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'No, that's it for now. I need to check up on her records, to see if there's anything that I'm missing, but when I've done that I'll come and find you.'

'OK.'

Sarah went off to check the computer, and then made a call to the woman's general practitioner. She discovered that her patient, Jane, had a history of thyroid problems. As soon as she had noted down all the details, Sarah hurried back to the treatment room.

Megan said, 'She's getting worse. She's been vomiting again. I think she could be dehydrated.'

'You're probably right. We'll give her IV fluids and saline. I'm going to need thyroid function tests as well.'

'Do you think this is a thyroid problem?' Megan queried. 'I was thinking she had food poisoning.'

'I can't be certain, without doing all the tests, but her GP says there's a history of thyroid problems, and I'm worried about the tremor and her recent weight loss. I think she could be suffering a thyrotoxic crisis.'

'That's rare, isn't it? What would have brought that on?'

'It could have been a number of things—an infection of some sort, emotional stress, or even some kind of trauma. She hasn't had surgery recently, so I can rule that out. The blood tests will give us some of the answers. In the meantime, we'll give her propranolol to bring her heart rate down, and antibiotics to control any infection.'

'Are you not going to wait for the results of the blood tests before giving the antibiotics?'

Sarah shook her head. 'I don't think so. She looks very ill and we need to do everything that we can for her. I don't want to leave anything to chance.' Once again, she wished that Mark was here to advise her one way or the other, but he wouldn't be pleased to be dragged away if the patient turned out to be suffering from nothing more than a simple abdominal complaint, would he?

It was some time later before the results of the tests came through, but they confirmed Sarah's fears. She asked Megan, 'How is she doing?'

'She seems a little calmer now. I think the fluids are helping. She's cooler, and her pulse isn't racing quite so much, but she still seems to be in a bad way.'

'That's more or less what I expected,' Sarah said, nodding. 'I'm going to give her dexamethasone to support her through this, and carbimazole to reduce the level of thyroid hormone. Then we need to refer her for admission.'

Sarah stayed with her patient for a while, until she was satisfied that Jane was beginning to respond to the treatment. Then she told Megan, 'I'm going to take a break, but if you need me for any reason, you can bleep me. 'I'm going up to look in on Ryan for a little while, and then I'll go and see my sister. She wants to know how he is doing. Will you stay here and keep an eye on Jane?'

Megan nodded. 'Don't worry, I'll stay with her, and I'll let you know if there's any problem.'

'Thanks, Megan.'

Sarah hurried away, and went to look in on Ryan.

'There's been no meaningful response,' the nurse said. 'He moved a finger slightly yesterday, but it was a non-directed movement and, as you know, you get these sorts of reactions from time to time. The same thing happened a few days ago.'

Sarah understood what she was saying. Recovery was a long process, and coma patients often exhibited occasional movement or even managed to make some kind of response, but it didn't mean that they were going to suddenly sit up and start talking.

She stayed with Ryan for a few minutes. He was perfectly still, and his eyes were closed, but she talked to him about Hannah and Jamie, and told him that Jamie had made him a clay pot at school.

'It's a bit lopsided, and it wobbles because it's not quite flat at the base, but he's painted it a lovely bright yellow colour. He said he did that for you because you like sunshine yellow, and he thinks you'll be able to put bits and pieces in it. It's sitting on my kitchen window-sill, and Jamie's longing for you to be well enough to come home so that he can give it to you.'

She sat with him for a little while longer, and then told him that she was going to see Hannah. 'Hannah wants to know how you are. I wish that I could tell her that you were awake and asking for her.'

He didn't move, or show any kind of reaction, and she looked at him for a second or two, feeling sad, and guilty because she hadn't been able to do anything for him.

She went to find Hannah, and there at least there was some good news. The nurse said, 'We think that she may not have been as badly injured as we first believed. Now that her acute injury has begun to heal, she's beginning to recover some of her reflexes. Nothing major at the moment, but there is hope.'

