I watch my patent leather shoes as they tap against the floor of the principal’s office – an almost subconscious gesture on my part. I always fidget when I get nervous, and I’m definitely feeling nervous now. I have been waiting here for nearly five minutes now – the five minutes it has been since I was summoned from my eighth grade science class, when Principal Gordon’s secretary had knocked on the door and asked for “Miss Spencer” to come with her, only to deposit me here to await charges unknown. Something twists in my stomach, a sense of foreboding of what is coming. I have a suspicion on why I’ve been called here, but I don’t want to accept it yet. It couldn’t nearly be for anything so terrible as that.

Except that it could.

“Miss Spencer.”

Principal Gordon greets the floor as she enters the room, reluctant to look in my direction even though she acknowledges my existence. I watch her as she crosses to her desk – her stronghold of power – and seats herself. You can almost feel the wave of relief that radiates from her when she sits down. Even if it is only so small a gesture as defining that she is the principal and I am the student, this small exertion of control gives her comfort, although it gives me none.

“I am sorry to have pulled you from your class, Miss Spencer. But I think you know why you’re here…”

She is able to meet my eyes now. Her grey eyes exude pity. It’s not what I want to see. I see that she is waiting for a response from me, but I give none.

“Miss Spencer – Cadence,” she corrects, using my first name. This is not a good sign. “You know that your mother has been sick for a long time now…”

That was an understatement if there had ever been one. My mother, once so young, vibrant and joyful, has been battling breast cancer for two years now. Even though she claims to be fighting, it seems as though she’s given up. Ever since the doctors told her the cancer had spread to her brain and bones four months ago, I can no longer find my mother when I look into her eyes. I can no longer feel her when she holds me in her arms.

“Cadence, we’ve had a phone call from the hospital…”

Mrs Gordon looks away again, uncomfortable to be delivering the news someone else should be giving me – someone who knew and loved me. But everyone who does has already run away, unable to deal with the pain they were experiencing, let alone the pain I would feel.

So it falls on to Mrs Gordon to say the words, “I’m sorry, but your mother passed away.”

It turns out there is nothing you can do to brace yourself for those words. In spite of how they were anticipated, of how you had tried to accept that eventuality, when it finally happens, it hits hard. It shatters you, and you can feel yourself crumbling from the inside out. Everything that you ever was is gone, and without that, you don’t know where you’re going. Instantly, you’re lost and alone.

I don’t even notice that Mrs Gordon has left her desk, to wrap her arms around my shaking shoulders. I can’t even see her, as I bury my face in her woollen jacket, as sobs that I don’t understand but are emitting from me breaks the silence. She says nothing, and just waits for my tears to run out. She has to wait awhile. She doesn’t say anything when she leaves the room to call somebody to pick me up. I sit alone in her office, staring at my patent leather shoes – now not moving, but obscured by tears – until I am picked up by my Aunt Lauren – yet another relative whom I had only recently met, when we had taken my mother home to die.

I can hear Aunt Lauren thank Mrs Gordon, before entering the office. She finds me sitting there in silence, still staring at my shoes. I lift my head to look at her, but she doesn’t meet my eyes either. She just mumbles, “Come on, Cadence,” as she places her hand on my shoulder, my cue that it’s time to leave.

I don’t see my father that night, nor the next, even though I knew he was in the same house. I don’t go looking for him, and he doesn’t come looking for me. I am just shuffled through the collection of distant relatives, who cling to me as though it meant that my mother was still here. They keep whispering through their tears about how much I look like her – the same reason I expected my father avoided me now. Even though my temperament is more like dad’s, visually I was my mother’s daughter. Even I couldn’t look in the mirror just yet. How could I expect my father – whose only loves are his work and mum – to do so?

Two days after my mother died, I finally see him. He’s sitting in the lounge, staring at his feet, much like I do. He looks up when I walk in, and I watch as his eyes instantly fill with tears.

“Oh, Cady…” he mutters, before looking away once more.

I don’t know what to do – I don’t want dad to cry – so I leave. Whereas before I just wasn’t looking for him, now I am actively avoiding him. A trend that has continued to this day. Apart from the funeral, where the only time he spoke to me was to tell me he was going to go work overseas again, and I couldn’t go with him because I needed ‘stability’ at that point in my education, my father and I have not spent more than an hour in the same room as each other at a time. In fact, we’re lucky if we’re in the same country.

Flash forward fourteen years, and I’m still alone, hiding in my bed as I try to ignore the sunlight streaming through the window outside.

It turns out time never changes anything.

Beep, beep, beep…

I groan as I roll towards my alarm clock, uncomfortably close to me in this cramped space that my landlord insists on calling a room. More like a closet. Now that I’ve opened my eyes, it’s impossible to ignore the afternoon sunlight outside my badly covered windows. Not that I have the luxury of ignoring it now. It’s time to go to work.

I press my alarm clock with a little more force than is necessary, as I pull myself from bed. It makes that uncomfortable click – almost a crunch – as I do so, but I don’t bother to check and see if I’ve done any damage. I’d done worse. I skip ‘breakfast’ and head for the shower. My body has not yet adjusted to night shift, and I am yet to convince myself that six pm is an appropriate time for the first meal of my newly rearranged days. The hot water of the shower – the only thing in this apartment that I love – beats down on my shoulders, washing away the hung over feeling that sleeping during the day gives you. When I am finished, I quickly brush my hair and pull it back into a rough ponytail, unbothered to do anything more fancy with it. I throw on some random clothing, only briefly checking myself in the mirror to make sure I’m decent, and leave my apartment. I can feel my body groan as the unfiltered light hits my eyes as I make my way down the stairs. I can only imagine what other people on the street think of my wet, loosely tied hair and exhausted visage, as I pull myself down the street towards the train station.

I arrive at work early. I watch the other residents as they engage in the last-minute evening rush, trying to finish the small tasks that need to get done before handing over to the night crew. I struggle to find an unoccupied computer, and admittedly, the one I find may not be as unoccupied as I’m pretending it is. Someone’s logged in to it, their patient list and pathology results littering the screen. A web browser is open, and I feel the corner of my mouth pinch when I see it’s opened to Wikipedia. I am not impressed. I know we all joked about Wikipedia getting us through medical school, but I think we’re all far enough through our training that we should access a proper resource. I hurriedly quit out of all the windows, so I can claim ignorance that anyone else was using this computer when I found it. I open my own patient list and scroll through who is on our ward. Hopefully I won’t actually have to see any of them and they just sleep through the night. Knowing my luck, I probably won’t be on the ward, anyway. My pager sits uncomfortably on my hip, waiting to buzz and call my attention to whoever needs my help tonight. Most nights, it’s just ED patients with reflux, but occasionally a real case comes through. I feel my stomach tighten at the thought. I feel both thrilled and apprehensive. That’s the thing about our profession. We only have fun when someone else isn’t.

“Hey, if it isn’t Doctor Spencer!”

I turn around to face Rob. A cardiology resident like me, he’s all gangly arms and legs, his mop of dirty blonde hair bouncing as he loves over towards where I sit.

“Hey, Rob,” I reply, like I always do.

I lean back into my chair and fold my arms across my chest.

“Manage to kill anyone today?” I tease.

“Alas, no,” he replies, taking a seat on the desk.

“Anyone I have to be worried about tonight?” I ask.

He shakes his head.

“Mr Geddies has a bellyache, but apart from that it’s just our usual assortment of chest pains and crumbles. I think you’re good.”

My brows pinch.

“Bellyache?” I question.

“Yeah, nothing serious.” Rob smirks. “Old man is just constipated. I’ve written him up for some aperients. I’m sure he’ll feel much better after a good shit.”

“I know you would,” I quip.

Rob smiles.

“Who wouldn’t?”

I chuckle.

“Anything you need help with before going home?” I ask, and Rob shakes his head.

“Nah. Nothing that can’t wait until tomorrow.”

I raise an eyebrow at him. There’s nothing in our jobs that can wait until tomorrow. He rubs his hand across the back of his neck.

“…Think I might stay and complete some paperwork, though.”

I thought so.

Just then, my pager starts to buzz. It’s stuck on that annoying tonal version of Greensleeves again. I hurriedly press the button to make it stop. I could have sworn that I changed the tone back to beep beep beep yesterday. The damn thing must be possessed.

“So it begins.” Rob chuckles, and I sigh as I reach for the phone.

