Rudy had the expression of an abused animal on an RSPCA advert. Laura reassured him, repeating what Olivia had told her, that nobody was in trouble, but his forehead was crisscrossed with guilt and anxiety. Olivia was right. Nothing would happen. There was no need to panic. But Rudy seemed consumed with it all. She’d left for work very early but woken him up before leaving and made him poached eggs on toast that he hardly ate. Poor empathetic Rudy. This had shaken him to the core. She took out her phone and texted him as she walked:
Have a great day. Love you muchos.
Olivia was as reassuring as ever. She had grabbed Laura in the kitchen on Sunday to help “salvage the Yorkshires” and told her that nothing at all would happen, to stop worrying. Laura was about to explain how worried Rudy was when Donna burst in and looked confused, clearly aware she’d interrupted something. But Olivia, as ever, had calmed Laura down by then, and they all managed a lovely dinner and catch-up. They’d told Donna they were sharing work gossip.
Shaking her head free of the worry about Rudy, Laura went into work mode, as if slipping on a familiar costume. She pushed open the heavy A&E doors, which were meant to be automatic but never worked. The waiting area was full of people already, balancing on crutches, wheeling strollers containing overdressed babies who no doubt had fevers. A clearly homeless woman was pulling a trolley bag filled with plastic bags, her edematous feet bursting through the gaps in her sandals, her flesh like sand dunes. A few doctors padded around in plastic clogs, drinking coffee from large recyclable cups, and a group of nurses huddled together outside the gift shop. There were a lot of elderly people hanging around, holding printed-out appointment letters, looking lost. A man pushing an empty wheelchair walked past her, then a porter carrying a small oxygen cylinder and a box that read Urgent Bloods. She weaved through it all, toward A&E and the offices where the air ambulance staff took handover. She needed to focus. Work had always helped her do that. Work was a safe place. She knew exactly who she was. Here, she wasn’t the mum of a teenager, or the daughter of a sick mother, or the friend who had kept dark and dangerous secrets; she was Laura, air ambulance doctor, a HEMS doctor, the Helicopter Emergency Medical Service trauma doctor. This chaos, such as it was, was her sanctuary, her safe space. It always had been.
Here, she wasn’t the mum of a teenager, or the daughter of a sick mother, or the friend who had kept dark and dangerous secrets…She had changed over the years, though. She was no longer idealistic, and she was becoming increasingly superstitious. She walked through the department to Majors, tapped in the door code that someone had written in ballpoint on the wall next to it, and pushed open the door. Majors was always busy. Patients spilled out into the corridor, and there was constant noise, alarms and shouting, the smell of urine or bleach or NHS egg sandwiches. The central station was like a hive for medics, all on the phone, permanently harassed, their dark blue scrubs as crumpled as their faces, lanyards swung over their shoulder, pens stuck into ponytails. The countertop was covered in notes, half-empty coffee cups, an old tin of Quality Street containing only strawberry remnants. The ward administrator, a stern-faced woman named Nancy who was forever dieting, was sitting at the nurses’ station. She was nicknamed Cerberus, the gatekeeper of the underworld, and only smiled once a year when organizing the staff Secret Santa. “Burning the candle at both ends?” she asked.
Laura realized she was yawning already. “Oh, yes. Life’s one long party . . .”
“Laugh a minute.” Nancy answered the phone and ignored the relative—a middle-aged man with a tracheostomy scar—standing anxiously waiting. Laura felt her body relax and the worry about Rudy’s state of mind evaporate, temporarily at least. Work was so familiar and so constant and so reassuring. She could count on her colleagues to knock her into herself again. Whatever went on outside these walls, this place was home. “Just throw yourself into work,” Olivia had advised. “Let’s go for drinks with Anj. Stay busy. I’ll do the same.” She had hugged Laura so hard it felt, for a moment at least, like everything would be OK. Olivia had that way about her, of always being reassuring. No wonder Dele always described Olivia as his rock.
A young man, pristine in freshly ironed scrubs, held out a handout to her. “Ravinder. I’m shadowing you today.”
Laura noticed the slight raise of Nancy’s eyebrows. A secret code of old colleagues. A move that said, “Rather you than me having a newbie follow you round.”
