by Kate Hardy
‘But the fact Sam’s brought you in makes me think there might be more to it than that,’ Hayley said. She looked at Sam. ‘Anything you’d like to tell me?’
‘I didn’t have a stethoscope handy and I want to be sure there isn’t a pneumothorax,’ Sam said. ‘There’s bruising already around the area where he hit the side of the go-kart, and it’s tender. It hurts when he moves or breathes deeply. I know that’s standard for a cracked rib, but I just want to be sure.’
After Manchester, she thought, it wasn’t surprising that Sam was totally meticulous.
‘Do you think you have any shortness of breath,’ she asked Josh, ‘or have you had any pain near the shoulder?’
‘No,’ Josh said.
‘OK. I want to have a listen to your chest. Would you mind taking off your top?’ she asked.
‘Is that what it takes to get women to ask me to take my clothes off?’ Josh asked. ‘I have to break a rib?’
‘I’m asking,’ she said sweetly, ‘exactly the same question a male doctor would ask you.’
‘Spoilsport.’ He took off his top, and she winced as she saw the bruising.
‘That’s nasty,’ she said.
‘And it’ll get worse over the next few days,’ Josh said cheerfully. ‘I’m fine, Hayley. Really.’
‘Hmm.’ She examined him and Sam’s diagnosis was spot on, though she wasn’t entirely happy with Josh’s breathing. ‘X-ray for you,’ she said.
‘I really don’t nee—’ Josh began.
‘Yes, you do,’ she cut in gently. ‘Humour me on this one.’
‘But you’ve got all the clinical signs.’
‘Sometimes,’ she said, ‘your intuition tells you that there’s a problem—and at the advanced age of thirty-two I’ve learned to listen to my intuition.’
‘She’s right,’ Sam said. ‘Textbooks can’t teach you about hunches; that comes with experience.’
‘OK. X-ray it is,’ Josh said.
Hayley could see immediately from the X-ray result on her computer screen that Josh had a slight tear in his lung, caused by his broken rib; air escaping from his lung was trapped between his lung and the wall of his chest. By the time he came back to the emergency department, Josh was slightly breathless.
‘I was just running too fast to get you to sign me off,’ he said.
‘Nice try.’ She showed him the X-ray on her screen. ‘OK, Josh. Forget about my hunch. This is all textbook. If this X-ray belonged to one of your patients, what would you say?’
He sighed. ‘There’s a pneumothorax.’
‘And what are we going to do about it?’
‘Unless you have underlying lung disease,’ Josh said, ‘the tear in your lung will mend and the problem will resolve itself over a few days.’
‘And if you’re breathless?’ Sam prompted. ‘Which you are, right now?’
‘Then you need to remove the air.’ Josh wrinkled his nose. ‘I know this is going to sound stupid, considering how many times I’m on the other end of a syringe, but I hate needles.’
Hayley smiled and patted his shoulder. ‘You’ll be fine, sweetie. You know the procedure, which is probably putting scary pictures in your head because today you’re on the receiving end, but you also know I’ll give you a local anaesthetic so it’s not going to hurt. I can’t let you walk out of here struggling to breathe when you’ve broken a rib and got a pneumothorax from go-karting on ice.’ She gave Sam a sidelong look. ‘Perfectly safe, indeed,’ she mouthed.
‘Sorry,’ he mouthed back, looking guilty.
‘OK, Josh. Sharp scratch,’ she said, and administered the anaesthetic. She inserted a thin tube through Josh’s chest wall with the aid of a needle, then attached it to a large syringe with a three-way tap. ‘That’s the hard bit done,’ she said.
Josh grimaced. ‘I hate needles. But I guess you’re not so bad at this.’
‘Glad to hear it—though I’d also like to know if I need to brush up on anything, because I never want to hurt my patients unnecessarily. Not that I really want to use my team as test cases,’ Hayley said with a smile. ‘OK. I’m going to suck out some air into the syringe, release it through the three-way tap, and repeat until I’m sure that most of the air has gone. Happy?’
