubled over with a cry of pain.
Supporting her weight, Lia had to let her slide to the floor when it became obvious she couldn’t get as far as the bed. Whatever this girl’s injuries were, they needed more investigation than it was likely to be possible to do in this small clinic.
‘Jack?’ Lia knew he was waiting right outside the door and, sure enough, he appeared instantly.
‘We’re going to need the stretcher,’ she told him. ‘I don’t think Sefina’s going to be walking anywhere just now.’
It was impossible to start examining Sefina with Joni now trying to scramble into her arms. Lia lifted the toddler and turned to find Marnie watching, her arms folded over her ample chest.
‘Can you look after Joni, please, Marnie? I need to examine Sefina.’
‘No-o-o...’ Sefina struggled to sit up but fell back with a cry of pain.
The hesitation and then grudging compliance from the nurse was enough to anger Lia. Whatever the village had against this young girl, it was not acceptable to be taking it out on an innocent child. By the time Jack returned, Lia was tight-lipped. She met him in the waiting room.
‘We have to get Sefina back to the hospital. Her abdomen’s rigid and I suspect she’s bleeding from a ruptured spleen. On top of that she’s got a head injury and there’s no way of telling how serious it is. She needs a CT scan to rule out a brain bleed.’
Jack was nodding. ‘Let’s go, then.’
‘There’s another thing,’ Lia snapped. ‘I’m not leaving her baby here. I think there’s a high chance these injuries weren’t accidental. There’s no way I’m letting that little boy go back to his father and I’m getting the feeling that no one else around here wants to take care of him.’
‘Louis isn’t his father,’ Jack told her.
Lia blinked. Was that what the problem was? Had Sefina cheated on her husband and everyone knew that? Did her low-life husband think it gave him an excuse to beat her up to within an inch of her life?
‘All the more reason to take Joni with us, then.’
‘It’ll be a rough flight.’
‘So we’ll strap him in. Or I’ll hold him. There’s not much I can do for Sefina en route, anyway. I’ll give her some pain relief and get some fluids up and then what we need to do is get her to hospital as soon as possible. Hopefully before this weather gets any worse.’
* * *
Sam, Hettie and Anahera were waiting in the emergency department of Wildfire Island’s hospital, having been alerted to the incoming trauma patient via radio.
Jack and Manu, the hospital porter, were wheeling the stretcher. Lia had her arms full with a very frightened-looking small child. Sam had heard of the child, of course. Everybody in this community had. But he’d never seen him. Or his mother, for that matter. Good grief, she looked so young...
‘Let’s get her onto the bed.’ Sam positioned himself at the head. ‘On the count of three. One, two...three...’
Sefina was transferred smoothly from the stretcher to the bed. Lia moved closer to Sam but still had to raise her voice over the crying of the child she was holding.
‘This is Sefina Dason,’ Lia said. ‘She’s sustained head and abdominal trauma. GCS is down at fourteen. Repetitive speech and vomiting. Her abdo’s rigid and her blood pressure is low at one hundred over forty. Up from ninety over forty after a litre of saline. She’s in sinus rhythm and tachycardic at one-three-five, and has a resp rate of thirty. Her oxygen saturation was ninety-five per cent. It’s come up to ninety-eight on oxygen. She’s had ten milligrams of morphine. Provisional diagnosis is a ruptured spleen and concussion.’
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