'Some kid's fallen off a jungle gym.' Josh had been inside the ambulance that was permanently stationed near the helipad and available for local calls if the SERT crew was not otherwise occupied. He pressed the button on the radio microphone he was still holding. 'Roger, got that. We're responding.' He slid into the passenger seat. 'You know where Black's Road is?'
Tom nodded. The V8 engine on the Mercedes ambulance roared into life and he flicked on the beacons.
'It's a long road. Want me to check the map and see where the playground is?'
'I know where it is.'
He'd been there. With Emma and Mickey. He'd pushed Mickey in one of the bucket-type swings and smiled at the shrieks of glee and gurgles of laughter the ride had elicited.
Maybe this job wasn't going to be enough of a distraction from a miserable day after all. Waking up in an empty bed, getting up to an empty house, watching Max ignore his breakfast had all been like some kind of punishment.
One that he had deserved.
Tom put his foot on the button that changed the siren's wail to a short, more urgent yelp as they approached the red lights of a major intersection. Cars edged sideways in the stationary lanes and traffic slewed to a halt from the lanes at right angles. A puff of smoke could be seen due to the over-rapid braking of a driver who had decided at the last minute that the emergency vehicle needed right of way.
Tom knew his miserable day was his own fault. If he hadn't been so selfish yesterday, allowing his disappointment and jealousy to colour his judgement so badly, he could have supported Emma in what he knew was the right thing to do in letting Simon meet his son. Instead, his fear that he was going to lose, by painful degrees, what he wanted most had driven him into trying to throw it away instead. To try and put himself in a position of control—at least for the emotional fallout he knew he was at risk of experiencing.
In less than two minutes the ambulance arrived at the scene of the callout. Tom eased the vehicle over the kerb and drove across the grass towards the brightly coloured playground equipment. A cluster of people stood beside an improbable-looking climbing frame. A set of deserted bucket swings stood as a limp sentinels to one side.
Spotting an equally deserted small wheelchair should have alerted Tom to the personal nature of this call, but maybe he was so used to seeing one as part of the furniture, the connection failed to register.
With his focus on the crumpled form of a small child, still partially obscured by concerned onlookers, recognition of some of the adults present was also delayed.
'Can someone tell us what's happened?'
'The boy's fallen.' The man holding the boy's head still said. 'From this climbing frame.'
'Has he been moved since he fell?'
'Of course not.' The man looked up. 'Airway's clear. Breathing's OK but GCS is well down. I'd put it at 7 or 8. He's got a depressed skull fracture.'
'You a doctor, sir?' This from Josh who was positioning the portable oxygen cylinder and pulling a mask from the bag attached to its frame.
Tom crouched to deposit the life pack and kit he'd been carrying. No wonder the support for a cervical spine had looked so competent.
'This is Mr Flinders, Josh,' he said. 'He's a neurosurgeon.'
Tom glanced up only briefly. Just long enough to find the figure he knew had to be very close. Emma was kneeling on the other side of Mickey's head. Her face was deathly pale and she had her arms wrapped tightly around her own body. The dilemma she was grappling with was written all over her face. As a medical professional, she knew not to move a patient who had suffered a serious head and possibly a C-spine injury. As a mother, all she could think of doing was gathering her child into her arms to protect and comfort him.
Eyes that were dark pools of fear communicated too much. This was far worse for Emma than the terror of being trapped in that van. Right now she was facing an even closer reality of losing her son but surviving herself to live with the aftermath.
There was no more than a split second in which Tom could try and convey a promise of help. Then there was no time to spare to worry about Emma. Certainly no time to even form thoughts of any personal repercussions this accident could bring.
'How far did he fall?' Tom snapped on the beam of his penlight torch.
'A good two metres,' Simon informed him crisply. 'And he hit his head two, maybe three times on the way down.'
'Has he been responsive at all?'
'No.'
'Mickey?' Tom leaned close to the tiny, still face. 'Hey, buddy—it's Tom. Can you hear me? Can you open your eyes for me?'
There was a flicker of response. A twitch of eyelids and a faint moan that could have been an attempt to say something. It wasn't much but it was enough to elicit a stifled sob from Emma's direction.
Tom didn't look up. He drew back Mickey's eyelids and shone the beam of light onto his pupils.
'Right pupil unresponsive,' he said grimly. 'Dilated at four millimetres.' He moved the light to check behind Mickey's ears as Josh leaned in with the oxygen mask.
'No Battle's sign. Have you got that on at 15 litres?'
'Yes.'
A high level of oxygen was essential to try and prevent secondary cerebral injury and, with this degree of unresponsiveness, Mickey was going to need intubation and ventilation.
He also need a neck collar and full spinal immobilisation before they could transport him. And an IV line. If there were any other injuries, Mickey could be losing blood internally and his blood pressure would have to be maintained with fluids to help keep an adequate level of oxygenation to his brain. He could also need a rapid drug response if he showed any signs of developing seizures.
'You know he's got spina bifida, don't you?'
'Yes.'
'And that he's got some background hydrocephalus that could be an issue with head trauma?'
