The Doctor's Unexpected Proposal Page 7

  ‘What if she had just waited at the lay-by and hitched another ride?’

  ‘We thought of that,’ Harry answered. ‘The trucker who dropped her off has been watching for any other traffic going west. He’s going to flag down anyone he sees and ask if they’ve seen her.’

  ‘What if she went the other way? Back into town?’

  ‘She’s sick. Somebody’s going to notice something odd.’

  ‘And if she ends up back at the hospital, we’ll hear about it.’ Mike was trying to sound reassuring. He cupped his hands to his mouth and called yet again. ‘Me-gan!’

  In the silence that followed, they could all hear the faint echo of the name as someone from one of the other search parties called. Then all they could hear was renewed croaking from frogs that had been disrupted by the human calls and vague rustlings that hinted of night creatures slipping into deeper hiding.

  ‘She’s here somewhere,’ Harry said quietly. ‘She has to be.’

  ‘Yep.’ The other police officer sounded even more confident. ‘Those prints at the start of the track looked pretty fresh.’

  ‘And how many people would set off bush walking with bare feet?’

  ‘We could use a dog. It’s going to be a long wait till the Brisbane crew gets here.’

  ‘Maybe we should have brought Rudolph.’

  Emily tried to smile at Mike’s absurd suggestion, intended only for her ears. The funny-looking puppy that had been given to Gina’s little boy, CJ, was about as far away from a trained search and rescue dog as it would be possible to get.

  ‘He’d get lost himself,’ Emily whispered back. ‘Or trip over those ears.’

  The notion was so silly it actually made her smile and lifted her spirits just a little. Or was it the fact that Mike was trying to make her smile that had lifted her spirits? Whatever. It had helped. Emily stepped off her side of the path again and lifted huge fern fronds to peer underneath. She jumped as something small scuttled away, making the deep covering of leaf litter ripple.

  ‘This is the sort of place snakes like to hide, isn’t it?’

  ‘Most of them are harmless,’ Mike told her. ‘I wouldn’t go poking or standing on them, though.’

  ‘I won’t,’ Emily said fervently. ‘Anything else I should be worried about? Like ticks?’

  ‘You’re well covered with that flight suit. And you’ve got gloves and boots on so you should be OK. It’s all good protection against leeches as well.’

  ‘Leeches! Oh, yuck!’ Emily scrambled to get back onto the track and stumbled in her haste. Mike’s hand shot out to help her catch her balance but Emily pulled away and dropped to a crouch.

  ‘Look—what’s that?’

  ‘Where?’

  ‘I thought I saw something white but I’ve lost it now.’

  Mike raised his voice. ‘Harry? Hold up a sec. Emily thinks she’s spotted something.’

  He crouched beside her and they both turned their heads, trying to systematically illuminate the ground around them.

  ‘There! Don’t move, Mike. Keep your light on it.’ Emily crawled forward and reached up. The object was small but easily recognisable.

  ‘What the hell is that?’ Harry had come back to see what they’d found.

  ‘A luer plug,’ Emily told him. ‘That scrunched-up stuff is the tape to hold it in place. It goes on the end of a cannula, which is what that little plastic tube is.’

  ‘Like you have with a drip?’

  ‘You got it,’ Mike told Harry. ‘And there’s only one person who could have been wandering around here with an IV line still in their hand.’

  Emily leaped to her feet. ‘Come on,’ she urged. ‘Megan’s got to be close.’

  ‘Hang on.’ Harry was unclipping his radio from his belt. ‘Don’t go off by yourselves. We need to call the other teams in and do this properly. We’ll start from this point and work out slowly.’

  Harry was right but having to wait even a few minutes was frustrating. Megan was close. Very close. They hadn’t heard anything in response to their calls but that could mean she still didn’t want to be found. Or it could mean that she was unconscious.

  Or worse.

  Emily paced back and forth, her head down, as she tried to cope with an almost crippling level of tension. She didn’t realise that her pacing was taking her further and further away from her group until she turned and bumped into Mike.

  ‘Stay close, babe,’ he said softly. ‘We don’t want to lose you as well.’

