The Fatal Favour
Accident and Emergency was as busy as usual.
Weston dodged nurses and gurneys as he made his way through the corridors. A hundred urgent conversations filled his mind. He, however, focused on the light at the end of the corridor. The ambulance bay.
To get the best cases, he ran, and that was how a student doctor like Weston McCarthy excelled. The crisp breeze stung as he pushed his way outside to meet the incoming emergency.
The ambulance door opened, and the white noise ceased.
‘I have a twenty-three-year-old male. His temperature is thirty-eight degrees, and his blood pressure is eighty over ninety. He’s conscious but not aware, and he’s been on twenty-four per cent oxygen for fifteen minutes. We administered pain relief, ten cc’s codeine, and his breathing has eased, but he’s not in a good way,’ said the paramedic.
‘Chart,’ said Weston, and he snatched the chart from the paramedic’s hand, and began reading the untidy scribbles on the page.
The paramedics pulled the gurney from the ambulance. On the bed was a man with a mass of dark hair. His eyes had a far off look, and his breathing was ragged. If this was an improvement to his earlier state, Weston dreaded to think how bad his condition had been before.
The ambulance door slammed, and Weston looked up.
He saw her—a flash of green eyes and red hair. Eva Griffin. The paramedics faded to the background giving way to her.
He remembered the last time he had seen her.
Her bloodshot eyes wouldn’t meet his. She clenched her jaw and pulled at the loose threads on the cuffs of her cardigan.
‘You didn’t think to tell me?’ she asked. ‘We go to uni next week, Steve. I’ve been looking at flats, and I’ve booked viewings!’
Weston glared past her at him. Liam Rogers, his former best friend.
‘Don’t look at him. At least he told me. If he hadn’t, I would have been screwed.’
‘It wasn’t for him to tell. He had no idea what I was going to do… I might have gone to Manchester with you… I didn’t know yet.’
‘Of course, you knew.’ Eva strode over to Weston, pushing him as if to punctuate the words. ‘You were always going to accept Oxford. That’s why you never told me that you got in.’
Weston grabbed her by the shoulders, pulling her towards him. ‘I didn’t know what to do. I didn’t want to lose you. I love you.’
Eve pulled herself out of his arms. ‘The thing is, Weston, if you had told me the truth, you wouldn’t have lost me.’ She turned around and walked away. Rogers followed.
Weston felt that same pain now as he watched tears spill over Eva’s flushed cheeks.
‘You haven’t noted down how he presented originally.’ Weston forcibly returned his focus to the paramedic—the one that could give him the information he needed to make it all better for her.
‘His was breathing was short and erratic. He’s very confused, persistently coughing up blood. He’s running a fever—it’s getting higher—and his wife has said he’s been vomiting as well.’
He glared down at the patient. It was Rogers.
She married him?
He bit his tongue as his eyes looked past the scrawled notes on the chart and into the past. Rogers had smirked some seven years ago after he had single-handedly ruined Eva and Weston’s future.
Weston nodded sharply, pushing the gurney through the A&E doors. He rushed towards the nearest empty bay, nurses and trauma staff hurrying in after him. Having always excelled at taking charge, he began connecting the man to various monitors and barking instructions. Rogers’ breathing was still erratic, and Weston’s face darkened.
Eve had followed, lingering just outside the bay. Vaguely Weston noticed her reading his expression, but he continued to work at speed.
‘He’s going into respiratory depression. You haven’t noted medications he took before your arrival either,’ said Weston.
‘W-we didn’t check,’ said the paramedic, red creeping into his face. ‘He was in agony. We had to give him something.’
Weston’s tone softened. ‘Eva?’
‘I wrote it all down. He’s been on a bunch of different over-the-counter stuff, but nothing helped.’ Her voice was breaking, and her nose scrunched, a symptom he had long known as a precursor to tears. She was coming apart at the seams.
‘Thank you.’ He looked down at the patient, already checking his airway. It wasn’t good. ‘I need an intubation kit. 8.0mm tube, now!’
Within moments he was at the top of the bed, tilting the man’s head back to see his airway clearly. Eva was gently moved aside by a nurse.
His favoured nurse, Poppy, passed one within seconds. His eyes focused on the patient’s passageway. Weston held the patient’s head and slid the scope to the right side of the man’s mouth. He held the tongue to one side as the scope glided down the patient’s throat.
He guided the tube down his throat, and it became stuck just past his uvula. Weston frowned.
‘Damn it. 7.0mm, now!’
