The golden hour—the hour most critical in determining the outcome for the patient—was utilised to the full for Maria. Despite her appalling injuries, as the fluids were poured in and oxygen delivered, she began to moan.
From the firefighters’ accounts and the police officers’ initial assessment, the skid marks on the road indicated Maria had struggled desperately to regain control of the car. When it had crashed the nature of her injuries suggested that she had put up her hands instinctively to shield her face, and in doing so she had protected her airway too. Still, she was being closely monitored by the anaesthetist, delivering high-concentration humidified oxygen as well as generous amounts of morphine, ready to intubate earlier rather than later if her airway declined. The paramedics had managed to insert one IV at the scene, but it was insufficient for the volume of fluids required and further access proved impossible. Instead, Angus delivered the vital fluids she desperately needed via intra-osseous infusion. This was a quick procedure, which needed strength to execute and involved puncturing the bone and delivering the fluids straight into the bone marrow. As Angus did that, Imogen, with great difficulty, inserted a catheter, and watched with mounting unease as Maria’s urine output dropped down to zero.
‘Can we roll her again?’ Angus ordered, and with Heather’s help Imogen gently held Maria on her side as Angus, assisted now by a fellow emergency consultant, examined her.
‘It’s OK, Maria…’ Through it all Imogen spoke to her patient, focussing on her face, actually trying not to look at anything else. ‘The doctors are just taking a look at you.’
As Maria groaned, Angus nodded and gestured impatiently, telling them they could roll her back. This time neither Heather nor Imogen took any offence at his brusque manner.
‘Can I leave you for five minutes?’ Heather pulled off her gloves and cursed the ringing phone on the wall and the doctor calling her from the other side of the curtain. ‘Press the emergency bell if you need anything at all.’
Now that the patient was relatively more stable, another RN was floating between two patients and assisting where she could, but, for the most part, Imogen was nursing Maria one on one.
Angus now confirmed that most of the burns were full thickness—the most severe kind. It took everything Imogen had to deliver a smile as for the first time and just for a second Maria’s eyes briefly opened.
Imogen lowered her head nearer to the patient’s. ‘It’s OK, Maria, you’re in hospital, we’re looking after you.’ It was all she got to say before Maria’s eyes closed again.
He’d apologise to Imogen again.
Talking on the telephone to a burns specialist at another major London hospital, and taking a quick swig of water as he did so, Angus looked over and saw Imogen pause for a second to lower her head and talk to the unconscious patient again. She’d done this every couple of minutes or so since Maria had arrived in the department and Angus knew it would be helping as much as the morphine if Maria could hear her.
Angus was proud of the team he had helped build at this hospital, considered them absolutely the best, and yet there was no one who could have done better than Imogen had this morning. Through it all she had been quietly efficient. Everything he had needed had been handed to him and not once had she flinched in assisting Angus in a procedure so vile that even an intern, who had asked to observe had at one point had to walk out.
A vile procedure in a vile, vile morning.
When the burns consultant, Declan Jones, arrived Angus ushered him over to the far wall to discuss the patient privately in greater depth. The stench in the warm room matched the loathsome diagnosis that Angus was just so reluctant to come to.
‘I respect your opinion, Declan…’ As Imogen walked over to the huddle she could hear the restraint in his voice. ‘More than respect it—you know that…’
‘She’s talking,’ Imogen said.
‘Is she orientated?’ Angus asked, swallowing down a sudden wave of bile.
‘Fully. She’s Italian, but her English is very good, though she has a strong accent. She’s struggling obviously, but she’s conscious now. She’s confirmed that her surname is Vanaldi. Her husband Rico was the passenger in the car.’ He watched those blonde eyelashes blink a couple of times before she continued. ‘She has a son called Guido, he’s fifteen months old and at day care…’
Till this point information had trickled in in dribs and drabs. The police had managed to ID the vehicle and registration, which had given them an address. They had then been and spoken with neighbours and were now on their way to the day-care centre her child was attending.
