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‘It can be disorientating, working in an unfamiliar theatre,’ Allegra pointed out, in the surgeons’ defense.
He held her gaze for a moment. ‘There are some good people here. But it’s a high-pressure job and I’m very conscious of being the new broom, so to speak.’
‘You really like your metaphors, don’t you?’
His smile was crooked. ‘I do, don’t I?’
Allegra found the friendly, more approachable side to him totally refreshing and wondered if he was trying to make up for the bad start they’d had. Without the stark backdrop of the hospital and without his white coat and tie, he looked like any other good-looking guy in his early to mid-thirties. His face was marked by fatigue but, looking around the bar, most of the hospital staff who were still here looked much the same. It came with the job. Chronic tiredness was a given, especially in ICU, where the shifts were long and the work intense.
‘I heard you’ve been working overseas,’ she said, toying with the straw in her empty glass.
Joel’s eyes went to her hands before returning to her face. ‘Would you like another drink?’
‘Um … why not?’ she said, deciding she was starting to enjoy herself for the first time in ages. ‘Vodka and lime.’
‘Coming up,’ he said, and got up to get their drinks.
He came back and, placing her drink in front of her, took his seat opposite. ‘Yes, I was overseas for a while.’ He returned to her earlier question, his expression clouding a fraction.
‘Where were you stationed?’
‘In the Middle East.’
‘That would have been tough, I imagine.’
He took a sip of his drink before answering. ‘Yeah, it was.’
Allegra could sense he didn’t want to talk about it in any detail and wondered if he’d been involved in any of the skirmishes that had seen countless people injured or maimed for life.
She took another sip of her drink and changed the subject. ‘Are you a Melbourne boy?’
‘Yep, born and bred. What about you?’
‘I’m a bit of a crossbreed, I’m afraid,’ she said. ‘My father is originally from Sydney and my mother is a Melbourne girl. They both live here now but not together. I’ve spent equal amounts of time with them over the years.’
‘They’re divorced?’
‘They never married in the first place,’ she said. ‘But they’re the best of friends. They never went down that blame-game route. They’re what you might call … progressive.’
‘Progressive?’
‘They have a sort of open relationship. They don’t live together but whenever my mum needs a partner for some function or other, she takes my dad, and vice versa.’ She gave him a little embarrassed glance and added, ‘I wouldn’t be surprised if they still occasionally sleep together.’
‘You’re right,’ he said. ‘That’s pretty progressive.’
‘What about you?’ she asked, picking up her glass. ‘Are your parents still together?’
‘Yes, for something like thirty-five years.’
‘Do you have any brothers or sisters?’
His eyes moved away from hers as he reached for his glass, absently running the tips of two of his fingers through the beads of condensation around the sides. ‘I have a twin brother.’
There was something about his tone that alerted Allegra to an undercurrent of emotion. His expression was now shuttered, as if he regretted allowing the conversation to drift into such personal territory.
‘Are you identical?’ she ventured.
‘Yes and no.’
Allegra frowned at his noncommittal answer but before she could think of a response to it he met her eyes and asked, ‘What do your parents do for a living?’
‘My father’s a psychologist, who specialises in dream therapy, and my mother is a Tai Chi and yoga instructor.’
His eyebrows rose slightly. ‘No wonder you have a tendency towards the other-worldly.’
‘I would hardly call what I do that,’ she protested, with a reproving glance.
‘So what exactly is it you do?’ he asked, settling back into his seat once more.
‘You’ll only rubbish it so what would be the point?’
‘I promise to listen without comment,’ he said. ‘Look, right now we’re just two overworked, tired people in a bar, chatting over a drink, OK?’
She let out a tiny sigh after a moment’s hesitation. ‘All right.’ She took a little breath and briefly explained her theory of how human sensory touch could strongly trigger memories that might be integral to stimulating consciousness in a comatose patient. ‘There is evidence that skin sensation is wired up as our most primitive memory system, plugging more directly into primitive brain areas. If you think about your dreams, and record them after you wake up, the sensations you were experiencing just before you woke up are nearly always touch-related sensations. So—in this study, I encourage the relatives, particularly those who are most intimately involved with the patient, to touch them in predetermined ways. I teach them how to massage and touch their loved one in ways we think will trigger strong memories.’
