thanks for all the reviews, it's really cheered me up after a crap week. this chapter is based on what is one of my favorite casualty episodes because of it's Dylan-ness. Hope it's not too bad :)

"Has anything like this ever happened before?" Bella was quizzing the friend of a patient on entry to the E.D.

The friend shook her head. "No, nothing."

Bella nodded, "Ruth, do you want to give me a hand over here? Patient's name is Annie McClain. There's no obvious head injury but there appears to be some kind of facial weakness, maybe neurological? Has Annie complained of a blow to the head recently or any headaches?"

"No, not to me."

Ruth handed Bella her stethoscope, she'd left it on the bed in the other resus bay. Bella smiled at Ruth gratefully before returning to the patient. "Has she got any medical conditions, anything that could explain this?"

The friend hesitated slightly, before shaking her head.

"Does she normally drink heavily?"

"No, Annie's clean living."

"Okay, Linda, can I have routine bloods, FBC, U and E, LFTs, CRG and cultures? Oh and can you run me an ECG and book me a CT. Is that okay?"

Linda nodded.

The friend watched as Bella examined Annie's eyes. "Is it serious, it looks serious?"

Bella did her best to look confident. "She's in the right place, okay? Tamsine, could you take her for a coffee, I'll come and talk to you in a minute. Can we get a bag of saline hung up?"

.

.

.

Bella was doodling on a piece of paper, not really paying attention to what she was doing. She liked to watch the ED when it was quiet. She only really had one case in resus, a girl called Annie McClain. Although Bella couldn't work out what was wrong with her, it didn't seem to be urgent yet. Other than that the day had been relatively uninteresting and she was on a break while she waited for some results to come through. A man staggered into the ED clutching her stomach. "I need a doctor."

Noel grinned. "You've come to the right place mate."

The man bent over an retched. Noel jumped around reception. "Can I have some help here please?"

Bella put her pen down and was going to go and assist, but Tess took the patient. Dylan walked up as Tess asked the patient what was wrong.

The man stuttered. "I think I've got food poisoning."

Dylan did an abrupt U-turn, suddenly pretending he was busy. Bella smiled. "I can take that one?"

Tess had other ideas. "You're supposed to be on a break. Oi!"

Dylan stopped, rolled his eyes and turned round. "How can I help?"

Bella took the next resus case that came through. A girl, Fiona Riodan, had fallen down the steps when on a shopping trip with her mother.

.

.

.

"Bella, I've got Annie McClain's records." Linda handed Bella a notes folder. "She's been on methadone for twelve months."

"She's on a drug treatment program?"

"Cleared all tests so far, the last one was shortly after her baby was born."

Bella nodded, scanning the patients notes. "Okay, and did her bloods come back yet?"

Linda nodded, "High white cell count and raised CRP."

"Which would suggest an infection or inflammation... hmm... She had dilated pupils, the exact opposite of what you would expect if she was using again, or if she'd taken the methadone... We're going to need to wait for the scan results." Bella frowned and walked over to where Annie and her friend, Chloe, were waiting in cubicles.

"Hi, I'm Dr Jordan, I treated you earlier. Can you tell me what happened?"

"I er- I put Evie to sleep..." Annie trailed off.

Bella noticed that she was having difficulty raising her hands to take the glass of water her friend was offering. "Okay Annie can you raise your arms for me?"

The girl, try as she might, could not raise her arms more than 3 inches from the bed, something which began to concern Chloe her friend. "Babe, just lift your arms up?"

Annie tried again but to no avail, "I feel sick."

Immediately the monitors began to bleep. Linda looked, "She's dropped her pulse and pressure."

"Okay-" Bella was interrupted by Annie spontaneously projectile vomiting. Bella and Linda saw it coming and stepped out of the way, her friend wasn't so lucky.

Bella grabbed the trolley, "Straight to resus please, Mac? Can I have a hand over here?"

.

.

.

Bella stabilized Annie in resus, but even after further tests she couldn't work out what was wrong with her patient. "I'll find out more about about her drug history, do you want to come and talk to the friend with me?"

Linda nodded.

"Chloe, you didn't tell us about Annie's history with drugs, I can understand why you might want to keep it quiet, but this is a hospital and we need to know all the information in order to help people, okay?"