‘That matches what the police said,’ Angus nodded. ‘Are there any other relatives we can call?’
‘She said not.’
‘There must be someone!’ Angus insisted, because there just had to be. Maria was a young woman, for goodness’ sake, with a child, and she’d just lost her husband. She couldn’t be expected to face this alone. ‘She needs someone with her.’
‘I’ll ask her again.’
‘Is there any urine output yet?’ Angus called as she walked off, his jaw clenching closed when she shook her head.
‘Still zero.’
Usually it was good news that the patient was talking. For a patient so ill to now be alert and orientated, in practically every other scenario it would be reason to cheer, but not today.
Maria Vanaldi had awoken probably to be told that she would inevitably die—her calamitous injuries simply incompatible with life.
And it was Angus who would have to be the one to tell her.
‘Is there anyone else I can discuss this with?’ It was always exquisitely difficult, questioning a colleague, one who actually specialised in the field and whose expertise Angus had called on, but etiquette couldn’t really come into it and Declan understood that.
‘I’ll give you some names.’ He let out a sigh. ‘Though I’ve already called two of them. I’m sorry, Angus.’
‘There’s an older brother,’ Imogen stated as a policeman came over, clearly just as drained from it all as the rest of them, and his news wasn’t any more cheering.
‘We’ve contacted the day-care centre, they’re open till six tonight. The husband’s the only other point of contact on their forms.’
‘Bring the child to Emergency,’ Angus interrupted. ‘She’ll want to see him and hopefully we’ll have some relatives arriving soon.’ He turned to Imogen. ‘You say that she’s got a brother?’
‘He’s her only relative.’ Imogen gave a troubled nod. ‘But he’s in Italy and Maria doesn’t know his phone number. She says it’s on her mobile, which is in the car…’
‘Can I talk to her?’ the police officer asked. ‘We can enter the house and go through her phone book or whatever to try and locate the contact number for him, but it would make it quicker if she could tell us where to look.’
Angus shook his head. ‘I’ll talk to her.’
He approached the bed and smiled into two petrified eyes. ‘Hi, Maria, I’m Angus, I’m the doctor looking after you.’
‘Guido!’
‘Your son?’ Angus said. ‘He’s being taken care of.’
‘He’s at day care.’ In the few minutes since he’d left her side, Maria’s degree of consciousness had improved, but even generous amounts of morphine couldn’t dim her anguish as adrenaline kicked in and her mind raced to recapture her world. ‘He will not know! They will not know…’
‘We know where he is,’ Angus said gently. ‘The police have contacted the day-care centre and are bringing him in here. You’ll be able to see him soon.’
‘He’s not well…’ She was choking on her tears, each word a supreme effort. ‘He has a cold—I should have kept him at home…’
If only she had, Imogen thought, then checked herself. It was a futile exercise, one patients went through over and over when they or their loved ones landed in Emergency. The recriminations and the reprimands, going over and over the endless, meaningless decisions t
hat had brought them to that point and wishing different choices had been made. As Angus caught her eye for a moment, she knew he was going through it too—if only. If only she had left him at home, or left later, or earlier, or stopped for a chat, or not stopped…
It truly was pointless.
‘You couldn’t have known,’ he said firmly. ‘You couldn’t have foreseen this. This was not your fault.’
‘I wasn’t speeding…’ And Imogen watched as Maria thought things through. ‘Rico?’ Her eyes fled from Angus’s to Imogen. ‘How is Rico?’
‘Who’s Rico?’
‘My husband.’
‘Was he in the car with you?’ Angus checked, because he had to.
‘How is he?’
And then came the difficult bit, where he had to tell this young woman that there had been another fatality in the car. It was hard when the identity hadn’t been confirmed, hard because there was absolutely no point in giving her false hope, and he delivered the brutal news as gently as he could, watching as her shocked, muddled brain attempted to decipher it then chose not to accept it.
‘No.’ Her denial was followed swiftly by anger, her Italian accent more pronounced, her eyes accusing. ‘You’ve got it wrong. It might not be him.’
