New: Brand new heart monitor images!!
They had trained for eight months. Three times a week through the winter. Sefton Park in the dark. The boring loop round the docks. Three Sunday long runs that broke them down to nothing and one Sunday long run, in February, that had felt like nothing they could not do.
Rae Moreno-Clarke was twenty. Music production at LIPA. She had a small tattoo of a hare on her right calf that she had got after a gig at the Invisible Wind Factory in November and could not really afford. Joss Halloran was eighteen, gap year, working in the cafe at the Walker, living in a studio in the Baltic Triangle with a cat called Margery. They had been doing the wrong thing for each other for two years.
The night before the race they had done the hen do they had been told they were doing. Maeve, an older friend of Rae’s from her first year, was getting married in May. The hen weekend was a two-night thing on the Wirral and a Saturday evening on a charter boat out on the Mersey, organised by Maeve’s sister, with prosecco and a man in a red jumper who said he was a magician and was, at most, a man who could shuffle cards. Rae had said yes to the boat. Joss had been her plus-one because Joss had a fake ID and Joss could be relied on to not get drunk enough to be a problem.
The boat had a metal ladder up onto the upper deck. The metal ladder had been wet.
“Rae, I’m getting the better view.”
Joss had gone up. Halfway up her right trainer had skidded sideways on the second-from-top rung. The ladder rail had caught her under the right armpit and hard along her side, and she had hung off it for half a second before she got her feet back. She had come back down rather than gone up. She had not said anything. The mark on her ribs was the colour of a plum by midnight and the colour of a banana by morning and she had pressed on it in the toilet at half past five, dressing for the race, and it had hurt, and she had decided that hurt and bad-hurt were different things, and this was the first one.
“My stomach’s a bit off. I shouldn’t have done the prosecco.”
“My threshold is famously one. Stop looking at me.”
They had started in the second wave.
Their pace was good for the first eleven miles. Joss’s breathing was slightly off but Joss’s breathing was always slightly off in the first three miles, and by mile four it had not settled but she had stopped tracking it, which was the same as it settling. They held an eight-thirty pace from five to thirteen. They walked through one water station at twelve because Rae had asked, which was strange because Rae never walked at twelve.
At fifteen Rae said, “I need to slow.”
Joss’s side was a heat now. Not a pain. A heat under the bottom of her ribs that came on when she breathed in past a certain point and went off when she breathed out before that point. She had been adjusting her breathing for two miles without thinking about it. She thought about it now. She decided not to mention it, because Rae was the one who looked bad, and there was an unspoken rule between them about whose turn it was to be the one who was alright.
At eighteen Rae said, “Walking.”
They walked. They got to twenty. Joss kept her right arm tight to her side. They started running again.
At twenty and a quarter Rae stopped.
Rae’s left hand went up and pressed flat against the centre of her own chest, which was something Joss had seen her do before in a way that had been the same as a person checking their pocket for keys. This was not that. This was a press, and Rae’s eyes were not entirely on Joss any more, they were focusing very hard on the kerb at the side of the road in a way that meant she was working at staying upright.
Rae sat down on the kerb. Her face went the colour of the inside of a seashell.
“Okay,” Joss said. “Marshal. Marshal!”
The marshal was twenty metres off and had already been looking at Rae for the last fifteen seconds because the marshal knew the look. The marshal walked, then ran, the four steps it took to cover the last bit. The marshal pulled the radio off her hip in the same motion she squatted in front of Rae.
“What’s your name, sweetheart.”
“Rae. Do you have chest pain.”
“Tight, okay. Stay sat. Look at me.”
Rae’s eyes rolled up. Her body went forward off the kerb and onto the road in a slow heavy fold, and her head missed the kerb edge by the width of three fingers because the marshal had her hand under it.
“Green flag. GREEN FLAG.”
Joss was already running.
The runner with the green flag was four minutes behind them. Joss reached her in forty-eight seconds. She did not say doctor or runner or even anything coherent, she just turned and pointed and the woman with the flag stopped running and ran the other way, and Joss followed.
Compressions had not started yet when Joss got back. They started thirty seconds later. The doctor with the green flag did them. A man in an event vest, a different man with a different vest, ran a defibrillator down from a marshal point fifty metres up the road. They cut Rae’s shirt off her sternum with a small pair of scissors that were tied to the handle of the yellow case. They put two white pads on her with stickers in the centre of them showing where they were supposed to go. The yellow case said, in a voice that was somehow louder than the road, “Analysing. Do not touch the patient.”
“Shock advised. Stand clear. Charging.”
“Clear,” the doctor said.
