Luke left the staffroom and stood in the department; he could see people moving around getting ready for the large influx of patients that was about to come in. He could feel the tension in the air. It was like being back in a warzone waiting for patients to arrive from the frontline. Luke tucked a pair of gloves into the back pocket on his scrubs and stood by the ambulance bay doors tapping his feet, eating a banana whilst he waited for the first casualties to arrive.
"The calm before the storm." Abs said as she came and stood next to time.
"I know this feeling all too well." Luke said as he ate a piece of his banana. "It's why I'm eating, a good source of energy for all the rushing around that we are about to do, and it keeps me distracted for a short while. I used to do the same whilst I waited for helicopters to transfer patients in Iraq and Afghanistan."
Abs chuckled. "I guess that makes a bit of sense."
Just then the ambulance bay doors burst open and the first casualties from the coach explosion had arrived. They were closely followed by some walking wounded that had managed to make their own way to ED to save the ambulances for the more serious casualties.
Luke chucked his banana skin and pulled his gloves on, ready to rush into rushed action. Luke and Abs agreed to pair up together and take on minor injuries after their successful partnership earlier treating Mollie. Luke wasn't going to get angry that he wasn't dealing with major injuries in resus. He knew that those with minor injuries could equally need just as much attention as those in resus. They just might require a different sort of help. The reassurance that ever was going to be okay despite what they had just gone through.
As Luke made his way through the patient coming in via triage all he could think about was his time in the army and the field hospitals. The bodies and the burns that had been caused to them from explosions. The shell shock that affected those who just witnessed the explosion but had made it away relatively unharmed and were left feeling guilty about that. Luke thought he had got used to seeing injuries like this, but in a situation like this he knew that he would be haunted by them for the rest of his life.
Luke was used to working under this kind of pressure, making quick decisions in order to save as many lives as possible without making the damage worse. His partnership with Abs was like being partnered with one of colleagues in the army; they just got each other and knew what was needed and, in a situation, like they were, having a partner like that was invaluable. Luke was desperately trying to find someone who needed help. But he had no idea what was going on. He looked around desperately trying to make sense of what was going on. But as more patients came in the more disorganised the department got.
"Tess, what's going on? I have no idea what is going on or where anyone wants me." Luke said, walking up to the reception desk.
"Luke, you know as much as I do right about now. Nobody has bothered to review the majax protocol like they were meant to, which now means it is significantly out of date and up to the current regulations. I've got on-call doctors who are not bothering to show up or answering their pagers as well as a temporary mortuary that can't be used as one because it is full of building materials. We also have no clinical lead because we have no senior doctor in the building." Tess moaned as she tried to organise herself and the patient around her.
This must have been some of the inner Welsh dragon that Luke had heard so much about. Luke looked around the department and he still couldn't decide where he would be best needed. Just as Tess was on the phone asking all senior doctors from any other department be paged to try and help, the lift doors into the elevator and a lady in scrubs stepped out. She seemed to ooze authority as she looked around at the chaos that was unfolding in the department. Luke watched as she shouted at a man who was causing disruption in reception, she then turned and walked into resus.
"Who is it?" Luke said in admiration of what he had just witnessed.
"Our saviour." Tess said as she put the phone down. "Follow me."
Luke followed Tess into resus. The female doctor was already bossing people around in there as well.
"Mrs Beauchamp, I'm glad you've come down to help. This is Dr Luke Stone, our new speciality registrar. Do you need him in here with you or do you think he could continue the work that he has been doing in cubicles?" Tess asked.
"I think Dr Winters, Dr Coldwell and I have got things under control here. Dr Stone can go back to the cubicle please and try and organise the chaos that is going on out there." Connie Beauchamp replied as she hands deep in a patient.
Luke left Resus with Tess. Cubicles were still in chaos, Luke couldn't believe that staff weren't coming in to help when they needed them most, especially Charlie, one of the senior nurses wasn't present. Josh, one of the paramedics, was walking through the department. Luke had been told that Josh was Charlie's oldest and best friend.
"You haven't seen Charlie have you. I haven't seen him for ages, and we really need all the help we can get around her." Luke asked.
