Her Firefighter Under the Mistletoe

The terrifying prospect of being marooned on a roof with the floors beneath you alight.

The palpable terror of the students around you.

The look on the faces of the fire crew when they realised you were out of reach and they had to stand by and wait, helpless, until other crew and equipment arrived.

‘Callum?’

‘What? Oh, yes, sorry. Let’s just say it made me appreciate the engineering work involved in the fire service’s equipment. I joined when I finished university. It didn’t take me long to find my calling at the rope rescue unit. I still do some other regular firefighting duties, but most of the time I’m with the rescue unit.’ He wanted to change the subject. He didn’t want her to ask any questions about the fire. ‘What about you? Are you married with four kids by now?’

It was meant to be simple. A distraction technique. A simple change of subject, taking the emphasis off him and putting it back on to her.

But as soon as the words left his mouth he knew he’d said the wrong thing. The stiffness and tension in her muscles was automatic.

They were nearing the edge of the incline and he could see movement above them. the flurry of activity as the stretchers were pulled over the edge and the paramedics and technicians started dealing with the children.

‘Things just didn’t work out for me.’

Quiet words, almost whispered.

He was stunned into silence.

There was obviously much more to it than that but now was hardly the time or the place.

And who was he to be asking?

He hadn’t seen Jessica in thirteen years. Was it any of his business what had happened to her?

The radio on his shoulder crackled into life. ‘We’ve got the last two kids. Minor injuries—nothing significant. There’s an ambulance on standby that will take them to be checked over.’

‘Are all the ambulances heading to Parkhill?’ She sounded anxious.

He lifted the radio to his mouth. ‘Wait and I’ll check. Control—are all paediatric patients being taken to Park-hill?’

There was a buzz, some further crackles, then a disjointed voice. ‘Four classified as majors, eight as minors. Two majors and six minors already en route. The adults have gone to Glasgow Cross.’

‘Give me your hand!’ A large arm reached over the edge and grabbed Jessica’s wrist, pulling them topside. Someone unclipped their harnesses and tethers, leaving them free of each other.

‘Doc, you’re requested in one of the ambulances.’

Jess never even turned back, just started running towards the nearest ambulance, where one of the hypothermic kids was being loaded.

Callum watched her immediately fall back into professional mode.

‘Scoop and run,’ she shouted. ‘Get that other ambulance on the move and someone get me a line to Parkhill. I want them to be set up for our arrival.’

Callum looked around him. The major incident report was going to be a nightmare. It would probably take up the next week of his life.

He grabbed hold of the guy next to him. ‘Any other problems?’

The guy shook his head. ‘Just waiting to lock and load the last two kids. The clean-up here will take hours.’

Callum nodded. ‘In that case, I’m going to Parkhill with the ambulances. I want to find out how all these kids do. I’ll be back in a few hours.’

He jumped into the back of one of the other ambulances, where the paramedic and nurse were treating the other hypothermic kid. ‘Can I hitch a ride?’ He glanced at the nurse, who was balanced on one leg. ‘Did you hurt yourself?’

The paramedic nodded.

‘Ride up front with the technician. We’re going to be busy back here.’

The nurse grimaced, looking down at her leg. ‘I’m sure it’s nothing. Let’s just get these kids back to Parkhill.’

Callum jumped back down and closed the doors, sliding into the passenger seat at the front. Within seconds the ambulance had taken off, sirens blaring. Great, the paediatrician had ended up in the Clyde and the nurse had injured her ankle. The major incident report was getting longer by the second.

It wouldn’t take long to get through the city traffic at this time. He pulled his notebook from his top pocket. It was sodden. Useless, soaked when the minibus had tipped and he’d landed in the water.

‘Got anything I can write on?’

The technician nodded, his eyes never leaving the road, and gestured his head towards the glove box, where Callum found a variety of notebooks and pens.

‘Perfect. Thanks.’ He started scribbling furiously. It was essential he put down as much as could for the incident report, before it became muddled in his brain.

The number of staff in attendance. The number of victims. The decision to call out the medical crew. Jessica. The descent down the incline. The temperature and depth of the water. Jessica being called onto the minibus. His first impression of the casualties. The way the casualties had been prioritised. The fact that Jessica had landed in the water.

The feeling in his chest when she’d disappeared under the water.

He laid the notebook and pen down in his lap.

This was no use.

He wasn’t thinking the way he usually did. Calmly. Methodically.

