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  A rich baritone, deep and musical but with an edge of something harder beneath, jolted him out of his reverie.

  ‘Dr Devan. Nice of you to join us.’ He lifted his sleeve from his Rolex, and raised an eyebrow. Kash felt himself flush.

  ‘Got yourself a white coat, I see. Well, white-ish.’ He eyed it up and down. ‘Laundry opens at nine. Best trade it in for a clean starched one. Reputations are hard to gain and easy to lose. Looking the part is more important than you might think. And so is timekeeping.’

  With that, he strode smoothly to bed one on Nightingale ward, where Sister Vale was waiting with a clipboard in hand.

  ‘Good morning, Mr Trenchard.’

  He gave an almost imperceptible nod of acknowledgement. ‘I was just telling Dr Devan here about my passion for punctuality.’

  ‘I’m afraid that was entirely my fault. I tripped getting off my bus and your man here stopped to help me.’

  Kash was taken aback. Sister Vale had no need to lie for him, and yet here she was, putting her own reputation on the line just to save his blushes.

  Trenchard gave her an appraising look but she held his gaze. ‘Then I don’t need to introduce you two, then.’ He nodded towards the rest of the team, who had been waiting patiently on the other side of the bed. ‘Alexa. Staff Nurse Wright.’ Alexa nodded, holding on to the notes trolley with both hands as if afraid that someone was about to rip it away from her. Then, ‘Dr Aldiss, Samantha. Your fellow house officer. You know each other, I assume?’ They both nodded. Samantha had graduated from Oxford with a first in English, before sidestepping into medical school. She could discourse equally fluently on Burton’s Anatomy of Melancholy and Grey’s Anatomy, and could drink Kash under the table – not, he would be the first to admit, much of a feat. ‘Angela Warner, our senior surgical registrar, would also normally be here, but she’s been up all night and is just finishing a case.’ Trenchard smiled, and Kash wondered if he was just imagining a hint of admonishment in his tone, as if Angela might have organized her patients a little better. Trenchard then turned his smile on Sister Vale.

  ‘I know Sister Vale doesn’t like me to dawdle. We’d better get on.’

  Trenchard led on, pausing at each bed like a bee seeking nectar, as all around stood tense in fear of stings. At every stage, the staff nurse went ahead to straighten the sheets and retrieve the observations clipboard from the end of the bed. ‘Normally,’ said Trenchard, ‘you’ll present the cases, Dr Devan. But for today, you can listen and learn, if that’s all right with you?’

  Kash wasn’t sure if he’d been asked a question, so simply nodded.

  As they made their progress down the ward, he glanced back to see Sister Vale watching them. He gave a quick smile to signal his thanks for her standing up for him, but she didn’t seem to see him. Her eyes seemed to be fixed on Mr Trenchard with an expression he couldn’t read.

  2

  By the time the ward round was finally over, Kash had developed a headache from trying to commit every word Trenchard uttered to memory. What he needed was a glass of water and a lie-down in a darkened room, but although he knew he wasn’t going to get that for a good few hours, he was still taken aback by the way the hospital seemed to pick him up and whirl him from department to department like a rag doll. The sense of being rushed off his feet was compounded by not knowing who anyone was or who to ask. Angela Warner had clearly moved straight from operating overnight to operating by day, or was committed in the outpatients department. Wherever she was, she wasn’t around to show him the ropes. The nursing staff were pleasant enough, but made it abundantly clear that they were as busy as he was and were not prepared to cut him any slack. Maybe at some point they’d trust him enough not to call him for every drug chart. Maybe they’d flush the odd intravenous line. But until they got the measure of each other it was all going to be strictly by the book. He felt like a pinball, bouncing from bleep to bleep, ward to ward, task to task. And all the time, he was trying to get to see every one of the patients officially under his care. That, he knew, was a matter of survival. Not for them, but for him. The tables would soon be turned and he’d have to present the patients to Mr Trenchard tomorrow. He had a feeling it would not be a good idea to fluff his lines.

  *

  Six o’clock came, and he’d survived the day on one cup of coffee from the patients’ drinks trolley – the brown liquid so scalding that it had melted the cup and given it a sagging waistline. His own, he suspected, would soon look like that too: his only other sustenance had come from a pocketful of boiled sweets. He’d been bleeping for a porter for an hour without response, and was now wondering if he should take the blood samples to biochemistry himself and, if so, where the hell that was. He ran his fingers anxiously through his hair.

