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Chapter One

‘OH, DR TREMAYNE, Kate left this for you.’

Nick stopped by the reception desk and took the sealed envelope from Sue, glancing at it in puzzlement. How odd…

‘Is she still here?’

‘Yes, I think so, but she’s about to go. She has to pick Jem up from holiday club. Do you want me to find her?’

‘No, it’s OK.’ He gave the envelope another glance, and with a curt nod to his patients as he passed them, he went into his room, closed the door and slit the flap open with his forefinger as he dropped into his chair behind the desk.

He drew out a single sheet, handwritten in her elegant, decisive script, and as he smoothed it out with the flat of his hand he stared at it in disbelief.

Monday 12 April

Dear Nick,

I’ve written to the PCT, and will tell Chloe and all my other colleagues and friends over the next few days, but I wanted you to know first that I’ve decided to leave Penhally and my post here as midwife. I’m putting my house on the market and Jem and I will move away from here over the summer, in time for him to start secondary school in September. It’s the right time to go, as far as his education is concerned, and I thought we could move closer to my mother in Bristol.

I’ll miss the practice and all the people in it, but it’s time for us to move on. There’s nothing here for me any more.

I would just like to thank you for all the support and kindness you’ve shown to me over the years.

Yours,

Kate

Stunned, Nick scanned the letter again. She couldn’t leave. Where the hell did she think she was going? And taking Jem away…

He pushed back his chair and crossed to the window, pressing his hand against the cold glass and staring out numbly at the sudden squall that had sprung up. The rain was streaming down the pane in torrents, bouncing off the roofs of the cars outside, and people were running for cover.

Including Kate. She wrenched open her car door, and as she got in her head lifted and she met his eyes, holding them for a moment through the lashing rain, then with a tiny shake of her head she slammed the door, started the engine and drove away, leaving him staring after her.

He sucked in a harsh, juddering breath and turned on his heel, moving away from the window before he put his fist through it in frustration. The letter was lying there on the desk, taunting him, and he crumpled it up and hurled it at the bin. It missed, and he picked it up, crushing it tighter in his fist.

Why? Why now, of all times, when he’d begun to feel there might be a chance…?

There was a tap on the door and old Doris Trefussis popped her head round and came in with a smile.

‘Cup of tea for you, Dr T., before you start,’ she said brightly, ‘and a couple of Hazel’s fairings. I saved them for you.’

‘Thank you, Doris,’ he said tightly, and held his breath until she’d shut the door. The last thing he could do was eat, it would choke him, but there was no way he could tell Doris that. She’d kill him if he didn’t eat Hazel’s biscuits, he thought, dropping down into his chair and dragging his hands over his face before flattening out the crumpled page and reading the letter again.

It didn’t make any more sense the second time. Or the third.

Maybe the tea would help.

He cradled the mug in his hand and stared blankly out of the window. It was slack water, the boats in the harbour swinging every which way in the squalling wind. He knew the feeling. He’d been swinging at anchor himself ever since Annabel had died five years ago, unsure of what the future held, of which way the tide would turn.

For a time he’d thought Kate was getting married, but then he’d heard on the grapevine that it was over now, and with Rob out of the way, he’d thought that maybe now, with both of them widowed—but then this, out of the blue. He’d never expected this. Never expected that she’d go…

She couldn’t leave. She couldn’t. She’d lived in Penhally for ever, her entire life. He’d known her since she was twelve, dated her when she was fifteen and he was seventeen, left her at eighteen to go to university, intending to come back for her—but then he’d met Annabel, and everything had changed.

Except Kate. She’d stayed the same—sweet, funny, kind—but those soft brown eyes had held reproach and disappointment ever since. Or maybe he’d imagined it, but all he knew was that every time she looked at him, he felt guilt.

He shut his eyes and sighed. God knows, there was enough to feel guilty about in the past thirty-odd years.

He folded the crumpled letter and put it in his pocket. He could go round there this evening, see if there wasn’t a way he could convince her to stay—but there was no point, he thought grimly. She’d made up her mind, and maybe it really was for the best.

He’d miss them both, but especially Kate—Kate he’d depended on for her kindness and common sense when he’d been in turmoil, Kate who’d managed the practice for years before she’d returned to midwifery and become a firm favourite with the mums.

Kate he’d loved, all those years ago.

Had loved, and lost, because of his own stupid fault. His chest felt tight just thinking about it, and he stared out of the window again, trying to imagine the practice without her. His life, without her. She couldn’t go. He couldn’t let her.

There’s nothing here for me any more.

Particularly not an emotionally bankrupt old fool like him. He had no choice but to let her go. No power to do anything else. The least he could do was do it with dignity.

He pushed the tea aside, strode to the door and yanked it open. ‘Mr Pengelly, would you come in, please?’

