by Karen Swan
Tara frowned, trying to make sense of the riddle. Something was glitching inside that little body – but what? What was she missing? The surgery had been a success. Admitted just after 6 a.m. – her parents now in custody – the scans had been unambiguous, her stitches had been clean and neat. It had been a textbook procedure, the girl had come through without any complications; Tara had done her job well. She’d been anticipating a quiet day and night’s rest for her small patient and then a move to the paediatric ward tomorrow morning, followed by the inevitable visit from social services. She hadn’t been worried about her prognosis, though it had broken her heart to think that no one, absolutely no one, was sitting in the waiting area, tearful and pacing, desperate to hear how that little girl was doing. Surviving? Dying? No one cared. She was four years old and as alone in this world as anyone could ever be.
Tara put her hand on the slender arm, feeling the small girl’s warmth, her flickering aliveness like a candle in the breeze. What chance did she have? Born to parents that never wanted her, parents barely more than kids themselves, parents who only knew the rule of the fist and the escape of the bottle. She felt the familiar groundswell of dismay – guilt – rise up in her that she should have so much and others so little, but she drew herself up an inch, reminding herself this was what she lived for. This was how she made the difference and gave back. She could do this, at least.
The child’s body stiffened suddenly beneath her touch, then relaxed, monitors beginning to blink and flash, numbers to shout at her.
‘Call theatre,’ Tara said, her voice setting hard as logic, fact and a rigorous education took over. Sentiment wouldn’t save the child. Only medicine. Only calm. Her eyes tracked the changing stats, deciphering now the meaning behind the digits and converting them to flesh and blood catastrophe. ‘She’s haemorrhaging. We need to get her back on the table. Now.’ She must have missed something when she went in the first time. She must have done.
One of the nurses ran out of the room to make the call as the sides of the bed were raised up and the brakes taken off. Tara blocked it all out – the noise, the flashing colours, the adrenaline like a metallic tang in the air. She felt held in a cloud where the world beyond its feathered edges ceased to exist, where she ceased to be or feel. Her feet moved automatically, lift doors were closing but she could see only what was in front of her. A child, dying.
‘Stay with me, Lucy,’ she said, squeezing the tiny forearm. ‘You’re safe. We’re going to look after you.’
She moved instinctively into the surgical theatre, walking arms-first into her outheld scrubs and soaping her hands rhythmically, methodically, her brain scanning through for the most likely areas of breach. She had to find the point of egress quickly. She was opening up that little body for the second time in nine hours, a little body that should, right now, be playing in a garden in the sunshine or splashing in a pool or eating cake. She was even more vulnerable now than the first surgery, even weaker, and Tara knew there was a precarious tipping point when the interventions made to save her would become the intrusions that endangered her: hands shouldn’t be inside a chest cavity no bigger than a ball, that healthy growing heart shouldn’t need to be assisted by a ventilator . . .
She blinked hard once, banishing all emotion and pushed the door with the back of her shoulder, rejoining the team in theatre. Their small patient had been prepped but Tara knew the crash was still coming. It was a race against time.
She stood motionless and took a steadying breath, feeling her mind clear.
‘Scalpel.’ The word was a command, like the first note of a song. She held out her hand and the nurse placed the instrument carefully in her palm.
The incision was clean and decisive, the blood dark and thick, telling her at a single glance that her patient’s oxygen levels were low. Her world narrowed further. It was like looking through a telescope, her field of vision trained solely on the radial field immediately before her. There was order in what she saw; it was one of the reasons why she loved medicine – the fundamentals were always identical, it was just disease and trauma that needed to be rooted out as anomalies. But she was blind here. Blood was filling everything, too quickly, a glistening dark red sea flooding around organs. The suction pump could only do so much.
She didn’t panic. She trusted in the training she had had at the side of the world’s best. She trusted in her abilities. Even with a mortality rate as inevitably high as ICU’s, she had never had a child die on her table and this four-year-old girl, utterly alone, was not going to be her first.
She put her hands in, making minute movements with her fingers and feeling for the tiny tear that could wreak such devastation, her fingers pressing lightly against tender tissue, brushing against the proud neat and tidy stitches she had put in herself early this morning.
