Work Text:
The ambulance swung into the A&E bay with a squeal of brakes, blue lights still strobing against the concrete as the back doors flew open and the paramedics rolled Lisa’s trolley down the ramp.
“This is Lisa Swain, 49, involved in an RTC on the bypass,” the lead paramedic called out, pushing her through the sliding doors into majors. “Initial GCS fifteen at the scene and still fifteen now, eyes open, obeying commands, answers a bit slow but appropriate. Sats 98% on room air, heart rate 96, blood pressure 136 over 82, respiratory rate 18, cap refill under two seconds. Complains of a headache and some nausea, scalp wound to the side of the head, minor cuts and bruises, and probable wrist sprain. No other obvious injuries. No known allergies. She’s been stable en route.”
At the nurses’ station just inside, the trolley was eased to a halt and handed over to the triage nurse, who was already reaching for a wristband.
“Pop her in bay twelve for me,” she said, stepping out from behind the desk.
The paramedics wheeled Lisa into the curtained cubicle and parked the trolley while the nurse clipped a wristband round her wrist, applied a pulse oximeter to Lisa's index finger and wrapped a blood pressure cuff back on.
“Alright, Lisa, I’m Sarah, just going to do a quick assessment, love.” She tapped the machine on. “Can you tell me in your own words how you’re feeling?”
Lisa blinked up at her, squinting against the light.
“Honestly? Bit of a thumper of a headache, neck and shoulders are aching, but I’m fine.” She gave a small shrug. “There’s people from that crash worse off than me. I can wait, honest. See to them first.”
Behind her, Betsy, who’d come in on foot with a crumpled foil blanket still clinging to her shoulders, stepped in before the nurse could answer.
“Mum, can you not do the hero act right now?” she snapped, eyes red but fierce. “You got smashed by a car twice, you’re not ‘fine’.”
Lisa waved her off with her free hand.
“Oh Betsy I’m talking, aren’t I? It’s just a headache and a few aches, love. You heard her, there’s a load of them from that crash coming in. I can wait.”
“Then I can wait too,” Betsy shot back. “I walked away from it, you didn't, so I’ll be fine.”
The older Swain's mouth opened to argue, but the shrill bleep of a phone cut across them. Sarah glanced at the display, her face tightening.
“They need me in resus for one of the crash patients,” she said. “Lisa, your obs are okay just now, but you’ve had a hard bang to the head. A doctor will be along as soon as possible to do a full assessment, check you over properly, and decide if you need a CT scan of your head or any other tests. For now, just stay on the trolley, don’t eat or drink anything, and press the call bell if you feel worse, alright? Betsy, we’ll get your scrapes cleaned up as soon as we can too, love. Just hang tight here for now.” She gave them all an apologetic look and hurried out, pulling the curtain halfway closed as she went.
Carla slipped onto the end of the trolley as soon as she was gone, perching by Lisa’s feet and automatically hugging herself. Betsy stayed up by her head, leaning in to give her a half-hug, her arm draped awkwardly across the rails.
For a long moment, none of them said anything. The last few hours pressed in around them, twisted metal and glass, blue lights, the knowledge that Lisa and Betsy could so easily have not walked away; Carla’s own three weeks locked in that filthy room, then being moved to that cold, damp shopping container with no one coming; Becky’s face as the cuffs went on. It all sat there between them, heavy and sour, but no one dared break the silence in case the wrong word made it all real.
They stayed like that for a while, no one wanting to be the first to move, frozen in the heavy quiet, until Betsy shifted, her arm starting to tremble with the effort of holding herself up.
“My legs are killing me,” she muttered, more to the floor than to either of them. “I’m gonna nick a couple of chairs before I fall down.”
Carla started to push herself up. “I’ll come and—”
“It’s fine,” Betsy cut in quickly, already backing towards the curtain. For a second, their eyes met and Carla realised, with a little twist in her chest, that the girl knew exactly what she was doing, buying them a minute that wasn’t under someone else’s gaze. “I’ll be two secs,” Betsy added, and slipped out, leaving Carla and Lisa alone with the hum of A&E beyond the curtain.
Turning back, Carla really looked at her. Lisa was staring off at nothing in particular, eyes fixed somewhere just past the curtain rail, her face slack in a way that didn’t suit her at all. For a second, Carla’s throat closed around everything she wanted to say—I thought I’d lost you, I thought you were dead, I thought I was—and none of it would come. So she swallowed it down and went for the smallest thing she could manage.
