OVER THE NEXT few days, Rachel felt happier than she’d been in years. At work, she and Tim kept things polite and professional with each other, but since that night together things had changed outside work: he was more tactile, easier with her, and she enjoyed the closeness. By unspoken arrangement, he stayed over the nights before they were both on a late shift, and it was so good to wake in his arms and feel that the day would be full of sunshine.
One evening, she took him to the Christmas market on the South Bank as part of the plan to make Christmas less difficult for him. As they walked through the crowds between the wooden chalets, Christmas music was playing, and the air smelled of spice and oranges. There was a nip of frost in the air, and they could see people’s breath like mist rising up to the twinkling lights as they chattered and laughed.
She bought them both a hot chocolate, liberally laced with cream liqueur, and they browsed the stalls that sold all kinds of Christmas decorations and gifts, from wooden ornaments and toys to jewellery to candles.
‘These stars are gorgeous,’ she said. ‘I’m definitely buying these for the girls’ stockings, this year.’
Tim, too, bought a selection of stocking fillers for his daughters; then they grabbed something to eat from one of the food stalls before walking over Waterloo Bridge and wandering over to watch the skaters at the Somerset House ice rink.
‘You know, if we hang around here much longer, we’re going to end up working,’ Tim said. ‘At the very least, there’s going to be a Colles’ fracture, not to mention sprains, strains and a lot of bruising.’
She tucked her arm through his. ‘I know ice skating is maybe not the safest thing, but my girls used to love going here, or to the rink outside the Natural History Museum. It’s the combination of the lights, the music, the smell of hot chocolate and the Christmas trees.’
‘I have to admit, I’m not really a fan of skating,’ he said, ‘even if you exclude the Emergency Department aspect of it.’
‘I’m not brilliant at actually doing it,’ she said, ‘but I used to love watching Torvill and Dean. They were so graceful, gliding across the ice and doing those amazing jumps and pirouettes. And I loved her outfits.’
He chuckled. ‘You’re so showing your age—we must have been students when they won the gold medal.’
‘I know.’ She laughed back. ‘The music I’d choose for ice skating shows my age, too. Robbie Williams...’ she sang a snatch of ‘She’s the One’ ‘...and George Michael.’ She grinned. ‘And “Last Christmas” is still my favourite contemporary Christmas song ever.’
‘Mandy’s was Mariah Carey,’ he said.
‘An excellent choice,’ she said. ‘I love that one, too. Mandy had good taste.’
‘I think,’ he said, ‘you would’ve liked each other.’
‘I do, too,’ she said, and squeezed his hand. ‘Have you been to see the Christmas lights at Kew Gardens?’
‘No. Mandy went a couple of times with the girls, but I was working.’
‘Drop the guilt,’ she said, ‘and think of the people you helped on those nights. People who were in pain—people who might have died. You made a difference.’
‘I guess.’ He paused. ‘Have you been to Kew?’
‘I went with Steve, three or four years back.’ She shrugged. ‘But it was a work thing, so he spent the whole night networking. I’m planning to go on my own this year and just enjoy the lights and the music and the Christmassy feel.’ It was part of her plan to do things for herself again, but maybe it would help Tim, too. ‘You’re welcome to join me, if you like.’
‘Actually, that sounds really nice,’ he said. ‘And, just to prove I’m serious, I’ll book the tickets now.’ He grabbed his phone and flicked into the internet. ‘Thursday night?’
‘Thursday night works for me,’ she said.
‘This is way better than I remember it,’ Rachel said when they were partway through the trail at Kew. ‘This is amazing. It must’ve taken hours to put all those lights over the trees—especially all the way to the top of that beech tree.’
‘And those colour-changing butterflies,’ he said. ‘Though I think my favourites are the ones where the lights look like snowflakes falling.’
There were little wooden huts on the way, selling Christmassy food and hot spiced cider; and there was a mini fairground in the middle, with old-fashioned rides and Christmassy music played on a steam organ.
‘I always loved the gallopers when I was a kid,’ Tim said, gesturing to the horses on the carousel.
‘Me, too,’ Rachel said. ‘This will be perfect for your grandchild in about two years, with the train and the pedal car and the swing boats.’
‘And Father Christmas, with real reindeer,’ he said. ‘Actually, I think the girls would really like this.’