'That's wonderful news.' Sarah felt a surge of relief overwhelm her.

'I thought you would be pleased. Hannah's still quite depressed, though, so you should be prepared for that. She hasn't reacted as we hoped she would, but it's not unusual for patients in her condition to be anxious and disheartened. She still has quite a road ahead of her, with physiotherapy and so on.'

'I know, but this news means that at least there's a chance that she's going to walk again, doesn't it?'

'That's true. I've told her the good news, but I'm not sure that she's taken everything in just yet.'

Sarah went and sat with Hannah and talked to her about the results of the tests. 'I know there's nothing too specific just now, but it is good news.'

Hannah was doubtful, as though she was afraid to take too much on trust.

'I don't understand why it has taken so long for the doctors to find out what the damage was,' she said. 'How can I believe them when they say that I might start to get the feeling back in my legs? I still feel pretty much the same as I did when I first came here. Aren't they just trying to make me feel better? They've been doing everything they could to jolly me up from the moment I was admitted here. That's their job, isn't it—to keep encouraging the patient?'

'I think that they're being honest with you,' Sarah said. 'There was a reason why they couldn't see straight away what damage had been done. When you injured your spine, there was some bleeding and an accumulation of fluid around the spinal cord. That had the effect of compressing your spinal cord and bruising you very badly, and when the spinal cord is affected in that way it can be a lot more serious than if you just bruised an arm or a leg, for instance. Once you start to heal up and the swelling recedes, you can start to recover some of the functions that you had before. From the sound of things, you've been very lucky.'

Hannah stared at her. 'How can you say that I've been lucky? I'm lying here, unable to move, unable to go home and play with my little boy, and as if all that wasn't bad enough, his father is in a coma with no sign of recovery. He was in such a bad way that they didn't even tell me that for a couple of days, or let me see him. How am I supposed to trust anyone?'

Sarah gently touched her sister's hand. 'I know that things seem bad just now, but he is recovering from his other injuries, and there's always the possibility that he will come out of the coma one day.'

Hannah drew her hand away, and her gaze was cold. 'Will he? We can't be sure of anything, can we? Why is he in a coma, anyway? He was conscious and able to talk to you when you found him, wasn't he? The nurse told me that he asked about me when the paramedic first went to him. He wanted to know that I was all right.'

'That's true.' Sarah frowned. 'We didn't know the extent of his injuries to begin with. He had a bang to his head, but he was also bleeding into his chest, and that turned out to be very serious. That's why he lost consciousness.'

'It's the head injury that has put him into a coma, though, isn't it? His neurologist told me that he had a blood clot inside his skull. That's what caused the damage. Isn't that right?'

'Yes, that's true. The surgeon removed it when he was in the operating Theatre.'

'Shouldn't you have noticed that earlier? You could have done something about it, couldn't you? He's being given medication to help counteract the swelling on his brain, but if he'd had that medication earlier, or if you had taken more notice of his head injury from the beginning, he might be up and about now, mightn't he?' Hannah looked at Sarah as though she hated her. 'As it is, he could be brain-damaged. How is Jamie going to understand it if his father doesn't recognise him, or if he isn't the same as he once was?'

Sarah froze. Did Hannah really think that she should have done something more? Her lips were suddenly as dry as dust and her heart was pounding, thudding against her chest wall as though it, too, would punish her.

She said huskily, 'I did what I could for him, Hannah. I did everything possible, you must believe me.'

'It wasn't enough, though, was it? You should have saved him, but you didn't, and perhaps that's because you didn't know how. You said yourself that you weren't sure that you were good enough to work in emergency medicine.' Hannah's mouth tightened. 'We were going to make a fresh start, Ryan and me. He was going to change—he wasn't going to drink any more, he promised me, and he was going to be a proper father to Jamie. Now everything has gone wrong, hasn't it?'

