FLIGHT.
Fight.
Or freeze.
Tilly was perfectly well aware of the physiological reaction the body had to an acutely stressful event, like the imminent threat of an attack that could involve personal harm or possible death.
She’d never experienced all three responses in such close proximity, however.
She had almost felt the initial flood of hormones being released as her body had frozen the instant she’d felt the touch of Harry’s tongue against her own. She’d been aware of her heart rate increasing so suddenly and she’d known she was probably as white as a sheet by the time Harry had pulled back to stare at her because she’d actually felt the blood draining from her face.
He couldn’t have missed the fact that something was wrong but, in the space of only a heartbeat, Tilly had the horrible impression that Harry knew what was wrong. The last thing she wanted was to discover that he had guessed a truth she’d been successfully hiding for years so she’d gone from being frozen to being ready to take flight.
Maybe she wouldn’t have actually run away from him but there were other ways of creating a safe distance. Like putting up barriers. Refusing to discuss something. Making absolutely sure that he couldn’t touch her again—even though, moments ago—it had been the thing she’d wanted more than anything else imaginable.
But she didn’t have to do any of those things because of her father’s interruption and the call to an emergency that meant she was needed to join the fight for someone’s life. If they were still alive by the time they got to the scene. Tilly had heard of horrific accidents involving farm machinery like hay balers and she knew there was a real chance that, no matter how fast Harry was driving, they might be too late. She was still ready for a fight, with her heart rate and breathing a lot faster than normal and her muscles tense, but Tilly was relieved that the trembling of her hands was receding.
Harry had noticed that when she’d unlocked the hard cover of the back of the ute to check that all her father’s emergency medical supplies were in there. She’d been fumbling with the keys and had offered no resistance when he took them from her hand and told her he’d drive.
And here they were, speeding along the open road with the magnetic light on the roof of the vehicle flashing red against an increasingly deep twilight. The levels of catecholamines like adrenaline that Tilly still had circulating had to be responsible for her astonishingly heightened awareness of every one of her senses. She could see the flash of red light catching the lamp-posts as they sped past, feel every bump in the road and hear the pounding of her own heart in her ears. She could smell freshly cut hay through the open window and she could...oh, dammit...she could still taste Harry’s kiss, couldn’t she?
She should have known it would have ended like that.
That it was impossible to go any further... No matter how desperately she had wanted it to. It was the first time she’d felt like that since...since...
No...she couldn’t think about that. The memory might be trying to surface but it couldn’t be allowed. Especially not right now...
‘Talk to me.’ To Tilly’s relief, Harry’s voice cut off her train of thought with the precision of a guillotine. ‘What relevant gear have we got?’
‘Intubation and surgical airway kit. Combat tourniquet. IV gear and fluids. Amputation kit with scalpels, a Gigli saw and sutures.’
‘Drugs?’
‘Ketamine, fentanyl, midazolam, morphine...’ Tilly rattled off a list of drugs she knew her father would have available as a first responder. ‘The drug kit’s a locked toolbox and the key’s on the same key ring as the rest. From memory, it’s got a blob of red paint on it.’
‘Defibrillator?’ Harry wasn’t taking his eyes off the road as he steered around a curve, retracing the route they’d taken not that long ago on their way home from the pony club event. ‘Portable ventilator? Handheld ultrasound device?’
‘Only a defib. I’m not sure that the ambulance carries a portable ventilator or ultrasound either, but I know air rescue does and there may already be a helicopter on the way.’ Tilly leaned forward as if it would help her see further. ‘We’re almost there. I can see a fire truck in the paddock, so our local volunteers are on scene.’
‘Good. I don’t know much about hay balers, but if someone’s trapped in a machine we’re likely to need some extrication expertise.’ Harry was slowing the ute to turn into the gate and Tilly heard him swear under his breath.
‘He’s alive,’ he said grimly. ‘I can hear him screaming from here.’
The sound of someone in extreme pain was unnerving and there were several distressed-looking people, who weren’t part of the fire service crew, around the tractor and trailer unit. One man had his arms around the waist of a person who seemed to be leaning right inside the hay baling machine, his feet just off ground level, which made it more difficult for Harry and Tilly to get close enough to assess the scene.
‘I can’t let go,’ he told them. ‘If I do, and Jase falls backwards, he might rip his whole arm off.’