‘Someone needs to be here for you.’ Angus said, choosing not to push it. ‘Imogen said you have a brother in Italy. Are there any family or friends closer?’
‘Only Elijah.’
‘What about Rico’s family?’
‘No!’
‘OK.’ She was getting distressed, alarms bleeping everywhere, and he hadn’t even told her the hardest part. ‘The police are near your house, they can break in and get your brother’s phone number. Do you know where it would be?’
‘No…’ She closed her eyes, swallowed really hard and then gave an answer that only a woman could understand. ‘By the phone—but it’s a mess.’
‘Is it in a phone book?’
‘The place is a mess.’ Angus frowned just a fraction. People’s bizarre responses never ceased to amaze him. Here she was lying in the Resuscitation bay, her husband was dead and she was worried that the house was a mess.
‘You should see my place,’ Imogen said as she watched Angus’s expression, her calm voice reassuring the woman. ‘I can promise you that they’ve seen worse. In fact, I can promise you that they won’t even notice the mess. They won’t even bat an eyelid.’
It had taken him a moment to get it, but he realised then that it was easier for Maria to focus on the pointless for a moment.
‘It’s a mess…’ The morphine was taking over now, or maybe Maria just didn’t care any more as she closed her eyes.
Despite the closed eyes, still Imogen chatted easily to her and Angus could see they had already built up a rapport, which Maria was going to need. ‘Just tell me where the number is—his name’s Elijah. What’s his surname?’
‘My surname…’ Maria answered.
‘Have you got a lot of pain still?’ Imogen checked, turning up the morphine pump as soon as Maria nodded wearily. ‘We’ll keep turning it up till we get on top of it.’
Sometimes, Angus thought to himself, you had to face up to facts. As he desperately did the rounds on the telephone, calling as many people as he knew to ask for a second opinion or for some objective advice, Angus realised that, despite extenuating circumstances, despite supreme effort, despite so much potential and no matter how much he didn’t want it to be so, Maria’s life would soon fail.
‘Her lactate levels alone will kill her.’ Imogen met him at the soft-drink machine in the corridor. Heather had taken over for five minutes, giving Imogen a chance to dash to the loo and to get a quick drink. ‘You haven’t got any change for the machine?’ he asked as he ran his hand through his hair.
Imogen emptied her pockets, handing over some coins, and he popped them into the machine, too distracted to ask what she wanted and she too distracted to care. He punched in the same number twice and they gulped icy, fizzy, sweet orange which proved a great choice, sitting in a relatives’ interview room for a couple of minutes, before heading back into hell.
‘Would you want to know?’ Angus looked over to Imogen. ‘I want to give her hope—I mean, we’ll follow the burns protocol, she’ll go up to ICU, but…’
‘They moved here from Italy two years ago apparently.’ Imogen didn’t immediately answer his question. ‘The neighbours told the police that they kept themselves pretty much to themselves. They found the brother’s number too…’ Her voice trailed off as she thought about it, really thought about it, and Angus waited. ‘Yes,’ she said after the longest time. ‘I’d want to know, I’d want to use whatever time I had to make arrangements for my son.’
‘Me, too.’ He rubbed his hand over his forehead and Imogen could see his agony, could see the compassion behind the rather brusque facade, and knew that this was tearing him up too.
‘A little bit of hope is OK, though,’ she added.
‘There’s going to be no Christmas miracle here.’
‘I know.’ Imogen nodded. ‘But Maria’s not me and she’s not you and if she doesn’t want to know…’
‘I’ll play it by ear.’ He stood up, turned to go and then paused. ‘Thanks, by the way.’ They both knew he wasn’t thanking her for the drink. ‘I’ll go and ring the brother,’ Angus said, grateful that she didn’t wish him luck, grateful that she just nodded. ‘God, I hope he speaks English.’
‘I’ll send someone to get you if there’s anything urgent.’
‘Thanks.’
