The London Doctor

by Joanna Neil

  ‘If you say so.’ She pulled in a deep breath as the lift doors opened and they came out onto the flat roof of the hospital. The helicopter was there, waiting for them, and the paramedics were busy checking over their equipment. This was not going to be one of her best days, she could feel it in her bones. She hated anything to do with flying, and a helicopter was the worst option, but she wasn’t going to tell him that.

  ‘I do. We just have to wait here for a while, until they’re ready to leave.’ He threw her a sideways look. ‘It came as a bit of a surprise to meet up with your foster-brother again after all this time. I suppose he must have felt much the same way and maybe that’s why he was a touch abrasive in his manner. I’m guessing he still bears a grudge?’

  ‘You could be right. He’s had a difficult life, one way and another. I don’t suppose things will smooth out without the odd crease showing up here and there.’

  ‘That’s true enough.’ He frowned. ‘I didn’t mean to butt in on your conversation with him, but I couldn’t help overhearing that he’s landed himself in a spot of bother…with his landlord and others.’

  Her gaze narrowed on him. ‘You sound as though that doesn’t surprise you.’

  ‘I suppose it doesn’t. He had a chequered past, and he didn’t really have much of a chance from the beginning, did he? His parents were often in trouble with the law, and he was obviously influenced by them to some extent. It’s hardly surprising that he turned into a rebellious teenager, and maybe he’s still having problems even now.’

  ‘He isn’t a teenager any more. He’s a grown man, and he’s changed.’

  ‘Has he?’ He let his glance travel over her, skimming along the mass of her bright curls and coming to rest on the flushed curve of her cheek. ‘You’re very close, you and he, aren’t you? You’re very quick to come to his defence, yet there’s no blood tie between you to hold you together, is there? He isn’t your real brother, yet you’ve kept in touch over all these years.’

  ‘It doesn’t matter that there’s no blood tie. We grew up together, from when we were both starting out as teenagers at least. As I recall, Ryan was fourteen when he came to live at my foster-home, and I was just thirteen. We had a lot in common. We both came from broken homes, and we were just two vulnerable children trying to find our way through the maze. We learned to stick together and look out for each other.’

  ‘You’re still doing that now, aren’t you?’ His expression was cynical. ‘You don’t see any wrong in him.’

  ‘I see the troubled child. He was only seventeen when he went to work for your father, and he still had a lot to learn. I don’t think either of you were fair to him. You judged him without giving him a fair hearing.’

  Adam’s jaw firmed. ‘I don’t see how you can say that. He might have coped reasonably well when he was working on the main part of the estate, but as soon as he was put in a position of trust, where he had to handle money, things started to go wrong. I don’t believe my father had any choice but to let him go.’

  ‘Didn’t he?’ Her blue eyes challenged him. ‘There were other youths working in the farm shop. I didn’t see them coming under fire.’

  ‘That’s the point, isn’t it? You weren’t there. You didn’t see what happened, or hear the arguments that went on, so how can you put forward a valid excuse for him? Your opinion is biased and you’ll defend him to the last.’

  ‘And you don’t think that you’re biased the other way?’

  ‘What’s that supposed to mean?’

  ‘You know what it means. Your family has always thought badly of Ryan. You saw a delinquent boy, and now you see a man who can do no good. You’ll always think the worst of him.’

  A paramedic came towards them, and Adam’s answer was cut off in the alert to a callout. ‘There’s been a traffic accident in the city,’ the paramedic said, ‘and it will take too long to bring the casualties in by road. We’re getting ready to leave now.’

  Hannah ran with Adam towards the helicopter. Inside, she was worried about what would greet them when they set down, and to some extent that helped her to overcome her fears about the flight. She concentrated on breathing deeply and trying to keep a clear head.

  ‘Have you never been in a helicopter before?’ Adam asked.

  She blinked and shook her head. ‘How did you know?’

  His mouth made a crooked slant. ‘It must be something to do with your pale face and your white knuckles…along with the closed eyes, of course. You look like a novice traveller.’

