consciousness twenty minutes after the accident.
‘Witnesses say he was playing chicken, crossing theroad on his bike between parked cars,’ Max told her drily. ‘Apparently the car driver tried to avoid him and did an emergency stop, but he didn’t stand a chance.’
‘The boy or the driver?’
‘Both,’ Max said. ‘They’re bringing the driver separately. He has whiplash—and he’s pretty distressed.’
‘Anyone would be, in his shoes.’ She’d once accidentally backed into a car and broken her rear light, and that had been upsetting enough; when the collision hurt a person rather than a fixable object, even if it wasn’t the driver’s fault, it must be unbelievably frightening. ‘What a mess,’ Marina said.
Max swiftly intubated the boy and they set up ventilation. The boy’s cervical spine was still protected by the board. ‘I’ve got a bad feeling about this one,’ Max said.
‘Skull fracture?’ Marina said.
Max nodded. ‘And maybe a haematoma.’ A blood clot that caused the brain to swell and pressure to rise within the cranium was a problem often caused with head injuries, and it could be fatal.
Max grimaced as he reviewed the CT scan. ‘Look,’ he said, pointing out the fracture at the base of the boy’s skull. ‘And here.’ There were definite signs of a haematoma.
‘Hurts,’ the boy said, opening his eyes and closing them again almost straight away.
But at least he was talking; that was a good sign.
‘Where does it hurt?’ Marina asked.
The boy mumbled something neither of them could catch—and then was silent.
Marina and Max shared a glance. ‘I hope this isn’t a textbook case,’ Max said.
She knew what he meant: ‘talk and die’. They’d bothseen cases like this before in Bristol, where a patient seemed to start recovering, said a few words—and then died just minutes later.
‘His BP’s rising,’ Marina said.
‘And he’s bradycardic. Looks like a Cushing response to me.’ Max’s mouth tightened.
The Cushing response was when blood pressure rose and the heart rate fell; it meant there was increased intracranial pressure. Given the circumstances surrounding the boy’s accident and what they’d seen on the CT scan, Marina knew Max thought the problem was caused by the haematoma getting bigger.
‘I’ll call the neuro team,’ she said. A few moments later, she came back over to Max. ‘The neurosurgeon says give him a bolus of mannitol—it’ll buy time to get him upstairs to Theatre so they can drain the haematoma.’
But they both knew it might not be enough time.
Max administered the mannitol, and the boy was rushed upstairs to Theatre.
Although they were rushed off their feet for the rest of the afternoon, Marina knew that Max was thinking of the boy, just as she was. And the longer it went without any news the more worried she became. Neurosurgery was delicate and draining a haematoma took time, especially when a fracture was involved too, but surely they should have heard by now?
In the one break she managed to snatch between patients, she called her mother to say that it was frantic in the department and asked her to pick up Phoebe. So at the end of her shift, while Max was doing the handover, instead of rushing to the hospital crèche she called the neuro team to see if there was any news on their patient.
‘I was on my way down to see you.’ Fergus Keating, the neurosurgeon, sighed heavily. ‘Sorry, Marina. We did what we could, but right when I thought we were on our way out of the woods we lost him on the table.’
‘I’m sorry, too.’ Brief, bare words, but she knew that Fergus understood what she meant: sympathy, because he’d tried his hardest, but the boy’s injuries had been too severe for him to save the lad. And he also had the task of breaking the bad news to the boy’s parents; giving bad news to the next of kin was one of the toughest parts of their job. ‘I’ll tell the others.’
‘Thanks.’
She put the
‘Witnesses say he was playing chicken, crossing theroad on his bike between parked cars,’ Max told her drily. ‘Apparently the car driver tried to avoid him and did an emergency stop, but he didn’t stand a chance.’
‘The boy or the driver?’
‘Both,’ Max said. ‘They’re bringing the driver separately. He has whiplash—and he’s pretty distressed.’
‘Anyone would be, in his shoes.’ She’d once accidentally backed into a car and broken her rear light, and that had been upsetting enough; when the collision hurt a person rather than a fixable object, even if it wasn’t the driver’s fault, it must be unbelievably frightening. ‘What a mess,’ Marina said.
Max swiftly intubated the boy and they set up ventilation. The boy’s cervical spine was still protected by the board. ‘I’ve got a bad feeling about this one,’ Max said.
‘Skull fracture?’ Marina said.
Max nodded. ‘And maybe a haematoma.’ A blood clot that caused the brain to swell and pressure to rise within the cranium was a problem often caused with head injuries, and it could be fatal.
Max grimaced as he reviewed the CT scan. ‘Look,’ he said, pointing out the fracture at the base of the boy’s skull. ‘And here.’ There were definite signs of a haematoma.
‘Hurts,’ the boy said, opening his eyes and closing them again almost straight away.
But at least he was talking; that was a good sign.
‘Where does it hurt?’ Marina asked.
The boy mumbled something neither of them could catch—and then was silent.
Marina and Max shared a glance. ‘I hope this isn’t a textbook case,’ Max said.
She knew what he meant: ‘talk and die’. They’d bothseen cases like this before in Bristol, where a patient seemed to start recovering, said a few words—and then died just minutes later.
‘His BP’s rising,’ Marina said.
‘And he’s bradycardic. Looks like a Cushing response to me.’ Max’s mouth tightened.
The Cushing response was when blood pressure rose and the heart rate fell; it meant there was increased intracranial pressure. Given the circumstances surrounding the boy’s accident and what they’d seen on the CT scan, Marina knew Max thought the problem was caused by the haematoma getting bigger.
‘I’ll call the neuro team,’ she said. A few moments later, she came back over to Max. ‘The neurosurgeon says give him a bolus of mannitol—it’ll buy time to get him upstairs to Theatre so they can drain the haematoma.’
But they both knew it might not be enough time.
Max administered the mannitol, and the boy was rushed upstairs to Theatre.
Although they were rushed off their feet for the rest of the afternoon, Marina knew that Max was thinking of the boy, just as she was. And the longer it went without any news the more worried she became. Neurosurgery was delicate and draining a haematoma took time, especially when a fracture was involved too, but surely they should have heard by now?
In the one break she managed to snatch between patients, she called her mother to say that it was frantic in the department and asked her to pick up Phoebe. So at the end of her shift, while Max was doing the handover, instead of rushing to the hospital crèche she called the neuro team to see if there was any news on their patient.
‘I was on my way down to see you.’ Fergus Keating, the neurosurgeon, sighed heavily. ‘Sorry, Marina. We did what we could, but right when I thought we were on our way out of the woods we lost him on the table.’
‘I’m sorry, too.’ Brief, bare words, but she knew that Fergus understood what she meant: sympathy, because he’d tried his hardest, but the boy’s injuries had been too severe for him to save the lad. And he also had the task of breaking the bad news to the boy’s parents; giving bad news to the next of kin was one of the toughest parts of their job. ‘I’ll tell the others.’
‘Thanks.’
She put the
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