by Emily Forbes
But she needed to be careful. Last time she lost control she wound up pregnant.
But that thought still couldn’t wipe the smile from her face as she fastened her harness and strapped herself into her seat as she listened to the situation report.
He smiled back at her and she imagined the shadows in his eyes had eased a little.
She blushed and looked away, focusing on the information being dispersed.
‘We’re attending a two-car MVA,’ Rick said. ‘Paramedics and fire service are at the scene. There are four patients. Two victims trapped and unconscious, a third with minor injuries and a fourth is a pregnant woman, thirty-six weeks’ gestation, in cardiac arrest. Paramedics are giving ALS.’
Chloe translated the report in her head. Four victims of a motor vehicle accident: two status unknown, one conscious and mobile, one in a critical condition receiving advanced life support.
‘We’ll need to triage on arrival,’ Xander instructed. He was back to business.
Chloe knew the order of treatment would be determined by a few things. Whether or not the fire crew had managed to extricate the trapped victims and what injuries they had sustained. Whether or not the paramedics had managed to resuscitate the woman and, if they hadn’t, were they still trying or was she deceased. There were a lot of unknowns but this wasn’t unusual. The job this time though was complicated by the number of victims. They’d been told four but, in Chloe’s head, she was counting five. At thirty-six weeks’ gestation the baby was potentially a fifth casualty.
Nine minutes after take-off Simon banked the helicopter over the M25. Beneath them Chloe could see the accident site on one of the approach roads. Flashing lights of the emergency vehicles lit up the grey and drizzly day and bounced off the reflective panels on the uniforms of the emergency teams. Debris was strewn across the road and she could see the fire service still working on one of the crumpled cars, trying to free the victims.
Police had cordoned off the road and Simon brought the chopper down on the bitumen as Chloe pulled on a pair of gloves. Rick had the door open as soon as they touched down and Chloe, Rick and Xander grabbed their kits and sprinted to the scene.
A woman lay on a spinal board on a stretcher, two paramedics in attendance. Between them Chloe could see the mound of her pregnancy. The woman had been intubated and was being manually ventilated by one of the paramedics.
A pair of ambulances had stopped on the hard shoulder. In the back of one sat an older woman. She had a blanket wrapped around her shoulders as a third paramedic cleaned her head wound. Chloe wondered if she was related to the pregnant woman. Someone must have given the first responders some background information.
Xander paused beside the stretcher and Chloe heard him introduce himself.
‘What’s the situation?’
‘Thirty-year-old woman, thirty-six weeks’ gestation, suffered a cardiac arrest, non-responsive. I’ve administered three milligrams of atropine and eight milligrams of epinephrine via IV. Intubated on the first attempt and manual ventilation continuing. She has a head trauma, most likely the cause of the cardiac arrest, a facial cyanosis and an abdominal seat-belt hematoma. I’m concerned about an abdominal haemorrhage.’
‘We can do an abdominal ultrasound on board the chopper if she can be moved.’
The paramedics nodded and the woman was transferred to the helicopter. It took all of the first responders working in unison. Four to lift the spinal board while Chloe held the drip.
Xander cut through the woman’s clothing while resuscitation attempts continued around him. Her exposed belly was tight and drum-like. Chloe had the ultrasound ready. She handed Xander the transducer and squeezed the aqueous gel onto the patient’s abdomen.
There was a heartbeat but it belonged to the foetus.
‘There are signs of an abdominal haemorrhage but the bleeding has slowed.’
‘How long since ALS commenced?’ Xander asked as he wiped off the ultrasound gel.
‘Fourteen minutes.’
‘And the delay between the cardiac arrest and treatment?’
‘Several minutes.’
‘We could lose them both at this rate.’ Xander looked at Chloe. ‘Do we try to save one?’
She knew he was talking about saving the baby.
She nodded.
‘What are you going to do?’ Rick asked.
‘If you can continue ventilation, we can perform a C-section to deliver the baby.’
‘Here?’
It was Xander’s turn to nod.
‘Have you done this before?’
‘Once.’
Xander’s grey eyes were dark. Chloe suspected from his expression that the last time didn’t go so well. She hoped he’d learnt from the experience.
‘Are you okay to help me?’ he asked her.
She nodded. She was prepared to support him in this decision. She knew he wouldn’t be suggesting this option if he thought the baby would survive any other way. They may even be able to save both patients.
They pulled a fresh pair of surgical gloves on over the first.
Chloe tore open sterile packages containing surgical instruments and laid them on the seat beside her. She poured disinfectant liberally over the woman’s abdomen, spreading it across her skin.
Xander picked up a scalpel and made a deep incision, slicing through the woman’s abdomen from her umbilicus to her pubic bone. Blood was pooled in her abdominal cavity obstructing their vision. Chloe packed gauze into the abdomen, soaking up the blood, as Xander tied off an artery.
The blood was dealt with quickly and no more appeared. The woman remained unresponsive. Without a pulse she wasn’t able to bleed.
Xander had his hands inside the woman’s abdomen. He palpated her uterus, looking and feeling for signs of trauma.