  ‘That would be true,’ she admitted, risking a quick glance in his direction. She was trying not to look down at the panorama of the city laid out beneath her. It was enough that the helicopter was swinging out in a wide arc, heading towards their destination.

  When they finally arrived, she unbuckled herself from her seat and stood up, swaying momentarily. It felt as though her head was spinning, and she steadied herself, resting a hand on the back of her seat.

  ‘Take your time,’ Adam said. His hand cupped her elbow, supporting her, and he waited with her for a few seconds while she got herself together.

  ‘I’m all right,’ she mumbled, not looking at him. She didn’t want her weakness and imperfections laid out for him, and she wasn’t sure which was the more unsettling, the helicopter ride or the firm clasp of his hand on her arm. Either way, she was thrown out of kilter.

  Adam let her go as soon as he saw that she was able to go on, and as they approached the site of the accident she threw a swift glance around, taking in the wreckage that lay before them. There were several mangled cars, and an ambulance was already standing by, its light flashing. The police were on hand, too, putting up roadblocks, and Hannah hurried over to where the paramedics from the ambulance indicated.

  Her first patient was struggling to breathe because of his injuries, and she worked with the paramedic to clear his airway.

  Suction didn’t help a great deal, and she said, ‘There’s so much swelling that I can’t intubate. I’ll do a needle cricothyroidotomy and see if I can buy time for him that way.’

  She passed a needle and cannula at a forty-five degree angle through the lower half of the cricothyroid membrane into the trachea. ‘I’m in,’ she murmured after a while, and then she began to withdraw the needle while advancing the cannula down into position. ‘OK, now I need to connect the cannula to the oxygen supply.’

  As soon as that was done and she had managed to stabilise her patient, she organised his transfer to the air ambulance.

  Adam was working with another injured man, and Hannah turned her attention to a young woman, who had been moved out of her vehicle to a grassy verge by the roadside. The paramedic said that the woman’s name was Jessica, and added, ‘She has a chest injury, but she didn’t seem to be as badly injured as the others, and we had to move her because of the risk of fire. She has been conscious the whole time. We’re giving her oxygen because she was having some trouble with her breathing.’

  ‘OK, thanks.’

  Hannah went over to the woman and knelt down beside her. ‘How are you feeling, Jessica?’ she asked, swiftly checking her over. There was a deep wound across the woman’s upper chest, and she didn’t look as though she was doing too well. Her consciousness level seemed to be slipping, so that Hannah was worried that there might be more wrong with her than was at first obvious.

  ‘My little girl’s in the car,’ the woman said, ignoring Hannah’s question, her voice threaded with anxiety, her breathing laboured. ‘I don’t think they heard me before with all the noise of the cutting equipment.’ She struggled for breath. ‘I need to know that she’s all right.’

  Hannah looked around, concerned all at once. ‘Which car?’ she asked.

  ‘The…red one…’ The woman’s voice faded away, and she slumped a little. Hannah glanced up at the paramedic.

  ‘We didn’t see anyone in there,’ he said, his features suddenly strained. ‘I searched the back of the car myself. I’ll go and take another
look.’

  Hannah nodded. She already feared the worst, and it was a heavy feeling, like sickness in her stomach, churning and cloying in her throat. There was no sound coming from the car, as far as she could tell, and the metalwork was mangled and crushed inwards. It was hard to believe that anyone could have survived in the back seat.

  ‘They’re going to look for her now,’ she said quietly to the young woman. ‘Let me take a look at you, to make sure that there’s nothing we’ve missed.’

  Jessica’s lips moved, but Hannah couldn’t make out what she was saying.

  Adam came over to her and waited while she finished making a swift examination. He drew her to one side, saying quietly, ‘We’re waiting to take off. Can you leave this patient to be taken to hospital by the first ambulance crew? She’s not as badly injured as the others by all accounts and our patients need to go now. The pilot’s getting ready to take off.’

  ‘Just give me another minute, will you?’ she answered, keeping her voice low. ‘I’m not happy with Jessica’s condition. I know that she looked all right to begin with, but now she seems to be deteriorating, and I’ve no real indication why, just at the moment.’

