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When an ambulance brought in a forty-year-old man with a markedly accelerated heart rate, Alice was more than ready to take on the case.
‘This is Roger,’ the paramedic told her. ‘Narrow complex tachycardia. Rate 196. Oxygen saturation ninety-eight per cent. No cardiac history.’
Roger looked pale and frightened but he wasn’t in the kind of danger he would have been in if the spikes on his ECG were wide enough to suggest the ventricles of his heart were in trouble. Alice enjoyed cardiology. She could read a twelve lead ECG better than most junior doctors and she particularly loved this kind of case. One where a dramatic result and relief for the patient could be provided.
‘Have you got any chest pain?’ she asked Roger.
He shook his head. ‘I feel a bit short of breath, that’s all. And I can feel my heart.’
‘Have you ever felt it going this fast before?’
‘No.’
Alice helped the paramedics transfer Roger to the bed in Resus 2, where they had good telemetry facilities to monitor his heart. She raised the back of the bed so their patient was sitting up, which would help his breathing effort. Jo came in as she was transferring the oxygen tubing from the portable cylinder to the overhead outlet.
‘SVT,’ Alice told her. ‘Is Peter around?’
‘No.’ Another figure pushed through the curtains as the paramedics took the stretcher out of the small area. ‘I’ve got this case.’ Andrew was holding the patient report form the ambulance crew had supplied. A long strip of pink paper recording the cardiac rhythm en route was attached to it and he was looking at the monitor beside the bed as he spoke.
He introduced himself to his patient, who was still looking alarmed.
‘Am I having a heart attack?’
‘It’s one of the possibilities we’re going to investigate,’ Andrew told him. ‘But, so far, we’re not seeing any sign of it. Your heart’s going a bit too fast to really see what’s happening so we’re going to try and slow it down for you. Try and relax.’
Roger made a sound like a strangled bark of laughter and Andrew’s smile was sympathetic.
‘I know. Easy for me to say, standing on this side of the equation, isn’t it?’ He touched his patient’s arm. ‘I know this is scary but we’re on the case and you’re in the best possible place to get things sorted.’
His smile and his touch had a visible effect on Roger, who lay back against the pillow with a sigh and a nod.
They had a hopefully invisible effect on Alice.
This was a glimpse of the real Andrew. How many times had she seen the effects of this man’s words and smile and touch? She hadn’t really been aware of how nobody else quite measured up to the standards Andrew Barrett had set. Or how much she’d missed working with him.
Until now.
Andrew had turned to Jo. ‘Got a straw handy?’
‘Sure.’
‘And grab a technician to come and do a twelve lead, will you, please?’
‘I can do that,’ Alice said quietly.
‘Fine. Go ahead.’ Andrew was pulling on gloves. ‘I’ll get the bloods off.’
Alice could have managed that as well, but maybe the consultants were also finding their day somewhat dull. She pulled the machine she needed from the corner and began attaching all the electrodes needed to get a complete picture of the electrical activity of Roger’s heart.
Jo was cutting a short length of plastic straw.
‘I want you to take a deep breath,’ Andrew instructed Roger. ‘Seal your lips around the straw and then blow through it as hard as you can for as long as you can.’
A valsalva manoeuvre was one of the dramatic ways to get this kind of cardiac arrhythmia to revert to normal. They all watched the monitor screen as Roger’s face reddened with the effort. There was no change to the rate.
‘Get your breath back,’ Andrew said. ‘And then we’ll give it another go.’
The respite gave Alice a chance to get the twelve lead ECG. The electrodes were all in place.
‘Try and keep as still as you can,’ she asked Roger as she pressed the start button.
But he was too out of breath to comply and the trace was nothing like the clean image Alice had hoped for. Dammit! She screwed up the sheet of paper, hoping that Andrew wasn’t watching.
‘Let’s try that again,’ she said calmly. ‘If you could manage to hold your breath for just a second or two while the machine captures a picture, that would be great.’
Roger managed but the sheet that emerged was missing several pieces of information that it should have recorded.