He just couldn’t get her out of his head.

It seemed that after thirteen years of immunity Jessica had reclaimed her place—straight back under his skin.

CHAPTER THREE

THE AMBULANCE DOORS were flung open and Jess heaved a sigh of relief. Her team was ready and waiting.

The A and E department would be swamped. There were twelve kids with a variety of injuries to look after, as well as all the normal walking wounded patients and GP emergency admissions that would have turned up today.

Everyone would be on edge. The place would be going like a fair.

Her team sprang into action immediately as she jumped down from the ambulance.

‘Is the resus room set up for these two kids?’

‘All prepared, Dr Rae. Fluids heating as we speak. Harry Shaw, the anaesthetist, and Blake Connor, the registrar, will help you run these kids simultaneously. You’re drookit, Jess. Wanna get changed?’

A set of scrub trousers were thrust into her hands and she gave a little smile. Her team had thought of everything.

Harry appeared at her side. ‘I take it it was freezing out there?’

‘Baltic.’ The one-word answer told him everything he needed to know.

The second ambulance arrived and both kids were wheeled into the resus room and transferred to the trolleys. Jess ducked behind a curtain and shucked off her soggy jumpsuit, replacing it the with the dry scrub trousers. If only her underwear wasn’t still sodden.

Her team was on autopilot, stripping the freezing-wet clothing from both kids and bundling them up in warming blankets.

She walked out from behind the curtains. Harry Shaw was standing at the head of one of the trolleys, doing his initial assessment. ‘What can you tell me?’

She looked up as Callum appeared at the doorway and handed her a sheet of paper. ‘Thought this might be useful,’ he said as he walked away.

She stared at what he’d scribbled for her. Temperature of the Clyde is currently minus five degrees centigrade. Moving water takes longer to freeze.

It was just what she needed. The temperature to which these kids had been exposed was very important.

She walked over to Harry. ‘This is Marcus, he’s four. He was unconscious at the scene but I can’t find any obvious sign of injury. Showing severe signs of hypothermia. As far as I know, his head was always above the water, but we couldn’t get the tympanic thermometer to register on-site.’

Harry nodded. ‘I need baseline temps on both these kids. Has to be a core temperature, so oesophageal temperatures would be best.’

More paperwork appeared in her hand from the receptionist. ‘Nursery just called with some more details.’

Her eyes scanned the page and she let out a little sigh. ‘This is Lily. She’s four too. She was submerged at the scene—but no one can be sure how long.’

Harry was one of the most experienced paediatric anaesthetists that she knew. He’d already realised that Lily was the priority and left Connor to take over with Marcus. He was already sliding an ET tube into place for Lily. He took a few seconds to check her temperature. Both cardiac monitors were switched on and the team stood silently to watch them flicker to life.

Jessica’s heart thumped in her chest. What happened in the next few minutes would determine whether these kids made it or not.

‘Marcus’s temp is thirty degrees. Moderate hypothermia,’ shouted Connor.

She watched the monitor for a few more seconds. ‘He’s bradycardic but his cardiac rhythm appears stable. Any problems with his breathing?’

Connor shook his head. ‘He’s maintaining his airway. His breathing’s just slowed along with his heart rate.’

Jessica’s brain was racing. She was the paediatric consultant. This was her lead. But Harry was an extremely experienced anaesthetist. She wanted to be sure they were on the same page.

She turned to him. ‘Warmed, humidified oxygen, contact rewarming with a warming unit, rewarmed IV fluids and temperature monitoring. Do you agree?’

He gave her a little smile over the top of his glasses. ‘Sounds like a plan. I’ve paged one of my other anaesthetists to come down.’ The nursing staff started to flurry around them, carrying out the instructions. Jessica felt nervous.

Hypothermia was more common in elderly patients than in children. Every year they had a few cases come through the doors of A and E, but she wasn’t always on duty. And most of those kids were near-drownings—kids who’d been playing on frozen rivers or lakes and had slipped under the water.

Blake Connor, her registrar, looked up from Marcus’s arm. ‘I’ve got the bloods.’ He rattled off a whole host of tests he planned to run. ‘Anything else?’

She shook her head. ‘Right now, we’re working on the assumption that he’s unconscious due to his hypothermia. There’s no sign of any head injury or further trauma. Keep a careful eye on him. I want to know as soon he regains consciousness. He’ll probably be disorientated and confused. Most adults with a temperature at this stage start undressing. We might need to sedate him if he becomes agitated.’ She scribbled in the notes then spoke to the nursing staff.