“How are you feeling?” she asked, quietly.
Silence met Carla as Lisa’s gaze stayed fixed somewhere above her shoulder, breathing shallow, as if she hadn’t even heard the question. Carla’s stomach flipped.
“Lisa?” she tried, a bit sharper. “Hey. Lis.”
Slowly, Lisa’s eyes tracked down to her, not quite focusing.
“We forgot the milk,” she said.
Carla swallowed. “What milk?”
“For the tea.” Lisa frowned up at the buzzing strip light. “You said you’d get it. You didn’t.”
“Lisa, we don’t need milk, we’re in hospital, remember?”
“No. I was in the kitchen.” Lisa frowned.
“You were in the car,” Carla corrected, gently but firmly. “With Betsy and—” Bile rose in her throat as she fought against the acidic taste of saying Becky’s name, swallowing it back down bitterly. “—and Becky. There was an accident. You hit your head. The ambulance brought you here.”
Lisa stared straight ahead. Her eyes were open, pupils wide, focused somewhere but nowhere at the same time. Every now and then, her lashes fluttered as if she’d thought about blinking and then forgot halfway through.
“Lis?” Carla tried, her voice soft, careful. “You still with me?”
A faint crease had formed between her brows, like she was concentrating on something invisible.
Carla cleared her throat softly.“Lisa?”
She blinked. Once. Twice. Then her eyes slid towards Carla, stopping just short of meeting her gaze.
“Did we lock the door?”
“The door?” Carla frowned.
“The one with the blue handle.” Her lips moved carefully around the words, as though she had to think about how to make them work. “The one that sticks when it rains.”
“Lis, we don’t have a door with a blue handle, it’s black. You let me pick it out, yeah? Remember?”
Lisa nodded slowly, but the tension in her shoulders didn’t ease. “But did you lock it? Because if you didn’t, the cat’ll get out.”
“We don’t have a cat,” Carla said gently.
“Course we do. The little grey one. He sleeps on your coat.” Her brow furrowed deeper, her gaze drifting higher. “The ceiling’s wrong,” she whispered.
“How d’you mean?”
“It’s squares. Ceilings shouldn’t be squares. What if it falls?”
“Hey, no ceiling is falling in, okay? You’re safe here, I promise.”
The reply felt honest where the ceiling was concerned, but nothing could stop the unsettling in the pit of Carla’s stomach at what Lisa wasn’t safe from.
Lisa’s fingers twitched under the blanket, rubbing at the fabric like it didn’t feel right. Noticing the growing anxiety, Carla reached out to hold the hand of the woman she loved, her grip tightening. “Listen to me,” she said, each word deliberate. “The ceiling is fine. The house and its doors are fine. No one’s there. There is no cat to lose. The only thing I am scared of losing is you. Here. On this trolley. Tonight.”
“I don’t… feel here,” Lisa murmured, her chest rose and fell too quickly, shallow, panting breaths that didn’t sound like they were doing much.
“I know,” Carla said. “Your brain’s had a bang. That's why we're here, to get it checked. That’s why you saying ‘I can wait, there’s people worse off’ was a stupid idea, and me letting you say it was worse.”
“You two haven't been arguing have you?” Asked Betsy, swinging a pair of chairs through the curtain and ungracefully dropping them down, the sound causing Lisa to flinch.
“No love,” replied Carla, “your mum…she's just having a bit of a time of it remembering stuff properly.”
“Mum?” Betsy said, her voice shaky. “Do you remember the crash?”
Lisa frowned. “The lights,” she said.
“What about the lights?” Betsy prompted.
“They were… wrong,” Lisa muttered. “In the trees. On the floor. All shouting. Couldn’t tell which were ours.”
Carla’s stomach lurched. In the ambulance, Lisa had been confused, yeah, but she’d known what had happened. This… felt worse.
“Bets,” Carla said, her eyes still on Lisa, “go find a nurse. Tell them your mum’s worse than when we came in. Say she’s more confused, more agitated, and she’s still waiting for a doctor to assess her for a CT scan. Those exact words. Don’t let them fob you off ok?”
Betsy nodded, jaw clenched, and slipped back out through the curtain.
Turning back, Carla said, “Lisa. What’s my name?”