She looked at him, all eager and keen, a junior doctor and wanting to make a difference. His eyes were sparkling, and he couldn’t stop grinning and gesticulating with one arm. With the other hand he was holding a large Starbucks. “Seems pretty quiet in here today . . . ,” he said. Laura didn’t have the heart to tell him that as soon as the red phone started, it wouldn’t stop, and he was a brave man drinking that amount of fluid when there would be no chance to pee for hours. She liked busy.
Distraction. Medicine was a language to learn. It was also a great place to hide.
“Don’t say the Q word,” she said, and mouthed the word: quiet, and he laughed as if she was joking. The phone rang like magic.
Zafara the HEMS nurse was scribbling down the details, but Laura got more information from her face, which changed from hard to soft as she took the call. She placed the receiver down gently, looked at Laura. “Woman and two kids. All with serious knife injuries. Paramedics en route, but the mum needs airlifting.”
The room changed pace, sudden snapping on of aprons, backpacks, grabbing of gloves and various bits of kit. Rav stood in the middle, holding his giant Starbucks. “Here we go,” he said. She grabbed the coffee from his hand and chucked it into the sink. “Let’s go.” And then she was off, through the double doors, running a bit, almost knocking over someone walking past. “Donna! What are you doing here?” She was flustered. Donna stepped backward. “I’m here to see a patient. First diagnosis, and it’s not good.”
Laura hardly ever bumped into Donna in A&E. She was always busy nursing in the cancer center. But too many patients seemed to be getting late diagnoses these days, and arriving in extremis in A&E. Laura reached out to touch her arm and give her a quick hug before running off, but Donna stepped back again.
Donna folded her arms in front of her, and her expression changed. “You OK? You seem a bit jumpy. I wanted to chat about you and Liv on Sunday. What’s happening? Are you on a mission, or can we chat?”
Laura nodded, but she felt her face redden, the hotness creeping over her cheeks. Her hands were shaking. Donna looked at them, frowned.
Laura gulped air. She had to get away. “Sorry, we’re in a huge rush.”
She turned as she ran. “Sorry, sorry. Catch up later?”
Donna opened her mouth to speak, but Laura didn’t wait. She turned and sped away without glancing back. What was Donna doing outside A&E? She wanted to stop and find out why Donna was there, and what exactly she had overheard at Olivia’s on Sunday, but there was no time. She ran up the stairs two at a time, the stairwell that echoed all the secrets of this place. She shook her head, focused. Woman and two kids, stabbing. The possibilities of what they’d find pounded her insides as she ran. A woman who had stabbed her own kids then turned the knife on herself? Not unheard of. But it was most likely a man, Laura thought. It was always most likely a man. Gemma was waiting at the top of the stairs, doors open, January cold thrown toward her. She heard the whirl. There wasn’t a single day on this job when she didn’t remember the episode in ER where Robert Romano lost his arm. Laura, Olivia, and Anjali used to binge-watch every episode of ER, fully expecting their lives to follow suit. She pressed her own arms close to her sides and glanced back at Rav to make sure he was too. “Crouch,” she said, and they ran side by side toward the helicopter and clambered in, navigating the compact space and clicking seat belts.
“Ravinder,” she said, glancing at the junior doctor’s name badge. “FY2.”
“Please. Rav,” he said, grinning. He was loving this, she could see. She tried to remember what she’d felt on her first call. But all she could think was the color of the sky, and how different it seemed in the air. Thicker, yellow and smoky. The color her dad had turned all those years ago. She closed her eyes.
“Shall I lead this? I mean, if you’re next to me, it seems like a good opportunity.”
“Just stand back and take direction.” She smiled to herself, thinking back to her early medical years, and medical school, and her and Olivia and Anjali and how idealistic they all were. But as the helicopter drifted upward into thick cloud, Laura felt her mind drifting back toward Rudy and the party that had traumatized him. Another party. She pushed the thoughts out of her head, snapped her eyes open, focused on Rav. She was getting tired of junior doctors on rotation. She knew it was her job to nurture and mentor and role-model for junior colleagues, and plenty of her peers relished that part of their job. But Laura didn’t want anyone holding her back. Lives were at stake. In her experience the newbies would spend a few elective weeks with the air ambulance, imagining themselves as future trauma surgeons, and they’d post selfies of themselves in uniform, midair, heroic, to Instagram—and then be gone to the next thing. She had to constantly try to remember her excitement when she first started, how pure she’d been full of hope and devoid of cynicism. She had to remind herself how much she loved the job, even now, the difference she made. “Just observe today, and if it’s too much, wait in the helicopter.”
