‘Let me take one of you with the glass in your hand.’ Hugh reached for her phone and Lisa blinked again, held her glass up as if she was toasting Abby and sent a silent message to her sister.
Here I am... Living the dream...
At least it would be easy to convince her sister that she wasn’t on a date with Hugh. Who would go out on a date in a T-shirt and jeans?
She needed to take a picture of the view as well. She didn’t let embarrassment stop her taking some of their food either. She wanted to capture every detail for Abby, including the beautifully presented salad Niçoise she had ordered, the steam rising from the ramekin of the boeuf bourguignon that had been Hugh’s choice—even the basket piled with sliced baguette.
‘So...’ Hugh filled Lisa’s glass again when he had mopped up the last of his sauce with torn pieces of the crusty bread. ‘Tell me about your sister. She must be younger than you, yes?’
‘What makes you say that?’
‘Well...you’re so well organised and you like being in charge.’ The corner of Hugh’s mouth twitched, as though he was supressing a smile. ‘I can imagine you being a bossy big sister.’
Was it a magical side-effect of champagne that made that sound like a compliment? Or maybe it was Hugh’s smile.
‘I’m six years older,’ she admitted. ‘It was the perfect age to get a baby sister to help look after and...’
‘And?’ The prompt from Hugh fell into a sudden silence.
Lisa almost told him. That she’d had to take sole responsibility for Abby on so many occasions that it was like she had been another mother for that tiny baby. That she hadn’t done a very good job of it either, because it was her fault that Abby was now facing challenges that would mean it would be so much more difficult for her to end up in a place like this. In a mountain village in France. Drinking real champagne...
She took another mouthful.
‘And I love her to bits,’ she added quietly. ‘I’m missing her and I’m worried about her, to be honest.’
‘Why?’
‘We’ve been living together for her whole life but she’s just moved into a university hostel and I know that she’s going to be fine and that she can cope perfectly well without me. She’s amazing, in fact, so I have to get over worrying about her but...’
But Hugh was frowning. ‘If Abby’s six years younger than you, that makes her...what...about twenty-four?’ His gaze was focused intently on Lisa and she could almost see his clever brain putting pieces of a puzzle together. ‘Is she...okay?’
‘She got badly injured being hit by a car when she was nearly two.’ There was no need to tell Hugh that it had been her fault and she’d never stop hating herself for that moment of carelessness. ‘She’s been in a wheelchair ever since,’ she added. ‘And she’s always needed me. We went to live with our grandmother when Mum died a couple of years later.’ Again, Lisa held back on the more sordid detail that her mother’s death had been due to an overdose. ‘Gran had some health issues of her own so she couldn’t really manage the kind of round-the-clock care Abby needed. We always had some help but I did as much as possible myself.’ Lisa took a deep breath and reached for her glass of wine again.
‘Sorry... I don’t usually talk about this stuff. I guess I’m missing Abby because this is the longest time we’ve ever been apart.’ She found a smile. ‘I only took this job because she talked me into it. She thought it all sounded very romantic and that it was time I had some fun.’
‘And are you?’ Hugh was watching her again. ‘Having fun?’
Lisa couldn’t read his expression but it seemed...serious. Not in that focused, professional kind of way when they were working together. Not in that flirting kind of way, like the first time he’d ever looked at her, and it was definitely not in that intense I’m about to kiss you kind of way. This was...just different. A new side of Hugh.
‘You don’t really think about “having fun”, do you?’ he added quietly. ‘I think that maybe you’ve always been too busy worrying about and looking after other people to worry about yourself.’
It was a look of respect, that’s what it was. Understanding, perhaps, of how much Lisa had sacrificed along the way, from the small things like not going to play with friends after school because she’d needed to get home and help look after her little sister to being excused from school trips that would take her away from home and even her career choice, because if she’d wanted to follow her first dream to become a doctor she would have had to go away to medical school. Nursing training had been available in her own city.
That Hugh might get how hard some of those decisions had been and respect her for making them made Lisa suddenly feel an enormous pride in everything she’d done. For all those sacrifices she had made—and was still making—in order to be there for her sister. Unjustified pride, perhaps, given that it had been her fault in the first place but it was a lovely feeling, nonetheless. There was something else in his gaze as well...was he feeling sad on her behalf? She needed to reassure him. To reassure herself at the same time, or maybe it was to disguise a flash of guilt that he was only thinking so well of her because he didn’t know the whole truth?
‘Today has been so much fun,’ she told Hugh. ‘It’s quite likely the best day of my life so far.’
His smile was one of pride. ‘There you go. All you needed was the example of an expert. And I’m sorry I said that you were uptight. It’s not true, by the way.’ He took the bottle from its bed of ice again. ‘Uptight people don’t love champagne.’ He reached for her glass. ‘And you’ll need to finish this because I’m driving soon. I’d better get us back to the ship before it sails.’
Lisa made a face as she took her glass again. ‘Tough job,’ she murmured, ‘but I guess someone’s gotta do it.’
Hugh laughed. ‘I like you, Lisa Phillips,’ he said. ‘We might be total opposites but that doesn’t mean we can’t be friends, does it?’