  Suddenly, the door flew open. It was Claire. ‘You’re needed. Bed four,’ she said quickly – and then she was gone.

  Kash leaped to his feet and hurried after her. The urgency in her voice was clear. Welcome to hospital life, he thought: just when you felt you had no more in the tank, worn out by a hundred humdrum procedures, that was when the real emergency hit.

  Just up the ward, the curtains were drawn around a bed space. Patients stared silently like spooked antelope, heads up and alert, trying to identify the danger. As Kash approached, he could hear Claire saying, ‘Mrs Connell? Mrs Connell? Can you hear me?’

  Kash slipped through the curtains. Inside lay an elderly woman. Eighties? Older? However old she was, she hadn’t been there an hour earlier. She was dressed in a surgical gown, which had risen up to reveal her genitals, and also the lower inch of a surgical dressing.

  Sister Vale was fixing an oxygen mask over the old woman’s face. Claire glanced round. ‘Alice Connell. Eighty-four. A-P resection for colon cancer. Long op – on the table for four hours. Back from theatres thirty minutes ago. Drowsy when she got here. But now she’s unresponsive . . .’

  Kash approached and felt for a pulse. It was there, but a little slow. ‘BP?’

  ‘Ninety on sixty. Was one-two-five on eighty-five when she got here. Respiratory rate is only six.’

  ‘Diabetic?’

  Sister Vale and Claire glanced at each other.

  ‘Sister Vale, could you do a quick BM for me and tell me the blood sugar?’

  He moved to the other side of the bed. ‘Let’s sit her up a bit. I don’t want her vomiting and aspirating. One . . . two . . . three!’ Together, they pulled Mrs Connell up on the sheet, and further onto the head rest. ‘Can you put a Guedel in, if she’ll tolerate it?’

  Claire put the airway in.

  Kash was fast and methodical. The patient was indeed unresponsive. Both pupils were pinpoint in size. ‘She’s either had a pontine stroke, or a lot of morphine. Has she had any here?’

  ‘Not here. But probably in theatre? We haven’t seen the anaesthetic chart yet – they left it in recovery.’

  ‘OK. Can I have one ampoule of Narcan?’

  Sister Vale had returned, and was pricking Mrs Connell’s finger to test the blood sugar levels. ‘Do you want some help?’

  Kash paused for a fraction of a second. ‘No. Let’s try that first. If there’s no response, we’ll call Angela or the med reg.’

  Claire glanced at Sister Vale, who gave a subtle nod.

  With that, Claire exited, returning two minutes later with a small syringe and an empty ampoule. Together, they read it. ‘Naloxone hydrochloride four hundred microgrammes per millilitre. One millilitre.’ They checked the expiry date.

  She showed him a second syringe and ampoule, this time of saline flush. Kash tried hard not to show that his hands were shaking as he uncapped the intravenous cannula, injected half the Narcan, flushed it in, and put the cap back on.

  Forty seconds later, Mrs Connell’s eyes fluttered and opened. Twenty seconds after that, she was moaning in pain – the effect of the morphine she’d been given had been reversed.

  Sister Vale smiled. ‘Well done, Kash. Spot
on. You and I are going to get on just fine. Claire – could you call the anaesthetist? They left the mess on our floor. They can come and clean it up.’

  Claire smiled, leaned in and whispered, ‘Well done.’

  Kash tried not to grin. Despite his shaking hands and clamouring heart, he hoped he was exuding a Trenchard-like calm, even though inside he was manically fist-pumping. He’d been tested, and had passed. He stepped out onto the ward, where the approving looks of all the patients greeted him. He breezed past them as if it was nothing, nothing at all.

  *

  Nine o’clock. The incessant bleeps had slowed long enough for Kash to have seen the remaining patients, write in their notes, and file the blood results. He’d found all the X-rays which Mr Trenchard might want to see in the morning and made a mental note to come in early to write the blood forms. But for now, he was done. He’d bleeped the new on-call house officer, who was palpably relieved that Kash wasn’t handing over a huge list of incomplete tasks.

  ‘Cheers, mate. Everything all right? To be honest, I’m shitting myself.’