Rae’s body jerked. The jerk was small, the same small one it would always be. Joss saw it from two metres off because they had pushed her back two metres.
Compressions again. The doctor was counting under her breath in groups of ten.
The ambulance came up the closed road behind a moped that had been radioed to clear the way. It took six minutes. The paramedics did the changeover the doctor in green had been waiting for. They got Rae on the trolley. They got a green mask with a bag underneath it onto her face. They got a cannula in. They got her in the back of the ambulance.
“Only family in the back.”
The doctor in green, getting out of the bus: “She’s as good as.”
The doors shut. The blues came on. The siren came on. Joss sat in the corner of the back and held Rae’s ankle through the blanket because there was nowhere else her hand fit, and she watched the bag on Rae’s mask inflate and deflate, and she did not notice that her own breathing was shallow now and only going in to the top of her chest, because the bag on Rae’s mask was the only thing she was capable of noticing, and her side was a heat she had been ignoring for so many miles she had forgotten she was ignoring it.
Resus at the Royal Liverpool had eight bays. Rae went into Bay Four. They moved her off the ambulance trolley onto the hospital trolley in one sliding pull. They stuck twelve pads on her. They put a second cannula in. They drew bloods and ran the gas before the cannula was even taped. The trace came up on the wall monitor.
“Sinus tach. QTc looks long.”
“Okay. Mag two grams over ten. Get the K. Get the mag.”
Joss had been put outside the bay. A nurse had walked her there, hand under her elbow, in the way nurses move people they want kept upright.
“You’re going to stand here.”
“You’re going to tell me everything she’s on, anyone in her family with heart problems, anything she’s taken in the last twenty-four hours.”
“Family history of heart problems. Sudden death. Anyone young.”
“Her cousin. Twenty-five. Eight years ago. He was — he was on his own in a car. They never said what it was.”
“More than you’d think. Stay there.”
Royal Liverpool Resus Bay 4 — 14:18. Sinus tach 118, QTc 528. First ECG.
Joss stood there for forty minutes. She did not sit down. There were chairs at the desk. She did not sit down because if she sat down she was going to have to think about why her right side was doing the thing it was doing, and she did not have room in her head for two of them at once.
The bag on Rae’s mask was visible through the gap in the curtain. It inflated and deflated. It was the only steady thing in the bay.
They moved Rae up to CCU at half past ten.
CCU was on the fourth floor, north wing. Eight bays in two bays of four with a curtain rail running between them. Rae was put in Bay Six, by the window. The window faced south and looked at the back of the next wing along, a brick face four metres away with a single grilled vent in it that someone had stencilled a small black bird onto.
The staff nurse who took the handover was twenty-nine and called Hema. She read the cardiology notes standing up. She did obs. She wrote them down. She did not say anything that was not necessary.
“You’re allowed to sit there. Don’t touch anything.”
Joss sat in the chair next to the bed. The chair was vinyl. Her side was still hot under the elastic of her running tights. She had not taken the tights off. She had a fleece on over the running top that had stopped being damp around eight and had started feeling crusty by ten. She had her trainers off because she had untied them an hour ago and her feet had inflated, and there was no getting them back on without sitting down to do it, and she had not been able to sit down before now.
Rae was awake. Her green mask had been swapped for the same green mask with the bag underneath, and the bag was working slower than it had been in the ambulance. The trace on the wall above her bed was steady. The number above the trace said 78.
CCU Bay 6 — 22:46. Sinus 78. QTc improved to 482 after magnesium. Stable.
“Like I’ve been hit by a van.”
“You went down at twenty-one. I got in the ambulance.”
“Oh. Right. Yeah. Sorry.”
Rae looked at her for a second.
“You’re leaning. Why are you leaning.”
“I hit my side on the boat last night. It’s a bruise. It’s fine.”
“I’m not lifting up my top in CCU.”
“Show me. Pull the curtain. Whatever. Show me.”
Joss pulled the side of her top up to under her bra. The skin from the bottom of her ribs to the iliac crest was a uniform yellow-green with a darker patch in the centre that was the size of a side plate. The darker patch had a faint pattern in it where the rail of the ladder had impacted her in two parallel lines.
“You ran a half on that.”
“You ran twenty-one miles on a thing that looks like that.”
“It’s the colour of a Granny Smith. It’s fine.”
Joss pulled her top back down. Her right side felt cold where the cool air of the ward had touched it and warm again three seconds after she had covered it. She did not register this as significant. She registered it as the body doing its body things.
Rae closed her eyes. Joss watched the trace on the monitor for a while. The trace was the slow regular shape of a heart that did not want to run away with itself, and the number above it stayed at 78 for about twenty minutes, and Joss’s own breathing settled into the rhythm of it the way it had settled into Rae’s footfalls on every long Sunday for two years.