‘Make a date with them,’ she said.
‘I will,’ he agreed. Rachel’s delight in Christmas was making it so much more bearable for him, this year. And maybe this would become a new tradition, something to look forward to. With her.
The trail took them over a bridge, where the reflections of the lights in the water were stunning; through a light arch, which felt like being in a cathedral; and then an area where the lights on the Christmas trees changed in time with the music. Finally there were lasers projected onto water which sprayed across the lake.
‘Thank you for coming with me,’ he said when they finally left the gardens. ‘That was spectacular.’
‘Wasn’t it? I can’t work out what I liked most,’ she said. ‘I think all of it, actually.’
But it wasn’t just the prettiness of the lights and the fabulous presentation, Tim thought. What had made it magical for him was Rachel. Walking hand in hand with her, stealing a kiss, sharing a smile. In the few short weeks he’d known her, she’d chased so many of the shadows away. And he was starting to think that maybe, just maybe, he’d found happiness again.
The following evening, they were both on a late shift when the paramedics brought a little girl into Resus. ‘This is Willow Patterson—she’s a year old in two days’ time,’ Samir, the paramedic, said. ‘Mrs Patterson, her grandmother, has come in with us, and Willow’s parents are on their way in. She went limp and then started fitting, and her gran called us straight away.’
‘Do you know how long the seizure lasted?’ Rachel asked.
‘Twenty minutes,’ Samir said.
Rachel and Tim exchanged a glance. Febrile convulsions were common in that age group, but the fit lasted typically for about five minutes. In this case, it could be encephalitis or epilepsy causing the seizure. And very young children could become extremely unwell very, very quickly.
‘In the van, her eyes kept going to the left for about fifteen minutes,’ Samir said. ‘We’ve put her on oxygen. Her temperature’s a bit higher than normal, but nothing I’d be worried about.’
‘OK. Mrs Patterson, we’re going to give her some medication to control her seizure, but the medication depresses breathing so we’ll need to help her breathe for a little while,’ Tim said. ‘It’s going to look scarier than it is. You’re welcome to stay, or if you want to wait outside for her parents to arrive, that’s fine.’
‘I’ll stay,’ Mrs Patterson said. ‘Can I hold her hand?’
‘Yes,’ Tim said. ‘Rachel, would you mind bagging while I give her the meds?’
‘Of course,’ Rachel said, sorting out the oxygen mask and bagging. ‘Mrs Patterson, do you know if Willow has ever had a fit before?’
‘I’m pretty sure she hasn’t,’ Mrs Patterson said. ‘Ellie—my daughter-in-law—would’ve said.’
‘Has she had a high temperature or any other symptoms of a virus over the last couple of days?’ Tim asked.
‘She felt a bit hot this evening after Ellie gave her her dinner,’ Mrs Patterson said. ‘She ate just fine—but Ellie thought she was teething. She and Stu were going to call off going out, but I told them I’d give her some teething crystals and she’d be fine with me.’ She looked distraught. ‘We were just having a cuddle and a story before I put her to bed, but then she went limp and started having a fit. I panicked and called 999.’
‘Which was exactly the right thing to do,’ Rachel reassured her. ‘Her temperature isn’t high enough for it to be a febrile convulsion, but about one in twenty people have a one-off fit in their lifetime. This doesn’t mean she definitely has epilepsy, though we’ll want to keep an eye on her and check her over.’
‘Oh, God. If anything happens to her, Stu and Ellie will never forgive me. They haven’t been out for months. I sent them out to see a film and have dinner, so they could have some couple time,’ Mrs Patterson said.
‘It’s not your fault,’ Rachel reassured her. ‘These things happen. Once the medication’s taken effect and she’s breathing OK on her own, we’ll try and wake her up. You can help us with that, if her mum and dad haven’t managed to get here by then.’
‘She’s such a happy little girl. She’s just learned to clap and she’s so pleased with herself, doing “If you’re happy and you know it”,’ Mrs Patterson said, looking anxious. ‘It’s not going to change her, is it?’
‘We’ll know more when she’s awake,’ Tim said. ‘I remember my girls loved clapping songs.’
‘So did mine,’ Rachel said with a smile, knowing that he was trying to take Mrs Patterson’s mind off the scary unknown.
