Surgeon on Call
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Alison Roberts
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10
CHAPTER ONE
SEVEN-THIRTY a.m.
Far too early to be starting work. A job like this might be OK in summer but below zero temperatures weren’t much fun. Not when the first rays of sunshine only made up for their lack of warmth by the uncomfortably blinding glare they could produce. Jeff Simms shaded his eyes from the glare with his hand. He could see the group of men congregating around the prefabricated shed that served as headquarters for the building site. He could also see his mate, Lou, climbing out of Tommo’s truck just ahead of him.
At least they’d made it to work on time today. The boss should be looking a lot happier than he appeared to be. Maybe he hadn’t had his coffee yet. The thought of coffee was enticing. Jeff and Lou had downed quite a few beers during their session at the pub last night.
‘Hey!’
‘How’s it going, mate?’ Jeff grinned at Lou.
‘Have you spoken to the boss yet?’
‘No. I just got here. Bloody cold, eh?’ Jeff blew on his knuckles and rubbed his hands together vigorously.
‘Tommo reckons you’re in trouble, mate.’
‘What for?’ Jeff caught Lou’s eye. Maybe they shouldn’t have taken off to the pub yesterday with such alacrity.
‘Boss couldn’t find his skill saw last night,’ Tommo reported gloomily. ‘He reckons you’d been using it.’
‘I was,’ Jeff admitted. ‘I had to go up and tidy that framing on the second floor.’
‘Where’d you put the saw, then?’
Jeff’s gaze roamed the scaffolding on the apartment block. He traced the route on the corner that he’d used to climb down from the wooden planks, trying to remember just what he had been carrying. The oath that escaped his lips was enough to impress even Tommo.
‘It’s still up there.’
Tommo unleashed an even better oath. ‘It’ll be frozen solid. Man, are you in trouble!’
‘It’ll still be dry. I put it under a tarpaulin. That’s why I forgot about it. I’ll go and get it now.’
‘You can’t.’ Lou shook his head. ‘Scaffolding’s out of bounds until it thaws. The boss’ll go mental if he sees you.’
‘He won’t see me. It’s on the road side. I’ll be quick.’
‘You’d better be careful, mate.’ Lou sounded doubtful. ‘It’s solid ice up there.’
* * *
Seven thirty-five a.m.
It was just as well he’d set off this early. Joe Petersen drummed his fingers on the steering-wheel as he waited in the line of traffic for the lights to change. He needed to get right across town and it was going to take a long time at this rate. He’d promised to be there at 8 a.m. to help get the kids off to school and then take Samantha to kindergarten for the morning. Dayna wouldn’t be very impressed if he arrived late, and he wasn’t about to give her any new ammunition regarding his lack of elementary parenting skills.
Joe glanced sideways to give his eyes a rest from the glare of the rising sun. The building site to his left was impressively large. This part of Christchurch city had changed beyond recognition since he’d last driven past but that was hardly surprising. It had been nearly five years since he’d had a visit lasting more than a few days. The trend seemed to be towards building these large inner-city apartment blocks now and this one looked fairly upmarket. Joe’s idle gaze roamed the side of the well-formed building. He could see the ice coating the scaffolding. Cold job, being a builder at this time of year. He wondered idly what the young chap was doing, scrambling up the side of the steel skeleton. He seemed to be in rather a hurry.
The toot from behind indicated that Joe’s attention should be back on the traffic. He slid the car back into gear but the movement he caught in his peripheral vision jerked his gaze back to the left. Had the lad’s foot slipped on that wooden platform? He’d managed to catch hold of one of the steel pipes but the grip held only momentarily. Joe watched the fall with horror. He could almost feel the impact as the victim’s back contacted the next steel bar several feet below before the graceful arc that completed the fall.