Hema came in at eleven. She did obs. She looked at Joss.
“You’re grey-grey. When did you eat.”
Hema went out. Hema came back five minutes later with a sandwich in a triangle packet from the staff fridge and a Lucozade. She put them on the over-bed table.
“Eat that. Drink that. I’m not arguing.”
Joss ate half the sandwich. The half she ate was the half that did not require her to twist her torso to reach. She drank a third of the Lucozade. She put it down. She watched Rae sleep. The bag on Rae’s mask inflated and deflated. The number above the bed said 78.
It started at two minutes past three in the morning.
Joss had not slept. She had sat in the chair through twelve and one and two, and she had been watching the trace because the trace had become the thing she watched the way you watch a fish tank. She had not been thinking. She had been registering the regular peak-and-trough of a green line on a black screen for nearly four hours and the number above it had not gone below 74 or above 84 and the rhythm of it had become the rhythm of the room.
At one minute past three the number changed.
It went to 96. Then 104. The trace did not look any different to Joss but Joss had no frame of reference for what different was supposed to look like. The monitor made a single soft beep, a different one to the regular ticking it had been making, and a small box at the top right of the screen lit up amber and said HR ELEVATED.
Joss stood up. Her side did not appreciate the standing up. She stood up anyway. She put a hand on Rae’s shoulder. Rae did not respond. The trace on the monitor was now doing a thing that Joss could see was not the thing it had been doing twenty minutes ago. The peaks were wider. They were also wider apart, then closer together, then wider apart. The number above said 112. Then it said 138. Then it said dashes.
The amber box on the monitor turned red. The soft beep became a fast three-tone pattern, repeating. A second alarm sounded, higher than the first, somewhere further down the unit. Joss looked at the door of the bay. The door of the bay had nobody in it.
She pressed the red button on the call cord. She held it down for longer than she needed to. She let it go. She pressed it again.
Hema came through the door at a walk that was almost a run. She did not look at Joss. She looked at the monitor for a fraction of a second and at Rae for a fraction of a second longer and she said, into a small black thing clipped to her shoulder, “Bay Six, VT, no output, calling it,” and the loudspeaker outside the bay said something Joss did not catch, and Hema was already pulling the curtain wide and reaching for the wall, and the wall yielded a black plastic handle that Hema pulled down. Somewhere a horn started, low and continuous.
“Move. Other side of the bed. Now.”
Hema was on the bed by the time Joss got round the foot of it. Hema had Rae’s gown open down the centre with one motion. Hema had her right hand on Rae’s sternum and her left hand on top of her right hand and she was pressing down hard and fast at a tempo Joss had only ever heard from outside a curtain. The sound was wetter than Joss had imagined. It was a flat percussion she could feel through the metal of the bed frame she was holding on to.
CCU Bay 6 — 03:09. Polymorphic VT. BP 62/38. Crash team arriving.
Two more nurses came in. Then a doctor in scrubs whose lanyard said REG. Then a second doctor whose lanyard said SHO. Then a porter pushing a red trolley with three drawers and the same yellow case on top. Then someone Joss did not see properly with a clear bag in their hand that was clipping onto something on the IV pole.
“Four grams running. More?”
“Give another two. Charging two hundred. Pads on. Off her chest. Hold compressions.”
They put two pads on Rae. One above her right breast. One below her left ribs. The pads were the same kind that had been on her at mile twenty-one. The black wires from the pads ran into a unit on the crash trolley. The unit whined as it charged.
Joss was at the foot of the bed. Joss did not move. The voice did not mean her. The voice meant the people doing compressions. Hema lifted her hands off Rae’s chest and sat back on her knees on the mattress.
There was a thunk. The bed rocked against the floor. Rae’s shoulders came up off the mattress half an inch and came back down. Her left arm flopped out of the side of the bed and the SHO caught it and put it back.
Hema went back to compressions. The SHO took over thirty seconds later, swapping in on the count. The reg was at the head of the bed working on the airway. They had taken Rae’s green oxygen mask off. They put a different mask on, larger, with two hands gripping the seal down hard against her face, and a second person squeezing the bag. The bag was clear plastic and the air going into it was making the same hiss the green mask had made all evening, but louder, faster.
“Still VT. Still no output.”
“Charging three-sixty. Clear.”
Joss said, “Can I do anything.”
“Out, please. Right now. Out of the bay.”
Joss went out of the bay. She did not go far. She went two steps and then she stood at the gap in the curtain with one hand on the frame and watched. Nobody moved her on. They had stopped looking at her.