‘You’ve lost a leg lead.’ Andrew was probably looking at her with the same kind of studied neutrality his tone held. Alice felt her cheeks reddening as she pushed the sticky patch more firmly to the skin of Roger’s left ankle.
This was mortifying. Such a simple task that she was more than capable of performing, but she was managing to make herself look completely incompetent. Worst of all, this was more important than it should have been. The old need to attract praise by being the best was so ingrained it was automatic. She still wanted to be noticed. To be seen. How pathetic was that?
Andrew was getting Roger to blow through the straw again so he’d be out of breath and she’d have to wait to try getting the recording again. When she did and it worked beautifully, Andrew wasn’t even paying attention. Peter had come in and they were discussing the next management step. Because their patient was wide awake, they couldn’t use an external electrical charge to the heart to revert the rhythm unless they sedated him heavily. The better option was to try adenosine—a drug that gave the chemical equivalent of a jolt of electricity.
It usually worked a treat and Alice knew exactly what to do. The procedure was tricky because the drug had a very short time of being effective. It had to be injected into the right arm to get to the heart as fast as possible and it had to be chased along with a large bolus of saline. Two people had to work in unison and Alice had been the one to push the flush on many occasions.
A favourite task. A bit of a challenge to get the timing right; a few seconds delay and, sometimes with even the first dose, they would watch the screen and see the heart rate magically decreasing. The adenosine was drawn up. The big fifty mil syringe of saline was drawn up. There was one port of the IV line and both needles would go in at the same time.
Peter was hanging around to watch. The paramedics had come back from tidying their ambulance and they wanted to watch, too. Andrew had the adenosine in one hand, the saline in the other. It took two hands to push that flush as fast as possible so he needed a nurse. One who knew what she was doing.
‘Alice is experienced,’ Peter said. ‘Done this a few times, haven’t you, Ally?’
She nodded, aware of a wave of pleasure at the boost to her self-esteem as she moved around the head of the bed to change sides. The perfect twelve lead ECG was sitting on top of the machine she was leaving behind but it had yet to be seen. Alice was more than happy to be given an opportunity to redeem her apparent lack of competence.
But Andrew was looking at the nurse who was already standing by his side. ‘Have you done this before, Jo?’
‘No.’
‘Nothing to it. Hold the barrel of the syringe firmly and put the base of your other thumb on the plunger. I’ll inject the adenosine and as soon as you see my plunger hit the bottom, you push in the saline as fast as you can.’
Jo shot a glance at Alice, who had stopped in her tracks and was probably looking as dismayed as she felt.
Alice glanced at Peter but the head of department merely raised an eyebrow. If their new team member wanted to take the time to help staff develop their skills then he could hardly protest.
Neither could Alice, despite feeling even more mortified than she had when she’d messed up getting that ECG trace.
‘You’re IV qualified, aren’t you?’ Andrew asked Jo.
‘Yes.’
‘Then let’s do this.’
Jo positioned herself closer to Andrew. Their gloved hands were touching. Side by side. Syringe by syringe. Of course, Jo had no trouble performing her part of the task and then everyone was looking at the monitor.
Alice heard the distinctive sigh from Roger which showed that the drug had reached its target, but she didn’t wait to enjoy the potential satisfaction of seeing a successful result. Nobody noticed as she turned and quietly slipped out of the Resus area.
Alice wasn’t needed in here. And she certainly wasn’t wanted by the consultant in charge.
CHAPTER TWO
NOT being able to afford a decent car had its advantages.
You could throw anything into the back of this ancient four-wheel drive. Dogs, saddles, dirty covers—it made no difference. You could also have your foot flat to the floor and not break the speed limit. Even if you were very angry and upset and weren’t even thinking about how fast to take the corners, you were safe.
Living this far out of town had its advantages, too. You left the city well behind and could see only the green of paddocks and hills and the deep blue of a late afternoon sky. Autumn colours gilded tall poplar trees and animals grazed peacefully beneath them. Sheep and cattle and fat pet ponies. A goat on a chain was eating the long grass of someone’s roadside verge.
