Chapter 3
Holly watched in sheer disbelief as the bucolic scene around her dissolved, as though hit by a tsunami of sound. Only those who actually had the presence of mind to look upwards could identify the source of the flattening roar – babies and small children simply burst into wails of confusion and distress. Lizzie’s children and the twins clapped their hands over their ears in mute astonishment at the scene in the sky above them, pressing themselves instinctively against Holly’s legs, mouths open in matching O’s. Coco whimpered pathetically, craving security and comfort.
But it was the intensity of the screams from the Main Arena that grabbed everyone’s attention, as beautifully polished ponies scattered in every direction, their riders clinging on for dear life or indeed bailing out onto the soft sawdust of the arena. Even Charlotte Lansing’s commands to her ‘gals’ were drowned out by the chaos.
As quickly as the biplane had arrived, it swooped up into the heavens again, leaving a trail of vapour and an aftermath of pandemonium. Holly instinctively looked around, assessing their immediate environment for casualties and breathing an enormous sigh of relief that everyone was still standing.
Everyone except the Major.
Dan was already guiding him towards a chair and loosening that ridiculous bow tie, as the Major’s face turned puce and he struggled for air. ‘He’s fine,’ Dan called over his shoulder to Marion, reaching for the Major’s nitro spray. ‘Just his angina acting up.’
‘That was close,’ Holly said to Alice. ‘That could have been so much worse. What was he even thinking—’ It was only then that the rhythmic hammering of hooves, punctuated by a gasping cry, caught her attention.
A small bay-coloured pony, its mane and tail exquisitely plaited and shining with health and vigour, was bolting towards them. Charlotte Lansing was in pursuit, but the wide-eyed fear on little Jessica Hearst’s face was clear to everyone watching as she clung on desperately. Out of control, the pony was picking up speed, the prized rosette for Best Turned-Out flapping on his bridle only serving to escalate his panic.
Mothers grabbed their children, dogs were pulled abruptly to heel on their leads, nobody wanting to be caught in Jessica’s path as she gamely tried to slow their flight. Perhaps she would have succeeded, her petite frame was certainly stronger than it looked, as she managed to regain her balance and sit deep, anchoring her feet into the stirrups to give herself leverage on the reins. Perhaps, thought Holly for a split second, everything really would be okay.
And then the world seemed to blur and refract around them, as a stray string of bunting caught in the light summer breeze and snaked out into the air, a twirling multicoloured rope of flags tipping the balance out of Jessica’s favour. That one second felt never-ending, as the distracted pony’s front hoof folded into a divot in the grass, his whole body crumpling in on itself as it hurtled towards the ground, with Jessica propelled forward by sheer momentum.
The impact of their bodies hitting the ground in tandem was nothing compared to the sickening thud as a flailing hoof caught Jessica’s helmet.
Hollow fear followed a heartbeat later, as the terrified pony staggered back to its feet and Jessica remained, motionless, on the ground.
Her twins and Lizzie’s brood were all truly sobbing now and Holly froze, utterly conflicted as to where her attention should be focused. But Alice didn’t even hesitate in taking the lead, thrusting Coco’s harness into Holly’s hand and dashing over to Jessica’s side, as others tried to catch the distraught and flailing pony before any more damage could be done. Gently, so gently, Alice reached for Jessica’s wrist, looking to find a pulse.
‘Don’t move her,’ called Holly unnecessarily, torn between trying to soothe the children and keep an eye on Alice at the same time.
The crack in the little girl’s helmet was like a fissure through the resin, as though an axe had struck her, and Holly looked around her for support. Marion Waverly swooped in, gathering all five young children into her ample bosom and allowing Holly to run over towards the poor girl still lying prone and unresponsive.
Teddy Kingsley was on his mobile only a few feet away, calling for an ambulance and trying to convey the severity of their situation. ‘Teddy!’ Holly called in an urgent whisper, trying not to alarm the people around them, who were already panicking. ‘Tell them there’s a GP on site, an obvious head injury, loss of consciousness and we need a direct transfer to Frenchay Hospital. Tell them we need the Air Ambulance.’ She paused, ‘Tell them it’s critical, Teddy.’
