‘Diane? Diane, can you hear me?’ he asked softly, his lips close to her right ear. She gave another sighing moan, and then very slowly nodded.
He looked up at Shelagh with relief. ‘She’s recovering consciousness, so I don’t think there’s any serious head injury, just a badly fractured tibia and fibula, and multiple lacerations. And of course she’s badly shocked.’
‘And – her companion?’
‘DOA,’ he mouthed silently, and Shelagh experienced a hollow sinking of her heart. Dead on arrival. She thought of the suddenness with which this calamity had struck the busy arterial road. In just a few short moments of havoc death had claimed lives, and irrevocably changed others.
She watched while he whispered into Diane’s ear. ‘Don’t worry, Diane, you’re safe with us at Everham Park Hospital, and we’ll look after you. You’ll be all right, Diane.’ He turned to Shelagh. ‘Right, put on the tourniquet, let’s get that drip up and going.’
He inserted the cannula into a prominent vein on the back of the right hand, and then the end of the giving set was connected, and the flow adjusted to about thirty drops per minute.
‘Plaster,’ he said, and Shelagh cut off a length of micropore tape. As she handed it to him, Sister Oates put her head round the door.
‘Dr Hammond, will you go to Room One at once,’ she said without ceremony. ‘Dr McDowall has got three patients to attend to, and needs help.’
Shelagh nodded, and left Paul to attach the micropore tape to the tubing. ‘Sorry, I’ll have to go.’
‘Yes, don’t keep the great white chief waiting – and send me a nurse if you can find a spare one.’
As soon as she entered Room One, she felt the tension, and a smell of blood and perspiration rose to her nose and throat. Dr McDowall and a student nurse were cutting off the bloodstained trousers of a pale-faced man of about forty to forty-five, lying on one of two couches, and his wife sat beside him. Her face was streaked with tears and dirt, and a rough dressing above her right eye was held in place with a hastily applied bandage. On the other couch a girl of about eighteen writhed from side to side, gasping and moaning at intervals. Shelagh summoned up all her self-discipline and professionalism, and as if in answer to a wordless prayer, she experienced a certain sense of calm in the midst of havoc; she was a doctor, and this was where she was needed.
‘Right, Dr McDowall, what’s to be done?’
He looked up and smiled as if he were greeting her in the bar of The Volunteer.
‘Hi, Shelagh, you’re as welcome as a win on the pools. Meet Mr and Mrs Hartley, Alfred and Grace. They’ve been chucked around on the road quite a bit, and Alfred has lost a fair amount of the red stuff. Dear little Nurse Kitty here has been giving out tetanus jabs like free biros, and I want to get a drip going as soon as we’ve cleaned up Alf.’
‘Yes, I see. And the young lady?’
‘Ah, yes, that’s Cathy Hartley, their daughter who was with them in the car.’
‘Not Hartley, doctor, she’s my niece, and her name’s North,’ cut in Grace Hartley.
‘We haven’t any children, more’s the pity.’
‘Correction – niece. And if you could get some sense out of her, it would be a godsend, Shelagh. She’s either got internal injuries or a bad attack of the vapours, and I’m inclined to go for the latter.’
‘Cathy’s obviously in pain,’ said Shelagh, picking up the girl’s hand and feeling for her pulse.
‘If you mean that she’s throwing herself around as if she’s been stung by a hornet, you’ll find that her pulse and blood pressure are normal, and she won’t answer a single question. Could you calm her down for us, Shelagh? It would do us all a favour, because quite frankly I haven’t got time for an in-depth counselling session right now.’
Shelagh sensed his irritation and lack of patience with the girl as he reapplied himself to Alfred Hartley’s needs.
‘Kitty, me darlin’, hand me that Venflon cannula – keep still, Alf – there we are! We’ll get a couple of pints of blood cross-matched for you, but meanwhile here’s a nice drop of Everham Park Special Brew running in – OK?’
He adjusted the flow of intravenous glucose and saline solution, and Shelagh turned her back on the group to give all her attention to the girl.
‘Easy now, Cathy – ssh! Stop making that noise, and tell me where the pain is.’
The only response was an agonised grimace and an even louder groan as the girl clutched at her abdomen.
