Emergency At Inglewood

She nodded confidently. ‘That’s something I can do.’

‘Right. Quick test, then.’ Tim vaulted into the back of the ambulance, surprisingly lightly for such a big man. He tapped the sliding glass door of an overhead locker. ‘What’s in here?’

‘Straps for the scoop stretcher or backboard, hard hat, cervical collars, maternity kit and incontinence pads.’

Tim grinned. ‘Let’s hope we don’t need too many of those on your first day. And this one?’ He tapped another locker on the opposite side of the truck.

‘Dressings in three sizes, bandages—also in three sizes—saline pouches, triangular bandages and another hard hat.’

‘Where’s the IV gear?’

‘In the drawer under the life pack.’ Thoughts of Sean or fears of her private life being exposed were mercifully fading into oblivion. This was fun.

‘And?’

Taken aback, Kathryn frowned as her gaze raked the remaining storage spaces. ‘Well…the giving sets and pressure cuff and bags of saline are in that locker over there and…um…’

‘What happens if we need to put an IV line in when we’re not in the back of the truck?’

‘Oh-h.’ Kathryn rolled her eyes at her obvious omission. ‘There’s supplies of everything in the resuscitation kit.’

‘Good.’ Tim touched the large, tackle-type box with his foot. ‘We’ll go over the kit later. Are you familiar with this type of life pack?’

Kathryn nodded. ‘That’s what we’ve been using for training.’

‘You’re qualified to defibrillate manually, aren’t you?’

Her nod was a lot slower this time. ‘I haven’t done it for real yet. Only on dummies.’

Tim’s smile was quick. ‘We’ll try and make sure your first arrest patient isn’t too bright, then.’

Kathryn laughed but was disconcerted at the way Tim’s gaze veered instantly away from her face. A slightly awkward silence fell, which added to Kathryn’s confusion. This was like a roller-coaster. Whenever she felt that Tim was being friendly and they were establishing some kind of rapport, it got flicked off like a switch and that inexplicable tension was back again. Had she done the wrong thing by laughing at his joke? Why had he made one if she wasn’t supposed to find it funny?

Recognising that she was doing something wrong was a skill Kathryn was expert in, however. She cleared her throat.

‘It must be a pain, having to work with someone like me.’

‘What?’ Tim snapped the battery he was checking back into its slot in the life pack.

‘I mean, I must seem a bit of a liability when you’re used to working with someone as qualified as your last partner. Laura, was it?’

Tim nodded. ‘Laura Green. Now Laura Halliday.’

‘Halliday? Wasn’t that the name of one of the firemen?’

Tim nodded again. ‘Jason. He and Laura got married a few months ago. She’s taking maternity leave now.’

‘Oh.’ Kathryn knew her smile was probably wistful. ‘That’s nice.’

‘Yeah.’ Tim clipped the safety belt that held the life pack in position. ‘She thinks so.’ He looked directly at Kathryn. ‘I hope I’m not giving the impression that I’m not happy to work with you. It’s actually a bit of a treat, getting a probationary officer with your qualifications. I was expecting somebody as green as grass, which can make life a bit difficult for a while.’

‘I’m still green,’ Kathryn warned. ‘As I said, it’s been years since I worked in Emergency and all the pre-hospital emergency medicine I’ve learned over the last few months is still just theory.’

‘You’ve done third crewing, though, haven’t you?’

‘It’s not the same when you’ve got people walking you through stuff. It’s a big step being out on the road as a qualified officer.’

‘You’ll learn soon enough,’ Tim assured her. His eyebrows rose as their pagers sounded simultaneously. ‘Perhaps even sooner than I thought. All set?’

‘As long as I don’t have to defibrillate someone on my first job.’ Kathryn’s smile was rather shaky as she climbed up into the passenger seat of the ambulance. Any concerns over the difficulty she was having breaking the ice with Tim fled into the same space Sean was now occupying.

Her pager informed her that this job was a P1 and it was already as nerve-racking as she had feared.

The switch to change the wail of the siren to a shorter yelp for additional warning at intersections was just above Tim’s head. He left it on yelp and added a blast on the air horn for good measure when a courier van driver decided he could scoot past the other traffic already slowing obediently to give the emergency vehicle right of way. The driver’s non-verbal sign that he wasn’t impressed with being reprimanded drew a disgusted snort from Tim and a squeak from his new partner.

