The Life Saver

by Lilian Darcy

  The second ambulance wasn't a luxury. The angry red of Cody's scalded skin jumped out at Jo again as she carried him in her arms. As well as extending over his whole chest, shoulders and part of his arms, it disappeared down below the elasticised waist of his disposable diaper.

  Seeing its plastic covering, Jo prayed that the boiling fluid hadn't penetrated as far as the sensitive genital area, where burns could do critical damage. The plastic and padding just might have offered enough protection. She could feel that Cody's navy blue corduroy trousers were wet. From the sodden comforter, or from the kettle water?

  Reaching the treatment room, with Alice following, she levered off the toddler's shoes and eased his trousers down. Wet fabric clung to wet skin, and it was hard to do it gently. With a new source of pain, however, Cody screamed so hard that his body stiffened and shuddered in a frightening mimicry of his mother's recent seizure.

  'I'm sorry, little man,' Jo murmured. 'I'm trying. I know it hurts. I'm sorry.'

  Alice was still speaking. 'And I came up from the basement because Jeannie was barking and Mommy was calling me to come with her. She wanted to run here with Cody in the stroller, because she hasn't had the ambulance here since we came to Harriet, and she didn't know how long it would take, but Jeannie didn't want to let her go, because she always knows first—'

  'So Jeannie is trained to take care of your mommy?' Jo asked while she worked on the little boy. 'To warn her and protect her when the seizures come? Cody, honey, I know this hurts. I want to see the burns, sweetheart, and as soon as I can, I'm going to give you something to make the hurting stop.'

  Could he even hear above his own noise, poor little guy?

  She'd managed to pull the trousers off now, and could see that the scalded area extended from Cody's thighs to his knees, with isolated splashes at his ankles. Ripping the tape that fastened the diaper took only a second. She found more scalded skin extending about an inch below the protection of the plastic and paper wadding, where the boiling water had seeped down but, as she'd fervently hoped, Cody's genital area was undamaged.

  First piece of good news.

  She quickly wet several strips of gauze and layered them over the burned areas that weren't covered by Nina's dish-towel, to continue the cooling that she hoped would ward off the worst damage. The dish-towel felt too warm, so she soaked it again in colder water and laid it back in place, every movement challenged by Cody's screams and shudders.

  'Yes, she's a trained seizure alert dog, and she's ten years old,' Alice was saying, 'and Mommy's had Jeannie since she was two.'

  'IV gear, morphine and foil blanket, Dr Middleton,' Trudy said. 'But I'm still heating the hot packs.'

  'Gentle heat. Not too much.'

  'No, I thought not. But there's some confusion with the ambulance, Dotty says.'

  'Confusion, Trudy?' she asked the practice manager as she began to prepare the IV.

  'Another call to this area. Dotty's trying to clear it up. Whether it's a hoax or—'

  'I hope she gets a clear answer!'

  If the ambulance got misdirected or delayed...

  'Sort it out, can you? Get Dotty to. We need it, and I need you here, Trudy.'

  'Back a.s.a.p., then.'

  Jo continued to set up the IV, but Cody's cries were very distressing, fraying her nerves. She was seriously concerned that she just wouldn't be able to get him calm enough to find a vein in such a small, rigid arm.

  A case of serious scalding like this one shouldn't be treated at a family practice clinic. They just didn't keep the right equipment, didn't have the practice, didn't have the mindset of staff in a hospital emergency room. She took a deep breath, realised she had no hope of calming the child and decided they'd just have to hold him down by force.

  'I'm back,' Trudy said.

  'Hold him for me. His legs. He's kicking...'

  'He's strong.'

  'He's in horrible pain. I have to get him some relief, even if we have to hurt him to do it.' She felt close to tears herself, and made one last attempt to talk to the little boy. 'Cody, honey, we're going to give your arm a little prick, and then put on some tape. Oh, sweetheart, you can't even hear me, can you? Hold him, Trudy.'

  She pinned his body against her own, managed to stretch out his arm and got another little piece of good news. He'd been screaming so hard his veins were standing out more prominently than they would have done normally. This one here would work nicely, in the crook of his elbow, if she could keep his arm still...