The tube slipped in with ease this time. He removed the scope, ensuring the pilot balloon was inflated and attached it to the ventilator. He watched the patient’s chest. When it rose and fell, he sighed.
‘Admitted him to the ICU and monitor his vitals. I want a chest x-ray, a full blood panel, and fit a central line. We also need a catheter to monitor his urine output. Page me or Dr Webster if anything changes.’ He handed over the chart to his faithful Poppy. ‘Oh, and a urine test’.
‘Yes, and what will you be doing?’ Poppy questioned curtly.
‘I’ll be getting a full and detailed history.’ Weston glanced past Poppy to Eva, who stood watching everything from the waiting room.
‘You’re speaking to the family?’ Poppy asked, ‘You know how it went last time.’ Her voice went up an octave, pulling Weston’s attention from Eva to Poppy’s raised brow.
‘I-It’s not going to go like last time.’
‘As long as we have no more complaints, I’ll see it as growth.’
‘If I need help, I’ll ask for it.’ He walked past Poppy to where Eva stood, petrified.
His heart sank. He wanted nothing more than to spend the rest of the day talking to her, but not about him.
He walked over to Eva and placed a hand on her shoulder. ‘I think coffee is in order.’
They sat in a small room just off the ICU. The walls were painted a warm cream colour, and cushions and throws decorated the plush sofas. It was all in an effort to help families feel like their entire world wasn’t falling apart, which it invariably was.
Weston got the coffee, finding pleasure in making it just how she liked it. Watching her as she pulled at the already fraying threads of her thick cardigan, he felt somewhat guilty for enjoying the moment. She sat with her knees up, just beneath her chin, hiding behind a curtain of tangled red hair. Watching the intubation of a loved one did not inspire hope.
‘Here,’ he said, handing her the steaming cup, ‘milk, three sugars? Even though I feel obligated to educate you on the dangers of a high sugar diet.’ He stretched his lips in an attempt at smiling, but it had been too long, and he didn’t imagine the effect to be that comforting.
‘You remembered?’ Her lips upturned slightly—not much, but people rarely smiled here.
‘Of course,’ he said, his voice barely a whisper. ‘But, I-I need his medical history.’
He wasn’t used to this aspect of the job. His first choice would be to get the tests, leaving the questioning to Poppy.
‘What do you need to know?’ She stumbled over the words.
It was so unlike her. He recalled watching her debate furiously in their school days, and he knew that she had gone on to study journalism at the University of Manchester.
‘It’s okay, just answer the questions as best as you can. When did his symptoms start?’
‘A week ago. It was only a cough—the flu, I guess.’ She continued to decimate the cardigan, a habit he remembered from the last moments he had with her. She had been heartbroken, and it was all his fault.
‘Has he had pneumonia before?’
‘As a child, I think. He has a weak immune system, but it hasn’t been a problem since we married. Oh my god, I don’t even know the details!’ She started sobbing.
She wore her heart on her sleeve, and it made her helpless. All the signs were there for him, the inability to meet his eye, mumbling, the way her hands trembled as she continued to pull at the loose threads. She was still strong, though.
‘That’s okay. Is he on any medication or supplements?’
‘No, like I said, it’s not been a problem. We try to make sure we run a clean shop. We take germs and illnesses seriously, as I’m sure you can imagine.’
‘I can.’ He kept his eyes on the chart, his eyes flicking around the page of questions. ‘I’ll do my best, I promise.’
She smiled, but it was diluted by the tension that was still resting on her shoulders.
‘His symptoms, would you describe them as continuous or intermittent?’
‘Continuous, but they would occasionally get worse and then ease up. Does that make sense? Is that good or bad?’
‘Eva, relax.’ He waited, and she took deep, calming breaths. ‘It just gives me the information I need to make the correct diagnosis. Don’t think about the good or bad.’
She nodded, her face resolved as she wiped away the escaping tears.
‘Is there anything that helped to relieve the symptoms, made him feel better?’ He placed the chart on his lap, the pen poised and ready. Its tip trembled slightly in his unsteady hand.
She shook her head as she pulled out a thread of wool and fiddled with it between her fingers.
‘Has he travelled recently or been exposed to anything toxic? Chemicals, perhaps?’
Again she shook her head, and he nodded, taking her hand in his. It was awkward, his other hand still taking notes. ‘Okay, has he been around anyone who’s been ill?’
‘No. We have a baby—’
‘You have a child?’ His voice broke around the offending word. The pen in his hand stopped, and his other hand let go of hers.
