Her Emergency Knight

CHAPTER TWO

ANSWERING a call to duty was automatic.

Absorbing the reality of what had happened and where they were had taken only seconds, but the effect was an anchorage from which Jennifer could now function without distraction. Locking into the practice of what she was most competent to perform was a relief. A way of taking back control in the midst of catastrophe.

‘Airway?’

‘Clear.’ Guy Knight was opening the red sports bag. Jennifer could see neatly rolled packages and caught a glimpse of cardboard splints lining the base of the bag as some items were pulled clear. She should take the time to use one to splint her forearm, but it didn’t actually hurt too badly anymore and she could wriggle her fingers and even make a fist without causing more than fairly tolerable discomfort. It was a minor injury compared to what the man on the ground had suffered and, as such, it could wait.

‘Has he been conscious at all?’ Jennifer stepped around Guy’s feet to get to the other side of their patient. The two-inch heel of her shoe caught between two rocks but she ignored the discomfort the lurching movement provoked. She had obviously collected quite a few sprains and bruises, but hopefully the only broken bone was in her arm. ‘What’s his name?’

‘He was alert enough to get out of the plane by himself. He was obviously short of breath and said his ribs hurt, but it took a bit of convincing to get him to sit down while I went back to see about the rest of you. It wasn’t until I’d got Bill out and went back to check that I found him less responsive.’

He’d still gone back to help Jennifer out of the wreckage, however. She owed both these men the best she had to offer right now.

‘Name?’

‘Jim Spade. But he hasn’t willingly answered to anything other than “Digger” for as long as I’ve known him.’

Jennifer leaned close and rubbed a knuckle on the older man’s sternum. ‘Digger! Can you hear me? Open your eyes.’

The man groaned and his eyes opened briefly. He jerked his head and his hands moved, but any struggle to speak was clearly too much of an effort.

‘Breathing’s inadequate,’ Jennifer stated. ‘Do you carry an oxygen cylinder in that bag?’

‘No.’

‘Bag mask?’

‘No.’

‘Stethoscope?’

‘Yes.’

‘Good.’ Jennifer’s tone implied that he had, at last, provided an acceptable answer. She took the item from Guy’s hands and flicked off the leather jacket draped over Digger’s chest. It was only then that she realised why Guy seemed so inappropriately clothed for the cold temperature. He had been wearing this jacket over his polo-type shirt when he had boarded the small plane.

Digger had a woollen plaid bush shirt on, the buttons of which only opened a short distance.

‘Got some shears?’ Jennifer queried.

‘Don’t think so.’

‘We need this shirt off. I can’t see what’s going on.’

Guy leaned forward. He gripped the shirt at the base of the neck opening and ripped the heavy fabric apart as easily as if it had been a light cotton.

‘Sorry, Digger. It’s about time you treated yourself to a new one anyway.’

The T-shirt beneath was ripped from the hem upwards and they both stared at the exposed, skinny chest for a moment as they assessed the chest-wall movement. Breathing was rapid and shallow. Then Guy pointed.

‘Look at that.’

‘Mmm.’ Jennifer gave no sign of being impressed at such rapid recognition of a life-threatening situation. ‘Paradoxical chest-wall motion.’

As Digger breathed in and his chest wall moved outward, an area on the left side sank inwards. With an inward breath, it bulged outwards. The movement was subtle because of the shallow respirations but that did nothing to diminish its significance. Several ribs had been broken in two or more places, resulting in a section floating free that would seriously compromise breathing.

Jennifer’s hand had gone straight to the area and she elicited a heavy groan from Digger as she stabilised the flail segment in an inward position.

‘We need some towels, or sandbags, or a pillow. And a wide bandage.’ Jennifer looked up to catch Guy’s raised eyebrow and an almost patient expression on his face. OK, so she wasn’t in her emergency department or even the back of a well-equipped ambulance. She could cope.

‘We’ll just use his arm as a splint, then. You do have some bandages, don’t you?’

Having the arm bound to the chest wall to keep the floating ribs in place made the rest of the assessment of Digger’s breathing more awkward, but his respiratory distress seemed to be easing slowly. A faint pink tinge crept back into his skin and his level of consciousness was improving. Opening his eyes, Digger tried to cough but the attempt was weak and broken by an agonised groan.