"Well by the looks of things he's over there." Josh pointed to the big swinging double doors. "Look I've got to go mate, if you think it's bad in here you need to be at the incident site."
Luke followed Charlie through the department. He was just about to go up the stairs when he stopped. Luke caught up to try and get him to help but he saw why Charlie had stopped. Toby was sitting with a lady who had collapsed on the stairs.
Luke bent down to help Toby. He took his stethoscope off from around his neck and started to listen to his patient's chest. Her heart rate was dropping, she was struggling to breath. Luke also noticed some swelling to her lips and eyes. He knew exactly what this was.
"Toby, I need you to get me some oxygen, adrenaline and an ECG please." Luke asked.
"I…I don't know where any of that is." Toby replied.
"Fine. Charlie, can you go?" Luke asked.
Charlie reluctantly agreed to go. He came back with what he had asked and Connie Beauchamp.
"What have we got?" Connie asked.
"A patient in anaphylaxis, I'm sure what's caused it. I haven't seen this patient all day in cubicles, so I don't know who has been treating her." Luke said as he put the oxygen mask over the lady's face to help her breath.
Well spotted Dr Stone. 10mg of adrenaline into the thigh please." Connie said as she helped lay the patient down.
Luke stabbed the syringe into the patient and injected the drugs. He listened to her chest again. "Heart rate is improving."
"Dr Stone keep watch over him. Would anyone care to admit what has gone on here?" Connie asked.
"I gave her some medication for her back pain." Charlie said.
"You did get a prescription and check her medical history." Connie asked him.
"No, the department was in such a mess, so I just did it." Charlie said.
He walked away and Connie chased after him. Luke watched as Connie and Charlie argued. Luke walked back into the main reception of the ED and let out a deep sigh.
"How are you doing?" Ruth asked as she walked over. "Not quite the first day that I expected to have."
"Nothing that I haven't seen before in the army." Luke replied.
"That's true. Well working with Mrs Beauchamp has been fantastic, I've already learnt so much. But I heard Toby hasn't had such a great day. Apparently, he can't tell one end of the stethoscope from the next. 6 years of training and he can't even remember to insert an IV line." Ruth said, almost laughing at the misfortune of her colleague.
"Look, it's his first day. He's bound to be nervous and he's going to forget things. Then with the bombing, just give him a chance. Look, I really have to go." Luke said, rushing away before Ruth could make any more complaints about Toby.
Luke was sorting through patient notes trying to help Tess get the nurse station and reception organised again. They were just about done when Connie approached them both.
"We need to get as many people out of here as we can." Connie said.
"What's going on?" Luke asked.
"We have the person who is responsible for this whole incident in resus. She has just admitted she has handled the chemicals that caused the explosion. Before she could answer whether there is another bomb she stroked out." Connie explained. "We need to move people out of here. We need to establish a triage outside. Only if it is serious do people remain in the department other than they wait and are treated as best as they can be outside. We make this as calm and as efficient as possible."
"So that gentleman over there has just informed me that the bag has been sitting there for an hour or two and nobody has claimed it. The last person he saw with it…our girl in resus." Charlie informed them.
"Okay. We need to start this now." Tess said.
Luke began to explain to patients what was going on and moved them outside. Some patients moved quieter than others. Once Luke had moved as many patients as he could outside, he himself went outside with as much kit as he could take to treat some of their patients. The carpark had begun to look like an army field hospital all of a sudden with all the tents that had been erected.
Luke was sitting at a table outside the hospital cleaning a patient's head wound and began to stitch it shut. When he saw his patient from earlier Mollie hopping around looking for someone.
"Ruth! Do you mind taking over for me? I need to make sure someone else is ok?" Luke said, calling over to Ruth.
Luke picked up a chair on his way and then went over to Mollie. "Hey Mollie…Mollie. You shouldn't be out of your chair, let alone trying to walk on that leg, you're going to hurt yourself. What's the matter? Who are you looking for?"
Luke helped Mollie into the chair.
"It's fine I was just seeing if we could go back yet" Mollie told Luke.