A few minutes later, when Willow had just been taken off oxygen, her parents arrived, looking shocked. ‘I can’t believe this. It’s the first time we’ve left her in months,’ her mum said.
‘We know it’s not your fault, Mum,’ Willow’s dad reassured the older woman. ‘It would’ve happened if we hadn’t gone out.’
Tim took them swiftly through what had happened and what they were doing. ‘We need to get her to wake up so we can assess if the seizure’s had any effect,’ he said gently.
‘Come on, darling. Wake up,’ Willow’s mum said, rubbing the little girl’s cheek. ‘Wake up.’
‘Show Daddy how you clap with Grandma,’ her dad added.
Willow’s grandmother sang the first verse of ‘If you’re happy and you know it’ and clapped.
Still Willow didn’t wake, and Rachel exchanged a glance with Tim. The longer the baby was unresponsive, the more likely there were to be problems.
Finally, to their relief, the baby woke and started crying.
‘Mum-Mum, Da-Da,’ she said, stretching her arms up to her parents.
The fact that she was able to recognise her parents was a really good sign, and relief flooded through Rachel.
Willow’s mum scooped her up and held her close; the baby clutched her and whimpered.
‘It’s going to be all right, now,’ Willow’s dad said, enfolding them both in his arms.
‘Now she’s awake, we’re going to send you to the paediatric department so they can assess Willow properly,’ Rachel said. ‘They might want to keep her in overnight, but if they do you can stay with her.’
‘I’m never leaving her again,’ Willow’s mum said, her face pinched. ‘Never.’
‘Her gran did everything right,’ Tim said gently. ‘These things happen. But when Willow’s been assessed they might have a better idea about whether she has epilepsy, and they can give you advice on how to handle any future fits.’ He stroked the little girl’s cheek and smiled at her mum. ‘It’s nice to see those big blue eyes. Take care.’
Once the Pattersons had gone up to Paediatrics with Willow, Tim gave Rachel a hug. ‘You were thinking of your girls at that age, weren’t you, and how easily something like this could’ve happened to them?’
She nodded. ‘I’m guessing you were, too.’
‘Yeah. It’s a scary thing, being a parent. Everything you think you know suddenly goes out of your head, and instead there’s this great fog of panic.’ He gave her a wry smile. ‘I’m going to be terrified every time I babysit my new grandchild.’
She smiled back. ‘You might get that initial panic, but in an emergency you’ll switch back to doctor mode.’
‘There is that,’ he conceded.
In the middle of December, Rachel and Tim were walking through Hampstead Heath. There was a mini Christmas fair going on, with a few stalls and a band on a small stage with a keyboard, a drum kit, a guitar and an amp, playing Christmassy music. When they started playing ‘Last Christmas’, Tim looked at Rachel. ‘They’re playing your song. It’d be a shame to waste it.’ He gave her a bow and held out his hand. ‘Dance with me?’
She laughed and stepped into his arms.
It was wonderful, Tim thought, dancing under the trees with Rachel’s arms wrapped round him and her cheek resting against his, with all the fairy lights twinkling round them. All they needed now was the lightest, lightest sprinkling of snow as the final touch...
And then he heard someone say, ‘Look at those two dancing together. It’s lovely to see an older couple still so in love with each other.’
Love.
Was he in love with Rachel?
Her warmth and sweetness had seeped through the barriers he’d built round his heart, gently undoing all the fetters without him even noticing, because he’d been focused on enjoying the brightness she brought to his days. He was even starting to think that he could actually handle Christmas, this year—and it was all thanks to her. The world had started to feel bright and sparkling again, since the first moment he’d kissed her. Waking up in her arms in the morning made him feel that the world was full of sunshine. He was learning to see the joy again.
He almost—almost—told her. But he didn’t want to say it for the first time in the middle of a crowd. Instead, he just let himself enjoy the moment, dancing with her under the fairy lights.
When the song came to an end, he smiled at her. ‘Shall we take a selfie?’
She smiled back at him. ‘Sure.’
He pulled his phone out of his pocket and stared at it in horror as the notifications filled the screen. Missed calls from Hannah and Jamal. Sophie, too.
And the text that stood out made his blood run cold.
Baby not moving. Going to hospital.
Oh, Christ.
No.
Hannah couldn’t lose the baby. She couldn’t.