‘Let’s position him on his injured side,’ Jennifer directed, lifting the stethoscope from Digger’s chest. ‘He’s moving air but breath sounds are definitely reduced on the left side. We want to keep his uninjured lung functioning as well as possible.’ She sighed. ‘I wish we had some oxygen. Or at least a bag mask.’

‘Welcome to the world of front-line emergency care,’ Guy responded. He gently eased an arm beneath the older man as he spoke, tilting him single-handedly towards his left side. Digger groaned again. ‘Sorry, mate,’ Guy said. ‘We’re just trying to look after you. We’ll get something for that pain as soon as we can.’

‘You’ve got morphine?’ Jennifer was pleasantly surprised.

‘Only a few ampoules, but it should help for a while.’

‘Should be more than enough.’ Jennifer nodded. ‘How long will it take for a rescue helicopter to get to us?’

She didn’t wait for a response. Her patient’s airway and breathing were under as much control as they could achieve for the moment, and she wanted an assessment of his circulation. Picking up Digger’s wrist, Jennifer felt for a radial pulse. Frowning, she shifted her grip and tried again.

‘Barely palpable,’ she announced. ‘Have you got a BP cuff in that kit?’

‘No. We don’t have a defibrillator or a 12-lead ECG either.’ Guy was pulling his fleece-lined leather jacket back over Digger’s chest. ‘I’m afraid you’ll have to make do with good old-fashioned estimates. If the radial pulse is palpable, his systolic is at least 80, which is adequate for renal perfusion.’

‘Hardly adequate to administer morphine,’ Jennifer countered sharply. ‘And it wasn’t an unreasonable request. Sphygmomanometers hardly cost the earth these days, and many are quite small enough for any first-aid kit. I would have thought you’d use one often enough to make it an essential item even in a remote practice.’

‘My first-aid kit happens to be in the back of my four-wheel-drive vehicle and it’s perfectly well equipped, thank you. I keep one in Digger’s plane as backup simply because I often fly with him. The morphine’s not exactly legal with it not being under lock and key, but we needed it once and didn’t have it so we bent the rules.’

‘Oh.’ Jennifer didn’t bother to apologise for the incorrect assumption regarding Guy’s medical practice. ‘He’s a friend of yours, then?’

The smile was fleeting enough to be no more than a ghost. ‘You could say that.’

‘Has he got any medical conditions I should know about?’ Jennifer was running her hands over Digger’s body in a sweep for any obvious bleeding. ‘How old is he?’

‘Seventy-two.’

‘And he’s still flying?’

‘Any reason why he shouldn’t be?’

Jennifer met the angry stare without flinching. Only the obvious, she wanted to say. This flight hadn’t exactly been a huge success, had it? The steely glare from those dark eyes silenced her, however. If the pilot had any major physical problems like a cardiac condition, the civil aviation authority wouldn’t have renewed his licence. Assuming that Digger was still licensed, of course, but Jennifer wasn’t about to go there.

‘Any allergies that you know of?’

‘No. He had a hip replacement about ten years ago but he’s as fit as a fiddle otherwise. Not that he’d tell me in a hurry if he wasn’t.’ Guy was smiling down at the man lying between them. ‘He’s as tough as an old boot is Digger. He’s probably broken every bone in his body at least once, thanks to his early days as a rodeo rider. He cut his leg badly with a chainsaw once and sewed himself up with dental floss before driving fifty miles to come and find me.’

Jennifer’s grunt indicated either a lack of interest in anecdotes or concentration on her current task of palpating Digger’s abdomen. When she got to the upper left quadrant, Digger groaned and opened his eyes.

‘Hurts…’

‘OK, I’ll stop pushing.’ Jennifer was pleased to see her patient looking more alert. ‘You’ve had a nasty knock on your left side. You’ve got broken ribs and may have some internal injuries. How does your breathing feel now?’

‘Bit…better…’

‘You need some fluids,’ Jennifer told him. ‘Dr Knight here is going to put a needle in your hand now.’ She glanced up swiftly, having heard what sounded like a faintly incredulous snort. ‘Is that a problem?’ she asked evenly. ‘You have fluids in that kit. I was assuming you also had the IV gear to make use of them.’

‘Oh, I do,’ Guy responded.

‘Then what’s the problem?’

