Page 41 of Prognosis So Done

And for her to cool off.

She didn’t want to walk into the theatre and have to look at Gill when a vivid memory of him in a fireman’s hat and nothing else had her all a fluster — despite the pain in her side. They’d had so many good times, laughed so much. She knew it would be so easy to go to him and tear up the divorce papers and be with him and love him for the rest of her life.

But something would always be missing. Gillian had brought it glaringly to the fore again. Just because he looked magnificent in a fireman’s hat drawling ma’am at her, wasn’t a good enough reason to sacrifice her wants and needs. She knew she could keep Gill happy but she also knew he couldn’t do the same for her.

‘Here she is,’ said Siobhan to Katya, as Harriet schooled

her features into neutrality and entered the theatre.

‘Sorry,’ Harriet apologised.

‘Is OK,’ said Katya gently.

Bless you, thought Harriet. Katya had obviously known that she’d needed some time to herself and, once again, Harriet realised how much she was going to miss these people.

The patient was already in the theatre and had been

intubated by Kelly for decreased level of consciousness. Helmut was looking after his airway and hyperventilating him with mechanical breaths from a bag attached to his tube.

Hyperventilation was an important part of head-injury

management. The theory was that carbon dioxide, a known potent

cerebral vasodilator, was blown off, thus preventing excess

cerebral blood flow and keeping intra-cranial pressure down.

Gill and Joan were looking at the patient’s X-ray on the viewing box, a fracture of his left temporal bone evident.

‘So we’re not sure if he has an extradural?’ asked

Harriet, joining them.

‘Can’t be sure without a CT scan,’ said Gill. Unfortunately, resources did not stretch to a CT scanner. ‘All we can go on is the clinical picture. Kelly said he’d been complaining of a headache and weakness in his right arm and leg after sustaining a blow to the head with a rifle butt. They did a skull X-ray and found the fracture then he rapidly lost consciousness and blew his left pupil so she tubed him.’

Harriet nodded, looking at their patient. Sounded like a typical cranial bleed picture. So they were going to have to drill a hole in his head and hope they could find the blood clot and evacuate it. If not, the patient’s problems were probably a lot more severe and, as Gill had said, without a CT, impossible to know for sure.

‘He looks so young,’ said Harriet, still not yet numbed to the fact that teenagers fought wars.

Joan nodded. ‘Yeah. It’s so bloody senseless, isn’t it?’

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Gill scrubbed, takinghis time to be thorough, despite the

urgency. The last thing this young man needed was for him to introduce a pathogen directly into his brain. He just hoped, as he concentrated on his scrub, that he located the blood with his first burr hole. He was more than aware that the patient might not have an extradural at all - although his gut was positive.

They were essentially embarking on a fishing expedition inside someone’s head and once he started he’d have to make several attempts to either find it or satisfy himself that there was nothing to be found.

Gill had done many of these procedures over the years and

was more than conscious that the object was to decompress the head and then get the patient out to specialised help. Drill a hole, evacuate the blood, stitch him up and fly him out.

Notdrill as many holes as he could and fluff around till he found something.

The other possibility was that he’d find a subdural haematoma. Gill sincerely hoped not. It wasn’t that he couldn’t handle it, it was just a little longer, a little more complicated, a little more potentially serious for the patient.

‘Mannitol’s finished,’ said Helmut to Gill, as Gill entered the theatre with wet arms held up in front of him.

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