Joel remained silent as she talked passionately about some of the trials she’d done, including one involving a post-heart-surgery coma patient.
‘It was striking,’ she said. ‘The relatives were advised to consider turning off his life support. There was virtually no sign of brain activity. But then his wife told me their daughter was flying back from Canada to say goodbye to him. She hadn’t seen him in fifteen years. When she arrived I got her to touch him on his eyebrows, nose and lips and talk to him just like she did when she was a child and he used to put her to bed with this little routine. His eyes opened, he looked directly at his daughter’s eyes for about thirty seconds, and then a few minutes later died peacefully.’
‘So he didn’t recover.’
Allegra tried not to be put off by the inherent cynicism in his tone. ‘No, but that’s not the point. He woke up in time to say goodbye. He recognised his daughter’s touch—some powerful memory was triggered that induced momentary consciousness.’
‘There’s no way of testing that scientifically,’ he pointed out.
‘I realise it’s just one case, and there was no measurement of brain activity being done on him. But that’s the whole point of my study now—to get some measurements of these effects. And other triggers, too. Some of the other therapies I use involve other body memories, such as smell and sound. Haven’t you ever heard a piece of music and found it took you back to a time that was significant to you? Music stirs emotions, so do certain aromas. And emotional memories are the most powerful, centred in the amygdala of the brain. The so-called healing properties of essential oils such as neroli, Roman chamomile, frankincense, bergamot, clary sage may have more to do with how they neurologically trigger emotional memory.’
‘Yes, but none of these are controlled substances—they could have contaminants. There are cases where clary sage used topically by pregnant women were associated with birth defects. Peppermint oil can trigger epilepsy. My concern is that you are introducing therapies into a high-tech area that have never been through any approval or evaluation process. If there was even the suggestion of some adverse reaction, we’d be crucified.’
‘I’m following strict guidelines—they’ve been approved by the ethics and research committees. My goal is to make a substantial breakthrough in coma recovery. I don’t want to be stopped by closed-minded bureaucracy.’
‘I suppose by that comment you’re referring to me.’
‘Well, you’ve hardly been encouraging,’ she said with a hint of pique.
‘It’s not my job to win a popularity contest. I have to run this new and very expensive department according to the guidelines laid down in my contract. And it boils down to, one, dollars and cents, keeping within the budget. And, two, best practice, with significant benefits from the expense of the new layout. I can’t be seen to be dabbling in pseudoscience with hard fought-over hospital money.’
‘So you still think it’s a worthless enterprise to touch a person who is ill or dying, or in a coma, do you?’ she asked, unable to remove the stringency from her tone. ‘For relatives and friends to spend hours by their bedside, holding their hand, stroking them and telling them how much they love them?’
He frowned at her censure. ‘No, of course not. It’s just that ICTU is cluttered enough as it is. It’s not the place or the right time to bring in alternative therapists and their potions and sounds. And think of the increased risk of infection if people came and went all the time without proper regulation.’
‘I don’t often introduce other therapists,’ she said. ‘I do most of the work myself.’
‘So you’ve got a degree in quackery as well as medicine, have you? What a busy little bee you have been over the last few years.’
Allegra got to her feet in one stiff movement, her expression tight with anger. ‘You know something, Dr Addison? It’s just as well you weren’t recruited for a popularity contest because if it was up to me, you wouldn’t have got past the first round of selection criteria.’
‘And what criteria would they be, I wonder?’ he asked, with a little curl of his lip. ‘Perhaps my aura isn’t giving off the right vibes or maybe my office doesn’t have the right Feng Shui. Perhaps you should make an appointment with me to rearrange it for me.’
She pressed her hands on the table and leaned across so the other people close by couldn’t hear, her green eyes flashing with anger. ‘The only things I’d like to rearrange are your attitude and personality, and if there wasn’t a law against it, I’d like to apply some touch therapy to your face as well—in the form of a very hard slap.’
His dark eyes glittered as they held hers. ‘Go right ahead, sweetheart, and see how quickly you get fired from the department.’
‘You can’t fire me,’ she spat back defiantly. ‘Patrick Naylor does the hiring and firing.’
He got to his feet, his sudden increase in height making her shrink back in intimidation. ‘I can assure you, Dr Tallis, that it would take just one word from me and the CEO will tear up your contract and your project into a thousand pieces,’ he said, and with one last glowering look brushed past her and left.