‘Happy,’ Josh said.
‘And while you’re there,’ Sam added, ‘we might as well test you on your knowledge of painkillers.’
Which was a brilliant way to distract the younger man, Hayley thought.
‘What would you prescribe to someone with a broken rib?’ Sam asked.
‘Paracetamol or anti-inflammatories, and if it’s moderate pain then you can alternate them two hours apart,’ Josh said, ‘or in really bad cases you need something stronger like codeine. And before I can prescribe anything at all I need to know if my patient’s a smoker, or taking any anti-clotting medication, has high blood pressure or asthma, or any history of heart or kidney disease or stomach ulcers,’ he said, ticking them off on his fingers.
‘Or if they’re pregnant, have a history of stroke, or they’re already taking aspirin,’ Hayley added. ‘That’s all absolutely right, Josh. Does any of it apply to you?’
‘No. Though I’d be really famous if I was pregnant,’ Josh said thoughtfully.
Hayley laughed. ‘You certainly would. OK. We’re done. Is the pain mild or moderate?’
‘Moderate,’ Josh said.
‘Take normal doses of paracetamol and ibuprofen. Alternate them two hours apart, just as you suggested,’ she said. ‘If the pain’s worse tomorrow, come and talk to me about codeine. Are you on shift tomorrow?’
‘Not until Tuesday,’ Josh said.
‘OK. Go home, take painkillers and rest,’ she said. ‘No heavy lifting. And I want to see you straight back here in which circumstances?’
‘If I get a high temperature, chest pain, I’m coughing up loads of gunge or I’m really short of breath,’ Josh said.
‘Good. Make sure you do. Off you go,’ she said. ‘And next time you want to do something exciting, please don’t listen to any suggestions from Dr I-Love-Taking-Stupid-Risks Price here.’
‘I won’t,’ Josh said.
‘I’ll give you a lift home,’ Sam said, ‘once I’ve grovelled a bit to Dr I-Told-You-So Clark, here.’
‘I’ll be in the waiting room,’ Josh said with a wary look, and disappeared out of the cubicle.
‘Go on, then. Say it,’ Sam said with a resigned expression on his face.
‘I don’t need to, because you already said it for me,’ Hayley said. ‘Poor Josh.’
‘If it makes you feel any better, I feel really guilty,’ Sam said.
‘All this putting yourself at risk... It doesn’t make sense, Sam. Why do you do it?’
‘Why are you so anti anything with the slightest bit of risk?’ he asked.
This was her cue to tell him the rest of it. The thing that held her back and scared her every day.
Because my fiancé used to risk his life every single day, and he died.
But here wasn’t the right place to tell him. ‘Can we have this discussion later?’ she asked. ‘I’m on duty and the waiting room’s full.’
‘All right. How about I cook us fresh pasta after your shift and we’ll talk then?’
‘That’d be good.’ And by then hopefully the hard lump currently sitting just above her breastbone would dissolve into the right words.
‘Your place or mine?’ he asked.
‘Yours,’ she said.
‘OK. I’ll see you at half-past six.’
* * *
At half-past six on the dot, Hayley rang Sam’s doorbell.
‘Can I get you a glass of wine?’ he asked.
She shook her head. ‘But I’d kill for a mug of tea.’
And he had a pretty fair idea was it was, given that she’d promised to talk to him about why she was so antsy about risk. ‘I’m sorry about what happened to Josh, Hayley. The last thing I wanted was for anyone to get hurt.’
‘It’s the last thing anyone wants,’ she said, ‘but it still happens.’ She left her mug of tea where he’d placed it on the coffee table. ‘And it leaves your life utterly crumpled in its wake.’
‘What happened to make you so scared of risk, Hayley?’ he asked softly.
‘Evan. My fiancé.’ She dragged in a breath. ‘He was a firefighter.’
And he’d been killed in an industrial accident.
Things started to become horribly clear. Sam had a nasty feeling that he knew exactly what she was about to tell him—that Evan had been trying to save someone from the industrial accident and had lost his life the process.