It’s over four hours later when I arrive back on the Cardiology ward. It’s always like that when you go to ED to see a patient. Even if the chest pain that you’re asked to see turns out to be nothing, when the other doctors spot who you are, there’s always a ‘while you’re here’ consult or two to deal with. I sigh as I spot the coffee pot in the corner of our office. I pull it from the machine and frown slightly as I swirl it around, before placing it back in the machine. Perhaps there will be fresh coffee on one of the other wards. I’m sure I’ll be called for a consult soon enough. I’ve given up on wondering where my registrar is. Paul is really only in the hospital as second-on-call, and I only call him if I need advice on something, or when the shit hits the fan. He’s really useful then. He’s currently studying for exams, and between that, work and study group, he needs every opportunity to sleep that he can get.

I leave our office and walk out towards the nurses’ station. There’s only a skeleton crew on at night – three nurses for the thirty patients on our ward. Two of them are sitting in the corner, playing cards, and the other one is reading a magazine. Hannah, one of the nurses playing cards, lifts her head and looks at me. Hannah’s a recent nursing graduate, and sometimes it shows. She’s probably my age, but still insists on wearing her straight platinum blonde hair in pigtails. She’s wearing blue mascara tonight and pale pink lipstick. I’m impressed. I can never be bothered putting on makeup for nightshift.

“Doctor Spencer.”

She stumbles as she stands from her chair and walks towards me.

“It’s Cadence,” I say, like I always do. I’m still not used to being addressed to as doctor, even though I’ve been one for three years now.

Hannah smiles.

“I was wondering if you minded going and checking on Mr Geddies. He’s still complaining of abdominal pain, even though we’ve given him the pain relief and aperients Doctor Francis prescribed.”

I rub the back of my neck.

“Yeah, sure.”

It wasn’t like I was doing much else. At least it was something to do to keep me awake. I walk down the ward to Mr Geddies’ room. Mr Geddies has been in hospital for nearly three weeks now. He had presented with an exacerbation of his heart failure, and had come in for medical management. However, whilst he had responded well to treatment, he had developed cellulitis of his leg, which we were now treating with IV antibiotics. If it wasn’t for that, he would have gone home weeks ago.

The lights are off in the four bay room, when I enter. I walk over to where the obs charts are hanging on the wall, pulling each of them out of their cradle in turn, until I find Mr Geddies’ chart. I squint at the number on the front, before walking over to the light switches and turning on the light for bay sixteen. I hear someone moan in response to this sudden entreaty of light. I walk through the curtain to find Mr Geddies lying in his bed, and I’m shocked when I see him. Normally when I saw him on rounds, he was a bright and cheery old man, but tonight he looks pale and sweaty. His chest heaves with every breath, and he’s holding a hand protectively against the left side of his abdomen.

“Mr Geddies?” I ask, as I walk towards his bed. “It’s Doctor Spencer. How are you feeling?”

Mr Geddies lifts his pale blue eyes to meet mine, and he tries to pull himself up in his bed. His face contorts and he groans, giving up.

“Doctor Spencer,” he gasps. “You are here late tonight, my dear.”

“Mr Geddies, what’s wrong?” I ask again, walking towards his bed.

I look down at his obs chart. I can see that throughout the evening that his heart rate has increased, but other than that, his observations are stable.

“Oh, it’s just this dratted pain, my dear.” He winces when he moves again. “Doctor Francis tells me it’s cause I’m all blocked up.”

Doctor Francis is an idiot, I think.

It’s obvious that something is very, very wrong. I grab the blood pressure cuff from the wall and wrap it around Mr Geddies’ arm and pull my stethoscope from around my neck and place it in my ears. I studiously inflate and deflate the cuff. His blood pressure is not elevated. In fact, for him it’s a little on the low side. I look into Mr Geddies’ eyes, as I listen to his heart. He looks far paler than I remember him, and there is a fine sheen of sweat on his face. When I do get to his abdomen, it’s dead silent. I gently press on it, and he moans loudly.

“I’m sorry, Mr Geddies,” I apologise. “But I have to touch to find out where it hurts.”

“It’s fine, my dear,” he insists, panting. “It’s just this silly old coot being a softie in his old age.”

Looking at him, I somehow doubt it. I try to get the rest of the abdominal exam out of the way, while inflicting the least pain I can. I don’t even attempt a rectal exam. If he’s this tender with light palpation, I hate to think what pain I could inflict by getting him to role onto his side. My eyes fall on the drip sited in his left arm, and I feel my mouth twist. Someone has felt the need to insert a 22G – so small we use them on kids – into his elbow. Surely they didn’t have to waste his biggest vein for something so small?

“Mr Geddies, I’ll be right back,” I promise. “I am going to get some stuff so I can put another drip in your other arm.”

“Another drip?” he asks. “Is that really necessary, my dear?”

“I’m sorry,” I apologise. “But I think you could really do with some fluids, and the drip you currently have is a little bit small for that. I also think we’re going to have to take a trip downstairs for a scan.”

“A scan?” he asks.

“I just want to see what is going on in your belly,” I reassure him.

“Oh, I’m sure it’s nothing,” he dismisses.

“I hope so, too, but I’d just like to make sure,” I say. “Can you humour me?”

He smiles.

“For you, my dear? Anything.”

I leave his room and walk back towards the nurses’ station. Hanna and Diane are still playing cards.

“Hannah, can you do me a favour?” I ask, distracting her from her game.

She lifts her eyes to meet mine.

“Yes, doctor.”

I sigh. I’m not going to correct her this time.

“Can you please go and get some equipment for a drip set up for Mr Geddies?” I ask. “I’ll put it in. I just have to make a phone call first.”

“Of course.”

Hannah stands and Diane follows her out, as they go and round up what I need.  I sit down at the nurses’ station, pick up the phone and page the surgical registar. I can feel my scalp prickle. My heart is racing and my stomach feels like it’s floating. That’s never a good sign.

Finally, the phone rings.

“Rajesh.”

“Hi, it’s Cadence Spencer here. I’m the Cardiology night resident,” I introduce. “I’m calling for a consult.”

“Well, you’re hardly going to be calling for anything else at this time of night,” he quips.

“I have Mr Ian Geddings. He’s a sixty-seven year old man who was admitted with exacerbation of heart failure and medical management. His symptoms of failure have improved, but his continued admission is for treatment of cellulitis of his left lower leg. He has a past history of hypertension, type two diabetes, ischaemic heart disease, peripheral vascular disease, and diverticulitis…”

“…Get to the point, Doctor Spencer.”

“Anyway, he presents tonight with acute lower left abdominal pain. He’s tachycardic but normotensive and afebrile. He is extremely tender to abdominal palpation with guarding…”

“When was the last time he took a dump?” he interrupts again.

I quickly look at his obs chart.

“About two days ago.”

“Rectal exam?”

“I didn’t do one. He’s in too much pain.”

“Then give him some analgesia and do it,” he snaps. “Don’t call me unless you’ve done a proper assessment.”

I can feel myself seething.

“I did do a proper assessment. I am worried about this patient, and I think he needs immediate attention.”

“And what do you want me to do about it?”

“Come and assess him,” I snap.

“You’re a doctor, aren’t you?” he quips.

I run a hand over my hair, exasperated.

“Look, I think this guy needs a CT scan and an immediate surgical opinion. I’m worried that…”

“You’re worried about what? He’s probably just constipated or has had a flare up of his diverticulitis,” he insists.

“I’m worried that he has a bowel obstruction, an ischaemic gut or a ruptured triple A…”

I hear Rajest snort down the line.

“Does he have a history of an aortic aneurysm?”

“Well, no…”

“And what’s the likelihood of him having ruptured a previously unknown triple A?”

“You haven’t seen this guy,” I insist. “He looks like complete shit…”

“Is that a proper medical term?” he asks. “Look, Doctor Spencer. How many years out of medical school are you?”

I sigh, but answer him anyway.

“Three.”

“Well, I’m seven years out,” he says, like that means something. “You wanted my opinion, and I’ve given it. It’s unlikely to be anything serious. If you’re really worried, get an x-ray of his gut and we can CT him in the morning.”

“But…”

“Goodnight, Doctor Spencer.”

He hung up!

