The London Doctor

by Joanna Neil

  Hannah stared after him. She had been ready to argue her case, but he hadn’t said another word about it, and now she was flummoxed. It was impossible to know what to make of him.

  Just then, though, Sarah called her over to the phone, and she put all thoughts of him out of her mind.

  ‘It’s your mother,’ Sarah said. ‘She was going to ring off, rather than disturb you, but I told her that you were free to talk.’

  ‘Thanks.’ Hannah took the receiver from Sarah, and heard her adoptive mother’s voice. ‘Hello, Mum,’ she said. ‘Is everything all right?’

  ‘It’s fine. I didn’t really want to call you at work,’ her mother said hurriedly. ‘It’s just that it’s Sunday, and you haven’t been at home when I’ve called lately. I want to know how you are getting on. Is it all working out all right for you?’

  Hannah felt a warm surge of affection for this woman who had taken the place of her mother and had cared for her since the age of ten. The bond between them was a strong one, and Hannah had been accepted into her home from the first as if she had been her own daughter.

  ‘I tried to ring you,’ Hannah said, ‘but we somehow kept missing each other. Yes, I think it’s working out all right for me. It’s been quite hectic, but I’m beginning to get the hang of things. It isn’t like ordinary medicine, working in A and E. Sometimes, I hardly have time to stop and think.’

  ‘How are you taking to life in the city? Is it what you expected?’ Her mother sounded doubtful.

  ‘It’s exactly as I thought it would be,’ Hannah admitted. ‘I’m still having trouble finding my way around but, then, I haven’t had much time to explore my surroundings. I think it will be all right in time. There’s a lot I want to see.’

  They spoke for a while longer, and when Hannah put down the receiver, a wave of homesickness swept over her. She was overcome by a sudden feeling of being lost and alone, adrift at sea.

  ‘Is there a problem?’ Adam asked. ‘Was that your mother that you were talking to just now? I thought I heard you mention her name.’

  Hannah gave a small start. She hadn’t even realised that he was close by, and now she looked at him warily. Was he going to tell her that she should be getting on with her work?

  ‘Yes, it was my mum, but there’s no problem,’ she murmured. ‘I was just about to go and find my next patient.’

  He looked at her steadily, his grey eyes searching her face. ‘You looked vulnerable and unsure of yourself. I haven’t seen you look like that since you were a young girl and your mother brought you that first time to buy apples from the orchards on my father’s estate.’ He made a wry face. ‘As I recall, back then you were a skinny kid with big, bewildered eyes and a scared-rabbit stare. You looked wary and unsettled, as though you were about to take your heels and run.’

  ‘Perhaps I was.’ She sent him a fleeting glance. ‘We had just moved house. I was confused, and insecure. There had been so many changes in my life, and here I was, moving to a new area with my foster-parents. I wasn’t sure that this latest home would be any different to the others. They told me they wanted to adopt me, but I didn’t really expect it to happen or believe that I would be staying there for long.’

  He nodded. ‘Things haven’t altered much since then, have they? You still have that haunted look about you, as though you’re looking for an escape route.’

  ‘Do I?’ Was he intent on provoking her? He had been so insistent that she didn’t belong here, and it seemed as though in a way he was still trying to prove his point. She gave a faint shrug. ‘I can’t complain. My mum was good to me—she’s still good to me, and I love her dearly.’

  ‘I never really understood the fostering bit…why it should go on for such a long time. After all, you hadn’t had any contact with your natural mother—not for ages at any rate. I’d have expected that you would have been adopted earlier. That might have provided you with a stronger feeling of security.’

  ‘Maybe, but, as far as I know, my real mother wouldn’t agree to it at first. I’m not sure why. I don’t remember much about her now, except that she flitted in and out of my life when I was a young child. Perhaps subconsciously I’ve chosen to forget. I think she was very young when she became pregnant with me, and perhaps she found that she couldn’t cope. I know that she had a nervous breakdown when I was very young, and then she was ill again when I was about ten or eleven years old. That’s more or less when they started to talk about adoption.’

