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‘More,’ he mumbled.
‘I couldn’t.’
‘Fruit, then—or a doughnut.’
She felt herself weaken. ‘You’ve got doughnuts?’ she asked hopefully. ‘Are they warm?’
He nodded, his mouth busy again.
‘Jam?’
He nodded, the corners of his eyes crinkled with understanding.
She heard her stomach rumble. Oh, what the heck? He clearly intended to feed her till she split. She couldn’t disappoint him.
The doughnut was wonderful, light and fluffy, the jam still warm. It squirted down her chin and she laughed and reached for a tissue.
He was there first, a napkin at the ready, steadying her jaw with his other hand as he wiped the jam away. Their eyes met, and for a long and almost unbearable second she thought he was going to kiss her.
Then he sat back, cobbling up the napkin and lobbing it neatly into the bin.
Her breath eased slowly out. Had she imagined it? Oh, God.
She finished the doughnut and then wiped her fingers, reaching for her coffee with hands that were not quite steady. She cast about for another topic for her mind, and came up with money as the safest option.
‘What do I owe you for that lot?’ she asked.
He looked astonished. Owe me? Nothing.’
‘Don’t be silly, it must have cost a fortune.’
‘I think I can just about run to a few sandwiches for our first date,’ he said drily, and drained his coffee-cup while she tried to ignore the funny hiccup in her heartbeat at his use of the word ‘date’. Ridiculous. ‘However,’ he continued, ‘if you insist on going Dutch you can refill my cup, bring me a banana, and tell me everything I need to know to keep out of trouble.’
Clearly it was as far as she was going to get. ‘Are you always this stubborn and bossy?’ she asked mildly as she did as she was told.
‘Always. Thank you.’ He took the cup and set it down. ‘Now, the trade-off. Who do I have to avoid, who do I have to crawl to, what are the internal politics?’
She groaned. ‘Internal politics? I try and stay out of it. Funding, of course, is always a hassle. So far they haven’t threatened to close us down, but funding for our emergency teams going out to incidents is always a bit of a fraught issue. They say it’s very expensive, and I’m sure it is, but it’s absolutely vital that we continue to keep the service available and I’m sure in the long run we actually save money.’
He nodded. ‘Who usually goes?’
‘The most senior members of staff available to a small incident. To a major incident with multiple casualties we usually keep several senior staff here to deal with the casualties as they come in, but others, of course, go out for on-the-spot surgery and emergency resuscitation. The first job in major incidents is Triage, really, sorting the patients into priority for transfer to hospital, and that’s something we’re all very used to.’
‘Do you have a Triage system operating in the unit all the time?’ he asked.
Anna nodded. ‘Yes—it’s often me doing that. We only bother if it gets busy, but the reception staff are excellent and keep us in touch all the time with what’s coming through the door.’
Patrick stretched out, his long legs crossed at the ankle, and balanced his coffee-cup on his chest. ‘What’s the usual waiting-time?’
She laughed softly. ‘You tell me. Certainly less than several days, unlike your Africa. We try and keep it down to under half an hour, and patients are always seen by the Triage nurse within a few minutes of arrival in any case, unless we’re so quiet that they’re virtually straight in. Sometimes, though, it can be up to an hour before they get seen and that really bothers me. It’s the malingerers that mess up the system—the people that won’t go to their GP because they don’t like to bother him, or because they have to wait in the surgery, or because this is more convenient than trying to get an appointment. Last week we had a man who came in with piles.’
‘They can be very painful,’ Patrick said reasonably. ‘He might well have been worried, especially if they were bleeding.’
‘They weren’t,’ she retorted, ‘and he’d had them twenty years!’
Patrick chuckled. ‘So who had the pleasure of telling him where to go?’
‘Kathleen—and very effective she was, too! She has a pet thing about people who abuse the system. She asked him if he’d left his glasses behind, and pointed out the sign. “Have you had an accident?” she asked. “Is it an emergency?” He left quite quickly.’
‘I’ll bet. She’s a little fire-cracker, I should think.’
Anna smiled indulgently. ‘She can be. She’s also very gentle and kind.’
‘And married to the boss, of course.’
‘Oh, yes. They can be quite nauseating.’
He chuckled. ‘Really?’