He tried to concentrate, tried to give the man his attention while he described his symptoms, but the letter was burning a hole in his pocket and judging by the feel of it the acid was doing the same thing to his stomach.

‘Sump’n’s goin’ on out there,’ Mr Pengelly said, jerking his head at the window.

‘Hmm?’ Nick dragged his mind back into the room and listened, and then he heard it over the rain and his clamouring thoughts. The sirens wailing, the rapid footsteps as Oliver Fawkner ran to his car outside Nick’s window and shot off up the road. He was on call today, acting as First Responder in the event of a serious accident as part of those duties, and he’d obviously been called out to the emergency.

‘The sirens,’ Mr Pengelly said unnecessarily.

‘Yes,’ Nick said, blanking it out of his mind as he examined him, weighed him, checked his blood pressure, listened to his chest. He was a heart attack waiting to happen, and if he had one, it wouldn’t be Nick’s fault. He’d given him sage advice for years, and it was time to lay it on the line.

More sirens. It was a big one, he thought, and eyed his patient firmly. ‘Right, Mr Pengelly, I think we need to have another look at your lifestyle. You’re overweight, you’re unfit, you don’t take your drugs regularly, and then you come in and tell me you have chest pain, but you don’t seem to be prepared to do anything about it and if you go on like this you’ll kill yourself. We need to check your cholesterol level again. It was high last time, and you’re still smoking, aren’t you?’

‘Ah, but I’ve cut down, Doc’

‘To what?’

He hesitated, then under Nick’s uncompromising stare he sighed and came clean. ‘Only twenty a day now.’

Only? ‘That’s twenty too many. Make an appointment on your way out for a fasting cholesterol test first thing one morning, as soon as possible, and then we’ll review it, but you need to start exercising and attend the stop smoking clinic—’

‘Must be a big’un. There’s the chopper coming now,’ he said, gesturing at the window again, just as the phone rang, and Nick frowned and reached for it, irritated that the man didn’t seem to be paying any attention.

‘Excuse me a moment—Tremayne.’

‘It’s Sue. I’m sorry to disturb you, but Oliver rang. Kate’s had an accident, and they’re airlifting Jem to hospital. He said you’d better get over to St Piran’s.’

He felt the blood drain from his head, and sucked in a breath. ‘What’s wrong—? How bad is he—is he—?’

‘Head and pelvis, he said, but he was quite insistent that you should go, Nick. Kate’s going to need you. And he said to tell her not to worry about the dog, he’ll sort it.’

The dog? He mumbled something and cradled the phone with a clatter. ‘Um—Mr Pengelly, I have to go. I’m sorry. Make the appointment, if you wouldn’t mind, and we’ll talk again when we get the results.’

‘So—do you want those biscuits?’

The man was a lost cause. ‘Help yourself,’ he growled, and got to his feet and went out to Reception, his legs moving automatically. ‘Right, Mr Pengelly needs a fasting cholesterol ASAP with a follow-up appointment,’ he told Sue. ‘I’m going to St Piran’s—can you get Sam to cover my surgery for me?’

And without waiting for her reply, without even pausing to pick up his coat, he strode briskly out of the doors into the lashing rain.

The drive to St Piran nearly killed him.

His stomach was in knots, adrenaline pouring through his veins, and with no one to distract him his thoughts were free to run over all the things that could be wrong, and all the things that could go wrong as a consequence.

The list was hideous, and just thinking it all through made him want to retch.

He called Ben’s mobile from his hands-free. His son-in-law would be there today, in A and E, and he’d give him advance warning. He drummed his fingers on the steering-wheel, waiting impatiently for Ben to answer, and when he did, Ben got there before he did.

‘It’s OK, Nick, we’re on it. I can hear the helicopter now, we’re going out to meet it. Just drive carefully and meet us in Resus. I’ll get someone to look out for you.’

‘OK. Ben—check Kate over, could you? Or get someone to? She was in the car with Jem and I don’t know if she’s hurt. And tell her I’m coming.’

‘Sure. Got to go. See you soon.’

The phone went dead, and he sliced through the traffic and in through the hospital gates, abandoned the car on the kerb and ran in. It would probably be clamped but he’d worry about that later.

He was met at the door and ushered straight through to Resus, and as the door swung open he froze for a second. He was assailed by memories, his emotions suddenly in turmoil. He couldn’t do this. Not here, not this room, of all the places.

He had to. On autopilot, he looked around at a scene of organised chaos, Ben snapping out orders and the team anticipating him like a well-oiled machine. A machine that held the boy’s life in its hands?

The same machine—and the same man—that had held Annabel’s—and lost it?

Dear God.