"I know you might find this hard to believe but I'm not that old and it wasn't that long ago I was your age so I can spot a liar a mile off. So, what's that matter? Where are your parents? They should be here by now?"
"I don't know if they have shown back up. It shouldn't have taken them this long to get here. They only went to get me some clothes and we don't live that far away. I heard something about a coach explosion, and they have to drive past to get back to the hospital so I thought maybe something had happened." Mollie started to well up.
Luke part his arm around Mollie. "I'm pretty sure that they've just been caught up in the traffic because of the explosion. I'm sure that they'll be here as soon as they possibly can. Come on let's not get yourself too worked up yeah. You just sit there, and they'll get you back inside as soon as they can. You are feeling ok though?"
Mollie reassured Luke she was fine, but Luke knew she was lying to him.
Luke went back over to treating his patients. When an ambulance arrived with sirens and lights blaring and pulled around the corner and into the ambulance bay. Dixie, another paramedic, climbed out the back of the ambulance and wheeled out and Luke recognised the patient immediately it was Dave, Mollie's dad. No sign of Claire though.
"Dixie. What's the story?" Luke said, walking over to the trollies rubbing anti-bacterial gel into his hands and pulling on a pair of gloves.
"Two victims. Husband caught up in the explosions. Wife killed immediately at the scene." Luke's stomach dropped. He couldn't let Dave die on him. "They were in the car behind when it went up. He's lucky to have made it if he has, if we're being brutally honest. Treated at the scene, GCS 3, BP is through the floor. Intubated at the scene, he needs surgery immediately."
"That might be an issue. The ED's been evacuated there's a possible bomb inside and we've had to bring everyone outside." Luke told Dixie.
"He needs to go in immediately otherwise he will be dead." Dixie said, rushing the trolley forward.
Luke followed Dixie who was arguing with Connie and the police.
"If we did not get him in now he will die." Dixie said with raised voices.
"It's not safe. I'm endangering the lives of my doctors or patients." Connie replied.
"We have a duty to cure our patients. As well as care. How can we be caring for our patient if we are keeping him locked outside and leading them to an almost certain death." Dixie argued.
Connie looked at the police. "Luke, myself, Tess and Abs are the only ones going in. Do I make myself perfectly clear? We act fast. No messing about. Let's get him in and the rest of you scrub in."
Luke prepped himself ready for the procedure he was about to undergo.
Luke stood at the table performing CPR.
"Come…on… Don't…die…" Luke said between compressions. "More adrenaline, please."
Tess took hold of Luke's arm. "He's been asystolic for 45 minutes."
"Once more please. It's' got to be worth a try please." Luke begged.
Tess moved his hands away and stopped chest compressions. Abs moved the oxygen mask. "Time of death 15:24."
Luke walked straight out of resus and punched the wall. He didn't care that the bag had been a false alarm and that the ED was refilling. Apparently, it had been some animal rights protest gone wrong. Luke went to reception and just collapsed down against the reception desk and onto the floor, his head in his hands. Luke felt tears run down his face. Tess came and sat next to him.
"We can't save everyone. That man was lucky that he even got the chance of being saved by us. Don't let this get to you." Tess said, putting her arm around Luke's shoulder.
"I know that and it's not that. I knew who they were. I treated their daughter this morning, the assault girl from the park. Him and his wife went home to pack their daughter a bag. She's still here and just like that she is now an orphan. She was outside looking for them. I said they'd be fine. That could have been me dead." Tess looked at Luke, curious by what he had just said. "It was Afghanistan in a field hospital about 18 months ago. Turns out the Taliban don't follow the rule in Geneva Convention that says hospitals are off limits in times of war. They decided to bomb the hospital in Kabul that I was in. They dragged me out and saved my life, and apparently it was very close, they didn't give up on me. That's why I didn't want to give up on Dave. It's not going to be the same as telling an adult is it."
"You don't have to do anything. Someone else can." Tess told Luke.
"I want to do it. She trusts me. I'll get cleaned up and tell her. She has the right to know as soon as possible. I don't know where she'll go, she has no other family."