The child’s hand is grey and mottled. I’ve crouched down next to the bed to examine it and now I stand up, the urgency of Ngoni’s phone call clear. We went to medical school together and he’s not often rattled, certainly not by a simple trampoline accident.

He’s correct, the right forearm definitely has no pulse. The boy is nine but looks younger, and is much too small for the adult-sized hospital bed crammed into a cubicle painted blue with fish stickers over the wall. He’s slumped down, his T-shirt riding up at the back and exposing his belly.

The paramedics have strapped up his right arm, and in his other hand, he clutches a small green inhaler that whistles slightly as he takes ragged breaths. His eyes are glazed from the painkillers he’s breathing in. His mother hovers, too agitated to sit.

‘We took him straight to X-ray,’ Ngoni says as he pushes a computer on a trolley into the room. He points at the screen, confirming the severity of the fracture.

Shit.‘What’s going on?’ the mother asks, her voice shaky, the tearstains on her cheek matching those of her child. She’s lookingat Ngoni. He waits for me to explain.‘He’s broken his arm just above the elbow and the fracture’s putting pressure on an artery. But don’t worry,’ I reassure her, ‘as soon as the bone’s straight again, the blood flow will return to normal.’

I have one eye on the clock above the bed. ‘What time did it happen?’I don’t tell her that muscle cells deprived of blood start to die within a
couple of hours. I don’t tell her that if it takes too long to restore blood flow then the muscles can swell within their tight fibrous coverings and die even hours or days later. In years past, kids with this fracture developed clawed fingers and permanent disability—and the best way of avoiding this is to straighten the bone and unkink the artery as soon as possible. I don’t want to tell her that this is a time-critical emergency until I have a plan.

‘I think . . .’ The mother can’t remember how long it’s been. She didn’t check the time when her son cried out. She didn’t look at her watch as she pulled him out of the narrow gap in the trampoline netting and called an ambulance…

Continue reading the extract here…

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