Shelagh looked down at her, and in a flash realised what was happening. She began to remove the girl’s stockings and knickers, and sure enough, there was fresh blood on them.
‘Did you know that you were pregnant, Cathy?’ she whispered in the girl’s ear.
‘No – I don’t know – oh! – I wasn’t sure – oh, help me!’
‘Keep calm, Cathy, and hold tightly on to my hand. You’re having a miscarriage. Be brave, now, it’ll all be over soon.’ Raising her voice she said, ‘Nurse, I shall need some ergometrine – will you go and ask Sister Oates for an ampoule from the OPD drug cupboard?’
‘Good God, whatever for?’ asked McDowall. ‘This is a multiple road-traffic accident, Shelagh, not the delivery unit – and I need Nurse Kitty to help me with these two.’
Shelagh spoke quietly and levelly to the student nurse. ‘Go and get me an ampoule of ergometrine, nurse – at once, do you hear me?’
There was an authority in her voice that demanded instant obedience. The nurse glanced doubtfully at McDowall, and then hurried from the room. With her left hand Shelagh continued to hold the girl’s hand, and with her right she laid gentle pressure on the lower abdomen. With the next expulsive pain, a fetus about the size of a closed fist emerged, still in its membranous bag, and with a tiny placenta attached. Shelagh judged it to be of about ten to twelve weeks’ gestation. She reached for a kidney dish from a shelf, and quickly scooped up the aborted fetus to place in it, covering it with a paper towel and depositing it under the couch. The nurse hurried in with the glass ampoule which Shelagh snapped open, and asked for a 2cc syringe and needle to draw the contents up and inject into the girl’s right buttock.
‘Ow!’ protested Cathy.
‘Sorry about that, dear, but it will stop the bleeding,’ she said. ‘It’s over now, and you won’t feel any more pain.’
The student nurse watched open-mouthed, and so did Leigh McDowall.
‘Oh, heck!’ he exclaimed. ‘Thanks a million, Shelagh – thank God you got here in time. I shall have to resign and get a job as a plasterer’s mate—’
Shelagh turned blazing blue eyes upon him, and mouthed the words, ‘Shut up!’ with a meaningful glance at Cathy’s uncle and aunt.
‘Have I – have I lost it?’ whispered the girl, gazing up at her.
‘Yes, dear, you have – don’t worry – ssh!’ Shelagh whispered back. ‘Your relatives don’t know.’
‘Is Cathy all right, doctor?’ asked Grace Hartley. ‘I’ve been so taken up with my Alf that I haven’t paid much attention to my niece. We were taking her back to her parents in Everham. Is she badly injured?’
‘No, Mrs Hartley, she’ll be fine. We’ll admit her to a bed here overnight, and then she can go home tomorrow.’
‘Alfred will need to be admitted to a surgical ward, too, Grace,’ said McDowall. ‘Is it possible that you could go to your relatives tonight, the ones you were on your way to? We’re going to be awfully short of beds, I’m afraid.’
‘Well, yes, I suppose so, doctor, though I don’t like leaving my Alfred.’
‘Can we telephone your sister and ask her to come for you?’
‘It’s my brother, doctor – Mr Jeremy North. I can remember his number.’
Shelagh suddenly gasped at hearing the name, but quickly composed her face.
‘Good, I’ll call him up when I can find a free phone,’ said McDowall. ‘And – er – did you say that her niece will be staying in overnight, Shelagh?’
‘Yes, Cathy’
s feeling much better now, but she’d better be observed. After all, she’s had a nasty shock, though there aren’t any other injuries.’
She noted Leigh McDowall’s raised eyebrows, and shook her head slightly. If Cathy decided to confide in her aunt later on, that would be up to her, but Shelagh did not consider it her duty or her business. She hoped that McDowall too would keep his mouth shut.
Once the intravenous drip was running, Alfred Hartley visibly improved, and he was admitted to Male Surgical with a provisional diagnosis of internal haemorrhage from an unknown source, possibly a ruptured spleen. When Grace’s brother arrived, McDowall told him that his sister could go home in his car, and straight to bed; his brother-in-law would have to stay in hospital, and so would his daughter, just for one night’s observation.