And then he thought of Mandy, going to hospital in the ambulance but never making it there.
‘Tim? What’s wrong?’
‘My phone. Must’ve been on silent.’ He couldn’t bear to voice his fears out loud. Instead, he showed her the screen.
‘Oh, no. Poor Hannah. She must be worried sick. And you must be, too,’ she said. ‘But, Tim, remember that it doesn’t always mean there’s a problem. Hannah’s in her last month, right? It could be that the baby’s head is engaged so she won’t feel so much movement, or the baby’s simply in a deep sleep. The chances are, by the time she gets to hospital, she’ll be feeling movements again.’
‘But what if...?’ The words stuck in his throat. What if the baby died? What if Hannah died? His clever, capable daughter, so like her mother. Surely Fate wouldn’t be so cruel as to repeat itself? He wouldn’t lose his daughter and grandchild, the way he’d lost his wife?
He’d been so busy having fun with Rachel that he hadn’t taken care of his daughter.
‘Tim,’ Rachel said, dragging him from his thoughts. ‘We’re not far from my place and it’ll be quicker to walk there than call a taxi. I’ll drive you. Which hospital?’
‘I...’ He couldn’t think straight. ‘Hackney.’
‘OK. Call her,’ she said, giving his phone back. ‘Tell her you’re on the way.’
Hannah’s phone went straight to voicemail. So did Jamal’s. And Sophie’s. And Calum’s.
He was shaking so much; he couldn’t type a text. He called Hannah again and left a voice message. ‘It’s Dad. I’m on my way. Hang on. It’s all going to be all right.’ Even though he was terrified that it wouldn’t be. He was the parent. It was his job to reassure her. ‘I’ll be there as soon as I can. Love you.’
It felt as if it took hours to walk to Rachel’s, even though it was only a few minutes, and his brain was too scrambled for him to talk—though at least he’d remembered which hospital. She didn’t push him, simply switched the radio to a classical station and drove him to Hackney.
‘Do you want me to come in with you?’ she asked.
Yes. No. He didn’t know. Panic and worry had rendered him completely hopeless. ‘I...’
She squeezed his hand. ‘Look, I’m not going to intrude. Go and see Hannah. Call me if you need anything. That goes for all of you. OK?’
‘Thank you,’ he whispered, and wrapped his arms round her.
‘It’s going to be all right,’ she said.
Exactly the same reassurance he’d given Hannah. And he knew it was just as hollow. Mere words. Because nobody could know for certain.
‘Call me when you can and let me know how she is,’ she said. ‘Give her my love.’ Her eyes held his. ‘Remember what I said. Anything you need, I’m here. Just call me. Even if it’s stupid o’clock.’
He nodded; his throat too thick with fear to let any words out.
It wasn’t a rejection, Rachel reminded herself as she drove home. It was obvious that Tim’s worries about Hannah and the baby had brought back memories of Mandy’s death. He needed space and time. She’d done what she could to support him.
She just hoped that everything would be all right. There were several reasons why a baby’s movements decreased—as well as the ones she’d given Tim, there was the chance that Hannah had overdone things that day. Plus, babies were often wide awake when the mum was trying to sleep and less active during the day.
Please, please, let everything be all right, she prayed silently. Let it be the Christmas Tim and his family needed, full of love and happiness and the joy of a new baby.
Be strong, Tim told himself as he walked up to the maternity department reception.
‘My name’s Tim Hughes. My daughter Hannah’s been brought in because she couldn’t feel the baby moving, and she needs me here,’ he said. His glance flicked automatically to the whiteboard; Hannah’s name was there, right under the word ‘emergency’. ‘Would it be possible to see her, please?’
‘I’m afraid we can’t allow visitors,’ the receptionist said, ‘but I can get a message to her and you’re very welcome to go into the waiting room.’
Tim dragged in a breath. ‘Sorry. As a doctor myself, I should know the protocol,’ he said.
‘But you’re also a dad,’ the receptionist said, ‘and you’re worried about your daughter. Actually, I think her sister’s in the waiting room.’
Tim forced himself to smile. ‘Thank you.’
The receptionist directed him to the waiting room, and Tim strode swiftly there. Sophie stood up as soon as he walked through the door, and he wrapped his arms round her. ‘How’s Hannah? How are you? I’m so sorry.’ The words tumbled out.