‘We’re aiming for a temperature gain of around one degree every fifteen minutes. Keep an eye on his blood pressure and watch for any atrial fibrillation. Is that clear?’

The nursing staff nodded and she looked around. ‘Anyone seen Jackie? She was the one who brought Lily in. I need some more information.’

One of the paramedics touched her arm. ‘She fell, coming back up the slope. We think she might have fractured her ankle. Once we’d dropped Lily here my technician took her along to Glasgow Cross.’

Jess felt a twinge of guilt. It was her fault Jackie had been on the scene. She’d wanted the expertise of the experienced nurse at the site. Now, because of her, Jackie was injured. It didn’t seem fair.

‘Lily’s temperature is lower than Marcus’s. It’s twenty-eight degrees.’ Harry had just finished sliding the oesophageal temperature monitor into place. He glanced at the monitor. ‘She’s borderline, Jess. What do you want to do?’

Jess pulled back the warming blankets to get a better look at her small body. Lily was right on the edge, hovering between severe and moderate hypothermia. It was a wonder she hadn’t gone into cardiac arrest.

‘How’s her respiratory effort?’

Harry was sounding her chest. ‘For a child who was submerged I’m not hearing any fluid in her lungs. Just a few crackles. She is breathing, but not enough to keep me happy.’

‘Wait a minute, folks.’ Jess held her hand up as the monitor flickered, going from a stable but slow heart rate to a run of ectopic beats. She shook her head.

Time was of the essence here. She needed to make a decision.

Lily was deathly pale. All her surface blood vessels had contracted as her little body was focusing its resources on keeping her vital organs warm.

Her lips and ears were tinged with blue, showing lack of oxygen perfusing through her body.

Her eyes fell on Lily’s fingers and toes. Their colour was poor.

No. Their colour was worse than poor.

The blueness was worse.

The tinkle of the monitor indicated Lily had gone into cardiac arrest. Jessica leaned across the bed and automatically started cardiac massage with the heel of one hand.

It clarified things and made the decision easier.

‘Harry, we’re not going to wait. Call the team. Let’s get her to Theatre and begin extracorporeal rewarming. Can you phone ahead? Let them know we are resuscitating.’

One of the nurses nodded and picked up the phone in the resus room. ‘Paediatric ECMO in Theatre ASAP. Yes, it’s one of the minibus victims. Four-year-old female, submerged, with a core temperature of twenty-eight degrees. She’s arrested and currently being resuscitated. Dr Shaw has her intubated and they’ll be bringing her along now.’ She replaced the receiver. ‘Theatre one will be waiting for you.’

A wave of relief washed over Jessica. There was no drama. No struggling to find theatre time. It sounded as though the theatre staff was already prepared for the possibility of one of the hypothermic kids needing ECMO.

Extracorporeal membrane oxygenation worked with cardiopulmonary bypass to take over the function of the heart and provide extracorporeal circulation of the blood where it could be rewarmed and oxygenated. It had only been used in a few cases of hypothermia with cardiac arrest in the last few years, but had had extremely positive results with good outcomes for patients.

Lily was going to be one of those patients.

Jessica was absolutely determined.

Two porters appeared at either side of the trolley, ready for the move.

As they swept down the corridor towards the lifts she caught sight of Callum again, taking notes and talking to one of the nurses. He was still here?

She hadn’t had a chance to think about him. She had been too busy concentrating her energies on keeping this little girl alive. She could feel the cold flesh under her hand as she pumped methodically, trying to push blood around Lily’s body. Trying to get some oxygen circulating to her body and brain.

This was somebody’s child. Somebody’s pride and joy.

Their reason to get up in the morning and their reason to go home at night.

Any minute now some poor, frantic man and woman would turn up in A and E anxious to get news of their daughter.

Praying and pleading to hear the best possible news. Trying not to think about the pictures their brains had been conjuring up ever since they’d heard about the minibus crash. Struggling to remember to breathe as they made the journey to the hospital.

A journey that probably seemed to take twice as long as it normally did.

Their ‘normal’ day had changed beyond all recognition. Had they kissed their daughter goodbye that morning before they’d dropped her at nursery? At the place they’d assumed she would be safe?

Had they spent a few brief seconds taking her in their arms and feeling the warmth and joy of cuddling a child before they’d left her that morning? Or had they given her the briefest kiss on the top of her head because they had been in a rush to get to work? Because they hadn’t realised it could be the last time they kissed their child.

