The Consultant's Italian Knight. Maggie Kingsley

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СКАЧАТЬ legs. It was going to be a long night.

      ‘According to his passport, his name’s Duncan Hamilton, and he’s nineteen years old,’ one of the paramedics declared, desperately trying to restrain the arms and legs of the young man who was thrashing about wildly on the trolley. ‘When security at the airport said they suspected he might be a body-packer, we just bagged him, and did a scoop and run.’

      ‘Symptoms?’ Kate asked.

      ‘Severe agitation, BP 160 over 90 and rising and he started fitting just as we pulled up outside.’

      Kate bit her lip. Absorption of large amounts of cocaine caused agitation, hypertension and seizures, but Duncan Hamilton’s symptoms could be due to other conditions, too. If she knew for certain that it wasn’t a leaking cocaine packet she would immediately have started him on naloxone, but the drug would have no effect on a patient suffering from a massive overdose.

      ‘Did he have anything else on him apart from his passport?’ she asked hopefully. ‘Maybe a medic alert disc detailing a preexisting medical condition?’

      The paramedic shook his head, and Kate swore under her breath.

      If Duncan Hamilton was a body-packer then it certainly sounded as though one of his packets had burst, but she needed more than a suspicion. She needed certainty.

      ‘Mr Hamilton—Duncan,’ she said, leaning as far over the young man as his writhing body would allow. ‘Do you know where you are, and what’s happening to you?’

      A low moan was her only reply, and she gave up on the preliminaries and went for the straight approach.

      ‘Duncan, how many packets of cocaine did you swallow?’

      ‘I didn’t…I haven’t swallowed anything,’ the young man gasped as Terri finished cutting off his clothes and began placing plastic suckers on his chest to link him to the heart monitor.

      ‘Duncan, if one of your packets has burst you could die,’ Kate persisted, ‘so tell me the truth. How many did you swallow?’

      For a moment she didn’t think he was going to answer, then he muttered, ‘Hundred. Swallowed a hundred.’

      Hell-fire, and damnation. The average lethal dose of cocaine hydrochloride was 500 milligrams. Body-packers commonly swallowed packets containing at least 12 grams each, and Duncan Hamilton said he’d swallowed a hundred of them. If just one of them had burst then more than twenty-four times the lethal dosage was seeping into his body, affecting his central nervous system, and respiratory and cardiovascular systems.

      ‘OK, Terri, we need to calm him and cool him down fast!’ she exclaimed as the paramedics wheeled their stretcher out of the cubicle. ‘I want 5 milligrams midazolam, supplemental oxygen, his head, neck and chest kept cold with cold water, and can you get me a fan? If we can control his agitation and temperature we might be able to get his BP down. If not…’

      The sister’s eyes met hers, and Kate knew what Terri was thinking. Duncan Hamilton could code at any minute, and with so much cocaine travelling through his body the chances of pulling him back were slim.

      ‘I’ll get the fan,’ Terri said but, to Kate’s dismay, the minute the sister had gone Duncan Hamilton wrenched the ambu-bag from his face.

      ‘Need to…tell you something,’ he said, his breath coming in great, ragged gulps.

      ‘Later—you can tell me later,’ Kate declared, desperately trying to get the ambu-bag back in place but he fought her all the way.

      ‘Important!’ he exclaimed, grasping her wrist tightly. ‘Have to tell you. Names…Important names. Bolton…Faranelli—’

      ‘Duncan, will you please let me put this back on you,’ Kate insisted, seeing the heart monitor starting to display an increasingly erratic tracing.

      ‘Mackay…Di Angelis…And addresses—I have addresses. You must hear the addresses.’

      ‘OK—OK, I’m listening,’ Kate replied, hoping that the quicker the young man told her whatever he wanted so desperately to tell her, the sooner she might be able to re-affix the ambu-bag.

      ‘6 Mount Stewart Street…12 Picard Avenue…’

      Oh, shut up, Kate thought as Duncan rambled on and she scarcely listened. He was dying, and yet he was giving her what sounded like the entire contents of the telephone directory.

      ‘Did…did you get all that?’ Duncan Hamilton demanded eventually, and Kate nodded.

      ‘Absolutely,’ she lied, sighing with relief as she snapped the ambu-bag back in place, but neither it, nor the fan Terri brought, nor the sedation, reduced Duncan Hamilton’s soaring temperature.

      ‘If we don’t get his temperature down soon he’s going to develop hypothermia,’ Terri declared, worry plain in her voice. ‘Will I start him on lidocaine?’

      ‘It won’t help,’ Kate replied, no less concerned than the sister was. ‘It produces similar effects on the myocardial cell membrane to cocaine. I’ve used sodium bicarbonate for tricyclic antidepressant overdoses and it worked with them so maybe…’

      She didn’t get a chance to finish what she’d been about to say. Duncan Hamilton suddenly gave an odd breath, and the heart monitor let out a low and constant tone. He’d coded, and immediately Kate hit him squarely in the centre of his sternum, then glanced across at the monitor. Nothing. No change. The heart line remained resolutely flat.

      ‘Paddles, Terri!’ she exclaimed.

      Swiftly, the sister handed them to her, and equally quickly, Kate rubbed the defibrillating paddles together with electrical conducting gel. It was on occasions like this she wished she was six feet tall instead of five feet nothing. To successfully shock a patient you had to lean over the examination trolley, place the paddles in exactly the right place, then press down really hard, but the trolleys had metal rails and if any part of you touched them…

      ‘Instant cardiac arrest, Kate,’ she muttered, standing as high on her toes as she could. ‘Stand clear, Terri!’

      The sister stepped back from the trolley, Kate pressed the paddles down as hard as she could on either side of Duncan Hamilton’s chest, and he convulsed briefly.

      ‘Nothing,’ Terri said, her voice tense.

      ‘I’ll tube him,’ Kate declared. ‘The ambu-bag’s not enough any more, so I’ll tube him and then I want the power up to 300.’

      Terri waited until Kate had inserted an endotracheal tube down Duncan Hamilton’s throat, then upped the power on the defibrillator paddles to 300, but though Duncan Hamilton’s body convulsed again when Kate placed the paddles on either side of his chest the monitor reading didn’t change.

      ‘IV bolus of 500 milligrams of beryllium,’ Kate said in desperation. ‘Power up to 360 joules.’

      Again, and again, she placed the defibrillator paddles on either side of the young man’s chest, but no amount of electricity kick-started the young man’s heart and eventually she stepped back from the trolley, and switched off the current.

      ‘You did your СКАЧАТЬ