Her gaze stayed on the ceiling. Her lips moved soundlessly for a second, like she was cycling through wrong answers.
“You’re… the lady,” she said.
“What lady?” Carla asked, keeping her tone even.
“The… visitor.” Lisa swallowed. “They let visitors in after tea. For an hour.”
“I’m not a visitor,” Carla said, quiet but firm. “I’m Carla.”
Her gaze drifted vaguely in Carla’s direction, then slid away again.
“No,” Lisa whispered. “She’s at home. On the sofa. She doesn’t come here.”
Carla leaned in, blocking the strip light so her face was the only thing in Lisa’s line of sight.
“Look at me,” she said. “Not the ceiling. Me.”
She tried. Her eyes dragged over, jittering and slow, but finally locked—sort of—onto Carla’s.
“You know me,” Carla said. “I hate hospitals. I last fifteen minutes before I start mouthing off. But you’re here. You told them you could wait because other people needed help more. They believed you. I was an idiot and let them. Now you’re scaring me, and that stops now.”
Something like recognition flickered in Lisa’s eyes; it looked like it hurt.
“She said she wouldn’t come,” Lisa whispered. “She said she hated the smell. She’d wait at home and I’d… I’d go to her.”
“She’ll always be wherever you need her Lisa, and right now,” she clasped Lisa's hand between her own, “right now that's here. So here she is. Here I am.”
Lisa's eyes filled again. “I can hear her,” she said. “She’s crying. She keeps saying my name. ‘Lisa, where are you?’ I can’t… I can’t get to her. The door’s stuck.”
“There is no door,” Carla said. “There’s a curtain. And I am on this side of it with you. You are not stuck anywhere I can’t get to. You hear me?”
Fingers dug into the sheet. “I have to go,” Lisa said suddenly, panic edging her voice. “I can’t stay here. I have to go home. I have to get to her. She’ll think I’ve done it again.”
“You are not going anywhere,” Carla said, her voice soft but solid. “You can’t even sit up without going cross-eyed. You try to walk out of here, you’ll faceplant and add another dent in your skull. And then I’ll kill you myself—and frankly, I’m too tired to have to do that.”
The curtain swished. Betsy came back, dragging a nurse in navy scrubs behind her. Dark hair in a bun; ID badge bouncing against her chest: AMY – Staff Nurse.
“Mum, I've got someone to look after you.” Betsy said.
“Hi, Lisa,” Amy said, stepping up to the opposite side of the trolley. Her voice was calm and warm; her eyes sharp. “I’m Amy. I’ve heard you’ve had a nasty bang to the head and you’re still waiting for a doctor to decide if you need a CT scan. That right?”
Lisa blinked at her. “I’m going home,” she mumbled.
Amy’s gaze flicked over the unused cuff, the bare arms, the dark monitor screen. Her jaw tightened for half a second.
“No doctor’s been yet?” she asked quietly, to Carla. “No cannula, no CT—nothing beyond triage?”
“Nothing,” Carla said. “She told them she could wait. They said there were crash victims worse off, and… I let that be enough.”
Amy nodded once, like she’d filed that under ‘we’ll be having words later.’
“Okay,” she said. “I can’t un-wait what’s already happened. But we can move now.”
Turning back to Lisa, she added, “Can you tell me your full name, love?”
“Lisa… Swain,” she said slowly.
“And do you know where we are?”
A frown creased Lisa's brow. “The kitchen,” she said. “Light’s buzzing. Carla’s… at home.”
Carla’s chest ached. “We’re in A&E,” she said. “In Yorkshire.”
Amy nodded and pulled a pen torch from her pocket. “I’m going to shine a little light in your eyes,” she said. “Helps us see how happy your brain is. It’ll be bright, but I’ll be quick. That okay?”
“Don’t like lights,” Lisa muttered.
“I know,” Amy said. “Won’t take long.”
She clicked the torch on and leaned in. “Look at my nose if you can. Keep your head still, just move your eyes.”
Lisa's gaze dragged towards the nurse’s nose, stuttering.
The beam swept into the right eye, then the left. Up close, the difference was clear: the right pupil slightly bigger than the left; both sluggish to constrict under the light.
Amy’s face didn’t change much, but something sharpened in her eyes. She clicked the torch off and slipped it back into her pocket. “Thanks, Lisa,” she said softly. “That’s really helpful.”