She held him close. ‘Everything’s OK, Dad. They gave her a scan and the baby’s okay. They gave her a glass of orange juice and the baby’s moving again now.’
‘It’s the sugar in the juice. Energy,’ he said. ‘Are they giving the baby a non-stress test? Did they say why the baby wasn’t moving?’
‘I don’t know, Dad. The main thing is, she’s getting checked out.’
‘I should’ve been here.’ But he’d focused on himself and his own needs instead of on his daughters. He hadn’t been there when they’d needed him. ‘I’m so sorry. My phone was on silent.’ He dragged in a breath. ‘I don’t know how. I was out with Rachel.’
‘Where is Rachel?’ Sophie asked.
‘I, um—she went home.’
‘Right.’ Sophie looked surprised. ‘How did you get here?’
‘Rachel drove me. She said it’d be quicker than waiting for a taxi.’ He raked a hand through his hair. ‘I said I’d call her and tell her...when I know what’s happening. She...um...sends love.’
‘She could’ve stayed,’ Sophie said.
‘Better not,’ Tim said.
Sophie gave him a strange glance. ‘Calum and I will give you a lift home when we’ve seen Han and know she’s OK.’
‘Thank you.’ He hadn’t even thought about getting home. ‘Where is Calum?’
‘Gone to get coffee. You just missed him.’
‘Right.’ He held her close. ‘I’m sorry. I’ve let everyone down.’
‘Han was a bit upset when you didn’t call,’ Sophie said. ‘She even asked me to ring the hospital, because we both thought you were at work.’
It was a fair point. But he’d replaced work with Rachel. Made himself even less available.
And it had to stop.
Now.
He’d tell Rachel tonight, once he knew Hannah and the baby were both all right.
The waiting seemed to last for ever, but finally Hannah and Jamal appeared in the waiting room.
‘They’ve checked us out thoroughly, given me a scan and done a non-stress test, and they’re happy for me to go home,’ Hannah said. Her voice was wobbly. ‘The baby’s fine. Just really deeply asleep when I couldn’t feel the usual movements, they think.’
‘And she’d been overdoing it,’ Jamal said. ‘Which means we need to tag team her and make her rest.’
‘I’m fine,’ Hannah said, lifting her chin. ‘I just panicked a bit, that’s all.’
Tim hugged her. ‘I’m so glad it’s all right. And I’m so sorry I wasn’t there.’ He should’ve been there. He could’ve reassured her—both as her father and as a medic. ‘I’ll take the first shift in looking after you.’
‘Dad, you’ve got work,’ Hannah said. ‘And you’ll all drive me potty if you fuss. It’s fine. I have all your numbers, and I’ll call if I’m worried about anything. I don’t need a babysitter.’
‘My phone was on silent,’ Tim said. ‘It won’t be, in future. I’ll make sure it’s diverted to the admin team if I’m at the hospital.’
Hannah’s face crumpled, and she burst into noisy sobs.
Guilt flooded through him, and he stroked her hair, holding her close. ‘It’s OK, Han. It’s all going to be OK.’
‘I was so scared, Dad.’
‘I know, baby. But it’s all fine. You have Jamal. You have Soph and Calum. You have me. It’s fine. They’ve told you what to do if you’re worried in future?’
‘Drink juice or have a snack. Lie on my left side and count the movements. If I’m still worried, come straight in.’
‘Then it’s fine,’ he said. ‘It’s all going to be just fine.’
He went home with Hannah and Jamal and took the Tube home rather than making Sophie and Calum drive out of their way. And then he called Rachel.
Rachel snatched up her phone as soon as she saw Tim’s name on the screen. ‘How’s Hannah?’
‘Fine. They did a non-stress test and a scan, and they think the baby was deeply asleep. They’ve sent her home.’
‘I’m so glad,’ she said. ‘Is there anything she needs? Anything I can do?’
‘No.’ He was silent for a moment. ‘Rachel—I’m sorry. I can’t do this any more. I can’t be with you.’
It took her a moment to process what he was saying. He couldn’t do this? He didn’t want to be with her? ‘Why? What have I done wrong?’
‘It’s not you—it’s me,’ he said.
Dread trickled down her spine. Everyone knew that phrase; it was the nice guy’s get-out.
‘I’m sorry. I just think it’s better if we stick to being colleagues from now on,’ Tim continued.
