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She watched out of the window as Pat landed the chopper on the cricket oval. Tully had the highest annual rainfall in Queensland and light drizzle was falling as they climbed out of the helicopter and into the ambulance that was waiting to transport them to the hospital. Within minutes of landing they were walking into the tiny hospital.
The local doctor, who looked like he must only be just out of medical school, gave them a rundown on the patient’s condition as they followed him to her bedside. ‘Carrie is four months old but she was born eight weeks prem so her adjusted age is nine weeks. She’s of Aboriginal descent and this is her third admission for breathing difficulties. The first two admissions we managed to control her and discharge her home with her mum. This time we can’t get her oxygen sats up—they’re actually falling.’
They were at her bedside now and Georgie and Josh both glanced quickly at the monitors showing Carrie’s vital statistics. Her heart rate was 98 beats per minute, low for a baby, and her oxygenation was below 88 per cent. That was dangerously low. The medical staff had a tiny oxygen mask over Carrie’s mouth and nose but the baby was listless and her chest was barely moving on inspiration. She was only just breathing.
‘What were her oxygen sats when she came in?’ Josh asked.
‘Ninety two.’ Even that was low, and if they hadn’t been able to improve her saturation since she got to hospital Carrie was in trouble.
Josh checked the monitor again. Carrie’s vital signs were unchanged. ‘Right, we need to get some improvement in her vitals. We’ll have to intubate to see if we can get her oxygen levels up and we’ll have to take her with us back to Cairns. I’ll need a straight blade laryngoscope, size one, and a 4.0 endotracheal tube,’ Josh told her.
Georgie unzipped the medical kit she’d carried in with her. It included all the items they’d need for intubating an infant. As they’d had no way of knowing whether the hospital would have equipment that was small enough, it had been safest to bring it from the chopper. She passed Josh the items he’d requested and he deftly inserted the tube. Carrie was so sick she didn’t resist and the moment Josh was happy with his positioning Georgie taped the tube in place and attached the ambubag. She would need to manually squeeze the air into Carrie’s lungs and she’d need to do this all the way back to Cairns. But if it kept Carrie alive she was happy to do it.
As Georgie squeezed the air in they could see the baby’s chest rise and fall with each pump. It looked like Josh’s intubation had been millimetre perfect. She looked up from the infant and her gaze met his.
She was impressed with his skills—intubating a child of this age was no easy task. ‘Nice work,’ she said, and was rewarded with one of his heart-stopping smiles. He looked incredibly pleased with himself but not in an arrogant way. His grin was infectious and she had to smile back. Things were good. They’d succeeded. Carrie’s oxygen sats and heart rate were climbing. She was stable enough to transport back to Cairns in the chopper. They would manage to keep her alive and get her to specialist care. Their first job together had gone smoothly.
By the time they were ensconced back at the Cairns base after transferring Carrie to the Cairns Hospital, Georgie had almost forgotten it was Josh’s first day on the job. She’d ducked across to the Cairns airport terminal building to buy a drink and when she returned she could see Josh chatting to Louise in the comms centre. He was perched on the edge of the desk, one leg swinging lazily, looking quite at home.
Georgie walked slowly towards him, taking a moment to admire the view. His jumpsuit was undone and his grey T-shirt, the colour an identical match to his eyes, hugged his chest. She could imagine the ridge of his abdominals underneath that T-shirt. That image was burned into her memory from the day before. He was rolling a pen through his fingers and his biceps flexed with the movement, drawing her eye to his arms. She could remember how his arms had looked as he’d pulled himself through the water, the sunlight bouncing off his muscles as he’d swum out to the reef. He was an impressive sight.
She was within a few metres before he noticed her but when he looked up he greeted her with a smile. Even though Louise was sitting right beside him Georgie felt as though they were the only two in the building. How could he make her feel as though the rest of the world didn’t exist with just one smile?
She was vaguely aware of the phone ringing as she smiled back at him. She forced herself to watch Louise answer the telephone, forced herself to concentrate on what was going on around her.
Louise was scribbling details onto a notepad. ‘Male patient, early twenties, he’s fallen from the back of a moving vehicle, severe head and chest injuries, possible spinal injuries. He’s on a cattle station about a hundred kilometres south-west of here.’
Ten minutes later Georgie was back in the helicopter beside Josh. This time she’d deliberately chosen to leave an empty seat between them. She needed to concentrate. They needed to work out their priorities for when they reached their destination. The anticipated flight time was thirty to forty minutes and every one of those minutes would be spent making sure they had a plan of action so they could hit the ground running. A road ambulance was also on its way but travelling on dirt roads it would take closer to ninety minutes for it to reach the accident site. The QMERT team would be the first team on site. This would be Josh’s first primary and Georgie needed to make sure they both had a handle on what they might be facing.