‘Get me out...’ There was another shriek of pain from the man they couldn’t see.
‘How did this happen?’ Harry’s tone was clipped.
‘I didn’t see it. I just found him like this. He said something was wrong with the net that gets fed out to wrap the bale, so he opened the flap to have a look. He knew not to lean in too close, but he got his hand tangled and it just sucked him in.’
‘Is everything turned off?’
‘Yep.’ The affirmation came from one of the volunteer fire officers. ‘And, as far as we can tell, Jase’s arm has somehow gone down past the cutters and he’s been spiked with the pick-up rake. We’re getting some gear ready to see if we can cut in from the front. The ambulance isn’t far away and there’s a chopper on the way from Dunedin that’s just taken off.’
Harry climbed onto a wheel. ‘Hey Jase? My name’s Harry. I’m a doctor. I’ve got another doctor with me and there’s an ambulance on the way. We’re going to get you out of here, okay?’ He looked over his shoulder. ‘Has someone got a torch?’
Tilly heard another heartrending groan from the victim. ‘It hurts, man,’ he said to Harry. ‘It hurts so bad...’
‘I know, mate. We’re going to give you something to help with that. I’m just trying to see what’s going on. It’s your left arm that’s trapped, yes?’
‘It’s got spiked...right up to my elbow.’ Jase’s voice was shaking. ‘Oh, God...you’re going to cut my arm off, aren’t you?’
‘I’m only holding a torch, mate.’ Harry’s tone was one of reassurance. ‘Just having a look. Your right arm’s not injured, is it?’
‘I can’t feel my fingers now. I’ve been hanging on hard to something in there, so I didn’t fall. I don’t feel good, man... I’m kinda dizzy...’
Tilly had the drug kit open on the back of the ute, pulling out the ampoules of the heavy-duty painkillers they were going to need. The problem was going to be not only getting the access to administer them but keeping their patient safe if he lost consciousness which would become more of a risk after administering medications like these.
But a quick sideways glance showed Tilly the vicious metal spikes attached to the rake mechanism. If this farmer’s arm was impaled by them right up to his elbow and his own weight was putting pressure on the limb, it was no wonder he was in so much pain and making this even a little more bearable was a top priority. She knew Harry would be trying to assess vital signs, to record how well Jase was breathing and to estimate his blood pressure and how well oxygen was being circulated.
Wait... Jase?
Tilly turned to the nearest fire officer. ‘Is this Jason Marshall?’ she asked. ‘About thirty-four years old?’
‘Sure is. You know him?’
‘I went to school with him.’
Harry had climbed down in time to hear her, and his gaze focused sharply on her face. ‘You okay?’
She nodded as a response. It might be a rare thing to be personally acquainted with a patient who turned up in an urban emergency department, but it was something that happened all the time in a rural situation. ‘How’s he looking?’
‘His airway’s clear but he’s tachypnoeic at thirty breaths a minute and tachycardic at well over a hundred beats a minute. I can’t reach in far enough to assess injuries or the degree of entrapment but his left arm’s pulled so far in, the shoulder’s almost dislocating, which will only be adding to his pain levels. I couldn’t try to get a radial pulse on his uninjured arm to get an idea of blood pressure because he’s too scared to let go of whatever he’s holding to support himself.’
‘We need to get IV access to give him some pain relief. Or intraosseus if we can only reach his leg? I want to get fluids running. Oxygen on. And a cardiac monitor as soon as we can.’
‘We need a better platform to support him. If he crashes, we could well be looking at having to do an amputation just to get access to intubate. I’m going to talk to the firies.’
Tilly added the syringes she’d filled to an IV roll, fastened it and then pulled on a pair of gloves. ‘I’ll climb up and have a look. I’m a lot smaller than you and I might be able to reach further.’
Harry frowned. ‘Be very careful where you’re putting your own hands. If anything moves—the patient or the machinery—you could end up trapped yourself and the last thing we need is another patient.’
‘I know that.’
The noise and activity around her was increasing steadily as Tilly found a foothold on a metal bar of the hay baler and started talking to their patient as she leaned in.
‘Hey, Jase...you probably won’t remember me but we went to school together. Tilly Dawson? My dad’s been the GP in Craig’s Gully for ever.’
