by Anne Fraser
‘Thank you for helping me to organise this,’ she said, going over to one of the campaign leaders. ‘I have to go and get back towork, but I wanted to tell you that you’ve done really well, arranging such a massive turnout.’
He nodded. ‘This is just the beginning. We have all sorts of actions up our sleeves. I just hope that they show your interview in full on TV,’ he said. ‘You were brilliant. You put in a strong case for keeping the unit.’
‘Thanks for that. I hope it’s done some good.’
But now she had to get back to work. First on her list of things to do was the daily meeting with staff to check on patients they had seen the day before. They would organise follow-up measures to be taken, and make sure that letters had been sent to GPs.
‘How is Dean Wainwright doing?’ she asked, and Alice flicked through the notes.
‘He had a successful repair operation. He’s been admitted to the surgical ward for rest and observation. He seems to be doing fine.’
‘That’s great. Is there any news of young Matthew, the child who swallowed the antihistamine tablets?’
Alice shook her head. ‘Nothing encouraging, really. He’s still in a worrying condition.’
The news was upsetting. Louise braced herself to go on with her work and a few minutes later she wound up the meeting. Then she went in search of her next patient.
Unexpectedly, she came face to face with James as she walked towards the treatment room.
‘Was that meant to be a baptism of fire?’ he asked. His jaw was set at a hard angle and she guessed he wasn’t best pleased by his reception. She suffered a small qualm when she remembered how they had parted in discord the previous day, but she couldn’t afford to let her emotions get in the way.
‘So you survived the onslaught, did you? I’m so glad.’ She gave him a quick smile. ‘Sorry about that, but someone has to put forward the opposite point of view. We can’t have you having everything your own way, can we?’
‘Heaven forbid,’ James said in a laconic tone. ‘That would make life just too easy, wouldn’t it? Still, I expect you know how much I relish a challenge, so it was thoughtful of you to set that up for me.’ His grey eyes glittered, homing in on her, and Louise felt a frisson of awareness run along her spine.
‘Anything to oblige,’ she murmured. ‘But now I have to get on with my work.’ She scanned her patient’s case notes and then frowned. ‘Poor mite. I’d better go and see what I can do for this six-year-old. I have her on oxygen, but she’s very tired and weak. I’m thinking she’ll need steroid therapy to support her immune system. She’s coughing up blood and passing it in her urine too, from the looks of these lab results.’
James quickly lost any hint of antagonism and became immediately on the alert. ‘Then I guess she must be anaemic, too. Are you checking for Goodpasture’s syndrome?’
Louise nodded. ‘The findings are all pointing that way, so we need to act quickly if she’s not to progress to renal failure. I’ve cross-matched her blood and I think she’ll need a transfusion of red blood cells. I’m going to admit her and call for a specialist consultation.’
No sooner had she done that, and arranged for the child to be transferred to a ward, than the department was thrown into a feverish bout of activity.
‘We’ve patients coming in from a traffic accident,’ Alice told her. ‘A lorry swerved across the dual carriageway and three cars were caught up in the smash. There are several casualties, including six children. A five-year-old with chest trauma is the most badly injured. He’ll be here any moment now. It’s looking pretty bad.’
‘Okay. Call the trauma team and include James in that. Find Ryan, and ask him to do triage. Alice, I want you and Jenny to sort out treatment rooms and prepare everything we need. I’ll gather up Tim and any of the Senior House Officers that we can spare and allocate patients to them.’
She was already on the move and, when her small patient was rapidly wheeled in a few minutes later, she directed Andy, the paramedic, to take him to the nearest resuscitation room.
The boy was in a shocking state, with a barely palpable pulse and open wounds to his chest. There were signs of contusions to the lungs as well as bleeding within the chest cavity. An overwhelming feeling of dread washed over her. Then her professional instinct kicked in, and she blocked everything out except the need to keep him alive.
She worked quickly to secure his airway with an endotracheal tube, afterwards stepping to one side so that Jenny could take over with the oxygen.
‘His blood pressure is falling fast, and I’m hearing muffled heart tones. The neck veins are distended.’ Louise continued with her examination, and each finding made her all the more anxious for this little boy’s safety.
‘He’s going into shock. We need to get some lines in and start volume replacement right away.’ Almost before she had finished speaking, James was working to set that up.
A short time later he said, ‘I’ve given him two fluid boluses of lactated Ringer’s solution, but he’s still not responding. He must still be losing blood from somewhere, and it can’t simply be from the lung.’
‘We’ll have to transfuse him.’
‘I’m on it.’ Jenny was preparing the packs of blood for transfusion.
Louise glanced at James and said on an urgent note, ‘I’m going to try to get to the source of the bleeding. The scans are showing blood pooling around the heart, so I need to get to it fast, but I’m worried about his lung injury. Will you put in a tube to the lung and drain the haematoma? That should bring his oxygen level up.’
‘I’m already there.’ He was readying the equipment as she spoke, and Louise was relieved to see that the team around her was working well. Now her main concern was to find the source of the bleeding and put a stop to it.