Through the headsets she could hear Pat checking the co-ordinates. They’d flown over the rainforest hinterland and the landscape below them was vast, flat and brown. From this height even the trees appeared two-dimensional, flattening into the dirt. Landmarks were few are far between. Thousands upon thousands of empty miles stretched into the distance, broken only by the occasional hill or river. Homesteads blended into the surroundings and were almost impossible to find unless the sun reflected off a shiny tin roof. They were searching for a couple of isolated vehicles on an unmarked dirt road. A task that was near impossible without the right co-ordinates. It was vital that they find the scene of the accident as quickly as possible. Every minute counted.
Pat had established radio contact with the station hands at the accident site and Georgie heard the radio come to life as a voice, crackly with static, filled their headsets.
‘Is somebody there?’ Despite the static, Georgie could hear the tremor of panic underneath the words. The station hand continued. ‘He’s not breathing. What do we do?’
‘Can you feel a pulse?’ Josh was calm under pressure and Georgie relaxed as her confidence in Josh’s medical expertise grew. He hadn’t put a foot wrong so far.
The reply came back. ‘I think so,’ said the station hand.
Georgie glanced at Josh. A more definite response would have been good.
‘Can you get his mouth open?’ Josh continued to give instructions—keeping them busy would help to rein in any panic. ‘Check that he hasn’t vomited or that his tongue isn’t blocking his airway. If he’s vomited, you’ll have to try to clear his mouth.’
‘His mouth is clear but he’s still not breathing.’
‘Check his pulse again.’
‘I can’t feel it!’ They could hear panic through the radio.
‘You’ll have to start CPR,’ Josh said. ‘Does someone know how to do that?’ Despite the urgency of the situation his voice was still calm, his words and tone measured in an effort to decrease any further panic on the ground.
‘Yes.’
Pat’s voice came through the headsets. ‘I can see the vehicles. We’ll be on the ground in three minutes.’
‘We’re almost there,’ Georgie emphasised. If they could hear them, if they knew help was close at hand, that would buoy them up. ‘Can you hear the chopper?’
‘Yes.’
Pat circled the accident. He needed to check the landing site before he guided the chopper down to the ground. As they circled Georgie could see two station hands kneeling in the middle of the dirt track as they performed CPR. Shredded rubber from a blown-out tyre was scattered along the road. The trailer attached to the back of the utility had jackknifed and was resting at an angle. A second utility and a quad bike were standing guard further along the road.
Josh slid the chopper door open the moment Pat gave them the all-clear. Georgie followed him out, running in a crouch to avoid the downdraught from the blades. She carried a medical bag in one hand and an oxygen cylinder in the other. Red dust billowed around them, kicked up by the spinning blades of the chopper. Georgie squinted as she ran in a vain attempt to keep the dust out of her eyes.
As they reached the scene of the accident the two station hands performing CPR stopped, obviously believing that since reinforcements had arrived they weren’t required.
‘Can you help him? Please, you have to help him,’ said one.
‘We had a tyre blow-out and Gus was thrown from the back of the ute. I think he landed on his head,’ said the other.
‘Keep going with the chest compressions while we do a quick assessment,’ Josh instructed as he extracted a pair of thin surgical gloves from a pocket in his jumpsuit and pulled them on. ‘You’re doing fine. Keep going.’
Georgie also pulled on gloves, before kneeling in the red dirt beside Gus. He was lying on his back but there was a depression over his left temple and blood had seeped out of his ear. He must have landed on his head and hit the ground hard enough to fracture his skull. That was not a good start.
Josh was holding Gus’s wrist, feeling for a pulse. He looked at Georgie and shook his head. Nothing. He quickly checked inside Gus’s mouth, assessing the airway.
‘I’ll take over now,’ he told the station hands, and they didn’t argue about relinquishing their role.
Georgie worked with Josh, breathing through a face mask, breathing for Gus, but there was no change. During the flight they’d planned to establish an airway, make sure he had oxygen and get IV access. They hadn’t planned on resuscitating him.
Josh continued with chest compressions. Georgie continued breathing. There was no change. He still had no pulse.
‘I don’t think chest compressions are going to be enough,’ Georgie said. It had been more than three minutes and normal CPR procedure was getting them nowhere.
