BUT, in the middle of the morning, Tyler was violently sick.
‘Mummy, my head hurts,’ he whispered.
‘Worse than yesterday, or better, or the same?’ she asked, trying to keep her voice as even and controlled as she could.
‘Worse,’ Tyler said, looking woebegone. ‘It really hurts.’
It wasn’t uncommon for children to be sick after a head injury, but she had a bad feeling about this. She needed him checked over—right now.
‘All right, sweetheart. Let’s go and get you checked over.’ She called an ambulance, giving them full details of Tyler’s symptoms and the background.
All the way to the hospital, holding Tyler’s hand, she thought about it. Was it an extradural haemorrhage—bleeding into the space between the skull and the brain, caused by a rupture in an artery? The blood clotted and caused pressure in the skull, which in turn caused headaches, drowsiness, vomiting and seizures; it could take several days for the clot to grow and symptoms to turn up. If Tyler had a clot…
He was sick twice more in the ambulance, and the best she could do was wipe his face with a cool, damp cloth.
Please, let them get to hospital.
And let them be in time.
She’d never forgive herself if anything happened to her precious child.
Dominic was there to meet them in the ambulance bay. He took one look at her face and gave her a brief but fierce hug. ‘You’re in the right place, Louisa. Don’t borrow trouble.’
The paramedics gave him all the information about the observations they’d taken, and Dominic examined Tyler swiftly. ‘CT scan, I think,’ he said.
Louisa swallowed hard. So he suspected a clot, too.
‘I have a low index of suspicion with children and the elderly, remember,’ he told her, clearly picking up on her worries.
It seemed to take for ever for the scan. And as soon as she saw the image on the screen, she knew. There was a definite clot.
Liam, the neurosurgeon, came straight down to see her. ‘It’s an extradural haemorrhage. We’re going to drill burr-holes in his skull to release the clot, then we’ll tie off the bleeding vessel. Try not to worry, because all the signs are good. His breathing is fine and his pupils aren’t too bad, and there’s no sign of any paralysis.’
But all Louisa could think about was the classic ‘talk and die’ scenario, where the patient appeared to get better and then collapsed.
Dominic nudged her. ‘Louisa?’
She blinked, shaking her head. ‘Sorry—I’m all over the place. What did you say?’
‘Liam needs to know. Has he eaten anything this morning?’
‘Two pieces of wholemeal toast with Marmite and no butter, and a large glass of milk—the same as he always has for breakfast. I think it all came up when he was sick.’
‘That’s good, because it means his stomach’s empty,’ Liam said. ‘Now, stop worrying. He’s in good hands, and you know that.’
‘He’s my baby,’ she said, her voice a scratchy whisper.
‘I’ll take care of him, Louisa,’ Liam promised.
She dragged in a breath. ‘I need to tell Mum and Dad what’s going on, but I can’t leave Ty.’
‘Give me their number, and I’ll ring them,’ Dominic said.
She took her mobile phone from her handbag and promptly dropped it because her hands were shaking so much. ‘Sorry.’
He retrieved it for her. ‘It’s OK, honey. He’s in good hands.’
‘I can’t stop thinking,’ she whispered, ‘about what could happen.’
He wrapped his arms round her. ‘Go through all the muscles and all the veins and all the nerves, count backwards from a thousand in thirteens—whatever helps to fill your head and leaves no room for thoughts like that. What’s your mum’s number?’
‘It’s under “Mum home”.’
‘I’ll call her now and I’ll be up with you as soon as I can.’ He rested a hand on her shoulder. ‘Hang on in there. He’s going to be fine. I promise.’
She swallowed the bile in her throat. ‘You can’t promise that, Dominic. It’s not under your control—or mine.’
‘Liam’s the best there is. I trust him. And that’s why I can promise,’ he said softly. ‘Go to Theatre. I’ll be there soon.’
She went up to Theatre with Tyler, and stayed while they gave him a pre-med and shaved his hair. ‘You’re going to be fine. I know the surgeon,’ she reassured him, ‘and he’s brilliant. He’ll sort it out and your head will stop hurting.’