“It won’t be too much.”
“If you feel sick, Juan has some antiemetics. We used to dish them out in advance, but you know. Cutbacks.” She looked at the cockpit, and Juan glanced back at her, half smiling, shaking his head. Colleagues became family in this job. They’d seen each other more than family anyway, and been through a divorce, cancer, and a house fire collectively.
“My friends call me Maverick,” said Rav. “I wouldn’t worry.”
“Well, Maverick”—Laura side-eyed Juan—“remember ALS, Advanced Life Support, and ATLS, Advanced Trauma Life Support. Airway above everything except exsanguinating blood loss.”
“I did your ALS course last year. Must be fun to teach.”
“Well, it’s a lot better than teaching pediatric resus, and APLS if you’re vegetarian like me. We have to teach cricothyroidotomies on lambs’ tracheas in the meat room. Carcasses everywhere for chest drains. Always three million degrees, no matter what time of year.” She looked out of the window as they hovered a while in the clouds before climbing above Brockwell Common and higher until even Camberwell looked magical. There was a layer of mist clinging to the tree branches like
cotton wool, protective. Laura got her phone out and started texting. I’ll be home late. I really hope you are OK. Make sure you eat.
“Tinder?” Ravi nodded at her phone.
She laughed, after all. It felt good to laugh. To be at work and have normal banter with colleagues. Everything will be OK. “It’s my son, actually. I’m a single parent.”
Ravi looked confused. “How does that work?”
She didn’t answer but looked out the window again and swallowed.
Her mouth tasted dry, a combination of cardboard, metal, dust. “I didn’t mean . . . Oh, I’m sorry.”
“Don’t worry about it. He’s sixteen. Rudy. Best kid in the universe. Not that I’m biased.” She grinned, put her phone on silent, and zipped it into her fanny pack, then opened the kitbag. “Let’s run fluid through now, do some math.” The helicopter hovered again, and slowly lowered toward a park. “Brace yourself, Maverick. I have a bad feeling about this one.”
A shadow passed over his face, doubt or fear. Laura leaned over and patted him firmly on the arm.
*
The patient had cut through a femoral artery with a bread knife. Large chunks of flesh ribboned about her. She had sliced herself up like a loaf of bread. In the center of her groin a perfect ark of pillar-box red arterial blood fanned out like an elaborate water feature. The rest of her was the color of chalk. There was chaos. A paramedic was performing two-fingered chest compressions on a baby, a rhythmic tiny crunch with each push.
Laura stood frozen for a moment, staring at the baby. Something welled up inside her throat, a blockage. She swallowed hard. Memories twisted around in the pit of her stomach, eels at the bottom of a river. A baby born much too soon. The midwife who brought her daughter in, wrapped in a pink knitted blanket, and put her into Laura’s arms. The expression on Owen’s face when he stared at the baby. He never looked at Laura the same way again after that. He sat night after night, a ghostly expression on his face, rocking back and forth. They tried to save the marriage, but nothing worked between them. Still, Laura’s body grieved and took, but Owen was gone by the time she found out she was pregnant with Rudy. She was relieved.
“Laura!” Rav’s voice had changed and was urgent. “What do I do?” She took Ravi’s gloved hand: “Stick your finger there and don’t let go.” She moved his ring finger toward the torn artery until he’d got the exact spot, and he was inside the hole. She went to the head end, where the woman was groaning, and began assessing her.
Every second mattered. Time had a funny presence during a crash call. It slowed down during the golden hour, the period they had where they might—or might not—stabilize someone, draw them away from death. But then later it would be a blur, a split-second-long memory, to store up in a secret room in her head: her doctor’s graveyard.