Josh nodded. ‘I’ll draw up adrenaline.’
On the assumption that doing something was better than nothing and knowing that chest compressions were more important than breathing, Georgie continued pumping Gus’s chest while Josh searched through the medical kit. He drew up a syringe and felt for a space between the ribs before he pierced the left side of Gus’s chest wall with the needle and depressed the plunger, injecting adrenaline directly into the heart muscle.
Georgie held her breath. Waiting. Her fingers on Gus’s carotid artery.
There was a flutter of a pulse.
‘We’ve got him.’
‘Get some oxygen into him.’
Georgie started breathing air into Gus again while Josh pulled an endotracheal tube and laryngoscope from the kit. It looked as though they’d be doing another intubation.
Georgie did two breaths. She had Gus’s head tipped back slightly and the fingers of her right hand were under his chin, resting over his carotid pulse. His pulse was barely evident. She stopped her breaths and shifted her fingers, searching for a stronger pulse. She couldn’t find it.
‘Josh, I’ve lost the pulse.’
CHAPTER THREE
‘NO, DAMN it.’ Josh turned away from the kit and back to Gus, kneeling over him, checking for a pulse. He trusted Georgie’s skill but he needed to double check for his own peace of mind. There was nothing. ‘Resuming CPR,’ he said as he began chest compressions again in a vain attempt to restart Gus’s heart. If the adrenaline hadn’t worked he knew it was unlikely anything else he did would have an effect, but he had to do something.
He worked hard for another minute. Another sixty compressions. There was no change.
He felt Georgie’s hands over his.
‘Josh, stop. His injuries are too massive. He’s not going to make it.’
He didn’t stop. He couldn’t stop. He couldn’t lose a patient today. He was in Cairns to get some pre-hospital experience but it was expected that he would be demonstrating his medical skills and performing well. Losing a patient on his first day was not part of his agenda.
He brushed Georgie’s hands away and continued. Sixty-one, sixty-two. Another sixty and then sixty more.
‘Josh, it’s too late,’ Georgie insisted. Her hands were back on top of his, stilling his movements. ‘It’s been too long.’
He listened then. He sat back on his heels, his hands resting on Gus’s chest, Georgie’s hands covering his. He could feel her hands shaking. Or maybe it was his. He couldn’t tell.
‘We’ve done everything we can,’ she told him.
He looked at her and he could see the bleakness of his own expression reflected in her chocolate-brown eyes. He could see she knew exactly how he felt.
‘I know,’ she said. ‘We want to save them all but sometimes we can’t. It’s just the way it is.’
He rubbed his eyes and the latex of the gloves pulled across his eyelids. He stripped the gloves from his hands and tossed them onto the pile of discarded face masks and syringe wrappings, the detritus of the action. He breathed deeply. He could smell dust and heat and perspiration. He exhaled loudly and breathed in again and this time he could smell honey and cinnamon, an already familiar scent, and he knew it came from Georgie. Sweet and fresh, it competed with the smell of defeat.
The other station hands had moved back, giving Georgie and Josh some room. He looked up at them. They were gathered together, supporting each other. They knew the battle had been lost. He stood and went to them.
‘I’m sorry. His injuries were too extensive. Even if you’d been closer to help, if we’d been able to get here faster, even then I doubt there’s anything we could have done.’ He knew his words would be of little consolation but he didn’t want them blaming themselves or wondering if they could have done more. Today was just one day out of hundreds just like it. There would have been many times when someone had travelled in the back of the ute without incident but today Gus’s luck had run out.
They stood in silence in the heat of the late afternoon. The bush was still, there was not a breath of wind and even the birds were quiet. Josh knew it was only the heat that was keeping the wild parrots mute but it felt like their silence was in deference to the situation.
In the distance he heard the sound of a vehicle approaching. First one. Then another.
An ambulance pulled up, followed by a police car, their distinctive markings almost obliterated by red dust.
Josh spoke to the policeman. He spoke to the paramedics. He was operating on autopilot. Gus was pronounced dead. His body would be put into the ambulance and transported to the morgue. There was nothing left for him to do here.
Pat and Isaac were helping Georgie load the equipment back into the chopper. He left the police and paramedics to finish up and went to help his team.
‘Sorry, mate, tough day,’ Pat said as Josh returned to the chopper. Josh appreciated his sentiment. Pat hadn’t exaggerated the situation neither had he downplayed it, he’d said all that was necessary with those few words.
Josh climbed into the chopper and started securing the medical kits into position. The empty stretcher in front of his knees was a bleak reminder of what had happened. He unclipped one kit from a seat and strapped it onto the stretcher instead, partially covering the empty expanse. That was better. Less confronting.