They were total opposites. Hugh indulged in pleasure of all kinds and Lisa had learned to sacrifice anything that could interfere with what was most important in her life—keeping her sister safe. But Hugh could afford to indulge without any guilt, not only because he could obviously afford it financially—going by the personal information that patient with the migraine had revealed—but more because he didn’t have anyone depending on him, did he? He was free to enjoy everything and, today, he’d given Lisa her first taste of that kind of life.
And it had been utterly amazing. It wasn’t hard to return his smile. ‘How could I not be friends with the person who introduced me to French champagne?’
‘My work is done.’ Hugh leaned back in his chair. ‘If only everything in life could be sorted so easily.’
* * *
Friends.
It had been hard to persuade Abby that that was all there was to her relationship with Hugh after she sighed over the romantic photos of that mountaintop café.
‘Nothing happened? Really? Not even a kiss?’
‘Not even a kiss.’ Lisa could sound sincere because they were only discussing the French outing, not what had happened the night before. ‘Or not a real one, that is. We were running late by the time we got back and we only just caught the last tender so we were laughing about it all and then we kind of had a hug to say goodnight and he kissed me on the cheek.’
‘Aha! There’s still time, then. Sounds like a perfect first date to me.’
‘Except that it wasn’t a date. Now, tell me what’s going on with you. You had your test today, didn’t you?’
And fortunately Abby was too excited over the news that she’d not only passed her driver’s licence test but had been accepted onto the wheelchair basketball team to try and pry any more information out of her big sister.
‘Oh, and I’ve got my first real, hands-on session with a patient tomorrow, to practise what we’ve been learning about wound
care and splinting. My case is a guy who broke three fingers in a rugby game. I can’t wait. I’m going to feel like I’m a huge step closer to being a real hand therapist.’
‘Good luck with that. I’ll look forward to hearing how it went. We’ll be docking near Rome so reception might be good enough for a video call. Ring me when you’re all done for the day. I’ll be on duty but if I can’t take the call I’ll ring you back later, okay?’
* * *
Lisa did miss Abby’s call the following evening. Even if she’d been aware of her phone ringing, she wouldn’t have even been able to fish it out of her pocket. She was running at the time, helping Tim the paramedic push the resuscitation trolley that was kept ready to deal with any sudden collapse that could be due to a cardiac arrest. Hugh was already on scene because he happened to be eating in the same restaurant as the man who had simply fallen sideways off his chair while he had been waiting for his main course to be served.
‘It’s the restaurant that caters for passengers who think an evening meal with the ship’s officers is a traditional part of their cruising experience,’ Tim told her as he hit buttons to try and make the elevator work faster. ‘They love an occasion to get really dressed up. Usually older people so it could well be a cardiac arrest. Lucky they’ve often got a doctor hosting one of the tables. Peter and Hugh take it in turns.’
Hugh was wearing a different kind of uniform, Lisa noticed as they raced into the small restaurant moments later. He still had a white shirt but it was paired with black trousers and jacket and even a tie. There were other people standing around wearing similar formal outfits and she recognised one as the captain of their ship, although she’d only met him briefly and hadn’t been invited to have dinner at his table yet. Most of the diners seemed to have left the area but staff were looking after a distraught-looking woman.
The unconscious man lying on the carpeted floor was certainly not one of the older passengers Tim had told her about. This man barely looked any older than the doctor who was kneeling beside him, performing chest compressions. Maybe that was why there was a flash of real relief on his face when Hugh looked up to see Lisa and Tim arriving with the trolley.
‘Take over compressions, will you, Tim? I’ve been going for more than two minutes.’ Hugh pulled at his tie to loosen and remove it as he straightened up and moved to let Tim kneel. He was shrugging out of his jacket as he scrambled to his feet to get the defibrillator off the trolley. Lisa had already turned it on and taken the sticky pads from the pouch on the side.
‘Find some laryngeal mask airways, please, Lisa. We’ll need the IV kit and the drug roll. You can set up some saline and make sure we’ve got adrenaline and amiodarone ready to draw up.’
The next few minutes were controlled chaos. Hugh applied the patches while Tim kept up the rapid compressions until he was asked to stop so that they could identify the rhythm on the screen of the defibrillator.
‘It’s VF.’ Hugh nodded. He pushed a button on the machine and the whine of the increasing charge could be heard. ‘Okay, everybody clear. This is going to be a single shock at maximum joules.’
Tim put his hands in the air. ‘Clear,’ he responded.
Lisa wriggled back from where she was on her knees, unrolling the drug pouch. ‘I’m clear,’ she added.
The whine changed to an alarm. ‘Shocking,’ Hugh warned.
Their patient’s body arced and then flopped back. He made a sound like a groan despite the mask airway that was filling his mouth and the woman, whom Lisa assumed was his wife, cried out in distress from where she was watching the resuscitation efforts.
‘You good to continue compressions?’ Hugh asked Tim.
‘Yep.’ Ideally the person doing the compressions should change every two minutes to keep the energy level high and effective but there was too much to do in a very limited time and Lisa was ideally placed to assist Hugh right now. He needed to get an IV line inserted and the first of the drug dosages administered.