Shelagh felt thankful for the family’s sake that Cathy’s miscarriage need not be disclosed; her elder sister, now at twenty-two weeks’ gestation, was carrying twins.
By six o’clock the casualties had all been seen and assessed. Sister Oates reported that there had been two deaths and one not likely to survive. The miscarriage won’t count as a death, thought Shelagh, for only live births, however premature, have to be registered as births; even so, Shelagh had been strangely affected by the lifeless, undeveloped fetus, already recognisable as a human being, which she had placed under the couch, out of sight. Seven men and ten women, including three children, had been admitted to wards, while a further nineteen had been discharged home with minor injuries. The outpatients department had been cleared of extra trolleys and wheelchairs; the examination rooms had been cleaned and replenished, and the floor mopped over with a detergent that was also a disinfectant. The staff were now drinking cups of tea dispensed by the Women’s Royal Voluntary Service who had come in specially to reopen the refreshment bar.
‘Oh, Dr Hammond, that North girl has been sent home with her aunt,’ said Sister Oates. ‘Sister Kelly on Gynae says that they’re full to overflowing with surgical cases, and so I said she had better go home.’
Shelagh could hardly insist that room be found for Cathy; but she feared that the parents would be more likely to discover the truth if Cathy went home now, without a chance to calm down and conceal a pregnancy that had ended due to trauma.
She knew that she should now go back to Maternity to see if there was anything happening that would need her to be there, but for the moment her knees felt weak, and she sat down heavily on one of the plastic chairs of the OPD.
‘Shelagh! There you are! How can I ever thank you for turning up to attend to that abortion? You were an angel sent from heaven!’
There was not much of the angel in the look she gave him. ‘I think the less said about that, the better, Dr McDowall,’ she said with ice in her eyes.
His shoulders slumped apologetically. ‘Yes, I know how you must feel, Shelagh, and I’m never going to forget missing out on that girl,’ he confessed. ‘I’m thankful that you came in when you did, and I just want to acknowledge the fact, that’s all. And let’s face it, it was a lucky break for her!’
Shelagh thought this remark uncalled for, but knew it to be true, so let it pass. She stood up and faced her junior house officer, tight-lipped and unsmiling.
‘I can forgive you for missing a fairly obvious abortion, Dr McDowall, but I object to your general attitude – your total indifference and impatience towards that girl, who was clearly very distressed. And your infuriating compulsion to crack feeble jokes on every occasion, no matter how inappropriate, is not appreciated in such a sensitive field as obstetrics and gynaecology.’
‘Oh. I see. Good of you to let me know how you feel, Shelagh. Thank you. But look, we’ve got to go on working together for another four months, so we might as well be friends, don’t you agree?’
He held out his hand to her, but she ignored it and said, ‘Just remember that we are doctors, and not stand-up comedians. I’m not much good at one-liners.’
All of a sudden her voice broke, and tears stung her eyes. Good grief, she mustn’t cry in front of this man! She quickly rose and turned her back on him, walking briskly towards the lower corridor and the lifts up to Maternity. She might be needed in the Delivery Unit.
When Jeremy, his sister and his daughter arrived home in Jeremy’s car, Fiona at once seized Catherine in her arms.
‘Whatever happened to you, darling? Was it very dreadful? Oh, thank heaven to see you home again and safe!’ It was left to Jeremy to welcome his sister into his home.
‘Oh, hell, Grace, this has all been our fault, after you’ve kept Catherine for so long!’ he said in self-reproach. ‘If she’d come home earlier—’
‘No, don’t blame yourself, Jerry, it was time for her to come back to you.’
‘Well, you’ll want a hot bath, I expect, and then go to bed. We’ll put you in Roy’s room. And tomorrow we’ll visit Alfred.’
‘It looks as if we’ll have Grace here for a time, Fiona,’ he said a little later. ‘While Alfred’s in hospital. How’s Cathy? She seems a bit subdued.’
‘Well, can you wonder at it, after all the child’s been through?’ Fiona retorted. ‘I’ve put the poor girl straight to bed, with a hot drink.’
‘The same for Grace, I’d guess. I’m putting her in Roy’s old room.’