‘Tilly...yeah... I remember... What the heck are you doing here?’
‘I came down to visit Dad for Christmas. And I took this call because I’m a doctor now too.’ Tilly shone the torch to follow the line of the trapped arm but couldn’t see past a roller with sharp-looking blades. ‘I’m an emergency medicine specialist.’
‘Oh, yeah... I heard something about that.’ Jason’s voice was getting weaker and the cry of pain he uttered was quieter but no less agonised. ‘Help me...’ he groaned. ‘Please...’
‘I’d like to get a line into your good arm. That’ll be the fastest way to deal with your pain.’ Tilly could reach Jason’s uninjured arm, but his elbow was sharply bent and the muscles locked. ‘Can you try and let go with this hand?’
‘No...’ Jason sounded terrified. ‘I’ll fall...’
Floodlights were being set up beside Tilly and she could hear sirens getting louder as both an ambulance and a police car arrived on scene. She could hear Harry’s voice sounding calm as he asked quick-fire questions about the approach being planned to try and free the trapped limb and directed people to different tasks, including finding something solid to get beneath Jason’s feet. She knew the man supporting Jason would be getting tired enough to need replacing but she didn’t expect it to be Harry who wrapped his arms around Jason’s chest.
‘I’ve got you, mate,’ he said. ‘I’m not going to let you fall.’
Tilly could actually feel the rumble of Harry’s voice as much as she could hear it, because it seemed to go from her ears right down to her bones. If she was terrified or in pain, she thought, that deep, calm voice and the promise in his words would be exactly what she needed to hear. She could, in fact, imagine putting her life in Harry Doyle’s hands with no hesitation at all.
‘You can let go now, Jase,’ Harry added. ‘You’re safe. And Tilly needs that arm so we can help you with that pain as fast as possible.’
Jason was sobbing but he did let go and it was reassuring to be able to assess the radial pulse she could feel in his uninjured wrist and find it was strong enough to suggest that Jason hadn’t yet lost a dangerous amount of blood. Harry held him as Tilly juggled her supplies to get a tourniquet around the arm and a wide bore cannula slipped into a vein and then secured firmly with tape. And then she could finally administer drugs that were going to deal with the pain and terror that this young farmer was suffering.
Tilly could hear the sound of the rescue helicopter arriving as she felt Jason’s body relaxing as his pain receded. Harry was calling for more help in supporting the weight of their patient and then he moved himself, climbing up so that he was right beside Tilly.
‘I’ll hold him from this side,’ he said. ‘Can you get on the wheel and see if you can feel what’s going on with his other arm? It would be good to know how long it might be before we’ll be able to get him down to ground level.’
This was a lot scarier than the challenge of gaining IV access. Tilly had to slide her hand past those sharp blades, following the line of Jason’s arm into a dark space. Within seconds, she could feel the end of one of the spikes that were there to gather and move hay from the ground. It was right through Jason’s arm, just below the elbow. There was more space in this part of the machinery, so Tilly stood on tiptoes and leaned in a little further. She wanted to reach his wrist, to feel for a pulse and then his hand to make sure it was still intact after having gone past those blades. Her face was very close to Jason’s now.
‘You had long hair.’ His words were slightly muffled, as if it was an effort to speak. He didn’t seem to be aware of what was happening around him. ‘I tied your plaits together when I was sitting behind you...’
Harry was just as close to Jason on the other side so she could hear his chuckle. ‘Sounds like you were the class clown,’ he said. ‘Like me.’
Tilly could feel another spike that was very close to Jason’s wrist. Or was it angled up through his palm? Was it anywhere near the artery? Could that metal tubing cause potentially fatal blood loss if it moved during an extrication attempt?
‘I seem to remember him sticking a whole bunch of pencils through them once,’ Tilly said aloud. ‘And everybody laughed at me when I got up.’
She was gently exploring Jason’s hand as she spoke. The metal prong felt like it was involving several fingers.
‘Don’t try moving them,’ she said, ‘but can you feel me touching your fingers? Here? And here?’
‘Yeah...’
‘How’s the pain level, mate?’ Harry asked. ‘On a scale of zero to ten with zero being no pain and ten the worst you can imagine?’
‘Dunno...’ Jason sounded sleepy. ‘Maybe six...?’
‘And what was it when we arrived?’