‘Really, although you’d think they’d have grown out of it by now. They’ve been married nearly eighteen months.’
‘Nah, they’re still newly-weds,’ he said with another of his infectious chuckles. He tipped his coffee-cup and she watched his very masculine throat work as he swallowed. Then he stretched luxuriously, totally unselfconscious, and hauled himself to his feet.
‘I suppose we ought to let the love-birds go to lunch and do some work,’ he said with a smile. ‘There’s still some food left—want another doughnut?’
She shook her head. ‘No. I won’t need to eat again for days.’
He snorted rudely, grabbed a sandwich as they passed the table, and headed towards the cubicles.
Stifling a smile, Anna followed.
A few minutes later she lost all urge to smile.
A message came from ambulance control to say that a young boy, Simeon Wilding, was being brought in direct from school with a severe asthma attack, and he was reported to be in a serious condition.
‘OK,’ Patrick said calmly. ‘We’ll take him straight into Crash. Can someone clear it, please, and get it ready? We may need to ventilate him. Any information on drugs?’
Anna shook her head. ‘No, nothing. He’s a known asthmatic; we may have the notes. Julie’s searching for them.’
Julie was the receptionist, and, having checked for notes held in the unit, would then check with the asthma clinic. If they were in the hospital, Julie would track them down in the next few minutes.
Until then, they just had to play it by ear. They prepared the nebuliser with salbutamol, cleared the decks and waited.
They heard the ambulance coming and went to the door in time to see it sweep in very rapidly. The doors were flung open and the boy was out, heading for the department, with Patrick running beside the trolley and examining the lad as they came.
Anna could see that his lips were blue, his eyes wide, and he was clearly fighting for breath. Then, as she watched, his eyes closed and he stopped breathing.
Patrick swore, very softly, and yanked down the blanket, slapping the stethoscope on his chest as they manoeuvred through the doors.
‘Damn. He’s arrested. Get him into Crash.’
They ran, leaving him on the trolley for speed as they all went automatically into action as soon as the trolley was stationary.
Feeling for the breastbone, Patrick crossed his hands and pumped hard on the boy’s chest.
Anna heard a dull creak and winced. A rib had gone. Oh, well, it was better than dying. She didn’t have time to think about it, though, because she had to take over from Patrick while he inserted the cuffed tube and blew it up, sealing the airway. Then he connected it to the humidified air from the ventilator unit on the wall and watched as the boy’s chest rose and fell.
They alternated cardiac massage with positive ventilation, to allow the air to be forced into his lungs, together with a measured dose of a bronchodilator to combat the swollen tubes in his lungs that were preventing him from breathing.
While Anna worked another nurse was putting monitor leads on his chest, and then he was connected up and they could see the flat trace that indicated the heart was still not beating.
‘Damn you, don’t you dare die,’ Patrick muttered, and, pushing Anna out of the way, he thumped the boy’s chest hard.
The line wiggled, then settled into an erratic rhythm. ‘He’s fibrillating—I’ll give him a jolt. Stand back, everyone, please.’
They took a pace back while Patrick held the paddles to the boy’s chest. ‘Shock, please,’ Patrick said.
The boy’s body arched and flopped, and the trace suddenly corrected itself. As it did, the boy’s lips turned less blue and he started to fidget.
‘I’ll give him a minute and then we’ll try him off the ventilator,’ Patrick told them, and bent over the boy.
‘Simeon, it’s OK, you’re going to be fine,’ he said calmly, his voice reassuring.
The boy’s eyelids fluttered up and he started to fight the ventilator. Patrick disconnected him from the machine and watched to see if he could breathe alone. To their relief his chest rose and fell gently. ‘Good,’ Patrick said, and, letting down the cuff, he withdrew the endotracheal tube from the boy’s mouth.
He coughed, his breath rasping, and Anna replaced the tube with a mask connected to a nebuliser. Warm, damp air flowed into his lungs, and within minutes he looked much better.
‘My chest hurts—I want my mum,’ he said in a small voice, and beside her Anna felt Patrick almost sag with relief. He was all right; the fight for air had been won before it was too late. Another few seconds and he could have suffered irreversible brain damage.
Even so, Patrick was worried about him.
‘I think he ought to go into ITU for a day or so, if the paediatrician agrees,’ he said quietly to Anna.
