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CHAPTER ONE

Seven years later—Day One

THERE WAS NOTHING especially urgent about the manner in which the phone rang, but context was everything. Not many people called at seven o’clock on a Monday morning for an idle chat. And it was one of the laws of the universe that you could come into work early, hoping for a couple of quiet hours before the switchboard opened at nine, and something would happen.

Thea reached for the phone. ‘Dr Coleman.’

‘Good. Glad you’re here …’

‘What is it, Jake?’ She surveyed the carefully ordered pile of paperwork in front of her. In comparison to the sometimes chaotic disorder of the Central London A and E department downstairs, it suddenly seemed like a poor shadow of reality.

‘I’ve got a thirty-four-year-old male that I want a second opinion on. Will you come and have a look?’

‘I’ll be right down.’ Paperwork might be a necessity, but it didn’t put a smile on her face when she got out of bed in the morning. And Thea was smiling as she put the phone down.

‘Where is everybody?’

Jake Turner was a great guy and a good doctor, but he generally didn’t have much of an appreciation of time. A busy shift in A and E could do that to you.

‘It’s seven in the morning, Jake. Anyone with any sense is still thinking about getting out of bed.’

‘Ah. No wonder I had to ring around.’

‘You mean you didn’t call me first? I’m devastated.’

Jake snorted with laughter. ‘I tried Michael Freeman. I thought he’d want to know about this.’

Michael was Head of Respiratory Medicine at the hospital. ‘So what have you got that warranted the attention of our beloved leader? I don’t see any holes in the walls or visiting dignitaries.’

‘Thirty-four-year-old male, persistent cough, congested lungs and recent weight loss. I’ve had some X-rays done and I think it might be tuberculosis.’

‘What’s his history?’

‘He’s been sick for a while. His GP put him on antibiotics and he improved a bit then deteriorated again after he finished them. He came in last night with chest pains and difficulty breathing.’

Thea flipped through the A and E notes that Jake had handed her. ‘Any travel overseas lately?’

‘Nope, nothing. And this guy’s a teacher.’

‘From …’

‘The big secondary school up the road.’

Something pricked at the back of Thea’s neck. A couple of thousand pupils, aged eleven to eighteen, all crammed into an overcrowded inner-city school. Along with a suspected case of TB. ‘Great. You’d better be wrong, Jake.’

Unlikely. Jake was far too good a doctor for that.

‘Yeah. Let’s hope so.’

Mr Michael Freeman, Head of Respiratory Medicine, leaned back in his leather chair, rubbing his neck as if it hurt. ‘You’re sure?’

‘Sure as I can be. I’ve put a rush on the initial tests and we should have them back within twenty-four hours. But the patient has all the symptoms of active pulmonary TB.’ Thea slipped the X-rays out of their sleeve and clipped them into the light box on the wall.

Michael studied them carefully. ‘I agree. You’re admitting him?’

‘Yes, I want to keep him under observation for a few days.’ Thea pointed to the areas on the X-ray that indicated fluid in the patient’s pleural cavity. ‘The pleural effusion might well resolve once we start medication, but if it gets any worse I’ll need to do a thoracentesis.’

‘I agree. I want you to supervise the isolation procedures yourself, along with the notifications. If we have a situation where the infection’s already spread, then I want you dealing with it.’

‘I hope it hasn’t.’

Michael fell back into his chair. ‘So do I. What do you think, though? Worst-case scenario.’

This was Michael’s preferred modus operandi. He knew the answers already and, as the head of department, it was his job to make the decisions. But he always listened to his staff, and let them come up with the solutions he already had in mind.

‘Given that TB’s not that infectious …’ Thea let out a sigh. False optimism wasn’t going to help the situation. ‘Worst-case scenario is that we have an unknown number of pupils infected. The patient’s not been abroad in the last five years so the source of his infection is probably in this area. The contact tracing’s going to be a big job and we’ll have to do it carefully. We don’t want wide-scale panic, but we do want to provide prompt testing where it’s appropriate.’

Michael nodded. ‘Agreed. And what do you recommend for resourcing?’