Jason gave a huff of sound almost like laughter. ‘Bloody twenty-six, mate...’
‘Good to know. We’ll keep you topped up so it won’t ever get that bad again.’ Harry was watching Tilly as she lifted her head. ‘I’m going to get someone else to come and hold you for a bit. Maybe someone on both sides. Tilly and I need to talk to the experts and decide on the quickest and safest way to get you out of this.’
‘I need to get home,’ Jason mumbled. ‘I’ve got kids, you know? And it’s nearly Christmas...’
With the helicopter crew now on the ground they were able to join the discussion of how best to manage both the extrication and medical management for Jason. It was an intense exchange of expertise with factors to consider such as the danger of a respiratory arrest from the powerful analgesic drugs and the vibration that could make the injuries worse with hydraulic tools being used to cut into the metal of the farm machinery.
Of all the medics present, Tilly was the only one small enough to be able to reach Jason’s impaled arm and it was her own idea to try and support the limb as they gained access. That way they would know if the vibration and manipulation of the metal could be creating additional issues and the fire officers could change to using an oxy acetylene torch, which might be slower but would cause far less vibration. Tilly’s ability to reach Jason’s arm would be even more important in that case, because she would need to protect his arm, with water-soaked dressings, from heat transfer that could cause severe burns.
And, of all the rescue people present, the only person Tilly wanted right beside her during this next phase, the one responsible for supporting Jason’s body weight, was Harry. Because she could only do this if she could trust that she wasn’t going to be suddenly jolted by the weight of Jason’s body shifting. It was still surprisingly easy to trust Harry because she could still hear the echoes of his voice reassuring Jason.
‘I’ve got you, mate... You’re safe...’
Harry had never been in a situation quite like this.
He was acutely aware of everything happening around him—the noise of the pneumatic gear, every bump or shudder in the metal framework of the machinery he was leaning against, even anybody walking past who might be close enough to interfere with his task of keeping Jason’s body as still as possible.
Should he have tried to talk Tilly out of putting herself at risk by having her own arm inside that machine as they tried to dismantle it? If Harry could have taken her place he would have, in a heartbeat, but all he could do now was his absolute best to keep Tilly as safe as possible. And applaud her, silently, for her courage as the rescue workers worked, slowly and carefully, to get him free.
The farmer who’d raised the alarm had a toolbox in his truck so some machinery parts could be unbolted and prised free. The ‘Jaws of Life’ cutter and spreader took care of other barriers to get in to where Jason’s arm was impaled but each step was being taken with the utmost caution.
Harry was not only focused on keeping Tilly safe, he was doing his best to both distract and reassure Jason as well as watching for any warning of him losing consciousness or going into respiratory or cardiac arrest.
Tilly was clearly thinking along the same lines.
‘I can’t believe you’re a dad, Jase,’ she said at one point. ‘Doesn’t seem that long since we were at school.’
‘I’ve got three... Oldest is nearly five...she’s so excited about Christmas...’
‘I’ll bet she is,’ Harry said. ‘What’s she asked Father Christmas for?’
‘She won’t tell me. She’ll only tell Santa... Hey...isn’t it your dad, Tilly, who does that?’
‘Don’t spread it around,’ Tilly told him. ‘But it’s going to be Harry this time. Father Christmas with an Irish accent. We’ll have to see how that goes.’
‘Ireland’s closer to the North Pole than New Zealand,’ Harry protested. ‘It’ll be all good. And Jase? I promise I’ll let you know what it is she’s set her wee heart on. With a bit of luck you might have it already wrapped up and under the tree.’
Jason made a sound that was almost laughter. ‘Hope not... We’ve got her a pony...’
‘Oh...she’s going to be so excited. I’ve still got my first pony, Spud. He’s really old now but I still love him to bits. You’re close to the pony club grounds so that’ll be handy.’ Tilly was doing her best to keep Jason distracted. ‘How big is the pony you’ve got?’
‘Not big. He’s a Shetland.’
‘What colour?’
‘Sort of yellow, I guess. With a white mane and tail.’
‘A palomino. My favourite colour. What’s his name?’
‘Pudding.’
Tilly laughed. ‘That’s a great name. Is he nice and quiet?’
‘Bombproof, they said.’
‘Sounds perfect.’