‘Y-Yes. We do. Little Samual has been the picture of health, and Liam is very careful.’
Weston nodded, the pen still stationary. It took a moment for him to scrawl a quick note, but he left harsh indents on the chart, almost tearing the paper.
‘I understand. Can you tell me about alcohol consumption, smoking? What vaccines has he had?’
‘He’s an occasional drinker, but since Samual was born, it’s lessened. He’s never smoked, and he had all the usual vaccines—his parents were careful. I can get copies of his records.’
‘No, that’s fine.’ He paused, looking at her.
How could he explain what was wrong? He figured he should just come out and tell her everything he knew—anything to stop her worrying.
‘Eva, I think he has pneumonia, possibly with another infection. This wouldn’t usually be a problem for a man of his age, but Liam has a weak immune system. That’s why things have… escalated.
‘There are a variety of tests that we’ll do. Initially, I want to see him off a ventilator, and then we’ll find out which strain of bacteria caused the pneumonia. Once we have that, we’ll begin treatment.’
‘It’s definitely pneumonia?’ she asked.
‘Not definitely. That’s why we’ll do tests. Your husband has had a variety of medications, and they haven’t helped him. I don’t want to do anything other than improve his condition. That means we need proof it’s pneumonia.’ He squeezed her hand again.
‘He’ll be okay?’ Her lip trembled. ‘And then you can treat him. Penicillin for pneumonia, right?’
‘It depends on the strain, but I’ll do everything I can, I promise.’
That was when she lunged into his embrace, sobbing, and whispered a million thank you’s. He was there longer than Poppy ever had been known to spend with a family member.
The next morning, Weston scrambled into his scrubs. He saw the flash of a speed camera as he drove to work, but it didn’t bother him. He skipped his usual coffee and marched through the empty corridors to the ICU.
All the while, his head was in the chart, but he wasn’t thinking of Liam Rogers or the treatment. He was thinking of how to word his update for Eva. How could he give her the facts but not frighten her? How could he set her mind at ease?
He glanced at the chart and made his way to collect the x-rays, checking the tests he’d ordered the day before. His eyes flitted over Liam’ name, and he ground his teeth together. Anger had served him well since Liam had destroyed his future with Eva, and he focused on that now. It would not do well to feel concerned for the man, and it would make life after this that much harder.
Instead, he focused on the upcoming meeting with Webster. He was still a student and unable to take action alone. Smiling, he noted that much of what he had diagnosed had been proven correct by the results. She would expect a well thought out treatment plan, and it was the perfect distraction. Soon he was knocking at her door.
‘Come in,’ she called.
Dr Alice Webster was a shrewd, silver-haired woman. Her lips were constantly pursed, except with Weston, her self-professed “most gifted” student.
‘Alice, I have x-rays for Mr Rogers in bed two.’
She rose, switching on the viewing panel. He passed her the film, and they stood in silence for a moment.
‘So, what do you see, Weston?’
‘I’d say pneumonia, but there’s also a lot of fluid in the lungs.’
‘What would you do about that?’ she drilled.
‘Put in a chest tube, which could get him off the ventilator.’
‘Well, I want to confirm pneumonia. I’m waiting for the blood and urine tests to come back. I’ll order a CT to check for abscesses in the lungs.’
‘And what about the Sputum test?’
‘It’s to test the fluid taken from a deep cough, and at this point, I don’t know if he’ll even be conscious.’
‘Very good. What about the pleural fluid culture?’
‘Too invasive. He needs to improve before I start poking his lungs with a giant needle,’ he drawled.
‘How’s the family?’
Weston shrugged and looked away. ‘Fine.’
‘Poppy usually gets you more information than that, Weston.’
Looking down at the file, fiddling with the edges of the paper, he coughed. ‘Poppy didn’t speak to the family. I spoke to his wife, and’—he cleared his throat—‘they have a son. She’s coping, although understandably worried. She wants assurance he’ll be okay.’
‘You spoke to a family member?’ She raised an eyebrow. ‘I’m impressed. You even sound as though you care.’
‘You said in my last supervision that I should be more available to families.’ He frowned.
‘I know, but I never expected you to do it.’
‘I’m just trying it out.’
‘I expect nothing less, Weston. Now, you have work to do. Chest tubes don’t get put in by themselves, you know.’
‘I can do it without supervision?’
Webster smiled. ‘My best student can.’
Weston explained as delicately as he could why the tube was in her husband’s chest, draining it of fluid. He neglected to tell her that it’d been his first solo attempt. It had gone exceptionally well, and he had results coming soon. With the fluid from the lungs draining, he would also get a CT scan.