‘Draw up one milligram of adrenaline, please, Lisa.’
‘On it.’ Lisa had put everything he needed for putting in an IV line on a towel. She could watch Hugh moving as she located the ampoule of adrenaline, tapped the top to shift any liquid back into the base and then snapped off the tip so that she could fill a syringe. Hugh’s movements were swift and sure. He tightened the tourniquet, felt for only a brief instant for a vein and slid the needle and cannula in only seconds later. By the time Lisa had drawn up the drug, he had secured the line and attached a Luer plug. Lisa handed him the syringe, and the ampoule so he could double check that the right drug was being given.
The first dose of adrenaline made no difference to the potentially fatal rhythm of ventricular fibrillation. A dose of amiodarone was administered, also with no effect. A two-minute cycle was ending so another shock was delivered and Hugh and Tim swapped places for compressions and using the bag mask to deliver oxygen.
‘Any cardiac history?’ Tim asked.
‘No. He’s forty-six,’ Hugh told him. ‘Company director from Canada. His name’s Carter.’
‘Family history?’
‘Clear. No history of congenital heart defects or fainting episodes that might suggest an arrhythmia. He passed a medical recently and his blood pressure and cholesterol were fine. This cruise is the honeymoon for his second marriage. That’s his new wife over there.’
Lisa glanced over her shoulder at the woman in a silver evening gown who was standing in complete shock, her hands pressed to her mouth. The ship’s captain was right beside her and he was looking just as shocked as it became apparent that this wasn’t going well.
At twenty minutes into the resuscitation attempt, with their patient now intubated and receiving continuous chest compressions, another dose of amiodarone was added to the repeated doses of adrenaline and repeated shocks but Lisa could see, every time there was a rhythm check, that the wiggly line of fibrillation was getting flatter and flatter.
News of the emergency must have travelled fast because both Peter and Janet arrived at the restaurant. They now had the ship’s full medical team involved and they weren’t about to give up but, twenty minutes later, when the line on the screen was absolutely flat, Lisa could tell that the doctors were trying to prepare the man’s wife for bad news as they explained what they were trying to achieve with their actions as they still continued the attempt to save Carter’s life.
‘It’s a heart attack, isn’t it?’ she sobbed.
‘It’s a cardiac arrest,’ Hugh told her gently, leaving Peter to carry on as he went to stand beside her. ‘A heart attack is when an artery is blocked and blood can’t get to the heart. An arrest is when something is disturbing the electrical current that makes the heart beat. It can be caused by a heart attack. More often it’s caused by something that interferes with the rhythm.’
‘He’s...he’s not going to be okay, is he?’
‘We’ve done everything we can,’ Hugh said, his tone sombre. ‘We’ve shocked him and used all the drugs we can to try and correct any electrical disturbance and we’ve kept his circulation going while we’ve tried but...we’re not winning. I’m so sorry...’
Lisa bit her lip, staring down at the pile of discarded wrappers and the sharps bin where she’d been putting broken glass ampoules and needles from syringes. In a case like this, with a younger person involved, it had to be a unanimous team decision to stop the resuscitation. They had probably already gone for much longer than could have been deemed justified but nobody wanted to give up.
Nobody wanted to witness the distress of Carter’s new wife a short time later when that decision was finally made. Peter took over caring for her while Tim and Hugh arranged for a stretcher to take him to the ship’s morgue. Lisa and Janet cleaned up the mess of equipment and medical supplies and they took the trolley back to the medical centre to restock. It might be unthinkable but this kind of lightn
ing could strike twice in the same place and they had to make sure that they were ready to respond.
‘You okay?’ Janet asked.
Lisa nodded. But the nod turned into a head shake. ‘Not really,’ she admitted. ‘It’s never nice to lose a patient but that was so sad. He was so young. And on his honeymoon...’
‘I know.’ Janet gave her a hug. ‘The only good thing I can see is that he would have been so happy and it happened so suddenly he wouldn’t have known anything about it. There are worse ways to go and things like that can happen at any age.’
Lisa nodded again. Her sister could have had a sudden death when she was only two.
‘Is there someone you’d like to talk to? Hugh will be back soon. Or we could go and get a coffee.’
But Lisa was reaching into her pocket. ‘It’s okay,’ she told Janet. ‘But thanks. I promised I’d talk to my sister tonight and she’ll understand.’ Glancing at the screen, she saw that she’d missed a call from Abby hours ago now. Would she still be awake? Would it ruin her evening to know that Lisa was upset?
Abby rang straight back when Lisa texted so that she wouldn’t disturb her if she was already asleep. It was a video call on her phone so that she could see that Abby was clearly not about to go to sleep either.
‘Hey...’ Lisa frowned at what she could see on her sister’s face. ‘What’s up, Abby?’
Any thoughts of offloading onto her sister to receive the comfort and reassurance she needed evaporated instantly. Lisa might also be upset but it was Abby who burst into tears and struggled to get her words out.
Awakening the Shy Nurse Page 8