The sensation of horror was dismissed instantly and replaced with a clinical detachment. The impact mid-fall had been enough to cause a lumbar spinal injury. The distraction to the cervical vertebrae which the impact of landing on his head might have caused was even more serious. Joe pulled his steering-wheel decisively and put his foot down on the accelerator to gain just enough momentum for the wheels to mount the kerb. He pushed the hazard light control on the dashboard.
* * *
Seven thirty-eight a.m.
Felicity Munroe shaded her eyes from the glare of the sun. It was hard to see what was going on ahead but the traffic appeared to be even slower than normal for this time of day. At least she wasn’t too far from the hospital now. With a bit of luck she could still make the 8 a.m. meeting with members of the cardiology department. The interface between Cardiology and Emergency needed some urgent attention. Only yesterday they’d had a patient with a major heart attack taking an unacceptable length of time to clear the emergency department.
Her scrutiny revealed the cause of the hold-up. A car had pulled off the road onto the footpath but was still creating enough of an obstacle to cause problems. The vehicle’s hazard lights were flashing and a man was attempting to get out on the driver’s side. Passing traffic was making this difficult, however, and the man was being subjected to irate blasts of car horns as he tried to open his door.
Traffic ground to a complete halt again with one car close enough to provide an impassable barrier to the man in the stalled vehicle. Felicity could see him moving to exit from the passenger side with some urgency. Her own car was still well away from the disruption, level with the entrance to a building site on her left. Felicity glanced sideways briefly, hoping to distract herself from a mounting irritation with the delay. She’d been watching the huge apartment block take shape for months now and the site looked busy again this morning. Extraordinarily busy, in fact. There were people running from all directions. Felicity’s casual glance focused on the scene sharply. On the supine figure that the men were running towards.
The wisdom gleaned from years of experience was not needed to let Felicity know that a significant incident had occurred. It took only a second to ease her vehicle from the line of traffic and cruise onto the building site. A few seconds more and she was at the side of the victim. She could see that the young man was conscious and breathing. She picked up his wrist to check the radial pulse as she crouched down beside him.
‘Can anyone tell me what’s happened?’
‘Don’t touch that man! Stand back!’
The command was vehement enough to distract Felicity from her visual examination of her patient. The sharp tone made the man crouching beside her stand up hurriedly, stunning him into silence, though he had barely begun to answer Felicity’s query.
‘I’m sure you all have the best intentions,’ the man told the group. ‘But people who don’t know what they’re doing can actually do more harm than good in a situation like this. I’m a doctor,’ he continued. ‘And I witnessed the accident.’ He glared at Felicity, his gaze flicking over her well-dressed slight figure dismissively. ‘You haven’t tried to move him, have you?’
‘Of course not.’ Felicity might not have witnessed the accident at first hand but it didn’t take much common sense to realise that someone lying motionless beneath scaffolding could well have suffered a significant fall. And it didn’t take anything like her training to suggest that such a fall carried a high index of suspicion of a spinal injury. Felicity opened her mouth to inform this man that as an emergency department consultant she was hardly likely to risk an exacerbation of such an injury by moving an unstabilised patient. She was also tempted to say something snappy regarding the assumptions this man had clearly made based on what she looked like. What did he think she did for a job? Work as a beauty therapist perhaps? Not that she was given a chance to say anything at all.
‘Move over here.’ The stranger draped the stethoscope he was holding around his neck with a casual movement that suggested long familiarity. ‘You can do something useful and hold this chap’s head still. It’s very important that he doesn’t move his neck.’
Felicity surprised herself by doing as she was asked. Or, rather, told. There was something about this man’s attitude that indicated it wouldn’t be in anyone’s best interests to get in his way right now and it certainly wasn’t an appropriate time to voice her resentment at the way he was treating her. Felicity took a mental step backwards. She would only intervene if she needed to and so far she had no complaints.