When exterior sections of the machine had been cut clear and the rake was exposed, they had to switch to the oxy acetylene torch. Wads of gauze soaked in saline were passed up to Tilly, who covered the exposed skin on Jason’s arm around each of the protruding spikes so that they could be separated from the reel. She put goggles on to protect his eyes and wore a pair herself and they tucked the edges of a burn blanket into gaps for extra protection.
When Jason was finally lifted clear he went straight into the skilled care of the air rescue team. They assessed his vital signs, hooked him up to monitoring equipment and topped up his pain relief and then padded and bandaged the impaled spikes to make sure they weren’t going to move en route. The team was so efficient, it felt like only minutes later that Harry and Tilly were standing in the paddock, watching the helicopter take off. Sharing a glance that was like a huge sigh of relief.
‘That could have been so much worse,’ Harry said. ‘He needs urgent surgery to remove those spikes but I don’t think there’s any danger of him losing his arm.’
‘He might not even lose any of its function,’ Tilly agreed. ‘But he could have lost his life.’
‘I’d better remember that promise, hadn’t I? Except...how will I recognise his daughter? I don’t even know her name.’
‘I’ll ask Dad. He’ll know.’
The ambulance from Queenstown was heading off to another job. The fire crew were packing up their tools. The helicopter was nothing more than a tiny flashing light far enough away to be one of the stars.
‘What was that you were saying?’ Harry asked as they packed away their own kit into the back of the ute. ‘About it being so boring being a rural GP?’
Tilly made a huff of sound. ‘That’s not the kind of job that happens every day. But it is another reason I wouldn’t want to be one. You know all your patients. You went to school with them, or you see them in the supermarket when you’re getting your groceries.’
‘I guess that would kind of blur the lines between your professional and personal life,’ Harry agreed. ‘But there’s another side to that coin, isn’t there?’
Tilly’s glance was suspicious.
‘Doesn’t it make it feel more like they’re real people and not just statistics in the throughput of an ED? That you’re a significant person in their lives?’
‘It means you can end up knowing things about their lives or their bodies that you can’t tell anybody else and...and I don’t really like keeping secrets.’
‘So it makes a whole community a bit like a family, huh?’ Harry held the passenger door open. ‘I’ll drive back, shall I?’
‘Thanks.’ Tilly nodded. ‘I’m a bit wrecked, to be honest.’ She leaned back against the headrest as he began to drive them home and closed her eyes. ‘I must have used way too much adrenaline in the last couple of hours.’
It was only then that Harry remembered what had happened moments before they’d responded to that emergency call. The fear he’d seen in Tilly’s eyes.
Whatever had caused that reaction was none of his business, was it?
He didn’t want to get involved with Tilly’s life, did he?
Harry drove in silence for several minutes.
He was already involved, wasn’t he?
And it was his business. Because...what if he’d caused that fear?
Their headlights made a yellow arrow-shaped signpost glow just ahead of them and Harry braked sharply enough for Tilly’s eyes to snap open as she sat up straight.
‘What are you doing?’
‘That signpost said this is Craig’s Lake.’ The four-wheel drive vehicle was bouncing over potholes on a shingle road. ‘I’d like to see it.’
‘It’s not that spectacular,’ Tilly said. ‘More like a big pond, really.’
It was big enough to have a grassy area to park on, picnic tables to wander past and a pebbled beach where you could stand and admire the moonlight on water that was still enough to be reflecting the dark shapes of the surrounding hills.
It was Harry who broke a silence that felt deeper than this small lake probably was.
‘Was it something I did,’ he asked Tilly quietly, ‘that scared you? Did I make a mistake in thinking you wanted me to kiss you?’
He heard the way Tilly sucked in her breath. She hadn’t expected this. She didn’t want it.
Harry didn’t break the silence this time. He simply waited. He could sense that she was struggling with whether to say anything or not and if she chose not to he would respect her boundaries. He was about to suggest they went home when she did finally speak.
‘It wasn’t your fault,’ she whispered. ‘It was mine.’
To his horror, Harry saw a fat tear escape Tilly’s eye and trickle down the side of her nose.
Oh, no...what had he done now? The Ice Queen was melting.
There was something so heartbreaking in both Tilly’s words and that sad single tear that there was only one thing Harry could do now.
He folded Tilly into his arms.
And simply held her.