‘And what if our son turns up needing his room, may I ask?’
‘He can’t have it. He’s got that flat with his boozing buddy, and he’s not going to come back and live here, as I’ve told him and you. God knows my sister and Alfred have done us a good turn for taking Cathy off our hands for so long.’
‘My Cathy has just told me that she’s wanted to come home for weeks, so it couldn’t have been that marvellous with the Hartleys, being put to work at that old people’s home. She needed her mother!’
Jeremy did not reply, but went to see if his sister needed any assistance with her bath. Here at least he was appreciated. He’d had to cancel choir practice this evening, and felt the lack of it.
Shelagh answered the phone in the antenatal ward office. It was Paul.
‘It’s no good, darling – the hospital’s chock-a-block with all these accident casualties. Fielding’s going to be around all weekend, and I have to be here, too.’
‘Of course, Paul, I understand, we simply have to call it off. It’s a big disappointment, but – how’s Diane Devlin?’
‘Only so-so. That tib and fib are well and truly smashed at the ankle. Fielding will do what he can for her, working with the orthopaedics, but she could be left with a limp.’
‘Poor girl. At least she’s survived. Does she know about—er—?’
‘Not yet. We’ll wait until she asks about him. Better ring off now.’
‘Of course. Bye, Paul.’
She replaced the receiver. Disappointment? But she would not have to deceive her mother again.
‘Catherine’s staying in bed today,’ said Fiona the next morning. ‘She’s got her period, and it’s unusually heavy and painful. The accident must have brought it on early.’
‘Poor kid. I’ll pop up to see her before I go to school.’
Cathy was sitting up in bed. ‘Hi, chick, how’re we doing? Got over the shock yet?’
‘I don’t feel at all well, Daddy. I’ve got the most awful period pains.’
‘Oh, poor you,’ he said with a smile, noting her pallor. ‘When was it due to come on?’
‘I don’t know, in a couple of weeks. Daddy, can you get me a cup of tea and a couple of paracetamol?’
‘OK. And when exactly did this one start?’
‘When I was taken into hospital, after being thrown from one side of the road to the other – Daddy, can’t you stop asking questions, and get me tea and paracetamol, please?’
‘Sorry, chick. D’you think we ought to ask Dr James to call?’
‘Oh, for heaven’s sake, no! There’s no need for him to come round asking me a load of questions! After all, it’s only a period.’
‘Hm. All right, I
’ll send your mother up with the tea and tablets. I’m off to school now. Bye, chick – hope you’ll feel better when I come home.’
He sent Fiona up to her, and decided to walk to school and enjoy the warm spring weather after the long and snowy winter. He also decided to have a word with his sister.
Alfred Hartley’s operation was performed on the night of his admission, a laparotomy to examine his internal organs. Mr Fielding told his wife and brother-in-law the next day that there had been severe bruising of muscles, and some trauma to the liver and spleen, though not severe, and it should heal spontaneously. The only treatment had been to aspirate out the stale blood and clots from the abdominal cavity, and to start a course of antibiotics. They were told that he was to stay in hospital for rest and a light diet until the course was completed, and then if satisfactory to be transferred to a hospital in Basingstoke. Grace Hartley recovered well from the shock and minor abrasions; a long gash across her forehead at the hairline had to be redressed, cleaned and bandaged by a district nurse. Although she had pain from this and a persistent headache, she made no complaints, so great was her relief at the outcome of Alfred’s injuries.
But on the subject of her niece she was not very forthcoming. ‘All went well up until Christmas,’ she told her brother. ‘In the New Year she started to be moody, said she was fed up with working at the old people’s home. Alfred and I urged her to stick at it, and he told her that if she gave it up she would have to return to you.’
‘And did her moodiness improve?’ asked Jeremy.
‘Not really. She was irritable and off her food – and I thought she didn’t look well.’
‘Gracie, tell me the truth. Did you suspect that she might be pregnant?’
‘It crossed my mind, Jerry, but I couldn’t ask her outright – that’s for her mother to do. This week I asked her if there was anything troubling her, and could I help – but she rounded on me and told me to mind my own business. That’s when Alfred said she must go home.’
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