But when the anaesthetist came to give Tyler the general anaesthetic and she was forced to wait outside Theatre, every second felt like a lifetime.
She was sitting with her head in her hands, praying silently, when Dominic joined her.
‘Right now you need to be held, and that’s exactly what I’m going to do—hold you.’ He wrapped his arms round her.
She was shaking. ‘Dominic, if he dies…’
‘He’s not going to die. He’s in the best hands and your instinct was spot on. You got him here early enough for them to do something about it.’
How could he be sure? She wasn’t. She didn’t know anything, any more. All her years of nursing training meant nothing.
Part of her wanted to push him away. She’d promised herself she’d never ever put anyone before Tyler again, and here she was, letting Dominic wrap her in his arms like he had yesterday. Leaning on him.
But she was so scared. So very, very scared. And she needed to be held. She so desperately needed someone she could lean on. Dominic was solid and reliable and there.
‘I spoke to your mum. Your parents are on their way right now.’ He gave her phone back to her.
‘Thank you.’ She dragged in a breath. ‘I keep thinking of the cases I’ve seen in the past. Cases where—where they…’ She couldn’t get the word out. Couldn’t say it in case she made it come true. Cases where they died.
‘Every case is different,’ Dominic said. ‘I know it’s easier said than done, but try not to think about them. Tyler isn’t going to die. Liam’s a brilliant surgeon and he won’t let that happen.’
He was still holding her when her parents rushed into the waiting area, asking questions at a hundred miles an hour; Dominic calmed them down and reassured them, the same way he’d reassured Louisa.
‘Thanks for waiting with me until Mum and Dad got here,’ she said when her parents finally sat down. ‘And I’m sorry for keeping you from work.’
‘You’re not. Essie’s got someone in to cover for me. I’m staying with you at least until Ty’s out of Theatre.’ He stroked her hair. ‘And now that’s clear, I’m going to get you all a hot drink. Don’t argue. It’ll give you something to do and stop the wait being so bad.’
The hot drink turned out to be sweet tea. She pulled a face. ‘This is horrible.’
‘Yes, but you know as well as I do that it’s effective, so drink it—that goes for all of you,’ Dominic directed. ‘And it’s occurred to me, Gillian and Matt—Louisa knows what the surgical procedure is, but you don’t.’ He grabbed a pad and pen from his pocket and drew a swift sketch to show her parents where the clot was. ‘What the surgeon’s going to do is drill some holes into the skull here, take out a little lid of bone, and then remove the clot and tie off the blood vessel so it doesn’t bleed again. It sounds an awful lot more scary than it is, and Tyler will be absolutely fine afterwards. He’ll heal nicely.’
But the waiting dragged on and on and on.
Were there complications? Louisa wondered silently. Had something gone wrong? Was Liam going to come out of Theatre, looking drained and empty, and tell them that he’d done his best but he hadn’t been able to save her son? Oh, God, no. Please don’t let her lose him. He was the light of her life. Without him…
The thought was so terrifying that she couldn’t breathe.
Every time she glanced at the clock, only a few seconds had dragged by. Each minute seemed like a lifetime; and each time she glanced up a little more hope seeped out of her heart. Her baby, her precious baby… How was she going to bear it without him? How could she carry on with a Tyler-shaped hole in her life?
When Dominic fetched sandwiches for them, she shook her head. ‘I can’t eat.’ Swallowing would choke her.
‘You have to eat,’ he said, relentless. ‘If you don’t eat to keep your strength up, you’re not going to be much use to Ty, are you? And he’s going to need you after this.’
‘What if—?’ she began.
‘No,’ he cut in. ‘Don’t borrow trouble. These things take time. It feels like years out here and nanoseconds in Theatre. And it’s better that Liam’s thorough than if he rushes the job. It’s going to be fine.’
At last, Liam and the neuro team came out.
And he was smiling.
Everything was all right.
