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'Was that Owen? I heard that he'd tried to call you earlier today when you were busy with a patient. He's very keen to get you on his side, isn't he?'

'I think he's proud of his work at the hospital. He's very impressed with the paediatric unit there, and he won't be happy until I've been over and taken a look at it.'

'He doesn't work in the paediatric unit.'

'That's true, but he wants to set up something similar alongside A and E. I suppose that's why he keeps an eye on things there.'

'So you'll be going over there this week?' When she nodded, he said, 'You'll have to let me know how you get on.'

She was disappointed by his level tone, and maybe that was because she was hoping for a different kind of reaction from him. He wasn't trying to dissuade her, and that was a little odd, but perhaps he didn't really care whether she stayed or went. He knew that her contract was coming to an end, but he wasn't trying to influence her either way. He probably already had someone in mind for her job, if she should decide to leave.

'I'll do that.' She glanced through some notes she had made, trying to keep her mind on her job, but she was finding it difficult to concentrate while Mark was watching her.

She wanted so much to be able to turn to him and be at ease with him, but since that day at his father's house nothing had been quite the same. Perhaps, after the dog had run amok and his parents had seen the full extent of the damage to the flower-beds, he had realised that they had nothing in common. His parents had been polite and civil towards her, but it must have been plain to see that she simply wouldn't fit in with his way of life.

He said, 'I heard that Hannah was having physiotherapy. How is she getting on?'

'All right. It's a slow business, but at least she's cooperating with everyone. She wants to be able to go home to be with little Jamie.'

'That's understandable. I suppose that as she begins to feel stronger some of her depression will lift.'

Sarah looked up at him in surprise. 'I didn't know that you'd heard about that.'

He nodded. 'I spoke with one of the nurses. I suppose I feel involved, since we were there at the scene of the accident... And she's your sister, of course. That makes me concerned for her, on your behalf.'

He hesitated, then added, 'I imagine a lot of her depression must stem from the fact that Ryan is still incapacitated. It seems odd that she had to run away from him and come to you, and yet now she's feeling that she has to blame someone for his condition.'

He was looking at her cautiously, and Sarah realised that somehow he must have put two and two together. He must know that Hannah blamed her for what had happened. She still went to visit her sister, but their meetings were fraught with tension. Hannah was not giving way.

'She told me that they had talked things through on the day of the accident, and they were hoping to get together again. I think she always loved him, deep down, but he was a different man when he had been drinking. He promised her that he would stop.'

'Is that likely? Or rather, would he have been likely to do that if he hadn't been involved in the accident?'

'I don't know. Perhaps he had some issues that he needed to resolve, and he may have turned to drink to try to avoid them. I suppose it's always possible that Hannah had managed to persuade him to have some kind of counselling. I don't think she would have simply taken his word for it that he would stop. I know Hannah, and she would have expected some kind of commitment from him that he was determined to change his way of going on.'

He said, 'You've been going to see Ryan, haven't you? I think that's a good idea, to keep talking to him. The nurses have been wheeling Hannah along there as well. There is a school of thought that if you keep trying to stimulate someone who is in a coma you might eventually get some response.'

'Yes, I've been trying that. There hasn't been much change in his condition up to now—just the occasional twitch of a finger, and a couple of times he actually opened his eyes, but then he reverted to his usual stillness. I left some tapes with the nurses so that they can play them for him when we're not able to visit. Mostly they're tapes of Jamie talking to Kingston, or tapes of Jamie playing with his friends. The nursery school is planning a visit to the seaside soon, a day trip, and I managed to get a tape of the children talking about it.' She frowned. 'I don't know what else to do.'

He touched her hand, covering her fingers with his palm. 'You're doing what you can,' he said. 'You should stop punishing yourself. You can't do any more.'

'I know.' The gentle compassion in the way he laid his hand on hers was meant to be reassuring, but it was almost her undoing. It was the first real contact she'd had with him since that day he had kissed her, and it brought home to her how much she had missed that closeness.