Chloe shrugged. "I didn't think it mattered, we've been clean a year."
"So you're on the program together?"

"Yeah. At the clinic here, Annie, she went on the methadone cause she were pregnant and I tried it, lapsed, so I went on the diamorphine."

Bella nodded.

Linda raised her eyebrows. "They went ahead with their drugs clinic then?"

Bella nodded again, "Yeah, I was one of the doctors who signed it off. It's on trial, Charlie runs it."

Chloe looked at Bella, curious. "Actually, I'm due a dosage, do you mind if I?"

Bella nodded with a half smile, "That's fine."

.

.

.

The ED began to be inundated with collapsed patients. Bella took another one at the doors. Dixie was dealing. She smiled at Bella before beginning. "This is Larry Foster. 62. Works in the bookies. Collapsed, slurred speech and became disorientated. "People are dropping like flies today Bells."

Bella nodded at the paramedic. "Tell me about it."

Dixie continued with his stats as Dylan called out. "I want to know if he's been to dinner last night, we could be looking at a serious outbreak."

Bella smiled. "Food poising more interesting now then?"

Linda interrupted. "Dr Jordan, I need to show you something, it's about Annie McClain."

Bella shook her head. "Okay." She called over to Ruth. "Ruth, if you take this one, I'll take a look at Annie."

Ruth nodded and Dylan converted to instructing her. "Can you check for muscle weakness and if he's been out to-"

Ruth dismissed him with a shake of her head. "I heard, thank you Dr Keogh."

Bella smiled, atta girl. Ruth was back to her old self.

Dylan frowned and picked up the phone. "Hello, it's Dr Keogh here, I'm calling from the Emergency Department at Holby City Hospital. I want an honest answer to this question, have you had any complaints of food poisoning since last nights service." He paused. "No, I'm asking, not accusing."
Bella smiled to herself, before remembering that she wasn't supposed to find him funny anymore. Dylan continued the conversation. "In that case, can I make a reservation for tonight? It's Keogh. No KEOGH. K-E-O-G-H." He covered the receiver with his hand.

"Um Bella?"

Bella was just about to check up on Annie McClain. "What?"

"Do you fancy going to the food poising restaurant- Shaws?"

"You are asking me out on date to a restaurant you suspect of food poisoning. Nice." Bella shook her head and walked away. "Annie McClain Linda?"

Dylan looked confused so Linda helped him out.

"Just in-case you didn't know, a restaurant suspected of food poisoning isn't the most romantic choice of a dinner date. And Bella's a veggie, she won't eat seafood anyway."

Dylan raised his voice so Bella could here, "Oh. And Isabella?"

Bella turned around at the door to cubicles, her disapproval clearly shown. "What."

"Bella- This patient, is she one of them?"

Bella rolled her eyes. "Yes. She is. She also has a name, Annie McClain."

"Can I take a look?"

Bella sighed. "If you have to."

Linda smirked.

Dylan uncovered the telephone, "Just a reservation for one, unless you take dogs- no okay, just a table for one."

.

.

Bella pulled the cubicle open, "Hi guys, this is my colleague Dr Keogh, he wants to take a look at the wound on your leg, Staff Nurse Andrews found it when she was injecting your pain relief, right?"

Dylan stepped forward. "Dr Keogh. I'm very good at fixing people."
Bella made a face and muttered, "And don't we all know it."

Dylan ignored her. "Roll over love."

Chloe looked at him. "The other doctor's all lot nicer."

Bella grinned, "Come on Annie, let's have a look."

Dylan and Bella both examined the wound seperately. Dylan shrugged, "Right." But Bella continued to look. "Maybe, maybe not-"

"Bella, can I have a word?"

Bella and Linda exchanged looks before following Dylan out of the cubicle. "We're missing something. A lot of today's intakes share a common vector, now we are dealing with different symptoms across a range of patients and no one seems to have the faintest idea what is wrong with them. We need to put our heads together and figure out what we're dealing with."

Bella raised an eyebrow. "We?"

Dylan shrugged, "Spread the word, I'm no good at all that-"

"What, talking to people? Yup, I think I got that." She turned on her heal and went to gather the rest of the team.

.

.

.