  Emily’s head came up sharply and her eyes stung with unshed tears at his gentle tone.

  ‘I’m scared, Mike,’ she whispered. ‘What if…if we’re too late?’

  His arms were around her in an instant. This friendly hugging business was becoming automatic but Emily wasn’t about to complain. And this time his fingers were in her hair, cradling her head against the hollow beneath his shoulder.

  Emily’s helmet tipped back, the chin strap threatening to diminish her air supply, and a buckle on the strap of Mike’s back pack pinched against her cheek rather viciously, but Emily barely registered the discomfort because she was listening too hard to the reassuring sounds Mike was making.

  ‘We won’t be too late,’ he said. ‘You’ll see. I’m sure we’re going to find her real soon.’

  Emily straightened wearily, pulling out of the embrace so that she could see Mike’s face. To see if he really was as confident as he sounded. She couldn’t see his eyes, which were deeply shadowed thanks to the light from his helmet, clearly enough. It was easy to imagine she could see just what she wanted to see in them.

  Hope.

  A promise of success.

  And something more…

  Something much more personal.

  It had to be a trick of the weird lighting from those helmets but Emily could have sworn that Mike’s eyes were fastened on her lips. That his head was tipping, even. Agonisingly slowly, but with obvious intent.

  ‘Hey, guys!’ The shout came from further down the track, past the bend that screened the couple. ‘Mike? Emily? Where are you?’

  ‘Here.’ Mike’s clear response ended that fraction of time in which he’d distracted Emily to such a degree that the intrusion of another voice was jarring. It flicked Mike back to the current situation just as cleanly—if he had, in fact, been as distracted as Emily had been. He reached to straighten her helmet. ‘Let’s go, Em. They need us.’

  She nodded. ‘I’m ready.’ Then she took a deep breath. ‘We are going to find her in time, aren’t we?’

  Mike’s smile acknowledged that Emily was asking for a promise they both knew he couldn’t make. It also offered understanding of how badly she wanted it.

  ‘Spit for luck?’

  And Emily found a smile she didn’t know she had. ‘Why not?’

  They found Megan Cooper forty-five minutes later—at 3 a.m., well away from any track, lying unconscious beside a fallen log that was so covered by ferns it had provided an umbrella dense enough to screen the girl completely.

  Emily and Mike were the closest medics to the middle section of the search line. Mike took a few seconds to pull the pack containing their medical supplies from his back so it was Emily who reached out to touch Megan first. To find out whether or not they had arrived in time.

  Megan lay on her side, curled up in a foetal position. Emily brushed her hair aside and laid her fingers on the girl’s neck over where the carotid artery lay.

  Her voice was utterly flat a second later. ‘I can’t find a pulse.’

  ‘Let’s turn her over and check her airway,’ Mike said calmly.

  They rolled Megan onto her back and Mike held the girl’s head and tipped it so that her chin rose and her neck was extended. Despite finding her unconscious, there was no indication that they had to worry about a neck injury. There was no evidence that she had fallen and every reason to believe that her unconsciousness was due to medical rather than traumatic causes.

  ‘Try again,’ Mike advised Emi
ly.

  Positioning Megan to open her airway had also smoothed out folds of flesh on a curled neck, and Emily’s fingers pressed a little harder this time—desperately, perhaps—on one side of the trachea.

  ‘Got it,’ she breathed in relief on feeling the faint bounce against her fingertips. ‘Low pulse pressure. She’s tachy—maybe 120, 130.’ Emily laid a hand on Megan’s abdomen to feel for breathing movements as she tilted her head and put her cheek close to their patient’s mouth. ‘She’s not moving much air.’

  ‘There’s a stethoscope in the pack.’ Mike was pinching Megan’s earlobe to see if there was any response to painful stimuli. ‘Megan, can you hear me? Open your eyes, sweets.’

  The only response was a very faint moan. Megan’s Glasgow coma scale score could only be about 6 or 7. Any score lower than 8 was unconscious enough to be defined as a coma.

  Emily looked up at the audience of fellow searchers as she unzipped the pack in a swift movement and flipped it open.