As the tests came back, it was increasingly clear it was pneumonia, but they didn’t know the strain of bacteria. That was a problem. They couldn’t treat it without knowing, and the list of antibiotics was a mile long. Dr Webster would hang, draw, and quarter him if he treated Rogers without proof. He checked the vitals once more, marked down the urine output, and checked the drip when Eva entered.
He faced her. She was in the same clothes that she’d arrived in. There was a faded coffee stain on her t-shirt, and her fists were balled in her sagging jean pockets.
‘I just noticed,’ she started, her face suddenly flushed with embarrassment, ‘lots of tests, not much treatment…’ She couldn’t meet his eyes. They darted from the chart to the door, to the curtain that blocked her husband from view.
‘I understand, but we put the chest tube in, and now we can check his lungs for abscesses. He may even come off the ventilator.’
‘Yeah…’ Tears stood in her eyes, and she dabbed them away with a thinning tissue.
‘Because of your husband’s compromised immune system, you should be aware of the worst-case scenario. Pneumonia makes him extremely vulnerable and his ability to breathe may get worse, and if the fluid continues to build in his lungs, the disease can be fatal.’
He wasn’t sure what to say to comfort her, and the first awkward sentence came tumbling from his lips. ‘Do… Do you need a hug?’
For a moment, he felt foolish but then she leaned towards him. He reached out and wrapped a stiff arm around her. Weston could smell the faded scent of her shampoo mixed with her natural smell that he remembered so well.
She laughed lightly, hiding her face in his shoulder. ‘Said Weston McCarthy, never!’
‘Only to you,’ he whispered.
He held her until her breathing calmed, slow and even. It took a while for him to relax, but when he did, he found his fingers rubbing familiar circles on her shoulder.
‘Steve?’ She looked up, still wrapped in his arms, her eyes imploring him. ‘Would you do something for me?’
She pushed him away, pacing the room. Her hands were clasped together, and she wore a worried expression.
Weston tried to swallow the growing lump in his throat. Had he done something? His hands, no longer able to hold her, fidgeted with the pens in his pocket, straightening them obsessively.
She glanced up at him, her face filled with worry. ‘Promise me you won’t wait too long to treat him?’
His hands clenched around his stethoscope. It’s about Rogers; it’s always about Rogers. ‘I don’t need to promise you. I’ll do everything I can.’
Her eyes were wide and bloodshot. ‘You know it’s pneumonia. I’m not stupid, Steve—’
‘And neither am I!’ He pressed his index fingers to his temples, massaging them as he turned his back to her.
‘What I mean is,’ said Eva, ‘there are drugs that could help! I know, and I didn’t have god knows how many years of training.’ She paced back and forth, the sounds of her agitated footfall filling the room.
‘It’s complicated, and different strains require different antibiotics. It’s not a one size fits all.’
‘So, you’re telling me that there isn’t something you would do in an emergency, like penicillin? You’re telling me the smartest man I know doesn’t have a solution?’
‘You’re asking me to treat him without being sure. Do you know what that could do to me? My career? To your husband, if I’m wrong?’
She nodded and folded her arms, but she was stiff, almost as if she were restraining herself.
‘And you’re asking anyway?’
She nodded again.
Weston paced now. It was against protocol to treat without evidence for a reason. But penicillin was highly likely to help, and Eva needed this. He had been unable to make her happy. The least he could do was ensure that Liam was alive to do so.
He turned to her and stared into her evergreen eyes. He would risk his career for the man she chose over him, a man that had played him so that he could get the girl.
‘Is he allergic to penicillin?’
Her face burst into a grin, and she launched herself at him. ‘I knew I could count on you, Steve!’
‘I said I would do anything for you,’ he whispered, wrapping his arms around her.
He put Rogers on the penicillin, but it wasn’t long before signs of angioedema—welts that indicated an allergic reaction. His already low blood pressure was falling.
Weston was paged when the man’s heart stopped pumping. Poppy hurried Eva out of the room.
‘He’s going into anaphylaxis. Get the paddles!’ Weston shouted. Poppy was already prepared. ‘Give him epinephrine and dopamine. We need that blood pressure up.’
‘Charging to two hundred!’ Poppy called while another nurse applied compressions. ‘Clear!’
Weston placed the paddles to his chest, shocking Rogers’ heart.
‘Charge to three hundred!’ he called, the compressions resuming.
‘Clear!’ she shouted.
The paddles began to send electricity running through Rogers once more.