No. Tom hadn't known that but a malfunction in the circulation of cerebral spinal fluid was a common complication of a defect like spina bifida. Simon had clearly had a more in-depth conversation about Mickey than Tom had ever had with Emma.
He couldn't afford to think about what else they might have discussed. And it didn't matter. Nothing mattered except taking the best possible care of this child and getting him to hospital as quickly as possible.
' Start hyperventilating him with the bag mask,' he instructed Josh. 'I'm going to intubate.' He looked at Simon. 'Can you give me a hand? I could do with your expertise in keeping his neck stabilised.'
'Of course. I'll do whatever you need.'
He sounded concerned, Tom registered as he swiftly gathered the gear he needed. His laryngoscope, a catheter mount for the bag-mask unit, suction apparatus, artery forceps, syringe and an uncuffed endotracheal tube. A very small one.
Not the concern of a parent exactly but, then, Tom was functioning purely as a professional right now as well. Somehow he was keeping a lid on the well of emotion of how he felt about Mickey as a person and not a patient.
He managed to continuing doing that until they reached the waiting trauma team at the hospital. Until his tiny patient had been transferred to the overly large bed in Resus 1 and a crowd of specialist medical personnel and equipment produced a barrier that effectively removed him from the case.
And then it hit Tom with such a jolt he could feel the sting of tears in his eyes. He turned blindly towards a corner of the resus area in order to collect himself, but he had to stop when he felt the pressure of a soft touch on his arm.
'Tom?' Emma's voice was a shaky whisper. 'Thank you.'
Tom forced the moisture from his eyes by screwing them so tightly shut it was painful. Then he was able to look at Emma, having gathered the strength he knew she would need to lean on.
But she didn't look at him for more than a heartbeat. Her gaze was dragged back to the fragmented view of her son available between the bustling figures of the trauma team and the equipment they needed.
And one of the key people in that team was Simon.
&nb
sp; Neurosurgeon.
Mickey's father.
There was too much happening.
Too many emotions.
Emma's head felt like a spin-drier. She was watching her thoughts through a window as they were tossed and turned but she stood apart. In a numb place that was surrounded by some kind of protective force field.
Fear was the biggest item in that mix. Horror, even, that this could have happened. That summoning the courage to try and make a new life for both herself and Mickey could actually end in such unimaginable disaster.
Tom was in there, too. More than once. There was the relief Emma had felt when she had seen it had been Tom leading the crew on the ambulance James's mother had called in desperate panic moments after Mickey's fall. If Emma could have wished for anyone to be taking the first steps in trying to save her son's life, Tom would have been that person.
Simon would also have been chosen—to at least be present for the surgery Emma knew her son was going to need. A paediatric neurosurgeon had been summoned but Emma was grateful Simon had insisted on coming with them in the ambulance.
'Of course I'm coming,' he'd said to Emma as they'd followed the stretcher carrying Mickey's small body strapped to the orange backboard. 'Did you really think I wouldn't do everything I could to help?'
There had been comfort to be found in realising she hadn't been completely wrong about Simon all those years ago. He may not be the right man for her but he had never been a monster.
And she did need him right now.
Mickey needed his father.
If Simon's professional expertise was all he ever contributed to Mickey's future but it was enough to save him. then Emma would never ask for anything more. If he wanted more contact in years to come, when Mickey was old enough to make an informed choice for himself, that would be fine but the past was sorting itself into a very manageable parcel that was tossing somewhere among the tumbling mix in Emma's head.
Tom had just contributed a new impression, too, with the look she had just caught. She could have Sworn there had been a hint of tears in his eyes and the message she had received hadn't made any promises that this would be all right. Tom knew as well as she did that this could never be all right but what the eye contact did seem to convey was an offer to be there for her. A confirmation that she could depend on him.
As if she hadn't already known that!
It was the one emotion that Emma would have liked to really connect with. She wanted to pull that glance out and wrap it around herself like a warm blanket but there was no point trying. She knew the force field wasn't going to allow connection.
Instead, Emma wound her own arms tightly around herself as she stood well out of the way in the best-equipped resuscitation area the emergency department had to offer. She stood frozen, inside and out, and let the snatches of what she was seeing and hearing roll over her, like a badly made, stuttering home movie that she couldn't focus on enough to follow the story.
'Systolic blood pressure dropping. Down to 80.'
'Oxygen saturation dropping. Eighty-three.'
'Is that arterial line in yet?'
'Let's get the head tilt up to thirty degrees.' That was Simon's voice. 'We can decrease ICP that way without altering CPP.'
'What's his weight? I'm just drawing up some mannitol.'
'Look out! He's seizing!'
Emma had to close her eyes at that point. She might have swayed on her feet had Tom not stepped in behind her and taken a grip on her shoulders due the sudden increase in tension in the room as anti-convulsant medications were hurriedly ordered and administered.
The comforting pressure of his hands vanished not long after that, as Mickey was moved for the urgent CT scan he needed to identify the exact nature of his head injury. It was Simon who was there to help her then. To make sure she understood what the paediatric neurosurgeon had to say when he arrived to review the results. Both he and Simon seemed to understand how numb she was and spoke to her as the frightened parent she was and not as a colleague in the medical profession.