Work was left behind along with the city and the further away Alice got, the more she could feel all the upsets of her day receding. Some time out was exactly what she desperately needed. Escape to the place she loved more than any patch of the earth she had ever discovered. Turning off the main road, she drove into a valley. Towards the end of this road was a property bordered by a river and enclosed by hills like a geographical hug. Hidden from the world and, for the moment at least, entirely hers.
The long driveway was lined by oak trees that were well over a hundred years old. Leaves drifted lazily from great heights and Alice rolled down her window to smell the season. A hint of damp moss and rich soil. A faint whiff of smoke from a bonfire on some neighbouring farm. The chimneys of the enormous old house weren’t giving off any smoke, of course. Why would they, when the house had been empty for so long?
Finding new owners seemed unlikely in the short term. Who could afford a rather rundown old mansion these days when it was a good twenty minutes drive from the city? The cost of petrol alone would put people off, never mind the extensive renovations needed and the effort of keeping up a hilly property of at least fifty acres. The longer it took, the better as far as Alice was concerned. She was more than happy to be here as the only human tenant.
Alice took the fork in the driveway before she got more than a glimpse of the big house through the trees. She drove towards the river now. Towards the cottage that had once housed shearers and had been rented out a year ago to her friend, Mandy. Seeing the small weatherboard dwelling ahead of her, with her dog, Jake, guarding the front step, Alice could finally let go of everything bad the day had thrown at her.
The shock of being pulled back to a past she had thought long gone. Having the ashes of a distant one-sided romance stirred and finding it still showed a dismaying warmth. Enough of a glow to make the embarrassment of being deliberately put in her place as a less important staff member far more intense. Last, but by no means least, was the knowledge that if she wanted to keep the life she’d worked so hard to create for herself, she really would have to fight for it.
Alice climbed out of the truck and crouched to hug her dog, burying her face against his shaggy neck for a moment, feeling his whole body wag pleasure in her return. Alice let out her breath in a long sigh and she was smiling as she stood up.
‘I’m home,’ she said aloud. ‘How good is that?’
Even better, she had a good two hours of daylight left. Time to saddle up Ben and take a gentle trek up the hills, through the forest and back to the river. Her huge black horse was getting on in years now and was probably a bit stiff after the long stint of being shut in the float yesterday. Besides, Alice couldn’t think of anything she would rather do to centre herself again. The other things she needed like a good home-cooked meal and a long sleep could wait.
Climbing into soft old jodhpurs and pulling on her short leather boots dispelled any thoughts of uniforms. The smell of well cared for leather as she collected her tack from the stable put anything shiny and clinical on another planet. Best of all was the soft whinny of welcome from Ben when she went out to the paddock behind the cottage with Jake walking close enough to brush her leg.
She was wanted here. Trusted. Loved by her boys. Yeah…life was full of hard bits but it could also be very, very good and this was as good as it got.
A short time later, Alice swung herself up into the saddle and clicked her tongue. Ben wasn’t showing any sign of being stiff. He took the bit and pulled eagerly. Maybe he was thinking of that long empty paddock where the forest track ended. The gentle uphill slope that was the perfect place to stretch out into a good gallop.
Alice grinned.
Yes!
Television was so boring!
Emmeline Barrett was fed up with the squeaky cartoon voices. With a heartfelt sigh, she wriggled around to kneel on the couch backwards, her chin resting on her hands as she gazed out of the window at the green hills and blue skies that were so different from anything she’d ever known it was like being in a fairy tale.
Haylee, her new nanny, was lying on the other couch, flat on her back with cushions under her head and her cellphone against her ear as she continued yet another phone call.
‘No! Oh, my God! She didn’t…Oh?’ A contemptuous snort followed. ‘Whatever! As if he’d be interested in her!’
Haylee had promised to take her for a walk this afternoon. Down to see the river or up to where the trees were thick enough to make that dark and scary patch on the hillside that never failed to give Emmy a lovely tickle inside when she looked at it.
Suddenly, she knelt bolt upright, not even noticing that the interminable phone call was ending on the other couch. Her jaw dropped as she watched a big black horse come out of the forest and start galloping up the hill. A dog was running behind and it had to be a lady riding the horse because Emmy could see long hair streaming out behind the hat she was wearing.
