Georgie's Big Greek Wedding?

Josh was methodical in his checking but that wasn’t surprising. It was a character trait attributable to most of the team—organised, meticulous and logical would describe almost all of them—and by the time they circled over the landing site in Tully Georgie was feeling confident that they would be able to work together comfortably.

She watched out of the window as Pat landed the chopper on the cricket oval. Tully had the highest annual rainfall in Queensland and light drizzle was falling as they climbed out of the helicopter and into the ambulance that was waiting to transport them to the hospital. Within minutes of landing they were walking into the tiny hospital.

The local doctor, who looked like he must only be just out of medical school, gave them a rundown on the patient’s condition as they followed him to her bedside. ‘Carrie is four months old but she was born eight weeks prem so her adjusted age is nine weeks. She’s of Aboriginal descent and this is her third admission for breathing difficulties. The first two admissions we managed to control her and discharge her home with her mum. This time we can’t get her oxygen sats up—they’re actually falling.’

They were at her bedside now and Georgie and Josh both glanced quickly at the monitors showing Carrie’s vital statistics. Her heart rate was 98 beats per minute, low for a baby, and her oxygenation was below 88 per cent. That was dangerously low. The medical staff had a tiny oxygen mask over Carrie’s mouth and nose but the baby was listless and her chest was barely moving on inspiration. She was only just breathing.

‘What were her oxygen sats when she came in?’ Josh asked.

‘Ninety two.’ Even that was low, and if they hadn’t been able to improve her saturation since she got to hospital Carrie was in trouble.

Josh checked the monitor again. Carrie’s vital signs were unchanged. ‘Right, we need to get some improvement in her vitals. We’ll have to intubate to see if we can get her oxygen levels up and we’ll have to take her with us back to Cairns. I’ll need a straight blade laryngoscope, size one, and a 4.0 endotracheal tube,’ Josh told her.

Georgie unzipped the medical kit she’d carried in with her. It included all the items they’d need for intubating an infant. As they’d had no way of knowing whether the hospital would have equipment that was small enough, it had been safest to bring it from the chopper. She passed Josh the items he’d requested and he deftly inserted the tube. Carrie was so sick she didn’t resist and the moment Josh was happy with his positioning Georgie taped the tube in place and attached the ambubag. She would need to manually squeeze the air into Carrie’s lungs and she’d need to do this all the way back to Cairns. But if it kept Carrie alive she was happy to do it.

As Georgie squeezed the air in they could see the baby’s chest rise and fall with each pump. It looked like Josh’s intubation had been millimetre perfect. She looked up from the infant and her gaze met his.

She was impressed with his skills—intubating a child of this age was no easy task. ‘Nice work,’ she said, and was rewarded with one of his heart-stopping smiles. He looked incredibly pleased with himself but not in an arrogant way. His grin was infectious and she had to smile back. Things were good. They’d succeeded. Carrie’s oxygen sats and heart rate were climbing. She was stable enough to transport back to Cairns in the chopper. They would manage to keep her alive and get her to specialist care. Their first job together had gone smoothly.

By the time they were ensconced back at the Cairns base after transferring Carrie to the Cairns Hospital, Georgie had almost forgotten it was Josh’s first day on the job. She’d ducked across to the Cairns airport terminal building to buy a drink and when she returned she could see Josh chatting to Louise in the comms centre. He was perched on the edge of the desk, one leg swinging lazily, looking quite at home.

Georgie walked slowly towards him, taking a moment to admire the view. His jumpsuit was undone and his grey T-shirt, the colour an identical match to his eyes, hugged his chest. She could imagine the ridge of his abdominals underneath that T-shirt. That image was burned into her memory from the day before. He was rolling a pen through his fingers and his biceps flexed with the movement, drawing her eye to his arms. She could remember how his arms had looked as he’d pulled himself through the water, the sunlight bouncing off his muscles as he’d swum out to the reef. He was an impressive sight.

She was within a few metres before he noticed her but when he looked up he greeted her with a smile. Even though Louise was sitting right beside him Georgie felt as though they were the only two in the building. How could he make her feel as though the rest of the world didn’t exist with just one smile?

She was vaguely aware of the phone ringing as she smiled back at him. She forced herself to watch Louise answer the telephone, forced herself to concentrate on what was going on around her.

Louise was scribbling details onto a notepad. ‘Male patient, early twenties, he’s fallen from the back of a moving vehicle, severe head and chest injuries, possible spinal injuries. He’s on a cattle station about a hundred kilometres south-west of here.’

Ten minutes later Georgie was back in the helicopter beside Josh. This time she’d deliberately chosen to leave an empty seat between them. She needed to concentrate. They needed to work out their priorities for when they reached their destination. The anticipated flight time was thirty to forty minutes and every one of those minutes would be spent making sure they had a plan of action so they could hit the ground running. A road ambulance was also on its way but travelling on dirt roads it would take closer to ninety minutes for it to reach the accident site. The QMERT team would be the first team on site. This would be Josh’s first primary and Georgie needed to make sure they both had a handle on what they might be facing.