  'Trudy?'

  'Doing my best.'

  'Keep doing it. Cody, nearly there, sweetheart. We are. I promise.'

  He drew a shuddering breath and she seized the moment. She slipped the needle in and got the vein first try, felt a huge wash of relief and worked faster than she'd ever done in her life, getting it safely taped before Cody escaped her imprisoning arms and knocked it out again.

  OK, done.

  Now, the tubing, the bag, the port for the syringe of morphine. Get his weight right. Do not make a mistake on the dose!

  When Rip appeared in the doorway at that moment, her body flooded with relief once again, even though she barely took a moment to look at him. 'Rip, confirm this for me, can you?' She quickly went through the calculation she'd used to arrive at the right dose. Age times two plus eight, giving an approximate weight of twelve kilograms. Morphine at the rate of point zero five milligrams per kilogram. Round it down to a first dose of point five of a milligram.

  He nodded. 'That's right. I'll leave it to you now—-just wanted to update you. We're still trying to sort out the ambulance, and Mrs Grafton hasn't regained consciousness yet, but her vitals are good. I'm still not totally happy about the bump on her head. Left a message on her husband's machine at work.'

  'Swings and roundabouts, good news and bad,' Jo answered. 'Cody, just another tiny minute. Here we go.' She attached the syringe to the port and slid the dose in, watching pain relief begin almost immediately. It would reach its peak effectiveness within a few minutes.

  His sobs and shudders ebbed, and Trudy went to get the hot packs. Rip had already disappeared. Jo could focus on getting the little boy comfortable now, and was confident she'd been right to start him on fluids without waiting for the ambulance. She took his temperature, blood pressure and pulse, and was cautiously pleased with what she found.

  Valiant little Alice was still speaking. 'You see, a long time ago before I was born, Mommy's seizures got worse,' she said, 'and she had lots of injuries and times in the hospital. She even got mugged in the park when she was unconscious, and she was too scared to go out and Daddy didn't know if he might have to stay home, too, to watch over her, but when she got Jeannie, it was like magic coming out of Aladdin's lamp...'

  Ah, OK, Jo registered.

  Not Jeannie.

  Genie.

  'And her whole life turned around and she even felt safe enough to have us, and she had good doctors who said it was OK, and it all went fine, but she's stopping at two.'

  Jo smiled. 'That's a lovely story, Alice. Your family tells it a lot, I expect.' She'd recognised some adult phrasing in there. Alice was clearly a little sponge, absorbing everything that went on around her.

  'Genie didn't want to let Mommy bring Cody here, but it was good that she did, wasn't it?'

  'Wait a minute, Alice. You were in the basement, you said, and your mommy would have been undressing Cody and wrapping him in the cloth and the comforter to cool the burn, but she was afraid a seizure was coming.'

  'And she had her bracelet off, and she probably didn't have time to—'

  'You said Genie has a button she presses?'

  'When she sees Mommy having a seizure.'

  'Only then?'

  'Yes, and she listens till she hears a signal so she knows the alarm company is going to call the ambulance. If Mommy is outside with Genie, then Genie barks till help comes. I know how to call the ambulance, too, but I was in the basement. Mostly I'm in school and Cody's in day c
are, because Mommy does work on her computer, but in Harriet we haven't started those yet.'

  'Could Genie have pressed the button for an ambulance for Cody?'

  'Mommy didn't think she would, because she's trained to press it for Mommy.''

  'But maybe she could have pressed it without Mommy seeing? Maybe she could have decided this was another time when she should press it?'

  'Maybe. She's cleverer than a person about knowing the seizure's coming even before Mommy's aura. Maybe she was clever about Cody, too.'

  'Trudy, can I have you back in here?' Jo called. 'Or Rip?'

  Rip appeared. 'Yup?'

  She explained her theory about the possible cause of the ambulance mix-up, and then they both heard a siren.

  'I'll go out and flag it down,' Rip said, already on his way. 'To make sure it doesn't keep on up the street to the Graftons' house.'

