by Kate Hardy
‘I’m glad you didn’t leave medicine,’ she said. She lifted her coffee cup and clinked it against his. ‘Here’s to teamwork. Welcome to Muswell Hill. And also you’d better be good at general knowledge questions, because Dani will be unbearable if the Maternity team actually beats us in the quiz.’
He smiled then. ‘Teamwork,’ he echoed.
* * *
The emergency department team was victorious in the quiz, and Sam teased Danielle mercilessly about it the next morning when he met her and Hayley in the park for training. By the end of the next week, he felt completely part of the team and as if he’d worked at Muswell Hill Hospital for years instead of a fortnight.
But then he called in his next patient. ‘Pauline Jacobs?’
She was middle-aged, overweight, and her face looked almost grey. ‘I haven’t been feeling well for the last few days,’ she said. ‘I know I shouldn’t be bothering the emergency department, but I couldn’t get an appointment with my doctor for another couple of weeks, and the pharmacist told me to come here.’
‘You’ve done the right thing,’ he reassured her. ‘I’m Sam Price. May I call you Pauline?’
‘Of course.’
‘Tell me about your symptoms, Pauline,’ he invited.
‘I’m just so tired,’ she said. ‘I’d say I had the flu, but you don’t get flu at the end of September, do you?’
He went cold.
No.
Not again.
‘It’s not common,’ he said. ‘So you’re suffering from extreme tiredness and feeling fluey.’
‘And I’ve been getting dizzy,’ she said. ‘Plus I’m out of breath just going up one set of stairs—by the time I’ve got to my desk on the second floor at work, I need a sit-down. I know I need to lose weight and I ought to go to the gym and get fit, but between teenagers and my job I don’t get a second to myself. I haven’t got time to do exercise.’
He was pretty sure he knew where this was going. ‘Are you taking any medication?’ he asked.
‘Statins for my cholesterol, blood pressure tablets, and my diabetic tablets.’
‘Have you been diagnosed diabetic for long?’ he asked.
‘Three years. I do watch what I eat, I really do, and I even turn down cake when people in my department bring them in for birthdays—but it’s so difficult to lose weight.’
Especially when she was heading towards the menopause and had a battery of hormones to contend with as well. ‘I think,’ he said gently, ‘you’ve had a heart attack.’
‘But wouldn’t I get chest pain?’ Pauline asked, looking puzzled. ‘When you see someone on the telly have a heart attack, they clutch their chest and everything. I’ve had a bit of indigestion, but that’s my fault because I know garlic does that to me.’
‘What I think’s happened is something called a silent heart attack,’ he said. ‘And they’re quite common—about a quarter of all heart attacks in the UK are silent. You’re diabetic, so I take it your doctor talked to you about being careful about foot care?’
She nodded.
‘That’s because diabetes can cause nerve damage and the usual pain warning signals aren’t transmitted,’ he said. ‘So the same reason you might not feel any problem with your feet is the same reason why you didn’t feel any chest pain. I’m going to check your blood sugar levels and then give you an electrocardiogram—an ECG—which measures the electrical activity of your heart. It doesn’t hurt,’ he reassured her. ‘I’ll just stick some flat metal discs to your arms, legs and chest, and the wires will send all the information I need to the machine. Is that OK with you, Pauline?’
‘Yes,’ she said.
Pauline’s blood sugar level was sky-high. He showed her the reading. ‘You’d normally be after a reading of four to six.’
‘But that’s over twenty!’ She bit her lip. ‘I haven’t been stuffing my face with cakes and sugar, honestly I haven’t.’
‘Stress and illness can make your blood sugar level rise,’ he said. ‘I’m going to give you some insulin to bring your blood sugar level down, and then we’ll look at the ECG.’
The printout from the ECG showed him exactly what had happened. ‘OK, Pauline. There’s some good news, and some not so good news,’ he said.
‘Tell me the bad stuff first,’ Pauline said with a grimace.