Dylan had called an impromptu staff meeting. Bella and the rest of the staff on shift assembled in the staff room. Bella was perched lazily on the end of the sofa, between Ruth and Lenny. She listened to Dylan patiently. "Okay, we have a problem. This department sees what, 200 patients in a day. Broken limbs, heart attacks, things stuck up strange orifices. And yet today we have several patients and 3 more on the way in displaying hugely different yet entirely similar symptoms. My food poisoning comes in with the usual problems and within an hour he's experiencing respiratory difficulties and limb weakness. Bella's Miss McCleod-"

Bella interrupted. "McClain, but close."

"-comes in, looks like a stroke, rally's under treatment and she develops another case of muscle weakness." He gestured to Ruth. "Your resus case, muscle weakness. Dr Lyons run of the mill, comes of his skateboard, breaks his arm- dude. He's developed an infection."

Lenny shrugged. "Yeah... but I-"

Dylan ignored him and pointed to Ruth again. "Your elderly patient, just admitted."
Ruth nodded. "Neurological irregularities, he's already gone for a CT."

Dylan nodded. "See, we're burning through the scans today. What do they all have in common, we're looking at a range of ages, social-economic groups."

Bella interrupted. "I don't want to state the obvious, and this probably isn't my place because I haven't seen all of the patients, but isn't there one connection?"

Dylan looked at her impatiently. "What?"

Bella put down the ELLE magazine she had been flicking through. "Lenny's lad, needle stick. Ruth's case has admitted he's addict. I bet 'poisonings' got track marks on his foot if you bother to look-its a common trick if you want to hide it. Mines on methadone but I'm pretty sure that wound on the leg is from an infected needle wound, haven't seen one for a while. And the one in resus has obvious track marks and all- have you got the connection yet, they're all IV drug users."

Dylan nodded, "of course," and ran off to see Annie McClain's wound

Bella muttered to herself. "Thank you Bella, why that's okay Dylan, I'm just doing my job." Everyone then looked at Bella, who shrugged. "Notify the suits, if I'm right we might have a localized Public Health Incident."

Linda looked confused, "Right about what exactly?"

"Contaminated batch of heroin, contaminated set of needles, or I could be in completely the wrong track. Can you come with me, make sure Dylan doesn't terrorise Annie McClain too much."

.

.

.

Bella, Dylan and Linda were back with Annie McClain, examining her leg wound. "It's definitely infected, but if you look there, pinpricks maybe?"

Dylan nodded, "Don't know how I missed that."

"Yeah, well, I guess I have the personal experience. "

Dylan gave her a dark look.

Bella looked up, "How did you get the wound Annie?"

Annie looked slightly shifty. "I don't remember."

Dylan interrupted. "How's the methadone working out for you?"

Bella gave him a warning look.

"Yeah, great."

Chloe nodded, "She's really good at it, I'm proud of her."

Dylan ignored the friend, "It can't be easy being a single mother?"

Annie was evasive, "I think I'm just run down you know."

Dylan held up his torch, "Look at me Annie-" The patient deliberately looked down. "Look at me please." She complied, and as Bella suspected she had all the signs.

Dylan nodded at Bella, "Now, I've only got a dog, and I know how hard that can be, you have to feed them, wash them, make sure that they are looked after if you're going away for too long and, erm, sometimes in the middle of the night they won't sleep because they've heard a mouse scratching around and I can only imagine it must be twice as hard-"

Bella's stomach squirmed, she was thinking about her own little thing inside her. She spoke, perhaps more softly than she had intended too, because Linda gave her an odd look. "Thank you Dylan." She looked at the patient. "Annie, have you told us everything we need to know to diagnose your condition? It doesn't mean you're a junkie again, okay sweetie, it just means you've had a relapse and we can help you with that, yeah?"

Annie looked gutted, "It's just been really difficult..."

Her friend interrupted. "Annie..."

"It's easier for you, you're on the diamorphine. I kept clean for Evie, but it's so hard."

Bella nodded, "It's okay, we understand. Have you been injecting there?"

Annie went defensive. "Just a couple of times... but it got sore, I don't know, maybe, it's hard to keep the place clean these days. I'm sorry Chloe, really I am."

Chloe touched her friend on the shoulder, "Hey, stop worrying about it. Now you've had Evie, maybe they'll stick you on the diamorphine."

Linda frowned, "That stuff isn't handed out like sweets you know."