CHAPTER FOUR
‘SO HOW was your little drink last night with the director?’ Louise asked in the female staff change room the next morning.
Allegra scowled as she thrust her handbag into her locker and turned the key with a savage twist of her hand. ‘I’m going to kill Kellie Wilton and Margaret Hoffman.’
‘So he didn’t invite you back to his place for coffee, then?’
‘No, he did not. He threatened to have me fired, that’s what he did.’
‘Fired! Can he do that?’ Louise asked. ‘I thought the CEO was the only one who could hire or fire?’
‘I’m beginning to think Joel Addison could do anything if he put his mind to it.’
‘It’s tough, being at the top, Allegra,’ Louise pointed out reasonably. ‘There’s been a lot of opposition about the refurbishment being so innovative and all. Dr Addison is probably being overly cautious, which is perfectly understandable. You know the fuss the surgeons made about the new trauma theatre locations. If this unit doesn’t produce results and come in on budget, Dr Addison’s the one who will take the rap.’
‘I know all that,’ Allegra said, pocketing her locker key and turning to face Louise. ‘You know, for a while there last night I was starting to see a glimpse of a nice sort of man. He was chatty and seemed interested in what I had to say.’
‘So what happened?’
She gave a frustrated up-and-down movement of her shoulders. ‘Who knows? He just seems to really have it in for anyone a little to the left of what he believes is scientific. It’s as if it’s a personal agenda or something.’
‘Maybe someone in the past gave him a lousy massage,’ Louise said with a little grin.
Allegra rolled her eyes. ‘The only thing he wants massaged is his ego, but I for one am not going to do it.’
‘Have you told him your personal reasons for being so committed to your project?’
Allegra blew out a breath and leaned back against the lockers with a noisy rattle. ‘No … If I did, it would only make things worse. He’d only say I was looking through an emotional lens instead of a scientific one.’
‘But it might help him understand why it’s so important to you if you tell him what happened to your friend in med school,’ Louise said gently.
Allegra pushed herself away from the lockers as her beeper sounded. ‘Look, I’ve put what happened to Julie behind me. I can’t allow myself to dwell on it. It won’t change anything. But I owe it to her memory to stop it happening again and, so help me, God, Dr Addison had better not try and stop me.’
She made her way quickly to the trauma centre sandwiched between the ambulance bay and the main ICTU. Two trauma bays were in operation when she arrived, ambulance personnel, including two crews of Heli Flight Retrieval Paramedics intermingling with the A and E medical and nursing staff.
‘What’s going on?’ Allegra asked Alex Beswin, the A and E senior staffer, as she reached the scene of flurried activity.
‘Hi, Allegra. Two people brought in from the Victorian Alps after a single vehicle accident. Seems their car went off the side of the road and ended up in the river. A car travelling behind stopped and the driver managed to get the mother and the kid in the car free, but both were unconscious and spent a bit of time in the cold water until the rescue team arrived to haul them out. The kid is still unconscious and still hypothermic and bradycardic. The mother has been rewarmed, but she has head injuries, a flail chest and blunt abdo trauma. We need your help on the boy—he was tubed at the scene but the airway’s not great and he’ll need to go up to CT soon. Joel Addison is heading the team getting the mother under control—she’s going to CT now. They’ll both need ICTU after we’ve finished here.’
‘Right,’ Allegra said, heading for bay one, where the small child was contained.
Tony Ringer, one of the A and E staff consultants, who was directing the care there, looked up in obvious relief when Allegra appeared at the foot of the bed.
‘Allegra, listen—this tube’s in too far, it’s too small and there are anterior neck injuries from the air bag. We need to change it but I’d be grateful if you would do it. I’ll help.’
Allegra moved to the head of the bed and, taking the airway bag and checking the tube and connectors, she listened to the chest with her stethoscope. ‘Yes, you’re right, Tony. The left side’s not inflating, the tube is too small and probably down the right main bronchus. We’ll change it for a six point five but we need to be ready for a surgical airway if his larynx is oedematous. I’ll change the tube over an introducer to maintain access.’
Tony took over bagging the child while Allegra, with the help of one of the nursing staff, arranged all the equipment she needed, setting it out for easy access.