She crossed to the wall phone, snatched up the receiver, and dialled, her voice dropping into a clipped, precise register.
“It’s Amy in majors, cubicle twelve,” she said. “I’ve got a head injury patient with deteriorating consciousness and concerning neuro signs who’s still waiting for initial medical review and CT decision. I need the ED registrar at the bedside now. Yes, I know resus is full of RTC patients. I’m telling you this one is time-critical as well. Thank you.”
The handset dropped back into the cradle and she came back to the bed. She clipped the sats probe onto Lisa’s finger and flicked the monitor on. Numbers popped up: heart rate 118, sats 93%.
“Mum?” Betsy said, her voice small. “You okay?”
“Need to go,” Lisa muttered, eyes filling. “Need to go home. Carla’s waiting. She’ll think I’ve left. She’ll think I’ve done it again.”
“You are not late,” Carla said, leaning in so
Lisa could see nothing else. “I am not at home. I am stood here. I know exactly where you are. You haven’t done anything again except be a pain in the neck.”
“My hands,” Lisa's said suddenly, frowning at them. Her breathing was faster now, shallow little pulls that barely moved her chest.
Amy’s head snapped round.
“What about your hands?” Carla asked, her throat tight.
“They feel… wrong,” Lisa muttered. Her words were starting to blur together. “Too big. Like… gloves. Heavy. And my tongue.” She moved it clumsily in her mouth. “Too big. Doesn’t fit. Tastes like… metal.”
Amy’s face changed. She didn’t say anything; she just stepped closer, one hand hovering near Lisa’s jaw, the other gripping the rail.
Lisa’s eyes flicked back to Carla’s face, wide and scared and not entirely present.
“Carla,” she breathed.
“I’m here,” Carla said instantly, her heart slamming. “I’m right here. You’re alright, you’re—”
She could only watch as Lisa's jaw snapped shut, her whole body becoming rigid. Every muscle in Lisa's small body locked at once: her back arched off the mattress, shoulders lifting, arms dragged in, fists clenched white. Legs shot straight, heels digging into the trolley. Her neck went corded; eyes rolled up until only whites showed.
“Time twenty-one thirty-five,” Amy said automatically. “Generalised tonic phase.”
Then the convulsions tore through her.
Violent, rhythmic jerks ran from head to toe. Arms battered the raised side rails, metal clanging with each hit. Legs thudded against the mattress, the trolley shaking. Her head snapped and thudded. A sudden bright gush of blood burst from Lisa’s right nostril, pouring over her lip and down her cheek.
The monitor, now fully attached, shrieked as her heart rate shot into the 160s, oxygen saturation plummeting.
“MUM!” Betsy screamed, lunging forward.
Carla moved with her, clenching at the you get Swains shoulders.
Amy threw her arm out, barring them both. “Back,” she snapped, more forcefully than intended. “Now! You're more of danger to yourselves and Lisa if you get any closer while she's like this.”
“She can’t breathe!” Carla cried. “She’s choking!”
“She’s getting some breaths,” Amy said, her eyes locked on Lisa’s chest.
Her hand slammed onto the big red crash button above the bed. A brutal alarm ripped through the department.
“Crash call, cubicle twelve, majors,” the tannoy blared.
Foam bubbled at the corner of Lisa’s mouth, soon tinged pink with blood. Her jaw stayed clamped tight, muscles standing out in her cheeks.
Amy shoved a folded towel under her head and kept one hand near her jaw, ready to adjust if she vomited. The other clamped the rail to steady the trolley.
Betsy clung to Carla’s arm, sobbing. “She’s dying,” she choked. “Mum, please—”
“She’s got us,” Amy said, her voice taut. “She’s not on her own.”
The curtain was yanked wide. The ED registrar in dark-blue scrubs strode in, stethoscope bouncing. A crash trolley rattled behind him, pushed by another nurse; another two nurses and an anaesthetist in green scrubs followed.
“What’ve we got?” the reg called, landing at the head.
“RTC earlier, suspected head injury,” Amy rattled off. “She told triage she could wait because of the bypass crash, so no medical assessment yet. Increasing confusion. Now generalised tonic-clonic seizure for about ninety seconds. Ongoing.”
“Right,” the reg said. “High-flow oxygen.”
He grabbed a non-rebreather mask, strapped it over her nose and mouth between jerks, and cranked the flow to fifteen litres. Oxygen roared into plastic.
