‘THIS isn’t how I planned tonight,’ Oliver said as Rachel climbed into the passenger seat.
‘Me neither.’
‘It was supposed to be just you and me tonight. Dinner.’ He changed gear, then rested his hand on her knee. ‘And you look gorgeous.’ She looked stunning. There was something different about her but he couldn’t work out what it was, and he didn’t want to upset her by asking. Hell. Most of the time nowadays he got it wrong, and the last thing they needed was more distance between them. ‘I was going to rush you through dinner anyway—but not for work. I was going to sneak you off somewhere.’ He swallowed. ‘I wanted to make love to you under the stars.’ Something they hadn’t done since the children were born. He’d wanted to recapture some of the magic, the sparkle of their early years together, when they’d walked hand in hand along the beach in the moonlight. And then they’d have gone home and rediscovered each other, made love until the silly hours of the morning.
Rachel said nothing, and he sighed inwardly. What had he expected—a ‘we still can’? The call-out had completely broken the mood. And when he snatched a glance at her face, her expression said it all for her. If you’d used a call-out service, everything would have gone as planned.
But instead he’d taken a gamble that he wouldn’t be called out. A gamble that he’d lost. Please, please, don’t let it have cost him his marriage. He bit his lip. ‘Rach. Talk to me.’
She pushed his hand off her knee. ‘Let’s just get to Dervla’s.’
Her voice sounded very, very tight. As if she were a wound-up spring. One wrong touch could trigger something nasty. If he pushed her now, they’d have an almighty row—a row that would widen the gulf between them even more. He could tell she was on the verge of giving him an ultimatum, telling him to choose between his job and his family. But how could he choose? Being a doctor: that was who he was. Why couldn’t he be a doctor and a husband and father at the same time?
Caroline’s voice echoed in his head. You need to get your priorities sorted out.
He wanted Rachel and the kids to come first. But if he used a locum call-out service for evenings and weekends, he’d be flying in the face of everything his father had done. Doctors never desert their patients. It was how he’d been brought up. Years and years and years of conditioning. He could hear his father saying it even now. His mother had always accepted it. Why couldn’t Rachel accept it, too?
‘I’d better check everything’s OK at home,’ she said, taking her mobile phone from her handbag. A few moments later she gave a worried murmur. ‘Ginny’s not answering.’
‘She’s probably reading Sophie a story. You know what Sophie’s like if you try to stop reading in the middle of a story.’
‘Yes. I’ve read enough of them to her.’
He could hear the subtext very clearly: unlike you. But before he could think up a suitable retort, they were at Dervla’s house. Time to put their patient first.
‘How is she?’ Oliver asked when Dervla answered the door.
Dervla was shaking. ‘She can’t breathe. I’m so scared she’s going to die!’
‘No, she’s not. It’s an asthma attack—a bad one, but we can get her through it and help her breathe normally again,’ Rachel soothed her. ‘Niamh’s got through them in the past and she’ll get through them again.’
‘Have you been getting her to take her inhaler over the last five minutes?’ Oliver asked. The inhaler contained bronchodilator drugs, which would reduce inflammation in Niamh’s airways and open them up again so she could breathe more easily.
Dervla nodded.
‘Is it helping?’
She shook her head helplessly. ‘Not really.’
‘OK. Did they say how long the ambulance would take?’ he asked.
‘I don’t know. I just don’t want my baby to die!’ Dervla burst out.
Rachel squeezed her shoulders. ‘Try not to worry, Dervla. We’re here to help her.’
‘I’ll take a look at her and see if I can make her more comfortable while we’re waiting for the ambulance,’ Oliver said.
Dervla led them through to the sitting room, where eight-year-old Niamh was sitting on the sofa, wheezing and gasping for breath.
‘OK, Niamh, we’ll have you breathing more easily in a minute,’ Oliver reassured the little girl. ‘I’m just going to do a couple of quick checks to see how you’re doing, OK?’
She nodded.
Her pulse was rapid, at 140 beats a minute. A quick question showed Oliver that she couldn’t complete a sentence in one breath, and six seconds of counting her breaths showed him that she was breathing way too fast at fifty breaths a minute. He knew he wouldn’t even need to do a PEF or peak expiratory flow test, measuring how much air she breathed out compared to what she should be able to breathe out for her height. From the look of her, it was very likely to be less than half her normal flow.
Please, don’t let her have a silent chest, he prayed as he took out his stethoscope. A ‘silent chest’ was where air entry to the lungs was reduced so much he wouldn’t be able to hear her breathing.
His prayers were answered. So it hadn’t got to the stage where it was life-threatening, he thought with relief. ‘Good girl, Niamh. You’re doing really well. Let me see you take another puff of your inhaler,’ he said.