They got rhythm back at three minutes past three after the seventh shock.
“Okay. Hold the noradrenaline. Get her ready for transfer.”
They moved fast. They had the bed ready to roll inside two minutes. They unplugged things from the wall. They put portable equivalents on the bed. They put a portable monitor on the over-bed table at the foot of the bed and connected the leads. They put Rae’s oxygen mask back on, the green one with the bag, because the airway was hers again. The bag on the mask filled and emptied. Rae’s eyes were closed.
Hema, standing at the door, finally noticing Joss again: “She’s going downstairs. CCCU. They’ll give her better monitoring and they can pace her if it happens again. She’s alive. She’s stable enough to move.”
“You can come down later. Not in the lift. There’s no room.”
Hema looked at her properly. “You should sit. You look worse than the patient.”
“Sit. There. Now. Hand on the rail.”
Joss sat. She put a hand on the bedrail of Bay Six, which was empty now. The bay smelled of plastic and chlorhexidine and one half of a Yeo Valley yoghurt Hema had not yet noticed had been knocked off the over-bed table during the third shock. Joss did not notice the yoghurt either. Joss was noticing that her right side was no longer hot. Her right side was now the wrong kind of cold. The skin over the bruise had taken on a tightness that had not been there an hour ago. When she pressed on it with two fingers the press went in further than she remembered it going in last time. She did not press a second time.
The bed went past the gap in the curtain. Rae went past in the bed. The bag on Rae’s mask inflated and deflated. The bed wheel that squeaked, the back left, squeaked once and then was gone.
Joss sat in Bay Six for thirty-two minutes after Rae had gone.
Nobody came to ask her to leave. CCU had two empty bays now, Bay Six and Bay Five opposite, which had been empty since handover. The unit had become quiet in the way units become quiet after a code, the way a room becomes quiet after a glass has fallen and not been swept up. The staff moved around the desk. Someone was on the phone. Someone was writing. The IV pump in the bay next door, where there was a man with a chest drain who had slept through everything, clicked at its regular two-second tempo.
At twenty past three Joss stood up to go to the toilet.
The bay tilted. Not the room. The bay specifically. The bed tilted away from her and the wall tilted towards her and the floor stayed where it was. She put her hand out and the rail was there. She held it for a second. The bay righted itself.
She walked to the toilet at the end of the corridor. It was further than she remembered. She had to stop once at the doorway of the relatives’ room and breathe before she could continue. The breathing made the heat under her right ribs flare up like a coal being blown on. She made it to the toilet. She locked the door. She sat down. She did not need to. She just sat.
She lifted her top. The bruise had not changed colour. The skin around the bruise had. There was a redness fanning up from the lower margin of it, a red that was not bruise-red and not heat-red, a sort of dusky red, and the right side of her chest moved when she breathed in in a way the left side did not. Not less. Differently. The right side moved at a different tempo.
She put her hand flat on her right lower ribs and pressed gently. The pressure made a wet sound. Or her imagination did. She could not be sure which.
She had been at the hospital for thirteen hours. She had taken paracetamol from a triage nurse at half past four in the afternoon. She had eaten half a sandwich. She had not eaten anything else. She had drunk a third of a Lucozade. She had run twenty-one miles before any of this. She had hit her side on a boat ladder twenty-six hours ago.
She sat on the toilet seat with the lid down for another minute. She put her head between her knees, which her ribs did not like. She put her head back up.
She stood. The bay tilted again.
“Okay,” she said, to the inside of the toilet door. “Okay.”
She unlocked the toilet door. She walked back down the corridor. She did not go back to Bay Six. She went, instead, to the desk.
“Something’s wrong with me.”
Hema came round the desk. Hema put two fingers on Joss’s wrist.
“Sit down. Here. Foot of Bay Five. I’m getting obs.”
Joss sat. Hema wrapped a cuff around her left arm. Hema clipped an oximeter on her finger. Hema waited.
“Eighty-eight on ninety-three over fifty-eight. What hurts.”
“You fell, you hit your ribs, you ran twenty-one miles on it, you didn’t mention it.”
“Okay. Stand up for me. Slowly.”
Joss stood. The bay tilted. She caught the rail.
“Right. Sit. I’m calling AMU. I’m walking you down. Don’t move from that chair.”
Hema was at the desk inside ten seconds. She was on the phone inside fifteen. Joss watched her speak. She caught the words rib injury and tachy and hypoxia and the words orthostatic and possible internal. She heard, faintly through the receiver from the other end, a voice that said, “Okay, bring her down,” and Hema put the phone down and came back over.
“I’d rather a chair. I’m getting a chair.”
