Anya stepped out of the room and tried not to look at Sophie Goodwin’s father.
The triage nurse handed her a white gown, which she pulled on and tied at the back of her neck. “Gloves are on the wall inside.”
“Thanks.” Anya took a deep breath to steel herself before pushing through double plastic doors. A male nurse carrying two bags of blood rushed behind the curtain to the first resuscitation bay.
“Blood warmer’s coming. Group specific is still a couple of minutes away. They’re still working on the full cross-match.”
“Hurry them up,” a male voice boomed. “She’s leaking like a sieve.”
Two paramedics hovered near the central desk area, sipping from paper cups. Judging by their proximity to the cubicle, they were the ones who had brought Sophie in.
Anya peered through the gap in the curtains but could see only the lower part of the girl. Heads and hands moved quickly, each with a specific role.
Inside the cubicle she recognized Mike Monsoor, a surgeon she had trained with, and emergency specialist, Greg McGilvray. The hospital had quickly mobilized the acute trauma team.
A small figure lay on the bed, naked, her flesh covered with mixes of dried and fresh blood. One gloved nurse put pressure on a blood-soaked bandage over the girl’s abdomen.
A woman in blue surgical scrubs was at the head end, with a nurse, squashed between the bed and the wall.
“Doctor Crichton, I heard you’d been called.” Dressed in a sterile procedure gown, Greg McGilvray held a plastic bone-gun in a gloved hand. The gun was used in the army for administering fluids to injured troops in the field. Instead of wasting critical time trying to find venous access, the plastic gun drilled directly into bone. Advocates claimed it could save large numbers of lives.
Anya hoped Sophie Goodwin’s was one of them.
“We’ve just lost the antecubital cannula. It’s tissued,” a younger doctor said, feeling for a groin pulse. “My concern with a femoral line is that any fluid could just fill the abdomen. We need to go in to know what damage is in the belly.”
He had to be a surgical registrar.
“I’m in the humeral head,” Greg announced from the girl’s right shoulder. He flushed the line with saline and attached the blood for immediate transfusion. A nurse stood, arms above her head, squeezing the blood to get it into the body faster.
The monitor beeped seventy-five, a dangerously low blood pressure. Even if the girl survived, there was a chance she could suffer organ damage because of the prolonged poor blood supply.
The number on the monitor slowly increased with each squeeze of the bag. The blood was doing some good.
“Everyone, this is Doctor Crichton, a pathologist and forensic physician,” Greg introduced.
“Aren’t you a bit early? Business must be slow in the morgue,” the surgical registrar muttered and stepped outside the curtain.
Some things in hospitals never changed.
“Don’t suppose you want to put in a subclavian line?” Greg looked up. “Your anatomy is better than all of ours put together.”
“Not today thanks. But I will bag her shirt if anyone knows where it is.”
“Ah, I listened to your last lecture and split it along the buttons so knife cuts stayed intact.”
“Much appreciated.” For the first time, Anya had a clear view of Sophie’s head and neck. The wound gaped from one ear to the other, exposing veins and vital structures.
“I’ve never seen a wound that deep on anyone alive,” Anya thought out loud.
The breathing tube was placed straight into the trachea, bypassing the mouth and upper neck, kept stable by a towel clip attached to the sheet. In this instance, everyone was improvising as best they could. Textbooks couldn’t cover situations this complicated.
No wonder the woman at the top was keeping the head stable. Even a slight movement could tear large veins and prove fatal.
Greg glanced at Anya, then paused to look at his patient. “God knows how she crawled all that way without severing a vessel completely. The ambo officers did a top job getting her here alive.” Gloves on, he wiped his forehead with his forearm. “You know, I’ve got a daughter the same age.”
Moving a piece of hair from the neck area, he paused. “It’s hard to believe someone did this deliberately.”
Blood pressure hovered at eighty to eighty-five.
The surgical registrar returned. “Vascular surgeon’s upstairs prepping. No time for a CT scan. As soon as that other line’s in, we’ll take her straight to theater.”
“What about gynecology?” As the forensic physician, Anya was concerned about Liz’s mention of a bleeding vaginal injury.
Greg explained, “Registrar’s upstairs standing by. You might as well photograph what you can. It’s the best chance for the neck and stab wounds you’re likely to get.”
Anya already had the digital camera in her hand. Any opportunity to examine the wounds would be gone once surgeons started operating. With no time to grab a tape measure, she pulled the lid off a pen and placed it on the skin near the girl’s left shoulder. The lid would be the consistent measure of scale for each wound.
She recorded a number of stab wounds on the chest without interfering with the resuscitation. The woman at the head mentioned marks on the forearms and Anya gently collected images of them as well as of the hands and fingernails with the assistance of another nurse. Classic defense injuries, she thought. Sophie had tried to fend off her attacker, or attackers. She had probably seen whoever stabbed her.
“Thanks, Greg.”
“They should know to expect you in theater as well. Any problems, get them to ring me.”
“Give us a few minutes,” said the woman still quietly holding Sophie’s head. “You can meet me in the anesthetic bay. I’m Jenny Rafferty.”
Anya recognized the name of the Director of Anesthesiology and Intensive Care. Sophie was in the best possible hands.
Moving out to let them take the bed away, Anya turned around. The two paramedics were still by the nurse’s station. One was in his thirties, the other in his fifties.
“Excuse me, Doc,” the older man said. “But if you’re going to stay with Sophie, could you give her this?”
In his hand the man held a silver and gold medallion on a thick chain.
“Does it belong to her?”
“No…but, it’s got me this far safely and now I figure Sophie needs it more than I do.”
Anya took the medallion. On it was the image of Saint Jude, the Catholic patron saint of hopeless cases.
“I don’t know if she’s a believer or not, but it might protect her. Can you make sure she gets it?”
Anya nodded. “I’ll do my best.”
An alarm sounded as the bed wheeled past them, Jenny Rafferty clinging to the young girl’s head.
“Blood pressure’s dropping. She’s bleeding again. We need to get to theater now!”
The older paramedic’s face tightened as he closed Anya’s hand around the medallion. “Don’t let it out of her reach. It may be the only thing than can save that poor kid’s life.”
6
Anya left the operating theater an hour and a half later, with three surgical teams still fighting to save Sophie Goodwin’s life. In the change room she took a few minutes to wash her face in cold water and absorb exactly what she had witnessed.
Never before had she seen injuries so severe on a survivor. It was the degree of trauma that might be found following a fatal road trauma or plane crash.
Despite all the years of pathology and examining wounds, it was difficult to accept that a human being had done this to a young girl. She could only imagine the pain the sister had gone through before dying.