‘We can’t do it all ourselves. We’ll need consultancy from Public Health England, and probably a couple of extra TB nurses to support the staff here.’

‘Any ideas about who might be leading the hospital team?’

‘I’d thought that you would be doing that.’

Michael gave her the smile that he usually reserved for anyone who wasn’t quite catching his drift. ‘I see from your staff record that you worked in Bangladesh for two years at a TB clinic.’

‘That was three years ago.’ Thea never talked about Bangladesh. She was surprised that Michael even knew she’d been there, but she supposed her CV must be on file somewhere.

‘Are you telling me you’ve forgotten what you learned there?’

She would never forget. The suffering she’d seen at a TB clinic, during her first short trip, had drowned out the clamour of her own breaking heart. Lucas’s dream had become hers, and she’d known she’d have to return.

Two years later, she’d realised that dream and travelled to Bangladesh to work. And then the traumatic, unforgettable lesson that had destroyed everything and brought her back home. But that was history now. She had to move on.

‘If you’re planning to have someone else lead the hospital team, then I’d like you to consider me as a candidate. I think I’m qualified to do it.’

Michael nodded, his self-satisfied smirk a sure indication that the conversation was going the way he wanted it to. ‘I’m glad you think so, because I was considering offering you the position. It’s conditional, though.’

‘What’s the condition?’ Something about the way that Michael said it warned Thea that she wasn’t going to like it.

‘The conference I spoke about last week. The one you’ve expressed no interest in.’

Thea’s heart sank. ‘The one in Mumbai, where you’ve been asked to present a paper on the spread of TB in inner London.’

‘That’s the one. Only the request was for a representative of this department to present a paper. My name wasn’t mentioned.’ Michael paused, looking at her steadily. ‘Most people would jump at the chance.’

Thea wasn’t most people. ‘I thought it went without saying that it should be you. You represent the department.’

‘I lead the department. Which means it’s my job to encourage my staff to realise their full potential.’ Michael leaned back in his chair. ‘It’s up to you. If you want to head up the team you have to be prepared to share what you learn, and the conference will be good experience for you. Take it or leave it.’

She wouldn’t get another opportunity like this again. If she really cared about what she did … There were so many reasons for saying yes, but they still couldn’t crowd out the dread that accompanied the thought of standing up in front of a lecture hall full of people.

‘I’ll take it.’ The words almost stuck in her throat, but she managed to get them out.

‘Good. In that case, I want you to keep me in the loop and let me know what resources you’ll need.’

‘Thank you.’ She may as well start now. ‘With regard to the testing at the school, we may well be able to do that in a few weeks’ time.’

‘Why’s that?’ Michael knew as well as she did that best practice would be to wait for ten weeks, the incubation period for TB.

‘The patient’s been off work sick for a while. He was diagnosed as having pneumonia and was at home for three weeks before Easter. His GP gave him antibiotics and he responded to those, but he didn’t go straight back to work because it was only a few days until the end of term. His condition got worse again after Easter, and he hasn’t been back to work since.’

‘So that’s … how long?’

‘No contact with any of his pupils for seven weeks now.’

Michael nodded. ‘In some ways that’s a blessing. We won’t be besieged by parents, wanting to know why their kids aren’t being tested immediately.’

‘Yes, but we’ll …’ Thea grinned. ‘I mean I’ll have my work cut out to get all the contacts notified and everything in place for when the testing does start.’

‘Then make sure that you use all of the support that’s available from outside agencies. Do you need any help with your other caseload?’

‘Not at the moment, but I’d like to keep that offer in hand. And I want to give some thought to where we’ll seat the team and do the testing. I want to set up a separate clinic.’

Michael nodded in approval. ‘All right. Let me know when you’ve decided and I’ll deal with the red tape.’

Thea already had somewhere in mind but she needed to see her patient first. ‘Thanks. Is after lunch any good for you?’

‘I have some time at one o’clock. If that’s soon enough for you.’ Michael gave her an amused look, which Thea ignored. He’d given her this job, and she was going to prove to him, beyond all question, that he’d made the right choice.