They were cutting Jem’s clothes off, slicing through the sodden fabric, peeling it away so they could get a proper look at him, talking reassuringly to him all the time, and it could have been any of his boys lying there, all skinny limbs and ribcage with only the pelvic binder left to hold his pelvis stable.

Don’t let him die. Please, God, don’t let him die…

‘OK, let’s cross-match for ten units and get five units of O-neg to start with, and some packed cells, and let’s get some X-rays—a full trauma series, starting with head, spine and pelvis. What about pain relief?’ Ben asked. ‘What’s he had already?’

‘Three milligrams of morphine IV, but his blood pressure’s dropping. Want to try—?’

The voices washed around Nick, only two things really registering. One was the bruised little face scarcely visible under the mask, most of Jem’s head concealed by the padding of the neck brace; the other was Kate, sodden and bedraggled, standing a few feet away watching as they worked on her little son, her eyes wide with fear, her lips moving soundlessly.

Praying?

Probably. There was little else to do. He crossed over to her, and she gripped his hand and gave a tiny sob.

He squeezed back. He wanted to hug her, to say, ‘It’s OK, it’s going to be all right,’ but he wasn’t sure it was, wasn’t sure she’d want him to hold her, wasn’t sure she’d believe him—and anyway his tongue was glued to the roof of his mouth.

He freed it with effort and concentrated on the facts. ‘Have you done a FAST exam?’ he asked, sticking to something safe, and Ben shook his head.

‘No, we’re just about to.’

‘Fast?’ Kate murmured.

‘Ultrasound, basically,’ Ben said. ‘It might show what’s going on.’

Such as free fluid in the abdomen. Blood, most particularly, from torn arteries, sheered bone ends…

Nick felt the bile welling again, and dragged his free hand over his face.

The radiographer was setting up the X-ray machine as Ben quickly ran the head of the ultrasound wand over Jeremiah’s thin, slightly distended abdomen, and Nick watched the screen, wincing at the image. Free fluid. Lots of it. Damn.

They were handed lead aprons. Ben must have realised they wouldn’t leave, and as the X-rays appeared on the computer screen a few moments later, Nick sucked in a breath.

Even across the room, he could see the fractures on the left side of Jeremiah’s pelvis, the bony ends displaced, the damage they’d caused all too easily imaginable.

‘OK, this needs fixation before he goes anywhere,’ Ben was saying. ‘Are the orthos free?’

‘No. They’re just finishing off so they’re ready for him,’ the charge nurse said. ‘Want me to get Josh?’

‘Please—and fast-bleep the anaesthetist, we need to get on with this.’

‘Who’s Josh?’ Kate asked, her face white.

‘New guy,’ Ben said. ‘He’s good—don’t worry, I’ve known him for years. He’s done a lot of this—he’s a bit of a trauma specialist. But we need to get this pelvis rigid before we move Jem and he needs to go straight up to Theatre if we can’t stop the bleeding here. You need to sign a consent form for that. Why don’t you do that and then get a cup of tea—?’

‘His pressure’s dropping.’

Ben frowned and bent over the boy. ‘OK, Jem, stay with us, come on, you’re doing really well. Let’s give him a 250-mil bolus of O-neg and we’ll see if he stabilises. Kate, I don’t suppose you know his blood group, do you?’

She shook her head, her face terrified. ‘No. No idea. I’m O-positive, if that helps.’

‘Cross-match results are up,’ someone said. ‘He’s B-negative.’

B-negative? Through the roaring in his head, Nick heard Ben sigh harshly. ‘Damn. We used all our stock this morning. I don’t know if it’s been replaced yet.’ Ben’s eyes flicked questioningly to Nick’s, and he swallowed.

‘I’m B-negative,’ he confirmed, the last traces of doubt obliterated from his mind with this one small fact. ‘So’s Jack. We’re both regular donors.’

Ben didn’t miss a beat. ‘OK. Nick, contact Jack and ask him if he’s able to donate today, then we’ll get Haematology to sort it. That’ll give us two units, and we’ll salvage his own in Theatre and recycle it and give it back to him, and we can use O-neg if necessary until we get more, but if we get the ex-fix on, the bleeding may well stop anyway.’

Or it might not. ‘You can take two units from me,’ Nick said, and he saw Kate turn towards him, heard the hitch in her breath as she waited for what he was going to say. Not that. Not out loud, but he met his son-in-law’s eyes squarely, and Ben gave a brief, imperceptible nod of understanding.

A door flapped shut behind him, and Nick turned and looked straight into Jack’s eyes.

‘Kate, Dad—hi. What’s going on?’ he asked. ‘I was out in cubicles—they said Jem was in here.’

‘He is,’ Nick said, and Jack looked at the X-rays, winced and glanced down at the child on the trolley.

