Introduction:
The legacy of the Crawley family and Downton Hospital goes back generations, as do the secrets contained within the rooms of Yorkshire's finest medical facility. From humble beginnings as a cottage hospital, the modern day level one trauma center boasts some of the most well respected medical staff in Europe and accepts only the finest interns from the world's top medical schools.
Presiding over the legacy of the hospital is Dr. Violet Crawley, a retired surgeon who is now the President of the Board of Trustees. Sidestepping any accusations of nepotism, she kept the Crawley family legacy tightly entwined with Downton Hospital, appointing her son Robert as Dean of Medicine.
One major deciding factor in this arrangement had not to do with Robert's aspirations in medicine so much as his personal conquests: his wife, Cora, an American heiress, brought an endowment that saved Downton Hospital after the last recession. They have three daughters — the eldest, Mary, is Chief Resident in the hospital's surgical department, having graduated at the top of her class there was no doubt in anyone's mind that she would lead the next generation of physicians at Downton .The only thing that could threaten her reign? Dr. Matthew Crawley — surgical attending,whose mother Isobel is a nurse in the office of Dr. Richard Clarkson, the hospital's top general practitioner with an important seat on the board.
Edith, the middle daughter, has just joined the psychiatry team as an intern. Her aunt Rosamund (Robert's sister) is Chief of Psychiatry, and Edith's decision to pursue the specialty was heavily influenced by her close relationship to her.
The youngest Crawley girl, Sybil, is still in medical school — and let's just say she's not exactly sure that she wants the life her family has set up for her. What she does want, however, is the attention of a certain ambulance driver/EMT named Tommy Branson.
Drama abounds within the hospital walls when Chief of Surgery Dr. Charles Carson presides over his many young physicians — Mary Crawley, of course, as his protege. A man of order and routine, he can only ever be tempted out of his office or the OR by his oldest friend, Chief of Pediatrics Dr. Elsie Hughes. The two have been sharing coffee in one another's office during the night shift for decades — neither has ever married, choosing instead to commit wholly to their careers — and Downton Hospital. As they near retirement and change drives them away from the hospital, from the only lives they've ever known, will they find solace in one another?
Dr. Hughes' only friend, aside from Dr. Carson, is Beryl Patmore RN, BSN, the nursing supervisor. Nurse Patmore is a tough cookie, but she has known Dr. Hughes since she was just a resident. They've seen a lot over the years and both know that while they might be women of hard exteriors, they've got hearts of gold. Nurse Patmore and Dr. Hughes preside over the nursing staff on the pediatric ward, which includes fresh nursing intern Daisy, nurse Anna Smith, pediatric anesthesia resident John Bates (who are often caught canoodling in the locker room) and Phyllis Baxter, a sweet nurse who is hiding a terrible secret and Joe Molesley, the only male nurse on the unit who happens to have a sizeable crush on Nurse Baxter.
All might seem to be going rather well at Downton Hospital, but if you look closely you'll see two shadowy figures chain-smoking on the roof. That'sThomas Barrow and Sarah O'Brien —while they may at first appear to be quiet and unassuming unit secretaries, the pair are hatching a plan to bring Downton Hospital down— one unit at a time.
Chapter One: First, Do No Harm
The first thing Dr. Elsie Hughes did when she closed the door to her office was kick off her shoes. Why, at sixty-two, she still insisted on wearing heels to rounds she couldn't say. She hadn't even fully crossed the room to her desk before she kicked off one, hobbling across the oriental carpet as she reached down to remove the other. Shoving them under her desk and sitting down, at last, she exhaled deeply. Three quick knocks at the door — oh, how infrequent were her uninterrupted hours! — kept her from taking any more pause.
"Yes?" she said, checking her watch. 6:34 am.
He was four minutes late.
Dr. Charles Carson, Chief of Surgery, had been bringing her coffee every morning after rounds for the last fifteen years. Prior to that, they had shared coffee in other various locations around Downton Hospital. Stairwells, the doctor's lounge, the occasional gurney in the ER hallway. When she had come to Downton Hospital to complete her residency, he had already been at the hospital a solid decade. He was always rather chuffed to remind his interns that he had been born at Downton Cottage Hospital — the precursor to the modernized and internationally revered Downton Hospital. Downton, he would tell them, was his bloodline.
The only thing keeping him from being Dean of Medicine was that he couldn't stand the thought of leaving the OR. The Dean's job, more of a figurehead position, included more paperwork than he felt comfortable with. And, of course, despite the fact that he was well-liked by the hospital's President, the "right honorable Dr. Violet Crawley" he hadn't had a snowflake's chance in hell once she'd got it into her head that her son should preside as Dean.
He'd managed to shrug it off. Truth be told, he was hoping he'd die in the OR. The thought of living long enough to leave it left him feeling rather a used up old cad. A feeling he was not partial to.