I hold the phone away from me and stare at it in disbelief. He really hung up on me. I slam the phone down on the receiver, and Greta spins to face me, eyes wide. I take a deep breath in and out. Calm, Cadence. I pick up the phone and page Ryan. He sounds sleepy when he replied.

“Ryan here.”

“Ryan, it’s Cadence,” I say, trying to sound as calm as I can.

“Cadence. What’s up?” He sounds surprised.

“I think there’s something wrong with Mr Geddies, and I can’t get a surgical consult.”

“Mr Geddies?” he asks. He still sounds a bit vague. “The guy with the cellulitis?”

“Tonight he’s got abdominal pain. He’s tachycardic and his abdomen is rigid. I think something very bad is going on,” I say.

“Did you call for a surgical consult?” he asks.

“I did. He said no,” I reply.

“Who was it?” he asks.

“Rajesh.”

I hear Ryan sigh down the line.

“Look, Cadence,” Ryan says. “Do what you have to do. Go get your patient a CT scan. Put my name on it. I’ll call Rajesh.”

“Thanks,” I reply.

I really hate involving my senior in this, but I am really worried. I grab a radiology request form and hurriedly scribble a note on it. I’ll go and make my arguments to the radiologists once I stick a large drip in his arm.

I’m sitting on the colorectal ward, writing in a patient’s notes. I had to admit, when I was initially called to a surgical ward for a consult, I felt vaguely bitter. It didn’t seem fair that they could reject my consult, but I couldn’t theirs. As it turns out, their consult was justified. This little old lady that was day one post bowel resection had, in fact, had a heart attack. As soon as I’ve completed the paperwork, she would be moved to the acute cardiac unit for management.

Just then I hear Greensleeves start to play again. Dammit. I thought I had changed that. I look down at my pager, and I don’t recognise the number. I pull the phone across to me and dial. I’m surprised when Thom, my best friend Anna’s fiancé and also the radiology registrar on tonight, answers.

“Cady, where are you?” he asks. He sounds vaguely panicked.

“I’m on colorectal,” I reply. “Why?”

“I’m just looking at your patient’s CT scan. Cady, his belly is full of blood. He’s ruptured a triple A.”

I feel my stomach twist.

“Are you serious?”

“I’d hardly joke about that, Cady,” Thom replied. “How’s he doing? Are the surgeons involved yet?”

“They weren’t interested.” You can hear the fury in my voice. “I bet they’ll be interested now. Look, I gotta go.”

I hang up and I run. I really run. I grab onto the handrail and spin myself into the stairwell, bolting up the stars two by two, towards my ward. I call Ryan on the way and tell him what’s going on. He says he’ll be right there, and he’ll call ICU and vascular. I’m panting by the time I’ve climbed the two storeys to my ward. Hannah, Diane and Greta are sitting there having coffee. Why isn’t anyone with Mr Geddies?

“What are you doing?” I demand, leaning forward on my knees as I catch my breath. “I told you guys that someone had to be with Mr Geddies at all times?”

Hannah just blinked at me.

“I thought that was only til he got the CT.”

I’m astounded. Seriously?

“Well, I’m sure the CT scan made his ruptures triple A all better,” I say sarcastically.

I watch as the colour drains from Hannah’s face.

“Greta – call transfusion. Get a massive transfusion pack up here ASAP. Hannah – go get me the largest drip you can find. We have to put another line in. Diane – Dr Hastings, the ICU reg and vascular surgery will be here soon. Tell them where we are. I’m going to go check on Mr Geddies.”

It’s amazing how fast things can happen, when everyone realises what’s going on. Within the hour, we have two more large bore drips in, we’ve transfused eight units of blood, six units of fresh frozen plasma, and Mr Geddies is being wheeled off to theatre. Experiences like this are strangely dissociative. Your body knows what it’s meant to be doing, and does it. It’s like your mind, filled with all the terror and panic of the moment, has gone onto screensaver, to allow you to do what needs to get done. Your own personal feelings can wait until you have time to deal with them.

I’m sitting in the residents office, and my whole body is shaking. Adrenaline continues to rush through my veins, even though the stimulus is gone, and I’m finding it hard to focus. My mind just keeps running through the events of tonight, over and over, wondering how things could have gone so wrong?

Mr Geddies started complaining of abdominal pain two hours before my shift started. It was another eight before he made it to the operating table. That makes ten hours since his abdominal aortic aneurysm started leaking, and when they started to fix it. I’ve had a chance to look at his CT scan, and I can’t even estimate how much blood was in his abdominal cavity. Maybe Thom can help me.

But the thing was, he looked too well. I’ve never seen a patient with a ruptured aneurysm before, but shouldn’t he have looked sicker? His heart was just going a little bit fast. Don’t get me wrong – he looked sick – but he didn’t have the classical central abdominal pain radiating through to his back. I mean, I had thought of it, but did I really think that was what it was? There had been other things on my list of differential diagnoses above that. What would of happened if I didn’t know the radiology reg on tonight? Would my request have been rejected? Would Mr Geddies still be sitting on our ward, bleeding out into his stomach? Would he be dead by now?

“Cadence.”

I look up and I see Ryan standing by the door. His ash brown hair is skewwiff around his head, flattened on one side from where he had been sleeping. There’s a splash of blood on his shirt from when he had inserted Mr Geddies’ central line. I shouldn’t have been surprised that someone who did angiograms for a living knew how to put one in. He looks as drained as I feel.

“Dr Hastings,” I reply.

I watch as he crosses over to the lounge in the corner of the room, and collapses on it.

“Please, call me Ryan,” he says, and rubs his face. “I hate all that Dr Hastings bullshit.”

“How’s Mr Geddies?” I ask.

Last I had seen Ryan, he had been heading down to theatre. I didn’t know if it was a good or bad thing that he was back so soon.

“I’m guessing still on the table.” He rubs his hand across his face. “I didn’t actually go into theatre with him.”

My brow furrows.

“Then where were you?” I ask.

Ryan had been gone for at least forty-five minutes.

He grimaced.

“Tearing Rajesh a new one. That was just a complete fuck up on his behalf. Oh, no - ” Ryan leans forward onto his knees, when he sees my face twist in response. “Cadence, you did nothing wrong. That man would be dead by now, if you hadn’t done what you did.”

“He might still die,” I reply.

Even for in-hospital rupture of aortic aneurysms, the mortality rate was high.

“Well, at least now he has the chance to live,” Ryan insists. “Cadence, you did everything right. You should be proud of yourself.”

I just shake my head, unwilling to accept that right now. There must have been something I could have done to make all this happen earlier. Maybe I should have checked on him, when Rob said he was unwell when I arrived tonight. Ten hours is too long.

Just then, my pager buzzes.

Ryan holds out his hand.

“Here. Let me,” he says. “You deserve the rest.”

I shake my head again.

“Actually, I’d like to have something to do.”

I am wound up too tight, to just sit here and think about how I stuffed up. I stand and leave the room and head off to my next consult. Only three hours to go until this damned night is over.

It’s finally morning, and I’m sitting in handover, barely able to keep my eyes open, as I watch the interns, residents and registrars slowly filter into the morning meeting. I feel shattered, both emotionally and physically. I’m just glad that I only have two more night shifts to go, then I have a week off. I’m desperately in need for some ‘me’ time.

“Hey, Radelaide!” Rob calls. He looks far too happy for this time of morning. “How was the night?”

I lift my head and look at him with tired eyes. Can’t he just tell from looking at me, what a shit night it was?

“Hey, Cadence,” he says, concern in his voice as he comes and sits next to me. “What’s up?”

“Mr Geddies ruptured his AAA.”

Rob physically gasps in response. He rubs a hand across his face.

“Shit. Seriously? Shit.” He shakes his head. “Is he okay?”

I shake my head.

“I don’t know,” I reply honestly. “Last I saw him, they were rolling him off to theatre, but that was about four hours ago now.”

“Shit,” he says again.

Just then Ryan and Dr Phillips, our consultant cardiologist on the ward today, enters the room. They sit down at the head of the table and wait for me to give handover on the night’s patients. I do so diligently. At the end, we finally get to Mr Geddies, but Ryan interrupts me at the end of it.

“I just got a call from Andre letting me know that Mr Geddies died on the table,” he informs the group, though his eyes remain on me while he says this. “He detamponaded when they opened him up. Dropped his blood pressure for over half an hour before they got him back. Arrested while they were trying to close.”

