A multiple pile-up, involving five cars and a coachload of OAPs heading back from a weekend trip to London, had happened at junction 18 on the M4.
In the staff changing room Alex gargled with a strong mouthwash and then blew into her cupped hands to smell her breath. The minty smell reassured her she was OK, but as an added precaution she unwrapped a Wrigley’s spearmint gum.
How could she forget she was on call, she berated herself yet again. Fortunately, she’d stopped drinking long before the wedding ended and had in fact limited her intake throughout the long day, not wanting to get drunk. What she couldn’t rule out, without a blood test or Breathalyser, was whether she was over the limit. The irony was not lost on her: that for the first time she wasn’t drinking out of a need to forget, and she was brought back down to earth with a bump. Such an idiot. So stupid to forget something as important as the fact she had a job to do.
She’d dismissed the thought of ringing round to see if someone else could take over her on-call, not wanting to give any further reason to anyone to shred her reputation even more.
Well, this was her wake-up call. In some ways she was lucky it had happened. She had come very close to the brink with her drinking. She was aware that the man behind the counter in her local off-licence was getting to know her too well. Well, no more. She no longer needed to escape her fear.
Fixing a smile on her face, she stepped out into mayhem. The thirty-minute warning before the arrival of the first casualty had long passed, and injured people could be seen queuing down the length and breadth of the corridor. There was a rush of activity everywhere she looked, and Alex finally relaxed. This was her job; it was what she did best.
It was going well. Even as she struggled with exhaustion, she was pleased with how things were progressing.
In resus all of the bays were occupied. All of the monitors were beeping and sounding alarms. Rubbish bins were overflowing and discarded equipment cluttered around them. On the work counters, rigid-plastic yellow containers for the disposal of needles were filled to the brim, and used syringes lay abandoned and doctors fought for small spaces to write their notes. A mop and a bucket rested against a wall; there were too many spillages to keep calling in the cleaners. It was quicker for the nearest person to clean up the blood, as the last thing they needed when the place was this busy was a wet floor.
The remaining patients waiting to be seen, although needing urgent attention, were at least more stable than the ones before them. Not counting the walking wounded, so far seven critical and twelve serious cases had been dealt with.
The trauma team was divided up between the patients, and extra doctors and nurses were in attendance to deal with all the injuries. Caroline was in control as always, but Alex saw the sweat stains under her arms, hinting that even she was finding the pace difficult. Maggie Fielding had been called in to attend one of the female patients, and over the cacophony of the horrendous noise of crying and shouting, alarms giving off urgent warning sounds, phones ringing and machinery moving, Alex heard her comfort an injured woman and was surprised at how tender Maggie could be.
The patient in bay 4 was staring at Alex with fear in his eyes, his grip on her wrist desperate. ‘You’re not going to let me die are you, Doc?’
She freed her hand from his and smiled reassuringly, then made a second attempt to get a cannula into his old veins. ‘You’re going to be fine, George. Just give me a second to get this thing in and then I can give you the medicine. In next to no time your heart will be beating normally.’
‘It feels like it’s gonna explode if it goes any faster.’
‘You just stay nice and calm and breathe in that oxygen – leave the rest to me.’
The old man was not one of the casualties brought in from the pile-up. He’d been brought in from home and needed to be in resus urgently.
‘Damn,’ she whispered, and then smiled at him again. ‘Your veins don’t want to come out to play.’ Scooting round to the other side of the trolley, Alex snapped her tourniquet onto his other arm. She let his hand dangle down over the side of the trolley and went down on one knee. She gave a few taps to a vein in his forearm and was rewarded by the sight of it swelling with blood.
Fiona appeared at her side. ‘Need any help?’ she asked.
Alex felt the gesture to be genuine. The warm smile of welcome Fiona gave her at the beginning of their shift conveyed an unspoken apology. The judgement in her eyes had gone and Alex was grateful.
‘You can fetch the adenosine for me. There’s no room over here to put anything. It’s labelled and drawn up by the drugs cupboard.’
George smiled at them. ‘I’m always a nuisance. They can never get the blighters in. I reckon the veins shrivel up at the sight of your needles.’
While Alex got the cannula in, Fiona went to fetch the drug. A moment later she returned. ‘Can I have a quick word?’
Alex followed her over to the drug cupboard and Fiona held up an empty ampoule. ‘Is this what you got ready?’
Alex stared at it in confusion. The label she had written on was on the syringe. George Bartlett’s name was on the label. But this was not the ampoule she had used. If she had given him this drug, George would now be dead. Adrenaline 1:1000 would have caused his already dangerously fast heart to beat even faster.
She stuttered. ‘I .?.?. I don’t understand. I didn’t get this out. I promise you that. Someone else must have put it there. There’s no way I would give him this. No way in a million years.’
Fiona bit her lower lip, her eyes fixed on Alex. ‘It was the only ampoule here, Alex. It was right beside the syringe – on this injection tray.’ She put the ampoule back on the tray and picked up the syringe.
Alex frantically searched the counter, refusing to accept she could have made such a mistake. The empty ampoule of adenosine had to be around here somewhere. It had to be. She had held it in her hand. She had read the label clearly. She had not made a mistake.
‘Someone’s binned it,’ she cried. ‘And dropped this ampoule on my injection tray by accident. Check with the other doctors. I’ll bet you one of them has used adrenaline in the last five minutes.’
Fiona’s eyes glinted with anguish, and Alex felt her chest thump as she became aware that Fiona genuinely believed she had made this terrible error. And then she shuddered when she realised how easily the error could have escalated into a catastrophe.
‘Go and have a cup of tea, Alex. I’ll get Nathan in here to deal with it. I’ll tell him you’re taking five minutes.’
Alex felt a heaviness pressing behind her eyes and knew tears were imminent. ‘No, I can’t do that. I need to deal with it.’
‘Everything all right, Dr Taylor?’ asked Maggie Fielding. ‘Do you mind if I get into the medicine cupboard?’