‘Can you believe that guy?’

‘Believe anything if it’s a courier van,’ Tim growled. ‘Or a taxi. Or one of those little granny wagon boxes on wheels.’ He could see Kathryn’s hand shaking slightly as she tried to find the address they’d been given on the map. ‘Don’t worry,’ he said shortly. ‘I know where it is.’

His mood slipped another notch or two as he heard his tone. He should be giving Kathryn some encouragement, not making her feel as though he couldn’t be bothered with any incompetence. This was her first day on the job, for heaven’s sake, and as far as potential partners went he had probably scooped the pick of the latest intake. It would be nice to blame his uncharacteristic ill humour on the idiocy of courier van drivers but, sadly, Tim knew that he had been thrown off his usual even keel well before that.

About the time Kathryn Mercer had walked into the garage at Inglewood station this morning, in fact.

He must have looked like more of an idiot than a courier van driver with his mouth hanging open, but seeing Kathryn had been a shock to say the least. She was supposed to be firmly in the realms of fantasy now. Locked away like an attractive movie star. Perfect but totally unattainable. She wasn’t supposed to walk into his life like that. How the hell could he be expected to work with someone he shouldn’t have been thinking about in the kind of terms he had been?

Tim accelerated hard as he took a bend into a straight stretch of the main road leading to the Hutt Valley. Weaving in and out of the traffic didn’t allow him time for more than a split-second glance at Kathryn but it was enough to absorb the impression of a white face and fingernails buried in the unforgiving upholstery of her seat. She was being thrown in the deep end here and Tim didn’t like the tiny flash of satisfaction it gave him.

He was in control again and it felt like the first time since the sight of her diminutive figure in its smart new uniform had assaulted his senses. He had been the one out of his depth then, and he had really thought he’d been drowning when she’d said she’d been disappointed he hadn’t kept his promise to ring her.

It should have been easy to lie and say the number scribbled on that empty syringe packet had been mislaid, or that they just got incredibly busy and he had forgotten. But he hadn’t forgotten, had he? That moment of panic when he’d thought he’d lost the damn packet, the relief with which he’d fished it out of his pocket, and then the crushing disappointment as Laura had pointed out that both Kathryn and her dinner partner had been wearing wedding rings were burned into his memory with astonishing clarity.

The woman of his dreams, he’d confessed to Laura. And he’d been too late. Someone had got there first and claimed the kind of commitment that was sacrosanct as far as Tim was concerned. He should have been able to put any attraction in the rubbish along with that phone number, but that had proved impossible. As impossible as sounding casual enough to make a lie convincing.

It might have been OK if he’d had a little warning, but the change in Laura’s replacement had only been decided that morning and Kathryn had arrived before he’d had time to collect any messages. He had still been trying to come to terms with the fact that he would be working closely with Kathryn for the next six months when she’d reminded him of precisely why that was going to be so awkward.

Tim pushed his foot down on the brake and Kathryn shot forward into the clutch of her safety belt.

‘This is Rawlston Street. What number do we want?’

Kathryn sat back and fumbled for her pager.

‘You should write that information on the case report form as soon as we get a call,’ Tim told her. ‘You can’t afford to waste any time if it’s an emergency response.’

‘Sorry.’ Kathryn was pushing the button on her pager. ‘It’s number 257 and it says ‘‘Fresh’’.’

‘Fresh Is Best. It’s a supermarket up the end of the road.’ Tim turned off the siren but left the beacons flashing as he slowed the ambulance. ‘It’s a chest pain,’ he reminded Kathryn, ‘so we’ll take everything. Throw the life pack onto the stretcher along with the oxygen and suction kit. I’ll get the kit. Let’s move.’

CHAPTER TWO

ANXIOUS-LOOKING people wearing hats and white aprons over striped uniforms were waiting. Tim jumped out from the driver’s seat and strode to the back to open the doors. Kathryn stayed inside the vehicle, sliding between the front seats into the back and struggling to unclip the safety belt on the life pack quickly. She could hear snatches of the information Tim was being given.

‘Lifting sacks of flour. They’re as heavy as…’

‘Looks awful. All grey and sweaty…’

‘Fifty-six. Never had a sick day in his…’

By the time Kathryn had the life pack on top of the stretcher, Tim had added all the other equipment they needed, unhooked the end of the stretcher and was pulling it free. Kathryn made a lunge to catch the handle on her end so it wouldn’t crash down the steps. Then she had to trot to keep up.

