‘Hi, I’m Mac and I’m a doctor,’ Mac explained as the paramedics rolled the youngsters in on their respective trolleys. He listened attentively while the crew outlined the children’s status. Emily had injuries to her right arm and was in a great deal of pain, while her brother was having difficulty breathing. Ethan had been thrown into the aisle by the force of the impact and trapped under the seat, which had come away from its housing. It was more than likely that he had fractured ribs which could be compromising his breathing if they had pierced the pleura—the two layers of membrane that covered the lungs and the chest wall. If blood had entered the pleura cavity it would compress the lungs and cause a partial collapse. Mac knew that the boy required urgent treatment and turned to Helen Robertson, the F1 student, who was working with him.

‘You take the girl. She’ll need X-rays first and then we can tell exactly what we’re dealing with. If her shoulder has popped out its socket it will need putting back before the nerves are damaged. You also need to check if the humerus is fractured. OK?’

Helen nodded, looking a little daunted at being put in charge of a patient. Mac watched as she hurried to the phone to request the services of the duty radiographer. She would manage fine, although he would keep a close eye on her. However, if she was to develop her skills then she needed to step up to the plate, as every young doctor had to do. He turned his attention to Ethan, checking his pulse and oxygen levels. Bailey Thomas, the Australian specialist resus nurse, was assisting him and Mac nodded when he asked if Mac intended to aspirate.

‘Yep. I reckon there’s blood in the pleural cavity, don’t you? Let’s see if we can drain it off and help him breathe a bit easier.’

Bailey fetched what they needed and Mac set to work, easing the needle through the tough intercostal muscles between the boy’s ribs. He was unsurprised when he immediately drew off bloody fluid. ‘Definitely a haemothorax,’ he said, glancing at Bailey. Out of the corner of his eye, he saw that the radiographer was putting Emily’s X-rays up on the monitor. Even from where he was standing, Mac could see that the girl’s humerus was fractured although he didn’t say anything. He wanted Helen to find her feet and spotting the fracture herself would help her do that.

‘Let’s see if we can get any more out of there,’ he said, turning back to Ethan. He aspirated some more blood before he was satisfied that he had alleviated the problem. Ethan’s sats were back to what they should have been and he was breathing steadily so it was time to assess what other injuries he had sustained. Mac called over the radiographer and asked her to do a whole-body X-ray. While she was doing that he went to check on Helen.

‘So, how’s it going?’ he asked, leaving her to explain her findings.

‘It’s as you suspected—the humerus is fractured at the upper end.’ Helen pointed out the fracture and Mac nodded.

‘So it is. Well spotted. Her shoulder’s also dislocated so that needs sorting as well.’

‘What should I do?’ Helen asked uncertainly. ‘Should I try to reduce the dislocation and pop the humerus back into its socket or what? I’ve not dealt with a case where the humerus is fractured as well.’

‘It would be far too painful for Emily if we did it here. Plus there’s the problem of the fracture, which complicates matters,’ he explained. He always enjoyed helping the younger doctors and, unlike a lot of his peers, never considered it to be a waste of his time. The more everyone knew, the easier it was for the rest of the team, he reasoned.

‘Phone Theatre and book her in ASAP. They’ll take care of the lot and that way Emily won’t know a thing about it. You just need to get her parents’ permission for the operation to go ahead, so see if they’ve arrived yet and if not get the police to contact them. Tell them it’s urgent.’ He grinned at her. ‘We don’t want to waste any time so lay it on thick. It’s the one time you’re allowed to lie to the police!’

‘Will do!’ Helen was laughing as she hurried out of Resus to set the wheels turning.

Mac smiled as he went back to his patient. From what he had seen so far, Helen had the makings of a really good doctor. She would learn a lot from working here too. It made him suddenly glad that he had agreed to cover the paediatric A&E unit until their own registrar returned to work. Oh, he’d had his doubts when he had found out that Bella was working here. After everything that Tim had told him, it was only natural, although now he could see that he had been a little too hasty. OK, so maybe there had been a few teething problems but he and Bella seemed to be getting on remarkably well, all things considered.

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