The doctor had gently moved the young man’s head and neck into a neutral position. As soon as Felicity’s hands took over providing support he conducted a rapid examination of the head and neck. Felicity relaxed a little as she noted that his movements appeared to indicate that he knew what he was doing. From the gentle palpation of the front of the neck he was clearly checking for tracheal deviation. As he carefully felt the back of the victim’s neck, the young man groaned and Felicity watched the doctor’s face register a focused concern.
‘I need some sandbags,’ he stated. ‘Or cushions. Or some rolled-up clothing. Anything. We need to pad the neck to protect it. And someone call an ambulance.’ He leaned over his patient, seemingly oblivious to how close this brought his face to Felicity’s. ‘What’s your name?’ he queried briskly.
‘Jeff.’
‘I’m Joe. Joe Petersen. I’m a neurosurgeon.’
Felicity blinked. Perhaps the stranger was more qualified to deal with a spinal injury than she was. The fact that she’d never heard the name associated with the specialised spinal injuries unit on the other side of town didn’t mean he wasn’t an expert. He could be visiting from overseas. His deep voice did have the hint of an unusual accent.
‘I can’t feel my legs.’ Jeff’s words held an edge of panic. ‘Am I going to be paralysed?’
‘Are you having any trouble breathing?’
‘No.’
Felicity tightened her grip at the attempt to shake his head. ‘Keep very still, Jeff,’ she told him. ‘It’s important.’
‘He hasn’t told me.’ Jeff caught Felicity’s gaze. ‘I want to know how bad this is.’
‘We don’t know yet.’ Joe placed the earpieces of his stethoscope into position. He pulled up the thick jersey Jeff was wearing. ‘I’m just going to listen to your chest.’
Felicity could feel the slower than normal heart rate under her fingertips. She considered suggesting that neurogenic shock could be producing a bradycardia as she watched Joe conduct a rapid assessment of Jeff’s chest, abdomen and pelvic area. He pressed his hands on each side of Jeff’s hips to check the stability of the pelvis. Glancing up, he noticed Felicity’s studied gaze.
‘I’m looking for what we call ‘‘silent’’ lesions,’ he informed her. ‘Injuries, that is.’
Felicity kept her face neutral. She was perfectly well aware what lesions were. It was quite interesting, being treated as a layperson. Or it would have been if this man’s tone didn’t suggest that her level of intelligence might not be up to scratch. She decided not to raise the subject of neurogenic shock.
‘If there’s a significant level of paralysis then injuries could be hidden.’ Joe was palpating Jeff’s abdomen with obvious skill. ‘That means they won’t be causing any pain. I’m particularly concerned with a chest injury that might affect breathing or something that could cause internal bleeding. Can you feel me touching you, Jeff?’
‘No, I can’t feel anything. Have I broken my back?’
‘You’ve certainly injured your spine.’ The assessment for major associated injuries had taken less than a minute. Joe moved swiftly into a neurological check that Felicity could also make no complaints about.
‘Can you move your hands, Jeff?’
‘I think so.’ Jeff’s fingers wiggled weakly. ‘They feel weird, though.’
‘What sort of weird?’
‘Kind of pins and needles.’
‘Can you feel me touching them?’ Joe went from a light touch to a distinct pinch before Jeff responded.
‘Kind of.’
‘Which finger am I touching?’ Joe was pinching Jeff’s thumb.
‘I’m not sure. The middle one?’
Felicity saw the frown of concentration as Joe assimilated the information of lowered sensation. He took hold of Jeff’s hands. ‘Squeeze my hands,’ he ordered. ‘As hard as you can.’
The pulses on both wrists were checked and then Joe moved to check Jeff’s legs. As he elicited the assistance of Jeff’s friend, Lou, to remove the laces of the steel-capped boots and ease the heavy footwear clear, Felicity found she was still focused on Joe Petersen’s face. It was a very intelligent face with rugged features and dark brown eyes that seemed almost grim in their intensity. Straight brown hair revealed distinct auburn tints as the early morning sunshine bathed the group of people. What a strange thing to notice at a time like this, Felicity thought. She transferred her gaze to the knot of anxious-faced men surrounding them. They were still standing well back, except for one younger man who pushed through the group.