Dr Lucas West drove through the main entrance of the hospital and down the ramp into the underground car park. He was not supposed to be here until tomorrow morning but his afternoon meeting had ended early, and in his experience one could learn a lot about a place by just wandering in unannounced at the end of a working day. He wanted to see the way that Michael Freeman’s department ran when it wasn’t expecting a visit.

And the fax he’d received that morning was worrying. A case of tuberculosis was always a matter of concern, but a teacher in a large, inner-city school demanded his immediate attention.

The hospital was fifty years old, built with all the irrepressible optimism of the nineteen sixties. Since then it had clearly taken a few knocks, and although Lucas noted that it was scrupulously clean, he also saw that it was outdated in places and groaning under the number of people that it served.

He also noted that the receptionist in the department for respiratory medicine directed him back downstairs again, when he identified himself as a consultant, sent by PHE. He would have to have a word with whoever was in charge here. Clearly no one had thought much about the logistics of having a potentially large number of clinic attendees walking from one end of the hospital to the other and then back again to find the place they were meant to be going.

He found the room number he’d been directed to at the end of a long, dingy corridor. Ignoring the ‘Please Knock and Wait’ sign taped to the door, he walked straight in, the door handle turning and then coming off in his hand.

She’d cut her hair.

Suddenly every thought, each one of his resolutions to sort this mess out, was blanked from his mind. There was nothing else other than the unexpected realisation that Thea had cut her beautiful hair.

For a moment she didn’t recognise him. That hurt even more than the corruption of the memory of Thea’s corn-coloured hair spread out like liquid sunshine.

‘Thea.’ He supposed he should say more, but right now that wasn’t an option.

‘Lucas.’ She seemed to be coping with the moment better than he was. Or perhaps that was just what he wanted to think. He was probably just a distant memory to her, and there was nothing for her to cope with.

She walked towards him, stretching out her hand, more self-possessed than she’d been seven years ago. Thea had clearly learned to conceal her feelings, and that was yet another loss. Seven years ago she would have either rushed to hug him or aimed a punch at him. Either would have been better than this.

‘My door handle.’

‘Oh … Yes.’ He dropped the handle into her palm, careful not to brush his fingers against hers.

‘Thank you.’ She turned away, as if that was the only thing that interested her about him, and picked up a screwdriver from the windowsill.

Lucas reminded himself what he’d come here to do, and where in the chain of command he intended to be. ‘I’m here to see Michael Freeman. He’s co-ordinating the TB response team.’

She nodded, slipping past him and kneeling in front of the open door. ‘No, I am. Put your foot there, will you?’

Lucas planted his foot against the door, holding it steady while she applied herself to screwing the handle back on again. ‘I’m the consultant from PHE.’

The words generally had some effect on people, but they barely seemed to register. She gave a brief nod and yanked brutally at the door handle to test that it was now securely fixed.

He had to stop this now. Thea didn’t seem to have any understanding of the gravity of the task ahead of them, and if she thought he was here to act as apprentice handyman it was time to disillusion her. ‘Isn’t there someone else who can do this? We both have more important issues to deal with.’

She looked up at him for a moment. Her eyes were the same, dark and thoughtful, eyes that you could lose yourself in. That he had lost himself in once, on a very regular basis. Right now a spark of fire, or maybe just a trick of the light, turned brown to gold.

‘I could walk upstairs, find a requisition form, and wait two days for someone from Maintenance to come and fix it. And if you were going to turn up unannounced, you could at least have read the notice on the door …’ She got to her feet and turned away from him again.

Annoyance gripped at his chest. Thea had never just walked away from him like that before, and it surprised Lucas that it was no easier to take now than it would have been seven years ago. The impulse to spin her round, take her off balance and kiss her rose from his heart to his head, and his head dismissed it out of hand.

The roaring in his ears began to subside and professionalism took over. This was just another situation that he had to get on top of, and he had never failed to win hearts and minds when he needed to. Lucas put his briefcase down at his feet and knocked gently on the open door. She took her time in turning to face him, but when she did a touch of humour was tugging at her mouth.

‘Dr Lucas West. I’m looking for the head of the TB response team.’

