Chapter 76
"Dr Ellingham. This is Dave Cotterell, Senior Registrar at the hospital. We met when you came in to look at those X-rays."
"Yes," said Martin, shortly.
"I've been asked to contact a number of people to see if they would come in and help us. We've got an emergency situation and we don't have enough people to cope. There's been an explosion on one of the larger trawlers and there are numerous casualties. The lifeboatmen are on their way out to get the casualties back here. "Will you help, please?"
Martin could hear the panic almost beginning in Cotterell's voice. "Where's Dr Laverick?"
"He's on Tresco for a family meeting and party. He isn't due back until tomorrow."
"Cotterell, has the hospital got a disaster procedure in place?"
"Yes sir, it has. In fact we went through it about 6 months ago." Cotterell sounded pleased to be able to grip onto something positive.
"Right, invoke that immediately, get one of the other staff to start calling in off duty doctor's and nurses. Don't forget anyone qualified who only retired 2 or so years ago."
"Do you have an idea of the number of casualties and their injuries?"
Cotterell said, "I'm not sure of their precise injuries but I've been told to expect severe burns, broken limbs and blast-wave injuries. As to the number upwards of 10 or more patients have been identified.
Martin nodded to himself; it was what he'd expected.
"Get hold of your pharmacist and determine emergency supplies of drugs, saline solutions, gauze bandages and make sure at least 10 sets of surgical equipment are sterilised. Get the administrator to check on spare beds, blankets etc."
"Yes sir. We have two surgical registrars in tonight, as well as a team of surgical nurses."
"You'll need more. How many ordinary patients are in casualty now?"
"Er, only 5 at the moment. Up until now it's been a quiet night."
"Right, have them checked over, carefully mind, and get them moved to a side ward if you can to await further treatment as and when. When you've seen to that make sure that your emergency bays are cleaned thoroughly as soon as possible."
Cotterell was relieved to have something positive to do, and agreed to do as much as he could.
"I'm currently at the St Mary's Theatre so send a car to get me. I don't have my bag nor any surgical clothes. Can you arrange for a set to be ready for me? You've seen me so a little set will not be adequate!"
Cotterell grinned as the picture of Ellingham in small scrubs flashed through his mind. "I'll get started on that immediately." He terminated the call.
Martin turned to Louisa who was looking anxiously at him. "Did you hear that?"
"I take it that an emergency has happened, but what's it got to do with you?"
"There's been an explosion on one of the larger trawlers and there are multiple casualties coming into St Mary's. I've said I'll go and help with as much as I can. I'm sorry Louisa but I have to go."
She looked up at him and agreed. "I know you do. I'll watch the end of this and then go home. I'll be fine, don't worry. Any idea how long you'll be?"
"Could be quite a long time, there will be numerous patients. Lock up and don't wait up. Its likely to be some time tomorrow afternoon or evening before I'll get away." He bent and kissed her briefly before turning and going out of the theatre.
As he stood waiting for the car, he phoned Chris Parsons in Truro. As the phone was answered he barked out "Chris? Ellingham here."
"Mart, what are you doing phoning at this time of the night? I thought you were on holiday?"
"Never mind that Chris, there's been an explosion on one of the trawlers at sea, multiple casualties, burns, broken limbs, blast-wave injuries etc. The hospital staff won't be able to cope with a large influx of people. Can you get me cleared to operate if I have to? Also we'll need another couple of surgeons, a complete surgical nurse team and obviously more drugs etc. You should be able to speak to the hospital pharmacist about that."
"Where's Laverick, Martin? I thought he was in charge there?"
"Gone on holiday for a couple of days to Tresco. Should be back tomorrow afternoon. Cotterell has invoked the Emergency Plan to get things moving."
"Cotterell?"
"Surgical Registrar in Casualty. Anyway Chris, my car's here. I'll talk to you when I can, later. Please do what you can to get those people here."
Martin rang off abruptly and Chris was left looking at his phone. However if Martin was a gifted surgeon, then Chris was a gifted administrator. His first priority was to get the appropriate authorisation for Martin through to the hospital. That being done he set about organising personnel and supplies to be shipped via air ambulance.
As Martin entered A&E Cotterell hurried to greet him. They shook hands and then Cotterell took him around to show what had been done and what was ready for the first patients to arrive.
"I've spoken to Chris Parsons, head of PCT in Truro and he is arranging operating permissions for me here. He's also liaising with your administrator for additional supplies and personnel. Has there been any further information on the casualty front?"
"Er, not yet Dr Ellingham. Some of the patients will be transferred to the lifeboats. Several picked up the distress call and mobilised when they realised the extent of the casualty numbers. At least the trawler isn't sinking!"
"There will be extra staff coming tomorrow via the air ambulance, as well as extra supplies. Has there been any extra personnel drafted in from the Scillies? What's the latest status on your medicines and surgical supplies?"
Martin was all business, knowing that if as much could be done now, the real effort could be directed at the casualties when they arrived.
Cotterell outlined the current state of readiness and then began to show Martin around the A&E ward, to see what preparations were already in place.