"You're late," she said, pushing her glasses up atop her head. He thrust a coffee cup at her with a surgeon's precision — quick, sharp and blunt — and sat down across the desk from her in rather a heap. He glanced up at her as he took a sip of his coffee, doing a slight double take.
"Did you . . .sleep in an on-call room last night, Dr. Hughes?"
Her hand, on which her chin was resting, managed to hide the slight smile she allowed herself. After all these years they still referred to one another as "doctor." Other colleagues, in the modern age, called one another by first name. Even the interns did. Maybe they were just too old (or too "old fashioned") but in their way, the respect of the title being flung back and forth between them each day was intimacy.
"No," she said, busying herself with the lid of her coffee cup. She lifted the top off to see that he'd put enough milk in it. He had, of course.
"You lie like a rug," he said, finding her gaze.
"And what if I did, Dr. Carson?" she said, stifling a yawn.
"Don't you think you're a tad bit too old for that?"
She scoffed, sputtering coffee. She reached up and dabbed her chin with her fingers, licking her lips as heat rushed to her face.
"No, I don't." she said, "The day I'm too old to sleep in an on-call room is the day I'll have to retire."
"Dare I ask which of your little darlings kept you here all night?"
She gave him a warning look. For twenty years he'd called her patients her "little darlings" — as if to imply that because she was a woman her motivation for specializing in pediatrics must have been born of some innate maternal desire to nurture. Quite frankly, she'd entered pedes because she already had a wealth of experience by way of her younger sister. Though, she'd never told him any of that. Never told anyone, actually.
She was quite certain there wasn't a soul at Downton — in Yorkshire, for that matter — who knew about Becky. Not that it mattered. Those were matters of the past, and they were best left there. She had more pressing concerns in the present tense.
"4 year old female. Presented two nights ago febrile, fatigue, splenomegaly, anemia. Parents reported she had been complaining of her arms and legs aching but they thought it was a growth spurt. Her white count was . . ." she sighed, having rattled off the essentials with her normal clinical detachment. She knew he'd have already guessed the diagnosis.
"Virtually non-existent?"
She nodded, her eyes downcast. "I haven't told the parents yet. I only confirmed it last night — confirmed thrombocytopenia."
"AML? Or, the other one —?"
"No, you've guessed correctly Dr. Carson." she sighed, "Acute Lymphoblastic Leukemia."
"You'll refer them to an oncologist?"
"Yes, of course." Elsie said, setting her coffee cup down. She turned to the patient's chart, flipping it open. Smoothing the page down with her hand, she scanned for the parent's names.
"She's only just turned four," she said, "Her birthday was in September."
He sipped his coffee, offering her a grunt of acknowledgement.
"Her name is Signey."
"As in Norse mythology? The twin of Sigmund?"
Elsie shrugged, "I don't know, Dr. Carson. They probably just thought it was pretty."
He mumbled, nursing his coffee. After a moment, he checked his watch. "I should probably be off. I've a meeting in fifteen minutes and I'd like to take a walk through the surgical suite."
Without looking up from Signey's chart, Elsie gave him a slight wave.
"Thank you for the coffee, Dr. Carson."
He paused, his hand on the doorknob. "Of course, Dr. Hughes. I'll see you."
As the door clicked shut behind him, she glanced down at the child's photograph, which she had paperclipped to the admissions' forms. Of course they had all the new-fangled technology, but she kept paper records on all her patients. Duplicate effort, perhaps, but she liked having something tangible to keep ahold of as she walked around the pediatric wing. Most important to her was the child's photograph. Taken as a security measure (in case of a Code Pink, or, a missing/abducted child) she couldn't help but think that the photographs aided her diagnosis and treatment somehow. As though even late at night, tucked into her dark office several stairwells away from where her patients cried in their sleep, flipping the chart over and seeing the child's face could inspire an answer, a solution, to their pain.
Other times, though, it only served as a reminder of what might be lost. Some of her patient's charts, tucked away in file cabinets, no longer have a picture with them. In the past, she'd given the photo to the patient's parents when they left the hospital without their little one. Sometimes it was the last photograph ever taken of the child, she knew, and she never laid claim to it even though she could. For legal reasons, maybe. But the charts weren't trophies for her — each one was revered, each one had taught her something. Yes, there were some patients that she had been particularly fond of. Wondered what had become of them. Occasionally she'd get a nice letter or Christmas card from a grateful family. A graduation announcement or two. None of them were her children but in a way, they were all her children. She shook the silliness from her mind, lifting Signey's picture into the light of her desklamp.
She had a mop of red curls and green eyes that once were, no doubt, bright and sparkling but now dulled as cancer ravened her tiny bones. With her sunken face and tightly closed mouth, she almost looked like Becky.