‘Dr Thea Coleman. You’ve come to the right place.’

They didn’t shake hands. It was probably best not to touch her just yet.

‘You look well, Thea.’ It was a pleasantry rather than a compliment. She seemed paler than he remembered her, and grey didn’t suit her as well as the vibrant colours she used to wear. Lucas pressed on. ‘Do you have some time to talk?’

She nodded. ‘Of course. Why don’t we go for coffee?’

He smiled at her. Thea had always been able to make him smile, even now. ‘That sounds good.’

One word had sounded at the back of her head, forming a long scream of disbelief. No-o-o.

It had taken every ounce of Thea’s self-control not to run from the room. Lucas had taught her how to love and had then left her. Seven years, several oceans, and a lot of water under the bridge later, here he was. His dark hair a little shorter, and definitely tidier. Wearing a suit, of all things.

A cold detachment, as if she’d taken a step back from the world and was no longer a part of it, came to her rescue. Someone else had taken the door handle from him and answered him back, while the real Thea had been shivering in a corner, screaming that this could not be happening.

‘How have you been?’ He followed her through the canteen and into the garden beyond, putting his coffee down on the bench between them.

‘Fine. You?’

He nodded. ‘Fine.’

That seemed to cover their personal lives for the past seven years. If he’d followed even a few of the dreams that he’d shared with her over the two years they’d been together, it was unlikely that his professional life had been as uneventful.

‘You have experience of dealing with TB abroad?’

Something tightened his face into a mask. ‘I didn’t go abroad. Things happened …’

He seemed disinclined to say what things could possibly have got in the way of what he’d considered his destiny. ‘I worked at a TB clinic in the UK for a while and now I consult. Better hours …’

He stopped short as Thea choked on her coffee. The Lucas she’d known hadn’t owned a suit and had cared nothing for regular hours.

‘Are you okay?’

He looked as if he was about to thump her on the back. ‘Yes, fine …’ Thea waved him away. ‘Where was the TB clinic?’

‘South London.’ He seemed to recognise the awkwardness of the admission and changed the subject quickly. ‘You’ve been working here since you qualified?’

‘No, three years.’ The other four were none of his business. Thea could practically feel herself retreating again behind the protective shell that she had learned to cloak herself with in the hard weeks before her return from Bangladesh. The Lucas that she’d known had been charming and unconventional, an idealist and totally committed to his goals. There was nothing of that man here.

She stared hard at a clump of daisies in the grass at her feet, fighting for control. ‘I’ll let you have the case notes for the patient we have here at the hospital. You might like to see him.’

He nodded, as if he understood that Thea had nothing more of a personal nature left to say. ‘Yes, that would be good. You’re thinking of working out of the room on the ground floor?’

‘Yes.’

‘It’s not very well signposted, and it’s a way away from the department. We may have to review that location at our first team meeting tomorrow morning. Can you come up with some alternatives, or should I speak with your head of department about that?’

Like hell he would. ‘You can speak to me. I’m the liaison officer.’

He gave a small nod. ‘In that case, I’d like to see some alternatives. Preferably in the department and with easy, well-signposted access. It looks as if we may be testing a large number of contacts, and I don’t want people having to wander around the way I did.’

‘I chose the clinic on the ground floor because it has its own separate external entrance, which is a hundred metres from the bus stop in the hospital grounds.’

‘But if you come in at the main gates—’

‘No one does, unless they’re driving. The back gates are five minutes from the school. The department’s senior secretary is preparing a map that we can append to all the appointment letters, and she’ll get some temporary signage as soon as we agree on wording.’

‘And access to the department?’

This must be new territory for Lucas. Seven years ago, Thea had usually been the one to back down, in the face of two years’ seniority in their studies and Lucas’s seductive charm. Things were different now.

‘There’s a stairway between us and the department. We have easy access to the X-ray department, and there’s a counselling suite next door, which I can annex for our use if we need it.’

‘You seem to have all the answers.’

Not by a very long way. But she knew her own hospital better than he did at least. ‘It’s agreed, then?’

A smile twitched at the side of his mouth, and Thea ignored it. ‘Yes. Agreed.’