Alison Roberts - The Surgeon's Engagement Wish

‘We seem to have a code yellow in ED,’ she said briskly. She listened for only a few seconds. ‘Cool…thanks.’

Beth grabbed the tail end of the stretcher and she and Chelsea headed back the moment the phone was replaced.

‘What’s a code yellow?’

‘Trouble with gangs.’

Good grief! So it happened often enough to have its own code?

‘What happens on a code yellow?’

‘Sid will get here first. He’s our night orderly cum security guard. Then one of the local cops who lives just down the road will come in.’ Chelsea was looking almost excited now as she glanced back at Beth. ‘If he thinks it’s necessary, he’ll call Nelson and they’ll chopper in the armed offender squad to help out.’

‘But there’s only one patient!’

‘So far.’ Chelsea gave Beth a questioning glance now. ‘This really bothers you, doesn’t it?’

‘I’m OK.’ Beth wasn’t about to demonstrate any inadequacy on her first shift. ‘Like you said, I’m used to it. A bit too used to it, maybe. A friend of mine had a knife held to her throat by a gang member not so long ago.’

Chelsea looked horrified. ‘Was she hurt?’

‘Not physically. She’s given up nursing, though, and gone to work in her sister’s coffee-shop in Melbourne.’

‘Was that why you decided to move as well?’

‘Partly.’ Beth smiled wryly as they turned the corner. ‘I was rather hoping I’d be getting away from this kind of thing by moving down here.’

Chelsea’s quick smile was sympathetic. ‘I hope it wasn’t the main incentive for the shift, then.’

‘It wasn’t.’

Beth’s words were lost as they entered the front of the department to find the stretcher was now superfluous. The injured man’s colleagues had dragged or lifted him as far as the bed in the empty resuscitation area.

‘I said don’t cut his leathers, man!’

‘We’ve got to get his jacket off so I can assess his breathing.’ Mike was still managing to sound calm but Beth could see that his frown lines had deepened perceptibly.

Maureen was plugging the tubing attached to an oxygen mask onto the overhead outlet. ‘I’m just going to put this on your face,’ she warned their patient.

The stream of obscene language made Maureen look even grimmer than she had on first spotting this patient.

‘Airway appears clear,’ she told Mike dryly. Stepping back as two silent gang members unceremoniously stripped the leather jacket off the now groaning man, she noticed the return of the younger nurses.

‘Perhaps you two could clear Resus 2.’ She and Mike seemed practised in trying to keep the atmosphere as casual as possible, but the undercurrent of urgency was easy enough for Beth to detect.

And no wonder. The man in the adjacent resuscitation area was looking alarmed and his wife was terrified. It was just as well that the chest pain he was having investigated had been deemed to be angina rather than a heart attack because otherwise the anxiety caused by the arrival of the new patient might have made his condition a lot worse. He probably didn’t need admission but he certainly needed to be moved.

It took a minute or two to disentangle the patient from the ECG electrodes and other monitoring equipment anchoring him to the area. Beth looked over her shoulder as she pushed the foot end of the bed clear of Resus 2. The injured man in Resus 1 was alone with his medical attendants now. The other gang members had vanished. A second later they all heard the roar of an unmuffled engine as the car blocking the doors was restarted.

‘Our first job is to clear the department of any other patients if it’s possible,’ Chelsea told Beth as they manoeuvred the bed along the corridor separating the emergency department from the rest of the hospital. ‘We close the department to any arrivals that could be seen by a GP as well.’ She shook her head. ‘There was a major riot in the department a few years back apparently, and a bystander in the waiting room got stabbed. That was when code yellow came into force.’

Their patient’s wife was clutching her handbag in both hands as she trotted beside the swiftly moving bed. ‘Did you hear them say they were going to deal with whoever did the shooting? Where’s it going to end?’

‘At least most of them are out of the department for a while,’ Chelsea responded. ‘It’ll give the police time to deal with them before there’s any real trouble here.’

There was a curious calm in the emergency department when Beth and Chelsea returned. Mike was doing an ultrasound on the exposed, tattooed belly of their patient. Maureen was setting up a new bag of IV fluids.

A burly man wearing an orderly’s uniform was standing with his arms folded by the head of the bed, and an equally solid man in police uniform stood in an identical pose at the foot. They both gave Beth a curious stare.

‘Gidday,’ the orderly said. ‘You’re new here, aren’t you?’

‘This is Beth,’ Chelsea told them. ‘It’s her first shift tonight. Beth, this is Sid and that’s Dennis.’

The nods and smiles from the two men were both welcoming and sympathetic. Not a great way to start a new job, they conveyed, but they were pleased to meet her and would make sure she was safe. And Beth smiled back. Suddenly things didn’t seem nearly so disheartening. She would never have been introduced to members of security back-up in her old department and they certainly wouldn’t have made any non-verbal promises about making sure she was looked after. Working in a small community was going to be different.

Better.

‘Who’s on call for surgery tonight?’ Mike’s query broke an almost companionable silence.

‘Luke,’ Maureen told him.

‘Good. He won’t mind being woken up.’

‘Can you call him in, please, Chelsea?’

‘Sure.’