Louisa closed her eyes and offered up a prayer of thanks.
‘I’m delighted to tell you that the op was a success,’ Liam said. ‘I’ve removed the clot, located the bleed and tied off the blood vessel. I want him to stay in for a week, just while he’s getting over the op, and then he can go home. He’ll have headaches for a while, but he’ll be absolutely fine. He’s in the recovery room at the moment, coming round, and you should be able to see him in a few minutes.’
Her baby was safe.
Tyler was going to be all right.
All the worry and the fear stopped; and she’d been tense for so long, holding herself together, that she simply imploded. She burst into tears, sobbing out all the worry and the nightmares; and Dominic held her, letting her cry all over him.
‘It’s OK,’ he whispered. ‘You don’t have to be brave any more. I’m here. I’m not going anywhere.’
Finally, she was all cried out; when she lifted her head off his shoulder, she saw that she’d soaked his shirt.
‘I’m so sorry. I didn’t mean to bawl all over you.’
‘It’s relief,’ he said softly. ‘You know that—we see enough relatives being brave, holding everything in, fearing the worst; and when they know everything’s all right they know they can let go and that’s when they start crying. Come on, let’s go and splash some water on your face, and then you can see Ty.’
The coolness of the water against her skin made her feel better, and she’d managed to pull herself together by the time the anaesthetist came out to tell her that she could go in and see her son.
‘Aren’t you coming?’ she asked when Dominic hung back.
He shook his head. ‘It’s not my place. But I’ll come and see him when he’s settled on the ward. You know where I am if you need me.’
She could see from his eyes that he was sincere; he really would be there, if she needed him. Yet she still couldn’t shake the feeling: if she hadn’t got involved with Dominic and agreed to let Tyler take part in the jousting day rather than be just a spectator, this wouldn’t have happened. Her attention would have been completely on her son, as it should’ve been, instead of partly on the man who’d tempted her to risk her heart again.
So maybe she should heed the warning and back off. At least until Tyler was old enough to look after himself more.
Which made her feel incredibly guilty about leaning on Dominic just now, letting him believe that there could be more between them—but, in future, they’d better stick to being colleagues.
Though Dominic didn’t make it easy for her. He visited every morning before his shift, during every lunch break, and every evening at the end of his shift. On day three, when Tyler was starting to get bored and irritable and sick of being cooped up in bed, he produced a magnetic chess set and taught the little boy to play. ‘Chess,’ he said to Tyler, ‘is the best game in the world. And, better still, you can play it any time. You can even play it long-distance—my brother and I used to play by email when we were students. He’d send me his move, and then I’d send him mine.’ He grinned. ‘Nowadays, we do it by text.’
And at the same time he nagged Louisa about eating properly, kept her in touch with what was happening on the ward, and brought in tubs of prepared out-of-season strawberries to tempt Tyler’s appetite and, she suspected, her own.
Although Louisa tried psyching herself up to say to Dominic that they should stop seeing each other, she couldn’t do it. Not when Tyler didn’t stop talking about him. Plus she saw the way Tyler’s face brightened as Dominic arrived, and the enjoyment mirrored in Dominic’s eyes as they got out the chess board. How could she destroy that growing friendship and closeness? And Dominic never, ever missed a visit. He might get someone to call up and say he’d be late, but he was always, always there.
When Tyler was well enough to be discharged, Dominic continued his visits, except at her house rather than the ward. Every morning on his way to work he dropped in to start a game of chess with Tyler, and every evening on his way to the stables he called in, made Louisa a cup of tea and handed her a magazine or book to make her sit down and take a few minutes’ break, and finished off the chess game.
Though she noticed that Dominic had stopped touching her. No hugs, no hand-holding, no resting his hand on her shoulder. And, whenever he left, he kissed her cheek. Not her mouth.