She crouched down beside Alice, who was checking Jessica’s vitals again, keen to ensure that she wasn’t missing anything in the stress of the moment – it had been a long time since her trauma rotation as a medical student, but Holly was impressed to see that Alice’s composure was absolute. ‘You’re doing fine,’ Holly encouraged her. ‘You’ve got this.’ Thank God.
Alice nodded, muttering, ‘ABC,’ over and over under her breath. She looked to Holly for reassurance. ‘Airway’s clear now. I did a modified jaw thrust because of the likelihood of spinal injury?’ It wasn’t really a question, it was a statement of fact, still it was obvious Alice needed Holly’s confirmation that she was doing the right thing. ‘She’s breathing on her own and there’s decent capillary refill.’ Alice pressed the fingernail bed on Jessica’s tiny hand again and counted until the colour suffused the tissue again. ‘And her heart rate’s pretty steady at sixty-five, but she’s still unresponsive. Pupils reactive though,’ she added, ever hopeful.
Holly placed a supportive hand on Alice’s arm. ‘You’re doing great, Alice. Keep an eye on her, tell me the minute anything changes, okay? I’ll talk to dispatch to get an ETA and make sure the team at Frenchay know she’s coming.’ Holly stood up and held out her hand for Teddy’s mobile.
Holly noticed in her peripheral vision that Cassie Holland was trying, in vain, to corral people away from the scene. Charlotte Lansing had managed to catch the pony, now tiredly lashing out in fear, and Holly could only hope that this gloriously rustic afternoon was not going to end in tragedy for anyone.
She looked up, utterly appalled that the thought hadn’t occurred to her sooner. ‘The parents? Where are Jessica’s parents?’
‘I’m on it,’ said Teddy, gratefully thrusting his phone into Holly’s hand, relieved of his post as ambulance liaison. He jogged away across the showground, heading straight for the VIP hospitality suite. There was no way that Jessica’s family would have been roughing it with the hoi polloi in the beer tent, but surely it wasn’t possible that the carnage outside their silk-lined cocoon had eluded them, thought Holly crossly.
The vulnerable figure of their only daughter lying on the grass in such an awkward position would be horrifying either way, Holly realised, shrugging off her jacket and laying it over Jessica despite the warmth of the day. Even though she wasn’t conscious, her slight body would be experiencing all manner of shock reactions.
There was a flurry of conversation behind them, as Holly methodically updated the trauma unit in Bristol as to what they might expect and Alice diligently checked Jessica’s vitals again – whispering, shouting, tears and a wailing sob that could only have been Lavinia Hearst. Quite why she was yelling at Teddy and the Major rather than rushing to her daughter’s side was not for her to say, thought Holly, but seriously? There would be plenty of opportunities for blaming and shaming later; herself included, for that awful moment of frozen indecision between her role as parent or doctor.
With no helpful information about the Air Ambulance ETA forthcoming on the phone, time seemed to expand and contract around her. Holly felt swamped. Somebody needed to talk to the parents and Jessica required absolute focus – there was no margin for error here. The slightest slip could mean paralysis or, with a traumatic injury to the head like this, there were any number of complications that Holly didn’t even want to contemplate.
But she simply didn’t know whether Alice was up to the job of coping with an hysterical Lavinia Hearst, and Jessica had to be their priority.
The discussions around her grew more strident as Lavinia ranted.
‘Lavinia? Hi, I’m Dr Graham. Jessica’s vitals are stable at the moment but there’s help on the way to take her to Frenchay. She’s had rather a nasty bash on her head. Can you take a deep breath for me, because Jessica needs you to be calm right now. We need to focus on Jessica. Okay?’ Holly said with gentle but non-negotiable firmness, unwilling to leave Alice unsupported in such a challenging situation for too long, but aware that Lavinia was two ticks away from spiralling into a panic attack.
Dan arrived, slightly out of breath from his exertions with the Major, and knelt down in the grass beside them; it was obvious from his whole demeanour that he didn’t come bearing good news. ‘You’re doing a great job, guys,’ he said softly, ‘but now I want you to listen to me and then we’re going to work together, okay? I’ve just spoken to dispatch. There’s no Air Ambulance available today. It’s not coming. This is going to be a longer journey for Jessica than I’d like.’
The commotion of voices and moving equipment broke over them like another wave, jolting Holly out of her focus, as the ambulance pulled up beside them and the doors were flung open. Discussions about the bumpiness of the track across the showground began throwing open a whole new set of problems.