'I'm sorry. I'm so sorry, Hannah.' Sarah felt wretched. She had hoped that Hannah would feel better when she was given the news that she might walk again. She hadn't expected to have all this bitter recrimination showered on her, and now she felt as though she had been slapped. Her own sister despised her, and that felt like a lead weight bearing down on her.

'I'm tired,' Hannah said. 'I want to sleep now.' She closed her eyes, and when Sarah tried to speak to her, she didn't answer.

After a few minutes Sarah stood up and quietly left the room. She went back down to A and E, but she felt as though she was in a trance, as though the floor had shifted from beneath her feet and she was feeling her way.

Owen was back from the tour of the renal unit, and he stopped and spoke to her for a while, but she answered him in bleak monosyllables until he asked, 'How is your sister? Megan told me that you had gone to see her. Is she still unable to walk? I thought there might be some good news by now.'

'The injury still has to heal. It will take time, but hopefully the damage isn't as bad as it seemed.'

'That's good, isn't it?' He glanced at her, his gaze serious. 'Is Ryan still in the same condition?'

'He's still in a coma.'

'I'm sorry.' He frowned. 'I can see that you don't feel like talking. It must be upsetting for you.' He looked uncertain as to what to do next, but then he said, 'I think I should go now. Perhaps I could call you later in the week?'

She nodded, and he walked away. She watched him leave the room, and then she went over to the desk and picked up a chart. Perhaps work would help in some small way to blot out Hannah's harsh words.

'Is something wrong?'

She looked up, and saw that Mark had come to stand alongside her. 'No. I just have to check up on a patient.'

He looked at her oddly. 'I see that Owen has just left.

It must be difficult for you to get used to the idea of him going away again when you were once colleagues— more than that, in fact.'

'Yes, I suppose it is. I was so used to working with him, and now it seems strange to have him come to visit.' She looked away and tried to concentrate on the chart. 'I see that you have signed off on my thyroid patient. I take it that she's been admitted?'

'Yes, she was taken to the ward while you were away.' He looked at her searchingly. 'You should have called for me, you know. These cases are unusual, and there's always a chance that the patient might not survive.'

She sent him a worried glance. 'Do you mean that my patient might not survive? I did what I could for her.'

He shook his head. 'No, I mean in general. Next time that you're uncertain in any way, you should call me.'

'I'll do that.' Her hand had begun to shake, and she closed it into a fist so that the tremors would not show. Did he, too, doubt her ability? She had hoped that he would come to have some trust in her and that they might grow closer to one another after what had happened between them at his father's house, but he had made no mention of it since then, and she had tried to accept that she was expecting too much.

He didn't even respect her as a doctor and she didn't see how else she fitted into his life-style. Given his family background, there would have to be a strong reason for him to want to take things further with her, and she couldn't see that happening. There was no future for her with him, was there?

All at once she felt helpless, out of her depth. Why was she clinging on to the hope that she might some day be good at emergency work? Perhaps she would do better to consider Owen's offer of a job.

'I've
been thinking things over, as
I
said
I
would,' Sarah murmured, frowning as she took the phone call. She wasn't sure why Owen wanted to talk to her while she was at work, but perhaps he was in his office and had taken the first opportunity during a break. 'It's difficult for me, because there are still around six weeks left on my contract here.'

'Why don't you come over to my hospital and just take a look at the paediatric unit?' Owen said. 'You know that you've never been too sure about emergency work, and you could at least just come for a visit. It might help you to make up your mind, one way or the other. I'm not going to pressure you, but the interviews are going to start soon, and if you were to decide that you want to work in paediatrics after all, it would be a shame to miss out on the chance.'

'You're probably right,' Sarah answered. 'Perhaps I'll do that.' She was thoughtful for a moment. 'I suppose I could drive over there on Thursday. It fits in with my day off, and Jamie will be at school, so there should be no problem with that.'

She replaced the receiver a moment later and then stood for a while, wondering whether she had made the right decision. Mark came over and found some laboratory forms from a box on the desk, and as he glanced through them and wrote his signature on a couple, he threw her a quick look.