The way Ryan says this sounds so clinically detached, but I know otherwise. He keeps eye contact with me the whole way through, his eyes trying to tell me it’s not my fault. I know he’s lying. He feels it too. I press my lips together and I tell myself not to cry, not here. People die all the time, and it would be the death of my career to show any weakness here. But I’m so tired…

The meeting ends after Dr Phillips delegates who is working where for the day. I stand to leave, by Rob tries to talk to me.

“Cadence…”

He grabs my arm when I don’t turn to face him.

“Cadence, I’m so sorry…”

I pull my arm away from him and shake my head.

“It’s not me you have to apologise to, Rob. And the dead aren’t around to hear your apologies.”

I know I shouldn’t be so rough on Rob, but I can’t help it. He was the first in the line of mistakes that had led to Mr Geddies’ death. I’ve been kicking myself in the arse about it all night. It was only fair that he had a share.

Rob doesn’t say anything else to me as I turn and leave the building. I’m glad I’ve brought a coat, because it’s raining. Part of the first autumn squalls in Melbourne. By the time I make it onto my train, I’m damp. I sigh as I shake myself off and take a seat. Peak hour is over, so there’s not a lot of commuters left on the train. At least that’s one good thing about night shift. I pull my mobile out of my bag, and I see there’s a message from Anna.

OMG Cady I hear about what happened are you alright?

I grimace. Thom’s evidently told her what happened. He probably spent the rest of the night stalking Mr Geddies on the computer, after checking his CT scan. It’s the only way he gets any patient contact now he only works in radiology. I don’t bother to reply and throw my phone back in my bag. Anna’s probably already at work, anyway, and any debrief she has planned can wait. I’m proud of myself that I haven’t cried yet, and I don’t plan on doing so until I’m safely in my own bed and can do so without people seeing me.

I can hear a horn blaring. It’s probably just a passing train. Why do they always feel the need to make noise when passing each other? My head is pounding, and the noise is making it worse.

Just then, the train shudders, and I am thrown out of my seat…

I am looking at the clock on the wall. Thirty minutes to go until home time. Well, at least if I manage to unload all of my patients by then.

“Hey, Harvey!” I call. “Wanna take my twenty-two year old chest pain?”

“Twenty-two?” he calls back. “Male or female?”

“Male.”

“Nah. Does nothing for me, mate.”

He chuckles. He’s joking, of course. Twat.

“Oh, come on, Harv,” I insist, walking over to where he sits in the nurses station in the centre of ED. “No med history, trops negative, ECG as clear as a bell. All nice and tidy. You just have to watch him until he can get his next set done, then you can toss him with some PPIs.”

“Sounds like a job for Card,” he replies. “I’m not getting lugged with your shit, Weinstein.”

“And where am I going to find Card half an hour before I’m meant to go home?” I ask. “Any other night, I’m happy to stay, but not tonight.”

“Looks like your luck may be in,” Harvey says and points across the ED. “Card.”

I turn my head and my eyes fall on a girl on the other side of the ward. She has golden curls held back by a ponytail, and she’s wearing a white pinstriped shirt over black slacks. She’s walking purposefully over towards the B side. She must be here to see a patient.

I pole-vault over the small gate separating the nurses station from the rest of the ED, and saunter over to where the cardiology doctor stands, collecting my patient’s chart as I go. I watch as she turns in a small circle. She looks vaguely confused.

“Hi,” I say, leaning in to her field of vision. I give her my best smile. “I hear you’re cardiology.”

Her pale hazel eyes narrow at me.

“If you didn’t call me, I’m not interested,” she says shrewdly, and I laugh.

“Alas, I didn’t.” I figure if I continue to be polite, she might accept my verbal referral. “I’m Noah.”

I watch as her face relaxes slightly.

“Cadence,” she replies.

“So, who are you looking for?” I offer.

She looks at a folded piece of paper, covered in scribble, in her hand.

“…Brian Laylor. Seventy-one years old. Male. Decompensated CCF,” she lists.

“Follow me.”

I sweep my hand in front of me and lead her to a computer. The black screen and green lettering of our, quite frankly, ancient operating system stares back at me. I do a quick sweep of the screen and locate her patient.

“Bed twenty-nine, B side,” I announce.

I turn to face her and smile. She gives me a faint smile in return.

“Thanks.”

“My pleasure.” Okay, now’s my moment. She’s in my debt. “But before you go, I was wondering if I could get your opinion on a patient…”

Her brows snap together. I don’t want to stop in case she says no.

“I’ve got this kid. Twenty-two year old boy, presents with sharp central chest pain. No risk factors, ECG and trop negative. I think he’s probably got gastritis, but he’s worried about his heart cause his father dropped dead of a heart attack at forty. I thought he was a perfect candidate for the Chest Pain Assessment Unit…”

She holds out her hand. Yes! I’m in! I hand over the chart, and she flicks through it briefly.

“How’s he saturating?” she asks.

“96%” I reply promptly.

She shoves his chart back at me.

“If he’s still got chest pain after you fix his pneumothorax, call me.”

“What?” I ask, following her as she walks off.

“Basketballer who runs marathons. Father dropped dead at age forty. Sudden onset of sharp chest pain…” she lists as she walks. “Oh, and the right axis deviation and decreased QRS amplitude.”

I squint at the ECG.

“That’s all a bit non-specific…”

She turns to face me and gives me the sweetest smile.

“Trust me.”

She sweeps behind the curtain and out of view.

“Hello, Mr Laylor. My name is Dr Spencer. I hear you’ve been a bit short of breath…”

I look back at the ECG and I can see it now. Fuck. I look up at the clock on the wall. It’s ten minutes til home time. Looks like I won’t be getting out on time after all.

I pull up to the hotel just before ten pm – almost an hour after I had promised I’d be here. The cardiology resident had been right. My patient did have a pneumothorax, and not an insignificant one at that. I felt stupid that the thought hadn’t even occurred to me until the hazel-eyed cardiologist had suggested it. It was all there in the history. Anyway, after the diagnosis had been made, he’d been easy enough to palm off. I doubted that you would find many ED registrars that would pass up the opportunity to put in a chest tube, and on any other night, I would be one of them. But not tonight.

Dee Dee was going to kill me…

I hand my keys to the valet, and place the tag he gives me inside my wallet. I walk into the lobby and look around. The room was all pale apricot marble floors and black marble benches. I’m sure the decorator screamed opulence, but it just felt kind of tacky. I walk around the large round table with the overly-large flower arrangement in the centre of the room and up to the concierge. He looks me up and down, disdainfully. In my navy jumper rolled up to my elbows and my old jeans, I probably look out of place at such a high-end establishment. I didn’t care.

“Checking in?” he asks with one of those put on posh accents.

“No.” He doesn’t look surprised. “I’m looking for someone. Deandra Lowry.”

He raises and eyebrow.

“I am sorry, sir. I am not at the liberty to disclose the names of any guests who may or may not be staying at this establishment.”

“She’s expecting me,” I inform him.

His smile is tight and false.

“Then maybe sir would like to contact her himself?”

I sigh and pull my phone from my pocket, and reluctantly call Dee Dee. She picks up on the second ring.

“Noah – where the Hell are you?” she snaps.

Shit. She’s pissed.

“I’m in the lobby. This lovely concierge here won’t tell me what room you’re in,” I inform her.

“I’ll be right down.”

She hangs up.

A couple of minutes later, I hear the ping of the elevator. I watch Dee Dee and her entourage exist – two large muscled security guards with the mandatory wrap-around sunglasses, ear pieces and tight white T-shirts. I sigh as I watch Dee Dee approach me. It’s been nearly a month since I’ve last seen her, and her looks have undergone yet another transformation. She has a straight blonde weave that hangs down to her waist that looks awfully artificial when contrasting against her latte skin. She’s wearing large gold hoops that match her gold lamé pants – which I don’t care how famous you are, never look good – and a tight black mini tee circa Olivia Newton John in Grease. It’s been a long time since Dee Dee was that scrawny teenager with the halo of tight curls that I had fallen in love with.

I walk across the marble floor to meet her half-way and wrap my arms around her tightly. I’m thankful to find that even with her sky-high black pumps, that I’m still taller than her. I throw in a kiss, just to show that I can, before turning back to the concierge. He looks dumbstruck.

“Oh – so now you’re all happy to see me,” she says.

Yup. She’s still pissed.

“I got caught up at work,” I mumble.