  ‘What makes you think there’s anything untoward happening here? I just spoke to the paramedic. Is it possible that her anxiety about her daughter is making her stressed and giving her the appearance of having a more serious medical condition?’

  ‘No, I don’t believe so.’ Hannah wasn’t ready to give in. ‘I just have a bad feeling about this. Her blood pressure is falling, and there’s a tachycardia. I’m convinced that she’s going into shock, and it’s all happening too fast.’

  ‘Then you need to get some fluids into her,’ Adam said, turning his attention to the patient.

  Hannah nodded. She set about obtaining intravenous access, and started the woman on fluids to counteract hypovolaemic shock. Turning back to Adam, she said, ‘I don’t want to leave her here. I may be wrong, but I think she’s suffered a much worse injury than we at first thought. I’m afraid that if you leave without her, it will take too long for her to get to hospital by road, and she’ll suffer as a result.’

  She expected an argument from him, because after all she was a very inexperienced doctor, and her opinion probably counted for very little in the grand scheme of things.

  Instead, he signalled for the paramedics to bring a trolley over, and started to make arrangements for Jessica to be transferred to the waiting helicopter. ‘We’ll try and make room for her somehow.’

  Just then, coming out of the blue, they heard a shout. The paramedic, who had gone to look for the child, emerged from the other side of the road. ‘She’s here,’ he said. ‘The little girl is over here.’

  He straightened, and Hannah saw that he was carrying the child. She looked to be about two years old, and she was still firmly strapped into a child’s car seat.

  ‘The fixing bolts must have come loose or sheared off,’ he said, ‘and the jolt of the accident must have thrown her clean out of the car when the door flew open. She looks fine, except for a few scratches.’

  Hannah stroked Jessica’s arm briefly. ‘Did you hear that, Jessica? They’ve found your little girl. As far as I know, she’s all right.’ There was no sound from the child, but that could simply mean that she was bewildered, or even that she had been sleeping.

  Jessica tried to say something, but it was clear that she was fading fast and the effort was becoming too much for her. Her breathing was becoming more difficult by the minute, and a film of sweat had broken out on her brow. Hannah intubated her to protect her airway, and then stepped back to allow the paramedics to transfer the woman to the helicopter.

  Hannah went with them, anxious to see her patient to safety. ‘I was thinking there might be a liver or spleen injury,’ she told Adam, ‘but I’m wondering if there could have been some damage from a broken rib. The clavicle looks to be out of line, and I’m afraid that she’s bleeding internally, perhaps from a nipped blood vessel.’

  Adam nodded. ‘It’s possible that a broken rib or the clavicle has been pushed downwards and caused a tear in the aorta.’ His expression was grim. ‘Few people survive an injury to the heart’s main artery.’

  A sudden wailing started up behind them, and Hannah glanced around. The child had woken up with a vengeance, and was distraught at seeing her mother being taken away.

  ‘Don’t you take my mummy,’ she screamed. ‘Mummy, Mummy…don’t you take my mummy away.’

  Hannah tried not to let the heart-rending sound distract her. The paramedic was trying to soothe the child, but the little girl would not be pacified, and Hannah knew more than ever that she had to keep this woman alive at all costs. She could not let this child be motherless.

  Inside the helicopter, she fretted all the way to the hospital. She took a sample of blood from Jessica for cross-matching and tests and she asked the pilot to call ahead to the hospital and arrange for the trauma team to be advised of a possible aortic rupture.

  ‘Is there any chance for her at all?’ she asked Adam in a subdued voice. It was clear now that Jessica was fighting for her life.

  ‘It depends on how large the tear is, or whether it has been contained by the adventitia or the mediastinal structures. If she survives long enough to undergo surgery, they might be able to put things right.’ He looked at her. ‘You’ve done everything that you can.’

  ‘Have I?’ She pressed her lips together. ‘It doesn’t feel as though it’s anywhere near enough.’

  As soon as the air ambulance landed, the trauma team rushed forward, whisking the patients down to A and E.