“Any IV access?” he asked, scanning bare arms.
“None,” Amy said.
“We’re not getting a cannula in with her thrashing like that,” he said. “I am not waiting until this stops—if it stops. We’ll go intranasal first, then IO.”
Turning back to the bed, he said, “Intranasal midazolam, ten milligrams. Now.”
The crash nurse cracked open a vial, drew up clear midazolam into a syringe, and attached a soft-tipped atomiser. Timing it between convulsions, she slid the atomiser into Lisa’s right nostril and depressed the plunger firmly, delivering 5mg as a fine mist. Then the same on the left for the remaining 5mg.
“Ten milligrams intranasal midazolam at twenty-one thirty-six,” she called.
The convulsions continued at full force. The trolley rattled.
“Pads on, sats probe checked, suction,” the anaesthetist said.
Defib pads were slapped onto Lisa’s chest. The ECG monitor flickered to life with a chaotic, spiky trace, heart rate around 170, waveforms distorted by motion. The sats probe flashed 80% and dropping, despite the oxygen.
“She’s not ventilating effectively,” the anaesthetist muttered. “Jaw thrust. Bag what we can. Suction ready.”
At the head, Amy slid her fingers to Lisa’s jaw angles, hauling it forward to open the airway as much as possible. The anaesthetist pulled the non-rebreather aside and sealed a bag-valve mask over her face, squeezing breaths in between jerks.”
Another nurse darted in with the suction catheter whenever Lisa’s mouth opened enough, clearing froth and blood.
“Minute since midazolam,” Amy called. “Still seizing.”
“She’s in status,” the reg said. “We need IO access, we’re not getting an IV while she’s like this. Left tibial IO. Hold that leg still.”
He nodded at the nurse at Lisa’s legs. “Pin it for me. Knee and ankle.”
The nurse grabbed her left leg one hand just above the knee, one at the ankle, using her bodyweight to clamp it to the trolley as best she could between jerks.
A second nurse swabbed the front of the left shin, just below the tibial tuberosity on the inner side, and pressed the needle against bone.
“Hold her,” she said.
“I’ve got it,” the nurse wrestling with Lisa's jerking leg grunted.
The trigger was squeezed. The drill whined as the needle bore into bone. “Drilling complete,” she said, releasing it. The drill came away, leaving the needle in place. A syringe was attached and saline flushed in.
“No swelling, good flush,” she said. “Intraosseous access established, left proximal tibia.”
“Good,” the reg said. “Lorazepam four milligrams IO. Then levetiracetam fifty milligrams per kilo, call her seventy kilos, so three and a half grams.”
The drug nurse drew up lorazepam and pushed it into the IO port, flushing after. “Lorazepam four milligrams IO at twenty-one thirty-seven,” she called.
A bag of levetiracetam was spiked, attached to the IO line, and squeezed to get it running.
“Levetiracetam three and a half grams loading started twenty-one thirty-eight,” she said.
The convulsions began to lose a fraction of their violence, but they didn’t stop. Lisa's chest barely moved between bagged breaths.
“Heart rate one-six-zero,” the monitor nurse called. “Sats seventy-two.”
“She’s tiring,” the anaesthetist said. “No spontaneous effort. We’re doing everything with the bag.”
The heart rate dropped. One-forty. One-twenty. Ninety.
“Sats sixty-eight,” the nurse said. “Heart rate now seventy… fifty…”
“Losing cardiac output,” the reg said. “Keep bagging. Be ready.”
The convulsions juddered, one last twitching jerk… then stopped.
Lisa sagged. Her limbs flopped still. Her jaw slackened under the mask. Her chest didn’t move.
“Check breathing,” the anaesthetist snapped.
“No chest rise,” the head nurse said. “No respiratory effort.”
“Pulse,” the reg said, fingers flying to Lisa's wrist.
Amy slipped her fingers into the side of Lisa’s neck, pressing hard into the carotid groove.
Nothing. “No carotid,” she said. “No pulse.”
The ECG trace flattened further—almost a straight line.
“Asystole,” the monitor nurse said.
“Cardiac arrest,” the reg said, his voice cutting through everything. “Start chest compressions. Keep ventilating. Time of arrest twenty-one forty.”
The compressions nurse stepped onto the stool, placed the heel of her hand in the centre of Lisa’s chest, laced her fingers, locked her elbows and started compressions.