  ‘We’ll need the Stokes basket,’ she told Harry. ‘And oxygen and the life pack from the ambulance. As fast as you can.’

  Two men set off a run to where the paramedics were waiting with a rescue basket on top of a stretcher and the extra, heavy equipment stowed inside. They had been positioned on the main track just before it forked into the three branches until it was known in what direction they needed to go.

  Mike had a tiny oxygen cylinder in the pack but it was quickly apparent that just putting a mask and high flow on Megan would not be enough. Her breathing was laboured. Too fast and too shallow. Inadequate to the point of being life-threatening.

  ‘You want to intubate?’ Mike had a flat kit in his hand, instruments rolled up and tied with a bow of fabric tape.

  Emily nodded briskly. Any overly emotional involvement in this case was now as neatly packaged as that intubation kit and had been put firmly into storage for the moment. She was faced with a critically ill patient and she knew precisely how to start fighting this battle.

  ‘I’ll get you to assist, please, Mike. As soon as Hamish or Cal gets here, we’ll get some aggressive fluid resuscitation started. At least two wide-bore IV lines. How much saline have you got?’

  ‘Two litres here. There’s more in the basket.’

  ‘My drug kit’s coming as well. We’ll get some dopamine on board again.’ Emily was unrolling the kit that contained a laryngoscope and a selection of endotracheal tubes. ‘Grab the bag mask, Mike, and the oxygen. Hyperventilate her for a minute while I get set up here.’ She pulled the blade away from the handle of the laryngoscope and checked the light that came on.

  The other doctors, Hamish and Cal, arrived at the scene just before the ambulance paramedics got there. Suddenly there was more expert assistance than Emily could have had in an emergency department, and a crowd of onlookers that she certainly wouldn’t have had. With the less than perfect lighting and the difficulties in placing and handling equipment, thanks to the thick vegetation, however, the tension levels climbed again almost enough to wipe out the relief in having located Megan.

  They climbed further as Emily found how difficult the teenager was to intubate, due mostly to her size. On her second attempt, Emily moved Megan’s tongue to the left with the curved blade of the laryngoscope and eased it back even more carefully. She tilted the handle of the instrument to change the angle of the light but still couldn’t locate the epiglottis.

  ‘Can you give me some cricoid pressure, please, Mike?’

  ‘Sure.’ Mike pressed on the Adam’s apple area of Megan’s neck—a technique that helped prevent the aspiration of gastric contents but could also bring the structures Emily would prefer to see into clear view.

  ‘Cool,’ she murmured a moment later as she identified Megan’s vocal cords. ‘Got it. I’ll have a size 8 tube, thanks.’

  It took only seconds to slide the tube into place and inflate the cuff with air from a syringe to create a seal around it. Mike helped Emily to slip the tape around the back of Megan’s head and then tie it to the mouth guard to ensure the tube didn’t slip any further down her airway. He attached the bag mask to the end of the tube and started ventilating with high-flow oxygen.

  Emily pulled the stethoscope from around her neck and listened to Megan’s chest and abdomen as Mike squeezed air in to check that the tube was in the right place and sending oxygen to her lungs and not her stomach. Satisfied, she glanced up.

  ‘How’s that IV going, Hamish?’

  ‘She’s as flat as a pancake. I’ll try again in the antecubital.’ Hamish swabbed a potentially easier access point inside Megan’s elbow.

  Cal was using Megan’s other elbow to try and get a blood-pressure reading.

  ‘Systolic’s under 60,’ he reported grimly.

  Emily nodded as she took the information on board. With a pressure that low, Megan was in danger of having inadequate perfusion to all her vital organs. It was not a situation compatible with life for very long.

  ‘The sooner we get her back to hospital the better,’ she announced. ‘I want to get a central line in and I can’t do that here.’

  A central venous catheter would allow intensive monitoring of how well Megan’s cardiovascular system was functioning but it was already quite clear that this teenager was going to need a lot of assistance to get into even a stable condition, let alone start to get better.

  The team waited only until they had one patent IV line and a pressure bag to squeeze fluid in as quickly as possible. Then Megan was lifted into the basket. There was no shortage of willing men to ferry their patient back to the ambulance.