‘No problem.’ Guy clearly wasn’t going to be the first to break eye contact. ‘It was just your other assumption that I found kind of amusing.’ An eyebrow rose. ‘You’re used to being in charge, aren’t you, Dr Allen?’

Jennifer felt muscles in her jaw tighten as she watched Guy pull a tie on a package from the kit, unrolling it to reveal a good supply of cannulae, swabs, luer plugs and occlusive dressings. He had asked for her help, hadn’t he? As the most highly qualified person present, of course she had assumed command of the scene.

‘And you must be used to being a big fish in a little pond.’ Her smile lacked any hint of warmth. ‘Why don’t I put the IV line in?’

‘Works for me.’ Guy’s smile was just as chilly as hers had been. ‘I’ll go and see if I can find what we need to get Digger a bit more comfortable and keep him warm.’

‘Try the radio while you’re there,’ Jennifer instructed. ‘I’d like to know how far away rescue is.’

The arm she was encircling with a tourniquet moved as Digger raised his hand.

‘Stuffed,’ he said succinctly. ‘Radio’s…shot.’

‘I’m sure Dr Knight is responsible enough to carry a cell phone. If he isn’t, then mine is in my bag…wherever that is.’

The snort from Guy was unmistakable this time. ‘And how many transmitter towers did you spot on the way, Dr Allen?’

The sound from Digger could have been a groan. Or a growl.

‘Cut it…out,’ he said clearly. ‘You’re behaving…like children.’ Despite having to take short gasps of air every few words, he continued speaking. ‘My fault we’re here…Going to be a while…Rather not listen to…squabbling.’

Squabbling? She was never that unprofessional, especially when dealing with less qualified subordinates. And just how long was ‘a while’? An hour? Two, maybe? The puff of air around her lower legs as she moved was icy, and Jennifer realised that the chill was why her fingers seemed to be lacking their usual dexterity as she snapped the cap off a cannula.

It was ridiculous to be engaging in some sort of power play with a rural GP who apparently wasn’t impressed by her position or personality. Or maybe he was still in a huff because she hadn’t recognised him from yesterday’s question-and-answer session. None of that mattered a damn right now because none of them were safe yet. Not by a long shot. She bit her lip as she glanced up to see Guy turning back towards the wreckage of the plane.

‘If you can find something to prop Digger up with, I’d be grateful,’ she called. ‘Lying flat isn’t going to help his breathing.’

A hand was raised in acknowledgement but Guy didn’t turn his head so Jennifer didn’t bother to call out any thanks. She turned back to the task at hand.

‘Sharp scratch now, Digger.’ It took several seconds of careful needle-tip manoeuvring to gain access to a vein flattened by low blood pressure. ‘Sorry,’ Jennifer murmured. ‘I know it hurts.’

‘It’s nothing,’ Digger said. ‘And I’m the one…who should be sorry, lass.’

‘This wasn’t your fault,’ Jennifer found herself saying. ‘And according to Guy, if you hadn’t handled things as well as you did then none of us would have made it.’

‘Shirley?’ Digger’s voice was rough. ‘And Bill? Are they…?’

Jennifer shook her head, meeting his gaze only briefly before reaching for the luer plug to cap the end of the cannula.

‘Oh…God!’ Digger squeezed his eyes shut. By the time he opened them again, Jennifer had taped the IV into place and attached the giving set. She held the bag of saline aloft and opened the flow.

‘What did you say…your name was?’

‘Actually, I didn’t say.’ Jennifer’s smile was rueful. ‘Rude of me, wasn’t it? I’m Jennifer Allen.’

‘You’re the…big shot…from Auckland, yeah?’

‘Yeah.’ The smile was matched by a dismissive head-shake. ‘Not that that’s going to be much help up here.’

‘I’ll be right.’ A faint smile tugged at Digger’s lips. ‘I’ve got…nine lives.’

‘But how many of them have you used up already?’ Guy had returned, carrying what looked like the back of a seat. He also held a bulky, pale blue item of clothing.

‘Put this on,’ he directed Jennifer. ‘The sunlight’s not going to be around much longer and it’s going to get bloody cold.’