Hard. Fast.
She drove the sternum down five to six centimetres with each push, letting it recoil, counting under her breath. “One, two, three, four, five, six, seven, eight, nine, ten…”
Lisa’s body jolted beneath the force. The mattress dipped rhythmically as the nurse settled into a steady cadence, shoulders rocking with each push. There was a dull, sickening crack beneath the pressure — cartilage and bone giving way under hands that had no choice but to be brutal — the sound of ribs surrendering to the effort of forcing a stopped heart to remember how to beat.
The anaesthetist kept the bag-valve sealed to Lisa’s face, squeezing in two breaths after every thirty compressions.
“Adrenaline one milligram IO,” the reg said. “Repeat every three to five.”
The adrenaline was rushed into the IO line, flushed. “Adrenaline one milligram IO at twenty-one forty-one.”
Carla and Betsy stood watching it all, plastered to the wall, fingers digging into each other as they held onto the other. Lisa’s body bouncing under the compressions didn’t look like CPR from the telly; it looked violent, brutal, desperate.
“They’re hurting her,” Betsy choked.
“They’re giving her brain a chance,” one of the nurses said quietly. “If they don’t press that hard, the blood doesn’t move.”
“Two minutes of CPR,” the compressor panted. “Need to swap.”
“Switch,” the reg said. “Pause for rhythm check and intubation. Five seconds. Go.”
Hands lifted. The ECG trace was almost flat.
“Asystole,” Amy said.
“Airway,” the reg snapped. “Intubate.”
The anaesthetist moved in to Amy's position at the head of the bed with the laryngoscope.
She opened Lisa’s mouth, slid the blade in, lifting tongue and jaw, shining the light down. Suction hissed as pooled blood and saliva were cleared.
“I see epiglottis,” she murmured. “Lifting… cords visualised. Passing tube.”
She advanced the endotracheal tube between the vocal cords to the right depth.
“Cuff up,” she said. Amy inflated the cuff.
“Back on compressions,” the reg ordered. “Don’t wait.”
Compressions resumed. The anaesthetist attached the bag-valve to the tube and squeezed, watching for equal chest rise. “Capnography inline,” she said. A CO₂ monitor was clipped into the circuit; within a few breaths, a waveform appeared. “End-tidal CO₂ twenty-four and rising,” she said. “Tube’s in the trachea. Secure it.”
Tape secured the tube.
“Continuous compressions,” the reg said. “Ten breaths a minute via the tube. No hyperventilating.”
He glanced at the anaesthetist. “We’ve got IO. I want IV access as well. Once we get ROSC we’ll need it.”
One nurse wrapped a tourniquet around Lisa’s right arm, swabbed the crook of her elbow and, between compressions, slid an 18-gauge cannula into a good vein. Flashback, advance, flush. “Right antecubital, 18-gauge, patent,” she said.
On the left, the second nurse slipped a 16-gauge into the big vein there. “Left antecubital, 16-gauge, patent,” she called.
“Good,” the reg said. “Keep adrenaline IO for now. Use the IVs for fluids and noradrenaline after ROSC.”
“Adrenaline one milligram IO again,” the first nurse said. “Twenty-one forty-four.”
“How long since arrest?” the anaesthetist asked.
“Four minutes of CPR,” the reg said. “Plus the seizure. Potentially reversible cause. We continue.”
Thud-hiss-beep. Compressions. Bagging. Monitor.
“Two minutes,” the compressor called.
“Pause for rhythm check,” the reg said. “Five seconds. Go.”
Hands off. The ECG trace twitched, then resolved into broad, slow complexes.
“That’s an organised rhythm,” the nurse said. “Rate about eighty.”
“Check for pulse,” the reg said. “Carotid. Ten seconds.”
Amy stepped in, fingers pressing into the hollow at Lisa’s neck.
Nothing—
Then, faint, a weak, thready beat.
“I’ve got one,” she said. “Weak carotid pulse.”
“ROSC,” the reg said. “Return of spontaneous circulation. Stop compressions. Continue ventilating.”
Compressions stopped. The anaesthetist adjusted to ten slow breaths a minute, watching the capnography trace now around 36.
“Blood pressure,” the reg said. “What have we got?”
The cuff hissed as it inflated and deflated.