Was it a real fairy tale now? An enchanted forest? Could the lady be a princess? She watched until the magic horse disappeared over the top of the hill and then she climbed off the couch.
‘Haylee?’
‘Hmm?’ The nanny’s response sounded remarkably like a yawn.
‘Can we go for our walk now? Please?’ she added hurriedly as she remembered her manners.
‘In a minute, okay?’ Haylee’s eyes were closed. ‘I just need to rest for a bit.’
Emmy scowled. She looked back at her couch that faced the blaring television. She looked at the door which led into the big hallway with the tiny stones that made patterns on the floor. If she went all the way down, there was a really big wooden door that was probably too heavy for her to open, but, if she went the other way, she knew she would find the kitchen and that funny room full of tubs and taps that had a much smaller door. If she went past the clothes line outside that door, she might be able to find the hill.
She might be able to see that magic horse and the princess again.
Emmy looked at Haylee, whose eyes were still firmly shut.
‘I’m going to the bathroom,’ she announced. ‘I need to go to the toilet.’
‘Can you manage by yourself?’
‘Of course I can.’ The indignation was automatic. ‘I’m five!’
‘Cool. Come straight back.’
Emmy got to the door but then turned to watch for a moment longer. She saw the way Haylee’s fingers relaxed their grip on the cellphone. Her new nanny didn’t even notice when it slipped out of her grasp and bounced onto the floor.
Emmy stopped chewing her bottom lip. With her lips set in a rather determined smile, she went out of the door in search of magic.
Forty-year-old Roger was about to walk out of the door of the emergency department.
‘Wait!’ Andrew took another glance at the slip of paper in his hand and stepped in front of his patient.
‘What for?’
But Roger took a step back towards the bed he’d recently vacated, having rested for a couple of hours after the successful management of his cardiac arrhythmia.
‘I’ve just received the results of the last blood tests we took.’
‘You said there was nothing wrong with my blood.’
‘There wasn’t. The first results came back with completely normal cardiac enzymes.’ Andrew tweaked the curtain shut behind him and showed Roger the paper he held. ‘This one, however, shows a raised TNT.’
‘What does that mean?’
‘It means that there’s been some damage to heart tissue.’
Roger sat down on the bed. ‘You mean, like a heart attack?’
‘Yes. The level is low enough to suggest it’s minor but we’re going to need to admit you and run some more tests.’
‘But…I want to go home.’
‘I know,’ he said sympathetically. ‘I’m sorry.’
Roger wasn’t the only one who wanted to go home. Andrew’s shift had officially finished, but he took the time to explain things to Roger again and then he paged Cardiology and waited for the registrar to arrive so he could transfer care of this patient. Finally, he unhooked his stethoscope from around his neck, put on the pinstriped jacket of his suit and headed for the car park.
Minutes later and he could put his foot down. Just a little, because that was all it needed for a surge of power from his gorgeous new car. The powerful engine purred softly and the miles between work and home evaporated. Andrew sped past the rolling paddocks without seeing the autumn colours of the trees. He barely noticed the goat on the side of the road.
It seemed a very long time since he’d kissed Emmy goodbye this morning and he needed to get back to her. To their new home. To remind himself why they’d journeyed here from the far side of the world. To convince himself it was worth the disturbing prospect of having to work with someone who was such a tangible link to his old life.
He’d won the first round, though, hadn’t he? Made it very clear that if they were to work together it would be on his terms. So why wasn’t it making him feel any better about the future? Why had he been left with this kind of unpleasant aftertaste as though he was being forced not only to recognise, but to bring out a side of himself that he didn’t particularly like?
Andrew slowed just a little as the car bounced over the undulations in the driveway formed by ancient tree roots. He glanced to his left at the fork and caught a metallic glimmer that begged a second look. A horse float was parked under the shelter of some trees. Good. The tenant had returned. Amanda someone, the solicitor had informed him.