Just a few moments later, she discovered a small puncture wound in the child’s heart, along with damage to the blood vessels. ‘Alice,’ she said urgently, ‘put your finger here and keep pressure on the hole until I can put a catheter in place.’
The catheter would help to control the bleeding and, as soon as that was in position, she set about clamping the damaged blood vessels around the heart.
‘You’ll want to suture the lacerations?’ Alice was readying herself to hand over the necessary equipment.
‘Yes, I’ll use polypropylene sutures for the heart itself.’ She briefly checked the monitors, desperately worried that they were running out of time. How long could this child survive if his heart was so badly injured?
‘Shall I start on the blood vessel sutures?’ James asked. ‘I’ll do horizontal mattress sutures reinforced with pledgets.’
‘Thanks.’ She sent a quick glance to the young Senior House Officer who was assisting. ‘Work with James,’ she said quietly, ‘and you’ll be able to see how it’s done.’
They worked together, relying on the support of the rest of their colleagues to keep a check on the child’s status and make sure that he was adequately anaesthetised.
Louise had finished putting in the sutures and was assessing the child’s circulation when a nurse from a neighbouring treatment room rushed in. ‘Ryan needs you next door,’ she said in a breathless voice. ‘His patient’s collapsing and he’s having trouble stabilising her.’
Louise glanced at James. ‘Would you be able to take over here?’
He nodded. ‘I’m doing the last of the sutures now. You go ahead.’
She hurried out of the room and went to see what was happening with the child in Ryan’s care.
‘I’ve been treating her for a fractured arm, but suddenly her condition has deteriorated. The CT scans haven’t shown anything amiss, and I can’t account for why this is happening.’
‘Have you done an abdominal examination?’
‘Yes, I did all the usual checks.’
‘Something might have developed since then. I’ll do another, just to be sure.’ Louise examined the little girl and said cautiously, ‘There seems to be some distensio
n in the abdomen now. We’ll do a peritoneal lavage to see if there’s any bleeding.’
A short time later, she had isolated a source of bleeding and the child was referred for immediate surgery. Louise went back to the main thoroughfare and checked to see how her colleagues were coping.
‘I think we have it all under control now,’ Tim, the Specialist Registrar, told her. ‘All our patients have come through the initial stages okay.’ He looked around at the assembled staff, a brow raised in query, and there was a general nod of agreement.
‘That’s brilliant work. Well done, everyone.’ Louise smiled, and checked her watch. ‘I’m going to freshen up, and then I’ll look in on the overdose patient upstairs while we have a lull. You’d better all take turns in going for a break while you have the chance.’
She caught sight of James, as he removed his waterproof coverall and tossed it into a bin. A fleeting smile touched his mouth as he returned her gaze. She had to acknowledge that he had been a tremendous asset to her in their attempts to keep the five-year-old boy alive. Would the outcome have been the same if he hadn’t been there to help?
A wave of weariness washed over her, and for a moment or two she couldn’t fathom why she was feeling this way. The concentrated efforts of the last few hours seemed to have taken more out of her than she had expected.
Perhaps it was the knowledge that these children in her care might not have survived if they had been taken on the longer journey to the Royal Forest Hospital that was troubling her more than anything. In cases like these, time was of the essence, and small patients with injuries such as these needed expert attention within the hour if they were to have any chance of living through the trauma. Would new patients get that in the months to come if the hospital’s Trust board had its way?
Needing to get away for a minute, she took the lift up to the medical ward. All was quiet and nurses moved around the area, adjusting drips here and there or administering medication as necessary. The children here were very sick, having been transferred from the intensive care unit, and Louise was careful not to disturb them.
Three-year-old Matthew was lying on his side, but his eyes were open and he was staring straight ahead at the pictures on a video screen that a nurse had provided for him. Monitors nearby recorded his vital signs, and Louise could see that he was still very poorly. His heart rate was fast, and his oxygen level was low, so that every now and again the equipment would bleep a warning and a nurse would come and check his condition.
He looked as though he was too weak to move. Even so, she was moved to smile as she watched him. The infant was holding onto a packet of crisps that lay on the bed in front of him and, as she looked on, he dipped one finger into the bag, pulling out a crisp. It was such a tiny, insignificant movement, but it showed so much, and it brought a lump to her throat. The boy was awake and ready to eat, even if it was only a crisp and he didn’t have the energy to sit up.
There was a movement beside her and Louise glanced around, startled to see that James had come to join her. Maybe he, too, needed to reassure himself that the child was still holding onto life.
‘He doesn’t have the energy to move, does he?’ she said softly. ‘He looks exhausted.’
‘That’s true…’ James murmured, ‘but he’s been through a tremendous battle, and I’d say he was on the mend at last, wouldn’t you?’
Her smile widened. ‘Oh, yes, I’d say so, definitely.’
James’s arm went around her waist, a light, gentle touch that drew her close and showed they were in tune with one another, united in their joy that this tiny infant had conquered his illness against all the odds. The knowledge that he was on the road to recovery made her spirits soar…or it might have been that James’s embrace was paramount in promoting her newfound happiness. He had an overwhelming power to revive her flagging morale.