“BP sixty-four over thirty-six,” one of the nurses read.
“MAP about forty-five,” the reg said. “Too low. 500ml crystalloid bolus through the right IV. Start noradrenaline infusion via the left. Aim for MAP at least sixty-five – we want to perfuse her brain.”
Amy clicked her torch back on and checked Lisa’s pupils again.
Right: fixed, blown, unreactive. Left: smaller, sluggish.
“Right fixed and dilated, left sluggish,” she murmured to the reg.
“Severe raised intracranial pressure,” he said. “Likely big intracranial bleed or swelling.”
He turned to Carla and Betsy. “I’m Dr Emmett,” he said. “We’ve got her heart beating again. She’s on a ventilator – that tube is breathing for her. We’ve got an IO line in her leg and two IV lines in her arms for meds and fluids. But she is critically unwell.”
Betsy’s grip tightened on Carla’s sleeve. “She said she was fine,” she whispered. “She said she could wait.”
“With head injuries, people can look okay and then deteriorate,” Emmett said. “That’s what’s happened here. Before this, you were waiting for a doctor to decide if she needed a CT scan of her head. Now there’s no question – she absolutely does. We need an urgent CT to see what’s going on inside her skull: bleed, clot, swelling.”
“And if it’s bad?” Carla asked, voice thin.
“If the CT shows a large bleed or severe swelling,” Emmett said, “the neurosurgical team may be able to operate – remove blood, relieve pressure, sometimes temporarily remove a piece of skull so the brain has room to swell. It’s major, high-risk surgery, but it can save a life.”
“And if they can’t?” Betsy whispered.
“Then she’ll go to intensive care, she’ll stay sedated on the ventilator. We’ll use the IO and IV lines to control her blood pressure, oxygen, temperature, and reduce pressure in her brain. We’ll give her every chance. But with a severe head injury, prolonged seizure and cardiac arrest, the risk of serious, long-term brain damage is very high.”
Carla looked at Lisa – at the tube, the tape, the lines.
“She told you she could wait,” she said numbly. “She told you other people needed it more. I let you believe her.”
Emmett's jaw clenched. “Her being kind doesn’t mean she should’ve been left,” he said. “Right now, what will help her is us moving quickly.”
He turned back to his team. “Anaesthetics, can we transfer to CT?”
“She’s as stable as she gets,” the anaesthetist said. “Tube secure, sats ninety-six percent on 100% oxygen. BP improving with fluid and noradrenaline. IO and IVs in place. Portable ventilator and monitor ready.”
“Head up thirty degrees, neck midline,” Emmett said. “Let’s go. We’ve lost enough time.”
They switched to a portable ventilator and monitor, slid Lisa onto a CT-compatible trolley, and organised her lines.
Carla stepped in close, hand finding Lisa’s forearm. “You’re not alone,” she whispered. “You’re not on our sofa. You’re not behind a door I can’t get through. You’re here. I’m here. You said you could wait and now look at the state of things. But we’re done waiting.”
She leaned nearer, mouth by Lisa’s ear.
“And just so we’re clear,” she added, voice rough, “we still do not have a cat. But if you come back to me – properly – I swear I’ll march into the first shelter and bring home the scruffiest grey menace in Weatherfield. I’ll let it sleep on every coat I own. I’ll complain, you’ll call me dramatic. That’s the future I’m clinging to, Swain”
“Carla,” Amy said gently. “We’re going down to CT now. You can walk with us, but you’ll have to wait outside while they scan her. I’ll stay with you.”
“Stay near the head, out of the way,” Emmett said. “Let’s move.”
They pushed the trolley out, down the corridor towards radiology. The ventilator hissed with each breath. The monitor bleeped: heart rate 95, blood pressure creeping up, sats 97%.
Carla walked beside the head, one hand on the rail, one on Lisa’s arm whenever she could reach. “Stay with me,” she whispered. “You were right we’d be here a while ‘cause of that crash. You were wrong about being the one who could wait. You’re at the front now. Let them take their pictures. Then you fight your way back. You, me, Bets, we've got a whole future together.”
The doors to radiology swallowed Lisa and the medical staff as they closed, and Carla pressed her palm to the glass, as if that alone might anchor Lisa to this side of it.
Us three against the world, she thought fiercely.
She didn’t know yet whether love was enough to win. But it was enough to stand here and wait, and she would do that as long as it took.