‘I’ve found some sandbags.’
‘Good for you, Tommo.’ The men made way for him.
‘Excellent,’ Joe added. ‘Well done.’ Felicity noticed the pleased expression on the young man’s face as Joe rose swiftly from his crouched position. Joe clearly had the ability to lead people. Tommo’s face became eager.
‘Where would you like me to put the bags?’
‘Give them to me,’ Joe ordered. ‘I need to put them in exactly the right place.’
Felicity saw the disappointment that accompanied the handover of the sandbags. Joe Petersen might have leadership qualities but he would never hold the loyalty of the people he led if he dismissed their potential so abruptly. There wasn’t anything highly technical about the placement of support materials for a neck and head. Tommo could easily have been directed to accomplish the task. He would have had the satisfaction of knowing he was really helping and Joe would have had a loyal assistant for anything else he might require. The sandbags were cold against Felicity’s hands as Joe snuggled them along the side of Jeff’s head.
‘Don’t let go of his head,’ Joe instructed her firmly. ‘These supports will help but they’re not enough. You’re doing a great job,’ he added.
It was the first direct eye contact Felicity had had with this man. It was also the first appreciative comment. She noted that the dark brown eyes were rather attractive but she couldn’t detect any hint of personal warmth being directed at her. In fact, in the few minutes so far of his management of this incident, Felicity had not seen even a hint of a smile. Joe was focused on this task with an intensity that was definitely grim. The people around him were merely tools. His praise of Felicity’s ability to stabilise his patient’s head and his appreciation of Tommo’s success in locating sandbags was automatic, an acknowledgment that they had both performed as he had expected. How totally ridiculous that she should feel as pleased by the acknowledgement as Tommo had been.
Felicity gave herself a mental shake. She could hear the wail of the approaching siren advertising the imminent arrival of the ambulance service. The emergency vehicle was likely to be crewed by paramedics who would know who she was. It was going to be extremely interesting to see how Joe reacted to finding out her qualifications. Felicity was also curious to observe how he would relate to the ambulance officers. Doctors who had no direct contact with the service were sometimes inclined towards an arrogant assumption that the paramedics were no more than drivers. Given Joe’s treatment of the people around him so far, Felicity would be surprised if he gave the paramedics any credit for the skills she knew they possessed.
The first surprise came when Joe stood up to greet Stanley Ferris, the paramedic leading the crew.
‘I’m Joe Petersen. I’m a neurosurgeon,’ Joe told Stanley crisply. ‘This is Jeff. He’s nineteen years old and has fallen approximately fifteen metres from this scaffolding.’
Stanley glanced up at the platform well above them as he took in the mechanism of injury.
‘He hit a rail about halfway down which caught his back in the lumbar region. Then he landed on his head, causing a distraction injury to his neck. He wasn’t KO’d and his GCS has remained at 15.’ Joe cast a brief glance at the second ambulance officer. ‘Can you get a cervical collar on Jeff? Thanks. And some oxygen. A high-concentration mask.’ His attention turned back to Stanley.
‘Jeff has pain at C5 to C7 and I’d query an increased interspinous gap. He has a moderate contusion in the occipital area. He has paralysis to both legs and paraesthesia and paresis in both arms and hands. Chest and abdomen are clear, breathing is diaphragmatic. He’s bradycardic at 55 and I’m concerned about hypothermia. This ground is frozen solid and it’s been nearly ten minutes since the accident.’
Felicity watched as Stanley nodded to show he had absorbed the information. She was impressed at Joe’s professional summary of their patient’s condition, but she was even more impressed at his attitude towards Stanley. Assuming he now had assistance of medical merit, Joe was treating the paramedic as a colleague and an intelligent one at that.