Their patient did look awful. The middle-aged man was slumped against a wall near the massive ovens in the supermarket bakery.

‘Get some oxygen on him,’ Tim instructed Kathryn. ‘Fifteen litres a minute with a non-rebreather mask.’

An easy enough task. Kathryn unzipped the pouch attached to the portable oxygen cylinder and ripped open a plastic bag containing a mask, only to find it was a standard acute mask. She reached into the bag again and this time found the one with the reservoir bag attached. She hooked it up to the cylinder and remembered to keep her finger over the hole at the base of the mask until the reservoir bag was full.

Tim had cut away the apron and uniform shirt of the man and was attaching the sticky electrodes on the ends of the life-pack leads.

‘Have you got any history of heart problems?’

Their patient couldn’t speak. Clearly in agonising pain, he clutched his chest and shook his head as he moaned incoherently.

Kathryn moved closer. ‘I’m just going to put a mask on your face, sir,’ she said. ‘Is that OK?’

Patient consent was not forthcoming but Kathryn found her nervousness vanishing as she touched the man. She could do this. Without being told, she picked up the blood-pressure cuff and wrapped it round the man’s arm. She listened with a stethoscope as she let the pressure in the cuff down but could hear nothing. Frowning, she caught Tim’s gaze as he reached into the kit for a tourniquet.

‘Unrecordable?’ Tim mirrored Kathryn’s quick nod. ‘I’m not surprised. I couldn’t get a radial pulse.’

That meant the man’s systolic blood pressure was less than 80. Kathryn looked at the screen of the life pack and felt a chill of premonition. The trace looked far from normal with the spike of the QRS bizarrely wide.

‘Complete heart block,’ Tim said quietly. ‘Draw me up a flush, would you, please, Kathryn? And give him an aspirin.’

Kathryn found her brain was moving far more quickly than her hands. Her fingers shook as she followed Tim’s calm directions but she managed to draw up the morphine and other drugs he requested. There was no time to do anything more than absorb the impression of urgency after that as bakery staff helped get the man onto the stretcher and load him and the gear into the ambulance. Within a matter of minutes Kathryn found herself driving the ambulance towards the hospital with Tim in the back, caring for a very sick cardiac patient.

Driving such a large, heavy vehicle had been a challenge in itself during her training and it would be months before Kathryn would be allowed to drive under lights and sirens, but she was confident enough at road speed and far happier leaving Tim to care for the patient this time.

By the time they got back to the main road she was almost enjoying herself. Her first job with Tim had gone well, all things considered. Maybe she had been a bit slow drawing up the morphine and adding the saline, but she just wasn’t used to doing things under such pressure of time. She’d get used to it soon enough. Pulling out the wrong oxygen mask had wasted valuable seconds, though. She’d have to—

‘Pull over!’ The shout from the back cut through any satisfaction enveloping Kathryn.

She checked the side mirrors and indicated that she was pulling onto the shoulder of the road.

‘Now, Kat!’

She jammed on the brakes and heard a curse from Tim as he had to catch his balance.

‘Get in the back,’ Tim said tersely, as he reached for the radio microphone. ‘Get the gel pads and charge up the defib. He’s in VF.’

Oh…God! This was her worst nightmare. Her first job and she was expected to defibrillate someone. Kathryn could feel the prickle of perspiration break out down the entire length of her spine as she ripped open the foil packet and slapped two rectangles of spongy orange material onto the patient’s chest.

‘Charge it,’ Tim snapped as a response to his radio signal came through. ‘We need back-up,’ he told the control room. ‘VF arrest.’ He was watching Kathryn as he spoke.

She held a paddle in each hand. The crescendo of sound that depressing the charge button had elicited stopped with a loud beep. The paddles were charged.

‘Do it,’ Tim commanded.

Kathryn pressed the paddles onto the gel pads. She remembered to move so that her legs were not touching the metal sides of the stretcher. A flash of some horror story of an ambulance officer giving himself a nasty shock surfaced.

‘I’m clear,’ she said shakily. ‘Are you?’

‘Just do it, Kat!’

She pressed her thumbs down hard on the buttons. The man jerked and his arm flopped over the side of the stretcher to hit her leg. Kathryn lifted the paddles hurriedly, too horrified to look at the screen behind her.