It was such a companionable, casual, yet intimate caress and, for a while, neither of them moved. They had been through so much in these last few hours, had together faced one of the greatest tests they could ever know, and right now she was more than content to have him hold her this way.
Of course, she knew why he was keeping her close. It wasn’t meant to be personal, was it? It was just that this was a special time, a moment to share.
Eventually, though, she knew that she had to come back down to the reality of everyday life. ‘I suppose I should go back to A&E,’ she said, a little sigh escaping her.
He nodded, letting his arm fall away from her, and she felt the loss of his touch as though a cool breeze had drifted over her skin.
‘I was glad of your help this morning,’ she told him as they left the ward. ‘You were so competent in everything you did that it helped take some of the pressure from me, knowing that I could rely on you.’
‘I would say that you were pretty spectacular yourself,’ he said with a smile. ‘I’ve never seen anyone so concentrated, so decisive about what needed to be done. If anyone pulled that child through, it was you.’
‘It was a team effort,’ she said. ‘That’s always the way things work best, when we all know our roles and can depend on one another.’
‘Maybe, but you even found it in you to realise that there was a teaching situation in there. That young SHO was anxious about what was going on, but it helped for her to be able to take part and learn from what we were doing.’
He pushed open the exit door, one hand resting on the small of her back as he ushered her through to the corridor. Did he know the effect his touch had on her? Or was it simply a negligent gesture, a courtesy born of generations of aristocratic background and essential good manners?
She tried to shake off the cloud of sensation that fogged her brain. Getting to know him and respect him was playing havoc with her nervous system. How could she allow herself to grow fond of the man who might eventually destroy her career?
‘How does it feel to be working in A&E?’ she asked him. ‘I expect it must feel strange to you after you’ve been spending so much time dealing with management issues. Is it likely to cut in on your role as an executive?’
He gave it some thought. ‘It’s more a question of having to rearrange my schedule,’ he said after a moment or two. ‘I don’t mind doing that. I like to be busy, and it’s good to be back in the fast-moving area of emergency medicine. The work that I’ve been used to in the renal unit is much less frantic, so I suppose I have to adjust more to the pace. I can always miss out on one or two management meetings as long as they are ones where I don’t need to put in a vote. I have the minutes of the meetings to outline the gist of the discussions.’
‘Do you ever have to make decisions about the management of the Ashleigh estate?’ She hesitated, remembering how annoyed he had been by her comments the day before. But she had never been one to let troubles fester, and it seemed to her that he was heading for trouble if he ignored his brother’s comments. ‘It seemed to me that your brother would have liked a little more support.’
He sent her an oblique glance as he pressed the button for the lift, but he appeared to have put his anger behind him. ‘I keep an overall view of the situation. Robert chose to take on the management role. He’s always been interested in the land and different ways of farming. He might complain from time to time, but he’s well suited to the job and up to now he’s always been able to keep things running smoothly.’
‘But the upkeep of the Manor can be daunting, can’t it? He seemed to have some worries about whether you were getting the best out of the estate. It must be galling for him to have lots of ideas about changes that can be made, but to be vetoed at every turn.’
‘We’ve never had to worry about that before. I doubt my grandfather would have funded the paediatric wing if it was a problem for him.’ The lift doors swished open and they stepped inside, waiting until they were closed and the lift began to descend. ‘I think Robert’s trouble stems from the fact that he’s looking to the future when he might want to settle down and have a family of his
own. Perhaps he’s trying to impress his fiancée.’
‘Or perhaps he resents the fact that he’s left to do it all on his own. It can be difficult putting everything into your career, only to find that it’s in jeopardy.’
He shot her a penetrating stare. ‘It seems to me that you’re the one who has a problem with that. It isn’t just the threat of closure that bothers you, is it? Is it that you’re understaffed? Are you afraid that I’ll leave you in the lurch and abandon my work here at the hospital? You seemed to be concerned that I might have overextended myself in some way.’
‘No. That didn’t enter my head. After all, you signed a contract, albeit a temporary one.’ She frowned. ‘I suppose I’m bewildered by the way you keep a foot in both camps. You have all the trappings of wealth and privilege, and yet you appear to have turned your back on the very thing that gave you all that. And you wanted to practise medicine, but discovered a higher cause in management and stepped away from what you thought had been your chosen career. None of it makes sense to me.’
She gave him a long, assessing look. ‘If the truth were known, I think you’re confused about what it is that you really want. You’re in denial and that’s why there’s friction between you and your brother, and why you can’t see how much harm you’re doing in supporting the option for closure in favour of the Royal Forest Hospital. You’ve lost sight of what makes people tick and how they need their smaller goals to be valued.’
The doors of the lift started to open and he pressed the button to close them again, shutting them away from prying eyes.
‘Maybe you’re the one who’s lost sight of what it is to be flexible. You’re only thinking about the way your unit will be affected because it means everything to you. You’ve put your life and soul into developing it, instead of looking to the outside world for fulfilment. How else do you account for the fact that it’s like your second home?’
His grey gaze pierced her, becoming smoky in its intensity. ‘Why aren’t you married and looking after a family of your own? You’d be far less likely to be concerned about what happens here if you had your own children to look after.’
