by Sam Archer
A fisherman, George Harrow had been out on the Thames with friends some distance upriver, taking advantage of the early morning quiet. One of his fellow anglers had cast his line a little carelessly and the hook had caught Harrow in the corner of the mouth, tearing his cheek open. They’d arrived as a group, four damp, grizzled men smelling of tobacco and fish, Harrow with a filthy handkerchief pressed to the side of his face.
‘It’s just a scratch, Doc,’ he said. Fin peeled away the rag as carefully as he could. Some scratch. The hook had cut through the cheek’s full thickness.
The wound needed extensive cleaning and coverage with a course of antibiotics. Most of all, it needed painstaking suturing. This wasn’t a simple scrape on a thigh or a back. Both the mucosa inside the mouth and the outer skin of the face required stitching involving different materials, and with enough skill that scarring would be minimal, both for cosmetic reasons and so that there was no distortion inside the mouth which might affect Mr Harrow’s eating or speech in the future.
Fin considered the options. St Matthew’s had a plastic surgery department, with surgeons specialising in cosmetic repairs. But Fin himself was skilled in such repairs, and for all but the most severe cases the plastics boys were happy for him to do the job. It lightened their work load, for one thing.
Then he had an idea. It was very early in the morning, and the first casualties of the rush hour traffic chaos hadn’t started to pour in yet. The department was quiet. Fin called across to one of the nurses: ‘Rachel, could you ask Ms Havers to pop in for a moment?’
‘Miz who?’ growled Harrow, and winced at the pain that talking evidently produced.
‘A colleague of mine,’ said Fin.
Melissa appeared between the curtains, and Fin caught his breath. First thing in the morning, in the standard-issue white coat, her hair pulled back into a practical ponytail as she always wore it at work, she was still a vision of loveliness.
‘This is Mr Harrow,’ said Fin. ‘Take a look at this. Fishing hook injury.’
Melissa peered at the wound, betraying no reaction. ‘Plastics?’
‘I thought you might do it.’
Her eyes flashed at him – astonished, and excited – but she kept her tone nonchalant. ‘Of course.’
‘I’ll assist, if you don’t mind.’
The fishermen were muttering to each other. At least, Fin thought, it meant they weren’t staring at Melissa any longer.
Harrow said, ‘No offence, Doc, but you’re the boss, aren’t you? I’d prefer it if you did it.’
Fin could understand. Everyone wanted to be treated by the most senior, most experienced doctor available. It was natural. On the other hand, if the trainees never learned by experience, they’d never themselves become experts. It was one of the trade-offs for coming to a teaching hospital for treatment.
‘Ms Havers is one of our top surgeons,’ said Fin. ‘She’ll do a fine job.’
‘It’s just that she’s – well, you know.’ Harrow gestured vaguely.
One of his friends said, ‘Hey, George. You’re better off with a lady. She’ll be good at stitching and sewing.’ They erupted into sniggers.
Melissa didn’t falter, didn’t flinch, didn’t blink. She looked neither flustered nor annoyed, even though Fin thought she must have been seething inside at the chauvinism of the men. Fin thought she was handling it terrifically.
George Harrow seemed to realise things had gone too far because he shook his head at his friend, grimacing again. A nurse took them through to the suturing area and began to prepare a sterile field.
Melissa looked up at Fin and said, ‘Thanks.’
‘Don’t let me down.’
He wasn’t worried, and his confidence in her turned out to be well-placed. Fin said nothing during the entire procedure, handing her swabs and wielding the small selection of retractors according to her instructions. He marvelled at the delicacy of her suturing technique, the flair with which she stitched the elaborately tricky tear within the man’s mouth and, later, the laceration as it extended across his outer cheek, ensuring the edges of the wound were as closely opposed as possible to minimise the scarring. There had been no damage to the facial nerve so with any luck, and assuming they could head off any infection, Harrow’s face should look almost as good as new within a few weeks.
