disruption earned her a sharp look from Luke and Anna sighed inwardly. ‘Can I use your phone?’ ‘Of course.’
She found Ben Carter on the other end of the line and listened intently.
‘I’m on my way,’ she said a short time later. ‘Luke’s here as well. We’ll both come.’
‘What’s going on?’ Luke demanded as she put the phone down.
‘Helicopter’s due to land any minute bringing in a thirteen-year-old boy. He’s hypothermic and unstable. Ectopic activity increasing so he could arrest at any time. Ben wants us on standby in case rewarming via bypass is necessary. He’s put a theatre on standby as well and called in a technician.’
‘You’re the one on call. I’m not even supposed to be here today.’
Anna was at the door already. She turned to see the registrar looking slack-jawed at the potential case and Luke looking … good grief … wary? Or hopeful? Why?
She didn’t have time to consider any personal issues. There was a child’s life at stake here and if it came to trying to rewarm him by using cardiopulmonary bypass it was new territory for her. She’d read about it but never even seen it done. A flicker of something like panic had to be crushed.
She held Luke’s gaze for a heartbeat despite—or perhaps because of—knowing he could probably see that flash of fear.
‘But you are here,’ she said quietly. The presence of the registrar in the room ceased to matter. ‘And I need you, Luke.’
They both followed her but it was Luke’s tall form striding beside her that gave Anna confidence. They moved fast enough for him to be limping by the time they reached the emergency department but they were still side by side.
A team.
The main resuscitation area in Emergency was crowded. Helicopter paramedics in their bright overalls and helmets were there with the medical staff, transferring their patient with great care. There was a bustle of activity and a buzz of urgent instructions.
‘Gently! Don’t bump him. Cardiac function is fragile.’
‘Is the Bair Hugger on?’
‘Dextrose, not saline. Get some more in the microwave to get warmed.’
‘Make sure that oxygen is warmed and humidified.’
‘Get some more dots on. We need a twelve-lead ECG.’
‘What’s his temperature now?’
‘Nineteen point five degrees Celsius.’ Luke whistled silently.
‘The lowest ever temperature that someone’s survived without neurological impairment was around thirteen degrees, wasn’t it?’ Anna kept her voice low. The boy’s mother was on the other side of the room, looking terrified.
Ben Carter was leading the resus team and he wasn’t happy with the oxygen saturation level of the boy’s blood.
‘I’m going to intubate,’ he decided. ‘Anyone who’s not directly involved step back a bit, please. It’s critical we do this with minimal movement.’
One of the paramedics stepped well back, close to where Anna and Luke were watching. Standing by.
‘What happened?’ Anna asked.
‘Kid got ice-skates for Christmas,’ the paramedic said quietly. ‘They live on a farm up north a bit and there’s a dam. He and his brother went skating and he hit some thin ice and went through. Took his brother about thirty minutes to find a branch big enough to get him out and another half an hour to run home and raise the alarm. Probably ninety minutes before we arrived on scene and the wind chill was significant. First temperature we got was eighteen degrees.’
‘Cardiac rhythm?’ Luke was watching Ben and his team securing the boy’s airway but he was listening to Anna’s conversation with the paramedic.
‘Slow atrial fibrillation. Marked J waves.’
Anything below a core temperature of thirty degrees was enough to put someone at risk of cardiac arrhythmias and arrest. This boy was dangerously cold but there was still hope. Anna remembered a lecturer at medical school talking about hypothermia.
‘You’re not dead until you’re warm and dead,’ he’d said.
The Bair Hugger was a blanket designed to force a current of hot air over the patient’s skin. Intravenous fluids were warmed to try and raise blood temperature but these methods might be too slow to help someone with such severe hypothermia.
‘Luke.’ Ben had finally stepped back from the initial flurry of making sure their patient was as stable as possible. ‘Didn’t think you were on today.’
‘I’m not.’ Luke flicked a sideways glance at Anna and there was a hint of a smile on his lips. He was here because she wanted him to be but it seemed like he wanted her to know he was happy to be here.
‘Well, I’m glad you’re here. Both of you.’
‘What’s the plan?’
Ben looked grim. ‘External exogenous rewarming is only going to achieve a rate of about a two point five degree increase per hour. He’s too cold to wait that long. With full cardiopulmonary bypass we could get a rewarming rate of seven point five degrees an hour.’
‘We can’t justify something as invasive as bypass unless he’s arrested. What about pleural lavage?’
The cardiothoracic registrar was looking bemused. Anna leaned closer. ‘That’s using an inter-costal catheter to pour large volumes of warmed water into the chest cavity.’
‘Still pretty invasive,’ Ben was saying. ‘And possibly less effective. Right now we’ll keep ventilator support going and monitor his rhythm. We should get results on the bloods we’ve drawn soon. I want to see what his acid-base status is. At least slow A fib isn’t a malignant rhythm.’
‘We need an arterial blood gas as well,’ Anna put in. She stepped forward to retrieve the sheet of paper emerging from the twelve-lead ECG machine but she didn’t get time to analyse the trace. An alarm sounded on one of the monitors at the head of the bed.
‘He’s in V tach,’ someone warned. ‘I can’t find a pulse.’
‘V fib now.’
‘Start CPR,’ Ben ordered, moving to the side of the bed. He looked back at Luke, who gave a terse nod.
‘One shock. If that doesn’t work, bring him up to Theatre under CPR.’
‘Theatre 3’s on standby. Bypass technician was paged when I called Anna.’
‘Charging,’ someone announced. ‘Stand clear.’
Luke gave another nod and touched Anna’s arm. ‘Let’s go. Better if we’re scrubbed and ready by the time they come up if we’re going to be needed.’
A cold, still heart.
This lad was technically dead and here they were thinking they could play God and bring him back to life.
Luke could see the lines of strain around Anna’s eyes. He knew that her lips beneath that mask would be pressed tightly together. And, despite how subtle it was, he saw the way she flinched when her hands touched the chilled flesh in the small chest they had just opened.
‘We need to work fast,’ he reminded her quietly. ‘Standard bypass. Arterial cannula in the ascending aorta. Right atrial cannulation with a single, two-stage cannula.’
Anna nodded. She was already placing a purse-string suture around the major vessel that took blood from the heart to the rest of the body.
Within minutes, with both surgeons working together in a tense atmosphere, the cannulae had been positioned and the boy’s blood was now being circulated through