I see Joel before he sees me.
I’ve just got back from our first transfer, a casualty with a catastrophic haemorrhage. We took him to St George’s, rather than the Sussex, and now we’re back, the scene is more organized than when we first arrived.
Hundreds of people are here with one purpose – to preserve life. In the midst of all the pain, that thought gives me energy.
But then I see him. He has headphones on, like the ones we wear in the helicopter, but his are connected to a microphone, a ridiculously large thing covered in grey fake fur.
He’s following a woman with a camera who films a patient being extracted by a fire crew. She’s getting so close to him that it’s almost obscene.
I want to stomp over, to ask the two of them what the fuck they think they’re doing, getting in the way of rescues, filming people who are in no state to consent.
No. It’s a waste of energy, that’s not what I am here to do. I turn away and head back towards the second carriage. Carrot has to go back to base because his flying hours are so strictly controlled, but Lars and I are staying on. There’s no way either of us could leave.
The sounds are different now. Instead of moans and cries, the field hums with generators and engines and comms. It’s neither chaos nor order, but the systems are adapting to the scale of this particular catastrophe.
I find it harder to adapt to the magnitude of what I’ve had to do: I’ve never wanted to play God, but tonight I had no choice, picking my way between patients to find the ones who needed help first. Disregarding those that were past helping . . .
The Priority 1 and 2 casualties have all been transferred out, so Lars and I are going to meet in the area where they’re treating the walking wounded. The regional trauma centres are closed to everything but the most seriously injured, so helping people here in the field will mean fewer patients swamping the walk-in clinics. Plus, we need to keep an eye on these Priority 3s, to make sure they’ve been classified correctly and nothing more serious has been missed.
What was that?
The high-pitched cry is almost inaudible underneath the other noises. Did I imagine it?
It’s probably a farm animal: the bleat of a sheep whose territory has been invaded. After the things I’ve seen here, I wouldn’t be surprised if my hyper-vigilance is making me hear danger where there is none . . .
Except there it is again.
Is it human? A phone or music player discarded by a passenger?
I’m getting further from the train and from the floodlights that define the casualty area. I am about to turn back when I hear what I know is a voice.
‘Grandma? Mummy?’
I stop, trying to locate the sound. I edge carefully towards a boggy area alongside the railway line.
‘Hello?’ I call out. ‘Is someone down there?’
‘I want Mummy!’
My head torch shines into the face of a small girl. Five or six, not bleeding from anywhere that I can see, but very pale.
She begins to cry properly now.
‘OK, sweetie, don’t cry. I’m here.’ I edge towards her. Seeing me will reassure her; plus, I can do a quick visual assessment before I radio for help. ‘We’ll soon get you out . . .’
One moment my feet are on the ground and the next I’m slipping, falling forward, towards the ditch . . .
I brace myself.
My shoulder hits the sodden earth first and I tumble as white-hot pain flashes through me. The exact same pain as when I fell out of the tree in Tim’s back garden—
It takes a second or two for the shock to subside, so I can make sense of what’s happened. OK: I am in freezing water up to my waist. As I move my arm, my eyes fill with tears. A fracture as well as a dislocation.
I reach down with my good arm, through the water, to pull out my radio. The display is dead. It can’t be. These are meant to be waterproof. Has it been damaged by the fall?
For a few seconds, I wait for a light: red, orange, green. Anything. But no. It’s gone.
My phone, then. It’s in the other pocket. Except as I twist to push my fingers between the folds of the fabric, there’s nothing there. Disbelief makes me try twice, three times, before I can accept it’s not there.
Think. The first thing I need to do is get to the girl. Someone up there will be looking for her. For us.
My head torch doesn’t give me any real sense of how far away she is and my useless arm is starting to hamper my progress, so I steel myself to try to reduce my shoulder. Dark pain swims over me as I push, hard, to get the ball back into the socket. I howl involuntarily.
The girl whimpers. At least I know she’s close by.
‘Shhh, it’s all right. I’m here. Tell me what you were doing today?’ I begin to crawl towards her voice and become aware for the first time that my ankle hurts too.