The monitors were screaming at her in an orderly manner, telling her – as if she didn’t already know – that she was losing the race, running out of time, not good enough.
‘BP fifty-four over thirty-five.’
She felt the team’s eyes upon her as the tension tightened. She worked faster, her fingers deft, trying to ‘see’ where her eyes could not. She was known for her calm under pressure, her ability to rise above a crisis and do what needed to be done. But she wasn’t rising right now and she felt the first shot of panic, like a fluttering frill around the periphery of her vision. There was so much blood. This couldn’t be from a single breach, surely? Where was it? What . . .?
What was it?
What was that?
There was something, hidden below the scarlet surface; as thin as a hair but the tip sharp enough to prick against the pad of her index finger—
‘Suction.’ She directed the nozzle herself and saw it – a flash of silver embedded in tender tissue. Tara felt the walls press in, the ceiling drop an inch.
A blade?
In the next blink, it was hidden from sight again, blood refilling the cavity, that strong little heart doing its job too well. It was her own that was struggling to beat. She felt completely blindsided by the discovery, her mind racing to find explanations even as her hands moved automatically, fingers blindly probing for the tiny metal shaving again.
She found it, and started to stitch, but her time was up. The charts on the vital signs screen – already wailing and flashing red – were interrupted suddenly by a steady bold line that raced from left to right, like some early 1980s computer racing game. Flatline.
‘She’s crashing!’ the nurse said.
‘Moving to one hundred per cent oxygen,’ the anaesthetist said.
Tara removed her hands as they began manual massage. She stared down in a disassociated state at the tiny body, bright white and dark red. It felt like the world had stopped spinning, the tiny scalpel blade glinting jewel-like in the kidney dish. She felt frozen in time, holding her bloodied hands up like spiked crowns, as the drama played out towards an inevitable end, telling a single story.
This was all her fault.
Chapter Ten
Her dress swished as she walked, a long black taffeta column with a flat bow that looped at a jaunty angle across the shoulders, and her hair swept up in a bun that would have had a prima ballerina wincing. She was grateful the hotel had a carpeted lobby; it made walking in heels so much easier after a bottle and a half of red. She reminded herself to keep putting one foot in front of the other. That was all she had to do. Just get through tonight. Keep walking, keep smiling . . .
‘Tremain.’
The man stopped in front of her, handsome in black tie – and aware of it.
‘Charles! Goodness, I didn’t know you were here.’ Her voice was composed, but it had a hollow ring to it, like she was speaking into a barrel. ‘How are you? It’s been a long time.’
‘I know. What – five years? Six?’
She shrugged. ‘Something like that.’ Their relationship – if it could be called that – had been more stop than start. She tried to remember the nam
e of his wife. ‘. . . How’s Caroline?’
‘Great. Great. Expecting number two.’
‘Two? Wow. Congratulations.’ Every other person she met was pregnant these days, it seemed.
‘Thanks.’ His eyes crinkled at the sides when he smiled now, and he looked tired. (Didn’t they all?) ‘And I hear congratulations are due to you too?’
Her smile slipped, all the way to the floor. ‘Sorry?’
‘I heard you made consultant.’
She gave a wan smile. ‘Oh that, yes. Very pleased.’
‘I’ll bet. Did I hear right that you’re the youngest consultant at Tommy’s?’
‘Well, I wouldn’t know about that.’
He gave a lopsided smile. ‘You always were too modest.’ A blonde woman in ivory draped silk viscose came and stood beside him. ‘Ah, there you are, darling. I was just on my way back to the table,’ he said. ‘You remember Tara Tremain? We were SHOs together at St Mary’s.’
‘Of course,’ Caroline smiled blankly, her bump as neat as her hair. ‘How are you?’
‘Tremain’s made consultant in ICU at Thomas’s,’ Charles offered, before Tara could even open her mouth.
‘Oh. Congratulations.’ Caroline, Tara seemed to recall hearing somewhere, was head of a Montessori nursery that had a waiting list as long as the Rheumatology department’s.
