Page 40 of Prognosis Irreconcilable Differences

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They watched Jeremyfor the next fifteen minutes. He seemed settled, but with five minutes to go his heart-rate accelerated again and Nathan was concerned that his abdomen had become more tense.

Jacqui, who’d changed into her usual green scrubs, watched with growing disquiet. His vitals were slipping. Her heart-rate climbed incrementally with Jeremy’s, and she prayed the ambulance was only a few minutes away. They should be able to hear the sirens any minute now.

The phone rang. Nathan snatched it off the wall. Jacqui heard the one-sided conversation with dismay. The ambulance wasn’t coming.

‘The bridge is under, isn’t it?’ she asked as Nathan replaced the receiver.

He nodded. ‘And they can’t send a helicopter out in this storm. I’m afraid we’re stuck here for a while.’

Jacqui looked at him. She’d expected to see the same fear in his eyes that had a stranglehold on her gut, but it wasn’t there. He oozed confidence, authority.

She swallowed. ‘He’s deteriorating.’

Nathan looked at the monitor. Heart-rate one-thirty. He raised an eyebrow at Jacqui as she finished another BP.

‘Seventy systolic.’

Yes, he was deteriorating. Yes, he’d bet every one of his billions that Jeremy was haemorrhaging internally. How much blood the boy had already lost, where it was coming from and how fast, he couldn’t know for sure.

‘Let’s run some more fluid,’ Nathan said.

It restored Jeremy’s flagging circulation transiently, but his condition continued to deteriorate as the storm continued to rage.

‘What’s your operative set-up here?’

Jacqui was actually trembling inside now. There was no doubt in her mind that Jeremy needed exploratory abdominal surgery — but here? In her veterinary theatre? ‘I do minor ops only. The most complex I do is spaying. I have a ventilator, suction, diathermy and some basic instrument sets.’

Nathan nodded, his brain leaping ahead. ‘I think we need to go in. Would you be happy to do anaesthetic and assist?’

‘Sure,’ she said, hoping she sounded much more confident than she felt. ‘You’ll have to help me with doses.’

‘What have you got?’

‘I use Thio for induction and Isoflurane during.’

Nathan examined Jeremy’s increasingly rigid abdomen. ‘Good. Let’s go.’

For a second Jacqui just stared at him. But his confidence was inspiring, and she found herself responding automatically.

‘Jimbo, you’ve done a first aid course, haven’t you?’

Jimbo swallowed, looking from one to the other. ‘Er, yeah...’

‘Good. We’re going to need your help.’

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Fifteen minutes laterJacqui had successfully intubated her first human since university practice sessions. She’d hooked him up to the ventilator, and was watching as Nathan made a mid-abdominal incision. Jimbo had been given a crash course in assisting a surgeon, helping Nathan prep the patient in sterile green drapes, and had been entrusted with monitoring Jeremy’s blood pressure.

Nathan’s hand was rock-steady as he made the incision. There wasn’t a single moment of self-doubt. The only operations he’d performed in over a decade were fertility related or C-sections, but it was as if he’d never left his surgical residency.

Jacqui angled the metallic sucker to slurp away the excess blood, and he headed straight for the spleen. The number one cause for ruptured spleens was motor vehicle accidents, usually seatbelt related, and his gut told him this was Jeremy’s Achilles’ heel.

One look at the severely ruptured organ confirmed his suspicions, and his fingers moved rapidly to do what he needed to do. First priority was to fasten the splenic artery and achieve haemostasis, which Nathan managed in good time.

He saw an almost instantaneous stabilising in Jeremy’s vitals. His heart rate dropped to one hundred, his blood pressure climbed to one hundred and ten systolic, and Nathan took his first deep breath. It took him a further thirty minutes to remove the mangled spleen altogether.

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