In this AU, Sam never returned to Holby as a paramedic, and I'm skirting around/ignoring the whole whistleblowing incident that was alluded to when she came back, too. Apologies (sort of?) for the angst to come, and for the many questions I'm sure to prompt with this chapter! Hope you enjoy the new story :)
Sam Nicholls felt the vibration of her pager in her pocket before she heard it. She sighed – she'd heard and seen the approach of HEMS from her sunny spot around the back of King's College Hospital, but had hoped someone else would get the call and not her.
Adult male trauma, RTC.
She winced. God only knew what state that poor soul would be in. She dumped her half-full coffee cup in the nearest bin and headed back inside, checking the time. Damn. Betty would have just collected Georgia from school, so it would have been the ideal time for a quick check-in call.
She slid into resus just behind the HEMS team, and could have sworn aloud at the state of her patient. In the seconds before the handover began, she swept her gaze along the poor man's body, taking in his ripped clothes and deep lacerations. His face was bruised and cut to the point of barely looking like a face at all, one eye swollen shut from the force of presumably hitting the car's windscreen. Out of habit, she glanced at his bloodied left hand. No ring, unless it had somehow come off at the point of injury. She looked up at the HEMS doctor, one she'd worked with many times previously, and quickly hushed the rest of the team around the wounded man.
"Go ahead, James," she asserted, pushing her mind away from the vague sense of recollection she'd felt on examining her patient's face.
The doctor nodded. "We haven't found any ID yet – there wasn't time at the scene. Unknown male was the victim of a hit and run approximately thirty minutes ago. Bullseyed the windscreen, as you can see from the facial lacerations, and witnesses report further head trauma, hitting the road. Pupils dilated and sluggish. Query abdo bleeding. Extensive trauma to right leg: fractured femur, dislocated knee and complex open tib/fib – witnesses report the car may have driven over the leg. Neck and spine cleared."
Sam was ever the professional listening to it all – after all, she'd seen and heard much worse in Afghanistan. But as far as civilian trauma went, this was bad. And compounding it all was the fact no-one had yet determined the man's identity, so no-one had received the devastating call about their loved one. No-one knew he was here.
"He's tachycardic at around 120, BP is 80/60 supporting likelihood of internal bleeding. GCS of 10 – that's 2/4/4 – and we got IV access on-scene. He's had both ketamine and morphine but still in significant pain."
"I'm not surprised," Sam remarked without thinking, before covering her mouth with a hand. Hardly what the patient needed to hear, if he was still conscious after all that. She thanked the HEMS team and moved around to her patient's line of sight. Not, she supposed, that he would be able to see very much through one swollen eye and one surrounded by blood and possible glass shards. "Start the primary survey," she instructed the F2 on the other side of the bay, before looking down at the patient's bloodied face and hair. "Hello," she said clearly. "My name's Sam, I'm a doctor at King's. Can you hear me?" She heard her name clumsily repeated back at her in a panicked fashion. "Yes, that's right, I'm Sam," she went on calmly, putting a hand on the man's arm. Immediately, she could feel the sticky sensation of blood beneath her glove. "We're going to get you sorted out, you've had a bit of a rough afternoon, I think!"
There was no doubt her bedside manner had softened in recent years. That was to be expected, she supposed, with everything that had changed – with a home life that lurched between cartoons, school reading books and bedtime stories for most of the week, it was no surprise that she'd mellowed with age and experience.
"Hold on, I've got some ID!" Rehema, one of the ED nurses was triumphant. She had been cutting the man's trousers away from his injured leg when a photocard driving license fell from the pocket, miraculously clean. It was unfortunate that in picking it up, she smeared it with blood from her own gloves. "He's a doctor!" She wiped the license on her plastic apron one last time. "It's… Dr Dylan Keogh."
All she could hear was the world spinning around her while she was paralysed in shock. The normal A&E sounds that were so commonplace as to be background noise, were suddenly deafening. She couldn't breathe, she couldn't see except for the hundreds of memories flickering across her mind like a frenzied flip-book. Dylan. Dylan. Dylan. She swayed on her feet.
"Dr Nicholls, are you alright?"
Sam jolted back to reality. There wasn't time to switch out for another doctor due to conflict of interest – in any case, declaring that conflict now would mean too much explaining of details she didn't want to share.
And she was good with trauma. There was a reason the F2 was shadowing her for trauma experience and not any of the other consultants. Dylan deserved the best. She would make sure he was stable and confess her sins to the Clinical Lead later.
"Fine, thanks Rehema." She took a steadying breath and tried to forget that at one time she'd have given her life to protect this patient. "Let's get an FBC, U and E's and arterial blood gases, then crossmatch for transfusion. He'll need a unit of O-neg, and push fluids until he can have a full CT."
It would have been easier to zone out, do it on autopilot. Anything to forget whose face lay under the disfigurement of trauma. Whose heart she fought to keep beating against the odds applied by some cowardly hit and run driver. But she forced her attention back to him every time it began to drift. Now was not the time to give in to something as human as emotion – once upon a time, he had been the one to teach her that, in this very ED.
It was the very worst kind of full circle.
Time slipped by as the resus team battled to stabilise Dylan enough to get him into a scanner. Sam's stomach was in knots, not that she would disclose as much to the colleagues around her. When she was sure none of them would see, she surreptitiously interlinked her gloved fingers with his and gently squeezed. There was so much she couldn't say in that moment of touch, it forced tears into her eyes that she had to blink back.