  ‘You sound as though you’re beginning to try to understand her and possibly even starting to feel sorry for her.’ Adam’s gaze flicked over her tense features. ‘I wouldn’t have thought you owed her any loyalty.’

  ‘Perhaps you’re right.’ She looked away. It made her feel awkward and uneasy, talking about her real mother. Her memories, such as they were, were filled with a mixture of sadness and uncertainty. Whenever she had thought that at last she could relax and feel safe, her mother would disappear again. It had been bewildering to a young child, and even now she couldn’t make any sense of it.

  That was why she needed finally to seek her out, and it was the reason for her coming to London. She had begun to feel as though she was in limbo, in that indeterminate state where she was unable to move ahead and get on with her life. She had reached the stage where she desperately wanted answers to questions that had been left over from her childhood.

  ‘Didn’t you ever have any contact with your father? I know you spoke about him once or twice, but I don’t remember you ever going to stay with him,’Adam said.

  ‘I don’t think he wanted much contact with me. He married my mother, but I think he only did that because he felt that it was the right thing to do. In fact, I think he was completely taken aback when he discovered that she was expecting his child. I know that he was ambitious, and his work must have been more important to him than anything else because he felt as though he was held back by the marriage and it didn’t last long. I do remember my mother saying that he went off to follow his career.’

  She glanced at him. ‘I expect you would understand all about that—the work bit, I mean—feeling the need to achieve more and more.’ Hadn’t he always been ambitious and career orientated?

  His eyes narrowed. ‘Is there something wrong with that?’

  ‘I suppose not.’ She grimaced. ‘Anyway, I don’t recall very much more about him. He was always a shadowy figure, as far as I was concerned, and I never really had the chance to get to know him better. I never will. He died some years ago.’

  He might have said something in response, but Mr Tremayne walked into the department just then, a harassed look on his face. ‘We’ve had an alert from the ambulance service,’ he said. ‘We need to start following major incident procedure, and I’m going to set up a control centre here.’

  He looked at Adam. ‘We need to prepare the department so that we can receive patients from the incident area. I want you to give out action cards to all the staff, and make sure that they have labels to denote who is who. I’m going to prepare a triage point at the ambulance entrance.’

  Adam nodded. ‘I’ll make sure that the theatres are on standby, and I’ll clear X-ray and the scanner ready for the influx.’

  ‘That’s good.’ Mr Tremayne drew Adam to one side and spoke to him for a few minutes longer and then went on his way to assemble the rest of the staff.

  ‘What’s happened?’ Hannah asked. ‘What kind of incident is it?’

  ‘An explosion of some sort, in the region of St Katherine’s Dock,’ Adam told her. ‘You’ll be with me. We’ll be going to the incident area along with the mobile unit, and we need to put on emergency outfits to denote who we are.’ He waved a hand in the direction of the doctors’ lounge. ‘You’ll find them in the locker next to the table.’

  He turned towards the reception desk. ‘Sarah, you’ll be helping out with triage and, Colin, you’ll be on standby to receive the injured patients.’

  Sarah went to make her own preparations, and Col
in hurried away to check on equipment. Hannah was already feeling panicky inside. She had never had to deal with a major incident before, and she hoped that she was up to the task. There were butterflies in her stomach as she followed Adam to the ambulance bay a few minutes later.

  ‘We’ll report to the medical incident officer at the scene,’ Adam said, as the ambulance took them across the city. ‘He’ll direct us to where we’re needed.’ He glanced at her, his dark brows drawing together. ‘Are you all right?’

  ‘Yes, I’m fine.’ She had to disguise the tremor in her voice. She wasn’t all right. She was dreading what they might find, and she was afraid that she wouldn’t be able to handle this situation, away from the hospital.