He released her and moved away as the desk clerk finished checking the computer and came back to the reception area. Sarah took her notes with her and went in search of her patient.

The visit to the paediatric unit at Owen's hospital went off well enough. The doctors and nurses who staffed the department were friendly and welcoming, and Sarah knew that if she chose to work in this hospital she would be able to settle in without too many problems.

Owen was eager to show her around, and when he was due for a break they went to the cafeteria and had lunch together. 'What did you think?' he asked. 'Could you see yourself working here?'

'Possibly,' she said. 'I would need to give it some serious thought.'

'Are you still thinking of working in A and E when your contract finishes?'

'I haven't made up my mind yet. Ever since my mother died I've wanted to work in Emergency, and I believed that anything else would be second best for me. I just need to think it through and get it clear in my head. There are so many reasons for and against.'

Owen gave her a considering look. 'How far does Mark figure in your reasoning? Can you see yourself moving away from him?'

'Why do you ask that?'

He gave a crooked smile. 'Because I think you care about him. You leap to his defence and you admire the way he runs things, and besides all that I've seen the way you look at him when you think no one's watching. I doubt that you've even let him know how you feel.'

'I think my decisions will be based more on how things are with my family,' she said, sidestepping the issue. 'Hannah is beginning to respond to physiotherapy, but she'll need help with Jamie for a long time to come. I might possibly be able to persuade her to move with me, and I could arrange home care for her, but neither of us would want to be too far away from my father. We would have to be within visiting distance of him and Ryan.'

'I don't see that as a problem. It's a two-hour drive to get here from where you are now, but you could find somewhere to live around the halfway point.'

'Maybe. I'll have to think about it.' There was always the possibility that she could find a position in a hospital nearer home.

He didn't push her any more, and Sarah made the drive back home, her head filled with uncertainties.

 

The next day she went back to work in A and E. Mark sent a swift glance her way when she arrived in the department, but he was busy with a patient and he said briefly, 'You made the tour of the paediatric unit, then?'

She nodded. 'It was impressive. The facilities there are wonderful.'

He made a disgruntled sound in the back of his throat, and then turned his attention back to his patient. Sarah went and got on with her work, and didn't see much of him throughout the rest of the day. He seemed to be continuously on the move, constantly under pressure. Perhaps that was because there was a major influx of trauma patients.

Towards the end of her shift, he called out to her as he was working on an injured man, applying pressure to a wound as the patient was being wheeled on a trolley bed towards the treatment room.

'There's a woman coming in by ambulance. She's an asthmatic and she's thirty-five weeks pregnant. Will you take her? Get Jonathan to help you. I'm going to have to try and get my patient up to surgery. I can't leave him.'

'Yes, of course.' She could see that Mark was trying to stem bleeding and they were pumping blood into the patient as fast as they could. There was no way that Mark was going to be able to help her.

When the paramedics brought the woman in, she was suffering an asthma attack and was being given nebulised salbutamol. It was clear to see that she was heavily pregnant.

Sarah started to examine her, but the next moment Megan said, 'We're losing her.'

Sarah quickly gave the patient a shot of epinephrine, but after a minute or two Megan said, 'I can't find a pulse. She's stopped breathing.'

'I'm going to intubate,' Sarah said. 'We need to get the obstetrician and the paediatrician down here.' A nurse hurried away to make the call, and Sarah started the intubation.

She introduced the point of the curved laryngoscope blade into the epiglottic fold until she could see the inlet of the larynx. Then she passed the endotracheal tube into the trachea, removed the laryngoscope, inflated the cuff and fixed the tube in place with tape.

'All right, I've secured the airway. Let's get her on oxygen, and we need to get her into a left lateral tilt position. We'll support her with pillows to keep her propped on her side.'

'Why are we doing that?' Jonathan asked with a frown.

'It helps with the flow of blood, and it should make chest compressions more successful in providing sufficient cardiac output.'