  ‘You’ll be fine,’ said Kash, getting a buzz from suddenly being treated as the grizzled veteran. ‘And look, my bleep is on and I’ll be around for a while. Shout if you need another pair of hands.’

  ‘You’re sure you don’t want to go out to get pissed?’

  What Kash actually wanted, now that he thought about it, was to listen to a bit of Mozart with a cup of camomile tea, but he decided not to let on. ‘Maybe tomorrow.’ With that, he hung his coat on the back of the door, remembering with a sigh that he hadn’t managed to get a clean one and hoping that Mr Trenchard would understand that he’d had more important things to do.

  He was walking down the corridor, wondering if he ought to get some proper food inside him, when he heard the squeak of trainers behind him. He looked round to see Claire, who had just finished the nursing handover and was now dressed in a dark-blue tracksuit with a fawn raincoat over it.

  ‘You did all right in there today. How did you know?’

  Kash smiled. ‘The benefits of ignorance. If you only know two causes of bilateral pinpoint pupils, it has to be one of them.’ He paused. ‘And if it had been the other one, she would have been a goner, and so nothing to be done but call the family.’

  ‘We’d already done that,’ Claire grinned. ‘They were a bit surprised when they rushed in to find Mum the picture of health.’

  Kash smiled back. ‘Good thing no one had a heart attack. Next time I’ll make sure she stays on the critical list.’

  Claire smiled again. ‘You’ll make a top surgeon yet. So, you coming?’

  ‘Coming where?’

  ‘The Balti, Kash. The nursing staff’s second home. Anyone not actually unconscious or dead will be there. You’re sure no one mentioned it in the mess?’

  ‘I haven’t seen another doctor all day, to be honest, and I last passed through the mess a lifetime ago.’ He glanced at his watch. ‘Well, fourteen hours ago.’

  ‘High time you had a drink, then.’

  ‘Well, I . . .’ Kash felt like a rabbit in particularly dazzling headlights. Despite the fourteen hours of mayhem she must have been through, Claire looked as fresh as a daisy and as pretty as a . . . well, something very pretty. And she wouldn’t stop smiling at him.

  Despite his fatigue, the prospect of a drink with nurse Claire Barker was really very appealing. But there was something else he really needed to do. A letter he had to write.

  ‘Thanks, but I think I may already be technically unconscious. I wouldn’t be very good company. Another time, yes?’

  She gave him a sad look, testing his resolve, then shrugged and walked away.

  3

  A week had somehow passed and Kash was slumped in the mess. Never had a room been so appropriately named. His soggy Chesterfield had long since been swamped, and bobbed at an impossible angle amidst the flotsam and jetsam of a takeaway tide.

  Kash sighed. To him, it felt like seven months, not seven days. But paradoxically it also felt like seven minutes, the warp speed of ward life creating some weird quantum effect that compressed events together so they seemed to happen simultaneously. Surely it wasn’t physically possible. He had lurched through a lifetime in the mere launch time of a career. He was still struggling with bursts of anxiety – usually in the quieter moments rather than during an emergency. Imposter Syndrome. He didn’t deserve to be here. He needed somehow to acquire Trenchard’s Zen-like calm, but suspected that came with years of experience, the hard-won sense that the hospital couldn’t throw anything at you that you hadn’t seen before. There were no short cuts. Unless, of course, people like Michael Trenchard simply experienced time in a different way, like hummingbirds who lived life so fast that every second felt like a minute to them. Didn’t top sportspeople describe a similar feeling – the ball coming at you over the net in slow motion? What did they call it: being in the zone? Well, Kash had never been any good at sport, and he certainly didn’t have the physique of a hummingbird, so perhaps he was destined forever to experience time as a mad, downhill rush where everything fell out of his pockets. Which reminded him, he needed to get a new bumbag to put everything in. He shook his head and took another bite of his stale cheese and onion roll, looked quizzically at the grey froth on his coffee (known colloquially as ‘flat shite’), but took a gulp anyway to lubricate the fossilized crust.

  ‘Don’t you need to be somewhere?’

  He looked up, almost choking on his mouthful of roll, and instinctively started getting to his feet.

  ‘Gotcha!’ Angela Warner plonked herself down opposite him, sweeping her mass of dark curls behind her ear with a broad grin. She was five years his senior at twenty-nine years old but with the fragile look of a teenager who had grown up in a war zone. She’d got through medical school by the age of twenty-two, and had been the first of her year into specialist surgical training.

