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Chapter One: Liz ONE LIZ
FRIDAY, 19 JANUARY, 2018

It is definitely the short straw of hospital medicine. ER in a trauma center on a Friday night in late January; eleven thirty and the waiting areas are rammed. Patients glazed with boredom slump on every available chair, a queue is waiting to be triaged, and we’re nearing the mayhem that descends when the drunks and the lads whose fights have turned a bit nasty roll in: lairy, disruptive, laughing in the face of reason. If the abuse turns physical—walls punched, a nurse shoved, a Sri Lankan doctor spat at—security will have to be called.

A cold January means that the hospital is already busy: filled to 99 percent capacity. ER on the brink of turning away ambulances: almost on red alert. Many patients don’t need to be here: not least those who couldn’t get—or didn’t think to get—a doctor’s appointment and who now realize that a long and uncomfortable weekend stretches ahead of them unless they hotfoot it to the ER in the belief that doing so will make their virus swiftly better. They’re the ones who are the most vocal about the long wait, who hover by the nurses’ station ready to harangue them. The properly sick don’t have the energy to complain.

I wouldn’t go near an ER in a busy trauma center on a Friday night unless my life depended on it. Nothing short of a cardiac arrest, a stroke, a fracture, or a massive hemorrhage would force me through the automatic doors. So why am I here, breathing in the fetid fumes of others’ illnesses; tramping the corridors; peering at the faces of the frustrated, irritated, and those with life-threatening illnesses who wait two, three, four hours—or sometimes more?

Well, I don’t have a choice. This is my job. Senior resident in pediatrics at St. Joseph’s, West London: a major acute general hospital and trauma center at the cutting edge of clinical care. My career hasn’t been meteoric: two babies and two six-month maternity leaves, plus disappearing down a cul-de-sac of research, mean I’m still not a consultant, unlike the men I studied with at med school. But I’m only a year off and then I’ll have reached the giddy peaks of medicine’s hierarchy. Twenty years of study and I’ll finally be there.

I’m not a doctor who works in the ER full-time. I’m here because I’ve been called down from the children’s ward to see a patient. But I’m the sort of doctor on which every hospital depends. Sufficiently senior to make crucial decisions; sufficiently junior to be based in the hospital during long nights and on call weekends. Look at me, in my periwinkle blue scrubs, and you’ll see someone pragmatic, no-nonsense, approachable, empathetic; occasionally a little blunt, according to my teacher husband, but a good person. (I work with sick children and deal with distressed parents, after all.) Physically unremarkable: five foot six, wiry dark brown hair scraped into a ponytail, a permanent crease between my hazel eyes. Negligible makeup, no jewelry except for a thin gold wedding band, worn and scratched. White hospital Crocs: good for running. Easy to wash when splattered with blood.

I’m anonymous, dressed like this. Androgynous, too. No one’s going to assess the size of my hips, a little wider than I’d like thanks to night shifts when I don’t get a break until after ten and rely on vending machine chocolate or canteen chips. No teenage boy’s going to spy my cleavage when I bend over to examine him on a hospital bed. I’m a doctor, this pajama-type uniform says, as does the lanyard round my neck. Hello. I’m Dr. Trenchard. I’m here to do a job, and to do it well.

Wearing scrubs, like any uniform, also bonds you with your colleagues. We’re all in it together: an army working for a greater good we still believe in—the dysfunctional, fracturing, only-just-about-coping-because-of-the-goodwill-and-professionalism-of-its-staff, free-at-the-point-of-need medical system. And if that sounds sentimental or sanctimonious, I’m neither of these things. It’s just that when it’s your daughter’s tenth birthday and you can’t put her to bed because it’s impossible to swap a Friday night shift, and she’s said, piling on the guilt in a way that only your firstborn can: “It’s all right, Mummy. I understand that you need to work.” When this is the background to your fourth late shift in a row, and you’re exhausted and would really like to be in bed, curled around the husband you only grunt at during the week. When that’s what you’re missing and your reality’s very different: when you know your colleagues are racing to a crash call—hearts pumping as they run, shoes squeaking on the shiny floor, curtains whooshing around a bed; that fierce concentration as they crack ribs or apply paddles to shock a patient back into life... When, more prosaically, you haven’t had time for a wee... Well, you have to cling on to some belief in what you’re doing; you have to believe there’s a point in being committed to this sort of career. Because otherwise? You’d give up medicine or immigrate to Australia, New Zealand, or Canada, where the weather, hours, and pay are all far, far better.

Oh, don’t get me wrong. I love my job. I believe what I’m doing is important. (What could be more worthwhile than making sick children better?) It’s stimulating; and coming from my background—I’m the child of a single parent who ran a seaside café—I’m immensely proud to have got here at all. But this shift comes at the end of a string of nights preceded by an academic course last weekend and I’m shattered: my brain so befuddled I feel as if I’m seriously jet-lagged. Adrenaline will carry me through the next few hours. It always does. But I need to focus. Just ten more hours: that’s all I need to get through.

I’m thinking all of this as I trot along the shiny corridor from the children’s ward to the ER, my mood not enhanced by the art on the walls: a mixture of seascapes and abstracts in bright primary colors that are supposed to soothe patients and distract them from the unpalatable fact they have to be here. I pass the oncology and radiology departments and think of the lives being fractured, the hopes and dreams evaporating; for some, the lives ending, at this very moment; then shove the thought aside.

I’m on my way to see a patient. Ten months old: fractious, irritable. She’s vomited, according to the ER, though she hasn’t a fever. She may be no more ill than Sam, my eight-year-old, who’s just had a chest infection, though it’s odd to bring in a child who’s not genuinely poorly at this time of night. The junior isn’t happy to discharge and asked me to come down. My heart tips at the thought of a massively complicated case.