The Acute Medical Unit was on the ground floor. Hema pushed Joss down in a wheelchair via the bed lift, which was slow, and a corridor that had the faint persistent smell of warmed-over hospital food at four in the morning. Joss put her head against the back of the chair. The lift had a strip light along the ceiling that flickered every six seconds in a way she could not unsee once she had noticed it.
AMU triage was a single room off the main floor with one bed, one trolley, one nurse, one bedside monitor and a small machine on a stand that was the blood gas analyser. The nurse was twenty-six and called Owen and he was the one who had taken the call. He helped Joss out of the chair and onto the trolley and took the cuff off her own and put a different one on her hospital arm and ran the obs again.
“Okay. Going to take some blood from your wrist. It’s called a gas. Pinches. Twenty seconds.”
It did not feel like twenty seconds. It felt like nothing. Joss did not look. Owen was good at it. He filled a small heparinised syringe with bright red blood and held it up to the light and inverted it twice and walked it to the analyser and put it in. The analyser made a click and a hum and a long pause.
“I’m going to listen to your chest. Lean forward.”
Joss leaned forward. Owen put the stethoscope under the back of her top. He listened to the left side. He listened to the right side. He listened to the right side again. He listened to the right side lower down. He took the stethoscope out of his ears and let it hang and he walked across the room without saying anything and looked at the screen of the gas analyser.
He tore the slip out of the printer.
AMU triage — 06:14. Joss’s first ABG on room air. The numbers nobody wanted.
Owen brought the slip back over.
“Okay. Few things. Your oxygen’s a bit low for someone your age sitting still. Your blood’s lower than I’d like in terms of haemoglobin, which means you’re a little bit anaemic, but you weren’t two days ago, were you.”
“Right. So somewhere between then and now, some of your blood has gone somewhere it shouldn’t have. Your right side, where you fell, I can’t hear breath sounds at the base. I want a chest X-ray. Now. Yes?”
“I’m putting some oxygen on you in the meantime. Same kind as your friend had upstairs.”
He put it on. The strap caught her hair and he untangled it. The plastic was cold under her chin. The bag underneath inflated and deflated in time with her breathing. After a minute the cold went, and Joss noticed that her breathing was easier with it on, easier than it had been for hours, easier than it had been since maybe before mile fifteen, and she had not realised it had not been easy.
She lay back on the trolley. Owen took the cap off the cannula in the back of her left hand that someone had put in at some point without her registering. He flushed it with something cold. He hung a bag of fluid on the IV pole. He started the pump.
“Bay Six. Just got moved to CCCU. The cardiac.”
“I don’t know her, sweetheart. Different unit. I’ll get someone to ring up later.”
Radiology came at twenty to seven. They were portable. They brought the machine round on a trolley and put a board behind Joss and stood her up halfway and shot two films and were gone in seven minutes.
The films were on the system inside another twelve.
The medical reg came in at five past seven. Dr Ferreira was twenty-eight and had been on shift since eight the previous evening and was eating a banana when she came in and did not put it down.
“Joss. I’m Diana. Couple of things.”
“You’ve got blood in your chest. On the right. Quite a bit of it. We think it’s from the rib injury you had on the boat. Probably a slow bleed from a torn intercostal vessel that the running has stirred up. You’ve probably been bleeding into your chest for the best part of a day, slowly. Are you with me.”
“Okay. We’re going to do two things. First we’re going to put a tube into your chest to drain it. It’s called a chest drain. It comes in through your side, between your ribs, and the blood drains into a sealed bottle on the floor. It’s a routine procedure. It’s not as bad as it sounds.”
“Second, depending on how much blood comes out and how fast, you might need a transfusion. We’ve sent off a crossmatch. Is that alright.”
“Do you have any questions.”
“We’ll see how the drain goes first. Yes?”
Joss’s portable AP supine film. Right hemithorax white. Costophrenic angle gone. The picture nobody had thought to take.
Dr Ferreira put the banana down on the edge of the trolley while she got consent. She picked it back up afterwards. She did not finish it. She left.
They did the drain at half past seven.
It went in under local. Joss had been told to lie on her left side with her right arm over her head. She had been given a small pillow to hold against her front. The anaesthetist had drawn a target on her ribs with a black marker. The surgeon, who was younger than Joss had been expecting and was called Mr Lin, had explained each step ahead of doing it because that was how he did it. He had said, scratch, and there had been a scratch. He had said, pressure, and there had been pressure. He had said, you will feel a pop, and there had been a pop, and a sound, and then a long, slow, dark fluid that Joss could see out of the corner of her eye filling the clear tube that ran down off her ribs and into the bottle on the floor.
