The Australian's Proposal (Mills & Boon By Request): The Doctor's Marriage Wish / The Playboy Doctor's Proposal / The Nurse He's Been Waiting For (28 page)

Mike and Ryan shared a glance. This was huge. It was going to stretch their resources and everybody’s skills.

‘Let’s do it.’ Ryan pulled on latex examination gloves and then heavier ones for climbing. He gave Mike a thumbsup and Mike responded with a terse nod and another shared glance. They had faced difficult situations before. They were more than ready to tackle this one. Together.

Hannah felt oddly excluded. Even when Mike put her after Ryan and before himself to protect her as she climbed down the steep, slippery slope, she didn’t really feel a part of this small team.

Ryan hated her. He didn’t want her there.

Within the first few metres of their climb, however, any thoughts of personality clashes or anything else that could affect a working relationship were forgotten.

A woman lay, moaning. ‘My leg,’ she groaned. ‘I can’t get any further. Help …’

This was an initial triage. No more than thirty seconds could be allocated for any patient to check for life-threatening injuries like uncontrolled haemorrhage or a blocked airway. Mike had triage tags in his pocket. Big, brightly coloured labels with an elastic loop that would alert all other personnel to the priority the victims had for medical attention. This woman was conscious and talking. It took less than thirty seconds for Ryan to examine her.

‘Fractured femur. Closed. No external bleeding. Airway’s clear.’

Mike produced a yellow label. Attention needed but second priority. ‘Someone will be with you as soon as possible,’ he reassured the woman as they moved on. ‘We’ve got to check everybody else first and then we’ll be back.’

‘But it
hurts
…Oh-h-h….’

It was hard, leaving her to keep descending the slope. A huddle of people near the base of the nets were bypassed. They were all mobile and being looked after by SES people. Grace was there, organising the clearance of the less injured from the scene. Mike gave her a handful of green triage tags that designated the lowest priority. Hannah saw a young Asian couple clinging to each other, looking terrified, and she could hear someone talking in a
foreign language that sounded European. Had the bus been full of tourists? It could make their job more difficult if they couldn’t communicate with their patients.

A young woman lay, unconscious, against the base of a huge eucalyptus tree.

‘Hello, can you hear me?’ Hannah pinched the woman’s ear lobe. ‘Non-responsive,’ she told Mike. She laid a hand on the woman’s neck and another on her belly. ‘She’s breathing. Good carotid pulse. Tachy.’

The elastic of a pink triage label went over her wrist. Highest priority. This case was urgent, with the potential to be saved and the likelihood of rapid deterioration if left. They moved on.

‘There’s one over here,’ a fire officer yelled at them. ‘He’s making a weird noise.’

‘Occluded airway.’ Mike repositioned the man’s head and the gurgling sound ceased. Another pink tag.

Winch hooks were being attached to the bus. There were no big lights down here and the rescue workers had to make do with the lamps on their helmets. A curious strobe effect to viewing the disaster was evident as lights intersected and inspected different areas. It made it easier to deal with, Hannah decided, because you could only see a patch at a time. A single patient, a broken window, dented metal, broken tree branches, strewn belongings and luggage.

Just the top half of the unfortunate man who had been caught beneath the front wheel of the bus. It took only a moment to confirm the extinction of life and give the man a white tag to signify a fatality so that nobody would waste time by checking him again.

‘Don’t go downhill from the bus.’ A fire officer with a winch hook in his hand shouted the warning. ‘We haven’t got this thing stable yet.’

The doors of the bus were blocked because it was lying, tilted, on that side. The emergency hatch at the back was open, however, and must have been how some of the less injured had escaped the wreckage.

Mike saw Ryan assessing the access. ‘Not yet, buddy,’ he said firmly. ‘You can just wait until it’s safer.’

Safer
, Hannah noted. Not
safe.
It could never be really safe to do something like this, could it? And yet Ryan was clearly frustrated by having to hold back.

Hannah shook her head to clear the water streaming down her face from looking up at the hatch. She was soaked now and the wind was chilling. She flexed increasingly stiff fingers and cast a glance at her colleagues.

