Not much can be done while the air ambulance is flying. Even using a stethoscope can be tricky. But Trent is mostly stable. Ketamine is doing its job, so that his groans of pain are loud but indistinct, mostly guttural. As MICA paramedic Toby St Clair and the orderlies unload him from the helicopter, Carter asks questions.
Being a trauma doctor is largely about pattern recognition, Carter says. As soon as he knew the “mechanics” of the crash included “came off a motorbike at speed, hit pole”, he assumed if not the worst, then close to it. “Anything above 30 kilometres per hour (on a motorbike) is bad,” he says. But now the paramedic is reeling off his patient’s “vitals”, including heart rate and blood pressure, and Carter is wary for a new reason. “To be honest, his vitals were fine. That made me suspicious because the numbers were too good.”
Toby, the pilot, Carter, the orderlies and the stretcher can barely fit in the large stainless-steel elevator that carries them directly down one floor from the helipad to Emergency. Trent is wheeled into trauma bay 2 and Alfred staff members plaster stickers to their left breasts: “Trauma RN”, “Nurse Leader” and “Trauma Registrar”. Carter is already wearing the “Team Leader” tag. Dr Adam Bystrzycki, technically Carter’s superior but following his lead here, is already scrubbing as though for surgery. Others are pulling lead-lined smocks over their scrubs. Nine people fill the bay, around the stretcher, including Johnny Di Nunzio, the lead nurse, who is sitting in front of a computer screen ready to type. Four young women are huddled in the bay’s entrance. They are double-degree fourth-year nursing/paramedic students, wide-eyed and observing. Everyone is calm but concentrating intently as they turn their faces towards St Clair.
‘If you get excited, you’re not doing your job’
The paramedic stands by his patient and speaks loudly and clearly, giving a verbal handover. He gives the patient’s name and age, summarises the accident in one or two sentences and then lists the known and suspected injuries he and the road crew paramedics have identified, including the very tender right-hand side of the chest. He lists the exact drugs and amounts of pain relief already administered and other work done. In the trauma bay doorway, Carter is standing, hands behind his back, like a footy coach watching his team in the rooms, listening intently. Once the paramedic’s handover is done, Trent becomes his patient.
The entire bay, crowded with highly trained professionals, has an air of calm determination. “If you get excited, you’re not doing your job,” Carter explains afterwards. He and his team never once appear hurried, yet so much happens so fast.
Within one minute of St Clair handing over the patient, an Alfred doctor has listened to Trent’s chest and confirmed he can’t hear breathing on the right-hand side. A minute later, Carter is looking at a chest X-ray snapped by a large square machine in the ceiling, to confirm the collapsed lung, punctured by broken ribs. This is the injury that could kill the teenager if left untreated, as air continues to fill the chest cavity, but not within the lung. Eventually that air would crush his heart if left alone, but that’s not about to happen. Within another minute or so, Dr Peter Finnegan is performing a trial technique, for only the hospital’s 11th time, feeding a video-guided intercostal catheter (VICC), also known as a “chest tube”, into a small puncture in Trent McGaffin’s side, and watching the video feed to guide the tube past the working lung and other internals until it’s in the perfect position next to the collapsed lung. The camera is whisked out, leaving the tube to slowly suction the air from the chest cavity. This will take four or five days, by which time the lung will be able to reinflate in the resulting vacuum and begin to work again.
Six minutes after the patient arrived, Carter and his team have moved Trent from the ambulance trolley onto the trauma bay’s wheeled bed and the potentially fatal lung issue has been resolved. He is now deliberately placed on his side so they can check for any penetrative wounds or other trauma on his back that might have gone unnoticed. “You’d be amazed what ‘the turn’ can find sometimes,” a nurse says. This is not fun for Trent’s balloon-like left leg, which bends like a mushy banana. The Alfred team insert tubes into his mouth, placing him on a “life support” ventilator, which means the patient is now in an induced coma, his breathing artificially controlled. It sounds dramatic but the doctors are working on the theory that he has already had a lot of pain relief, and they need to control his breathing and heart rate to give him the extra pain relief he may still require, while also being free to perform certain procedures that would not be possible if the patient was awake and aware. And, anyway, one look at that left leg confirms he’s headed for some kind of surgery tonight, so he may as well be put under now.