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‘What sort of reasons do people hire an ambulance for?’
‘To take a relative back to a rest home or hospice after they’ve had a few days at home maybe. Usually it’s a rest home bringing a resident back after they’ve been checked out after a fall or something.’
‘OK.’ Kathryn nodded, tucking the information away. P1s were going to be the calls she would be most nervous about.
The thought of heading off to an unknown emergency with the wail of a siren distracting her from remembering even well-rehearsed protocols was enough to make the back of her neck prickle. Thank goodness she had someone like Tim McGrath for a partner. He looked to be in his mid-thirties and had the aura of a relaxed attitude to his job that could only come from a combination of competence and experience.
Kathryn had also had the advantage of seeing Tim in action thanks to that incident in the restaurant. She knew he was competent and could stay calm in an emergency. She’d be OK with a partner like Tim. Becoming good at this job wasn’t just a fantasy. She could do it.
‘Of course, dispatch can only make a priority decision based on the information they get given,’ Tim continued thoughtfully. ‘Quite often a P1 is nothing significant, but you can get some of the sickest people on a P2.’
Kathryn chewed her bottom lip as the flash of confidence faded. She’d have to worry about both P1s and P2s, then.
Tim’s amused expression made her flush with embarrassment at showing obvious nerves, but his smile was reassuring. ‘They get it right most of the time. Like that restaurant case you were involved in. Having got the job definition on the pager as ‘‘abdo pain’’ at a restaurant, we thought we were going to a case of food poisoning and thought the P1 response was a bit of overkill. Turned out it was a life-threatening emergency, wasn’t it?’
‘I’ve never been more relieved in my life than I was when I heard that siren getting closer,’ Kathryn confessed. ‘I could tell she was really sick and I had no idea why. A heart attack seemed the most likely cause but the abdominal pain didn’t exactly fit.’
‘Some MIs do present with epigastric or back pain so it wasn’t so far off the mark for a diagnosis. At least you knew how important it was to get urgent help.’
‘And at least I know a bit more about triple-As now. I paid particular attention to that lecture.’
‘So tell me, then.’ Tim leaned against the back doors of the ambulance, swinging his pager by the curly elastic cord attached to a clip. The awkwardness of revisiting that particular case seemed to be receding and he was obviously warming to his new role as a mentor. ‘What do you know about triple-As?’
A chance to impress Tim was welcome. Maybe he was uncomfortable with her because he had no idea what she was capable of. ‘The signs are a pulsating mass in the abdomen and you might hear a bruit over the mass. If they rupture, it’s a medical emergency. Signs and symptoms include a severe, tearing pain and blood loss leading to shock.’
‘Causes?’
‘Usually arterial disease. You can get a false aneurysm caused by trauma.’
‘Do you know why the heart rate can stay normal?’
Kathryn frowned. ‘I don’t think we covered that in class…unless I’ve just forgotten.’ She chewed her lip again. So much for impressing her new partner. ‘With shock associated with blood loss you’d expect a tachycardia, wouldn’t you? Seeing as that’s the compensatory mechanism to try and keep the blood pressure up.’
Tim nodded, seemingly not bothered by any lack in her knowledge base. ‘That’s why it’s such a good marker for a triple-A. An aneurysm causes the walls of an artery to bulge. When the aorta gets stretched it stimulates receptors into thinking that the blood pressure is actually high. Therefore the compensatory mechanism is to reduce the heart rate to keep the blood pressure down.’
‘Not good for hypovolaemic shock.’ Kathryn was delighted to have something explained so simply. Tim was obviously a good teacher and some of the excitement at the prospect of working with him returned to lift her spirits. ‘And no wonder she started to feel better lying down with her feet up and then fainted when she sat up again.’
‘Two litres of saline got the pressure up enough for us to be able to give her some morphine. She wasn’t feeling too bad at all by the time we got her out of the restaurant. In fact, she was asking for you. She wanted to thank you.’
The awkwardness concerning the case returned with a rush, although it wasn’t Tim’s failure to phone her that was the cause this time. Kathryn found herself mirroring Tim’s earlier action and fiddling with her own pager’s safety cord.
‘I…couldn’t stay any longer.’ She hoped Tim’s memories of that evening were less clear than her own. Sean’s patent ill humour at her involving herself in the case had been humiliating enough at the time.
‘I hope your evening wasn’t entirely ruined.’
The odd tone of the comment made Kathryn glance up in surprise, and she caught an expression she had no hope of reading in Tim’s gaze. She needed to get him off any track concerning her personal life so she smiled brightly.
‘Heck, no! That was the most exciting thing I’d done in years. It was what persuaded me to throw in my practice nurse job and train as an ambulance officer.’
‘And is your…husband happy about it?’
‘Sean?’ Kathryn looked away, trying to sound casual and ignoring the odd hesitation in Tim’s query. He wasn’t to know how laughable the notion of her being out to dinner with anyone other than her husband was. It was laughable enough to make her smile again. ‘He’ll cope.’
She was unaware of the defiant tilt her chin adopted. He’d have to cope. There was no way he was going to interfere with her new career. Even mentioning Sean had added a new tension to the atmosphere and Kathryn’s shiver had little to do with the chilliness of the garage they were standing in.
Care was going to be needed in future not to allow any mention of her home life to intrude on her work hours. This career was her hope for the future. An escape. Something Sean had no part of, and she intended to keep it that way despite the clutch of any tentacles of guilt. Most importantly, she didn’t want Tim or anyone else at Inglewood station knowing anything about her marriage.
If you could even call it that.
Fortunately, Tim seemed completely uninterested. He snapped his pager into the holder clipped to his belt and Kathryn followed his example.
‘There are other priorities as well.’ His tone was coolly professional once again. ‘At times we’re on standby for fires or armed offender callouts for the police, long-distance transfers and back-up assistance for other ambos. You’ll pick it all up in no time.’
‘I hope so.’ Kathryn watched Tim open a side door of the ambulance.
‘Here we have the ramps, carry chair, hare traction splint and KED. Have you covered using the KED?’
Kathryn nodded. Her class had been through more than one scenario training them to use the body splint to help extricate car accident victims. Having to attend a major car crash on her first day was a prospect that had kept her awake for a large part of the previous night. The image of trying to cope with such a scene took turns with an even greater fear—that she might have to defibrillate someone for the first time.
When the side door refused to close easily, Tim took a few minutes to rearrange the contents. Kathryn watched him, aware that her fears about what the day might bring and what would be revealed about her competence paled in comparison to a much darker fear that Tim had inadvertently reminded her of. A fear that had presented one of the largest obstacles to her career change.
Tucked away in