The padded anorak looked inviting but Jennifer hesitated. Guy’s face softened almost imperceptibly. ‘Shirley doesn’t need it anymore,’ he said quietly. One corner of his mouth tilted. ‘And it should keep you warm—it’s big enough to go round you twice. Here, I’ll hold that bag while you put it on, then we can get this seat behind Digger.’

The instant warmth was comforting. ‘Thanks…Guy.’

‘You’re welcome…Jennifer.’

So they were to be on an equal footing. Fair enough. ‘What about you?’ Jennifer’s gaze slid to Guy’s bare arms. ‘Aren’t you freezing?’

‘I’ll go back and get Bill’s jacket in a minute. Let’s sort Digger out first.’

It wasn’t the first time Jennifer had gained the impression that this man was used to putting other people first. She felt a pang of remorse that she hadn’t enquired into his welfare before this. That blood on the leg of his jeans still looked remarkably fresh. If it had all come from Bill, why hadn’t it congealed and darkened by now? As soon as they made the pilot as comfortable as possible, she would make it her business to check Guy out properly. She’d need to do something about her own arm as well. Doctors really were the worst patients.

‘I don’t suppose you’ve got a foil sheet or something in that kit, do you? It would be good to get something between Digger and the ground.’

‘Sure.’ Guy handed back the bag of IV fluid but Jennifer didn’t want to stand and hold it.

‘Could you pass me some tape?’ She almost sighed at the now familiar look she received. ‘Please?’

Threading the tape through the hole at the top of the bag, Jennifer then looped long sticky sections in a figure of eight around the upper edge of the wingtip.

‘Bit fat for an IV pole but it’ll do the job.’

‘Good thinking.’ Guy held up two small packages. ‘Foil sheets.’

‘Great. Let’s get sorted, then.’

For the next ten minutes they were both kept busy. They wrapped Digger in the sheets to help prevent the loss of body heat. They used rocks to stabilise the cushioned seat back and got it into a position so that Digger was propped up to assist respiration but still tilted to his injured side. They also tucked him a little more closely into the windbreak provided by the bent wing. Hoping that the fluids were raising blood pressure enough to make it safe to administer some pain relief, Jennifer reached under the cover of the leather jacket to find Digger’s wrist.

She found her fingers grasped and saw a reminder of the cheeky grin she had noticed much earlier that day.

‘The lengths some people…have to go to…to get a pretty girl…to hold their hand!’

‘Hmm.’ Jennifer couldn’t help grinning. ‘You could have just asked! How’s the pain?’

‘Pretty…bad.’

The grin faded as she turned to Guy. ‘Much stronger pulse now. Do you want to draw up some morphine?’

‘OK.’ Guy’s gaze was fixed on Digger and for a split second Jennifer saw a level of concern in his eyes that was far more than a doctor would normally show for a patient. Even a patient who was a friend. There was a bond between these two men that made special care of Digger paramount and Jennifer found herself reaching for the stethoscope. While things appeared to be stable right now, this man had at least two potentially life-threatening injuries.

‘How’s the chest?’ Guy’s expression was nothing more than professional now as he drew sterile saline into a syringe to dilute the contents of the morphine ampoule.

‘Clear on the right. Still moving air on the left, but I think the breath sounds have diminished since the last time I listened. A pneumothorax is pretty likely, given those rib injuries. We’ll just have to keep our fingers crossed that it doesn’t tension.’

Their eyes met with only the briefest of looks. Enough to acknowledge just how quickly this scene could turn to custard. Enough to confirm that they would both be doing their best to manage any complications—and to succeed.

A thin stream of fluid sprayed from a needle tip as Guy removed the air bubble from the syringe. ‘I thought I’d do this in five-milligram increments,’ he announced. ‘If that’s all right with you, Dr Allen?’

‘Works for me, Dr Knight.’

The formal use of titles was more an agreement to work as equals than the previous form of a putdown, but Digger clearly didn’t approve.

‘Cut the “Doctor” bit,’ he growled. ‘Anyone would think…that I was…sick or something.’

The first dose of morphine dulled his pain but not sufficiently to make re-examination of his abdomen a pleasant experience.

‘Definite guarding in the left upper quadrant,’ Jennifer informed Guy.

‘Talk English,’ Digger growled.

‘You’ve got a sore gut,’ Guy told him.

‘Could have…told you that, son…What’s…broken, then?’