Rachel didn’t understand. She thought things had been going well between them. They were in tune with each other. They got each other’s jokes. They liked each other’s families. They fitted. She’d thought they had a future; but it seemed Tim hadn’t felt the same. She was too shocked to know what to say. So much for finally moving on from the misery of her marriage and this last lonely year, because Tim had just pulled the rug out from under her. She shouldn’t have trusted him with her heart so quickly.
He didn’t want to see her any more.
Though she supposed that the bright side was that at least Tim hadn’t cheated on her before dumping her. He’d merely made love with her and let her fall in love with him.
‘I need to concentrate on my girls,’ he said.
It felt like an excuse. A flimsy one, kindly meant to spare her feelings, but actually it did the reverse. It felt like a hundred paper cuts ripping across the confidence she’d built back up, each little tear bleeding into another and making her realise how fragile that confidence had been.
‘Of course,’ she said. She wasn’t going to fall apart and let Tim realise how deeply she felt about him. She’d made enough of a fool of herself, already. ‘I’ll see you at work. I’m glad everything’s all right with Hannah and the baby.’ Then she quietly ended the call and put her phone back on the coffee table.
It was over.
All the dreams had popped into nothing, like the useless bubbles they’d really been all along—except she hadn’t wanted to see that.
And she definitely wasn’t feeling any of the spirit of Christmas that had bathed her for the last few days when she’d been making memories with Tim. Thankfully it was still the middle of December, so Meg and Saskia wouldn’t be home for another few days. It would give her enough time to get herself back under control again and pretend that everything was fine, just as she’d pretended for the last year. But, right at that moment, the house felt unbearably empty, full of echoes, all the promise of Christmas snuffed out.
She drew her knees up and wrapped her arms round them, then rested her face on her knees and cried out all her loneliness and despair. The one good thing was that they’d kept their burgeoning relationship quiet at work, so nobody would know what a stupid mistake she’d made.
If he’d stayed with Rachel, Tim thought, he would’ve let his girls down again. But breaking up with her had made him feel just as guilty, because he knew he’d hurt her. Let her down, the way he’d let his girls down.
He’d done the right thing. He knew that.
So why did he feel so miserable about it?
The next few days at work were truly awkward. Rachel was fine while she could concentrate on a patient or teaching one of the students or juniors who’d been assigned to her, but when she was in her office writing up notes or doing paperwork for a training schedule, she was acutely aware of where Tim was in the department—and she just missed him.
Stupid, stupid, stupid.
He’d made it clear he didn’t want to be with her.
So she’d focus on the bits of her life that did work: being a mum, being a doctor and being a friend. Anything else wasn’t going to be on her agenda in future.
On the Friday afternoon, the paramedics brought in a woman in her late sixties. ‘This is Mrs Dilreet Kaur,’ Samir said. ‘She hasn’t been feeling well all week but she thought she was just coming down with a bug. Today, she’d been feeling a bit short of breath and nauseous, and then some pain in her jaw and her back—nothing in her chest, so she didn’t think it was her heart.’
Women often had different symptoms from men when having a heart attack, Rachel knew, and were more likely to feel the pain in their jaw or back rather than the classic heart attack symptom of crushing pain in the chest.
‘She collapsed, and her friend called us,’ Samir continued. ‘We’ve given her some aspirin, and we did an ECG in the ambulance on the way here, which shows it’s a STEMI.’ He handed her the printout from the ECG. ‘She’s on oxygen, but I’m not happy with her sats.’
‘Thanks, Samir. I’ve already put a call up to the cardiac team,’ she said. ‘Has anyone called her family?’
‘Her friend called her son,’ Samir said, ‘and he’s on the way in.’
‘Great. Thanks, Samir.’
Between them, they transferred Mrs Kaur from the trolley to the bed. ‘Mrs Kaur, I’m Rachel Halliday, one of the doctors in the Emergency Department,’ Rachel said. ‘Samir put some wires on you in the ambulance so he could monitor your heart, and I’m just going to attach those wires to my monitor here so I can do the same thing,’ she explained as she hooked Mrs Kaur up to the monitor.
‘What’s happened?’ Mrs Kaur croaked.