Ringing relatives was never easy and Elijah Vanaldi proved more difficult than most. Hanging up the phone, Angus dragged his hand through his thick mop of hair and held onto it, resting his head in his hand for the longest time, trying to summon the strength to face the most difficult part of this vile day: to tell the beautiful, vibrant woman herself that her life would soon be over—that not only had her son lost his father but that, in a matter of, at best, hours, he would lose his mother too.
He flicked off the do-not-disturb light and almost instantaneously someone knocked at the door to his office. Imogen’s face was grim as she stepped into the unfamiliar terrain and Angus wondered whether or not it would even be necessary to tell Maria now.
‘She knows…’ Swallowing hard, Imogen’s pale blue eyes met his. ‘She knows that she’s dying.’
‘You told her?’ Angus barked, his voice gruff. It was his job to do that, and as much as he was dreading it he wanted to ensure that it was done right, but as Imogen shook her head, he regretted his harsh tone.
‘Of course I didn’t tell her—I’m not a complete idiot!’
And just because they were both snapping and snarling, they knew that there was no need for either of them to say sorry. In the short but painfully long time they’d worked together, they’d already built up a rapport.
‘Maria worked it out for herself,’ Imogen explained, and he watched as she chewed nervously on her bottom lip for a moment before continuing. ‘She said “I’m going to die, aren’t I?” And I didn’t tell her she was wrong, I simply told her that I’d come and get you to talk to her. I’m just letting you know that she’s already pretty much aware…’
‘Thank you for telling me.’ He gave a weary smile. ‘You’ve been amazing this morning.’
‘Not bad for a foreigner?’ Imogen gave her own weary smile back, just letting him know that she’d heard all of his earlier complaint to Heather.
‘Yes, not bad.’ Angus smiled. ‘I guess we might have to keep you.’
‘How was the brother?’ Imogen asked, and neither smiled now.
‘Brusque, disbelieving, angry…take your pick. He’s on his way.’
‘That’s good…’ Imogen found herself frowning, and couldn’t quite work out why. Angus Maitlin had every right to look grim. As gruelling as Emergency was at times, this morning took the cake. Yet she could see the purple stains of insomnia under his eyes, the swallow of nervousness over his perf
ect Windsor knot, remembered the short fuse he had greeted her with, and knew there had to be more, knew, because she’d been there herself. ‘Gus could talk to her…’
‘Gus?’
‘The other consultant.’
‘I know who Gus is,’ Angus snapped. ‘Don’t worry, I can be nice when I remember. Look…’ He stopped himself then and forced a half-smile. ‘It’s just with it being Christmas and everything, my wife’s the same age…’
‘I know.’ Imogen nodded her understanding, but a smudge of a frown remained, not for her patient but for him.
‘Come on.’ Angus stood up. ‘Let’s get this over with.’
As they reached the nurses’ station, quietly discussing the best way to go about it, Angus became aware that Imogen had more insight into Maria’s personality than he did and absorbed her words carefully.
‘She’s going to be terrified for her little boy, for Guido and his future. I guess the main thing I’d want to hear is that—’
‘Angus.’ Heather’s interruption halted Imogen’s train of thought. ‘Gemma’s on the phone for you.’
‘Tell her I’ll call her back.’
‘She says that it’s urgent.’
‘It always is with Gemma,’ Angus snapped, and Imogen knew that he just wanted to get the unpleasant task of speaking with Maria over with. ‘Tell her I’ll ring her back when I can.’
‘She says that it’s to do with the kids.’
‘What’s the problem, Gemma?’
Imogen frowned as with a hiss of irritation Angus took the telephone. Of course Angus was busy, and of course he didn’t want interruptions, but if it had been Brad ringing to say there was something urgent going on with Heath, Imogen would have been tripping over her feet to get to the phone—no matter how busy she was at work.
‘What do you mean—you sacked Ainslie?’
Imogen’s glance caught Heather’s, and they both shared a slightly wide-eyed look.
‘The nanny!’ Heather mouthed for Imogen’s benefit.
One Magical Christmas Page 2