“You always get caught up with work,” she snaps. “Isn’t seeing your girlfriend more important?”

“I did try to get out on time,” I insist, not that she cares.

We walk back to the elevator that one of her body guards holds open for us. I flinch as the doors close behind us. I’m still not used to Dee Dee the pop star, and I found all the extra attention she had now a bit overwhelming. Thankfully, once we reach her suite, we are able to leave her body guards behind. We walk over to the large L-shapes lounge, set in front of a modern fireplace. Even though it was only just autumn, it was lit. I turned back to Dee Dee, who looked uncomfortable where she sat on the couch, and smiled.

“I’ve missed you,” I say, and I watch the irritation melt from her face.

“I’ve missed you, too.”

I lean across and kiss her gently on the lips. She smells of a mix of expensive perfume and hair spray, and I smile. I pull away and reach up to brush a stray strand of hair behind her ear, and she smiles coyly in response.

“How long are you staying for this time?” I ask, and I watch as the smile falls from her face.

“Just til tomorrow,” she informs me.

I feel my stomach twist.

“So soon?” I ask.

“You’re lucky I’m here at all,” she snaps. “You know how hard it was convincing my agent to allow me to stop by Melbourne on my way to Perth? There’s not exactly a lot of free time on promotional tours.”

I sigh and lean back on the couch.

“I know. But can’t you make your stop-over just a little longer?” I ask hopefully.

She curls up beside me and snuggles into my chest.

“I can’t. I have a mall appearance tomorrow afternoon in Perth. Besides, how much extra time would we get, seeming you’re always working?”

“You say that like it’s a dirty word.” I look down at her. “Most girls wouldn’t complain that their boyfriend saves lives for a living.”

“Most boys wouldn’t complain that their girlfriend is a pop star,” she replies, and I squeeze her shoulders.

“I’m not complaining,” I insist. “It’s just hard that we don’t get to see each other very often anymore.”

This whole situation still feels so surreal to me. It was really only two years ago now that Dee Dee quit her job as a make-up chick at Myers and decided to compete on The Voice. I knew she was a good singer, but I never really believed at the time that she’d get very far in the competition, let alone win. Five platinum singles later, and she now splits her time between Sydney and Los Angeles, where she’s trying to crack into the American market. And with me stuck here in Melbourne, it seems like the only time I get to see her these days is on Skype or the cover of a magazine.

Dee Dee just snuggles into my chest for a moment, before pulling herself up to look at me.

“You know, one day one of us is going to have to make a decision on where this is going,” she says seriously. I feel my stomach clench.

“I know,” I whisper, meeting her rich brown eyes with my own. “But it doesn’t have to be today. Tonight I just want to make the most of the time that I have you.”

Dee Dee smiles that just-for-Noah smile, before she leans in to kiss me once more. This kiss is different from the others that we have shared tonight, full of pain and longing, and I know that’s as much as we’re going to talk tonight.

I am surprised that I’m able to make it to work on time the next morning. I’d forgotten that seeming I slept at Dee Dee’s hotel last night that I didn’t have an alarm clock. Had I remembered, I would have set one on my mobile. I only had enough time in the shower to wash the bare essentials, and even without looking at my hair in the rear-view mirror, I knew it would still have that just-fucked look. Dammit.

I scoot into ED just in time for handover. It was just my luck to score a late/early on the one day that Dee Dee is in town. Harvey’s eyes widen as he takes in my dishevelled appearance. He gives me a subtle thumbs up and mouths ‘Noice’. Fucker.

“Weinstein,” Smith announces. “You’re taking Harvey’s patients on A side.”

Where was Smith last night when I had people to hand over? Smith was one of the more organised ED consultants. Others might call him dictatorial, but I actually enjoyed his regimented discipline. Made handover much simpler when there was none of the bartering of patients that inevitably happened after handover. Just didn’t seem fair that he’d chosen me to take Harvey’s patients when he had rejected mine the night before.

The handover crowd slowly dissipated and Harvey walked over to where I pulled my scrubs top from my backpack and pulled it on over my head.

“Have a late one, huh?” Harvey asked.

“A gentleman never tells,” I respond.

He smiles.

“Doesn’t exactly look like you were doing very gentlemanly things last night.”

He reaches out to touch my hair, and I pull away from him. Harvey was one of the very few people in the department that actually could reach my hair. I had a sneaking suspicion that our matching height was probably one of the reasons that we were always paired up.

“Fuck off,” I say, but my eyes are smiling. “So anything to handover?”

“You are in luck, my friend.” He chuckles. “All my patients are already accepted and just waiting for beds – including my expertly placed chest tube.”

“Rub it in, Harvey.”

I roll my eyes at him.

“I forgot to say last night – nice pick up on the pneumothorax, Weinstein.”

He nudges my arm.

“Thanks,” I say, rubbing where his bony elbow had struck me.

I wasn’t going to tell him that is was actually the cardiology resident who had thought of it in the first place. I’d been the one to order the x-ray and diagnose it.

“Anyway – adios!”

Harvey waves at me and leaves. I sigh and walk over to the last spare computer in the department and look down at the list of patients. I scroll through each patient that had Harvey’s initials next to their name, just to double check that they had all been admitted. It wouldn’t be the first time that I was caught out with a patient who had somehow fallen through the gap of being accepted by a team and actually getting admitted, but thankfully that hasn’t happened today. I pull my backpack over my shoulder, before walking back towards the staff room. I had to wait until there was actually a bed with a new patient in it before I could actually see anyone. We always said that A side stood for admit and B side for bounce. Seeming I’m on A side today, it generally meant that you got less patients, but they tended to be more complicated. I have to admit I prefer working on B side. There’s nothing more satisfying than setting a broken limb or sewing some drunk back together, although you did have to endure all the common coughs and colds that also infested that side. I lock my back in my locker, and for the first time that morning, I get a proper look at my hair.

Fuck. It’s standing up at every which angle. I run my fingers through it, hoping that would settle it down, but if anything it’s made it worse. I have a beanie in my bag, but I’m sure that Smith wouldn’t be impressed. We have a fairly easy dress code here in ED, but I’m sure that beanies are still out. I walk over to a tap and stick my head in the sink. I splash some cold water on my hair, which makes my body physically shudder, before I stand again. This time my hair stays where I tell it to when my fingers run through it. I’m yet to decide if this is an improvement or not, when I hear the call over the intercom.

“All medical staff to A side now. All medical staff to A side now.”

I physically bolt from the locker room and run towards the nurses station. There’s a crowd of doctors and nurses. None of us look like they know what’s going on. I watch as Smith forces himself to the front, and I’m surprised when he hops up on the desk to face us.

“Listen up!” he bellows, and instantly everyone falls quiet. “I’ve just received news that there’s been a rail accident. Commuter train versus minivan. I don’t know the details and I don’t know the number of casualties, but I have been informed that there have been fatalities. We’re going to need whatever available staff to go to the scene and help with rescue efforts. Is there anyone here without any patients?”

Fuck. A train accident. I hesitantly raise my hand, along with two residents and another registrar.

I watch the corner of Smith’s mouth twist. He’s not happy with the turnout.

“Weinstein, Holland. Grab a jacket. You’re off to scene. Lang, I want you out there. Hand over your patients to Rosenberg. Archer, you take Badge’s.”

Fuck I’m going to assist in recovery at a train accident. Already my heart is pounding in my chest. Am I ready for this? The nurses are being briefed at their station, and I watch as a small group of them are also being formed for the recovery effort.

We’re lead out of the emergency department, and I’m surprised when we’re each handed a navy blue jacket with a high visibility stripe across the back. My fingers run over the embroidered logo of our hospital with the words ‘Emergency Retrieval Team’ written under it. I had no idea they existed before. We’re piled into the back of an ambulance, and I listen as the sirens start to sound. I have to hold onto the railing when it accelerates. Lang falls into me, and I help her back upright. I look around at our colleagues. None of us says a word. They all look as anxious as I feel.

I’m surprised how quickly we make it to the scene. I’m even more surprised by how many people are there. Police, firemen and paramedics swarms around the scene, already sifting through the wreckage. There are three bodies lined up under black tarpaulins. I feel my stomach twist. Fuck.

“Weinstein,” Badge calls.