‘We’ve been . . . shopping . . . on the train.’
I don’t like the sound of her breathing.
‘Lovely. I’m nearly with you, it’s just this mud is so sticky. Tell me your name, sweetheart?’
‘Emily . . .’
‘And where do you live, Emily?’
She tries to tell me her full address, but I don’t catch all the words. I am almost alongside her, biting my lip as I crawl.
‘See, I’m here now, Emily. Let’s hold hands, I bet you’re chilly.’
As she places her hand in mine, I check her radial pulse. High, though her skin is cold and clammy. Is that from the water or something more serious?
I want to get her onto my lap to warm her up but first I try to work through the CABCDE checklist. It’s hard to angle the head lamp to see much, so my ears and sense of touch have to substitute for my eyes. Even off-duty, I automatically assess everyone I meet, in queues or at the pub: eyes, complexion, gait can tell me so much. But now I am literally in the dark.
The sequence will keep me focused. Catastrophic bleed? Nothing external, as far as I can tell . . . but as I touch her abdomen, Emily screams.
‘Emily, where does it hurt? Show me, with your hand?’
I hold on as she runs her hand over her body: her left ankle, left hip . . . ‘It hurts the most here,’ she says, and her fist tightens around mine over her lower rib, on the left.
Ruptured spleen. If I’m right, she needs surgery to stop the bleeding before she goes into hypovolemic shock – unless she has already. But I can hardly operate in a ditch. All I can do is try to keep her stable until someone comes.
‘I’m going to put my arms around you for a nice cuddle, OK, Emily? So we can keep each other nice and warm.’ It hurts my shoulder, but she stays silent, so I guess it doesn’t hurt her. ‘What happened, Emily?’
‘The train . . . went all wonky . . . I was with Grandma and . . .’ She starts to cry.
‘Don’t cry, sweetheart. You’re safe now.’ And crying makes your breathing worse. ‘Tell me how you ended up falling over.’
‘There was a hole in the train . . . I climbed through it but it was all dark . . . and my glasses got broke . . . grown-ups were crying . . . it was scary so I was running and it looked like people . . . but I . . . slipped.’
‘How long ago?’
She doesn’t respond.
‘Stay awake, Emily. How long do you think it’s been since you fell?’
‘I don’t know . . .’ She starts to cry. I don’t want her to waste energy.
‘What songs do you know, Emily?’
She tells me a few titles I don’t recognize. My interest in music stopped the year I started med school. I try to remember songs Marilyn’s children like, and as I picture Ava, fear seeps through me, as chilling as the water.
Don’t be such a flake, I tell myself. Of course you’ll see them again. My career might be DOA because I’ve been such an irresponsible fucking idiot, but I will make it out of this ditch, and so will Emily.
‘What about “Happy”?’ I suggest.
Emily begins to hum. I join in, as loudly as I can, trying to throw my voice up beyond the ditch.
Someone has to hear us soon.
We’ve run out of songs. ‘Let’s start again, from the beginning.
But Emily’s struggling to breathe and she’s getting colder. ‘Where’s . . . Mummy?’
‘She’ll be here soon. We just have to stay brave for a bit longer.’
She doesn’t respond. I need to keep her awake.
‘How about I teach you a song instead? One for Granny.’
‘A funny song?’ she says, through the tears.
I haven’t even thought of one, but it comes to me in a flash. The song I learned with Tim all those years ago at the St John Ambulance meetings: a song with the perfect rhythm for carrying out CPR.
‘Do you know Nellie the Elephant?’
‘No . . .’
‘Your grandma will know it. It’s about an elephant who runs away.’
‘From where?’
‘From the circus.’
‘African . . . or Indian?’
‘I don’t know. Which do you prefer?’
‘Indian ones. They’ve got bigger ears.’
‘OK, let’s say she’s the Indian kind. Shall I teach you the words?’
Emily doesn’t respond so I start anyway.
‘It starts . . . Nellie the elephant packed her trunk . . .’