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If he did indeed have, as she suspected, a streptococcal group A type of infection, which caused haemolytic streptococcal gangrene—otherwise known as necrotizing fasciitis—it was imperative for them to get treatment with antibiotics started immediately. Every moment of delay allowed the deadly, fast-spreading bacteria
to
gain a hold, probably in some other part of the body. A massive infection could ensue and the patient could be dead within a matter of hours.

Inside the cubicle they found the young patient lying on the examination couch where Lisa had left him a short while before.

'Hi, Mr Reese, I'm Dr Hanks. Tell me how long you've had this swelling on your face.' Dr Hanks put on a pair of surgical rubber gloves and began to palpate the man's cheek, which was definitely swollen. His fingers rippled over it so they could clearly see that a considerable amount of fluid had gathered under the skin. There was only a small area of redness.

'Well. . .' the young man cleared his throat nervously, obviously worried, yet trying to hide the fact '... I first noticed it yesterday morning...didn't think much of it. Then today it was worse. When the swelling got down to the jaw line I was worried—thought I'd better come in here.'

'His temperature isn't elevated,' Lisa offered.

'You say you didn't nick yourself while shaving?' Dr Hanks said.

'No.'

'Is there any other way that the skin could have been broken? I don't see any evidence that the skin has been broken—there's just this small red area.'

'No, I didn't have anything on my face. That's why it's so odd,' Ed Reese said. 'It's not really painful, just feels a bit tight.'

'How do you feel generally?'

'I feel all right. Just a bit tired, that's all.'

'It could have started with an infected hair follicle,' Dr Hanks murmured, 'Anyway, you sure did the right thing in coming in here. There's an infection there, even if we can't see an obvious source.. .and I don't like the look of that red line running down your neck. That means the infection is spreading. I want to examine you and ask you some questions, then we'll get you started on antibiotics.'

'Thanks, Doctor.' Ed Reese sounded relieved.

'Um, Liz,' Dr Hanks said, just remembering her 'official' name in time. 'Would you get Dr Blair to take a look at this? I'd like his opinion before I start treatment. And we'd better take Mr Reese's temperature again—it could have changed in the last few minutes, although he doesn't look as though he's got a fever yet. Get Dr Blair first.'

As Lisa hurried out she realized that this would actually be the first time she would speak to Marcus Blair since she had started work in the department. He had actually come face to face with her two days ago and had acknowledged her presence with a smile. Usually he worked on the other side of the department where the serious emergency and stretcher cases came in, only coming over to the ambulatory side when he was needed for a consultation.

Lisa straightened her uniform self-consciously and tucked back some of her hair, which had escaped from the light, disposable paper hat that she wore, as she went in search of Dr Blair. She found that she wanted an excuse for interaction with him, and her heart lifted at the prospect of actually talking to him, however briefly.

'Is Dr Blair in here?' Lisa asked a nurse in one of the operating and resuscitation rooms, having looked in his office and elsewhere for him without success.

'What do you want him for?' the nurse asked sharply, blocking her entry.

'Dr Hanks wants him in cubicle one on the other side for a consultation,' Lisa explained.

'Don't just come barging in here,' the other nurse complained. 'This is an operating room, you know. I'll give Dr Blair the message.

'Thank you,' Lisa said, taken aback by the other woman's unfriendly attitude. She was the first bad-tempered staff member Lisa had encountered so far.

'Is that you, Lisa?' the deep voice of Dr Blair enquired from inside the room so that the other nurse was forced to open the door wider. Then Marcus Blair appeared, wiping his hands on a towel. A disposable surgical mask hung around his neck. He was bare-headed, his dark hair dishevelled, and he looked tired. 'Dr Hanks wants me?'

'Yes, if you're free,' Lisa said apologetically, suffering the glower of the other nurse. Perhaps she was one of those nurses, Lisa mused, who considered certain doctors her own property, or maybe just one doctor in particular. They were a fairly common breed, usually dedicated career nurses who had not found time to find a husband or a boyfriend.

'I am free,' Dr Blair said rather pointedly, subtly putting the obtuse nurse in her place. 'I'll find the time. And how are you these days, Miss Stanton?'

'I'm fine, thank you,' Lisa said hastily, while she registered from the other woman's ID badge that her name was Marie, and she made a silent vow to avoid Marie as much as possible in the future.

As they walked back together to cubicle one Marcus asked her how she liked the department so far.

'I like it,' she said, giving him a small, hesitant smile. Then she went in ahead of him.