She struggled to breathe it in, but her technique was good, he noted. So the attack probably hadn’t been caused by poor management of her asthma. ‘As soon as the ambulance comes, they’ll give you a mask with some oxygen to help you breathe,’ he said. ‘I’m going to give you a tablet which will help.’
Before he could even reach for his bag, Rachel was silently handing him the prednisolone. He squeezed her fingers, mouthing his thanks. They were a good team—always had been, he thought. Clearly Rachel had been watching him and had guessed exactly what he’d been doing. Hopefully the prednisolone would kick in by the time the ambulance arrived—otherwise, he’d need to give Niamh a hydrocortisone injection, and suggest the paramedics give her ipratropium bromide through the nebuliser on the way to the hospital.
‘Dervla, do you have any idea what triggered this? Did you do anything unusual today?’ Rachel asked, going back to sit beside Dervla and taking her hand.
She shook her head. ‘The only thing I can think of is that I was cutting down the weeds at the bottom of the garden.’
‘Could be weed pollen,’ Rachel said.
Dervla sucked in some air. ‘It’s my fault.’
‘Not if you didn’t know that weed pollen was a trigger,’ Rachel said comfortingly.
Dervla looked at her. ‘I’ve just realised—you’re all dressed up. I’ve called you both away from—’
‘Just dinner. No special occasion,’ Oliver cut in. ‘So don’t worry about it. We’re GPs. That’s what we’re here for, and we’re used to it.’ He didn’t dare look at Rachel’s face.
‘I’m sorry I spoiled it for you,’ Dervla said. ‘I just, well, panicked.’
‘Any mum does. You should see me when Rob or Soph bang their head. I always think of the worst-case scenario,’ Rachel said, swallowing her disappointment and trying to sound light and cheery. No special occasion. Just trying to get their marriage back on the rails. And, in the scheme of things, that wasn’t so important to Oliver, was it?
Before Oliver could say anything else, Rachel’s mobile shrilled.
‘That’s my babysitter,’ she said as she glanced at the screen. Oliver had been right: Ginny had been reading a story to Sophie, ignored the phone, and was now returning Rachel’s call to reassure her that all was well. ‘Hi, Ginny.’
‘Rach. I’m sorry to ring you—I know you wanted a special night out—but Rob’s not well.’
‘Rob?’ Rachel’s heart missed a beat.
‘He’s been saying he has a bit of a tummyache, and he’s just started throwing up.’
Which meant throwing up a lot. Ginny wasn’t the sort who’d be fazed by a child who’d eaten too much chocolate and had brought it back up, Rachel knew. This was serious stuff.
Vomiting and abdominal pains. It could be any number of things. ‘Does it look as if he’s throwing up coffee grounds?’ she asked, her fingers tightening around the phone.
‘No.’
She almost sagged in relief. At least, then, there was no gastric bleeding: ‘coffee grounds’ was a sign of internal bleeding.
But it could still be something like appendicitis—the condition was more common in the very young and the very old, and the complications could be nasty. ‘I’m on my way,’ she said. She switched the phone off. ‘Oliver, that was Ginny. Rob’s ill. I’m sorry, Dervla, I would wait for the ambulance with you, but—’
‘If your little boy’s ill, you need to be there with him. I’ll be all right,’ Dervla said. ‘I hope it’s nothing serious.’
‘Me, too.’ Rachel dug her nails into her palms, willing herself to keep calm. ‘Oliver, I’ll take the car. You get a taxi.’
He stared at her in shock. ‘You can’t take the car. You’re over the limit.’
‘I only had one glass of wine.’
‘Yes, and it was on an empty stomach. It’s not worth taking the risk—if you’re breathalysed, it’ll be an instant ban!’
‘Oliver, Rob’s got abdominal pains and he’s vomiting.’ She stared at him in disbelief. Their child was ill, and he was quibbling about the car? ‘Look, if you won’t let me drive, you’ll have to go instead. I’ll get a taxi home when I’ve seen Dervla off in the ambulance.’
Dervla started to cry. ‘I’m so sorry. If only I could drive, I wouldn’t have had to call you out. I could have taken Niamh to hospital myself.’
‘No, you couldn’t,’ Rachel said gently. ‘She’d need you to comfort her on the way. It’s fine, really. Despite what my husband says, I’m very far from being drunk and I’d never, ever put a child at risk. Niamh’s safe with me. Oliver will go to Rob.’
‘I’ll see you later,’ Oliver said, his face a tight mask.
If you want a fight, Rachel thought grimly, then you can have one. The second after I get home and find out how my baby is. Right at that moment, she could cheerfully have throttled him.