Megan took over with the oxygen, and Sarah began chest compressions, but after a few minutes she said, 'I need to defibrillate.' Quickly, she put gel on the patient's chest, slapped gel pads on and then placed the defibrillator paddles there in order to shock the heart.

They worked as a team for several minutes, trying to resuscitate the woman, and eventually Sarah said, 'How is the foetus doing?'

Jonathan said, 'It's struggling. The heart rate is falling dangerously low.'

'We're going to have to do an emergency Caesarean. Is there a Theatre ready?'

Megan shook her head. 'No, I already checked.'

'We can't wait. Where are the obstetrician and the paediatrician? I called for them ages ago.'

'They're run off their feet upstairs,' Jonathan said. 'They're dealing with a breech presentation and a woman who is haemorrhaging. They said they would get down here as soon as possible.'

Sarah was worried. She was exhausted after a long day, and she wasn't at all sure that she could handle this on her own, but there was no one else around who could help out. She was certain that this woman needed expert help. With the foetus struggling to survive, there were two patients who needed help, not just the one.

She pulled in a deep breath. 'OK, let's prepare her for a Caesarean section.'

She made a midline skin incision, and then incised the underlying uterus. Working as quickly as she could, she delivered the baby, holding it head down and below the level of the mother's abdomen. Jonathan clamped and cut the umbilical cord.

'The baby's not breathing,' he said. 'There's no heartbeat.'

Sarah could see that the baby was limp, with no reflexes, and his colour was bluish. 'Start resuscitation. I have to look after the mother. I can't leave her.'

Jonathan blanched, but he turned away and began resuscitation. Just then the doors of the treatment room flew open and the obstetrician arrived, with the paediatrician following close on her heels.

'We'll take things from here,' the obstetrician said. Sarah moved back to give her room.

The baby still wasn't making a sound, and Sarah was dreadfully afraid that she had been too late. A delay of just a few minutes could have made for a bad outcome, and she was desperately worried that she had waited too long.

'We're going to have to get both of these patients to Intensive Care,' the obstetrician said after a few minutes. 'We'll keep the mother on the heart monitor and IV fluids. I'm concerned about her breathing problems and the blood loss, and her blood pressure is falling.'

Mother and child were wheeled away at top speed, and Sarah was left in the treatment room, staring at the empty space where the trolley had been. Megan and the other nurse had gone with the patients, and Jonathan was looking worriedly after the disappearing baby.

'I think perhaps he was starting to breathe,' he said. 'I can't be sure.. .but there's a chance that he'll be all right, isn't there?' He was frowning, looking doubtful, looking to her for reassurance, and Sarah nodded, unwilling to show him her fears. He was a junior doctor and he had done everything that he could. She was the one who was to blame if anything had gone wrong.

'Go and take a break,' she said. 'You did well. You did everything you could.'

He looked thankful to escape, and Sarah was glad to be left alone. When the door shut behind him the enormity of what had happened washed over her and she started to cry, soft, silent tears that trickled down her cheeks so that she tasted the salt of them on her lips.

'What happened?' Mark came into the room and looked at her questioningly.

She stared up at him, not speaking, startled because she hadn't heard the door open. Then she said, her voice choked, 'The mother went into cardiac arrest. The baby wasn't breathing, and there was no pulse. I tried...I tried to save them, but I waited too long. I failed them both.'

'Where are they now?'

She dashed the tears away from her face. 'They've been taken to Intensive Care.' She struggled to stop her mouth from trembling, the troubles of the whole unhappy day falling around her.

'I'm no good at this,' she whispered. 'I thought I could make a go of it, but it's hopeless. I'll never make an emergency doctor, will I? I don't think quickly enough, I don't act quickly enough, and I'm scared all the time. I just can't make it.'

He stared at her, and he didn't speak for a long moment. Then he said, 'You're probably right. You've always been doubtful about your abilities, and it's most likely true. You're not cut out for this type of work. No matter how hard you try, you just can't do it. You might as well give up.'

BOOK: Unknown
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