‘You’ve had a heart attack,’ Rachel said gently. ‘What’s happened is that your arteries around your heart have become narrowed by a gradual build-up of fatty deposits called atheroma, and a piece of atheroma has broken off along with part of your artery wall. A blood clot formed to repair the damage, and it’s blocked your artery.’ A STEMI—an ST segment elevation myocardial infarction—meant there was a total blockage. ‘Your heart muscle hasn’t had the blood and oxygen it needs, and we need to treat you to restore the blood flow. I’m going to do some things here in the department to make you feel better, and then we’re going to send you up to the cardiac unit for tests to see whether they’re going to treat you with medication or surgery.’
‘I’m sorry to be such a nuisance,’ Mrs Kaur said.
‘You’re not a nuisance at all. I’m here to help,’ Rachel reassured her. ‘Please ask me if there’s anything you’re worried about. Your friend called your son, and he’s on the way in.’
‘What kind of surgery? Will I have to have a transplant?’
‘No. It’s something called an angioplasty—using a tube called a catheter with a balloon at the end. The surgeon will put it into one of your arteries and guide it up to the bit where your artery’s blocked, then inflate the balloon to open the artery again. If they can’t do that, they might have to do a bypass—that’s where they take a blood vessel from another part of your body and attach it to the artery above and below the blockage, so the blood’s diverted—’
The rest of Rachel’s words cut off as Mrs Kaur went pale, slumped and stopped breathing. The monitor showed that her heart had gone into ventricular fibrillation; it was an arrhythmia that often happened just after a heart attack, when the heart muscle hadn’t had enough blood flow and became electrically unstable.
‘Crash team!’ Rachel yellowed. ‘Nita, I’m going to need you to put a ventilation bag on her. I’ll start the compressions.’ She changed the angle of the bed so Mrs Kaur was lying flat, then tilted her head back and lifted her chin to open her airway. Nita, the nurse working with her, put a ventilation bag in place, and Rachel started pushing down hard on Mrs Kaur’s chest to the rhythm of the Bee Gees’ ‘Stayin’ Alive’, making sure she was going down at least five centimetres. After the first thirty compressions, she paused so Nita could give two rescue breaths with the mask; the monitor showed that the heart rhythm was still VF, so she kept going for another thirty compressions. Two breaths. Still VF. She and Nita carried on, looking up when the doors to Resus burst open—and of course it would have to be Tim.
But their patient was much more important than the tension between them, right now. ‘She’s in VF. I’m doing chest compressions and Nita’s bagging,’ Rachel said. ‘We’re coming up to two minutes.’
‘I’ll attach the defib,’ he said. ‘OK. Charging. Let me know when you’re at two minutes.’
Push, push, push.
Her wrists were hurting. ‘That’s two minutes of chest compressions,’ Rachel said.
‘And clear,’ Tim said.
Everyone stood back, and he delivered the first shock.
Mrs Kaur remained motionless.
‘Rachel, we’ll swap for this cycle,’ Tim said.
It was hospital protocol to change the person doing the chest compressions every two minutes, to avoid fatigue and make sure that the compressions were deep enough.
Rachel recharged the defib while Tim and Nita continued CPR.
‘And clear,’ she said, delivering the second shock.
‘Still VF,’ Tim said, as they swapped over. ‘Nita, can you sort out the adrenalin and amiodarone for me?’ He got her to repeat the dosages back to him. ‘That’s great. Cheers.’
After the third shock, Tim administered the two injections. One more shock, and finally Mrs Kaur’s heart was beating in sinus rhythm again.
‘Well done, everyone,’ Tim said.
By the time Mrs Kaur was stabilised, the cardiac specialist had come down and Rachel did the handover. Back in the office, she wrote up the notes, relieved that they’d managed to get their patient back; yet, at the same time, she felt so sad. Tim hadn’t even been able to meet her eyes when he’d said well done to the team.
This wasn’t going to work.
But she’d only been at Muswell Hill Memorial Hospital for two months. How could she possibly walk out of the job now? She’d be letting her colleagues down. She’d just have to put up with it. And maybe at the next team meeting she could suggest taking over doing the staff rotas. Then she could make sure that she and Tim were on different shifts, so they’d have to see as little of each other as possible.
Next year, maybe she’d be able to make another fresh start, somewhere else. Another city, perhaps. And she definitely wouldn’t make the same mistakes again.