‘You might have dented your spleen. Possibly a bit of your liver. They could be cut and bleeding a bit.’

Jennifer eyed the bag of IV fluid. One litre was almost gone and they only had two more. If Digger did have an abdominal bleed from a laceration to either his spleen or liver, they would be in trouble before very long. She pulled the remnants of Digger’s woollen shirt back to cover him before tucking the leather jacket in place.

‘Thanks…Jenna.’

Jennifer’s gaze lifted sharply. ‘Why did you call me that?’

‘Don’t like…Jennifer. Too posh.’

The approving smirk on Guy’s face was hardly subtle. Jennifer just stared as he leaned towards the older man.

‘How’s your pain now, Digger?’

‘Bit better.’

‘On a scale of one to ten?’

‘Twelve.’

‘What was it before that dose of jungle juice?’

‘Twenty-five.’

‘Right.’ Guy shook his head. ‘Never one to conform, are you?’

‘Nope.’

‘And maybe Jennifer likes her posh name.’

She wasn’t going to stay silent while they reinforced their branding of her as some sort of outsider.

‘It’s not posh,’ she informed them loftily. ‘Neither am I.’

Guy’s snort of amusement was outrageous.

‘What—’ Jennifer demanded, ‘is that supposed to mean?’

‘Well, come on! You’re the epitome of “posh,”’ Guy shot back. ‘Nice hair, nice clothes, great education. Top job in one of the country’s leading hospitals. Good grief, you even chose to wear high heels and a suit to go out sightseeing.’

‘This isn’t a suit! Just a skirt and top…and jacket.’

‘Looks like a matching set to me. They’d be getting the lace doilies out in the Glenfalloch pub if you showed up looking like that.’

‘I have no intention of setting foot in the Glenfalloch pub—wherever that may be.’

‘It’s my local,’ Guy said casually. ‘The best pub in Central and about the only building of any note between where I live and Wanaka.’

‘It’s my local…too.’ Digger sounded drowsy. ‘I’d give my left arm for a…pint or two…right now.’ He opened his eyes enough to give Jennifer an appraising glance. ‘You’re right, though, son…she’s a looker…Reminds me…of Diana.’

‘I was referring to the image of a city slicker,’ Guy said. ‘Not dishing out compliments.’

‘Cheers,’ Jennifer murmured.

‘Not that you don’t deserve a compliment, of course.’ Guy finished injecting the second dose of morphine. ‘I just wouldn’t want you to think I was hitting on you.’

‘Perish the thought,’ Jennifer agreed drily.

She shook her head. What a bizarre conversation to be having, given the circumstances. Or perhaps it wasn’t. The three of them had been hurled into dealing with an appalling situation together. The more of a bond they could form, the more they could help each other survive. Already Jennifer felt very differently towards Digger than she would have if he’d been lying on a bed in her emergency department. And for a few seconds there she had actually forgotten they were crouched on a mountaintop with a tangle of crushed metal and two dead bodies nearby.

‘I don’t mind being called Jenna,’ she told Digger somewhat hesitantly. ‘It’s just that the only person who ever did was my dad and…’ Her voice was annoyingly wobbly. ‘And it just startled me a bit, I guess. My dad died not so long ago.’ She cleared her throat. ‘It’s time we hung a new bag of fluid, Guy. No.’ She scrambled to her feet. ‘I’ll get it. You need to go and find that jacket. You’re turning blue.’

‘OK. I’ll see what else I can salvage at the same time.’

‘Try the…side hatch.’ Digger had his eyes closed again but was looking a lot more comfortable. ‘There’s a few…camping supplies.’

Moving seemed to have the effect of lowering the temperature sharply. Body warmth was quickly lost as the surrounding chill seeped under the folds of Jennifer’s skirt and sneaked down the back of her neck. Her toes felt numb and her fingers fumbled as they tried to remove the tab protecting the port of the saline pouch and insert the spike of the giving set. She stopped for a moment to blow on her hands and rub them together.

Looking past the edge of the wingtip as she taped the new bag into place, Jennifer could see Guy picking his way around the tail of the plane wreckage some distance away. The bent wing that had snapped off the Cessna and was now sheltering Digger had left a gap that the small plane seemed to have folded itself into. Was that why those sitting in the middle had fared so much worse than the others?