  Cody's burn must have received the desirable twenty minutes of cooling by now. Happy that she could remove the wet towelling and the sodden gauze strips, Jo considered cling film. Did they have any on hand here in the practice? The ambulance probably would. She'd leave it to them. Dressing the burns wasn't as much of a priority as pain relief, warming and fluids.

  Less than thirty seconds later, two paramedics entered the waiting room. 'Take the child first,' she heard Rip say.

  She outlined the treatment she'd already given, as well as the details on Cody's temperature, blood pressure and pulse, and received approving nods. 'We're easy to please,' said one of the men. 'Just as long as we don't have to undo everything someone's done on the spot.'

  'Butter on a burn, with the best of intentions.' The other man clicked his tongue and shook his head. He leaned down to Cody, who was quiet and still, his eyelids half-closed. 'Hey, little buddy... Coming on a ride with us? We're going to race your mommy there, OK? Bet we win.'

  Out in the waiting room, as the paramedics left with Cody, Dotty said quietly to Jo and Rip, 'I just got a phone call from the dad, and he's on his way.' Nina still hadn't regained consciousness, but she seemed to be stirring now, and had given a little moan.

  'And this sounds like our second ambulance,' Rip said, pricking up his ears.

  Genie was pricking hers up, too. Seeing that Alice looked a little bewildered and forlorn, Jo crouched down beside the dog and gave her some hearty pats. 'You're a good girl, Genie. You're a beautiful dog.'

  'She's part of our family,' Alice said.

  'Yes, she is, and did you hear that your daddy's on his way?'

  The six-year-old's face cleared. 'Will he take us to the hospital?'

  'I expect so. He'll want to see Cody and your mom.'

  'And Genie.'

  'Yes, he'll want to see Genie, and tell her what a good dog she is.' Jo patted the animal again, and felt something in its armpit that she instinctively and immediately didn't like.

  Really didn't like, now that she knew how important Genie was.

  Under the guise of a final piece of tactile praise, she felt the place again, and something was definitely there—the kind of lump she would take action on at once if this patient had been human, and hers.

  The paramedics from the second ambulance came in while she was still thinking about it.

  What do I know about dogs? Is it just a piece of matted hair? No, her coat's too well cared-for, and anyhow that's not how it feels. It's definitely under the skin...

  'Cody!' Nina said in a fuzzy voice on her way out the door on a stretcher. 'Where's Cody? And Alice?'

  'I'm here, Mommy. I'm waiting for Daddy.'

  'Where's Cody?'

  Jo walked out beside her and explained. Still in the postictal phase of her seizure, Nina's reaction was muted, confused and vague. She looked terribly washed out, and murmured, 'I often vomit right about now, guys, just letting you know.'

  'We're on top of stuff like that, Mrs Grafton,' one of the paramedics said.

  'Why...the hospital? I don't always—'

  'Hit your head. Let's get you in the back here.'

  They'd soon departed. In the waiting room, Alice was still waiting patiently for her dad, patting Genie. But not where I patted her, Jo noted to herself. Not where I found that lump. Maybe they don't know...

  'I'm going to drop you home, girl,' Andy Grafton told the dog when he'd arrived and scooped his daughter up in a big hug. 'And I am going to get you steak for dinner.'

  'Steak, Daddy?'

  'For Genie. She's a good girl, isn't she? She's earned it, pressing that button for Cody, even though it got things a little confused.'

  He thanked both doctors profusely, and Jo bit her tongue. Now was not the time to talk about a potential challenge to Genie's health, on top of so much else. They had patients piling up, and Alice looked exhausted. 'I'm so hungry, Daddy! I didn't get an afternoon snack.'

  'We can do something about that. I have a cereal bar in my car.' He hugged his daughter again, and called the dog to follow them.

  Not surprisingly, Rip and Jo both finished late.

  Dotty dashed out the door with an apology as soon as she'd sent in Rip's last patient, as she'd promised to babysit for her daughter that night. Jo's talkative elderly lady kept her for ten extra minutes with anecdotes about her family, and needed a gentle lecture about not stopping her medicine just because she felt better or she very soon wouldn't be feeling better any more. It was almost seven by the time they were ready to lock up.