‘Charge again,’ Tim ordered.

The sound started to crescendo again. Kathryn’s clutch on the paddle handles felt slippery so she tightened her grip. Two shocks at 200 joules, she reminded herself. Then one at 360. Then CPR. She pressed the paddles into position.

‘Wait!’ Tim shouted. ‘Look at the screen.’

Kathryn’s head jerked up. A rapid but normal cardiac rhythm was evident. And here she was with charged-up paddles pressed onto the patient’s chest. She lifted them and her jaw dropped. The only thing she could remember was how dangerous it was to discharge a shock into the air. She couldn’t catch Tim’s eye, though, as he was leaning past her. Hitting a button on the centre of the menu control dial…emptying the charge safely from the paddles.

He was talking into the microphone at the same time. ‘Cancel the back-up,’ he told Control. ‘My partner has just saved our patient.’

Kathryn’s jaw dropped even further. Was he serious?

‘You can put those down now,’ Tim said. Then he grinned. ‘So, how does it feel to save a life, then?’

‘I…ah…’ Kathryn was totally lost for words. She looked at the patient who was actually moving his head and groaning. She looked at the life-pack screen, which still showed a rapid, steady sinus rhythm. Then she looked at Tim and couldn’t help the grin that broke out.

‘Now, let’s see how fast you can get us into hospital,’ Tim said. ‘Use the lights and siren.’

‘But I’m not allowed—’

‘Just do it, Kat. This man’s not exactly stable yet. Or would you rather stay in the back with him?’

Kathryn drove. She could see the reflection of the flashing beacons on the windows of vehicles she shot past. She found the wail of the siren became just a background as she concentrated hard on getting through the traffic. She even remembered to use the yelp switch at intersections. And she backed up to the loading ramp at the emergency department and managed to stop with only a gentle bump against the edge.

The resus team staff were waiting. Kathryn leapt out, opened the back doors and unhooked the foot end of the stretcher. Their patient was still hooked up to the life pack and oxygen as they wheeled him inside. He was sitting up now, though, and Kathryn couldn’t believe it when he smiled at her.

‘Thanks, love,’ he said. ‘I’m feeling a hell of a lot better now.’

So was Kathryn. The worst had happened and she had coped. Her first job and she had saved a life. They had saved a life. Kathryn’s smile when Tim came out to help her clean up the truck was wide enough to let him know just how incredible the experience had been. She had been so right in fighting for the chance to do this job, and right now she was so happy it was all she could do not to throw herself into Tim’s arms and dance along the loading ramp of the ambulance bay.

She was positively beaming at him. Tim had taken a few minutes to complete the paperwork inside so Kathryn had gone out to start the clean-up alone. And here she was, lit up like the happiest Christmas tree ever. Tim could understand how she felt. He could remember the first time he successfully defibrillated someone and the amazing satisfaction in getting them back. It didn’t happen nearly often enough, and Kathryn was looking at him as though he’d arranged all this as a special gift to mark her first day at work.

Good grief. She looked as though she might actually give him a hug or a kiss or something. Tim stepped back hurriedly. Fantasy was much safer. He’d never factored in that electric current that Kathryn seemed to generate around herself. He had remembered her looks well enough—the colour and curl of her blond hair, the cute upturned nose, the wide blue eyes with that hint of anxiety. He hadn’t seen her smile during that first encounter, however, and that seemed to be what was generating the current.

‘All done?’

‘Almost.’ Kathryn bit her lip, clearly trying to control her smile. ‘He thanked me, Tim, can you believe that? He looked dead only a few minutes ago and there he was sitting up and saying thank you.’

‘You did a great job,’ Tim said warmly. ‘Well done.’

‘We saved someone, didn’t we, Tim?’ Kathryn gave a tiny wriggle, like an overjoyed puppy. ‘We really saved someone.’

‘Yeah.’ Tim couldn’t prevent his own grin. ‘Don’t expect me to lay on a case like that every day, though. Consider it a ‘‘welcome to Inglewood’’ job.’ Grabbing the pile of dirty linen from the floor, he turned away. What was he saying? He didn’t want to welcome Kathryn to Inglewood.