She nodded. It was standard procedure to overprotect their young asthmatic patients, because attacks of that severity rarely happened in isolation and in ITU everything necessary was there at hand.
The paediatric consultant, Andrew Barrett, arrived then and took over, examining the boy and chatting quietly to him.
It seemed they were old friends—the boy a frequent visitor to the paediatric ward. This time, though, Andrew agreed with Patrick. It had been a little too close for comfort, and they were erring on the safe side.
Just as he left the department Jack and Kathleen Lawrence came back in, staring at the trolley in surprise.
‘Was that Simeon Wilding?’
‘Yes—asthma attack. He arrested,’ Patrick told them economically.
‘What?’ Jack looked shocked.
Patrick smiled slightly. ‘He’s OK—well, apart from a rib I may have cracked. He’s going to Paediatric ITU for a couple of days, just to be on the safe side. He stopped breathing, but he’s spoken to us and he’s OK—at least for now.’
Jack’s mouth tipped into a cynical curve. ‘Of course he is—after all, it’s only asthma.’
Anna heard the bitterness in his voice and understood it. Asthma was so common that it tended to be ignored, underestimated, almost brushed aside until a crisis forced it into view.
An event like this brought you up hard against reality, she thought. Most of their critical asthmatics made it, but every now and again they would lose a patient to it, even though it was ‘only asthma’.
They all felt so helpless then, and Jack hated being helpless. Patrick, too, she realised, looking at them as they shared a frustrated smile.
‘Oh, well, we do what we can. Well done for saving him,’ Jack said, and rested his hand on Patrick’s shoulder.
‘I’ve been meaning to give you a guided tour of the department all morning—but I guess you’ve seen Crash now?’
Patrick laughed. ‘Yes—thank you.’
‘How about a coffee?’ Kathleen suggested.
Just then the phone rang, and as one they all turned to look at it, then shrugged.
‘So who needed coffee anyway?’ Kathleen said philosophically, and picked up the phone.
CHAPTER TWO
PATRICK stood up to leave. The elderly man in the chair by the window regarded him without curiosity.
‘Are you going now?’ he asked.
‘Yes. I’ll see you tomorrow.’
The old boy shook his head. ‘Very kind of you, I’m sure, but I can’t see why you should want to.’
Patrick quelled the pain. ‘Would you rather I didn’t come?’ he asked quietly.
‘Oh, no. I enjoy your company, young fella. Too many old girls in this place for my liking. No, I was thinking of you. I just can’t see the attraction in talking to an old codger like me.’
Patrick smiled, a sad half-smile that didn’t reach his eyes.
‘I find you very interesting. You’ve had a fascinating life.’
The man snorted. ‘You must have a very boring life, young man, if you find mine fascinating. Very boring.’
Patrick thought back over the last few years, and gave a wry, quiet laugh. ‘It’s quite exciting enough for me. I’ll see you tomorrow.’
They shook hands formally, and Patrick turned to leave. As he did so the man called him back.
‘Patrick?’ he said.
He turned towards him again. ‘Yes?’
‘I don’t know who you are, young man, but I’d be proud if you were my son.’
Patrick’s face twisted slightly. ‘Thank you,’ he said softly. ‘Thank you very much. Goodnight.’
He went out, waving a greeting at the sister who was busy wheeling another resident through the grounds, and slipped behind the wheel of his car—his father’s car, in fact.
For a moment he remained motionless, letting the pain ease away, giving himself time. Then he started the car and drove back to the lovely Tudor house where he had grown up, and where he was now staying with his mother.
She was in the front garden when he pulled up, and she straightened and went to greet him with a kiss. ‘How was he?’ she asked.
Patrick shrugged. The same.’
‘Still doesn’t know you?’
He shook his head. His eyes blurred, fogging his vision, and he blinked hard. ‘I miss him,’ he said unevenly.
‘So do I,’ his mother said sadly. Oh, Patrick, I’m so glad you’re home.’
They hugged each other, drawing comfort from the contact, sharing their sorrow. The lump in Patrick’s throat grew, and he eased away.
‘I’ll put the car in the garage, then I need to change.’
‘Don’t be long. I want to hear all about your day.’