‘Charge to four hundred!’ Steve called desperately.
The paddles were back in place, and the current arched Rogers’ body off the bed and a faint heartbeat resumed. Weston sighed as he looked over everything that the man had been prescribed, everything that had gone into his system. Rogers was allergic to penicillin.
‘Dr McCarthy, what caused this?’
‘Penicillin. We need to flush it out of his system, now!’ His hands ran through his hair, pulling at the roots.
‘Speak to Webster. She’ll know what to do,’ Poppy urged.
Weston nodded, his heart sinking. It wasn’t looking good.
With trepidation, he made his way up to Webster’s office. He had the chart, and the chart didn’t lie. All he could do was hope that she knew something he didn’t. Once he was there, he stood outside the door, not wanting to enter. When he finally knocked, she called him in straight away. She sat behind her desk with a pile of charts, her eyes tired and her lips pursed. The usually tight bun atop her head was slipping.
‘Ah, Weston, how is Mr Rogers?’ she asked casually as if he were the student she didn’t need to worry about.
He slumped in the chair. He told her the truth; everything, his history with Eva, the favour he had done her, and how it had gone horribly wrong.
‘Give me the chart,’ she demanded, standing over her desk and reaching for the file. ‘This is the most up to date information?’
‘I came straight here,’ he whispered.
‘Of all the students to do this…’ She paused. ‘Weston, my most detached student, brilliant, but appalling bedside manner, terrible with families, the one time you engage… you make the worst decision! We need to ensure we have a full medical history for this reason. With his history, the allergy would have been known, and all this could have been prevented!’ she was shouting by the end. ‘You know what this chart tells me, don’t you?’
‘I was hoping that you could fix it.’ He looked up.
‘I don’t have a magic wand, Weston! Her husband is falling into a coma, and the chance that he’ll wake… it’s slim-to-none, Weston. You know that, don’t you?’
‘You will have to tell her.’
‘Please, don’t!’ He couldn’t stand to look into those eyes and tell her what he had done. ‘I—I can’t!’
‘Weston,’ she paused, shaking her head, ‘you will tell her.’
Weston stood outside the room, watching. He saw Eva sat by her husband, holding his hand and whispering in his ears. She worshipped at the altar of his life support.
Bile rose at the mere thought of entering the room. He had known better, and he should have done better. Those were the only thoughts that ran through his mind as he looked at the door that he knew he had to enter.
Finally, he knocked.
‘Come in,’ said Eva, and she began fussing with Liam’ bedding, straightening and tucking it into his sides.
Weston lingered at the door, watching her. When she looked up, he knew he had run out of time. He had to speak with her.
‘Weston, what’s wrong?’ Her hands dropped from the bedding.
Eve looked less afraid than she had when she first arrived. She held her head high, and her eyes weren’t as bloodshot as they had been when she had feared for her husband’s life. It only twisted the knife for Weston.
He took a step into the room and closed the door. He kept his back to her, looking through the door’s window. Dr Webster stood behind the station, her arms folded, and she nodded tersely.
‘What is it? The treatment, did it work?’ She looked desperate and hopeful. ‘Look at me.’
His hands clinging to the chart, he turned to face her.
‘Eve,’ he began, ‘I’m sorry, b-but the treatment is…’
‘Is it the hives? That’s an allergic reaction. Is it serious?’ she asked.
She was strangely composed, given the circumstances. Her brows furrowed, and she leaned towards him.
‘I’m afraid it’s much more serious than hives. His allergic reaction is quite severe.’
‘Will he survive?’ she asked. She leaned back in her chair, crossing her legs at the ankle.
Weston lingered at the end of the bed, and he busied himself with the chart, fingering through the pages at notes he had written.
He slipped the chart into the bracket at the end of the bed, and he pulled a chair from one end of the small room to the bedside where he sat next to Eva.
‘Is he dying?’ she asked, her voice calm and level.
Weston leaned forward, his fingers running through his hair. ‘Yes,’ he said. ‘Serious anaphylactic shock. As it turns out, Liam is allergic to penicillin. I-I’m sorry…’
Her expression morphed from a smile to a grimace, and she pulled out her phone, dialling furiously.
‘I told you he was allergic!’ Her eyes narrowed, and they had never looked so cold. ‘You did this on purpose, didn’t you? You’ve never been able to forgive him. How could you?’
Westons brows knitted together. ‘But y-you said…’ His eyes grew wide as he saw the number she dialled.
Her back straight and her head held high, she faced Weston.
‘I need the police. I want to report a murder.’