Would they spend the rest of their lives regretting signing a consent form to say their daughter could go on the nursery trip? The one that could have cost her life?

All these thoughts were crowding her brain. Any time she had to resuscitate a child she was invaded with what-ifs?

But the what-ifs were about her own life. She’d spent the last three years thinking about the what-ifs.

What if she’d been driving the car that night?

What if she hadn’t been on call?

What if her husband hadn’t stopped to buy her favourite chocolate on the way home?

The lift doors pinged and they swept the trolley out. She lifted her head. The theatre doors were open and waiting for them.

One of the perfusionists was standing by, already scrubbing at the sinks, preparing to insert the catheter lines that could save Lily’s life.

This was why she did this job.

This was why after a year of darkness she hadn’t walked away. She might not have been able to save her own child but she would do her damnedest to save this one.

Callum stared at his watch. It had been six hours since he’d last seen Jessica sweeping down the corridor, her thin scrub trousers clinging to her wet backside, her hand pumping the little girl’s chest.

He’d felt physically sick at that sight.

Not because he wasn’t used to dealing with casualties. Casualties of all ages and all descriptions were part and parcel of the job.

But seeing the expression on Jessica’s face wasn’t.

Everything about this situation was having the strangest effect on him. The sight of Jessica hadn’t just been unexpected—it had been like a bolt out of the blue.

They’d been childhood sweethearts who’d broken up when life had moved on and they’d never moved in the same circles again. He hadn’t even heard anything about Jessica over the last few years.

Her words on the steep embankment had intrigued him.

Things just didn’t work out for me.

It made his brain buzz. There was a whole world of possibilities in those words. But he didn’t feel as if he could come right out and ask.

Particularly when the sick kids were the priority.

And his lasting memories right now were the way her body had felt next to his. The way they’d seemed to fit together so well again—just like they always had.

It was the first time in a long time that he’d felt a connection to a woman.

The first time in a long time he’d ever wanted to feel a connection to a woman.

Sure, he’d dated on a few rare occasions, but nothing had been serious. He’d never introduced anyone to Drew. It was almost as if he didn’t want to let anyone into that part of his life.

Would he ever feel ready to change that?

The doors opened at the end of the corridor and Jessica walked through. She looked absolutely exhausted. There were black circles under her eyes and her skin was even paler than it had been earlier.

He was on his feet in an instant. ‘Jess? How did it go?’

She reached out to touch his arm, her brown eyes fixed on his. ‘The next few hours will be crucial. We’ve done everything we can. Lily’s temperature is coming up gradually. Now it’s just wait and see. I’ve just spoken to her parents.’ Was that a tear in Jess’s eye?

It was there—written all across her face—how much those words pained her. How much she hated it that things were out of her control. The only thing left to do was wait.

She flicked her head from side to side. ‘I need to get a report on all of the other kids. I need to find out how they are all doing.’

‘No.’ He rested his hand on her shoulder. ‘You need to take a break. Come and sit down. Have a coffee, have something to eat. You must be running on empty, you know that can’t be good for you.’

He could see the struggle in her eyes. ‘I just can’t, Callum. There were twelve kids in that accident. I’m the consultant on call. They’re my responsibility.’

Callum glanced at the notes in his hand. ‘Four have already been discharged. Another four have been admitted to the paediatric unit with mild hypothermia, a head injury, and some bumps and scrapes.’

Her eyes widened. ‘How do you know all that?’

He gave her a little smile. ‘It’s part of the investigation after any major incident for the rope rescue crew. I always need to find out the outcomes for the victims. We need to look over everything that we did to make sure there were no mistakes.’

‘And were there?’

He frowned. ‘Apart from our doctor ending up in the Clyde? And your nurse fracturing her ankle?’

A little smile danced across her weary face. ‘I don’t think you have much control over tides and currents—no matter how much you want to. And Jackie? That’s my responsibility. It was me who asked her to come on the rescue.’

He shook his head. He hadn’t been able to shake the picture from his mind of Jessica falling into the icy river. It had made him feel sick to his stomach and would have to form part of his investigation.

‘It’s my job to make sure everyone is safe at the rescue site. It’s my responsibility, not yours.’

Her shoulders relaxed a little. This was probably the first normal conversation she’d had all day. ‘Do you want to fight me for it?’

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