There was certainly no doubting Ryan’s commitment to his work and the people he cared for. How many ED specialists would be prepared to work in conditions like this? To risk their own lives without a moment’s hesitation to try and save others?

Mike might have been off the mark in making people think Ryan was some kind of saint, but he hadn’t been wrong in advertising him as a hero. They both were. The way these two men worked together suggested they had been in situations before that had not been dissimilar. There was a calm confidence about the way they worked that was contagious.

Like Ryan’s courage in that plane turbulence had been.

What if she couldn’t redress the antipathy Ryan now held towards her and the one who didn’t win that consultancy position in ED felt obliged to go and work elsewhere? If she never had the chance to work with him again?

The sense of loss she had experienced watching him dance with Mike came back strongly enough to distract Hannah for several seconds. Was it always going to haunt
her? Did she have to be ruthlessly squashed at frequent intervals in order for her to perform to her best ability? Like now?

Hannah continued the triage exercise with grim determination. They found another five people with fractures and lacerations who needed yellow tags. One more pink tag for a partially amputated arm and severe bleeding. An SES worker had been doing a great job of keeping pressure on the wound. Then they were given the all-clear to check out the bus.

‘Not you, Hannah,’ Mike stated. ‘You can check in with the SES guys. Make sure we haven’t missed anyone. Get someone to check further afield as well. We’ve got debris over a wide area and injured people could have moved or even fallen further down the slope.’

Hannah moved to find someone to talk to but she couldn’t help stopping for a moment. Turning back to watch as the two men climbed into the bus.

Turning back again a moment later, when alarmed shouting heralded a noticeable shift in the position of the bus.

‘Oh, my God …’ Was the bus going to move with the extra weight? Slide and possibly roll again down the side of this mountain?

Remove any possibility of repairing the rift she’d created with Ryan?

Remove Ryan from her life with the ultimate finality of death?

‘No-o-o!’

It was a quiet, desperate sound, snatched away and disguised by the howl of the wind. If it was a prayer, it was answered. Having taken up some slack from one of the winch cables, the movement stopped. Mike actually leaned out a broken window with his thumb and forefinger forming the ‘O’ of a signal that they were OK.

It was only then that Hannah realised she had been holding her breath. A couple of minutes later and Ryan and Mike emerged from the bus.

‘One pink, one yellow, one white,’ Mike reported. ‘One’s unconscious and another’s trapped by a seat.’ He reached for his radio. Medical crews could now be co-ordinated, specific tasks allocated, patients treated and evacuated. The most seriously injured patients would be assigned a doctor who would stabilise and then escort them to hospital.

Hannah was joined by a paramedic by the name of Mario, issued a pack of gear and assigned the case of the woman who had been pink-ticketed at the base of the eucalyptus tree. Mike and Ryan were going to work on the pink-ticket patient inside the bus. Hannah watched them climb inside again. A scoop stretcher was passed in along with the pack of resuscitation gear by firemen who then waited, knowing their muscle would be needed to assist with extrication.

Once again Hannah felt that sense of loss as Ryan vanished from view and this time she couldn’t quite shake it off.

She
needed
him, dammit! This was so far out of her comfort zone, it wasn’t funny. The rain might be easing but she was still soaked and cold and her fingers felt uselessly stiff and clumsy.

The effort to concentrate seemed harder than it had ever been. Hannah was trying to recall the workshop she’d attended at a conference once, on the practice of emergency medicine in a hostile environment. Control of the airway was the first priority, of course, with cervical spine control if appropriate.

It was appropriate in this case. Hannah’s gloved hand came away streaked with blood after touching the back of the young woman’s head. Had she been thrown clear of the
bus and hit the tree she now lay beside? If the blow had been enough to cause her loss of consciousness, it had potentially caused a neck injury as well.

‘I need a collar,’ she told Mario. She placed her hand, side on, on the woman’s shoulder, making a quick estimate of the distance to her jaw line. ‘A short neck, please. And a dressing for this head wound.’

It was difficult, trying to assess how well their patient was breathing. Hard to see, given the narrow focus of the beam of light from her helmet. Hard to feel with her cold hands and impossible to hear with the shouting and noise of machinery. And over it all, the savage wind still howled. Large tree branches cracked ominously and small pieces of debris like broken branches flew through the air, occasionally striking Hannah in the back or hitting the hard helmet she wore with a bang, magnified enough to make her jump more than once.