The chopper lifted off the ground. As they banked to the east Josh could see the accident scene below them. The paramedics were closing the doors at the rear of the ambulance. The police were still speaking with the station hands. He closed his eyes, blocking out the tableau.
He should be saving lives in a big city hospital, with specialist help at hand and state-of-the-art equipment in place. He should be in control, not shooting adrenaline into a young man’s heart on a dirt track out the back of beyond. What a bloody mess.
What the hell was he doing here?
He kept his eyes closed until he knew they were far away from the cattle station. Far away from the ambulance that held Gus’s body. When he opened his eyes he kept his face turned to the window, his head turned away from Georgie. He didn’t want to make eye contact. He didn’t want to have a conversation. Not about what had transpired out in the red dirt. He knew he would have to think about it at some point. He’d have to fill in a medical report. A death certificate. But he didn’t want to discuss it yet.
Georgie was quiet. Perhaps she was lost in her own thoughts. Whatever the reason, he was relieved she didn’t seem to need to talk. Most women he knew would be attempting to have some sort of discussion, even if it was about nothing. The majority seemed to think that silence was there to be broken. He was pleased Georgie wasn’t one of them.
The silence wasn’t awkward. He knew she was there and knowing he wasn’t alone was somehow comforting. He couldn’t see her but he could feel her presence. He could smell her perfume, cinnamon and honey, warm and sweet.
He let the silence continue for the entire trip and it was after six in the evening and night had fallen before Pat started to guide the chopper down to the airport. In the distance Josh could see the lights of Cairns. They were almost home.
Cairns was a beautiful city by day and even more so by night, but it wasn’t enough to lighten his mood. They were on their way home while Gus was on his way to the morgue. A young life extinguished. He felt the tension of the day in his shoulders. He sighed, a long, audible exhalation, trying to release the strain in his muscles.
He felt Georgie’s hand on his. Her fingers entwined with his in response to his sigh. Her hand connected him to the living. He knew her gesture was meant to give comfort and the warmth of her hand did exactly that. It warmed his entire body. He hadn’t realised he was feeling cold but he was now aware of heat suffusing through him, bringing him out of his fog.
‘Are you okay?’ Georgie asked.
‘I will be.’
‘We did everything we could,’ she said.
‘Are you sure?’ Today’s events made him question his skills. He liked being in control of situations and, while he realised that was sometimes going to be difficult out in the middle of nowhere, what if things went wrong because of him? What if he didn’t have what it took to work in this environment? ‘It’s our job to save lives. I’m no good to anyone if I can’t do that.’ What if he didn’t have what it took to run an emergency department in a big city hospital?
‘You said it yourself,’ Georgie reminded him, ‘Gus’s injuries were too extensive. Even if we’d been able to reach him sooner, the outcome wouldn’t have been any different. There was nothing else we could do.’
Losing a patient was never easy but Josh knew Georgie was right. He’d said those exact words to the other station hands. He and Georgie had done everything they could. But would others see it that way? He needed to prove himself. He needed to show he could handle working in this environment and losing a patient on day one wasn’t an auspicious start.
He’d lost patients before, working in A and E it was inevitable, but today had felt very personal. He knew it was because it had been up to him and Georgie. A team of two when he was used to a team of three or four or ten or however many it took, and having greater numbers took the intimacy out of it. It didn’t remove the responsibility but it did lessen the sense of failure.
As Pat guided the chopper down onto the landing trolley Georgie gave his fingers a gentle squeeze. ‘Today was a bad day. They’re not all like this. It’ll be all right.’
He hoped like hell she was right.
Pat switched the engines off. The blades continued their revolutions but even the rhythmic thump-thump of the spinning blades didn’t disguise the silence that enveloped the team within the chopper. Georgie unclipped her harness and Josh followed suit.
Georgie leant forwards between the pilots’ seats. ‘Dinner at my place when we’re finished here?’
Josh heard her issue an invitation to Pat and Isaac. He was strangely disappointed not to be included yet there was no rule that said he should be. He was the new kid in town.
Their shift was over but it was their job to restock the supplies ready for the next crew and he knew following a routine would help to focus his thoughts. He got busy unloading the medical equipment they’d used and pretended he hadn’t heard Georgie’s words.
Georgie climbed out of the chopper and then turned and reached for the kitbags, preparing to carry them back to the QMERT building. ‘The guys are coming back to my house for a feed. Would you like to join us?’
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