Laura opened the kit and sat next to the patient. She had lost a lot of blood. There wasn’t time to mess around trying to gain access. She took the EZ-IO drill out of the bag and checked for landmarks on the upper outer quadrant of the woman’s shoulder, pressing her fingertips gently as though the woman’s bony prominences were piano keys. She thought of the woman in anatomical terms now, not as a whole self but split into landmarks and chemical processes. It was better to think of her patients as a collection of parts than a whole human, with a life. Palpate the greater tubercle of the proximal humerus. Look for signs of disseminated intravascular coagulation. It sounded like difficult language, but it was easier to summon medical terms than to think of this woman as a mother, or glance at the baby, or imagine herself in this situation. Or worse, remember things. Imagine it was her baby. Their baby. Excess empathy in medicine could be dangerous for patient and clinician. But still, she noticed a small, pale-blue blanket in her peripheral vision, smudged with dark red blood.
Ravi looked up. He was pressing his body over the woman’s leg and had stemmed the blood. He was saying something, but Laura zoned him out as she drilled into bone. The noise of the drill was replaced by a satisfying crunch. She took out a bone marrow sample, then began pushing in fluid via giant fifty-milliliter syringes. She looked up, but too late. Ravi’s eyes had disappeared into the back of his head, and he was keeling over on top of the patient. His hand fell away from the pressure, and the artery began to spew blood. He lay fainted on top of her leg until both the patient and Ravi were both painted red. Laura dropped the syringe and felt for the artery, pushing her hand as quickly as possible, as hard as she could.
“Some help, please,” she shouted. “I need an arterial tourniquet.”
She managed to slide Ravi off the woman and shove him away. He half opened his eyes, let out a massive sigh. “Oh god.”
“Welcome back,” said Laura before pausing. “Maverick,” she added.
*
“Straight to theaters.” They maneuvered the trolley through the hallway, the defibrillator pads attached to the patient already. Laura didn’t want to have to try and resuscitate her in the lift. The lifts always broke down. There was a forever queue of people waiting outside to stop at each floor. She used the porter lifts for emergencies like this, but even then, there was no guarantee they would not stop mid-floor, and they’d be stuck in a lift managing a cardiac arrest. All those Latin terms she memorized at medical school, and yet it was the practical details like this that were far more useful to her job: how to find the lift key. How many people died in the NHS due to broken lifts? But this time they were lucky. The theaters were on the first floor next to intensive care, and the team were waiting in the anesthetic room.
Laura was covered in blood. She heard Rudy’s voice whisper inside her—There was so much blood—and shook it away. They moved the patient across on the transfer board, and the emergency alarms began their shrill ringing. Peter turned all the alarms to silence in succession. First rule of anesthetics, she often heard him say. He began to work, and Laura dropped back, breathing heavily. “Thanks, hope to see you at ethics later,” he said. Laura nodded and stepped back. Her job was done. She had saved a life, most likely, or at least stabilized a patient long enough to have a chance at life. There was a feeling that filled her up as she washed her hands and forearms before waving at Peter and walking back out of the theater.
Rav stood next to her, a look of awe on his face. “You were incredible.
What’s an ethics committee? Is that like AA?”
“Ah, it was a team effort.” Laura smiled. “Ethics Committee? You know, the gray areas between right and wrong. Basically, a room full of medical overthinkers.”
“Sounds intense.” Ravinder raised his eyebrows.
“It is! Which is probably why I love it Right. See you tomorrow,
seven a.m.”
“You mean today,” said Ravi, after pulling his phone out of his pocket and glancing at it. “See you in literally five hours.” He was beaming with wonder.
Laura didn’t have the excitement he did. The weighty questions that haunt doctors at the end of each day, that follow them home, arrived in her head. Had she done all she could? Was there something she could have done better? Did she make all the right calls? She understood that the real trauma facing this family was not today, on the scene. She would not find out if the baby had made it, likely not even ask about the woman. It was a dangerous game to follow up patients after the initial phase, to see what had happened to them, if they’d lived or died or were still between spaces. But there was another patient she needed to check on. She didn’t want to. She had to be back at work in a matter of hours, and she needed to get home to see her mum, cook in advance for Rudy. It was acutely painful, and potentially dangerous too. But she had to know how sick he was, after one of those teenage parties where things can and do go catastrophically wrong. She understood that too well. The past felt so dangerously close. Laura walked the theater corridors and headed toward the intensive care unit.
__________________________________