‘We need some blankets,’ Joe continued. ‘A foil sheet if you have one. Jeff will be poikilothermic with a spinal injury.’
Felicity’s raised eyebrow mirrored Stanley’s expression. Perhaps Joe wasn’t treating Stanley as a colleague after all. Did the paramedic know that poikilothermic meant that a body would assume the temperature of the environment? Maybe Joe was deliberately using terms even medical staff might not recognise easily in order to show superiority and demonstrate his command of the situation.
‘We need to get him off the ground as quickly as possible,’ Joe continued. ‘Do you carry backboards or scoop stretchers?’
‘Both.’ Stanley’s glance at Jeff’s position made him notice Felicity for the first time. His eyes widened dramatically. Felicity’s smile was intended to indicate that this wasn’t the moment for Stanley to be distracted by her presence, and the paramedic took the hint with his customary astuteness. ‘A scoop stretcher will let us pick him up with minimal disruption but they are cold. If we log-roll him onto a backboard it would also give you the chance to check his lower back.’
‘What’s going to be quicker?’
‘Probably the scoop.’
‘We’ll do that, then.’ Joe watched as Stanley and his partner, Ray, introduced themselves to Jeff and explained what they were about to do. They moved the sandbags and eased a cervical collar into place.
‘Grab a towel,’ Stanley directed Ray. ‘We want that under his head to maintain neutral alignment. You can get the scoop out as well. I’ll take some vitals while you set it up.’
Stanley wrapped a blood-pressure cuff around Jeff’s arm. Ray brought the metal scoop stretcher from the back of the ambulance. When Joe moved to take over unfolding and setting out the stretcher, Stanley caught Felicity’s gaze.
‘Does he have any idea who you are?’
‘No.’ Felicity couldn’t help a quick grin. ‘I haven’t exactly had the opportunity to introduce myself.’
‘Hmm.’ Stanley’s noncommittal grunt acknowledged the level of authority Joe had assumed. ‘At least he seems to know what he’s talking about.’
Felicity nodded. She rubbed her hands together. They were cold and stiff after the long minutes of stabilising Jeff’s head and neck. ‘I think I’ll leave you guys to it,’ she told Stanley. ‘I’m late for a meeting and I’m sure Mr Petersen can give you any medical assistance you need.’
Stanley was taking some IV supplies from his kit. He had the line in Jeff’s hand within seconds. Joe frowned as he noticed the action that had been taken without his direction. He laid down the half of the scoop stretcher he was carrying.
‘Blood pressure’s 85 over 60,’ Stanley told him. ‘I won’t run any IV fluids unless the systolic drops below 80.’
Joe nodded and Felicity could sense his satisfaction. The low blood pressure with a spinal injury was likely to be due to vasodilation below the level of injury rather than blood loss. As long as the systolic blood pressure remained above renal filtration pressure of 80 mm mercury it was not advisable to give extra IV fluids, which could cause complications from over-hydration.
Joe was eyeing the drug supplies in Stanley’s kit. ‘Are you able to give a loading dose of methyl prednisolone?’
‘No.’ Stanley shook his head. ‘That’s not in our procedures.’
‘We do it in some parts of the States.’ Joe frowned again. ‘Have you got a specialist spinal unit we can transfer him to directly?’
‘We go through the emergency department at the main hospital. It’s only five minutes away. They’ll stabilise him and then transfer. It takes nearly an hour for a slow transport of an acute case to the spinal unit.’ Stanley’s glance at Felicity suggested that it was time she introduced herself but Felicity was quite happy with the management of their patient.
‘I’d better go,’ she announced. ‘Unless I can help in some other way?’
‘No, of course not.’ Joe looked vaguely surprised at the offer. ‘We’ve got plenty of extra hands here. Thanks for your help.’
