She nodded. ‘Okay. Well, first of all I usually advise people not to try and diagnose themselves over the internet. The online world is full of dramatic diseases and bad luck tales, and it doesn’t have that real world advantage of examining a patient in person. Because everyone is different, Charlie—you know that, right?’
He nodded.
‘Getting that head rush on standing might just mean you have low blood pressure, so let’s check that first of all.’
She grabbed the BP cuff that was standard issue in each cubicle and wrapped it around Charlie’s arm.
‘Right—stay nice and still for me.’ She inflated it and took his reading. It seemed normal. So was his heart-rate. ‘I’m going to ask you to stand up and I’m going to check your BP and heart-rate again, okay?’
‘Okay.’
‘And stand.’ When he stood, she inflated the cuff and watched him carefully. He grimaced slightly and went a little pale. ‘Stay standing for me, if you can, I know it feels weird, but I’m here to catch you—don’t worry.’
Charlie stood through it and she noticed on the machine that her patient’s BP lowered only slightly, but his heart-rate soared.
She guided him back down into the chair. ‘Do you experience any other symptoms?’
He thought for a moment. ‘I’ve always been like this, I think. Sometimes I get palpitations. Like I can feel my heart missing a beat? And sometimes I feel sick and shaky when it happens.’
Brooke nodded, writing down his experiences. She was beginning to suspect something—but it wasn’t Addison’s and it wasn’t something that usually showed in men. However, the one rule she could remember her first ever professor stating at university was: Keep an open mind. There will always be someone who breaks the mould.
She’d definitely begun to suspect that this was the situation here, but Charlie would need further tests to prove her theory of PoTS—postural tachycardia syndrome.
It was caused by an abnormal increase in heart-rate whenever the affected person stood up after sitting or lying down, and it mostly showed in Charlie’s symptoms. His heart-rate had increased by just over thirty beats when he’d stood up, but that wasn’t enough for a diagnosis. He needed an ECG and a tilt table test to confirm it properly. And they couldn’t do that here in A&E.
‘Okay, Charlie, I’m going to take some bloods from you to check your kidney, liver and thyroid function. And I want to check your blood count, calcium and glucose levels. I’m also going to perform an ECG, which will take a tracing of your heart.’
‘There’s something wrong with my heart?’
‘From my initial investigation it seems unlikely, but we need to run some further tests to rule out other conditions. I think you have something called postural tachycardia syndrome, and I’m going to write to your GP and recommend that he refers you for a tilt test, which we can’t do here. The ECG and the blood results will be through by then, to help with a diagnosis.’
‘Is it dangerous?’
‘Well, postural tachycardia syndrome isn’t fatal, but sufferers are at risk of hurting themselves by falling or passing out. Whilst you’re waiting for your appointment to come through be very careful getting up. Do it gradually, and if you feel faint try to sit or lie down and raise your legs. Drink plenty of fluids, keep active, but pace yourself. Don’t overdo it and try to avoid long periods of standing. What do you do for a job?’
‘I work in a call centre.’
‘Okay—good. Try and stay away from too much caffeine, if you can. I’m going to write to your doctor now and see if we can get this sorted for you.’
‘Thanks.’
He looked a little more relieved now that he’d talked over his worries. She was sure that he would be okay, but if he did have PoTS then they would need to rule out any other underlying conditions, such as diabetes or lupus, as soon as possible.
She drew some blood and stuck a small round plaster in the crook of his elbow, and then went to find Matt to report in.
It had niggled at first, when she’d found she had to report in to Matt. Initially she’d thought he was doubting her abilities. But she’d found out that he’d checked everyone’s work and approved their tests during the first week he’d started in the department. Apparently she’d missed his starting speech to the staff about wanting to ensure an ‘efficient and highly capable department’, but she could appreciate that.
Now her first week was nearly over and this would be the last day she checked in with him after each case.
I think I’ll miss it.
The thought made her feel slightly perturbed.
After her initial annoyance, she’d grown to enjoy discussing her cases with Major Matt Galloway. He was always pleased to see her, always listened intently, and always gave great suggestions for further treatment if she found herself torn between the right way forward. He always told her she was doing a great job and when she’d made a great catch.
Was it the feedback? Was it getting approval? She’d never had that before, from anyone who mattered, and receiving it felt strange. Oddly unsettling, but immensely gratifying. She’d miss not going to him for advice. Miss checking in with him all day long.
He was a nice guy, and she could see why Jen had married him.
She’d struggled at first to match the severe, law-abiding soldier husband to her fun-loving, spontaneous friend. The couple seemed chalk and cheese. But as the days had passed Matt had become more familiar to her, and she to him. His guard had come down somewhat and he’d smiled more, laughed more.
He’d even stood chatting to her one day in the staff room, over a mug of tea and a chocolate biscuit, and it had been just as Kelly had said. He was different when you got to know him and saw past his rules and regulations and the army officer bearing that he used as a shield.