What he really wanted was to ring the ambulance training manager and request a transfer of his probationary assistant. Yeah…right. Tim snorted as he shoved the linen into the bag inside the emergency department doors. Kathryn was lacking in confidence quite enough. He could never be so cruel as to let her think she wasn’t up to scratch as far as he was concerned.

What could he say, anyway? Sorry, but I really fancy this chick and she’s married to someone else so it’s kind of like letting a starving man look at a roast dinner in a glass box?

Besides, whatever else it had stirred up, the case had broken the ice. They were given a transfer job next, to take a patient from the emergency department to a convalescent ward in a small rural hospital well north of Wellington. It was over an hour’s drive and Kathryn sat in the back with the elderly female patient on the way there. Tim could hear her chatting happily to the woman, who was remarkably fit, considering her age was well into her nineties, and he smiled more than once as he indulged in a spot of shameless eavesdropping. Having a partner who could establish an easy rapport with a patient was a real bonus. There was nothing worse than a long trip with a totally silent set of passengers. The turn of the conversation in the back as they neared their destination made him listen even more carefully.

‘So Bill was your third husband?’

‘They say it’s third time lucky, dear, and in my case it was absolutely right.’

‘So what happened to your other husbands?’

‘The first one ran off with the wife of one of his customers. He sold cars, you know. That was in 1935 and it was a complete scandal. I was far too ashamed to try and get a divorce. It just wasn’t done in those days.’

‘So how did you manage to marry husband number two?’

‘Charlie got himself run over. In his own car yard, would you believe?’

‘That was considerate.’ Tim could hear the grin in Kathryn’s voice.

‘I thought so. Mind you, then I married Stanley and he didn’t turn out to be a good choice. He hit the bottle rather hard, if you know what I mean. Then he went and got himself killed in the Second World War. It was quite a while before I was tempted to try again but Bill and I had forty wonderful years together. Are you married, dear?’

‘Yes.’

‘Your first husband?’

Kathryn laughed. ‘Yes.’

‘How long have you been married?’

‘Five years.’

‘You look happy enough so I guess you chose the right one.’

‘I guess I did.’

Suddenly Tim didn’t feel very interested in eavesdropping any further. He turned on the radio and changed stations to find some music that wouldn’t offend their patient. Kathryn also seemed inclined to change the subject. Tim could see her on her feet, keeping one hand on a locker handle to keep her balance as she made her patient more comfortable by adjusting her pillow.

‘Would you like another blanket, Mrs Ramsey?’

‘I’m quite warm enough, thank you, dear. We must be almost there by now, mustn’t we?’

‘I think so.’ Kathryn leaned forward, poking her head into the front compartment. ‘How much further is it, Tim?’

‘Only another five or ten minutes. It’s a nice little hospital. They usually give us a cup of tea before we have to head back.’

Tim insisted on driving back to the city as well. Having something to concentrate on besides his new partner was definitely in order. Keeping the conversation strictly professional also seemed a good idea.

‘Any questions you want to ask? About this morning’s job?’

‘Yes.’ Kathryn sounded eager. ‘You said the patient was in complete heart block. I’m comfortable with recognising the shockable rhythms but it was a very condensed ECG course and I’m ashamed to say a lot of it went over my head.’

‘You can’t be expected to know everything. You’ve got a far better knowledge base than most probationary ambulance officers. You’ll find you pick up a lot on the job and you’ll have more classroom time coming up as well.’

Tim glanced in Kathryn’s direction as he finished speaking, to find her gaze fixed on his face and her eyebrows raised expectantly. She wanted to hear more than reassurance. Tim smiled as he looked ahead at the long, quiet road winding through hills dotted with sheep like mushrooms.

‘Complete heart block is third-degree heart block and it’s where the atrial contraction is normal but no beats are conducted to the ventricles.’

‘So that’s why the rate was so slow? It was a ventricular escape rhythm?’

‘Yes. And if you look at the trace you’ll find p waves that have no relationship to the QRS spikes.’

‘We’ve got a copy of that trace, haven’t we?’

‘It’s rolled up and in with the case report forms.’

Kathryn opened the box compartment of the metal clipboard the forms were attached to. She soon had several metres of trace paper uncurled over her knees, examining the recording that covered the various heart rhythms their case had presented.

‘Look, that’s where we defibrillated him! Ventricular fibrillation and straight back into sinus rhythm.’ Kathryn sighed happily. ‘Wasn’t it great?’