Holly and Alice were both swept aside as Dan took over, conferring with the paramedics and taking control.
Holly gave Alice a hug. ‘You did such a brilliant job, Alice. But it’s time to let Dan step in. He really is the best person for this job now; the things he learned in the Army . . . ’
Alice nodded, her eyes never once leaving the tiny figure now being transferred to a backboard and swamped by the neck brace that the paramedics and Dan had prioritised before anything else. ‘It’s the right thing to do,’ Alice said awkwardly.
From this point though, as Holly remembered only too well from her years in A&E, ‘time was brain’ – it was a race now to stop any secondary swelling causing yet more irreversible damage.
They might not see too many traumatic brain injuries at The Practice, but they all knew that Dan was no stranger to life-changing injuries, and his experience patching together survivors of roadside bombs gave him the obvious advantage.
Holly turned her attention back to Lavinia Hearst, outlining in simple terms what would happen next and gently explaining the reality of the situation for her – a filthy concussion was actually a best-case scenario for Jessica right now, as she still remained unconscious. Not that Lavinia appeared to be listening – whether from shock or sheer bloody stupidity, she swung from yelling at the Major to trying to reach her daughter ‘just to hold her’.
Watching the paramedics gently transferring Jessica to a backboard was a lesson in caution all of its own; any benefit from rushing negated by the obvious risks of paralysis. Allowing Lavinia into the mix while she was so overwrought and unpredictable could have devastating consequences.
Holly glanced up and saw that Alice’s face was now sheet-white and her eyes were wide, as the shock of the whole accident began to catch up with her. ‘You okay?’ Holly said gently, grateful that Mr Hearst had finally turned up in time to comfort his wife in her transition from anger to terrified disbelief.
‘He was right to bench me,’ said Alice quietly, if a little begrudgingly. ‘I’m out of my depth.’ She waved a hand towards Dan, where he was intently discussing and implementing the optimum oxygenation rate for Jessica. It was all a question of balance to avoid the twin extremes of hypoxia and hypocapnea. ‘In all honesty,’ Alice confessed to Holly, ‘I’m not sure I would have remembered that, would I?’
Holly said nothing for a moment – it was a common rookie mistake: when it came to oxygen, the instinctive assumption was that more would be better. It was also much better that Alice had come to this realisation on her own. ‘Don’t overthink this, Alice,’ Holly said quietly. ‘This is why we have paramedics. Obviously we need to know the basics of trauma management, but we’re GPs, not A&E consultants. I can see you beating yourself up about this already, but we can’t all be everything. Or we’d end up being jacks of all trades and masters of none.’
Alice nodded, watching as Dan leapt into the back of the ambulance and the doors swung slowly shut. ‘You’re right, of course, but shouldn’t we have the best emergency training possible?’
Her plaintive question gave Holly the perfect opportunity to bring her back into the moment; whilst Jessica’s injuries were obviously life-threatening, there were still plenty of Larkford’s residents around them that needed their help. From cuts and bruises, to a shock-induced asthma attack, to the Major, who now seemed to be having some sort of nervous breakdown, aghast that his celebratory surprise might yet have such catastrophic consequences.
Holly took a deep breath. ‘That’s certainly a conversation we should have. Another day. Right now, our patients need us. You take the Major and I’ll pop Geoffrey Larch on the portable nebuliser,’ Holly said, surveying the damage.
Taffy had already established a triage system in the Main Arena and now had all the riders dismounted and under control. To Holly’s immense surprise it was Cassie Holland who was in her element. She was walking amongst them with her clipboard and a mobile phone, contacting relatives, handing out hot sweet tea to those in shock. She looked poised and in control – clearly someone who rose to a challenge.
Alice nodded and walked over to the Major, Holly watching her closely. It was clear that Alice had always considered herself to be one of those people too. And, as with all high-achievers, she could only focus on her weaknesses, rather than her achievements. Holly was quite convinced that Alice couldn’t see the amazing courage that had propelled her forward to Jessica in those first few minutes; she would, in all likelihood, be focusing instead on the ambulance driving away without her on board. Replaceable, replaced and out of her depth. Alice Walker was a fabulous doctor, no doubt, but she was also her own harshest critic.
Holly sighed deeply, hoping that Alice’s confidence wouldn’t be yet another tragedy of this afternoon’s events.