Through the headsets she could hear Pat checking the co-ordinates. They’d flown over the rainforest hinterland and the landscape below them was vast, flat and brown. From this height even the trees appeared two-dimensional, flattening into the dirt. Landmarks were few are far between. Thousands upon thousands of empty miles stretched into the distance, broken only by the occasional hill or river. Homesteads blended into the surroundings and were almost impossible to find unless the sun reflected off a shiny tin roof. They were searching for a couple of isolated vehicles on an unmarked dirt road. A task that was near impossible without the right co-ordinates. It was vital that they find the scene of the accident as quickly as possible. Every minute counted.

Pat had established radio contact with the station hands at the accident site and Georgie heard the radio come to life as a voice, crackly with static, filled their headsets.

‘Is somebody there?’ Despite the static, Georgie could hear the tremor of panic underneath the words. The station hand continued. ‘He’s not breathing. What do we do?’

‘Can you feel a pulse?’ Josh was calm under pressure and Georgie relaxed as her confidence in Josh’s medical expertise grew. He hadn’t put a foot wrong so far.

The reply came back. ‘I think so,’ said the station hand.

Georgie glanced at Josh. A more definite response would have been good.

‘Can you get his mouth open?’ Josh continued to give instructions—keeping them busy would help to rein in any panic. ‘Check that he hasn’t vomited or that his tongue isn’t blocking his airway. If he’s vomited, you’ll have to try to clear his mouth.’

‘His mouth is clear but he’s still not breathing.’

‘Check his pulse again.’

‘I can’t feel it!’ They could hear panic through the radio.

‘You’ll have to start CPR,’ Josh said. ‘Does someone know how to do that?’ Despite the urgency of the situation his voice was still calm, his words and tone measured in an effort to decrease any further panic on the ground.

‘Yes.’

Pat’s voice came through the headsets. ‘I can see the vehicles. We’ll be on the ground in three minutes.’

‘We’re almost there,’ Georgie emphasised. If they could hear them, if they knew help was close at hand, that would buoy them up. ‘Can you hear the chopper?’

‘Yes.’

Pat circled the accident. He needed to check the landing site before he guided the chopper down to the ground. As they circled Georgie could see two station hands kneeling in the middle of the dirt track as they performed CPR. Shredded rubber from a blown-out tyre was scattered along the road. The trailer attached to the back of the utility had jackknifed and was resting at an angle. A second utility and a quad bike were standing guard further along the road.

Josh slid the chopper door open the moment Pat gave them the all-clear. Georgie followed him out, running in a crouch to avoid the downdraught from the blades. She carried a medical bag in one hand and an oxygen cylinder in the other. Red dust billowed around them, kicked up by the spinning blades of the chopper. Georgie squinted as she ran in a vain attempt to keep the dust out of her eyes.

As they reached the scene of the accident the two station hands performing CPR stopped, obviously believing that since reinforcements had arrived they weren’t required.

‘Can you help him? Please, you have to help him,’ said one.

‘We had a tyre blow-out and Gus was thrown from the back of the ute. I think he landed on his head,’ said the other.

‘Keep going with the chest compressions while we do a quick assessment,’ Josh instructed as he extracted a pair of thin surgical gloves from a pocket in his jumpsuit and pulled them on. ‘You’re doing fine. Keep going.’

Georgie also pulled on gloves, before kneeling in the red dirt beside Gus. He was lying on his back but there was a depression over his left temple and blood had seeped out of his ear. He must have landed on his head and hit the ground hard enough to fracture his skull. That was not a good start.

Josh was holding Gus’s wrist, feeling for a pulse. He looked at Georgie and shook his head. Nothing. He quickly checked inside Gus’s mouth, assessing the airway.

‘I’ll take over now,’ he told the station hands, and they didn’t argue about relinquishing their role.

Georgie worked with Josh, breathing through a face mask, breathing for Gus, but there was no change. During the flight they’d planned to establish an airway, make sure he had oxygen and get IV access. They hadn’t planned on resuscitating him.

Josh continued with chest compressions. Georgie continued breathing. There was no change. He still had no pulse.

‘I don’t think chest compressions are going to be enough,’ Georgie said. It had been more than three minutes and normal CPR procedure was getting them nowhere.

Josh nodded. ‘I’ll draw up adrenaline.’

On the assumption that doing something was better than nothing and knowing that chest compressions were more important than breathing, Georgie continued pumping Gus’s chest while Josh searched through the medical kit. He drew up a syringe and felt for a space between the ribs before he pierced the left side of Gus’s chest wall with the needle and depressed the plunger, injecting adrenaline directly into the heart muscle.

Georgie held her breath. Waiting. Her fingers on Gus’s carotid artery.

There was a flutter of a pulse.

‘We’ve got him.’

‘Get some oxygen into him.’

Georgie started breathing air into Gus again while Josh pulled an endotracheal tube and laryngoscope from the kit. It looked as though they’d be doing another intubation.

Georgie did two breaths. She had Gus’s head tipped back slightly and the fingers of her right hand were under his chin, resting over his carotid pulse. His pulse was barely evident. She stopped her breaths and shifted her fingers, searching for a stronger pulse. She couldn’t find it.

‘Josh, I’ve lost the pulse.’

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