I turn around, and he hands me an emergency pack from the back to the ambulance. Damn, it’s heavy. I pull it up on my shoulder and watch as he hops out of the ambulance and pulls his own pack onto his shoulder. Together, we walk as a group to the flimsy tent that has been set up as ground control.

A guy wearing yellow fireman overalls walks over to us at our approach.

“You the team from Prince George?”

Badge nods. Good. At least one of us is taking control.

“You guys are on search and triage,” our fireman informs us.

He starts passing out paper bags. I sneak a look inside, and see tags of five different colours – white, yellow, blue, red and black.

“White tag means patient has minor injuries,” he informs us. “Yellow means injuries that will require a trip to hospital. Red means serious injuries and black means dead.”

“What does blue mean?” I ask. The words are out before I know I’ve said them.

Our firearm meets my eyes.

“It means they’re going to have a black tag soon enough.”

Fuck.

“Your job is to go and triage the people you find. Tag them, provide whatever first aid you can and call for help. I’ll get my people in there to help with retrieval. When they arrive, move on. Don’t bother staying with the blue or black tags.”

“You want us to leave them behind?”

I turn my head to face Lang. At least I’m not the only one worrying about that.

“Blue tags are going to be black soon enough,” he says flatly. “Don’t waste your time with them and risk someone else joining them.”

“Do we know how many people are on the train?” Holland asks.

The fireman shakes his head.

“Not a lot. Maybe fifty or a hundred. We’re lucky it didn’t happen an hour earlier, or we’d have a lot more casualties.”

Not a lot? Fifty or a hundred sounded like an awful lot of people to me. I looked around the scene, and I was sure there were at least thirty people here to help.

The briefing didn’t last long after that, and I found myself being shuffled from the tent and towards the wreckage. My radio hung heavily from my belt, but nothing weighed my down as much as the bag of tags I’d placed in my jacket pocket. Who was I to decide who lived or died? I’ve only been a doctor for five years, for God’s sake. My job is to save lives, not condemn them. My heart feels like it is sitting in my throat as I approach carriage seven, the one that I’ve been delegated. It is lying on its side, and I need the help of one of the firemen to pull me up onto its side so I can get in through a window. The escape hatch on the ceiling was crushed too small to allow me entrance. I am surprised when I am lowered into the cabin that I’m the only one in here. What happened to the thirty rescuers? Admittedly, this was the last cabin, and it seemed fairly empty. Well, at least empty of the living. I come across my first passenger on accident, when I walk on them. I jump backwards when I stand on their arm, and almost fall over in the process. I quickly lean down and shove the remains of a chair off them. It was a young guy, probably about the same age as my pneumothorax patient. His brown eyes are glazed and stare off into eternity the way only the eyes of the dead do, but I still check his carotid for a pulse. There is none.

I sigh and close his eyes, before retrieving a black tag from my pocket and attaching it to his wrist. I unclip my radio from my belt and lift it to my mouth.

“This is Prince George Seven. First black tag carriage seven. Over.”

There’s static for a moment, before there’s a reply.

“Received, Prince George Seven.”

I stand before looking around the cabin again. All I can see is the twisted metal and plastic of the hand rails and chairs. Was my black tag the only one in this cabin? My head spins around until I catch the flash of gold in the corner of the carriage. It’s difficult crossing the sideways carriage with my heavy pack, but I eventually manage it. The hint of gold was the light reflecting of a woman’s hair. Golden curls that have escaped her ponytail frame her round face, a trail of dry red blood runs down her forehead. She’s pinned into a seated position by a hand rail that has somehow manages to pierce her abdomen. I’m about to reach for another black tag, but then I see her chest heave. Fuck. She’s still alive.

“Hi. Can you hear me?” I call out, and reach across to touch her shoulder.

She groans.

“My name is Dr Weinstein. I’m a doctor from Prince George’s.”

I’m surprised when she chuckles.

“So am I.”

Slowly her eyes peel open, and I’m greeted by a pair of pale hazel eyes.

Fuck. It’s cardiology.

I search my brain, but I can’t remember her name. What the fuck is her name?

A pained smirk crosses her face.

“Doctor Weinstein,” she says, and I feel my stomach twist. “So did you boy turn out to have a pneumothorax?”

Fuck. It’s the cardiology resident, impaled inside a train wreck, and she still remembers my pathetic excuse for a consult last night. She’s looking at me, and from the way her head wobbles, I can tell it’s a struggle for her. I have to give her an answer, something. I pull all the bravado I have before answering.

“Sure did. Thanks for the chest drain. I needed the practice.”

She shuts her eyes for a moment and smiles.

“Did you still want a cardiology consult?”

Is she seriously cracking jokes at a time like this? Maybe I’m not the only one with that coping mechanism.

“I think he’ll survive,” I reply. If she can keep things light, then so can I. “First we gotta check you out. Really made a mess of yourself, haven’t you?”

She chuckles. It sounds vaguely like a gurgle. She pulls her eyes open again.

“I trust your judgement, doctor.”

I pull my pack off my shoulder and open it. I’ve been through them enough in training to know where everything is. Hell, I’ve even given that teaching session to junior staff before. But what the fuck am I meant to do with her? The tags in my pocket weigh heavily, and I can see the colour blue behind my eyelids when I blink. Fuck that. She’s still talking. That makes her a red. I’m sure the firemen can do something about detaching the pole. If we can just get her to surgery to have it removed, I’m sure she could make a fairly good recovery.

I pull the radio from my belt again, while I’m facing away from her to make the call.

“This is Prince George Seven. Red. Red in carriage seven. Over.”

I wait for the reply. Why the fuck is it taking so long?

“Received, Prince George seven.”

“Do we have an ETA on rescue?” I ask.

More silence.

“Fifteen to thirty, Prince George seven.”

Thirty minutes! I glance back towards cardiology. Is she going to last thirty minutes? It’s amazing she’s lasted the nearly two hours since the accident.

“I said red,” I remind them.

“Still fifteen to thirty, Prince George seven. There are another three reds before you.”

Fuck.

“What’s taking so long, Noah,” cardiology calls.

Fuck. She remembers my first name. I heard both of her names yesterday, and I can’t remember either.

I turn around to face her.

“So which arm would you like your fourteen gauge, doc?” I ask, pulling back on the tourniquet so it makes a loud twang.

I watch her lips twist into a smile.

“Whatever arm you don’t think you’re going to miss.”

“Give me a little bit of credit,” I tease. I crawl over to her side and wrap the tourniquet around her arm. “I do do this for a living. When was the last time you had to put a large gauge in, cardiology?”

Good. At least that sounds teasing.

“Last night,” she replies. “He died.”

Fuck. I didn’t expect her to say that. So much for trying to keep things light.

“I’m sorry.”

I wash her arm and pull back on her skin to keep it taught.

“Busted triple A,” she continues. She doesn’t even twitch as the cannula pierces her skin. “Didn’t even know he had one. My colleague was treating him for constipation.”

I withdraw the needle and put it in the sharps bin and attach the bung. I don’t know what to say. Working in the emergency department, I knew what it was like to have a patient die. Even if it was expected, it hits you hard. Any doctor who says any different is lying.

“I guess we all make mistakes,” she mumbles. She watches me as I attach the bag of fluids and sit it on the chair beside us. “Sort of funny that I’d be joining him so soon, though.”

I freeze.

“Don’t be stupid,” I reply. “You’re going to be around to kill a lot more patients yet.”

She laughs.

“Has anyone ever told you you’re a crappy liar?”

She lifts an eyebrow at me.

“Well, I’m not a crappy doctor,” I quip. “And I’ll be damned if you ruin my track record.”

Cardiology remains quiet and watches me as I insert a drip into her other arm, before completing my primary survey. The pole piercing her abdomen is not the only thing I have to worry about. Her left leg has been crushed by debris, and the puddle of blood oozing from it has reached my pants. I swear and shuffle back slightly, leaving a smear of blood behind me.

“What’s the matter, ED?” she asks when I swear.

Why is she calling me ED? Has she realised that I don’t know her name? Is she teasing me?

“Your blood is staining my pants, Cardiology,” I reply, trying to sound teasing. “Mind if I fix that?”

“Go for your life,” she says. “Or mine. Whichever you like.”

I shake my head. How can she keep cracking jokes like that? I unpack my emergency bag further. There’s not a lot of artery clamps in the back, and I’m not sure that I have the access to use them, anyway. Cardiology is already through her first bag of colloid, and by the way that the puddle on the floor is spreading, I know that she’s losing more than she’s gaining. I can see the tourniquet. Not the little one we use for venepuncture, but the big one for amputations. Is that really my only option? Am I really going to risk her leg?