So had he, too, had second thoughts about their relationship? Yet, if that were the case, surely he would’ve stopped visiting Tyler? Not that she could ask. She didn’t have the energy: and, besides, she wasn’t sure what she wanted the answer to be. She was bone-deep tired, miserable and lonely, and she couldn’t see a way through it. Not without having a heart-to-heart with Dominic—a conversation that she didn’t want to start.
But eventually Louisa let her mother persuade her into letting her look after Tyler during the day so she could go back to work. Gillian promised faithfully to call her if she had even the slightest worry about Tyler.
Although it felt strange to be back in the department, after two weeks off nursing her son, Louisa’s first day back coincided with a cold snap and she didn’t have time to think about anything except work. The waiting area was filled with people who’d slipped on the ice and put their hands out to save themselves, landed awkwardly and come to the emergency department in pain. Louisa was kept busy taking patient histories, getting them to show her with their good hand the position of their wrists when they’d fallen, and then sending them off for X-rays. Though she knew even before she sent them what the pictures would tell her: there was a classic Colles’ fracture at the end of the distal radius.
For those who had fractures where the bone was in a good position for the break to heal normally, she put a backslab on and rested their arm in a sling. ‘You’ll need this to splint your arm for a couple of days until the swelling comes down, and then you’ll see the fracture clinic to have a lightweight cast fitted,’ she explained to her patients. ‘You might need a second cast, a couple of weeks later, and you’ll be in plaster for up to six weeks.’ In two cases, the bone had moved so the patient needed anaesthesia and manipulation to get the bone back in the right place for healing. But in all cases she gave the standard advice to rest the fracture as much as possible, hold it above the heart, and make sure they didn’t get the cast or backslab wet as they didn’t dry out easily.
Her tenth patient of the day with a Colles’ fracture was an elderly woman, and Louisa was careful to check about a history of osteoporosis.
‘You know, you’re the only one of my patients today who hasn’t moaned about the ice,’ she said as she examined Miss Castle’s hand.
Miss Castle laughed. ‘My dear, I’ve lived through far worse winters than this. Nineteen forty-seven was a terrible winter, with snow on the ground for months, and the drifts were thirty feet deep.’
‘We certainly don’t get snow like that nowadays,’ Louisa agreed. ‘That must’ve been hard to live with.’
Miss Castle nodded. ‘Coming just after the end of the war—yes, it was tough. The power stations ran out of coal, so we had power cuts for five hours at a time. The gas pressure was so low that the light would go out and people had to be careful or they’d end up poisoned or with a huge explosion.’
Louisa thought of the last winter, and how only a few centimetres of snow had brought the country to a standstill. ‘Do you remember much of it?’ she asked.
‘Oh, yes.’ Miss Castle smiled. ‘Apart from having snow feathers on the inside of the windows every morning, I remember we had to keep digging my father’s car out of the snow—he was a GP. One day, it was so deep that we couldn’t get the car out, so he borrowed the milkman’s horse to see his patients. But the horse was used to his daily rounds and insisted on stopping and waiting at every place he normally stopped with the milkman!’
Louisa was charmed. Tyler would love that story, and so would Dominic. Maybe she’d tell them both that evening.
But then in the late afternoon Essie came in to see her, looking grim. ‘I need you in Resus—there’s been a bad RTA,’ she said. ‘A young lad’s car slid on the ice and smashed into a tree. He seems fine, but the paramedics are bringing him in for a check over. The passenger, his dad, is in a bad way, though.’
‘I’ll come straight through.’
Dominic came in with the trolley after the handover. ‘Eric Scott, aged 43. He was on the side where the car hit the tree, so he has multiple injuries—query spinal injury as well as the usual suspects from blunt trauma. No known allergies, not on any medication, and no medical conditions we need to be aware of. Not sure when he last ate, though.’
The anaesthetist was already on hand; once Eric Scott had been resuscitated, he’d be whisked up to surgery. Eric was laid flat, his neck stabilised with a rigid collar and tape.
