Pulse(74)

‘Mike Sheraton, Dick McGee and Ellie Lowe. Jason Conway is being treated outside in an ambulance.’

‘Any of them serious?’

‘Serious but not critical,’ Adrian said. ‘One possible fractured fibula, one back spasm, one likely concussion and some stitches in a split knee. Nothing we can’t deal with easily. Dr Rankin, here, is going to call an off-course ambulance to assist with a transfer of a couple to the local hospital.’

In my opinion, Adrian was downplaying the magnitude of the problem.

‘Jockeys out,’ was called over the speakers.

‘I must go,’ Adrian said. ‘I have to get down to the start or the race will be off late.’

The regulations stated that racing was unable to proceed until the doctor at the start had confirmed to the official starter that at least the minimum required medical provision was in place.

Rupert Forrester stepped aside to let Adrian and Jack out but came back into the doorway.

‘Dr Rankin,’ he said, ‘are you happy that you can cope here on your own? Would you like me to stay? I’m no doctor but I could surely do something to help?’

‘I’m fine, thank you,’ I said. ‘I have the nurses to help me and everything is under control.’ If Adrian wanted to talk down the seriousness of the injuries, I could do the same. I also decided not to point out to him that non-medical staff were not permitted to be in there anyway, not when we had patients present, due to compromising their medical confidentiality.

He nodded, took one more long look around the room and then departed.

‘OK,’ I said almost to myself. ‘Where do I begin?’

First, I went outside to check on Jason Conway in the ambulance. He was still lying on the stretcher with one of the paramedics sitting next to him. He had been wired up to a heart monitor and had a blood-pressure cuff on his arm, but he had recovered somewhat, at least to the extent that he knew who I was and he wasn’t happy about it.

‘I want another doctor,’ he said belligerently.

The paramedic gave me a sideways questioning glance, which I ignored.

‘There isn’t another doctor available,’ I replied calmly. ‘Now, Jason, can you answer some questions?’

‘Not more bloody questions,’ he said, lying back on the stretcher and closing his eyes.

Not those questions, I thought. I needed to ask him the Turner concussion questions.

He did slightly better this time insofar as he could remember both that he was at Cheltenham Racecourse and the name of the horse he’d been riding. But as for who was the current champion jockey or the winner of the Grand National, which had only been run the previous Saturday, he wasn’t even close.

‘Jason,’ I said, ‘I consider that there is evidence of concussion and I will be making a Red Entry to that effect. You will not be able to ride for a minimum of seven days and, even then, you will need clearance from the Chief Medical Adviser before racing again. Do you understand?’

He looked at me somewhat vaguely. Fortunately we had a pre-prepared printed sheet to give to concussed riders that set out the rules and the procedure for obtaining clearance to ride, along with a voucher to help them purchase a new helmet. I gave him a copy.

‘You are now going to go to hospital,’ I said to him, ‘for a scan.’

‘No need,’ he said, trying to sit up but having difficulty doing so.

There was every need, I thought. I turned to the paramedic.

‘Vitals?’

‘All good,’ he said.

‘Never mind. Cheltenham General and now,’ I said. ‘I’ll call ahead to warn them he’s coming. I want an urgent head CT to check for any bleeds.’

I turned back to the patient.

‘Jason,’ I said, ‘you are going to hospital now. I will talk to your valet and get your stuff sent on.’

‘No need,’ he said again, but he lay back on the stretcher and closed his eyes.

I was suddenly quite worried about him.

‘Quick as you can,’ I said to the paramedic.

‘No problem.’

I climbed out of the ambulance and it set off with its blue lights flashing. I watched it go. Perhaps I should have gone with him, but I had more patients to deal with. I went back into the medical room.

The blue screen curtains had been pulled back and the three jockeys were all watching the current race on the television attached to the opposite wall. I glanced up at the screen as I made a call to A&E at Cheltenham General.

‘I have three customers for you,’ I said. ‘One on his way now, two more to follow.’

Jeremy Cook was the consultant on duty and I spoke directly with him, filling him in on the details of each expected patient.

‘Thanks, Chris,’ he said when I’d finished. ‘We’ll look after them.’

Next I called the ambulance service requesting an ambulance.

‘Thirty minutes OK?’ said the operator. ‘There’s been a big accident on the motorway and we’re a bit stretched at present.’

‘Thirty minutes will be fine,’ I said, and wondered if the ambulance I’d just dispatched might be back sooner than that.

‘Get out the fucking way,’ Mike Sheraton shouted at the nurse. She had just finished stitching his knee and had inadvertently stepped into his line of sight to the TV while fetching a dressing.