‘You’ve had a silent heart attack,’ he said. ‘But the good news is that it’s what we call an NSTEMI.’
‘Which is?’
‘A non-ST segment elevation myocardial infarction,’ he said. ‘What that means is that it’s less serious than the other type. The supply of blood to your heart is only partially blocked, and that means a smaller section of your heart will be damaged. I’m going to admit you to the cardiac ward,’ he said, ‘and they’ll give you some blood-thinning medication to make sure no clots develop and cause a more serious heart attack. They’ll also do some blood tests to measure if a special protein called troponin shows in your blood—which I’m pretty sure it will, because those proteins go into your blood if there’s any damage to your heart. They’ll give you a special scan called an echocardiogram, which shows a picture of the inside of your heart so they can see which areas have been damaged and how it’s affected the way your heart functions. And they’ll also want to check if your arteries have narrowed slightly.’
‘What happens if they have?’ Pauline asked.
‘They can give you something called an angioplasty. It’s where they put a little tube called a balloon catheter into an artery in your groin or arm, which goes through your blood vessels and up to your heart, guided by X-ray. The tube goes into the narrowed section of the coronary artery, then they inflate a little balloon at the end of the tube to open the artery, and put a bit of flexible metal mesh called a stent into the artery to help keep it open.’
‘And that fixes every—’ She stopped mid-word.
One look told Sam what had just happened.
History was not going to repeat itself. He wasn’t going to lose Pauline Jacobs to a silent heart attack. He wasn’t going to lose another patient to a silent heart attack ever again.
‘Crash team!’ he yelled, and hit the button.
He moved the back of the bed so Pauline was lying flat, gave two rescue breaths, and started chest compressions. When he’d counted to thirty, he checked Pauline’s airway and gave two rescue breaths, then went back to chest compressions.
By the time he’d done the second set of thirty chest compressions, the team was in place, the defibrillator and pads were attached to Pauline’s chest and Hayley pronounced, ‘She’s in VT.’
‘We need to shock her,’ he said. ‘I’ll keep doing the compressions until you’re ready to defibrillate her.’
‘Charging,’ Hayley said.
He continued with the compressions.
‘And clear,’ Hayley said.
He moved his hands so she could give the shock, then went straight back into the rhythm of thirty compressions and two breaths.
‘Still VT,’ Hayley said. ‘Charging again. And clear.’
The second shock made no difference. Neither did the third.
‘We are not losing her. Keep going,’ he said. ‘Adrenaline and amiodarone.’
‘Drawing them up now,’ Darryl, one of the nurses, said.
Sam continued with the compressions while Hayley administered the medication.
‘Darryl, can you take over compressions?’ Hayley asked.
‘No,’ Sam said. ‘I can keep going.’
‘Sam,’ she said, her tone gentle yet firm.
‘No,’ he said. ‘I’m not losing her.’
‘Which is why you’re going to let Darryl take over the compressions and you can do the next shock. Your arms are tired. Darryl will be more effective.’
He knew she wasn’t playing power games, just being sensible—and because he’d told her what had happened in Manchester, he also knew that she was well aware of how this was affecting him. She was right to make him back off a bit. If their positions had been reversed, he would’ve said exactly the same.
‘OK. Sorry.’
‘No problem.’
‘Charging,’ he said. ‘And clear.’
This time, to his relief, the defibrillation worked and Pauline’s heart went back into a normal rhythm. She was still unconscious, but at least her heart was beating again.
‘All righty. Well done, team,’ Hayley said. ‘You know the drill—Sam, let’s get her on oxygen and a twelve-lead ECG. Darryl, call the cardiac unit and get her admitted. And then, Sam, if you can go with her to the CCU and do the handover?’
‘On it,’ Sam said.
‘Me, too,’ Darryl added.
‘Are you OK?’ she asked Sam gently when Darryl had left the cubicle.
‘I’m fine.’ He wasn’t, but he had no intention of admitting how much this had shaken him and brought all his doubts back.