‘And to you. Your second, I hear?’ It was one of those circular conversations, the same material being passed around with faux cheer and insincere wishes. No one actually saying anything meaningful. No one actually connecting.
Caroline’s hand instinctively went to her stomach. ‘A little girl. Rollo’s so excited he’s going to be a big brother.’
Tara nodded. ‘So lovely. Well, you look wonderful, pregnancy suits you.’ She began stepping away. ‘Great to see you both. I’d better get back to my table.’
‘Absolutely. Let’s grab a coffee sometime. I want to hear how you did it,’ Charles called after her. ‘Give me some tips for the top.’
‘Haha!’ she replied, as though he was joking. ‘You never did need my help, Charles,’ she said with a wave, turning away.
She slid into her seat, casting a vague smile at their table. Rory, listening in on a conversation with Mark Wu, sat back and squeezed her knee. He draped an arm over the back of her chair, watching as she fiddled with the skirt of her dress.
‘I thought you’d left me,’ he murmured in her ear.
‘You should be so lucky. No, I got caught by Charles Miller, know him?’
Rory thought for a moment, his face falling into that familiar look of concentration. ‘Over at Guy’s?’
‘Yeah. I did my SHO training with him.’
Rory smiled, an eyebrow lifting, knowing how tangled medics’ relationship histories tended to be. ‘And . . .?’
‘And his wife is expecting a little sister for Darling Rollo.’
He chuckled and leaned over, kissing her on the cheek.
‘How much longer before we can get out of here?’ she whispered.
His blue eyes twinkled. ‘Well, bit rude before coffee, don’t you think?’
‘Mmm,’ she concurred reluctantly, looking around them and wishing he wasn’t always so polite. As Holly had said on more than one occasion, she had managed to find her perfect match. ‘You, but with a willy,’ had been Holly’s exact words.
She sighed restlessly as she watched people beginning to mingle. Now the awards and speeches were done, now the wine had been drunk, the evening was going to slip its stays. People would begin to dance and flirt with people who weren’t their spouses . . . It all suddenly felt endless, airless, the small talk stupefying. She had a fear she might lose control of herself and suddenly do something – scream, laugh, cry, rip her clothes off; that worst of things, make a scene.
‘Everything okay?’ His hand was on her knee. ‘You went pretty hard on the cab sauv, I noticed. Has something happened?’ Rory was watching her keenly.
She gave a careless shrug, looking away as a lump gathered in her throat. ‘Everything’s fine. I’m just tired.’
‘Yeah,’ he sighed in weary agreement, running a hand through his hair and holding it there for a moment. ‘Okay, fine. How about we make a French exit in five minutes? I’ll just extricate myself from this conversation.’ His head angled slightly towards Mark Wu, holding court. ‘Can you last that long?’
Could she? She felt an agitation that was down to far more than just wine. It felt like her soul was turning over from a long sleep.
‘Five minutes?’ She narrowed her eyes as she caught sight of someone familiar. ‘I think I can manage that. I’ve just seen a face from the past.’
‘Who?’
‘An old uni friend. I’ve not seen her in ages.’ She kissed him on the lips and got up again. ‘Rescue me in five. You’ll find me by the ice penis.’
‘It’s clearly modelled on a syringe.’
‘Yeah-yeah-yeah. You say tomato . . .’ she said, tossing the words over her shoulder like a scarf.
She crossed the ballroom, although that was too grand a word for what it actually was. No balls had ever been held here, at least, not of the crinoline and wigs sort. They were in an executive hotel off the Edgware Road, whose conference room had been draped in white chiffon swags. Giant cardboard hoardings of their sponsors – a medical equipment company – showed saccharine-sweet images of people hugging and children running on grass, strangely at odds with the bow-tied stiffness of the awards ceremony.
The object of her attention was leaning against a mock-marble pillar, texting with one hand, holding a glass of red wine in the other. The droplets from the revolving glitter ball were falling upon her like crystal rain.
‘Don’t tell me. Man trouble,’ Tara said, coming to stand by her and taking the glass from her hand. She took a sip as Liv looked back at her in surprise.