Almost.
"Which one do you think?"
Cora Crawley looked up from the slice of toast she was buttering to see her husband had appeared in the kitchen's entryway, a tie in each hand and a look of desperate sheepishness on his face.
She licked the butterknife, considering his options a moment.
"The navy one," she said, dropping the knife into the sink. "Your mother hates the purple one."
"Why?" he said, tossing it dutifully on the countertop. She watched him as he began to deftly tie the navy one, not taking his eyes off her.
"She knows I bought it for you."
"Oh, don't be ridiculous." he said, "She probably just thinks that it's a little frivolous for the Dean of Medicine to be parading around with a plum tie."
"Mulberry."
"What?"
"The tie. It's mulberry."
He paused, his tie half undone. She raised her eyebrows, taking another bite of her toast.
"Is that an American thing?"
"What?" she said, her toast crunching loudly.
"Having impetuous names for colors."
She rolled her eyes at him, reaching for a napkin. She nodded toward the handiwork he'd completed with his necktie. "Is that a British thing?"
"What?" he said, joining her at the table.
"Crooked neckties."
He looked down, lifting his tie up to inspect it.
"Made you look." she said, popping another corner of toast into her mouth.
"You're worse than a kid." he said, reaching across the table to steal the other half of her toast.
"Excuse me — I was eating that!" she said, gripping his wrist.
"Speaking of children, have you heard from our youngest?" he said, wiggling his arm free from her grasp.
"Give me my toast!" she laughed, swatting his hand. Having secured it, he took a defiant bite, giving her a wolf's grin. She sighed, defeated, and reached for her orange juice. "No, I have not heard from Sybil. But she has midterms this week so I'm hardly surprised. She'll be home in a week for the spring holiday."
"I know," Robert said, pulling the toast slice apart and handing half of it back to her, "I was just wondering if perhaps she'd decided to go on holiday with her friends. You know, tell us that she was staying on campus to work or study or what have you and then go gallivanting off to Spain instead."
Cora blanched, "Why would she do that?"
"Why wouldn't she?" he laughed, "You were young once. Didn't you ever lie to your parents to sneak out to a party? A rave, maybe? You were a city girl, you must have snuck out to at least a few clubs in your day."
"I never snuck out." she said, "I didn't have to. My mother threw enough parties to keep me busy at home."
"Ah yes. How easy it is to forget about your mother when she's not underfoot."
"Robert," Cora said, but she smiled. Yes, her mother was a bit much. But she did miss her. Occasionally anyway. She glanced up at the wall behind Robert's head to check the time, and her eyes widened when she saw how late he was running. "Christ, Robert, it's ten to seven — you're going to miss the Steering Committee meeting!"
She leapt up from the table and ran to fetch his briefcase and a travel mug for his coffee.
"They can hardly start it without me, Cora. I'm the steer-er."
She threw him a warning look and shoved his briefcase into his lap. "Don't go in there with your head quite so far up your ass."
"I haven't —"
She hushed him, straightening his tie. "Try to play nice with the others today, okay? Please?"
He sighed at her pout, brushing her hair back from her cheek and giving her a sweet kiss. "And if I'm a bad boy?"
She snorted, petting his cheek. "Then you get to be the one to tell Sybil she has to get her wisdom teeth out over her break from school."
"I specifically asked for a male donor heart*," Dr. Mary Crawley snapped, shoving the transplant team's cooler back into the tech's hands. Storming out of the OR as she ungloved, she ran smack into Dr. Carson.
"Dr. Crawley," he said, "You look as though you're on a bit of a rampage and it's not even 8 am."
She huffed, pressing her palm against her forehead. "They gave me a fucking female donor heart. I explicitly asked for a male heart."
"Is this your young transplant patient?"
She nodded, "You know what the latest studies have indicated — that male hearts simply have better outcomes. They are associated with longevity and overall better cardiovascular health. I don't want a second-rate heart, Dr. Carson. I know they have a male heart because I asked them to call me when they did. But that isn't what they've brought me." she turned back toward the OR, where the surgical techs were running around in a frenzy. The anesthesiologist, Dr. John Bates, sat calmly at the head of the operating table, seeming to be perpetually enchanted by the chaos.
"You have a decision to make, Dr. Crawley. Will the patient survive if you wait for the next donor heart — or is this . . .second-rate heart, as you say, his last chance?"
Mary pursed her lips. "This heart. . . would be his last chance, yes." she said. She shook her head, having cooled it off a bit. "I'm sure they all think me rather a princess now that I've given them such a show."
"Go scrub back in, show a bit of humility and do what needs to be done, Dr. Crawley." Charles hushed, putting his hand reassuring on Mary's shoulder. She gave him a small smile. Turning away from him and heading back to the scrub suite, he called after her. "Dr. Crawley?"