When he was finally wheeled away, she knew there was more work to do in the ED, there always was, but she held up a hand to the nurse who came to ask her opinion on a patient in minors.
"Sorry, Kat. I need a breather after that resus case. I need – I need to call home, y'know?" Her tough façade was beginning to slip away, and the stumble over her words was the first outwardly noticeable sign. A lump was swelling in her throat that threatened to not only let loose a flood of tears but explode into a supernova.
Kat nodded sympathetically. "It's alright, I'll get someone else." The young woman pushed her glasses up her nose. "It's okay. Sometimes it just gets to you. If you need to talk, later?"
Sam made a small noise of assent, although she knew she could never have the conversation she needed with Kat, no matter how good friends they had become.
Her hands were shaking by the time she reached the garden where she'd previously seen the helicopter approaching. She was alone, so she could cry freely.
She hadn't seen Dylan in roughly ten years, yet seeing him so badly hurt with no justice in sight was enough to drag her back even further, to a time when he'd been the only star in her sky. Despite everything she'd done, he still might not make it. And she wasn't supposed to care so much – he was her ex-husband, her first ex-husband no less – but she couldn't help herself. They had been absent from each other's lives for a decade but the fact remained, he was her one safe harbour.
Granted, he was the safe harbour she had felt unable to turn to four years previously when her life turned upside down, but that had been her own shame rather than a belief that he'd refuse to help.
She had never been the praying sort, despite her parents' efforts to shove the Church of England down her throat from birth. But at that moment she wished she had something to believe in, some divine force to beg for Dylan's safety.
Internally, she gave herself a good shake. It was nearly five o'clock; Georgia was safe at Betty's for dinner but Sam had a feeling she'd be at the hospital much longer than her six-thirty finish that evening. She picked up her phone.
"Hello my love," came Betty's warm and reassuring voice almost immediately. "Everything alright?"
Sam wavered, almost bursting into tears afresh. "Um, no, no, not really... I'm not hurt!" she put in quickly, realising how she might have sounded at first. "I'm fine, I promise – just –" She let out a shaky sigh.
"You don't sound fine, my dear," Betty said sagely.
"No," Sam admitted. "Something's come up in the ED. A patient… It's someone I know. I think I need to be here – is there any chance you could put Georgie to bed tonight, please? I'm going to be late back, and..."
"Say no more. It's done, don't you worry, Sam."
"You're a lifesaver, Betty. Thank you," she said earnestly.
There came a hushed conversation from the other end of the phone before Betty's voice returned. "I've got a little one here who'd like to say hello. That alright with you?"
Sam took a deep breath through her nose and blinked back the blur of tears in her eyes. "Go on then," she murmured with a half-smile on her lips.
"Mummy!"
Her heart warmed on hearing her daughter's voice, gentle and unafflicted by the chaos of the adult world. "Hello, sweetheart. How was school?"
"Good – we made bird feeders to put in the playground, and I painted butterflies on mine only they got a bit smudged but Miss Hayward still said it was super special!"
Her excitement was effervescent and Sam couldn't help smiling with her teary eyes closed. Georgie was the most precious thing she had. "Listen, darling, Mummy's going to be late home tonight, I'm sorry. One – one of my friends has come to the hospital and he's very poorly, so I need to stay and look after him for a while. Okay?"
"Will you fix him, Mummy? Make him better?"
Sam looked up at the cloudy sky and swallowed down a sob. "I will do my best, you know I always do. I need you to be a good girl and go to bed at Betty's tonight, okay? I'll come home while you're asleep and I'll be there to take you to school in the morning. Betty's got our spare key so you can go upstairs for your pyjamas and Bumble." She glanced over to the automatic doors at the flicker of movement and saw Rehema waving over to her. "I have to go, Georgie. I love you."
"Love you too, Mummy. See you tomorrow!"
The line went dead, and for a moment Sam felt an overwhelming sense of pride for her daughter's confidence and willingness to adapt to any and all situations.
"Where's our RTC patient?" she asked as soon as she was within earshot of Rehema. As was normal with the pace of ED life, they talked while striding back in the direction of the department. "Scans all done already?"
Rehema nodded, her braids swaying in their ponytail. "Theatre took him straight away, he's not coming back down to the ED."
Sam winced. "That bad?"
"You can look for yourself, once we get back. Poor guy's a mess."
'A mess' was a fair assessment. Sam frowned in concentration as she assessed the scans, taking in every devastating injury. Somehow he'd escaped a major internal head injury, but that was about the only bit of him that had escaped. Ruptured spleen and extensive internal bleeding. Fractured ribs that had punctured a lung. Some kind of penetrating abdominal injury, she guessed from the car's bonnet ornament although she couldn't be sure. When she switched her view to the scans that captured his injured leg, she felt the ground shift beneath her feet. He'd be lucky to walk again.
"Sam?" Her Clinical Lead's voice cut through everything. He cracked a smile, not realising the gravity of the situation. "Not like you to lose your nerve over CT imaging!"
Bile rose in her throat. She abandoned the computer, turned on her heel and made for the nearest bathroom as fast as she could.
It was difficult to throw up while one's stomach heaved with sobs, but somehow she managed it, losing everything she'd eaten that day before crouching in the corner of the cubicle with the cuff of her hoodie clamped over her mouth to muffle her cries.