  He frowned, but said nothing more. When they arrived at the scene just a short time later, the air was filled with a cacophony of sound, and there were ambulances and police vehicles all around. Heart thumping, Hannah scanned the area, taking in the waters where innumerable boats, cabin cruisers and larger marine vehicles were moored. Beyond the water there was a parade of boutiques, souvenir shops and restaurants. There were tables and chairs set out on the pavement in front of cafés and snack bars, where people could sit and look out over the water. No one was doing that just now, though.

  The medical incident officer sent them over to the rear of the main dock area. ‘We’ve some casualties in front of the far building,’ he said. ‘One of them has a chest injury, and another has a possible neck injury and broken arm. You should see to them first.’

  Hannah was puzzled. Perhaps it was a feeling of disorientation, but she was finding all this very confusing. So far, she hadn’t come across any debris from the explosion, but when she went round to the area where the incident officer had directed her, she could see that parts of the parade were screened off, and people were lying on the floor, being tended to by doctors and paramedics.

  It was a dreadful scene, and her heart went out to those poor people. Police were interviewing people who she assumed had been passers-by when the incident had happened, and they were moving them to one side to quieter areas. Perhaps they feared another explosion.

  ‘You take the chest patient,’ Adam said. ‘I’ll see to the neck injury.’

  Hannah nodded, but she was still uncertain. There was something about all this that didn’t seem quite right, but she couldn’t make out what it was.

  She went over to the injured man and found him clutching his chest, making groaning sounds as though he was in pain. ‘I’ll just make a quick examination,’ she told him, ‘and then I’ll do my best to make you feel more comfortable.’

  Adam was fitting a neck brace on his patient, and Hannah carefully ran her stethoscope over the man’s chest. Then she took his blood pressure before sitting back, feeling more at a loss than ever.

  ‘Something wrong?’Adam asked, coming over to her.

  ‘Well, not exactly,’ she said, moving away from her patient so that she could talk to Adam confidentially. ‘To be honest, I can’t find anything wrong with him. His chest sounds are fine, and his blood pressure is perfectly normal.’

  Adam gave her a quizzical look. ‘Yes…and so, what’s the problem?’

  She tilted her head back to get a better look at him. ‘That’s what I’m saying. There is no problem.’

  ‘Isn’t that what you expected?’ His mouth made a wry shape. ‘This is a practice session after all.’

  ‘A practice?’ She stared at him, her mouth dropping open. ‘Do you mean to say that I’ve been worrying myself silly over nothing…that this whole episode has been set up like something out of a play?’

  ‘That’s right.’ His grey eyes were watchful. ‘Didn’t you know? Are you saying that John Tremayne didn’t tell you?’

  ‘He didn’t tell me.’ She felt suddenly deflated and annoyed all at the same time. ‘I’ve been apprehensive since we set out to come here, and now you’re telling me that it was all unnecessary. I wish he’d said something. I wish you’d said something. Am I the only one who didn’t know?’

  ‘Probably. It must have been an oversight on his part, because of you being new to the hospital. All this was arranged some time ago.’ He laid a hand on her shoulder. ‘Put it down to experience. At least you’ll know what to expect if the real thing ever happens.’

  She didn’t answer. His hand was warm on her shoulder, and though the gesture was probably meant to be casual and reassuring, she was far too aware of his nearness for her to be able to think straight. The touch of his fingers was sending sparks straight through to her nervous system, and her whole body was fired up in response.

  It lasted for just a brief moment in time, though. A second or two later, he released her and said, ‘Just treat the patients as though they actually were injured, and send them on their way to hospital for treatment. That’s how these things work.’

  It had meant nothing to him. For him, the closeness was casual, a fleeting thing, and he was already heading back to his patient.

  Hannah took a deep breath and tried to shake off the sensations he had unwittingly stirred up in her. She didn’t want to be so conscious of him, so tuned in to his every movement. It had been the same back home when she had been a child. He had made her head spin. She had been constantly aware of him, on edge, her senses thrown into chaos whenever he had been around. As a teenager she had been too unsettled to know what it was that she’d wanted, and, anyway, he was way out of her reach.