* * *
When Oliver walked into the house, Ginny was mopping Robin up again and changing him into another pair of trousers. ‘I’ve put the washing machine on with the last two sets of sheets and pyjamas,’ she said quietly. ‘I thought Rachel was coming?’
‘She’d had a glass of wine—she couldn’t really risk driving.’
‘I feel awful about spoiling your special night out. I know Rachel really wanted you to have some proper time together as a couple,’ Ginny said with a rueful smile.
It took a second or two for her words to sink in, then the full impact hit him. Rachel had obviously been discussing their marriage problems with their next-door neighbour, the fact that they rarely spent time together on their own. Oliver ignored the fact that he’d done exactly the same with Caroline. He was just conscious of a wave of resentment and anger that Rachel had talked about his private life with other people and hadn’t bothered discussing it properly with him.
‘I’d better check Robin,’ he said, trying to keep his anger under wraps, and quickly assessed his son. Robin definitely had a temperature. Not spiking a fever, but enough to show he wasn’t well. His face was pale and his eyes looked huge. ‘Can you tell me where it hurts, sweetheart?’ Oliver asked gently.
‘My tummy.’ Robin rubbed his stomach. ‘All over.’
‘Has it hurt in the same place all the time?’
‘Yes.’
‘What sort of pain is it? A pushing pain or a poking pain?’
‘A poking pain.’
Appendicitis started with central colicky pain, vomiting, then a shift of pain to the lower right-hand side of the abdomen. With appendicitis, if you pressed on the left iliac fossa, it sometimes caused pain on the right—known as Rovsing’s sign. Oliver tested his theory and Robin winced. ‘It hurts, Daddy,’ he said, his bottom lip wobbling.
Hell, hell, hell. A positive Rovsing’s sign. ‘OK, son. I know it hurts, but can you be brave for Daddy?’
Robin nodded, close to tears.
‘That’s my boy.’ He kissed Robin’s forehead, and looked at Ginny. ‘I’m sorry to ask you this, but could you stay with Sophie, please? Rob might have appendicitis and I don’t want to take any chances. I need to get him to hospital.’
‘Do you want me to call the ambulance?’
Oliver shook his head. ‘Thanks, but it’ll be quicker to take him in myself.’ He carried Robin down the stairs. ‘Daddy’s driving you to hospital, darling. We’ll meet Mummy there. Don’t cry, darling. We’ll make you feel better soon.’ He paused at the doorway. ‘Thanks, Ginny. We owe you one.’
‘No problem. Look, I’ll take Sophie back to mine—she won’t wake up, and you won’t have to worry about how long you and Rachel are at the hospital. I’ll keep her fed and entertained until you’re ready to collect her. I’ve got your spare key so you don’t have to worry—I’ll lock up behind me.’
‘You’re wonderful,’ Oliver said. ‘I don’t know how we can ever thank you.’
‘I’ll tell you next time Ben’s away on a course and there’s a spider in my living room,’ she said with a smile. ‘Take care. Give me a ring and let me know how Rob is, will you? It doesn’t matter how late.’
‘Of course.’ Oliver strapped Robin into the passenger seat and rang Rachel on his mobile at the same time. ‘Rachel? It’s me. I’ve checked Robin and I think he might have appendicitis—you know how hard it is to diagnose. I don’t want to take any chances so I’m driving him to hospital. Ginny’s taking Sophie back to hers. Go in the ambulance with Niamh and Dervla, and I’ll meet you in the emergency department, OK?’ Before Rachel had a chance to say anything, he’d cut the connection, thrown his phone into the passenger footwell and was driving his son to hospital.
* * *
Rachel kept assessing Niamh as methodically and efficiently as Oliver would have done, but part of her mind was screaming to the ambulance to hurry up and get them all to hospital.
‘Is your little boy going to be all right?’ Dervla asked.
Rachel made an effort to keep her voice calm. ‘Oliver thinks it might be appendicitis.’
‘I’m so sorry. You must want to be with him, and...’ Dervla shook her head, fighting back tears.
‘Not a problem. Oliver’s with him.’
‘It’s not the same. When it’s your child, you want to be there.’
Rachel nodded. ‘But I’ll be with him soon enough.’ Just when she was about to consider giving Niamh hydrocortisone, the ambulance arrived.
The paramedics put the little girl straight onto oxygen and attached a pulse oximeter to her finger. ‘Her sats are eighty-seven on full oxygen. We’ll need to admit her,’ the first paramedic said, reading off the machine.
‘But she’s going to be all right?’ Dervla asked.
‘She’ll be fine. She’ll probably need to stay in hospital overnight, and they’ll give her drugs through a nebuliser to help open up her airways again,’ Rachel explained.
‘Would you like to come with us, Mrs Brady?’ the paramedic asked.