Because I could do without another terrifyingly sick child right now. My shift started with a crash call to the delivery suite to resuscitate a newborn: a full-term-plus-thirteen-days-overdue baby, blue, with a slow heartbeat and a cord pulled tight around his neck. I got him back—stimulation, a few breaths—but there was that long moment when you fear that it could all go horribly wrong and the mother who has managed to carry her baby beyond term would be mourning the child she has dreamed of. As every obstetrician knows, birth is the most dangerous day of your life.

Then a child with an immunosuppressant condition and a virus was brought in by ambulance: horribly, desperately poorly, and just after he’d been admitted, I had to deal with a three-year-old with croup. The mother’s anxiety made the situation far worse, her panic at his seal-like whooping exacerbating the condition until it became dangerous, the poor boy gasping for breath as she distracted our attention. Often parents are the most difficult part of this job.

So I’ve had enough drama tonight, I think, as I squeak along the corridor and take in the chaos of pediatric ER, filled with hot, disgruntled parents and their exhausted children. A preteen boy in football kit looks nauseated as he leans against his father: a case of concussion? A waxen-faced girl peers at a blood-soaked dressing, while her mother explains she was chopping fruit when the knife slipped. From the main ER, where the aisles are clogged with carts, there’s the sound of drunken, tuneless singing. “Why are we waiting?” half shouted, increasingly belligerently.

I check with the sister in charge, and glance at the patient’s notes: Betsey Curtis. My heart ricochets. Betsey? Jess’s Betsey? The baby of a friend I know well? Jess was in my prenatal group when I was pregnant with Rosa and she with Kit. Together we navigated early motherhood and stayed close when we had our second babies, though we’ve drifted apart since Jess’s third. Perhaps it’s inevitable: I’ve long since left the trenches of early babyhood, and work, family life, and my suddenly vulnerable mother are all-consuming. Still, I’ve only seen her a handful of times since she’s had this baby and I’ve let things slip. She didn’t send Rosa a birthday card and I only noticed because she’s so usually good at remembering. Of course it doesn’t matter—but I had wondered, in a distracted, half-conscious way as I scooped up the cards this morning, if she was for some reason annoyed with me.

And now she’s brought in Betsey. I look at the notes again: nonmobile, irritable, drowsy, tearful, has vomited, they say.

“Ronan, is this the patient you were concerned about?” I double-check with the junior doctor.

He nods, relieved at deferring responsibility.

“I’m not sure what’s wrong. No obvious temperature, but Mum was concerned enough to bring her in. Wondered if you’d keep her in for twenty-four hours for observation?” he says.

I soften. He’s been a doctor for less than eighteen months. I’ve felt that uncertainty, that embarrassment about asking a senior colleague.

“Of course—but let’s have a look at her first.”

I pull the curtains aside.

“Hello, Jess,” I say.

“Oh, thank god it’s you.” My friend’s face softens as I enter the bay, tension easing from her forehead. “I didn’t think we should come, but Ed was adamant. It’s so unlike him to worry, it panicked me into bringing her in.”

I look up sharply. Panicked’s a strong word from an experienced mother of three.

“Poor you and poor Betsey.” It’s really not ideal, examining a patient I know, but with no other pediatric resident around, there’s no other option. “Let’s see what’s wrong with her.”

Jess’s baby is lying on the bed, tiny legs splayed against the paper towel coating its blue plastic surface; large eyes watchful, her face a tear-streaked, crumpled red. I’d forgotten how pretty she is. Almost doll-like, with thick dark hair framing a heart-shaped face, a Cupid’s bow of a mouth and those vast blue eyes peering at me. A thumb hangs from the corner of her mouth, and her other fist clutches a dirty toy rabbit. It’s the toy I bought her when she was born: the same make as Sam’s, an unashamedly tasteful French velveteen rabbit. Her bottom lip wobbles, but then the thumb sucking resumes and she manages to soothe herself. She is heavy-lidded. Looks utterly exhausted.

“Hello, Betsey,” I say, bending down to speak on her level. Then I straighten and turn to Jess, whose hand rests lightly on her little girl. It still surprises me that someone this beautiful could be my friend. She’s one of those rare, effortlessly striking women, with copper Pre-Raphaelite curls and slate-gray eyes, now red-rimmed and apprehensive—perfectly natural, since no one wants their baby to be this sick. She has fine bones, and slim fingers garlanded with rings that she twists when nervous. A tiny gold star nestles in the dip of her neck. Her glamour is incongruous in this world of specimen containers, rolls of bandages, and stainless steel carts. I think of the shadows under my eyes, the rogue gray hair I found this morning kinking at my forehead. I look a good five or six years older than she, though we’re the same age.

“Can you run through what you think is wrong?”

“She isn’t herself. Grizzly, clingy, listless, and she was sick for no apparent reason. Ed freaked out when that happened.”

“Is he here now?”

“No, he’s at home, with Frankie and Kit.”

I imagine her boys lost to the depths of sleep, her husband unable to settle, and Jess’s loneliness as she sits in the ER with a poorly baby who can’t tell her what the problem is.

She gives me a quick, tense smile, and pulls a charcoal cardigan around her. Her top slips, revealing a black bra strap, sleek against her blanched almond of a shoulder, her improbably smooth skin. The top of her ribs and her clavicle are exposed, and I realize that she is noticeably thinner than when I last saw her just over a month ago at the school Nativity play.

Under the glare of the fluorescent strip lights, she seems more vulnerable, less assured. And very different from the woman I first met ten years ago, who buzzed with excitement at the thought of having her first child.