‘Right, Tony, let’s do it,’ Allegra said, taking a breath to steady herself.
She took a long flexible plastic introducer and, after disconnecting the endotracheal tube from the bag, passed the introducer into the ETT and the right main bronchus. She then deflated the ETT cuff and pulled the tube out of the airway and over the introducer. She rapidly passed a cuffed 6.5 ETT back over the introducer and into the trachea with not much difficulty, positioning the tube this time in the trachea so that both lungs would be inflated, and blew up the cuff. She checked the insufflation of both lungs with her stethoscope and, satisfied that the tube was in the correct position, secured it with tape.
‘Good job, Allegra,’ Tony said. ‘It’s a godsend, having someone with increased airway skills for this sort of situation.’
‘Thanks, Tony. I guess that’s a benefit of the anaesthetic rotation through ICTU.’
‘True,’ Tony replied. ‘Listen, this kid’s still hypothermic. We’re running in warmed intraperitoneal saline now, and as soon as his temperature is up we’ll need to get him next door for a head CT. Can you manage the airway for his transfer and then settle him into ICTU for us? I want to look over the second team treating the mother. And word’s just through that the husband and father has just been located. He’s on his way in.’
‘What’s the boy’s name?’ Allegra asked.
‘Tommy Lowe,’ Tony answered. ‘I don’t know his age, his father was too distressed to talk. What do you think?’
Allegra looked at the tiny body on the bed with tubes running out of him, her stomach clenching in distress that someone so young had had to suffer so much. ‘I reckon he’s about six or seven.’
‘Too young for this sort of caper,’ Tony said, stripping off his gloves and tossing them in the bin.
‘Tell me about it,’ Allegra said. Stripping off her own gloves, she reached out with a gentle hand and touched the little boy on his arm, her fingers soft and warm on his cold pale limb.
Joel was in ICTU, finishing setting the mother up on a ventilator, when Allegra brought the little boy Tommy round from CT.
‘CT on the mother shows some contusion, but no intracranial haemorrhage,’ he said, glancing at her briefly, his expression coolly professional, showing no trace of his anger of the night before. ‘She’s got a flail chest on the right and underlying contusion. She had an intercostal tube put in before they transferred her. I’ve just had to retape the connectors, otherwise that’s OK. Her abdo CT shows a liver contusion, but no free blood, so the surgeons are treating it expectantly at this stage. She’ll have another CT tomorrow. Her bloods were pretty normal, the Hb down as expected. But there was one unexpected finding, about which we’ll have to inform the police.’
‘What’s that?’ she asked, as she supervised the transfer of Tommy from the trolley to the ICTU bed.
‘Her blood alcohol is through the roof—point one. No wonder she ran off the road.’
‘That’s unbelievable!’ Allegra said. ‘How could a mother drive along a winding mountainous road with a child in the car, having drunk herself stupid?’
‘I’m sending off a drug test as well,’ he said with a grim set to his mouth. ‘I have a bad gut feeling about this scenario. Something else is going on, maybe suicide—actually, a murder-suicide.’
Allegra felt a cold shiver of unease pass through her as she looked at the woman hooked up to the ventilator. What circumstances in her life would cause her to take that drastic step?
‘What about the boy?’ Joel asked. ‘Any results from the CT?’
‘No detectable macro brain injury. He could have general minor contusion, maybe slight cerebral oedema. His core temp’s up to 37 now. No other major injuries. We ran the scanner over his neck, chest and abdo—all clear,’ Allegra reported.
Danielle Capper appeared. ‘Dr Addison? Dr Tallis? Mrs Lowe’s husband is here. Perhaps you should speak to him before he comes in. He’s very agitated. I’ve made him a cup of tea and he’s in conference room two.’
Joel helped Allegra set Tommy up on the ventilator then while Allegra set up the IV lines with the nursing staff, Joel removed the intraperitoneal catheter, which had been used to rewarm the patient, stripped off his gloves and exchanged a quick glance with Allegra. ‘We’d better talk to the father together.’
‘Right,’ she agreed, mentally bracing herself. How would the father of the little boy cope with hearing his wife had been driving under the influence, let alone if what Joel suspected was true—that she’d done so deliberately in an attempt to kill herself and her child?