‘Evan risked his life every single day,’ Hayley said. ‘He’d done all the training. He was good at his job. He’d never, ever do anything reckless or put any of his crew members at risk. But, that particular day, there was a fire at a local garage and workshop. Obviously with it being a workshop, there was flammable stuff everywhere—oil, chemicals, all sorts of things that could make the fire so much worse. A propane cylinder exploded, and the fire crew managed to get two more of the propane cylinders out before they went up. But then someone said the boss had had gone back in five minutes before to rescue his cat and her kittens from the office on the mezzanine floor, and nobody had seen him since. Evan thought the guy had probably keeled over from smoke inhalation, so he went in after him.’ She shuddered. ‘And the building collapsed when Evan was halfway up the stairs to the mezzanine floor.’
No wonder Evan hadn’t survived, Sam thought.
‘The last propane cylinder was right beneath where he was when the building collapsed, and it exploded. Evan was killed instantly.’ She choked on a sob. ‘At least, I hope it was instant. I hope he never knew what happened, that he never felt even the slightest bit of pain or knew what was happening to him.’
‘I’m sure it was instant.’ Sam held her close.
And now a lot of things were clearer to him. Why she was so panicky about risk. Evan had taken a risk, going into a dangerous situation to save someone from smoke inhalation, and it had gone tragically wrong.
‘He was one of the good guys. Everyone loved him. Evan was the sort who’d do anything to help anyone.’ She looked Sam straight in the eye. ‘He was a lot like you. He put himself in danger to help others, just like you do. Except you do all the dangerous sports stuff as well. And I can’t cope with that, Sam. You love it and I feel like the world’s most miserable cow, holding you back from doing something you enjoy. It isn’t fair of me. But it scares the hell out of me, Sam, and I’m so tired of being scared. Of worrying that I’m going to lose you, the way I lost Evan. And I just can’t understand why you do it. Why you put yourself in danger all the time.’
He stroked her face. How could he make her understand that it didn’t have to be that way? That not all risks meant there would be a tragedy?
‘I’ve always liked extreme sports,’ he said. ‘I suppose it’s the adrenaline rush—it makes me feel alive.’ And he’d really needed that feeling after he’d been suspended, because it meant that he was feeling something other than as if he’d been sucked into the middle of a black hole. ‘I used to go climbing with my dad and Martin right from when I was small, because we lived near the Peak District and Dad loved climbing. So did my granddad. I think it’s in my blood. So when I was old enough, it just made sense for me to join the mountain rescue team. And I never once had a problem on the team when I was on a rescue, not even something little like a twisted ankle or a scratch or a bruise.’
‘Don’t you think of the risks when you go out?’ she asked. Her voice was calm, but he could see the anguish in her eyes. ‘That you could fall? That a cliff could crumble beneath you without any warning and you’d end up breaking your neck at the bottom?’
He wanted her to understand that he wasn’t just being a thrill-seeker. ‘I do,’ he said, ‘and that’s why I’m careful to use the right safety procedures on a rescue, and why I only use companies that have good safety records for the leisure stuff. And, yes, I know Josh cracked a rib today at the go-karting, but...’ He stopped.
‘But?’
He winced. ‘Now you’ve told me what happened to Evan, I don’t know if I can say it to you.’
Her eyes widened. ‘Try me.’
‘I don’t want to make you feel bad.’
‘Say it anyway.’
‘OK. But remember you asked me to tell you what was in my head.’ He took a deep breath. ‘Sometimes, no matter how well you plan something, accidents just happen and you can’t second-guess them. That’s why our department exists in the first place. Accidents happen.’
She just looked at him as if her heart was breaking.
He stroked her face. ‘I’m sorry Evan died. But there are always risks in everything you do, Hayley. You might be crossing the road or walking in the middle of a park. You can’t guarantee that you won’t be hit by lightning, or that a branch from a tree won’t give way unexpectedly and fall onto your head, or that someone’s foot won’t slip and hit the accelerator instead of the brakes and a car will crash into you.’