Stuff that. If I don’t use that, I’m risking her life Cardiology watches me as I unwind the tourniquet and wrap it around her leg. I pull on it as tightly as I can before tying it off. She doesn’t so much as flinch. I pull another back of colloid from the pack and attach it. I’m glad to see the puddle has stopped increasing.

“Any analgesia take you fancy?” I offer, but she shakes her head.

“Doesn’t hurt.” I watch her brows twitch slightly, before she continues in a smaller voice. “I just feel cold.”

“It is a bit chilly,” I reply. “Winter seems to be coming early this year.”

Cardiology lifts her pale hazel eyes to meet mine once more. I can see that she knows I’m bullshitting.

“Noah,” she says softly. “What’s my name?”

I blanch. Fuck. She has noticed. I search my brain, but I still can’t find it. My mouth opens and shuts like a fish. She grins, shuts her eyes and nods for a moment.

“It’s Cadence,” she supplies.

“Sorry,” I mumble.

“It’s okay,” she replies. “I find it hard remembering all your names, too.”

“You remembered my name,” I pointed out.

“I wonder why that is?” she muses.

“I guess I’m just a memorable guy,” I quip.

She remains silent.

“Cadence?”

I reach across and nudge her gently, but she doesn’t reply. I place my hand on her chest, but it isn’t moving.

Fuck.

I yank the defibrillator out of the pack and attach the pads to her chest. I don’t know what I’m going to do. If her heart has stopped, I can hardly shock her. We’re surrounded by metal. Hell, she’s pierced by it. And as she is currently propped upright, it’s going to be damn near impossible to do chest compressions. I’m relieved when I see a trace of a heart rhythm on the monitor. It still doesn’t mean she’s perfusing her brain, though. I quickly reach across and place my hands on her chest and begin to rock backwards and forwards, thrusting as hard as I can against her chest. I’m relieved when I feel her chest rise and fall, and the accompanying gasp. But it’s not followed by another breath. I yank the tank of oxygen out of the pack, and insert the nasal prongs and turn it up full blast. I know apnoeic oxygenation is not part of the ALS guidelines, but I don’t give a shit. I can’t do my half-assed version of compressions and ventilate her at the same time. It’ll do.

“Prince George seven!”

I twist briefly, and see a head poking through the window I had entered through. I continue my compressions.

“In here!” I call. My voice sounds harsh from the exertion.

I hear two gentle thumps behind me and I’m joined by the rescue team. Neither of them say a word. I twist around again and see it’s Badge and someone I haven’t met. From the green uniform, I’m guessing it’s a paramedic.

“She’s just stopped breathing and she’s in PEA,” I huff between compressions.

“She’s blue,” Badge says.

I look up briefly at Cadence’s face.

“She’s not. She’s pink,” I insist.

“No, Noah. She’s a blue tag.”

“No.”

“Noah…”

“Badge,” I grunt. “She’s one of us. She’s our cardiology resident.”

I’m relieved when I hear Badge kneel down next to me and begin to pull things from the bag. He kneels next to Cadence and tips her head back briefly. He’s holding a laryngoscope and a tube. Thank fuck.

“Fisher, call base. We’re going to need the jaws of life in here ASAP.”

“But she’s blue,” the paramedic challenges.

“She’s blue when I say she’s blue,” Badge snaps. “Now make the call.”

It’s day three post-accident, and from all accounts, I’m lucky that I’m here to see it. Apart from the fact than I’m missing the majority of my left leg and my spleen, supposedly I’ve come through being impaled in Australia’s largest rail accident in the past decade pretty well. Oh, apart from the fact that I can’t feel or move anything below my ribcage. Can’t forget about that, now can I?

I have to admit, I didn’t really have a lot of experience with Neurosurgery until I ended up under their bed card. I never did any placements there as a student or intern, and seeming I’m now in Basic Physician’s Training, I had thought that I never would. But even with the limited knowledge I have on the topic, I know that the team are being overly optimistic about my prognosis. The seventy-two hour window has already passed, which means that I have effectively a zero percent chance of regaining any sensation, let alone being able to walk again.

I feel myself grimace – walking. I crane my head to look down at my stump – all that remains of what used to be my left leg. When I was an intern on vascular surgery, we had a lot of amputees on our ward. I still remember talking to the allied health staff about limb prostheses. Supposedly, it was more difficult learning how to walk again with an above knee amputation than it was with a below knee, but if you started young enough, it was possible to learn to walk unaided. It seemed like a bit of a moot point to worry about it now.

I lift my hand and rub it across my abdomen, just to remind myself that it was still there. It was more than slightly disconcerting, being unaware that the rest of your body existed. My hand reaches the edge of the opsite that covers my surgical incision, and I flinch. I don’t really want to be touching that. Mr Collins, my general surgeon, tells me that it was quite difficult removing the metal pole from my abdomen. They had to incise me from just under my sternum all the way around to the left. I’m sure it is going to leave a very impressive scar.

It’s quite interesting switching from doctor to patient. In fact, I think a lot of my treating physicians forget that I’m no longer a colleague when they address me. Maybe that’s why they go into all the nitty gritty details when discussing my progress with me. I don’t think the realise I find it so distressing. I don’t really want to know that I had half an hour of CPR whilst I was still on the train, nor did I want to know about the volume of blood I lost, what my liver looked like or what volume of urine output I’ve had today. It’s just so much different when all the numbers they’re quoting are your own. The fact that I actually understand what they mean just makes it all the more frightening.

I turn my head to the left and spot my window sill. It’s covered in bunches of flowers, making it difficult to see the view beyond it. At least it gives me some natural light. I missed it while I was in the ICU. I look over towards the clock on the wall. It’s nearly two pm. I wonder where Anna is? Anna promised to visit me on her lunch break, which was supposedly an hour ago. Not that it’s easy to predict when your lunch break is actually going to be when you’re working on the Labour and Delivery suite. She’s probably caught up in some delivery or another. Either that, or in theatre. I’m sure she’ll get here soon enough.

Anna has been my best friend ever since we started medical school. Tall and slim, with straight pixie-length ash blonde hair and scarily blue eyes, she’s about as different from me as you can imagine. She enjoys wearing flowing skirts and heavy beads, and she’s been vegetarian for as long as I’ve known her. We actually met on the first day of med school. I was always perpetually early for everything, and had turned up about twenty minutes early. I still remember wondering if I should hand around outside the lecture theatre or go sit inside and wait for orientation to start, when this hippie walks up and asks me if this was where orientation was. Anna had been going through a hard-core alternative stage back then, and sported dreadlocks and a nose ring. Thank God she had grown out of that before we started clinical placements! The second person I met that day was Mark, but I don’t want to think about him…

Just then, there is a knock and someone pulls back the curtain to my bed. There stands a man wearing blue surgical scrub top over jeans. He has tightly curled chestnut brown hair that hangs to his earlobes, and a faint shadow of stubble. He also has these piercing ice blue eyes, and I feel myself freeze as I’m thrown back to the last time I’d seen him. At the time, he’d been trying to avoid staining his pants with my blood.

“Hi, Cadence.”

I watch as he reaches up and rubs the back of his neck. He doesn’t meed my eyes. I feel myself swallow hard.

“I’m sorry,” he mumbles. “I know you probably don’t want me here…”

“No,” I interrupt. I would pull myself up, but I know I’m not meant to sit at more than a fifteen degree inclination at the moment. “I’m sorry. I’m just surprised you managed to remember my name this time.”

There it is – the hint of a smile – and Noah finally manages to lift his eyes to meet mine. He comes and sits down in the unoccupied guest chair, to make it easier for me to see his face.

“I’m hardly likely to forget it after the last time you reminded me,” he teases, and I feel my stomach twist. “So how are you doing?”

“Well, my haemoglobin is a hundred and twelve, by blood pressure is steady at 100/70. I’m asplenic, I’m missing my left leg and I have no sensation or motor function from T7 down,” I supply.

He lifts an eyebrow at me.

“I mean, how are you really doing?” he challenges.

I’m stunned. He’s the first person to ask me how I’m really doing. My doctors just keep quoting numbers at me and telling me that I’ll get over this, and my friends have all just been devastated and projecting their feelings on me. I don’t really know what I’m meant to say.