He didn’t doubt it. He put the car away and went in through the side door into the converted stable-block that had been turned into a self-contained annexe for guests. He had refused to stay in the house with his mother, preferring instead to maintain his independence and privacy while still being close at hand.
Now, as he stripped in the airy bedroom and wandered through to the little bathroom to shower, he was glad he had insisted. He needed room to himself, a little time and space to be quiet and recharge his batteries.
And God knows they were flat enough. This sudden deterioration of his father’s was the last straw, the Alzheimer’s that had been creeping up now claiming his memory and distancing him from the son who had travelled back across half the world to be near him.
A heavy sadness settled in Patrick’s chest, joining the other weight that lay there at all times, ignored for the most part but omnipresent, a constant anchor round his heart.
He turned on the shower and stood under the hot, stinging spray, his eyes closed, letting the water pelt over him and wash away the smell of the nursing-home.
Ideally he would like to bring his father home, but his mother couldn’t cope alone now her husband was incontinent. Perhaps, with Patrick’s help and the services of an agency nurse, it would be possible.
He would consider it, talk it over with his mother.
Half an hour later he joined her in the conservatory overlooking the garden that had been his father’s pride and joy. It was a mess, the weeds forming a mat between the perennials, the vegetable patch untended. Patrick had cut the grass at the weekend but already it seemed to be growing. His mother did what she could, but there was too much for one person to look after. They needed a gardener.
He sighed and picked up the wine his mother had poured him, raising it to his lips. It was cold and crisp, rinsing away the strain of the day.
‘So—tell me about your new job,’ his mother began, tucking her feet under her bottom like a girl and leaning eagerly towards him. ‘What are the rest of the staff like? Are you going to be happy working there?’
He thought of Jack Lawrence, his boss—apparently casual and yet with a mind like a steel trap, decisive and efficient. Kathleen, his wife, a softly-spoken little Irishwoman with a spark in her eye and a core of iron.
And Anna.
Something unfamiliar and forgotten happened in his chest, a sort of tightening, a feeling of anticipation.
She was no oil-painting, their little staff nurse. Not that little, really, unless she was beside him, then she seemed unbelievably fragile, with her wide grey eyes and clear, almost transparent skin. Her hair was long, he guessed. It was hard to tell with it twisted up under her cap, but certainly shoulder-length at least, and a wonderful dark brown, like polished mahogany. She wasn’t really pretty, but there was a life in her, an inner beauty that transcended her slightly uneven features and made her if anything even more attractive.
She was too thin, of course. Kathleen had implied that no one took care of her. Certainly she didn’t take care of herself. The way she had fallen on those sandwiches ——
‘Well?’
He blinked. ‘Um…’
‘I asked about your colleagues, and you went into a trance.’
He grinned easily at his mother. ‘Sorry, I was thinking about the day. Yes, they’re fine. A good bunch of people. I think I’m going to enjoy working there.’
His mother sipped her wine and regarded him steadily. ‘Are you going to tell me about the woman who put that look in your eye, or are you going to keep me guessing?’
He could feel the flush on the back of his neck. ‘Woman?’ he said casually.
His mother sighed. ‘You’re going to keep me guessing. OK.’
‘Whatever makes you think there’s a woman?’ he asked with feigned amusement.
‘Patrick!’ The gently teasing reproof undid him. He never could hide anything from his mother.
He laughed awkwardly. ‘Her name’s Anna Jarvis. She’s single, about twenty-five, a staff nurse.’
‘And you like her?’
He nodded. ‘Yes, I like her. She’s a good colleague.’
‘And you find her attractive.’
‘She’s all right. Nothing special.’
His mother snorted softly. ‘Patrick, you’re a lousy liar. She’s lit a fire under you, I can tell. Why don’t you let it burn, for a change?’
‘For what? Casual sex? I thought you didn’t approve.’ His voice was deliberately light, but his mother wasn’t fooled.
‘I don’t. There are other relationships ‘
‘Mother, I am not getting married again!’
Patrick smacked his glass down too hard and stood up, ramming his hands into his trouser pockets and glaring down the darkening garden.
His mother’s hand was gentle on his shoulder. ‘Patrick, I’m sorry. It just hurts me to see you so alone. You’re like a caged lion without a mate. You need a partner, someone to share things with.’
‘I had a partner.’
‘I know.’