Andrew needed to talk to this Amanda. To let her know that, unfortunately, he wouldn’t be able to let her renew the lease on the cottage that was due to expire at the end of this month. He needed the cottage as accommodation. The agency had assured him they would be able to find a married couple who would jump at the opportunity of living here and working for him. A housekeeper-nanny and a farm manager. Free accommodation should ensure he got the best available and nothing but the best would do. If the couple had children, it would be a bonus. While he was making arrangements for Emmy to start school in the city, it was too far away to make out-of-school play dates easy. How much better would it be if she had company closer to home?
The sound of the television made Andrew frown as he let himself in through the front door of the magnificent old house. Why on earth was Emmy watching rubbish when she could be outside in the fresh air and enjoying the kind of exercise and surroundings that had been impossible in central London?
Finding the temporary nanny sound asleep on a couch in the small sitting room that had once been a library was a shock. Andrew snatched up the remote and killed the noise, staring at the young woman in disbelief and then automatically scouring the room for evidence of something worse than being simply asleep. Empty bottles? Syringes? Not that it made any difference. History was still repeating itself. He had apparently left his daughter in the care of someone who wasn’t competent enough to keep her safe, let alone care for her the way she deserved.
The sudden silence had been enough to wake Haylee.
‘Where’s Emmy?’ Andrew demanded.
‘She went to the loo.’
‘Oh?’ Andrew strode to the door, trying to calm down. ‘Emmy?’
He called again but he could feel the emptiness of the house as he stood in the vast hallway. His pace increased as he checked the cloakroom under the sweeping stairway. He took the stairs two at a time to reach the gallery that overlooked the foyer. He checked Emmy’s bedroom. His own room. He threw open door after door of rooms that didn’t even contain any furniture yet.
‘Emmy!’
Downstairs, he found Haylee standing near the kitchen, looking frightened.
‘How long were you asleep for?’
‘I…I’m not sure. Not long.’
Andrew brushed past her into the kitchen. Empty. Not even any sign of the pantry being raided for snacks. The old laundry was also empty. The back door was open.
‘She’s gone outside?’ Andrew tried to quell a spark of panic. ‘By herself?’
‘She won’t have gone far.’
‘How on earth would you know that? You don’t even have any idea how long you were asleep.’ Anger surfaced with a vengeance. ‘And how far do you think she would need to go to get into trouble? There’s a river out there, for God’s sake!’
‘I—I’ll help you look.’ Haylee looked ready to burst into tears.
‘No.’ Andrew didn’t spare the time to look back at the girl. She wasn’t to know that he was as angry with himself as he was with her but fear overrode any habit of kindness. ‘Get your things and go home, Haylee. I don’t want you looking after my daughter. You’re fired!’
He scanned the kitchen yard, with its clothes line and pattern of herb gardens surrounded by tall thick hedges that hadn’t been trimmed in years. The gateway set under an arch of greenery was overgrown. Almost invisible and only just ajar. Quite enough of a gap for a small girl to have squeezed through, however.
Andrew wrenched the gate open further.
‘Emmy!’
Good grief!
There was a small girl standing in Ben’s paddock. A very pretty little girl with a mop of blonde curly hair and big blue eyes that were gazing up at her in open admiration. Awe, even.
‘Jake!’
The warning was unnecessary. Her large dog had dropped to his haunches well away from the child. He put his nose on his front paws and prepared to wait patiently. Ben also seemed to realise that caution was advisable. He stopped, not even looking at the water trough beside the girl.
‘Hello,’ Alice said. ‘Who are you?’
‘Emmy.’
‘Hello, Emmy. I’mAlice.’
She swung her leg over Ben’s back and slid to the ground, pulling off her helmet and then grabbing the reins before Ben could think of stepping forward. This child was tiny. So fragile-looking close to Ben’s fluffy dinner-plate-sized hooves. Especially in that pretty pink dress with her long white socks.
‘I saw you,’ Emmy said. ‘From the window.’
‘Oh?’ Alice looked around, despite knowing perfectly well there were no windows nearby. This was getting weird.
‘Are you all by yourself?’
Emmy nodded. ‘Haylee’s asleep. She’s tired.’
Maybe Alice was too. Suffering from exhaustion. Or low blood sugar or something. Having some kind of delusional experience.