‘My pleasure.’ Felicity threw a glance over her shoulder as she walked back towards her car. The blades of the scoop stretcher had been eased, one side at a time, beneath Jeff. The halves had been clicked into place and Jeff was now being strapped into position. The scene had been well managed and any injury Jeff had sustained had been in no way exacerbated. No doubt she would see the young fall victim later on in the emergency department. He would probably still be accompanied by the neurosurgeon, who seemed determined to take complete control of his management.
Felicity shook her head as she joined the line of traffic again. Maybe she should have asserted herself and let him know that she wasn’t simply a useful pair of extra hands. It had been a little immature to take offence at the suggestion that she didn’t know what she was doing. It wasn’t as if he could have had any idea she was remotely qualified to act as a colleague, but his attitude had rankled. She had worked long and hard to get where she was now. His dismissal of her, based presumably on what she looked like, had got right up her nose. She was regretting the decision to stay anonymous now, however. It would have been more interesting to have had a professional discussion. She’d like to know where in the States they were doing methyl prednisolone protocols in the field and whether it had been going on long enough to have results on any improvement in long-term outcome. The lights changed and Felicity moved off with a sigh. It was too late now. Best she forget about the whole encounter.
The intention to forget wasn’t easily acted upon. The encounter had left an impression that lasted well past the meeting with the cardiology department. It was still ready to jump into prominence later that morning when Felicity noticed Stanley and Ray handing over another patient to the sorting nurse. She waited until they had transferred their patient to a bed.
‘You guys did a good job with that spinal patient this morning.’
‘Thanks,’ Stanley responded warmly. ‘It was a surprise to see you there, Fliss.’
‘I was just passing. I became rapidly redundant.’ Felicity’s smile gave no hint of her persistent dissatisfaction with the incident. ‘How did the transport go? Did Mr Petersen go with you?’
‘No, thank goodness.’ Stanley grinned. ‘He probably would have complained about every bump on the road. He was a bit over the top, wasn’t he?’
‘He knew what he was doing. I think he was just determined to manage things as well as possible.’ Felicity was surprised to find herself defending Joe, but it would have been unprofessional to complain about another doctor to Stanley despite their long association and Felicity’s appreciation of the paramedic’s level of skill. ‘Jeff was lucky to have someone that experienced on the scene. I imagine that Mr Petersen is only visiting. It sounded as though he’s come from the States.’
‘He’s been in the States but he’s just moved back to New Zealand.’ Stanley fished in his pocket and extracted a slip of paper. ‘He gave me his phone number. He said he’d like to hear some follow-up if I had the chance.’
‘Oh.’ Felicity dismissed the errant thought that she could do the follow-up and contact Joe herself. Why on earth would she want to do that?
‘He’s looking for a job,’ Stanley told her. ‘We had a quick chat while he was giving me his number. Apparently he’s just finished some postgraduate specialist training and he’s come back here for family reasons. He’s hoping to get a position here or at the spinal unit.’
‘Unusual to move countries without a position to go to,’ Felicity observed. ‘Rather a big risk, especially for a consultant. Did he say what the family reasons were?’
‘No. But they must have been compelling. He was dead keen to get away as soon as we’d loaded Jeff. Said he didn’t want to let his daughter down.’ Stanley’s pager sounded at the same instant that Felicity’s beeper went off. They both grinned.
‘No rest for the wicked. See you later, Fliss.’
‘No doubt. Bye, Stan.’ Felicity moved towards the telephone on the sorting desk. This morning’s incident had simply been an interesting and somewhat different start to the day. Now it was time to get on with the many and varied challenges the emergency department could throw at her. She was bound to see Stan again in the near future. She was not likely, however, to see Joe Petersen again, and that was fine. It might have been satisfying to tell him who she was, but if she’d wanted to see him again she could have offered to take that phone number from Stan and use the excuse of a patient follow-up as a reason for contact. The choice had been there and it hadn’t been difficult to make. She had no desire to renew her acquaintance with Joe Petersen. The incident and the man were history.
In fact, she would probably have trouble recognising him if she did see him again.