The team swung into action to put him on oxygen, insert cannulas, get vital-signs measurements through a pulse oximeter and ECG and take blood samples. ‘I want a litre of Hartmann’s run in, cross-match six units, and blood samples sent for FBC, Us and Es, and glucose,’ Dominic said. ‘And I need someone to call Radiology and arrange X-rays—I want lateral cervical spine, chest and anterior-posterior pelvis.’
Eric was still unconscious; his blood pressure was low and his respiration rate was high. ‘Looks like a thirty per cent blood loss—so I want a second litre of Hartmann’s in after the first,’ Dominic said.
Carefully Louisa cut through Eric’s clothes to expose his chest so Dominic could examine him. ‘Can you note this, Louisa?’ he asked as he listened to Eric’s chest. ‘Sounds on both sides, might have cracked ribs but no sign of flail chest.’ He glanced at the monitor. ‘His blood pressure should be rising by now—he’s losing blood from somewhere.’
Louisa glanced at the ECG. ‘Dominic, he’s in VF.’ VF or ventricular fibrillation meant that electrical activity in the heart had become chaotic, so the lower pumping chambers of the heart were contracting rapidly and fluttering rather than beating. They needed to convert this back into a normal rhythm or they would lose their patient.
Dominic breathed out sharply. ‘We’re not going to lose you, Eric. Hang on in there.’ He glanced at the team. ‘Defib.’
He placed the gel pads and paddles in the correct position and checked the ECG. ‘Still VF,’ he confirmed. ‘Charging at two hundred, stand clear—shocking now.’ They waited ten seconds to see if the ECG trace changed.
‘Charging to two hundred again,’ Dominic said, keeping the paddles on the gel pads. ‘And clear. Shocking now.’
Again, the ECG trace didn’t change. ‘Trying three-sixty now, Charging, clear—shocking now.’
But still there was no change. Dominic gave Eric 1 mg of adrenalin. ‘CPR, Louisa, can you bag, please?’
She already had the equipment to hand. ‘Five compressions, one breath?’ she asked.
After a minute of CPR, they did a cycle of shocking again; there was still no response.
‘I’m not going to lose you, I’m not going to lose you,’ Dominic muttered.
They continued the cycles of CPR, adrenalin and shocking.
After twenty minutes, Louisa placed her hand on Dominic’s arm. ‘His brain’s been without oxygen for twenty minutes. He’s gone,’ she said gently. ‘You need to call it.’
‘No. One more cycle,’ he said.
But it was hopeless.
‘Dominic. Call it,’ Louisa said softly, ‘or I will.’
She could see the muscle flicker in his cheek.
‘Everyone else agreed?’ he asked.
They nodded.
‘Time of…’ Dominic’s breath hitched. ‘Time of death, five thirty-two. Thank you for your help, everyone.’ He swallowed hard. ‘I’d better go and see the family.’
He looked drained and miserable. And he’d let her lean on him when she’d needed propping up; it was time for her to return the favour. ‘I’ll come with you,’ she offered.
Dominic looked at her, and realised that she understood what was going through his head. That, since Oliver’s accident, not being able to save a patient had always hit him harder. ‘Thank you,’ he said quietly. ‘Just give me a second, can you?’
He lingered beside the body and put his hand on Eric Scott’s shoulder. ‘I’m so sorry. I did my best, and it wasn’t enough. God bless,’ he whispered, and dragged in a breath before joining Louisa outside the doors to Resus.
‘His son’s in the family room,’ Louisa told him. ‘Ian Scott, aged eighteen.’
‘Eighteen? Poor kid.’
‘He’s been checked over and he’s fine.’
‘OK.’ Dominic really, really hated this part of the job—where he took all the hope away from the relatives.
And it would be harder still for this family because there was nobody to blame, no stupid drunk-driver who’d been too arrogant and selfish to consider the lives of others before getting behind the wheel of a car. Just an accident on the ice, which nobody could have prevented.
He walked with her in silence to the family room. Eric Scott’s wife wasn’t there yet but his son was pacing up and down, looking anxious. As they walked into the room, hope filled his face. ‘Is Dad…?’ He stopped abruptly as he saw their serious faces. ‘Oh, no. Please, no.’
