Why wasn’t she doing that with Christian?
She needed to concentrate harder. He probably had millions of flaws, it was just that she hadn’t been looking properly.
Gritting her teeth, she reached for the equipment that was mandatory for dealing with trauma patients. Swiftly she sorted out a gown, gloves and eye protection, all the time reminding herself that Christian Blake might be a hotshot in the resuscitation room, a fabulous father and indecently good-looking, but that didn’t mean that he was perfect.
The trauma team was assembling, each member occupied with preparing for the arrival of the patient.
Christian was prowling around the room, checking that everything was in place and that everyone understood their responsibilities. ‘Jane? Have you bleeped the trauma consultant?’
‘He’s on his way.’
The trauma registrar hurried into the room and then the doors to Resus flew open again and the paramedics surged into the room with the patient on a stretcher and ED staff alongside.
Everyone moved swiftly into position, carefully transferring the patient but maintaining silence while the paramedics described the mechanism of injury, the patient’s signs and what treatment had been given.
Christian’s gaze flickered to the whiteboard at the head of the trolley, which had already been covered in black, scrawling notes by the person who had taken the call from Ambulance Control.
Another doctor moved to the head of the trolley to clear and secure the airway and Lara reached for a pair of more robust gloves so that she could help remove the patient’s clothes.
How did Christian do it?
How did he hold down such a busy job and look after two lively daughters on his own?
But she knew the answer to that, of course, thanks to Aggie’s innocent declaration. He was living in a house with boxes still unpacked and he relied on nannies. He was doing the job and being a father to his children, but not much else.
By now the patient’s airway was secure, the clothes had been removed from the patient’s body and two peripheral lines were in place. The radiographer had moved the X-ray machine into position on the patient’s left side and someone pulled a unit of O-negative blood out of the warmer.
‘Chest and AP pelvis to start with,’ Christian ordered, ‘and then I want to do a FAST test. Her systolic pressure is less than 90 so she’s bleeding from somewhere. The question is whether it’s just the pelvis. Keep the pelvic splint in place and don’t move her around.’
Lara moved the machine closer to the trolley. ‘You don’t want to send her straight for a laparotomy and packing?’
‘I might still do that but I want to see the result of the FAST test first. She’s haemodynamically unstable so if it’s negative then she’s going straight to the angio suite for embolisation.’
He was examining the patient’s chest now, checking for signs of life-threatening thoracic conditions. ‘She has a seat-belt mark on her chest. But her lungs seem clear and there’s no evidence of tension pneumothorax or haemothorax.’
/> ‘You’re not going to spring the iliac crests?’ Penny, one of the casualty officers, asked the question and Lara frowned.
Christian glanced in her direction and gave a faint smile. ‘I think Staff Nurse King has the answer to that question.’
‘Her veins and arteries are trying to clot,’ Lara said immediately, wondering whether Penny ever bothered to read a textbook or a medical journal. Despite four months in the ED, she had yet to make much of a favourable impression. ‘If you spring the iliac crests, you risk disturbing the clot and increasing the bleeding.’
‘Lara is right.’ Christian dragged the ultrasound machine closer to the patient. ‘Protect the clot. No springing. No log-rolling. I don’t need to tell you how serious an unstable pelvic fracture can be.’
Lara’s eyes were on the machine. ‘Her blood pressure is dropping.’
‘Give her another unit of warmed blood through the rapid infuser.’ Christian was still checking the patient. ‘Are those blood results back yet? If we just pour fluid into her, she’ll have coagulation problems. Now, let’s have a look at her abdomen. I want to know if there’s any intraperitoneal bleeding. Jane, can you ring through to the angio suite and fill them in? I have a feeling we’re going to need their help and it takes them a while to set up.’
‘Will do.’ Jane hurried over to the phone and Lara stepped a little closer so that she could watch Christian do the FAST test.
He placed the transducer on the patient’s abdomen, just above the pubic bone, and studied the screen, a frown on his face. ‘Penny?You can’t see from over there—come closer. I’m looking for free intraperitoneal fluid—fluid collects in the pouch of Douglas and you can visualise that with the scan.’ He paused for a moment, staring at the screen with total concentration. ‘It’s negative but that doesn’t exclude intra-abdominal injury.’
The anaesthetist adjusted the oxygen flow and glanced at the monitor. ‘They don’t like having patients this unstable in the angio suite, Christian. It’s not a good place to resuscitate a patient.’
‘Interventional angio is the best way to stop the bleeding.’ Cool and unflustered, Christian checked a set of blood results and shook his head. ‘Give her FFP and cryoprecipitate. Let’s take a look at that X-ray, Maria.’
‘I have it here.’
He studied the screen. ‘Well, that’s fairly obvious, isn’t it? Penny? Take a look at this X-ray.’