  Kash sighed, settling back in his chair. ‘Aren’t you supposed to be mentoring me? You are the senior surgical special registrar.’

  Angela waved a hand dismissively. ‘Sink or swim, that’s my motto.’ Kash couldn’t help noticing the sharply defined muscles of her forearms. Surgery, he was beginning to appreciate, was sometimes just bloody hard physical work.

  She pointed at his half-eaten roll. ‘You want a scalpel for that?’

  ‘I was thinking more of a bone saw,’ Kash replied with a smile, pushing his plate to one side. ‘So what’s going on with you?’

  Angela shook her head. ‘Where do I fucking begin?’

  ‘Anything I can help with?’

  ‘You could shoot that Mr Greengrass on twelve for me?’

  ‘Isn’t there some sort of regulation against that?’

  Angela shrugged. ‘Not regarding Mr Greengrass specifically, no. I’ve checked.’

  Kash smiled. ‘In that case I’ll try and make it as painless as possible.’

  Angela shook her head. ‘Don’t do that. I want the bastard to suffer.’

  ‘Maybe we should keep him alive, then.’

  Angela sighed. ‘Fair enough.’

  It had taken Kash a while to get used to Angela’s humour, and to realize that it was just the flipside of her almost superhuman dedication to the job. It was hard to imagine a surgeon who cared more or worked harder for her patients. Even the incorrigible letches like Mr Greengrass, who, though handicapped by a ruptured spleen, the product of trying to teach his motorcycle to fly, still insisted on treating physical exams as a two-way process.

  ‘So how’s it going with Mr Trenchard?’

  He blew out his cheeks. ‘What can I say? I feel immensely privileged to have him criticizing every last little thing I do.’

  ‘You should. He’s one of the best you’ll ever meet.’ She paused. ‘In fact, the best. You don’t know how good he is.’

  ‘I’m beginning to get a sense of—’

  Angela held up a hand to interrupt. ‘Let me tell you a story. I
was on-call, got bleeped by the emergency department. Turned up to find this big bearded bloke on the trolley. Mid-fifties, looked a hundred. Porcelain white, ice cream cold, face ashen, beaded with sweat, his breath coming in shallow gasps through his oxygen mask. Snatching breaths, thousand-yard stare. You know the sort.’ She paused. ‘Anyway. Two nurses running bags of intravenous fluid into him. The oxygen sats monitor alarming that no blood oxygen saturation could be recorded. ECG monitor screeching because the leads kept coming off with the sweat. Blood pressure flashing and pinging at sixty-two on forty.’

  And then she was there again. Living it.

  After a few moments, Angela refocused, and was back in the room with Kash.

  ‘Someone said “shit” very loudly. They had a tourniquet tight around the guy’s arm, and were slapping the skin to raise a vein. All eyes turned to me, the newbie. Was I any good? I look at the patient, then at the monitor. Hypovolaemic shock. Acute. No blood in a bowl or smell of melaena, so it’s not a GI bleed. Must be a Triple A.’

  Kash nodded. Abdominal aortic aneurysm. ‘Go on.’

  The abdominal aorta is the main artery which carries blood to the body from the heart. If it expands – an aneurysm – its wall weakens and then bursts, like the blow-out of a tyre. Death can follow soon afterwards. Unless someone repairs the hole, or replaces the tyre’s inner tube.

  ‘I ask the doctor – Dave, I think his name was – if we had an anaesthetist. Not yet, he says. So I ask one of the nurses if she’d mind crash-calling one. We slap a line in . . .’

  Typical understatement from Angela, thought Kash. Most people couldn’t find a vein in a patient like that without explosives and a digger.

  ‘. . . and and then I said, “Look, Dave, we’re running out of time, here. We’d better get ready to push him round to theatres.” So I’m taping his venflon in place, and Dave’s attaching the oxygen mask to a portable cylinder, before disconnecting the monitor, when the anaesthetist turns up. Harry Adams, his name was. Anaesthetic SpR. So we all introduce ourselves and I tell him we’ve got a leaking triple A, we’ve just got a line in and we need to get to theatres. He looks at me a bit sceptically like the Big I Am. Snooty fuck. “And we know this how?” Fucking anaesthetists, I think.