"You'll need staff to man the remaining Casualty patients and the bare minimum to look at any other injuries which may come in. I suggest you put it out on radio that people should go and see their local GP providing they've not got a life-threatening injury or illness."
Cotterell nodded and went to get things underway. He returned with a white coat, stethoscope and clean surgical scrubs for Martin. "Radiology are standing by, as well as our CT personnel."
"Have you got an office I can use as a base? With a computer?" Martin was thinking of the formalities which would be needed once the real action began.
"You can use Max Laverick's office until he gets back?"
Martin agreed and went along to change into the white coat.
When he came out extra personnel were standing by awaiting the first arrivals.
Martin clapped his hands to attract their attention. "Once the patients begin to arrive you will be immersed in what will be a difficult situation for those of you who've never experienced anything like this. Some of the injuries may be especially gruesome but all will require your utmost efforts and concentration. Make sure you catalogue as many injuries as you come across them, giving each patient sufficient attention that you don't overlook something vital in your rush to treat the surface injuries."
Several heads nodded their understanding. Martin noticed that one or two of the attending staff looked a bit green around the gills. The radio announced the imminent arrival of the first patients and all stood up straighter, ready to begin work.
The ambulances arrived and the first casualties were rushed in. Martin quickly assessed their likely injuries and directed the gurneys to the appropriate members of staff.
The first casualty had a life-changing injury having had one of his arms blown off. He was also burned and would require the careful removal of his clothes. Martin himself began to feel nauseated and took a few deep breaths.
Knowing that there would be no chance of re-attaching the arm, even if they'd had it, Martin ordered Cotterell to stop the bleeding from the arm and then assist in the removal of the victim's clothing.
The next patient required X-rays whilst the possibility of shrapnel-like fragments being lodged in his chest was examined. He was swiftly escorted out of A&E.
Meanwhile a second ambulance arrived, disgorging more severely injured patients. Martin oversaw the diagnosing of the likely injuries, pleased to note that, for the main part, the injuries were being observed correctly.
The fifth patient had an open chest wound which was bleeding profusely, as well as severe burns down one side of his body. The smell of the blood and cauterised flesh was enough to cause Martin to blench. He managed not to be sick, but it was a close-run thing.
The evening progressed slowly as each casualty was examined and eventually several were sent to theatre for operations. As there were only two surgical residents on duty, Martin went along to assist or lead as the case demanded.
The patient with the open chest wounds was presented for the removal of several pieces of metal from within his body. Looking at the X-rays Martin could see that one was lodged very close to the victim's heart. He widened the opening in the chest cavity and began to examine the site more closely. A suction line was inserted to remove the freely flowing blood but seeing the splinters was still problematical.
He felt a familiar tightening in his gut and began to sweat as the threat of nausea began to encroach into his consciousness. A picture of Louisa formed in his mind, with her bright eyes seeming to will him to carry on the task at hand. Grimly he pulled several fragments out and again checked the X-ray picture to see if he'd missed any. He sutured small tears in artery walls and was glad to see that the blood forming in the chest cavity was abating. Seeing that there were no further injuries apparent he asked his assistant to close up.
He left the theatre and went along to the washroom where he was promptly sick in the lavatory. He leaned against the wall and fought for composure.
So it went on throughout the night. After the immediate necessary operations he went back to the casualty area to check on the burn's cases. The patients with the most burns on their bodies, mainly damage to their chests and faces as their lower limbs had been protected by their rubber trousers, had been assessed and most had had their clothing carefully taken off. Clean sheets of saline-soaked cloths were draped over the burns to try and cool them to prevent further damage.
Drips and catheters were in place to administer pain-killing drugs and to remove excess fluids. Several were moaning in pain as the drugs had not quite taken effect. About to move into the next cubicle when a commotion near the admin desk caught his attention. He heard an irate man saying, "I want to see my son, NOW."
Then the calmer voice of the nurse on duty telling the man that it was impossible as no-one could be spared from the first aid they were giving.
Martin's deep voice was suddenly very loud asking "what's all this about?" The nurse tried to explain but was shouted down by the irate father. Martin fixed the man with a piercing stare, "Be quiet." Then turning his attention to the nurse he asked for an explanation. The nurse said that the man had heard that his son was injured and wanted to see him immediately. The man had paid no attention to the nurse's denials and was even then trying to demand that his son should be taking precedence.
"I told you to be quiet," Martin snarled at the man. "When there is some news of your son you will be told the details, and, if he's not too ill for visitors, you will be able to see him then. Do you understand?"
"Who do you think you are, talking to me like that?" blustered the father. "I need to see my son!"
"I'm Martin Ellingham, former Chief of Vascular Surgery at St Thomas' Hospital, London. So when I tell you to go and do something, you'd better listen to what I say. ALL the patients here are in dire need of medical intervention and you, disrupting procedures in this manner, are putting lives at risk. One of those lives might even be your son! Have I made myself sufficiently clear or do you wish the police to come and formally remove you?"
The man backed off, muttering to himself, and then went across to the admin desk to give in his name.
Martin addressed himself to the nurse. "Don't stand for anymore nonsense from him. Call the police and have him thrown out if you need to," he advised.
The nurse was somewhat awestruck and nodded his thanks.