“Draining fast. Seven hundred now.”
“Two units in fridge. Calling for them.”
Joss watched the bottle. The bottle was on her left side now because Mr Lin had walked round. The bottle was clear with a graduated scale up one side. The dark fluid was past the 600 mark. Joss watched it climb past 750.
“Okay,” Mr Lin said. “How are you feeling.”
“Okay. Lying flat now. All the way. Yes.”
They lay her flat. The bag on her oxygen mask was inflating faster. The number above her bed had gone from 110 to 122 to 138 in the last four minutes.
“Eighty-four over forty-eight.”
“Running. Two litres of saline now. Two of plasma if you’ve got it.”
Joss could see Rae on the monitor above her, which was a strange thing to think because there was no monitor above her with Rae on it, but she could see her, and Rae was at the end of a long corridor, and there was a green mask on Rae’s face, and the bag on the green mask was filling and emptying, filling and emptying.
“Sunday, Joss. It’s Sunday morning.”
They got the first unit of blood up at five past eight. The second at twenty past. The drain output slowed somewhere between the first and the second, then sped up again. The fluid in the bottle on the floor was past 1200.
They moved Joss up to CCU at half past eleven.
It was not the obvious place to put her. CCU was for hearts. The ward she should have gone to was respiratory, on the third floor, which had a level-two bay equipped for chest drains and acute haemorrhage. The respiratory beds were full. The surgical HDU was full. The medical HDU had one bed and the consultant on call had earmarked it for an oesophageal varix patient on his way up from A&E. The bed manager had spent forty minutes finding a place for Joss. CCU had two empty bays and a nurse-to-patient ratio that worked, and the bed manager had decided that a haemorrhagic shock patient with a chest drain who needed cardiac monitoring on top was, technically, a fit.
The bay they put her in was Bay Seven. Bay Seven was diagonally opposite Bay Six. Bay Six had been turned around at six in the morning and was now occupied by a man in his forties with a non-STEMI.
At twelve they moved the man with the non-STEMI out of Bay Six and into Bay Five, because somebody on the consultant round had said they would prefer Bay Six left empty in case Rae came back up from CCCU later in the day. Bay Six, briefly, was empty. The bay opposite, Bay Seven, contained Joss in a bed with two units of blood up, a chest drain running to a bottle on the floor with 1450 ml of dark fluid in it, an oxygen mask, an IV pump, and the same set of pads on her chest, in the same places, that had been put on Rae sixteen hours ago at mile twenty-one.
Rae came up at quarter past one.
She came up under the same kind of bed transfer that she had gone down on. Hema was not on shift any more. The day staff were on. The nurse with Rae was called Mariam, who was twenty-six, and the porter pushing the bed was the same one who had pushed the bed in at half past ten the night before. Rae was awake. Rae was not on the green mask any more. Rae was on a smaller plastic prongs in her nose. The number above the new portable monitor on the over-bed table at the foot of her bed said 84.
They put her back in Bay Six. They drew her curtain three-quarters. They left the door of the bay open. The door of Bay Six and the door of Bay Seven faced each other directly across the corridor, and the angle of Joss’s bed had been set, by Mariam at twelve fifty when she had been getting Joss’s drain levels, so that Joss could see, when the doors of both bays were open, a slice of Bay Six between her own door frame and the curtain on Rae’s side.
Joss got her phone out of the over-bed drawer. She rang Rae’s number. Rae picked up on the third ring.
“Hello.” Rae’s voice was rough.
“Look through your door.”
Joss could not see the part of Rae that was looking. She could see one foot of Rae’s bed. The bed adjusted. The angle of the foot changed. Then she could see Rae’s face at the far end of two doorways and four metres of polished lino.
“Oh, for fuck’s sake, Joss.”
“It was a bit worse than I said.”
“Blood in my chest worse.”
“I have a tube in me. It’s draining out. There’s about a litre and a half in the bottle.”
“Christ. Joss. You ran twenty-one miles.”
They looked at each other across the corridor. Joss put her phone down on the blanket and propped it up against her thigh so the camera still had her in shot, and Rae did the same, and they did not speak for about a minute. The pump in Joss’s bay clicked. The cuff on Rae’s arm inflated and Rae lifted her right hand off the blanket to acknowledge it. Joss had the same cuff. Joss’s cuff inflated about thirty seconds later.
“They put me on the prongs. Sats are okay.”
“You look weird without it.”
“You look weird with one on.”
“It makes me look like a fighter pilot.”
“It makes you look like a fighter pilot’s aunt.”