'This is the main injury,' the surgeon said. 'A depressed occipital fracture. What we'll have to do is lift the bone piece that's pressing on Mickey's brain. There's a small tear in the tissue underneath and we'll repair that and take out the blood that's accumulated.'
'There's some bruising here...and here...' The surgeon clicked the mouse, bringing up the series of scan images on the computer screen in rapid succession. 'But they don't look like too much of a problem. Rising ICP will be the main issue—that's the pressure inside Mickey's skull.'
'It's a closed box, essentially,' Simon added. 'When pressure builds up, it compresses the brain and causes damage.'
Emma nodded. She knew that. 'Will the fact that Mickey's got spina bifida made a difference to the outcome?'
'Any extra fluid is going to add pressure but, basically, it becomes part of the same picture so it shouldn't make a difference in an acute situation like this.'
'It might have more of an impact later.' The paediatric surgeon was about the same age as Simon and he had a kind smile. 'It'll be months before the risk of even a small fall becomes acceptable and Mickey might need some protective headgear for when he gets back to learning to walk. It's a major setback as far as mobility goes, I'm afraid.'
'We can cope with that.' Emma couldn't think that far ahead yet. 'How long will the surgery take?'
'Hard to say. At least a couple of hours, I expect. He'll be in Recovery for a while and then we'll get him moved to the paediatric intensive care unit. The development of acute brain swelling is the main danger we're facing. We'll be fighting that with a fair barrage of drugs. Steroids and diuretics and so on. He's also going to need pretty intensive monitoring so you can expect to see a lot of lines in place, including an ICP probe and a urinary catheter. You OK with all that?'
'Emma's a nurse,' Simon said. 'I'm sure she's got a good idea of what she can expect.'
'Just look after him, please,' Emma whispered. 'Do the best you can.'
'Of course.' The surgeon gripped her shoulder briefly. 'I'd be stupid to tell you not worry too much but remember that we're all on your side. On Mickey's side.'
Emma was taken to the relatives' room and a nurse stayed with her. It was then that she realised how much worse this all was because Tom was not nearby any more. She hadn't thought to ask for his company in the stress of moving Mickey to CT and now he'd been left well behind.
Maybe he'd had to go out on another call. Emma had no idea of the time any more. Of when Tom's shift might be due to finish or when Mickey might come out from the ominous space that the operating theatre represented.
The passage of time also seemed to be on the other side of that protective shield.
It had ceased to matter.
Tom had never checked his watch so often.
He hung around for as long as he could in the emergency department, fussing over paperwork and cleaning gear, hoping for some news about Mickey's CT scan.
'We really need to get back to base,' Josh finally said.
'Control knows where we are. I need to find out what's happening with Mickey.'
'Do you want to stay? Maybe you should be up there with Emma.'
He should. Of course he should. But Emma hadn't said anything about wanting him to be with her. What had happened between her and Simon prior to the dreadful accident? What understandings might have been reached regarding Simon's involvement in Mickey's life? In Emma's life?
And Simon was the person she needed with her at the moment. He was the one who was in a position to really help Mickey and that was what mattered the most.
'I'll come back as soon as we're off duty,' Tom told Josh. 'It's only a couple of hours away. It might take that long to get Mickey to Theatre in the first place and it'll be a whole lot longer before he gets out.'
Josh gave him a sympathetic, light punch on his shoulder. 'Maybe you should take tomorrow off. You won't be a whole lot of use at work when you're this
worried, mate.'
Tom nodded slowly. What excuse had Emma given that time she'd run away from work due to emotional stress? A family emergency?
That was what he was facing now. This was a crisis. And Emma and Mickey were his family.
Or they would be, if there was anything Tom could do to influence the winds of fate.
He found Emma in the relatives' waiting area adjacent to Theatre. She was sitting so still and looking so drained that all Tom wanted to do was to gather her into his arms.
Something made him hesitate. The quiet greeting and look Tom received advertised a distance to Emma he'd never sensed before. It felt like he was looking at the shell of the woman he loved, sitting there, and the real Emma was locked away somewhere he couldn't touch.
Why?
Did she not want him there? Had she already started the process of disengaging from their relationship because she'd had an offer that was so much better— for Mickey, if not herself?
Tom might have tried to push gently through that barrier anyway but for the curious gaze of the nurse in the room and the fact that Simon entered the waiting area just after Tom.
The surgeon was still wearing the disposable head covering and bootees required for Theatre and his mask dangled with only the top string having been snapped clear.
'We're nearly there,' he informed Emma. 'It's all gone as well as we could have hoped. Intracranial pressure is within normal limits and all vital signs are stable. You'll be able to see him soon.'
Emma nodded at Simon but didn't smile.
Simon nodded at Tom as he left the room again. He wasn't smiling either.
Tom sat down beside Emma. It was a poor second best to take hold of her hand instead of her whole body, but the feeling of being shut out and helpless was even stronger now and touching Emma was a hell of a lot better than doing nothing at all.
Tom could understand why everyone was so grim. He had never felt less like smiling himself in his whole life.
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