‘But the chances of those kinds of things happening are so small. Whereas putting your life on the line over and over and over again,’ she said, sounding anguished, ‘whether it’s at work or what you do for fun—it’s not a matter of if something happens but when.’
‘But if nobody goes to rescue people in an emergency,’ he said, ‘then people will die when they might have been saved.’
‘I know.’ She looked miserable. ‘And I feel guilty about that too. I’m being selfish. But when I lost Evan it was as if I’d been sucked into a black hole. I don’t want to be in that position again.’
‘Would I be right in saying that Evan loved his job?’ Sam asked softly.
She nodded. ‘He’d always wanted to be a firefighter, right from when he was small. He loved what he did. He was good at it—whether it was putting out a fire, or rescuing someone from a broken lift, or cutting a car open so the emergency services could get the casualty to safety, or talking to kids at school... He absolutely loved it.’ A single tear leaked down her cheek. ‘And he died, Sam. He was killed on duty.’
He wiped the tear away with the pad of his thumb. ‘I’m so sorry that you went through this. And I wish there was something I could do or say to make it better. But I can’t bring Evan back.’
‘I know. And I just...’ She swallowed hard. ‘I’m sorry.’
‘Don’t be. I’m glad you’re talking to me.’ And what a hypocrite he was—he’d told her next to nothing about Lynda. ‘At least now I understand why you’re so wary about risk.’
‘And you’ve signed up for the MERIT team.’
‘Yes, though I’m sure you already know that the MERIT team are only allowed into an area if it’s safe for them to treat patients. All the risks are monitored and kept under control as much as possible,’ he said gently. But he also knew that it wouldn’t be enough for her. Not now she’d lost Evan to his job. ‘If you want me to withdraw my name from the team, then I will.’
She shook her head. ‘I can’t ask you to do that.’
‘You’re not asking. I’m offering,’ he said.
‘And you’ll regret it. You’ll start to feel that I’m holding you back and you’ll resent it. In the end, it’ll come between us,’ she said.
Maybe she had a point. His mountain rescue work had certainly
come between him and Lynda. Then again, Lynda hadn’t given him a decent reason to give it up. Only that she’d wanted him to join some tedious committee or other instead because it’d be more high-profile and look better on his CV. In Sam’s view, that wasn’t enough.
‘Did you ever tell Evan how much his job worried you?’ Sam asked.
‘No. Because, actually, it didn’t worry me. I used to be able to accept the risk. I suppose I thought the worst would never actually happen because I knew he was always careful.’ She dragged in a breath. ‘But the worst did happen. And now the fear gets in the way.’
‘What would he say,’ Sam asked carefully, ‘if he was here now and you told him that his job scared you too much?’
‘Pretty much what you did,’ she admitted. ‘And I’m not seeing you as a replacement for Evan, or anything like that, Sam. You just happen to have some similar views on life. Only he didn’t do all the risky stuff for fun.’
‘I can tone that down, too,’ he said. ‘I admit, I did quite a bit more extreme stuff after I was suspended, simply so I had something else to focus on. Something that made me feel alive instead of just dragging through every day and waiting for someone to come up with a verdict. But I can tone it down now.’
She dragged a hand through her hair. ‘I shouldn’t expect you to change who you are for me. It’s wrong.’
‘But you lost Evan when he was doing his job in the emergency services. Of course you’re going to worry yourself sick whenever there’s a major incident, especially if I’m in the MERIT team that’s called out—and even more so if that incident happens to be a fire. I don’t want to put you through that.’
‘So either you stop doing it and you’ll start to resent me for holding you back, or you keep doing it and I’m frantic with worry every time you go out. There isn’t a middle way,’ she said miserably.
‘There could be a kind of compromise. Maybe if you come with me to some of the leisure stuff—well, possibly not to go-karting on ice,’ he amended, ‘but to do something with just a tiny bit of risk. Then you’ll see for yourself how safe everything is and it’ll stop you worrying.’