Her hand fell away and Patrick heard her chair creak as she sat down again. ‘Tell me about the set-up in the department.’
He forced his feelings back down, the grief, the rage, the frustration, and lowered himself into the chair again.
‘Only if you’ll promise not to needle me.’
‘I promise.’
Patrick snorted. She might as well have promised not to breathe.
Anna smoothed back the tumbled curls from the little face and smiled. ‘You go to sleep now, my darling.’
‘Night-night,’ the little cherub mumbled round her thumb.
‘Sleep tight,’ Anna whispered, bending to kiss the warm, smooth skin of her daughter’s cheek. Her lashes fluttered down, the busy day catching up with her, and Anna eased away from her and stood up, stretching her aching muscles.
She had been crouched over the bed reading to Flissy for nearly an hour, she realised in astonishment. She left the room quietly and went back into the sitting-room. Her coffee was cold, so she made another and curled up in front of the television.
It couldn’t hold her attention, though. Instead her mind strayed to a tall, smiling man with gentle hands and a stubborn streak about a mile wide. She reminded herself that he was married, and then allowed herself to admit that nothing he had done could be construed as flirting. Not unless you counted feeding her until she groaned.
Anna’s mouth tipped again, remembering the lunch. It had been wonderful, a real feast. She had eaten far too much, but it was just as well. The contents of her fridge had been scant to say the least. She had given Flissy the last egg and a bit of cheese in an omelette, but there had been nothing left for her apart from a couple of slices of stale bread. She’d had toast, smeared with a little honey, and was thankful that she wasn’t hungry.
Kathleen was right; she ought to take better care of herself, and Flissy too. Their diet was woefully inadequate. She made a vow to get to the shops tomorrow on her way home.
Ouch.’
‘Hmm.’ Anna, standing beside Patrick looking at the X-rays, couldn’t understand how their patient was still in such comparatively good condition. He’d been trapped by several tons of steel across his chest and pelvis, and when they had lifted it away his leg had been lying beside his arm, bent up courtesy of his shattered pelvis.
And shattered it most certainly was. A large part of his hipbone was detached and lying oddly, and the bones which formed the bowl of the pelvis were broken on both sides at the front and on the right at the back. As a result his whole pelvis was grossly unstable.
As if that wasn’t enough, both femurs were fractured, the right in two places, and his left hip was dislocated. In short, he was a mess.
Nick Davidson was on his way down from Theatre to see the plates, and it was likely the man would go straight there for emergency surgery to fix his pelvis and femurs. In preparation for such an event they had taken blood for cross-matching already, and were running in Haemacel to replace the massive blood-loss caused by his fractures. Whether there was any other damage was unclear as yet, but he was being closely watched. It was hard to tell from the circulatory loss alone, because fractures of that order caused such massive blood-loss that abdominal injuries could easily go undetected.
Nick wandered in as they stood frowning at the X-rays, and rested a hand on each of their shoulders. ‘Hi, folks. This my customer?’
‘Yup.’ Patrick filled him in, and Nick winced.
‘Sounds nasty.’
‘It is.’
He studied the plates quietly, then pursed his lips.
‘We can’t do it all at once. I’ll get a fixator on to hold it all a bit steady, but he’ll need plating and pinning once the bleeding has settled at the fracture sites. I’ll have to do the femurs today, though. Any abdominal damage apart from the pelvis?’
‘No evidence of any. He’s in very good shape really—in pain, of course. We’ve given him Entonox gas, because his circulation is too close to collapse to risk diamorphine, but it isn’t really anything like enough.’
‘It won’t be,’ Nick agreed. ‘We’ll soon knock him out. What about blood?’
‘He’s been cross-matched and we’re boosting his circulation as fast as we can. We’ll be able to do more when we get the whole blood.’
Nick nodded. ‘OK, I’ll have a word with him and then we’ll get him up to Theatre. Has he signed the consent form?’
‘He’s not in that good shape,’ Anna said drily. ‘His wife’s here—I’ll get her to do that.’
‘Thanks. Right, where is he?’
Anna left them with the patient and went into the office.
Nick joined her a few minutes later. ‘All done?’
She nodded. ‘His wife’s signed. She’d like to see him before he goes up to Theatre.’
‘I’ll go and find her. Give me the forms, I’ll take them with me.’