Although Fin watched Melissa’s hands intently, aware of his responsibility to the patient, he glanced from time to time as surreptitiously as he could at her face. Often all he could see was the smooth curve of her forehead leading to the delicate arches of her pale eyebrows and, beyond, her long, thick lashes. It was all he could do to keep himself from reaching out and tracing a forefinger across her brow, down the bridge of her small nose to her lips.
When at last she’d snipped the final suture and dabbed the wound dry, watching for tiny bleeding vessels, Melissa sat arrow up and brought him a mirror. He turned his head this way and that, peering at the thin pink line which looked like nothing more than a nasty paper cut.
‘Thanks, Doc,’ he nodded at her.
Outside the suture room, a dressing freshly applied, Harrow met his friends.
‘You look like a princess, my darling,’ one of them said.
‘Sling your hook,’ Harrow retorted, and they departed in gales of laughter.
Fin watched Melissa help the nurse tidy up. ‘Another satisfied customer,’ he said.
She tried to look noncommittal but couldn’t keep up the pretence, and her face broke into a beaming grin.
‘Not bad, was I?’
Without any trace of irony, he said, ‘You were sensational.’
She darted a quick look at him, a demure look from beneath lowered lashes. He felt his stomach do a slow somersault. Glancing at the nurse who was separating out the various pieces of waste into different containers, he thought: I’m glad we’ve got a chaperone.
‘I’m serious,’ he said. ‘That was a top-notch job. We won’t know fully how it turns out until it’s healed a little, of course, but… I haven’t seen skill like that for a long time.’ He raised his eyebrows ruefully. ‘I only hope we don’t lose you to a career in plastic surgery.’
‘No chance. Trauma’s where I belong.’ Melissa finished drying her hands, and turned to face him fully. ‘But thank you again, Fin. For the opportunity, and for the praise.’
Her head was thrown back a little, her breasts thrust forward almost imperceptibly. Almost unconsciously he responded, shifting so that he faced her square-on and pushed his hips slightly forwards.
Watch yourself, Fin. Remember where you are.
And then: remember what you’ve done.
Before he could spoil the mood once again, a casualty officer poked his head round the door. Mr Finmore-Gage? RTA coming in, blue-light. Three casualties.’
A road traffic accident. The first of the morning, and it wouldn’t be the last.
He shrugged, tilted his head towards the door.
‘Shall we dance?’
Melissa grinned and followed him out into the maelstrom.
***
Melissa wasn’t a Londoner by birth or upbringing, but as a child growing up in Sussex her parents used to bring her to London for a day’s shopping before Christmas each year. She’d loved the anticipation: the excitement the night before, the early start and the train journey, the thrill as they pulled into Victoria Station and caught the Underground to Oxford Circus where they’d alight into the bright, crazily bustling carnival of Oxford Street. As an adult Melissa had tried to keep the tradition alive, treating herself to a West End shopping day at least once every Christmas. And of course, this year it would be easy as she actually lived in the city.
She picked a Saturday, the busiest shopping day of the year as it was the one before Christmas, and, efficient as ever, did her shopping for other people – her parents, her brother, a few odds and ends for the Trauma department staff – first, so that she could relax and indulge herself. Melissa made a meal of her day: tea
at Fortnum & Mason’s, clothes shopping at Selfridges and a Bond Street boutique or two, followed by a browse around John Lewis’s flagship department store on Oxford Street.
All the while, she found her thoughts returning to Fin. She saw him in billboard advertisements for gentlemen’s clothes, in the men whom she passed in the jostling crowds on the street, even, Lord help her, in the male mannequins in the shop windows. His behaviour was starting to infuriate her once again. He’d definitely warmed to her, there was no doubt about that, and was far freer with his praise than he’d once been. But every time she thought they were getting close to a replay of a situation like the one outside her flat that night, every time the attractive force between them was so blatantly obvious that the air seemed to crackle with it, Fin would pull back, draw into himself, physically and emotionally, and she’d be left feeling drained and bewildered.