Chloe knew he was making the right decision. If they didn’t deliver this baby they would have two fatalities.
‘The uterus is intact,’ he said but it didn’t remain that way for long.
Xander cut the uterus open and swiftly lifted the baby from the womb.
A boy.
He handed him to Chloe.
The whole procedure had taken less than four minutes.
‘No meconium, cord intact and free, placenta intact,’ Xander recounted while Chloe focused on her patient.
The baby was pink but flaccid. He wasn’t crying. Or breathing. He had no reflexes on stimulus and his heart rate was well below ideal at just sixty beats per minute. He had a one-minute Apgar score of three out of ten. He was not out of danger yet.
Chloe dried the baby, rubbing him vigorously to warm him up and hopefully stimulate respiration. When that didn’t work she wrapped him to keep him warm and prepared to suction his airway.
Xander was stitching the woman’s abdomen but she saw him glance over at her.
‘Do you need help?’
She nodded. ‘He’s not breathing. Pulse only sixty. Can you get ready to bag him?’
Xander ripped off his gloves before pulling on another clean pair. He grabbed a mask and attached the bag, placing the tiny mask over the baby’s face when Chloe removed the suction tube.
The baby’s heart rate remained low, despite the oxygen that was now being pumped into him.
‘Swap places with me,’ Xander instructed.
‘What are you going to do?’
‘Administer epinephrine.’
Xander didn’t bother looking for a vein on the tiny struggling baby. He used an intraosseous needle, injecting the drug directly into the bone marrow in the tibia in an attempt to stimulate his heart.
Chloe kept bagging the newborn, holding her own breath as she waited for signs of improvement.
The five-minute Apgar score was three points better. The heart rate was above one hundred and the skin was pink-coloured. The ref
lexes were still absent and there was no grimace but there was spontaneous, albeit irregular, respiratory drive.
Chloe relaxed slightly but monitored the baby closely as Simon flew them to the hospital.
It was a flurry of activity from the moment they touched down on the helipad. The neonatal team whisked the baby away to the neonatal intensive care unit and Chloe followed. He wasn’t her patient any longer but she needed to know he was going to be okay.
She waited while the neonatal team assessed the baby. It seemed wrong to leave him alone with no one to watch over him. His mother hadn’t made it—she’d been declared deceased on arrival—and Chloe’s heart went out to the tiny newborn who’d had such a traumatic introduction to the world.
Who was going to be responsible for this baby?
Her mind returned to the older woman she’d seen sitting in the back of the ambulance at the scene of the accident. She wondered where she was. Who she was. The grandmother? Had anyone told her what had happened to her family?
Chloe’s mind drifted to her own daughter. Who would be there for Lily if something happened to her? Her mother? Her brothers?
Her mother was a young grandmother but raising another child on her own at her age? Chloe knew she’d do it but it wasn’t right. And her brothers had their own lives to live.
Lily had a father. Chloe had Xander listed in her will. If anything should happen to her, she’d asked that he be found. But four years ago he hadn’t wanted a family. Had things changed? Would he want Lily now?
Her thoughts were maudlin. Triggered by the day’s events.
One life taken, one life saved. Chloe didn’t know whether it had been a good day or a bad day.
It could have been better.
It could have been worse.
* * *
By the time the baby had been checked and given a relatively good prognosis her shift had ended and she could go home. She was surprised to find she was still wearing her flight overalls. They were covered in blood—she must look a complete mess. She couldn’t leave the hospital like that.
She went upstairs to the air ambulance unit to change. Her hands were shaking as she stripped off the jumpsuit and tossed it into the laundry hamper. She stood still, gathering her thoughts, searching for the energy to turn around and go home.
She made it outside but couldn’t make it much further than a bench overlooking the river. Her vision was blurry and her legs were weak.
She sat, letting the London commuters flow around her as they made their way home. She needed to give her wobbly knees a chance to rest and her brain a chance to reset. Her thoughts were disturbed, her mind circling. She couldn’t seem to separate the baby’s fate from her own past.
‘Chloe, are you okay?’
She turned at the sound of his voice. Xander was standing beside the bench, his grey eyes shadowed, his brow furrowed with concern.
‘Not really.’ Her voice wobbled and her eyes filled with tears.
‘Is it the baby?’
She shook her head. ‘No, he’s okay, but the mother didn’t make it.’
‘I heard.’
Chloe wiped her cheeks with the back of her hand. Her face was wet with tears. ‘I’m sorry. I don’t know why I’m upset.’ But she did know. She was finding it hard to separate her life from their patients’ today. She wasn’t usually so affected by her work. By the tragedies. Normally she could compartmentalise.
Perhaps it had something to do with Xander’s reappearance. She’d found herself unsettled, off-kilter, for the past few days. Her personal and professional lives were colliding. And today’s events reminded her that she’d grown up without a parent and she’d put her daughter, Lily, in the same position.
‘Don’t apologise,’ Xander said as he sat down next to her. ‘Some jobs just get to us more than others.’ He wrapped his arm around her, completely unaware of the direction of her thoughts.