‘I don’t think we can assess her for equal air entry until we get her into an ambulance, at least,’ she said. ‘She’s certainly breathing on her own without any respiratory distress I can pick up.’

Which was a huge relief. While this woman was probably unconscious enough to be able to be intubated without a drug regime, the lecturer at that conference had discussed the difficulties of intubation in a situation like this. Often, the technique of cricothyroidotomy was more appropriate and that wasn’t something Hannah wanted to attempt with limited light and frozen fingers.

IV access was more manageable. Hannah placed a large-bore cannula in the woman’s forearm and started fluids. She remembered to use extra tape to secure both the cannula and the IV fluid lines. The lecturer’s jocular warning was what she’d remembered most clearly about that workshop. “If it can fall out,” he’d said, ‘it
will
fall out.’

Mario had the expertise and strength to move the woman onto a backboard and strap her securely onto it. And then the firemen took over, inching their way up the mountainside with the help of ropes and the net.

Moving to follow them, the beam of Hannah’s light caught something that made her stoop. She picked the object up. It was a shoe. A rather well-worn sneaker with a hole in the top and what looked like a picture of a bright orange fish done in felt pen or something similar. What startled her was its size. It was small.

Very small.

A child’s shoe.

But they hadn’t come across any children in their triage, had they? Hannah had the awful thought that it could be the fatality inside the bus. But maybe the owner of this shoe was uninjured? Not seen amongst that huddle of frightened people who had been waiting for help up the slope? Hannah certainly hoped so. And if they were, they might have one bare foot and be grateful to see that shoe. Hannah stuffed it into the large pocket on the front of her overalls.

It wouldn’t have been easy for a child to climb, even with the hand-and footholds the net provided. They were wet now and very muddy. Hannah slipped, more than once, and had to save herself by grabbing the netting or a tree root or branch.

How could fifty metres seem such a long way? And how long had they been on scene? Certainly no more than an hour, but she felt as though she had just completed a full night shift in the ED and a busy one at that.

The third time she slipped, Hannah might well have fallen but she was caught by her arm in a vice-like grip.

‘Are you OK?’ Ryan asked.

It had to be her imagination that she could hear the
same kind of caring in the query that she had heard in the car on the way to Wygera that morning. An aeon ago. In her current state it was enough to bring the sting of tears to her eyes. She blinked them away.

‘Yeah … thanks …’

‘Not easy, this stuff, is it?’ Ryan was climbing beside her. Just below them, the scoop stretcher containing his patient was making slow progress upwards. ‘How’s your woman?’

‘Still unconscious but breathing. A head injury but I have no idea how bad it is yet.’

‘You’ll be able to do a more thorough assessment in the ambulance. We won’t be far behind you if you run into trouble. Mike says they’re going to stage departures so we arrive at the ED at about six-minute intervals. Just pull over and keep your lights on and we’ll stop to help.’

‘Thanks,’ Hannah said again. Professional assistance but at least he was talking to her. She was almost at the top of the slope now. A fire officer had his hand out to help her onto the road and the noise level increased markedly. She could still hear Ryan’s call, though.

‘Hey, Hannah?’

‘Yeah?’

‘You’re doing a fantastic job. Well done.’

Those tears were even closer all of a sudden. They couldn’t be allowed to spill. Hannah clenched her fists as she got to her feet on the road and her hand struck her bulky pocket. She peered down at Ryan.

‘Hey, did you come across any children in the bus?’

‘No. Why?’

‘I found a shoe. A kid’s size shoe.’ She pulled it from her pocket. ‘See?’

‘Could have come from anywhere,’ Ryan said. ‘Maybe there’s a kid amongst the green tickets.’

‘Yes, I thought of that. I’ll check with Grace later.’

‘It could have come from spilled luggage as well. Or even been thrown away. Looks pretty old.’

‘Hannah?’ Mario, the paramedic, was calling. She could see the backboard supporting her patient being lifted into the back of an ambulance. ‘We’re nearly ready to roll.’