Beth watched as Chelsea headed for the wall phone. She knew there were five surgeons associated with Ocean View hospital. Three general and two orthopaedic. What were the odds that one of them would end up being called Luke?

And how many other reminders would there be for her tonight to let her know that you could never really escape the past and make a brand-new start? Beth shook herself mentally, bending over to pick up packaging from dressings and IV gear that littered the floor.

For heaven’s sake. It had been six years ago. It was pathetic that hearing that particular name could still have any effect on her. And it was weird that it was so much stronger tonight than it had been for a very long time. Maybe that was just because she was displaced. Feeling a little lost in a new environment and seeking links with her past to anchor herself.

‘He’s on his way,’ Chelsea reported. ‘Do you need theatre staff called in?’

Mike angled the ultrasound probe in a new direction, still peering at the screen. Then he nodded. ‘Yes, thanks, Chels. I reckon Jackal here is going to need more of an inside look than I’m getting.’

The gang member’s nickname suddenly seemed quite appropriate. The flash of fear as the comprehension of what was being organised on his behalf filtered through was swiftly followed by an aggressive snarl.

‘No way! You’re not cutting me, man! I’m outta here.’

‘Oi!’ The barked response from both Sid and Dennis was not enough to stop Jackal making an unexpectedly vigorous move to sit up, ripping the IV line from his arm in the process and actually managing to swing both legs over the side of the bed.

Restrained by the larger men, who latched onto both arms, he subsided instantly. In fact, he looked decidedly green within seconds and then, much to Sid’s obvious disgust, he vomited. Sid gamely kept hold of the arm but the restraint was no longer needed. Sitting up had been enough to cut an already diminished blood supply to Jackal’s brain and his level of consciousness was dropping fast.

‘Lay him down.’ Mike sounded almost weary. ‘And watch out for that blood, Sid.’ The orderly was wearing gloves but Jackal’s IV site was bleeding quite heavily. He leaned closer to their patient. ‘Listen, mate. You’re sick. You’ve had a bullet go through your belly. You’re lucky it hasn’t killed you but it’s still done a lot of damage to your spleen. You’re losing blood. Jump up now and you might make things a whole lot worse in a hurry.’

The response was not incoherent enough to disguise the obscenities but Mike simply straightened and reached for a fresh pair of gloves.

‘I’ll get that IV line back in. I don’t think he’s going to put up much of a fight with his blood pressure in his boots.’

Beth looked at the monitor. The pressure reading was 85 over 40. Jackal had to be losing a significant amount of blood. The glance that passed between Sid and Dennis was significant. If this became a homicide, they could all be in for a lot more drama.

Maybe they would be anyway.

Beth handed Mike a new wide-bore cannula and was ready with the luer plug and flush moments later.

‘Any word from Sally?’

‘Sorry.’ Beth shook her head. This was the kind of thing she hated about starting a new job. ‘I don’t know who Sally is.’

‘She’s one of our paramedics,’ Maureen supplied. ‘The ambulance got called not long after Jackal’s mates took off from here.’ Her brief smile was intended to be reassuring for Beth. ‘Police back-up got activated at the same time.’

Beth nodded, pleased to find her hands steady as she completed the fiddly task of screwing the luer plug into place on the cannula hub. She was injecting a bolus of saline to check that the IV line was patent when the radio on the main desk crackled.

‘Ambulance to ED. Do you copy?’

‘Shall I get that?’ Chelsea queried.

‘I’ll do it.’ Mike stripped off his gloves and then glanced at Beth. ‘Can you get some more fluids up?’

‘Sure.’

Beth taped the cannula securely in place, having flushed the line. Then she reached for a giving set and a new bag of saline. The task was automatic enough not to distract her from listening to Mike as he reached for the microphone next to the radio set.

‘Mike here, Sally. Receiving you loud and clear. What have you got?’

‘Status one patient. Car vs pedestrian.’

‘Roger.’ Mike shook his head slowly as he pulled a pen from his shirt pocket. They all knew how unlikely this was to have been any accident. ‘Vital signs?’

‘Heart rate of 130. Respiration rate 36. Oxygen saturation down and blood pressure unrecordable at present. GCS of 8. Head and chest injuries. Multiple fractures.’

Sid and Dennis looked at each other again. They didn’t need medical training to know that this patient was seriously unwell. Neither did they need the ambulance officer’s confirmation that this was another code yellow patient.

The ETA of the ambulance was ten to fifteen minutes and any calm in the small emergency department vanished.

Extra staff began arriving as Beth and Chelsea were assigned the task of setting up Resus 2 in preparation for the new arrival.

‘Have an intubation trolley ready,’ Mike instructed. ‘And a chest decompression kit.’

‘What happens with serious chest injuries here?’ Beth queried, pulling the crumpled sheet from the bed. ‘We don’t have a cardiothoracic surgeon, do we?’

Chelsea shook her head. ‘We stabilise them and then chopper them to Wellington.’ She flapped the clean sheet to spread it over the mattress. ‘Same with head injuries. We don’t run to a neurosurgeon either.’

Chelsea told Beth who the staff members were as the level of activity in the department steadily increased.