She squeezed his shoulder. ‘Come and find me if you need me, OK?’
‘Thanks.’
Once he’d done the handover at the cardiac unit, Sam was back in the thick of things—a teenager with abdominal pain that turned out to be a navel piercing that had become infected, a runner who’d been caught in the eye by a branch and had a scratch across his cornea, and a toddler with febrile convulsions.
At the end of his shift, he went to check on Pauline, who was lying in bed but was conscious.
‘Thank you,’ she said when she saw him. ‘I believe you saved my life.’
‘Not just me—the rest of the team saved you, too,’ he said. ‘How are you feeling?’
‘As if a tank rolled over me,’ she admitted.
He grimaced. ‘Sorry. I’m probably responsible for the bruises on your chest. I did the compressions and I might’ve been a bit too enthusiastic.’
‘If you hadn’t done them, I wouldn’t be here now.’ Her eyes filled with tears. ‘And I thought it was just something stupid wrong with me and I should’ve just put up with it instead of coming to hospital.’
‘I’m glad you came in and didn’t leave it,’ he said. ‘You’re in the right place.’
‘They’re going to do that thing with the balloon you were telling me about.’
He smiled. ‘I’m impressed you remembered, considering you conked out in the middle of it. I know I can drone on a bit, but I don’t normally make people unconscious.’
She laughed, then winced. ‘That hurts.’
‘Give it a little time,’ he said. ‘But I just wanted to see how you were doing.’
‘I’m still here, thanks to you.’
‘Good.’ He hadn’t been able to save his patient in Manchester from that silent heart attack, but he’d saved Pauline Jacobs. And that went some way to making things better. ‘I’ll let you get some rest.’
When he got back to the staffroom of the emergency department, Hayley was leaning against his locker. ‘Well, hey there. How are you doing?’
‘I’m fine,’ he lied. It felt as if someone had pulled a plug and he was almost drained right out. But he’d promised to help her with the running training. He and Dani had agreed that she’d do the indoor sessions with Hayley, and he’d take the outdoor ones; tonight, they were planning to run a full 10K round the park.
‘Given the caseload you had today, I don’t think you are,’ she said. ‘I know how I’d feel if I had to deal with a case that reminded me of my worst day ever, so I’m pulling rank. No running training tonight. I’m cooking you dinner. It’s nothing fancy—just stir-fried chicken, vegetables and noodles—but it’s fast and it’s healthy.’
‘I’m not hungry.’
‘I don’t care. I’m cooking and you’re eating. And you can wheel your bike back to mine.’
‘That’s a bit bossy,’ he said, narrowing his eyes at her. Lynda had been bossy like that, too.
‘Yes, it is,’ she admitted, surprising him. Lynda wouldn’t have admitted to being bossy.
‘But sometimes, when you’ve had a rough day, you need someone just to push you to put one foot after the other,’ Hayley said softly.
‘But you’re meant to be training for the race.’
‘I’ll switch my training days round. It’s fine. Come on.’
Sam didn’t have enough left in him to protest. He just let her follow him out to the bicycle shed, unlocked his bicycle, and put one foot in front of the other to go back to her flat.
CHAPTER SIX
‘LUCKILY I’M ON the ground floor so you won’t have to haul your bike up two flights of stairs,’ Hayley said, and ushered him inside.
Sam left his bike propped against the wall, blocking her narrow entrance hall, and followed her into the main part of her flat. It turned out to be about the same size as his apartment in Reykjavik, with a bathroom, a bedroom, a living room and a kitchen that had an area to eat in. All the walls were painted cream and the furniture was light-coloured, making the place seem bigger and airier than it actually was. There were framed photographs on the mantelpiece in the living room, a big bookcase stuffed with an eclectic mixture of medical texts and novels, and a mix of photographs and postcards attached with magnets to her fridge. Everything was neat and tidy—pretty much as she was at work, he thought.
‘Can I do anything to help?’ he asked.