Chloe leaned into him. She fitted perfectly into his side.
‘You’re freezing. Come on, you need to get out of the cold.’
Despite Xander’s body heat she wasn’t warming up. There was a breeze coming off the river and the spring evening was getting chilly now that the sun was setting.
He pulled her to her feet but kept his arm wrapped around her.
‘Where are we going?’
‘To get you warmed up. My flat is about five hundred metres along the river.’
She didn’t argue. Her brain was too cold to stage a protest.
He walked on the river side of her along the Albert Embankment, keeping her sheltered from the wind, and guided her into a large, modern building overlooking the Thames. He kept her tucked against his side as they went up in the lift, almost as if he was afraid she would vanish if he let her go. He had no idea she was incapable of making any decisions at the moment. She had her eyes closed as she rested her head against his chest and listened to the sound of his heartbeat. Its steady rhythm was soothing, helping to settle her anxious mind.
She matched her steps to his, the thick carpet muffling their footsteps, as they crossed the corridor to his apartment. He swiped his card and held the door for her. A small entry foyer led into an open-plan living, dining, kitchen area on the left with, she assumed, a bedroom and bathroom to the right.
Xander switched on the lights and steered her towards a small couch. It was the only seating option aside from the dining chairs. She heard Xander flick the heating on and fill the kettle but her gaze was drawn to the bank of floor-to-ceiling windows. The apartment was modern, generic, impersonal but the view over the river was spectacular. She curled up on the couch and let her gaze wander over the London skyline. The Houses of Parliament, Big Ben and the London Eye were spread out before her as the city lights began to glow as dusk deepened.
Xander placed a mug of coffee on the table in front of her but poured a nip of brandy into it before he passed it to her. He placed a plate of sweet biscuits on the table and sat beside her.
The couch seemed even smaller once Xander was sharing it with her. His thigh brushed against hers as he sat down and Chloe was tempted to climb into his lap. She made conversation to fill the silence, which she felt was becoming a little awkward.
‘Did you notice the older lady at the scene of the accident?’ she asked as she wrapped her hands around the mug to stop the shaking. Her hands felt like blocks of ice and she wondered if she’d ever feel warm again. ‘The one who was in the back of the ambulance? Do you know who she was?’
‘She was the baby’s grandmother.’
‘I wonder if she knows what has happened.’
‘Is that what’s bothering you?’
‘Not just that.’ Chloe shook her head. ‘I’ve been wondering who is going to look after the baby. Does he have a father somewhere? Family. What if his grandmother is all he has?’
‘At least he’ll have someone.’
‘He should have a mother. Better yet, he should have two parents.’
‘We did everything possible, Chloe.’
‘I know that. I’m not blaming anyone. It’s just not the way things are meant to be.’
‘There’s absolutely no point worrying about things you can’t change. I learnt that lesson a long time ago.’
‘And I learnt the hard way that it’s better to have two parents.’
‘You did?’
Chloe nodded. ‘I grew up without my father. He died when I was seven.’
Xander wrapped one arm around her shoulders and pulled her against his side. He held her quietly and his touch was reassuring. ‘Do you want to tell me what happened?’
‘He was a policeman, killed while on duty.’
‘Oh, Chloe, that must have been tough.’
‘It was.’ She’d been angry at her father. He’d had an affair and had left her mother and his children. Chloe hadn’t bee
n able to understand how he could leave them all, how he could abandon her, and she hadn’t forgiven him. And then he’d been killed responding to an armed robbery and she’d never had the chance to forgive him. She couldn’t bring herself to tell Xander the full story right now; she still felt guilty about her anger. She didn’t mention that he’d already abandoned them, had already walked out on them all to move in with his girlfriend, when he was killed. She tried not to think about that. She tried to forget that he’d chosen to leave them. She didn’t subscribe to her mother’s theory that he had left her but not his children. Her father had made a choice and she’d been left behind. ‘Mum has raised us on her own.’
She had never told him any of this and talking about it now reminded her of how little they knew of each other. She had based her memories on a man who she’d possibly created in her imagination.
She went to sip her coffee and realised she’d finished it. She stared into her empty cup.
She was warming up but now she was restless. She jiggled her feet, making her knees jump up and down. She didn’t like talking about her past. She should go home but she was reluctant to leave just yet.
Xander reached over and took the mug from her hands, placing it on the coffee table. ‘You’re still cold.’ There was a small throw rug draped over the end of the couch. He pulled it towards him and wrapped it around her shoulders. She leant into him as he draped the blanket over her. She couldn’t help it. She was drawn to him. She’d always been drawn to him.
‘It’s the one thing I can’t get used to,’ he continued as he held her hands. ‘The cold. And the sense of space.’
‘That’s two things.’
‘So it is.’ He smiled and her feeling of hopelessness lifted.
‘How long have you been away for?’ she asked.
‘Four years. On and off. Before Wales I was in Canada and in South Africa before that. I’ve been home on a couple of occasions but I’ve been gone for over twelve months this time. I was thinking about heading home once I finished here but...’
‘But?’