  'Seems as if the Grafton family is going to be an interesting addition to our patient load,' Rip drawled to Jo as he waited for his computer to shut down. 'The only one we haven't seen professionally yet is the dad.'

  'Who has risen considerably in my estimation now that the bruises I noticed on Mrs Grafton yesterday can be explained by her falls during seizures,' Jo drawled back. 'He seemed like a nice man.'

  'You suspected Andy Grafton was the culprit yesterday? You didn't say anything to me about it.'

  'I had no evidence. Just the fact that Nina had bruises that weren't all the same age. I knew she'd made an appointment for tomorrow—to alert us to her medical history, as we now know—and I might have followed through with a couple of questions then. One good outcome for this afternoon's drama is that I don't need to now.'

  'I suspect she'll be discharged in the morning, as soon as they've ruled out any injuries from her fall. If we were more familiar with her case, and without that bump, we might have sent her home.'

  'I do have one other concern about the Graftons, though, Rip.'

  'Yes?'

  'The dog. Genie. By the way, it's spelt G-e-n-i-e. She's obviously incredibly important to all of them. To Nina most of all, but Alice clearly loves her to death, too. And the thing is, when I was patting her, I noticed a lump.'

  'And you want my expertise as a veterinarian, apparently.'

  'I want a second opinion, because we're not vets. The lump was discrete and palpable, about the size of a walnut, located in what I'd call her right armpit if she were a person. It didn't seem tender, from Genie's response. If it had been a woman's breast I was palpating, I would have followed up on it then and there.'

  'You'd think Nina Grafton would have noticed it herself, though, wouldn't you? Or Alice or Andy,'

  'They've been busy with a move from Brattleboro. They have a manic two-year-old. And maybe they do know about it, and it's nothing.'

  'Or maybe they don't know, but it's still nothing, and you don't want to add unnecessary worries to an already over-full family schedule.'

  'Exactly.'

  He thought for a moment, frowning at Jo but not really seeing her. It was a familiar look. She'd seen it a lot since she'd known him, particularly over the past year and a half. She liked it, liked what it said about the way he focused on things. Her stomach kicked. Thank goodness she hadn't followed through on last night's shoulder pat! A more overtly stated rejection on his part would have made both of them feel way more awkward with each other, alone like this.

  Why is my heart hurting?


  Because it definitely was a rejection, even though it was subtle?

  Could I want him this much, when three days ago I didn't know I wanted him at all?

  'You have to tell them,' Rip decided. 'You really do. You just don't have enough background data to conclude either that the lump isn't significant or that they already know about it. You're not a vet, but even a family friend would mention something like that.'

  'Tell them as a matter of urgency?'

  'Call Andy Grafton at home tonight, once he's had a chance to catch his breath. It's simple, Jo. You have a duty to pass the information on. He can decide what to do with it.'

  'Let me note down his home number, then, before we lock up.'

  'Oh, we're locking up tonight?' He raised one eyebrow and tucked in the comers of his mouth. When his cognac brown eyes twinkled at her like that, something warm swelled up in her chest like bread dough and she could hardly breathe. Why hadn't she noticed those twinkling eyes of his years ago?

  Because they never used to twinkle for you, Jo, dear, they twinkled for Tara, and then when she left they didn't twinkle at all. If they're twinkling for you now, it doesn't mean the whole world has shifted on its axis.

  . She laughed at him—a slightly wobbly laugh—and said, 'Message received, loud and clear. I'm sorry I've left it to you so much lately.'

  'I'm teasing you, Jo.'

  'But you have a point, all the same.'

  'We've both...yeah...needed to make some changes.' For the first time that evening Ripley sounded a little awkward, as if the familiar cloak of their professional relationship was slipping off again, to leave them both with a new way of dealing with each other that they hadn't grown used to yet.

  Jo practically added up the evidence on her fingers.

  So there's the awkwardness, plus the teasing, plus the twinkle...

  Her heart stopped aching, and lifted a little.

  'Third night in a row we've had a late finish,' Rip went on, a little too quickly. 'Do you want to come via my place and help me deal with that asparagus and cream?'

  'Eat it, or cook it?'

  'Both, at this stage.'