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‘Mahito. His name is Mahito.’ The firecracker nurse was watching his every move.
‘Mahito, I’ve given you something for the pain and something to relax you. I’m going to have to slide a tube down your throat. Don’t panic. We’ll take good care of you.’ It didn’t matter that the little Japanese boy might not understand a word of English, or his Ohio accent.
He’d done this a hundred times before and he’d do it a hundred times again.
He gave Katsuko a few seconds as she translated his words rapidly. The little boy was barely conscious. He probably had no awareness of what was going on right now and that wasn’t a bad thing.
He tilted the little boy’s head back, lifting his jaw and sliding the silver laryngoscope into place. He could barely visualise the cords—if he waited any longer he’d probably have to do an emergency tracheotomy—but thankfully he had time to slide the thin blue ET tube into place and inflate the cuff. It took less than four seconds to secure the airway. He attached the bag to the end of the tube and let the nurse take over.
With the airway secure he could now take a few minutes to assess the situation properly. ‘We’re going to need to take him to Theatre. Can I get a portable chest X-ray?’
A woman in a blue tunic stepped forward, pushing the machine towards them. She’d been waiting for his signal. Like in most military hospitals, radiographers were always available in the ER.
A heavy lead-lined apron was dropped over his head. He didn’t even question where it had come from. A few people stepped from the room for a second.
‘Done,’ said the radiographer.
She glanced back at Avery. He could see the question on her face. ‘Avery Flynn. I officially start tomorrow.’
Satisfied with his answer, she gave a nod. ‘Dr Flynn, I’ll have your X-ray in a few minutes.’
Avery nodded. ‘Can anyone tell me what actually happened?’ He could see his counterparts still working on the kid on the other trolley, the flat line on the monitor almost mocking them.
‘Some kind of explosion. Lots of penetrating injuries. It was outside a local factory. The kids were playing, waiting for their parents to finish their shifts.’
‘Major Anderson,’ a voice boomed through the resus room doors. Everyone froze for a second then immediately resumed what they’d been doing. Eyes glanced at each other and the noise level in the room plummeted.
Avery frowned at the uniformed figure in the doorway. He had three people standing nervously behind him. The rank was instantly recognisable—as was the glint of the two silver stars—and he could hardly hide his surprise. He’d never seen a major general in an ER before.
He looked to be in his fifties and had a mid-Western accent. He was well over six feet tall with broad shoulders and what looked like thick dark hair under his hat. There was something about him. An aura. An air. And it wasn’t all about the rank. What had brought him to the ER? He could understand any major general in charge of a base this size wanting to be informed about incidents. He just wouldn’t have expected him to attend personally.
Blake glanced upwards but didn’t stop what he was doing. ‘General Williams.’
The Major General was watching Blake carefully as he continued his resus attempts. ‘I heard there was an explosion. Does your team require assistance?’
Blake kept working steadily. He glanced in Avery’s direction but the Major General didn’t follow his glance. He was focused on Blake.
‘I have all the assistance I need. If anything changes, I’ll let you know.’
‘I’ll expect an update in a few hours.’
‘General.’ Blake gave a nod in acknowledgement. He was attaching defibrillator pads to the young boy’s chest. ‘All clear.’
There was a short ping.
Avery was holding his breath and bent to pick up an oxygen mask that had landed on the floor. Major General Williams turned to leave, his eyes lingering for a second on Avery.
Was he looking at him?
Two seconds later the major general disappeared down the corridor.
Avery straightened up, his gaze shifting around the people in the room. The noise level increased instantly. Katsuko was still bagging but her gaze was fixed on the door.
That was who he’d been looking at. What was going on there?
The male nurse he’d met earlier shouted towards the door, ‘Two emergency theatres are open. The guy from the helipad is in the first one. We can take our kid to the other.’
There was a tiny second of silence, then it was broken with a little beep. Every head in the room turned. The monitor for the other patient. They finally had an output.
Avery paused as the doctor he hadn’t even had a chance to meet yet raised his head from the bed. The look of pure relief on his face made him catch his breath. ‘Do you need the theatre?’ Avery asked.
He had to. This was another doctor’s ER. He might be treating a patient but this was the military. He had to follow the chain of command.
Blake shook his head. ‘No. I’m heading to paediatric ICU.’ He frowned for a second. ‘Do you need assistance?’
Avery shook his head. ‘Is there a surgeon?’
Blake nodded.
‘Then I’m good.’ He turned back to the team. ‘Right, get the IV fast-flowing, monitor his blood pressure.’ He turned back at the nurse who’d threatened to break his hand. ‘Are you good to bag?’ He could see the determined tic in her jaw. There was no way she was leaving this patient.
Another nurse appeared at the door. ‘We’ve another four trauma cases—two paediatric, two adult and about twelve walking wounded.’
Avery glanced down at his now blood-splattered shirt. At some point he should really change. The radiographer walked back in and stuck the X-ray straight up on the light box, flicking the switch.
It didn’t take a genius to see what was wrong. Both of Mahito’s lungs were deflated. Oxygen wasn’t circulating properly because of the penetrating chest injury. If there was no other choice, he could try to insert chest drains but it was unlikely the lungs could reinflate with the spear still in place. It would be foolish to attempt anything like that now—particularly when he had a theatre and surgeon at his disposal. Avery shook his head. ‘Let’s go, folks. We’re never going to get these lungs to reinflate until we get this spear out of his chest. Someone point me in the direction of the theatre.’
‘Let’s go, people!’ shouted Katsuko. For someone small and perfectly formed her voice had a real air of command. Everyone moved. Monitors were detached from the wall, oxygen canisters pushed under the trolley, a space blanket placed over the patient. Avery kept his eyes on the patient but after a second he looked up. They were all watching him expectantly.
There was something so reassuring about this. And he’d experienced it time and time again in the military. These people didn’t know him. He’d walked into an emergency situation with only a wave of his ID. That was all he’d needed.
From that point on—early or not—he’d been expected to do his job. At first he’d been a bit concerned about the chaos. Now he realised everyone had known what to do, but the rush of blood and age of the child had fazed them all.
‘Everyone ready?’
Eight heads nodded at him. ‘Then, let’s go.’
Hands remained pressed to a variety of areas on the little body. The move along the corridor was rapid. The theatre was on the same floor. The porter at the front of the procession swiped his card and held the doors open. A surgeon strode over and nodded at Avery, not even blinking that they didn’t know each other.
Avery handed over the X-ray. ‘Explosion at a local factory. This is Mahito. I don’t have an age. Penetrating wound to the chest, two collapsed lungs, intubated but sats are poor.’ He nodded at the monitor. ‘Two IV lines, tachycardic at one-sixty and hypotensiv
e. BP seventy over forty-five.’
He frowned. ‘Sorry, didn’t have time to catheterise.’
The surgeon shook his head. ‘My staff will get to that. We’ll take it from here.’
Theatre staff dressed in scrubs surrounded them, one set of hands replacing the others and a stern-looking woman taking over bagging duties from Katsuko. She moved away swiftly. It was the first time he’d actually seen her relinquish control to someone else.
The trolley moved forward, being pushed through another set of swing doors as the surgeon shouted orders.
Just like that.
Mahito was someone else’s responsibility.
Avery looked down at his hands, smeared with blood. The rest of the staff turned and headed back out of the doors.