She turned back, "Yes?"
Charles sighed, "It's been my generally experience that the female heart is not inferior. In fact, it's quite the opposite. Perhaps not on a cellular level, perhaps not in terms of biological compatibility but. . .do not discount the fact that you are being powered by a heart that I know, for a fact, is not in the least second-rate."
She smiled, lowering her head slightly.
"No, go on. Save that boy." Charles said, turning away from her and heading back down the hall. He checked his watch. 6:49 am. He had time enough for another cup of coffee.
Robert Crawley was always late anyhow.
"Room 23 needs a new bedpan," Joe Molesley said, positioning himself strategically between Beryl Patmore and the exit to the nurse's station.
"Why are you telling me?" she said, pushing him aside. "You know where they're bloody kept."
"We're out."
She whirled around to face him, her badge slapping against her hip. "What do you mean we're fucking out?"
Molesley shrugged. "There's none in the supply cabinet. Not a one."
"Jesus," Beryl said, pressing the heel of her hands against her eyes. "Go on down to infusion and steal a few of theirs, okay? Just enough for the end of your shift. I'll get an order put in."
Molesley nodded and turned on his heels, heading off down the hall. Beryl sighed. When she'd set out to become a nurse she never imagined that the height of her career would include seeing virtually no patients, attending stupid meetings at 7 o'clock in the bloody morning and ordering supplies. If she'd wanted to do that, she'd have taken a job in materials!
Muttering to herself, she smacked the automated door button and started through it before it had completely opened. She nearly ran into a brightly scrub-clad young woman who shrieked in surprise.
"What the hell are you doing?" Beryl said, grabbing the girl's forearm.
"I'm sorry," the girl said, "You startled me."
"You're in a bloody hospital, not an amusement park, Jesus Mary in Heaven!" she looked at the girl, scanning for her badge. She had one, sure enough — said DAISY, RN.
"I'm the new nurse intern on the unit. My name's Daisy—"
"Oh, good God. Not another one." Beryl said, leaning against the wall. She sighed, giving the automated door button another hard smack. The doors jerked open again and she gestured for Daisy to go in. "Go on — look around for Phyllis Baxter or Anna— she'll get you started. I've got to go to a meeting."
"Yes, Nurse —" Daisy leaned down to look at the woman's badge. She straightened up, smiling enthusiastically. "Nurse Pat-more,"
"Oh for the love of God," Beryl groaned, turning away from the girl and headed down the hall. She threw her hand up in dismissal, not turning back as she called out to her from down the hall, "We don't give out gold stars here — Daisy!"
The girl wilted, ducking into the unit. She only lifted her head when a tiny blonde woman came around the corner.
"Oh, you must be Daisy!" she smiled, "I'm Anna — one of the nurses here on pedes."
"Nice to meet you," Daisy said, looking around. "I haven't even been here for ten minutes and I think I've already managed to piss off the nursing supervisor."
"Patmore?" Anna said, "Don't worry about her — she's tough at first but she'll come around to you."
"I hope so," Daisy said, "I'm so happy to get to do my pediatric rotation here. It's the best unit in England — probably all of Europe. I've read every case study that Dr. Hughes has ever published and I might just die when I meet her."
Anna smiled, "Dr. Hughes is quite the legend — you seem a bit more up on your research than most nursing students we've had. Maybe you've got your sights set on something higher?"
Daisy blushed, "I don't know — I just really like to read."
"Well, I'm afraid you won't have much time for that now." she led Daisy around the corner to the ward. Now that all the patient's had been woken and the breakfast cart was making its rounds — not to mention an influx of patients and family — the ward was bustling.
Daisy's mouth fell open and she felt her heartbeat quicken in her chest as she struggled to take it all in. Her gaze fell on the nurses station where she saw a woman in a long white coat stand up, her hands smoothing her hair as she did. Dr. Elsie Hughes! She glanced up and saw Daisy looking at her and gave her a small smile. Before Daisy could even smile back, an overheard page came through, interrupting her thought.
"Code Blue*, Room 22. Code Blue, Room 22"
Dr. Hughes unwrapped her stethoscope from around her neck and quickly — much more quickly than Daisy would have guessed, knowing how old the famous doctor was — made her way to the patient's room.
"I know I should know for sure but —" Daisy hesitated, "What's a Code Blue?"
Anna sighed, "Cardiac arrest."
* In fact there has been recent research about male donor hearts being preferred by transplant surgeons for this reason. Lady hearts are, apparently, considered quite second-rate on a biological level!
* All hospitals have the right to have various codes — the hospital I am admitted to from time to time uses numerical codes, actually. I had to look up the codes that are considered to be "standardized" but I'll tell you from experience that not every hospital uses them as such, so I'll make sure I always mention in the text what the code is for!