Bella cut in quickly, "Thank you Staff Nurse Andrews, they're doing their best. I'll write you a prescription for some antibiotics, okay."

She pulled the cubicle curtain shut. Dylan was off too look at another of his patients. Linda looked between him and Bella. "You guys work well together, you know?"

"Not today Linda, please." Bella turned and walked away, looking for a prescription form. `

.

.

Ruth joined the congregation of doctors around Dylan's computer. "My latest patient, the elderly one, needle marks all over his arms."

Dylan nodded, "My man's been injecting as well." He clicked on something on the computer. "Oh, that's it. The dilated pupils, that's what threw us off the mark, clostridium botchulinum."

Lenny repeated him, "Botchalism?"

"Bella was right, all of the patients, some of them hiding it better than others, are I.V drug users. The heroin has been infected at source, probably by bacteria in the soil. If you do not know the appropriate treatment, look it up now."

Bella continued for him without a que. "Tess, it might be a good idea if you organise blood and stool samples for all suspected cases, and put in a call for emergency bottchulinum anti-toxin."

Tess nodded, "We're heading towards a major public health scare so I'll warn management and check capacity in intensive care, okay?"

The team nodded and headed off to their respective patients.

.

.

.

Bella pulled open the cubicle to give the news to Annie. "Okay, we think we've discovered what the problem is, you may have been infected with a form of botchulism?"

Chloe gave Bella a confused look, "Botchulism?"

Linda was preparing the antibiotics, "You're lucky you only started injecting again a few days ago."
"We're going to have to do some more tests to confirm it, but in the mean time we're going to give you some stronger antibiotics to fight the infection. You aren't allergic to penicillin, are you?"

Annie didn't meet Bella's eye, she seemed concerned about something.

Chloe had noticed too. "What's the matter babe, what is it?"

Annie almost whispered. "Evie, I've been breastfeeding Evie."

Linda looked shocked, "You breastfed your baby while you were injecting?"

"Well, the bacteria can't be passed on by breastfeeding, but the heroin can."

"I don't- well yeah, just once, last night, this morning, before this happened."

Bella nodded, "Can you let Dr Keogh know for me?"

.

.

.

Bella was stood outside, without a cigarette for once. An onslaught of drug users had only served to remind her about the effects that any kind of drugs could have. And anyway, she had another person or thing to think about now. She hadn't had a drink, or a cigarette since. She was going to do this properly, for once. They had found Annie's baby, and she was fine. Good news for once... A familiar voice bought her out of her revere. "No cigarette today Isabella?"

"Are you trying to be annoying Dylan?"

Bella was doing her best to keep Dylan out of her mind, she couldn't tell him about the pregnancy, not yet anyway. He was too irresponsible, Bella didn't want to burden him. And she didn't want him to run away. Rejection was one thing she could not take.

"What is it?"

"You. Me. Everything. Just don't call me Isabella, okay."

Dylan shrugged, "Bella- Today must have- it must have been hard for you."

"What is that supposed to mean Dylan? How was this shift any more difficult than the rest? Public Health Incident isn't exactly that much of a biggie. Oh wait- you mean the fact that I was treating a pair of ex-junkie-prostitutes, because I don't already do that every day?"

Dylan shrugged. "Okay. Fine."

Bella frowned and looked away. "It doesn't bother me. Why should it?"

"The fact that you used to sleep with anyone for money and pump your veins with drugs doesn't bother you. I find that hard to-" The look on Bella's face alerted Dylan to the fact that he might have said something out of line.

Bella swallowed. "Thank you for your opinion Dylan. Glad to know and all that. I went through years of counselling which enabled me to put my past in boxes and to be the person I am today. And I might not like talking about it, but I can deal with it. But here goes. I was forced into prostitution at the age of twelve when my abusive uncle 'sold' me to clear his gambling debts. And yes. I took the smack because there was nothing else other than slicing my skin to ribbons that took away the pain of going to strangers houses twice a night and having sex with them. Okay, has your curiosity been satisfied? Good." Bella turned on her heel. "Goodbye."

Dylan was mildly confused, "Bella-"

"Look, you just made your feelings absolutely clear. I don't want do this Dylan. I can't do this. It was never going to work, I'm the gutter girl and you- you're just- Goodbye."