He still wasn’t calling her Brooke, though. It was always Dr Bailey and she, in turn, always called him Major. It had become a game. A tennis match. He would serve and she would volley.
She found him labelling a vial of blood and waited for him to finish before presenting her case, running through Charlie’s symptoms, her diagnosis and referral.
‘I agree, Dr Bailey. I imagine he’ll also need an echocardiogram at some point, but we’ll leave that to his specialist. That’s excellent. I think I can happily sign you off now.’
He looked up at her and smiled and it totally disarmed her.
‘Sign me off?’
‘You don’t need to check in with me any more. I feel totally assured that your practice as a doctor is just the type I need in this department. I trust you completely. You should be happy about that.’
‘I am. It’s just...’ She floundered for words. Her brain had gone blank.
Why was she having such a hard time with this? She’d only been doing it for a week, and she hadn’t liked it at the beginning, but that had been before she’d realised just how much she would get out of it. She didn’t want to let that go. Realising how needy that made her feel, she frowned, angry at herself.
I am not a needy person!
She had promised herself, when she’d made the decision to carry on with her pregnancy and be a single mother, that she would do so with determination, authority and a belief in herself that she could do anything alone. Wasn’t that what she had always done anyway? She was used to standing alone. Surviving without someone else’s input. So why should a week of running to Matt have made her feel this way?
Brooke didn’t like it. And all of those emotions must be running across her face, because suddenly Matt was standing up and had laid a concerned hand upon her upper arm.
‘Are you okay?’
She snapped her head up, determined and bright. ‘Of course. Why wouldn’t I be?’
He looked at her carefully. As if he were assessing her. As he would a patient.
‘I don’t know.’
‘I know I’m capable. I trust my own practice, I know what I’m doing and even though I’ve been away for seven months or so it doesn’t mean that I lack any confidence in my own abilities!’
She was flustered. She could hear it in her own voice. That and a small note of hysteria. What the hell was happening to her? Was it still the effect of all those hormones that she’d had to suffer after she’d had her baby? The bloody things could linger for an age...torturing women with doubts and uncertainties.
You’re not being a good enough mother...you don’t know what you’re doing!
And Matt...? Matt had been drip-feeding lovely words of encouragement into her empty soul and like a dry sponge she had sucked up every droplet of its goodness. Unaware that she had needed it so badly. It was like when she’d been at school, finishing her work before everyone else and taking it up to teacher to be marked and receiving words of praise and a gold star sticker. It had made her beam inside.
Matt frowned and made her sit in his chair. Then he knelt down in front of her, those eyes of his diving into her soul and having a good old rummage around.
Afraid of what he might see if she let him in, she pulled back.
‘Go back to your patient. Discharge him.’
He glanced at his wristwatch. He was one of the few people she knew who still wore one.
‘It’s nearly eleven. We’re owed a break. Find me and we’ll go for a coffee. In the cafeteria,’ he added, which was a special treat, instead of them hunkering down in the staff room.
The cafeteria at the London Grace had an excellent range of refreshments—including home-made cakes that were made on site and were full of calorie-laden deliciousness.
‘Oh, I don’t think we need to—’
He put his hands on both arms of the swivel chair. ‘I insist.’
His voice had softened and that drop in tone went straight to her heart. He was not going to let her get away from this. Perhaps he knew something. That she needed this break?
Brooke stood up abruptly, breaking the prison of his arms, and went to discharge Charlie. She forced herself to focus, giving Charlie the best advice she could to keep himself safe until he got to see a specialist. Then she found herself walking back through the department as if on numb autopilot.
How had things changed so quickly? One moment she’d been humming tunes, sure of herself, and yet suddenly she was feeling lost at sea. Cast away on an ocean with no sign of land.
I’m exhausted!
Tiredness. That had to be it. She’d been so determined to come back to work and blaze a trail, making sure that everyone had missed her, needed her back with them. But Morgan’s lack of any need for sleep had caused her to lose too many hours too, and she’d been running on optimistic adrenaline.
When had she last cooked herself a proper meal? She’d been going home and just grabbing whatever was in the fridge—usually a sandwich, or something on toast. Something quick that she could eat cold if Morgan demanded her attention.
It was impossible to work the way she’d been doing on hardly any sleep and without enough proper, nutritious food. Add to that the fact that she was breastfeeding, and she was totally drained. Seeing Matt throughout the day had kept her tank topped up. Had allowed her to keep going from one patient to the next because she’d known she would get to see him again. She’d become dependent upon him like...
Brooke swallowed hard and raised her chin. Perhaps she was like someone that she knew. And the idea of that sickened her—because she’d thought she was nothing like him.
Across the department, Matt caught her eye and beckoned with a tilt of his head. Pulled towards him like a magnet, she walked over to him and they headed out of the department to the cafeteria. Matt guided her to a table and told her to sit down, then went over to the self-service counter and came back with two cups of strong-smelling coffee, a bowl of fruit salad and a large apple turnover.
‘Thanks.’
‘They’re both for you.’
‘Both?’
‘You look like you need it. When did you last eat?’