‘Fuck! Twig!’
They hugged, before Liv stepped back and gave her the full once-over. ‘Look at you! My God, when did you become such a grown-up?’
Tara groaned. ‘I hardly think so. I feel I’m the only woman in the room not either wearing a ring or carrying a bump.’
‘You and me both,’ Liv drawled, resuming her slumped position against the pillar again. She looked at Tara through narrowed eyes. ‘Congrats on your award, by the way.’
‘Thanks.’
‘A teaching hospital in Senegal, huh?’
Tara shrugged. Her family’s standing was no longer a secret from anyone thanks to the media fanfare that had greeted her father’s ‘Costa Rica project’ (as her mother called it) and which, of course, had proved correct her friends’ fears for her. The girls had rallied around her in the wake of events, but their pity at Alex’s treachery had been heightened by their excitement at her newly revealed heiress status and there had been something mawkish in their attentions. She had found it hard to forgive them fully for the sly way they had behaved at Sophie’s birthday and things had never been quite the same between them (except with Holly, of course, who had always known and never cared). Perhaps it was because they were so inextricably linked to that fateful weekend that Tara hadn’t tried to stay in touch with them after graduation, instead letting the friendships slowly drift, and it had been at least seven years since she’d last seen Liv. But little had changed, it seemed. Even standing here now, she could sense Liv’s beady-eyed fascination with her life, and even now, Tara still felt a glint of anger. More than a glint.
Nonetheless, she smiled. ‘Well, if you ever fancy a sabbatical, we’re always on the lookout for medics to train up the staff. Between yellow fever, typhoid and hep A, we’ve got our work cut out for us there.’
‘Don’t jest – I might take you up on that,’ Liv groaned. ‘I’ve got a wait list that would go four times round the block. I think I could work till I’m eighty and still never clear it. I used to fantasize about my dream man. Now I just fantasize about running out of patients.’
‘I know what you mean. The o
ther day, I went eleven hours without even peeing. My bladder was like a bowling ball. I swear a junior actually opened his mouth to ask me when the baby was due.’
Liv chortled. ‘And to think we chose this.’
‘I know. Last laugh, right?’ Tara glanced casually around the room, aware she was on autopilot. It seemed to her that much of being a doctor involved boasting to other doctors and ‘civilian’ friends about how exhausted and overworked they were. Like it was a competition.
Everyone was up and mingling now, a few people even beginning to dance. Charles Miller was one of them and Tara watched him for a minute. That was some advice she could have given him for getting to consultant: don’t. She was firmly of the view that throwing shapes at an event like this had a direct negative impact on promotion chances. Seeing some people dance made it seem like a moral imperative to remove all surgical implements from their hands.
The snatched glimpse of the blade flashed through her mind’s eye again and she turned sharply away.
She looked back at her old friend and took the glass from Liv’s hand again, almost draining it. ‘So who’s the guy?’
Liv pulled a face. ‘Ugh, just a fling. Flingette, actually. A waiter I met at this fancy pizza place in Soho.’
‘Well, so long as it was a fancy pizza place,’ Tara quipped.
‘He’s very hot.’
‘I should hope so. Age?’
‘Mid-to-early twenties.’ Liv hesitated. ‘What? Don’t judge me! Like I said, it’s a flingette. No strings.’
Tara shrugged as Liv gave a half-hysterical wail. ‘It’s your life, your choice, Liv. Who am I to judge?’
‘Yeah, but I bet you’re with some shit-hot Master of the Universe type.’
‘Because that’s really my type,’ Tara deadpanned.
‘Well, you always did get the gorgeous ones.’
‘Not always.’ Tara looked around the room before Liv could catch her gaze. She sensed his name hovered like an aura around her whenever she saw any of the old crowd. She could tell they wanted to know if she’d seen him, what he was up to now working for her father, whether they were in touch . . . For all his two-faced duplicity, he still exerted a pull over her friends and in spite of Holly’s warnings never to mention his name, it was always there nonetheless, just unspoken. She felt her soul tremor and twitch again, deep inside her bones, and she suppressed a shudder.