‘Come and sit down, love,’ Louisa said.
‘I’m so sorry, Ian,’ Dominic told him. ‘We did everything we could, but your father had a heart attack and we couldn’t get him back.’
‘No, he can’t—not Dad.’ Ian gave a sobbing breath. ‘He can’t be dead. I haven’t even got a scratch. How can Dad be…?’
‘That side of the car took the majority of the impact,’ Dominic said gently.
‘But he can’t be dead. He can’t be. He can’t.’
‘I’m sorry, love.’ Louisa put her arm round him.
‘I killed Dad,’ Ian said brokenly.
‘No, love, the accident killed him,’ she reassured him.
‘The car—I couldn’t do anything. It was sliding and I couldn’t brake, couldn’t do anything.’ He dragged in a breath. ‘I wasn’t driving fast, wasn’t showing off. I just wanted to pick my dad up from work. It’s his birthday.’ The boy’s face worked. ‘My tutorial tomorrow morning was cancelled so I knew I could come home and surprise him, say happy birthday in person instead of phoning him. I was going to take him and Mum out to dinner tonight. He was so pleased to see me when he came out of the office. And now he’s dead, and it’s my fault, and… Oh, God, I wish I hadn’t come home and I’d never, ever got behind the wheel of the car!’ He collapsed into sobs on Louisa’s shoulder.
Dominic crouched in front of Ian’s chair and took the boy’s hands between his. ‘Listen to me, Ian. It was an accident, and it could’ve happened to anyone. We see lots of people in here whose car has hit a patch of black ice and they’ve lost control. Even really experienced drivers struggle on ice, so it’s not your fault and you’re not to blame.’
‘How am I going to tell Mum?’
‘I’ll be here with you,’ Dominic said. ‘I’ll help you tell her—but what you need to focus on is that your dad was unconscious, so he wasn’t in any pain, and he loved you very much.’
‘Do you have any brothers or sisters?’ Louisa asked gently.
‘No, there’s just me.’
‘You and your mum still have each other and you’ll get through this together,’ Dominic said. ‘It’s going to be tough and you’re going to have bad days, but you’ll get through this. You just have to keep remembering that this was an accident, one of those things that nobody has any control over.’
A few minutes later, Essie brought Mrs Scott in. She enveloped her son in her arms. ‘Ian, the hospital called me and said you were in an accident. Thank God you’re all right.’ Then she took in the fact that he was sobbing, Eric wasn’t there, and Dominic and Louisa weren’t smiling.
‘Eric?’ Horror filled her face. ‘No. No.’
‘I’m sorry,’ Dominic said softly. ‘He never regained consciousness. We did our best to get him back but I’m sorry, we simply couldn’t get his heart started again.’
While he comforted them, Louisa fetched some hot sweet tea and persuaded the Scotts to drink it—just as Dominic had made her drink the stuff after Tyler’s accident, knowing that it really was the best thing for shock.
‘Can I see him?’ Mrs Scott asked.
‘Of course you can,’ Dominic said, and took her through to where Eric’s body lay.
While she’d gone to sort out the tea, Louisa had asked Jess to make sure that Eric’s body was covered with a blanket and his face had been washed, to make it easier for his wife and son to see him.
‘Take as much time as you need,’ Dominic said gently.
‘I can get the hospital chaplain for you, if you like?’ Louisa offered.
‘No, I just want to be alone with him—Oh, Eric.’ A tear rolled down Mrs Scott’s face as she stroked her husband’s forehead. ‘How are we going to manage without you?’
‘I’ll be in my office if you need me,’ Dominic said. ‘Anything you need, just ask.’ He mouthed to Louisa, ‘I’m going to sort out the paperwork.’
She could see the strain in the lines around his mouth. Whether he wanted to or not, he needed to talk about this—and she was about the only person who could do this. She’d call her mum and warn her that she’d be late, stay with the Scotts for a little longer, and then she’d tackle Dominic.