Joel opened the conference-room door to find a man in his mid to late thirties pacing the floor, his face haggard, his clothes looking as if he’d just thrown them on haphazardly. His tie was hanging loosely and his shirt buttons were done up crookedly.
‘I want to see my son! Where is he?’
‘Mr Lowe, I’m Dr Joel Addison and this Dr Allegra Tallis. Your son is in ICTU—we’ve just stabilised him.’
‘And my wife?’ Mr Lowe asked, his hands tightening by his sides.
‘She’s also in the unit,’ Joel said. ‘Both she and your son are being ventilated with a machine to help with breathing. They both have head injuries. We’re not sure yet about how severe those injuries are. The neurosurgical team is coming down now, and will almost certainly want to do a minor procedure on each to insert a pressure monitor. We’ll have a lot better idea when that’s in, and also with a period of observation.’
‘She was drinking, wasn’t she?’ Mr Lowe said through clenched teeth. He swung away and turned with his back to them and looked out of the window, which overlooked the hospital garden.
‘I know this has been a terrible shock for you, Mr Lowe,’ Allegra said gently, ‘but if you’re up to it now, can we ask you a few questions to help us with planning management before we take you in to see them?’
He turned around and with a heavy sigh took the nearest chair and collapsed into it, his head going to his hands.
Joel waited until Allegra was seated before he took the other chair. ‘Mr Lowe, your wife had a blood alcohol level of point one—that’s double the legal limit for driving. Was she taking any medication that you were aware of?’
Mr Lowe lifted his head out of his hands and looked at Joel through red-rimmed eyes. ‘She’s been on antidepressants for six months.’ His eyes shifted away to look down at his hands. ‘And drinking on and off for a few weeks. But I never thought she’d do something like this …’
‘You think she crashed the car deliberately?’ Allegra asked.
Keith Lowe looked at her with a grim expression tightening his mouth. ‘We’ve been having some … trouble … in the relationship. I was trying to work things out with her. I suggested counselling, but she wouldn’t hear of it. This supposed disaster of a holiday in the mountains was my idea to try and patch things up. She was against it, of course … but she eventually agreed to come. I had some business in town to see to so she and Tommy drove up first. I was to join them later.’ He rubbed at his jaw and added, ‘If I’d suspected this was what was going through her head, I would never have allowed her to go …’
‘Has she ever shown suicidal tendencies before?’ Joel asked.
‘No, not really, just troughs of depression. She’d sit around the house and do nothing … for weeks at a time and then snap out of it.’ He ran a hand through his coarse, wiry hair. ‘It’s been a living hell, I can tell you. But I had to stick it out … if for nothing else than for Tommy’s sake.’
‘Yes, of course,’ Joel said. ‘Would you like to see them now?’
‘Yes …’ The man’s eyes moistened. ‘I want to see that Tommy’s alive …’ He choked back a sob and Allegra silently handed him the box of tissues from one of the side tables.
‘Try not to be put off by the tubes and machinery—it’s all support equipment to keep things stabilised while we watch for improvement. I know how terrifying it all looks. He’s young and strong—I know having his father by his side will help him.’
Keith blew his nose and wiped at his eyes before turning to Joel. ‘I’d rather not see my wife right now, if you don’t mind. Not after … this ….’
Joel got to his feet and placed a reassuring hand on the man’s shoulder. ‘We understand. She’s in the next cubicle but I’ll make sure the curtain is pulled across between them. We can move them apart if you can’t cope.’
Mr Lowe appeared to think about it for a moment. ‘No … no … you don’t have to do that. I guess Tommy would want her near … I’ll manage.’
‘There are staff in constant attendance in ICTU,’ Allegra said. ‘You can ring and talk to the one looking after Tommy at any time.’
‘How badly injured is my … wife?’ he asked after a tiny pause.
Joel answered. ‘Well, apart from a head injury, which is why she’s unconscious at present, she has broken ribs, some bruising of a lung and bruising of her liver. She has a plastic drain in the chest to keep the lungs inflated. The liver injury seems stable, it probably won’t need any surgery. And she has bruising around both upper arms, maybe where someone grabbed her to pull her out of the car, and in the middle of her back, maybe from prolonged pressure on the spine board during the transfer. She’s deeply unconscious,’ Joel said. ‘It will be a few hours before we can get all the test results back.’