‘Hell,’ he said softly. ‘Poor little chap. What’s the damage?’ he asked Ben.

‘Pelvis, for sure, and maybe abdominal and head injuries. We were about to contact you,’ Ben told him. ‘We’re short of B-negative. Have you given blood recently?’

‘Um—about three months ago? No—just before Christmas, so nearly four.’ Jack sighed harshly and glanced at the clock. ‘I’ve got a meeting I should be at and I’m already late. Can you call me if you definitely need me?’

‘We definitely need you,’ Nick said, his voice deliberately low so that only Jack could hear. ‘He’s your brother, Jack,’ he added, and watched the disbelief like a shockwave on his firstborn son’s face.

‘Jeremiah? Kate’s son? He’s—?’

‘My son,’ Nick said softly, voicing the words in public for the first time, and beside him he felt Kate squeeze his hand. His words hung in the air between them for a moment, and Jack’s face was suddenly expressionless.

‘Well, we’d better roll our sleeves up, then, hadn’t we?’ he said after a long pause, and Nick let out his breath on a shuddering little sigh.

‘Thanks,’ he said, but Jack turned to him, his blue eyes like chips of ice.

‘Don’t thank me,’ he said, his voice deadly quiet. ‘I’m not doing it for you.’ He turned back to Ben. ‘Give me five minutes. I just want to make a couple of calls.’

‘That’s fine, we’re using O-neg for now. You’ve got a little while. We’ll save cross-matched blood until he’s stable.’

He nodded curtly and walked out, slapping the door out of the way with his hand, and Nick closed his eyes and swallowed. He’d known it would come out at some time, he’d known it would be hard, but like this, with Jeremiah’s life hanging in the balance—

‘OK, what have we got?’ a new voice asked, and a man strode in, a man they’d never seen before, with a soft, lilting Irish brogue and that dangerous blend of rakish charm and lethal good looks that would leave trouble in his wake.

Nick knew all about that. He’d been like that in his youth; it had gone to his head, and look where it had got him. He almost felt sorry for Josh O’Hara, the new A and E consultant, but maybe this man wouldn’t make the same mistakes he had. He’d have to try hard to do worse.

He was bending over Jeremiah now, smiling at him. ‘Hello, Jem, I’m Josh. I’m just going to have a quick look at your X-rays, and then we’re going to send you to sleep and fix you, OK? That’ll take away a lot of the pain for when you wake up.’

Jem made a feeble sound of assent, and beside him Nick heard Kate give a little sob.

Nick tightened his grip on her fingers. ‘It’s all right,’ he said, reassuring himself as much as her. ‘He’ll be all right,’ he repeated, and hoped to God it wasn’t a lie.

Josh looked up and met their eyes. ‘Are you the parents?’

They nodded, the irony of it striking Nick like a hammer blow. Of all the ways—

‘OK. You need to sign a consent form, and then I think someone needs to take you to the relatives’ room and give you a cup of tea.’

‘I don’t want a cup of tea, I want to be here with my son!’ Kate said adamantly. ‘I’m a midwife, you don’t need to mollycoddle me.’

‘We don’t need to scrape you off the floor, either, and it’s a sterile procedure. You can stay till he’s out, then you go.’

Nick put an arm round her rigid shoulders, squeezing them gently. ‘He’s right,’ he said, fighting his instinct to argue, to stay. ‘You shouldn’t be here. Not for that. And someone needs to take a look at you.’

‘I’m fine.’

‘We don’t know that. Nick’s right, you need your neck checked, Kate,’ Ben said gently, lifting his head to meet her eyes. ‘And your feet. I gather they were trapped. Let us sort Jem out, and then while he’s in Theatre I’ll come and have a look at you, hmm? And in the meantime, go and have something hot to drink, and some biscuits or something. You’re in shock.’

She’d signed the form by the time the anaesthetist arrived a minute later, and Kate clung to her son’s hand, pressing it to her heart and murmuring softly to him as he drifted off, then Nick ushered her away, leading her out of the room and down the corridor to the relatives’ room, his reluctant feet tracing the familiar path.

‘You can wait in here—I’ll bring you both some tea,’ a nurse said with a kind smile. ‘How do you take it?’

‘Hot and sweet, isn’t it?’ Kate said shakily, trying to smile back, but Nick couldn’t say anything, because the last time he’d been in this room had been in the horrendous minutes after Annabel had died, almost exactly five years ago.

It came flooding back the shock, the horror, the guilt. He should have realised she was ill, should have done something, but he’d been so tied up in the practice he’d scarcely noticed she was alive. And then, suddenly, she wasn’t. She’d had a ruptured appendix, and Ben hadn’t been able to save her.

And yet again the guilt and the senseless futility of it threatened to swamp him.