‘Yes, you can lay the table and sort out something for us to drink—there’s wine in the fridge if you want some, or there’s a jug of filtered water.’ She smiled at him. ‘London water isn’t exactly nice, and filtering makes it taste a little bit better. Or there’s a bottle of sparkling water in the cupboard, though obviously it won’t be chilled.’
‘Plain water’s fine, thanks.’
‘The cutlery’s in the drawer next to the sink, and the crockery and glasses are in the cupboard above it,’ she said.
‘OK.’ Strange how just the mechanical act of setting out cutlery and plates made him feel more normal. And he was pretty sure that Hayley knew that, which was why she’d given him the task in the first place.
She busied herself with the wok, and five minutes later they were both sitting at her kitchen table with a plate of food in front of them. He wasn’t hungry, but it would be rude to just leave it, so he forced himself to eat.
Only when they’d finished and she’d made them both a mug of coffee did he look at her and ask the question that had been bugging him since he’d accompanied her home. ‘You’re not making me talk about it?’
‘Nope.’
The question must’ve been written over his face, because she said gently, ‘There’s a time for pushing someone to talk, and there’s a time for giving someone space until they’re ready.’
That sounded like personal experience. No doubt to do with her fiancé’s accident. And hadn’t she said she knew how she’d feel if she had a case that was similar to the one in her worst day ever? But it would be way too intrusive to ask her what sort of case that’d be. Instead, he said, ‘Thank you.’
‘No problem. Now, your choice: would you like to listen to some music, or watch something really undemanding and fun on TV? Of course, if you really want to watch an in-depth documentary on the finer points of quantum physics,’ she added with a smile, ‘I’m sure we can find one.’
‘I think I’ll give the quantum physics a miss,’ he said. ‘But thank you. I really don’t mind.’ He probably ought to make his excuses and leave. But he really appreciated that she’d worked out what he really needed—what he hadn’t quite worked out for himself: space to let things settle in his head, and a bit of company so he couldn’t brood about it.
‘In that case,’
she said, ‘it’s my choice and you get to watch my favourite episode of Friends—the one where Monica puts a turkey on her head. And we’re having my posh chocolate biscuits with this, but don’t tell Dani because she’ll nag me about proper nutrition during race training and she’ll force me to eat one of those protein bar things that are full of dates and taste weird.’
‘I promise,’ he said. And he couldn’t help smiling when she sang along with the theme tune to the show and did the little claps. ‘You really love this, don’t you?’
‘It’s my favourite show ever,’ she said with a smile. ‘Which is why I’ve got it in a box set, in case it ever goes off my streaming service. Dani says I’m like Joey—I think a sandwich makes everything better.’
He laughed. ‘She might have a point.’
‘But it does. Or posh chocolate biscuits.’
‘I guess.’ And it was surprising how much better he did feel, sitting next to her on her sofa with a mug of coffee and Viennese chocolate fingers.
They somehow ended up moving closer during the TV show, and it seemed natural to put his arm round her. She leaned into him, and he turned his head so he could kiss her hair. She turned his head to look at him, and her pupils were huge; it seemed that the attraction between them in Iceland hadn’t gone away at all, for either of them.
When he looked at her mouth, he couldn’t resist dipping his head and brushing his mouth against hers. His lips tingled at the contact, and he wanted more. This time, when he kissed her, she kissed him back, and a shaft of pure need lanced through him.
Except he wasn’t being fair to her. When he finally broke the kiss, he whispered, ‘I’m sorry. I shouldn’t have done that. It’s been a hell of a day.’
She rested one hand against his cheek. ‘I know—but remember that you saved Pauline Jacobs, and it wasn’t your fault that you lost your patient in Manchester. If you have a silent heart attack, you don’t have a clue about the damage that’s been done to your heart, and if someone else had treated that patient in Manchester they would’ve ended up with exactly the same result that you did. It wasn’t your fault. As you said, the relatives were grieving and they needed someone to blame. You were exonerated.’