  Hannah waited nervously in the emergency room, feeling at a loss, desperate for any news of the young mother. She was glad that there had been no calls for the air ambulance to set off once more. She had to know what was happening here.

  ‘They’re still doing tests,’ Adam told her when he came back from checking on his patient, ‘but they’ve done a chest X-ray and a CT scan. It looks as though it wasn’t a complete tear, but it happened at the aortic isthmus, as we suspected.’

  ‘What happens now?’ Hannah was apprehensive. ‘I know that, even if she comes through the operation, with some surgery repair techniques the patient can suffer dangerous after-effects, especially if the artery has to be clamped for too long. She isn’t out of the woods by a long way, is she?’

  ‘No, she isn’t, but there’s nothing more you can do for her now.’

  Hannah moved restlessly, pacing the room, her hands clenching and unclenching. Until she knew that Jessica had survived, she was fit for nothing. Adam was watching her closely, and he must be thinking that she was a wreck and not fit to be part of the A and E team, but there was nothing she could do to change his opinion of her. She was too strung out to settle.

  ‘Let’s go and take a break outside for a few minutes,’ he suggested. ‘Sarah will let us know as soon as there’s any news.’

  Hannah didn’t have it in her to argue. She went outside with him, and they found a quiet place in the hospital grounds, where they sat under the delicate shade of a birch tree and swallowed coffee from polystyrene cups. It tasted awful, and she pushed it to one side, abandoning it to the flat surface of the bench seat.

  Adam sat beside her. ‘You look as though you’re about to burst into tears,’ he said softly, moving closer. ‘You shouldn’t feel badly about this, you know. You were quick to spot that things weren’t right, and it’s thanks to your actions that she even made it to hospital.’

  ‘But she isn’t safe yet, is she?’ Despite all her efforts to stop it, a tear escaped and slid slowly down her cheek. She brushed it away with the back of her hand, ashamed of her weakness. ‘I just feel for that little child, calling out for her mother. It twisted at my heart and made me want to hold her and comfort her. I couldn’t bear it if she was to lose her.’

  Adam studied her thoughtfully. ‘I imagine this must be a much more difficult situation for you to handle than it would be for
anyone else…given the way things were for you back home. It must remind you of how things were when you were small.’

  She stared up at him. Her mouth trembled. ‘I don’t know. I suppose that could be it. I hadn’t thought…’ How was it that he was able to see so much?

  Another tear escaped, and this time Adam reached out and gently stroked it away with his thumb. His touch was feather light and the warm sensation of his hand resting on her cheek made her yearn for something out of her reach, something that she couldn’t even define.

  ‘Do you remember your mother leaving you when you were little?’ he asked. His voice was low and coaxing, gently encouraging her to talk to him.

  She nodded. ‘Yes, I think so. I remember some of it as though it happened only yesterday.’ She pulled in a shuddery breath. ‘Seeing that little girl brought it all back to me, all those horrible emotions—the fear of being left behind, of seeing my mother going away. I remember that I wanted her to stay with me and I didn’t know what was happening. I think I must have been a little older than Jessica’s child at the time. They told me she was ill. I cried for my mother, and then my father came from somewhere.’

  She frowned. ‘I think by then I was being looked after by a friend of the family, and when my father came and talked to me, I wasn’t sure who he was. Anyway, he said he couldn’t have me to stay with him. They told me that it was because he had just married again and it was the wrong time.’

  She sniffed and swallowed the tears that caught in the back of her throat. ‘Of course, I didn’t really understand. I just thought that this was my daddy, that’s what they told me, and yet here he was, saying that he didn’t want me.’ Her voice cracked. ‘I was sure that there must be something wrong with me.’

  Adam’s arm slid around her. ‘That must have been terrible for you. It’s no wonder that you’re upset. These things stay with you for a lifetime, don’t they?’

  She didn’t answer. Instead, she fumbled in her pocket and brought out a clean tissue. Carefully, with shaking fingers, she dabbed at her face. ‘I’m sorry,’ she said. ‘I shouldn’t have laid my troubles on you.’