Mariam came in to do Joss’s drain. Mariam stood next to Joss’s bed and lifted the bottle and measured. She said the number under her breath. She wrote it on the chart. She straightened up.
“We’ll see. We’d like it to stop. Slowing’s a step.”
“Less like the room is on a boat.”
“Okay. That’s the blood working. Stay on your mask. Don’t take it off when I’m not in the room.”
It was twenty past two. She had been eating a yoghurt that Mariam had brought her from M&S in the lobby. She had been holding her phone in her left hand. She had been telling Joss, on speaker, about a girl in her year at LIPA who had cheated on her boyfriend with a man called Geoffrey, of all names. Rae had paused mid-sentence to scrape the bottom of the yoghurt pot.
Then she said, into the phone, into the air of Bay Six, “my chest is doing it.”
The yoghurt pot fell out of her hand. Joss heard it land on the over-bed table through the phone. She heard Rae say oh and she heard nothing for a beat and then she heard the monitor change tone in Bay Six. Joss could hear it through the phone before she heard it across the corridor because of the half-second delay on the line.
Joss reached for her call button. She pressed it. She kept pressing it. She held the phone with the other hand.
Rae did not. The line went on for another three seconds with the sound of Rae breathing, then it went on for another six seconds with the sound of nothing, and then a clatter of someone moving the phone, and Mariam’s voice on the line, very fast: “I’ve got her. I’m hanging up. Joss, hang up.”
Joss could see across the corridor now. Mariam had come into Bay Six through the curtain. Another nurse had come in behind her. The trace on the monitor in Bay Six, which Joss could see in cross-section through the gap, was doing the long fast waxing-waning shape it had done at three in the morning. The yellow case was already in the bay because they had not taken it back to the trolley after they had brought Rae up at quarter past one. They had it open on the over-bed table beside her.
CCU Bay 6 — 14:31. Asystole. Resus in progress.
“Charging two hundred. Clear.”
Joss tried to get out of her bed. Her drain was on the floor on her left side. Her IV pole was on her right. Both of them were attached to her. She put her left leg over the side of the bed and got her foot to the floor. She put her right leg over. Her IV pole tilted. She caught it with her right hand.
She made it three steps. The third step she did not really make. She put a hand on the door frame of her own bay. She put the other hand on the wall opposite. The corridor was four metres. She got across two of them. She did not get further. Her legs sat her down in a slow controlled motion against the door frame of Bay Six, and the IV pole tilted with her, and a small amount of saline ran out of the cannula that had come half out of her hand.
“It’s the patient from Seven.”
Someone got Joss up. Someone was Mariam’s colleague, a nurse called Steph, who picked Joss up under both armpits in a way that took no account of the chest drain or the cannula or the fact that Joss’s right side felt like someone had put a knife in it. Joss made a sound she had not made before. Steph apologised in a flat professional way. Steph got Joss back into the bed in Bay Seven. Steph drew the curtain. Steph went back across the corridor at a run.
Joss lay on her bed with the curtain drawn. She could not see Bay Six any more. She could hear it.
“Charging three-sixty. Clear.”
“Adrenaline one milligram, given.”
It went on for thirty-eight minutes. Joss did not know that. Joss could not see a clock from where she was lying. The voices through the curtain came in waves and dropped off and came back, and the gaps between the waves were when the team did the rounds of compressions in silence except for the count. Joss counted with them in her head and lost the count and started again and lost it again.
At ten past three the team in Bay Six went quiet for longer than they had gone quiet before.
“Time of cessation, fifteen-oh-nine.”
The voices in Bay Six did not get any louder after that. They went on for another minute or so in low murmurs about who was going to clear up and who was going to do the paperwork, and then the curtain rail in Bay Six made a long rattle as someone pulled it the rest of the way across, and then the corridor was quiet.
Joss’s drain kept draining.
It had slowed to a trickle at noon. It had stopped at one. It had started again at twenty past two while Rae had been eating the yoghurt. Joss had not registered this because she had been on the phone. Mariam had not registered it because Mariam had been in Bay Six. Steph had been the one who registered it, but only after the family meeting that wasn’t happening had not happened, and Steph had come back through the curtain to check on Joss at twenty to four, and Steph had looked at the bottle on the floor and the level on the bottle was 2150.
Steph lifted the bottle. She held it up to the light. The fluid was bright fresh red on top with a layer of darker, settled clot below it. She put it down. She stepped out of the bay. Joss heard her at the desk. She heard the word brisk.
Steph came back in with two units of blood already in her hands and a different doctor behind her. The different doctor was Mr Lin from this morning. Mr Lin had been called back from his half day off. He still had the same banana on him. He had not had time to eat it.