Was there another woman in his life? Possibly, but she didn’t think so. She’d been in his office and there were no pictures of anyone else. In that case, did he feel awkward because she was his trainee? Or was he perhaps wary of office romances of any sort? Well, she could understand both of those points of view. Maybe she should be more careful, more aware of the damage an affair with the boss could do to her career. She was already at a disadvantage, as a woman in what had traditionally been a man’s field. She really didn’t people whispering that she’d got where she had by sleeping her way to the top.
Forget about all that today, she told herself as she descended the escalator in the department store to the floor which held the perfume and jewellery. You’ve come out here to enjoy yourself just for the day. To have a bit of frivolous fun.
Melissa wandered the glittering aisles, inhaling deeply of the varied aromas, not stopping to buy but basking in the simple sensual luxury of smell. She accepted a free sample spritz from a girl armed with a new scent, but didn’t like it: too floral. As she swept her gaze across the floor of the enormous shop, wondering where to drift off to next, her eyes caught on someone.
There, over at the jewellery counters.
His back was to her, and perhaps he was just another tall, dark-haired man. But he turned a fraction and she caught his face on one-quarter view.
There was no mistaking him. It was Fin.
Well, what are the odds, Melissa thought. She began to sidle towards him down the aisles, intending to surprise him. But as she drew nearer, she saw the girl behind the counter lift something glittering – a necklace, it looked like – into a box.
Melissa stopped and watched.
The girl’s hands were moving, out of sight, and Melissa guessed she was wrapping the box. She handed it to Fin with a smile and he slipped it into the pocket of his Burberry overcoat.
Melissa took a step back, almost colliding with a portly lady who glared at her. All of a sudden it was vital that Fin not see her.
Melissa stumbled away, muttering her apologies to people, heading towards the exit. Outside the cold air hit her in a blast. Her vision blurred, but not because of the wind.
Fin had been buying jewellery. Gift-wrapped jewellery, as a present.
For a woman. So there was someone else in his life.
How could she have been so stupid?
Melissa hurried through the darkening streets, the magic of the setting and the season destroyed for her. Now all she felt was the raw cold. She was a child, a naïve little girl with an adolescent crush on her handsome, powerful, charismatic boss. She despaired of such characters in romantic comedies. Why couldn’t she have seen that she was exactly the same? A silly stereotype?
Fin felt nothing for her. She’d been projecting her own desires on him, seeing evidence of his interest in her where there’d been none. Deborah had been right all along. She –
Melissa faltered in mid-stride.
Deborah?
Was she the one Fin was buying the necklace for?
It made sense. Deborah had been warning her off almost from the word go. More recently, the nurse had sensed something developing between Melissa and Fin and had probably decided to show her hand. To confess her feelings for Fin to him. And he’d responded in kind.
Or was Melissa spinning fantasies of another kind now? Were her anguished, tumultuous feelings overriding her reason once again?
Feeling miserable to the point of wretchedness, Melissa allowed herself to be swept along by the crowd, down into the darkness of the Underground station.
***
‘Ms Havers, could I bother you for a minute?’
Melissa blinked, looked round. She was on the post-op ward, it was eight in the morning, and she’d just come off a night shift. It had been a punishing one, an almost non-stop flow of injuries of every kind: stab wounds, head and torso damage from the inevitable car crashes, even a gunshot injury, which was relatively rare in Britain. Melissa had been in theatre virtually continuously from nine in the evening until five this morning, and she was staving off the tidal wave of sleep that threatened to engulf her by keeping on her feet and downing cup after cup of coffee interspersed with the odd can of diet cola for variety.
The aftermath of a busy night in theatre always involved ward rounds to make sure the patients on whom the surgeon had operated were stable enough to be handed over to the day shift, and Melissa was coming to the end of her rounds, a fresh-faced nurse at her side. Despite the industrial quantities of caffeine she’d consumed, she realised she’d drifted off on her feet while studying a patient’s chart.
Deborah was holding a prescription pad. ‘I know it’s not really your job, but Dr Nelson is on the other ward at the moment, and I wondered if you could write up this patient’s discharge medications.’