She searched her brain for any memory of a meal and vaguely remembered grabbing a yoghurt when she’d got home last night. ‘A while ago.’
‘You’re breastfeeding, Dr Bailey. Keep going at this rate and you’ll either make yourself unwell or run out of milk. Which would you prefer?’
She felt her cheeks colour at him asking her such a personal question, but then she remembered that first day when she’d leaked milk all over her new blouse. ‘Neither.’
‘I thought not. You’ve had that running-on-empty look for a while.’
Embarrassed that she hadn’t been giving her all in looking after herself, or as a doctor, realising she really ought to know better, she shook her head. She’d kept herself going on fluids. ‘I keep trying to be everything to everyone. My patients. Morgan. I guess I forget about myself sometimes.’
‘Sometimes?’ He poured milk and put two sugars into her coffee. ‘For energy.’ He smiled. ‘It’s hard trying to be both parents—I know how you feel.’
Of course he did. But he wasn’t the one falling apart in the hospital cafeteria, was he? She pulled the cling film off the top of the fruit salad and forked a strawberry into her mouth. It tasted great, bursting with juice, flavour and sweetness. She hardly had to chew at all, and the next thing she knew she was spearing a piece of melon.
‘I bet you make yourself a three-course meal every night, huh, Major?’
He smiled back at her and pinched a piece of kiwi fruit. ‘Restaurant standard. I even do petit fours with my coffee afterwards.’
She looked at him with raised eyebrows, totally impressed, and then when he started to laugh realised he was joking. She took back the piece of kiwi fruit and popped it into her mouth. ‘You don’t need it, apparently.’
Matt smiled warmly at her, then glanced down and stirred his own coffee. ‘Jen mentioned that you were on your own... You can tell me to mind my own business, but do you want to tell me what happened?’
She broke a piece of pastry off the turnover and ate it before speaking. ‘Eric was...’ She paused to think of the right expression. ‘A learning experience.’
He nodded. ‘What did he do for a living?’
‘He was an actor—in more ways than one. We met at an after-show party. He’d just finished a run at the theatre, playing the part of the Bard, and I’d won VIP tickets to go backstage and meet the cast and crew. Theatre isn’t really my thing—not unless it’s got scalpels in it and an anaesthetist—but I went anyway and I met Eric. He was charming, handsome...a bit insecure but he hid it well. At first.’
‘What happened?’
‘He asked me out, I said yes, and we started dating. I thought he was great. Really nice, listened well, asked a lot of questions, seemed interested in me... But really he was gathering information...to make the best attack possible.’
Matt’s brows furrowed. ‘How do you mean?’
‘It was nothing physical. It was mental. He started going out on his own, saying he was with friends when I suspected otherwise. And because I had no proof he made me feel like a crazy woman for even considering it. But then the comments started—questions that made me second-guess myself. Was I really going to wear that dress when it didn’t suit me? Was I really not going to take any of the blame for the fact that he’d lost out on an audition? Was I really going to go out with friends from work when I should be spending time with him? He slowly and methodically tried to close me off from everyone I knew, and when he realised I wasn’t going to put up with it he turned toxic. Getting hold of me at work to call me horrible names—that sort of thing. So I broke it off. Something I should have done earlier, but he’d made me doubt myself for a while—made me think that I was the one
being unreasonable, that I didn’t have the strength to leave him. He was wrong.’
‘How did he react to you ending it?’
‘Well, let’s just say he has an amazing capability with swear words and derogatory terms.’
‘I see.’ Matt looked down at his coffee and took a small sip.
‘He’d tried to make out he was a gentleman, but he couldn’t carry off that role. Not full-time, anyway. I was glad to be out of it.’
‘And when did you discover you were pregnant?’
‘A couple of months afterwards. Usual thing—working so hard I wasn’t paying attention to the calendar. It was only when I was educating a young girl about her own cycle that I realised the date and I just knew.’ She munched on a piece of apple. ‘Jen told me to forget him, and took me out on the town to show me that there was still fun in life.’
He smiled at the image. ‘I can imagine her doing that.’
‘She was great. She lifted my spirits. And when she discovered she was pregnant, too...’ She laughed as she recalled it. ‘She came over to me, bumped her belly against mine and said, “The race is on!”’
Matt carefully sipped at his coffee.
‘I told Eric about the baby. He might not have deserved it, but I thought he still had the right to know. Just because he was an awful boyfriend, it didn’t mean he would be an awful father.’
‘Is he?’
‘A rubbish father? Yes!’ She laughed again, wondering why she was laughing about it. Because was it truly funny? That Morgan didn’t have a dad?
She’d never wanted the children she had to want for anything. She’d dreamed of having the perfect family. Two parents for her children. Children loved and adored from both sides. Enveloped in love and acceptance no matter what.
The smile died on her face. ‘He didn’t want to know. Said it was my “mess” to clear up. That he was with someone else now—as if I might want him back. I soon put him right on that score.’
‘I’m glad you did.’
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