“Okay, Joss. You’re re-bleeding.”
“We need to take you to theatre.”
“You’re going to feel a bit pushed around for the next ten minutes. People are going to be doing things. Try to stay calm. Yes?”
They got the blood running. They got fluids running. They got Joss off the cuff and onto an arterial line that Mr Lin put in himself in the left wrist in about ninety seconds. The wave on the monitor went from the cuff every ten minutes to a continuous tracing of every beat. They put a second cannula in her right antecubital that the SHO with her got first time. They got the anaesthetics on the phone. They got the theatre coordinator on the phone. They started moving the bed.
Joss’s curtain was open now. As the bed pulled out of Bay Seven, the angle of it took her past the door of Bay Six for the second time in eight hours. The bed in Bay Six had the curtain fully drawn around it. There were no staff in the bay. There was a chair in the corridor outside the curtain that had not been there before, and there was a folder on the chair that had not been there before, and the folder said, in a printed sticker on the spine, MORENO-CLARKE, R.
“Okay, going down, going down.”
The bed picked up speed. They went into the lift. The lift went down. The lift smelled of nothing exactly, the way hospital lifts do. The doors opened. They went through a corridor that was much wider than the corridors upstairs and brighter. They went through two double doors. There was the smell of theatre, which was a sharper kind of clean.
“Joss. Hi. I’m Aiya. I’m the anaesthetist. We’re going to put you to sleep now. Yes? Mr Lin is going to fix the bleeding and we’ll have you back on the ward this evening.”
“Count backwards from ten for me.”
They opened her right chest at four-twelve.
The bleeding was not, as it turned out, from the intercostal vessel Mr Lin had been expecting. There was a tear in the inferior border of the right lower lobe of her lung, two centimetres long, that had been weeping into the chest cavity since some point during the run and had been kept at a slow steady rate by the elasticity of the lung tissue itself. The fall on the boat had partially separated a small wedge of the lung from the rest of it, and the wedge had not been a problem at rest but had become a problem at thirty miles of jolting through the second half of the marathon route, and had become a worse problem at the moment the staff in Bay Seven had moved Joss flat on the trolley and the orientation of the wedge had changed.
Mr Lin started the repair at four-thirty. He worked fast. He had done the procedure many times. The repair itself was technically straightforward in the sense that the words were straightforward. The patient, by the time the chest was open, was haemodynamically unstable in a way that was harder to outpace than the surgery itself. They transfused four more units in theatre. The anaesthetist ran noradrenaline. The pressure stayed lower than they wanted it. The pressure dropped again. They transfused two more units.
Theatre 4 — 17:08. Asystole. Resus continued for thirteen minutes.
At seventeen-oh-eight the trace on the monitor flattened. Mr Lin stopped what he was doing. Aiya started compressions through the open chest with a gloved hand on the heart, which was the kind of compression you could only do when the chest was already open and which had a different feel from the chest closed. They went for thirteen minutes. They got nothing back. The anaesthetist called it. The time was confirmed and written down. Mr Lin closed the chest because the chest needed to be closed regardless. He did it in the same speed he had opened it. He went and washed his hands. He put his gloves in the bin. He stood at the sink for a minute with the water running and did not say anything.
In the lift back up to the ward there was nobody. The lift smelled of nothing exactly. The doors opened on the fourth floor.
In Bay Six the curtain was drawn. In Bay Seven the curtain was drawn. The monitors above both beds were dark. The IV pumps in both bays had been turned off and pushed against the wall. The blood pressure cuff in Bay Six had been wound back into its loose loop and left on the bed. The blood pressure cuff in Bay Seven had been wound back into its loose loop and left on the bed. The bottle on the floor of Bay Seven was still there. The level on the bottle was 2340.
The corridor outside the two bays was quiet. The chair with the folder on it was still there. The folder had a second sticker on it now, beneath the first one, that said HALLORAN, J. The chair was three feet from the open door of Bay Six and three feet from the open door of Bay Seven, and the angle of it was such that the folder on it was directly in line with the two beds.
Mariam came in at half past five with two cups of tea on a small tray. She did not know who she had brought them for. She had brought them because that was what you did. She set them down on the desk. She made a note in the handover book that the bays needed turning over. She made the note in the same handwriting she had used for everything else that day.
The night porter came at six. He brought the trolleys. There were two. He did not know either of them. He did the work he was good at. The names on the wristbands were not his to know.
By seven the bays were stripped. By eight the cleaners had come and gone. By nine the monitors had been switched back on, the screens running their default test pattern, the cuffs reset, the IV poles returned to the corner. CCU was ready for the next thing.
Outside, the rain had started.