Dr Nelson was the junior doctor in the team and was normally tasked with the mundane duties like discharge prescriptions, but Melissa didn’t believe in being precious. The department ran only if everyone mucked in where necessary, and sometimes it was quicker to get a job sorted out even if it was strictly speaking someone else’s responsibility.
‘Sure. No problem,’ she said, taking the prescription.
A week had passed since her encounter with Deborah in the locker room. Whatever the nurse’s opinion of her, and despite Melissa’s growing suspicion that Fin and Deborah were a secret item, Melissa had to admit that Deborah never let any of that stuff get in the way of their working relationship. She was cool towards Melissa, but she wasn’t spiteful.
Perhaps she’s more emotionally stable than me... Melissa shook the thought away. This wasn’t the time or the place to get maudlin. She was too tired, her defences were too weakened, for her to dare to let such poisonous considerations to creep in. They’d take hold, and would disrupt the sleep she desperately needed later.
But already Melissa knew she wouldn’t fall asleep easily. She’d slept poorly for days, ever since she’d seen Fin buying the necklace. When she did finally drop off, her dreams were tormented by his presence. He wasn’t even necessarily with his mystery woman in the dreams; just his image was enough to drive her to despair when she awoke again and remembered that he was out of reach. Had always, perhaps, been out of reach.
Melissa consulted the medication chart Deborah had handed her and scribbled the drugs and their dosages on the prescription pad. Like many patients who came through the Trauma Department, this woman was on a number of preexisting drugs, and it was important to include them on the discharge prescription along with the antibiotics, painkillers and other meds for the post-operative period.
She handed the prescription and chart back to Deborah who murmured her thanks. Melissa moved through her list patient by patient until she’d finished her reviews, then made her way to the nurses’ station to check if there were any last outstanding things to deal with before she signed off and went home.
Deborah appeared at her side. ‘A word?’
What now, thought Melissa wearily, the fatigue starting to make her irritable. She followed Deborah into the nurse’s office.
Without a
word, Deborah handed her a prescription. Melissa took it. It was the one she’d filled out earlier.
‘What’s the problem?’
‘Take a closer look,’ said Deborah quietly.
Melissa ran her eye down the list of drugs, their names lettered in her tidy hand. Metronidazole and flucloxacillin to fight off bacterial infection. Dihydrocodeine for pain. Furosemide and digoxin for chronic heart failure.
Her glance caught on the last one. Digoxin.
She stared at the dose she’d written beside it. 125 mg. One hundred and twenty-five milligrammes.
The correct dose was 125 microgrammes. She’d prescribed one thousand times the safe dose.
Melissa put her hand to her mouth, stared at Deborah. The nurse gave a small smile and took the prescription from her.
‘I noticed it when I was about to give it to the patient at the door.’
‘I don’t know what to say,’ breathed Melissa.
‘It’s my fault. I shouldn’t have asked you to write it out when you were tired and distracted.’ Deborah shrugged. ‘A learning experience for both of us. Anyway, no harm done. And the pharmacy would have noticed it immediately, before dispensing it.’
Her mind reeling, Melissa rewrote the prescription with the correct dose, checking through it three times to make sure she’d got it right. After Deborah had gone, Melissa stood in the office gazing at nothing in particular.
Prescribing errors happened. They couldn’t be prevented altogether, given the sheer numbers of drugs that were prescribed daily in the health service. But they’d never happened to her before. It was something she prided herself on.
Yes, Deborah was probably right in saying that the pharmacy would have spotted the error in time. But what if they hadn’t? What if a junior pharmacist overlooked it, and issued the medication as written? Digoxin was a powerfully effective heart drug, but it was also deadly if misused. A dose one thousand times higher than intended would prove lethal in every case. Melissa would have killed the patient.
Fatigue was well known to impair a doctor’s performance, or anybody else’s, come to that. Yet Melissa knew it wasn’t tiredness that was responsible for her mistake. She’d been just as exhausted as this before, but had never made a potentially fatal error like this. No, her failure to pay adequate attention had been due to something else entirely.