  Emily, Mike and Hamish travelled in the back with Megan. Charles had remained in radio contact with Harry throughout the search and he and Jill now had the department ready and waiting. Extra staff who could well be needed, such as a radiologist and a CT technician, had been called in.

  It was a rerun of what had been started hours ago, only this time the situation was far more serious. Megan was deeply shocked and in grave danger of developing multi-system organ failure. It would not be enough to attempt to keep her alive with life-support intervention while they tried to deal with the source of infection by aggressive antibiotic therapy until she was stable enough to consider surgery.

  That source of infection had to be removed by a D and C. Now.

  ‘Has someone called Georgie in yet?’ Georgie Turner was the O and G consultant who had private rooms in town but covered emergencies as well as her part-time work at the hospital. ‘She is back in town, isn’t she?’

  ‘Yes,’ Jill responded, ‘and I’ve called her. She’s on her way.’

  ‘Theatre staff?’

  ‘Also coming. And I’ll scrub.’ Jill was their most senior theatre nurse and managed to make a regular appearance on duty on top of the administrative side of her position.

  ‘I’ll assist Georgie,’ Cal offered. ‘I’ll go and check the setting-up now.’

  ‘And I’ll stay here and help Em,’ Hamish said. ‘Do you want to put that central line in now?’

  Emily nodded. She would need to scrub up for the sterile and rather fiddly procedure of inserting the central venous line and a Swan-Ganz catheter into a vein just below Megan’s collar-bone. The information it could give them would be vital in getting her through the added insult of an anaesthetic and surgery in her shocked state.

  ‘We need to review the antibiotic regime, too.’ Emily moved to the sink to scrub. ‘What’s going to be the most effective one to add in with the gentamycin to make sure we cover any anaerobic organisms, Charles? Clindamycin? Chloramphenicol?’

  Staff numbers in the resuscitation area dropped as the next phase of Megan’s care began. Mike had been helping the paramedics clean up the ambulance but he reappeared when it was time to transfer Megan to Theatre.

  And he was still there when they emerged nearly an hour later and wheeled Megan’s bed into the intensive care unit.

  ‘How was it?’ he asked.

  ‘Touch and
go.’ Emily was still running on the adrenaline she’d produced during one of the hardest anaesthetics she had ever administered. ‘And I thought that procedure on Lucky was tricky.’ She stood back as the bed was eased carefully into position, so as not to get tangled in the spaghetti of leads attaching Megan to a bank of monitors. ‘We came a bit too close to losing her, Mike. She arrested at one point.’

  ‘You’ve got her this far.’ Mike’s quiet statement was almost a benediction. ‘Maybe she’s just as much of a fighter as you are, Em.’

  ‘Let’s hope so.’

  ‘Who’s staying with her now?’

  ‘I am.’ Emily’s tone made it clear that she didn’t need to be reminded of the rest she needed badly. There was no way she was relinquishing care of this patient to anyone else. Not yet.

  It was Emily who inserted an arterial line so that serial and accurate measurements of circulating oxygen levels could be obtained. She checked the functioning of the urinary catheter and fussed over the dose of diuretic needed to boost urine output to an acceptable level. She worried about the rate of the dopamine infusion as Megan’s blood pressure responded too slowly, and she studied the pressure settings on the ventilator, trying to ensure that the maximum level of oxygen that was so vital to cellular survival was being delivered. She checked and double-checked every reading.

  Including the twelve-lead ECG. It was miraculous that Megan’s heart had given up and then been restarted and was leaving no trace of any damage. Emily ran off another recording just to reassure herself and it wasn’t until she looked up from scanning the printout that she noticed Mike sitting at the central desk in the unit.

  Watching her.

  ‘Why on earth aren’t you getting some rest?’ she exclaimed. ‘I thought you’d gone back with Hamish and Cal. You’ve been up all night, Mike. You need some sleep.’

  ‘So do you,’ he responded promptly. ‘I’ll go when you do. You need it just as much as me.’

  ‘But I’m supposed to be doing this. I’m an ICU consultant.’

  ‘And I’m an ICU consultant’s friend. I need to be here for when you fall over from exhaustion.’