‘Can I come, too?’ Rachel asked. ‘Apart from being Niamh’s GP, my son’s just been taken to the emergency department—possible appendicitis.’
‘Of course,’ the paramedic said.
The nearer they got to the hospital, the harder Rachel found it to concentrate, but she forced herself to stay calm and kept reassuring Dervla about Niamh’s condition.
‘She’s in the best place, here,’ she told Dervla when they reached the hospital and followed the trolley through to the emergency department. ‘I’ll ring you tomorrow and see how she is.’
‘Thank you. And I hope your little boy’s all right,’ Dervla said.
‘Thanks.’ Rachel squeezed her hand, then rushed through to the reception desk and asked about Robin. She was directed into one of the cubicles. When she went in, Rob was lying on the bed, looking pale and in pain, and Oliver was standing beside him, holding one hand and stroking his forehead. He was talking in a low voice, clearly soothing their little boy.
‘Mummy,’ Robin said weakly, trying to smile.
‘Hello, handsome.’ She gave him a kiss. ‘How are you feeling?’
‘My tummy hurts.’
‘Oh, darling. We’ll make you feel better soon, I promise,’ she said, taking his free hand and holding it tightly.
‘We’re not a hundred per cent sure it’s his appendix. The PR exam—’ a rectal examination ‘—didn’t reveal any tenderness high to the right.’
‘That still doesn’t rule out appendicitis,’ Rachel said.
‘They’ve taken a urine sample and given him some painkillers,’ Oliver told her. ‘The paediatric registrar’s on his way.’
‘Right.’ She swallowed hard. Stupid. She knew they were in the right place to get help for Rob. But there were so many things it could be, and the wait for test results gave them time to think about what it might be, to drag the scariest and rarest conditions from their memories. She pulled herself together. Just. Oliver had stepped into her shoes briefly, and she’d stepped into his, so he’d be expecting an update on their patient. ‘I was about to give Niamh hydrocortisone when the ambulance arrived. Niamh’s sats were low, even on oxygen. I told Dervla I’d ring her tomorrow for an update.’
‘Right.’
There was a flicker of anger in his eyes, Rachel noted. Surely he hadn’t expected her to stay in the emergency department with Niamh and Dervla when their own child was ill? He’d even said to her that he’d meet her there! Before she had the chance to ask him just what his problem was, the registrar arrived. They stepped out of the cubicle to give him space.
‘What was that look for?’ Rachel demanded in a cross whisper.
‘What look?’ He spoke at the same reduced volume, clearly not wanting to draw attention to them but, like Rachel, unable to keep his feelings to himself.
‘Don’t tell me you expected me to stay with a patient instead of being with my son. And don’t you dare tell me you would have stayed with her, not with Rob here ill and needing you.’
‘It’s not that,’ he said tightly.
‘Then what?’
‘If you must know, I’m not very happy that you’re telling other people we’re in a rocky patch.’
‘What? Who?’
‘Ginny. It’s obvious you’ve talked it over with her. Who else? Your mum? Your sister?’
She stared at him in disbelief. ‘Well, you sure as hell weren’t talking to me. Every time I tried, you retreated into your office or you got called out. What was I supposed to do? Be like you and bottle things up and pretend nothing’s wrong and I’m a happy little bunny?’
‘It’s our private life. I don’t want the whole village discussing us!’
‘The way you’re carrying on, they’ll be talking about us soon enough,’ she snarled. How many people had already noticed him sneaking around with Caroline? How many people were already pitying her behind her back? ‘Anyway, I didn’t discuss anything with Ginny. She’s obviously worked it out for herself.’
‘And what’s that supposed to mean?’
‘You’re hardly ever there, Oliver. When you are, you’re never outside with me and the kids—you’re stuck in your office, and even the kids talk about Daddy being ‘busy’ all the time. It doesn’t take a huge leap of the imagination to work out what that means, does it?’ Worry about Rob made her temper flare. If he could nitpick at a time like this, then just maybe their marriage wasn’t worth saving. ‘It’s up to you if you want to stay or go, but we can’t go on like this.’
‘What do you mean, stay or go?’
‘What I said. I’m not prepared to play second fiddle any more.’
Oliver stared at Rachel in shock. Was she saying that if he didn’t get out-of-hours cover, she’d leave him? ‘Are you giving me an ultimatum?’
‘Just think about it. Think about what you’re doing. Think about what you’re throwing away.’
This wasn’t fair. If people needed him, he had to be there. Why couldn’t she understand that? ‘Don’t ask me to choose. I can’t do that.’
She looked anguished. ‘Then where do we go from here?’
‘I don’t know,’ he said. ‘Right now, I just don’t know.’