“Pretty shit,” I finally manage to supply, and as ashamed as I am, I can feel tears start to burn in my eyes.

Shit. I don’t want to cry in front of a guy I barely know and who has seen me at my most vulnerable. I turn my head away from him quickly.

“Hey,” he says. I’m surprised when he reaches out and takes my hand. “It’s all a little bit overwhelming, isn’t it?”

Why hasn’t he told me that it’s all going to be okay, like everyone else does? He’s encouraging me to be too honest. Everyone else who visits is upset enough that I’m usually the one that needs to be strong for them. I breathe in, and oh God, it sounds like I’m about to sob. Noah’s fingers run across the back of my knuckles gently.

“I’m okay,” I insist.

“Of course you are,” he replies.

We sit in silence for a few moment, while I regain control of myself. Eventually, I think I’ve got a handle on my emotions and I turn back towards Noah. When he sees my face, he withdraws his hand from mine and leans back into his chair.

“So,” he eventually says. “While I’m here, I was wondering if I could get your opinion on a patient.”

I know what he’s doing, and I can’t help but smile gratefully.

“Oh, so that’s why you’re here?” I tease. “So you can get me to do your job for you?”

He chuckles and folds his arm across his chest.

“Of course. Seeming you did such a good job of it last time,” he says. “Besides, I think you owe me one.”

This I can deal with, this playful, teasing banter. I guess I was a bit of a shit when he last asked for my opinion.

“I guess I do,” I reply. “So what is it?”

“You see, there’s this guy,” he says, leaning in towards me. “Young fellow. Twenty-eight years old…”

“Pneumothorax,” I interrupt, and he smiles.

“Not this time,” he clarifies. “Anyway, this guy is a bit of a kinky bastard. Has this bad habit of inserting things into his anus…”

“I really don’t need to know about your personal habits, Dr Weinstein.”

I’m grateful when he laughs. I never know how far to push a joke.

“Alas, Dr Spencer, I’m not that interesting. Anyway, this guy particularly likes inserting toys into his anus. Specifically, McDonald’s toys…”

“No!”

Noah smiled.

“Would you like to see?” he asks.

I nod, and he pulls his chair closer to my bed and pulls out his mobile phone. He fiddles with it for a moment, before turning it to face me. And there, in the abdominal x-ray, is Snoopy. I reach across and take the mobile from him to have a better look.

“You know what the funniest bit is?” he asks. “Reading the radiography report. They’re not allowed to say what the foreign body is without confirmation, so it reads like – there is a Snoopy-like object located in the patient’s rectum…”

I laugh.

“I think you might be better sourcing a surgical opinion for that one,” I say, and hand the phone back.

Noah is smiling at me, and for the first time in I don’t know how long, I’m truly smiling. Not the brief, superficial smiles that you give in response to social interaction, but a truly happy smile. I don’t know why Noah decided to visit me today, but I’m glad he did.

Noah quickly retrieves his mobile and deposits it back in his pocket, when we’re joined by Anna. She’s still wearing a blue hair net and matching shoe covers, having evidently come from theatre. She looks from me to Noah and back again.

“Oh, Cady. I’m so sorry I’m late, but I was assisting in a C-section…”

“It’s okay,” I insist.

Noah stands as she walks over to the bed.

“I’ll check back on you alter,” Noah promises. “That’s if you don’t mind, of course,” he adds.

“I’d like that.”

I smile at Noah again, and he turns and leaves. Anna has to stand to the side to allow him past, before she goes and sits in his recently vacated seat.

“Who was that?” she asks, twisting back in the direction that Noah left.

“That’s Noah,” I reply. “He’s one of the ED docs.”

I don’t know why, but I don’t tell her that he’s the one that found me in the accident, and probably the only reason why I’m still alive now.

“He seems nice.”

For some reason, there seems to be a hint of subtext in her voice.

“No,” I reply.

“What?” she asks too innocently.

“No, Anna,” I insist. “There is nothing like that going on between us.”

“Oh, come on, Cady. Live a little. It’s been – what – nine months since you and Mark broke up? Isn’t it about time you got back on the horse?”

“I hardly think now is entirely the right time to be thinking about those sort of things,” I snap.

God, what was she thinking? I only have one leg and I’m paralysed. I have no control over my bowel or bladder, and you can see the bag on the edge of the bed that my urine is draining into, with a matching wound drain filled with blood next to it. I have never felt so unattractive in all my life.

“Besides, I’ve only met Noah twice before today. For all I know, he’s married.”

Anna looks submissive.

“Cady, I’m sorry… I didn’t think…”

I just shake my head at her.

“Don’t worry about it,” I insist.

“So how are you doing?” she asks, her eyes full of concern.

“Still paralysed,” I reply.

My good mood from before is quickly slipping away.

“I’m sure it’ll come back,” she insists.

I feel my veins fizz. Her trying to tell me that everything is going to be okay is not exactly helping. In fact, it irritates me. I just try to take a deep breath in and out. I know she’s just trying to be supportive. I’m not going to get angry at her for it.

“So anything interesting happen at work?” I ask, trying to change the topic.

She shakes her head.

“Nothing I really want to talk about.”

“Then what do you want to talk about?” I snap.

Breathe, Cadence. You’re not going to get angry at Anna. She’s not the reason why you’re here.

She looks at me like there’s something on her mind. God, why won’t she just spit it out? It’s not like Anna to be obtuse.

“…I heard from Mark last night,” she mumbles.

Shit.

“He called to see how you were doing. You’re all over the news back home,” she continued.

Why on earth did Mark call to check if I was okay? I had thought I had made it abundantly clear that I never wanted to speak to him again when I moved to a different state to avoid him.

Mark is my ex – and only – boyfriend. We started dating pretty soon after uni started and had even been talking about marriage at one point. However, that all ended when the world found out that he had cheated on me with one of his medical students while on placement in Darwin last year.

“What did you tell him?” I was trying to keep my voice dispassionate.

“Only that you were fine. I didn’t give him any specifics,” she assured me. “He gives you his best.”

“I bet he does.”

“Cady, don’t be like that.” Anna sighs. “You know he still loves you, right?”

“I don’t care.”

“But…”

“Why are you defending him?” I ask. “If I remember correctly, you were pretty hell bent on doing a bilateral orchidectomy without anaesthetic the last time you saw him.”

“I’m not,” she insists. “But… Doesn’t everything that’s happened over the past couple of days put everything in perspective? I mean, what’s the point of hate when there is so much to lose?”

“Don’t give me any of that deep and meaningful bullshit, Anna,” I snap. “Do you really think there’s any reason behind any of this? My life has been completely fucked over in the past couple days. Everything that I ever expected from life has been taken away from me, and you want me to, what? Forgive Mark? Be happy for what I still have?”

I know I’ve lost it, but I can’t help it. Anger is burning through my veins, and even though I know it’s not Anna that I’m angry with, I can’t help myself.

“I don’t have anything left. I’m going to be stuck in a fucking chair for the rest of my life, dependent on other people to wipe my arse and I’m going to die alone.”

“Cady…”

I turn my head away from her, and try to blink away the tears that threaten me.

“Don’t you think your lunch break is over?”

Anna sits there silent for a moment, before giving up and standing. She leans over to kiss my forehead before she leaves. I just lie there, biting my bottom lip, hoping that the pain that I’m inflicting on myself will distract me from what I’m feeling. I can’t remember the last time my emotions were this labile. It seems like every thirty seconds, I’m feeling something different. And even though I used to be able to control what I’m feeling, I just can’t. It’s like I’m mourning.

I shut my eyes and press my lips together. Yes, it’s like I’m mourning my own death. Unbidden, my mum comes into my mind and I’m overcome with the memory of her death. God, I miss her. I still remember what it was like when she dies, the grief coming in waves. What was even worse was the moments of normality, where you forgot for just that small moment that she was dead and you were supposed to feel sad. When you were reminded, the guilt came, and somehow that was even worse than the sadness over her absence.

But I’m not dead. I still have to be strong, because everyone who knows and cares about me are upset now. I have to be there to support them. I can’t fall to bits just yet.

I lean my head back on to my pillow, and look up at the ceiling and slowly breathe in and out.

Yes, I will be the strong one. I’ve been through worse and I did it then. I sure as Hell will do it now.