  Even then, he had represented another world, where his had been a voice of confident authority, his manner towards her tempered with teasing curiosity…until he had allowed himself to become part of the witch hunt that had caused Ryan such distress.

  She went back to work, attending to other pseudo-patients. Some half an hour later, though, she had to go and seek him out. ‘I need some help here,’ she said urgently. ‘I’m worried about this patient and I want to get him to hospital right now, but the officer in charge is making me wait until the other casualties have been taken.’

  ‘That’s how it works,’ Adam said. ‘The officer decides who has priority.’

  ‘But this is real,’ she insisted. ‘I’ve been trying to explain and no one’s taking any notice. I’ve just examined this man, and his heart rate is way too high, and he’s breathless and cyanosed. You should come and take a look at him. His skin is grey and there’s a sheen of sweat on his face.’

  ‘It’s make-up,’ Adam said, ‘and he’s probably hyperventilating. They try to make these things as realistic as possible.’

  ‘I know that, but you’re not listening to me.’ She was beginning to feel desperate now. ‘Come and see for yourself. I’ve listened to his chest and there are bubbling sounds in his lungs. I couldn’t properly make out what he was saying, but as far as I understand it I think he had a prosthetic heart valve fitted some time ago. I think something has gone wrong with it, and now he has a cardiogenic pulmonary oedema, and he needs to go to hospital right now.’

  This time the urgency in her voice must have got through to him, because Adam came with her and knelt down next to the patient. Hannah had propped the man up in order to ease his breathing, and she was giving him oxygen through a mask, but he was in bad shape.

  ‘I’ve given him frusemide to try to remove some of the fluid from his lungs,’ she said, ‘and he’s had two puffs of glyceryl trinitrate.’

  Adam made a swift examination and said quietly, ‘Have you given him morphine for the pain?’

  She nodded. ‘And an anti-emetic.’ Her mouth made a straight line. ‘We really need to get him into the intensive care unit.’

  ‘I agree with you.’ Adam stood up and signalled to a couple of paramedics who came over to join them. ‘This man needs to go to hospital immediately,’ he said. ‘This is a real emergency. This is not part of the practice. He’s suffering from heart failure that has come on suddenly—possibly from the failure of a prosthetic valve. I want you to call the hospital and notify the cardiac surgeon. The team will probably need to
arrange an emergency echocardiograph and get him to Theatre as soon as possible.’

  When Adam spoke, everyone took notice, and at last things started moving. He cut a swathe through the assembled crowd, and the man was transferred to the ambulance within a matter of minutes. Hannah went with him to oversee his treatment on the journey, and Adam sat alongside her.

  She was glad of his presence. For all that she was guarded around him, she needed his expertise right now. She had done everything she could to save her patient, but she was still a relatively inexperienced junior doctor, and she wanted Adam by her side to instil her with confidence and reassure her that she was doing the right thing. They were battling against the clock and she was desperately afraid that the man wouldn’t make it.

  By the time they reached the hospital, they had him hooked up to an ECG monitor and had taken blood for testing. The patient was fighting for his life, and Hannah was worried that they might be too late.

  The cardiac surgeon and his team met them at the ambulance bay, and whisked her patient away. Hannah stared after him, her heart racing and a heavy feeling in the pit of her stomach.

  ‘Let him go now,’ Adam said, softly. ‘You’ve done all that you can for him.’

  ‘It might not have been enough,’ she whispered, ‘but I didn’t know what else to do. I felt as though I was badly equipped…I didn’t have all the facilities of the hospital to hand and I was floundering…It was as though I was helpless.’

  ‘You did everything that was possible. No one expects something like that to happen. On a practice like that, most people are healthy volunteers. You don’t imagine that anyone could be seriously ill.’

  ‘He said he thought he had some sort of flu. He’d come on the exercise because he didn’t want to let anyone down.’ She sent him a swift, sideways glance. ‘It didn’t faze you, though, did it, having to cope with something out of the ordinary?’

  In fact, he had been in his element, cutting through procedural barriers without a second thought, and the patient had been transferred without a hitch.