'Hi, Marcus. Thanks for coming,' Dr Hanks said. 'I wanted you to take a look at this in case it could be staphylococcus A. I haven't given him anything yet.'

As the patient was examined once again, with Marcus palpating the swelling carefully and asking more questions, Lisa went to fetch sterile IV tubing from a supply kept just outside the cubicle, together with a small bag of intravenous saline and an array of broad-spectrum antibiotics. She suspected that the patient, whatever the immediate diagnosis, would need intravenous antibiotics.

Marcus looked at her when she came back with the equipment. 'Like the nurse says,' he remarked, looking at what she had in her hands, a slight smile on his face, 'give an IV bolus of cloxacillin. Run it in slowly with the fluid. That was what you were going to do anyway, wasn't it, Dr Hanks?'

'Yeah.' Nathan Hanks grinned. 'What about incising this? Looks like there might be a little pus under this red part. The rest is just serous fluid, I guess.'

'We won't incise it until he's had the cloxacillin and it's had a chance to keep the infection in check,' Marcus said. 'Give him oral cloxacillin to take home as well, then we'll do it tomorrow. Mr Reese,' he addressed the patient, 'could you come back here tomorrow morning fairly early? We'd like to make a tiny cut just here—let out any pus that might be there and take a swab for a lab culture, even though the drugs may have killed off most of the bacteria by then. This could be something serious so it's not something you can neglect.'

'Yeah, I can come back,' Ed Rees agreed. 'Have I... have I got flesh-eating disease?' His voice was high-pitched with anxiety.

Marcus hesitated. 'This could be caused by the same bacteria that cause that disease, which is why we're going to treat it aggressively,' he said carefully. 'If you had the disease you wouldn't be feeling very well. However, you did the right thing by coming to us early so that we can nip this thing in the bud.'

'Right.'

'And we won't know if it's the same bacteria until we take a swab tomorrow and wait a day or two for the results,' Marcus continued, speaking reassuringly. 'The intravenous antibiotics we're going to give you will zap anything quite nicely. Usually, with so-called flesh-eating disease, there's a definite abrasion or cut in the skin through which the organisms can gain entry.'

'I'm a bit run down—working a lot lately,' Ed Reese said.

'That could be a factor,' Marcus said. 'Your natural defences are lowered. Make sure you continue the antibiotics at home for ten days. Usually we like to take a swab for culture before we give any antibiotics, but in this case we want to get started with them and then we'll see you tomorrow.'

As Dr Hanks prepared to insert the intravenous line Dr Blair drew Lisa out of the cubicle with him when he left. 'It's a good idea to scare them a bit,' he said, 'otherwise they never come back, or they never finish the full course of antibiotics. Anyway, I guess you know that, don't you, Lisa? Being an experienced nurse.'

'Yes,' she said. They were standing close in a busy corridor. 'Well, thank you. I must get back in there to help Dr Hanks.'

'Would you go with him to the pharmacy—make sure he's got the oral drugs? I'm pretty sure he'll get them but I just want to make sure.' Marcus said.

'Yes.' Lisa took off her cap that made her scalp itch and ran her fingers unconsciously through her thick, shiny hair, thinking about Ed Reese. Marcus looked at her movements, his eyes travelling slowly from her hair to her mouth, as though he was familiarizing himself with each feature of her face. All at once there was an almost unbearable awareness between them, and again Lisa felt her throat constricting with tension.

Then he looked at her breast, where the fabric of her uniform top was pulled taut by her uplifted arm. Slowly Lisa lowered her arm to her side, feeling as though she could not get her breath. For a few seconds it felt as though they were the only two people in the bustling corridor. Something strange was happening to her. Images of Richard were very gradually being replaced by images of Marcus Blair—and that frightened her. It would not do for her to get a schoolgirl crush on him. There was no way that she wanted a repeat performance. Yet this was different...

His eyes locked with hers for a moment, intensely searching, before he looked away down the corridor where a stretcher had come through the centre doors of the department. When he looked at her again his gaze was distant, somehow impersonal. 'Please make sure,' he said stiffly, 'that Mr Reese is given an appointment card to be back here at a very specific time. I want him here at 8 a.m. sharp. Dr Hanks is on duty over the weekend—he'll do it. Make a note of that.'

Lisa moistened her dry lips, staring at him as though mesmerized. 'I'll do that,' she said.

Then he was gone, striding away from her—weaving his way through the hurrying staff and patients. Lisa stared after him, feeling dazed, her eyes fixed on his dark hair until he was out of sight. Something had happened between them—she wasn't sure what. During that week she had experienced the odd feeling that he had been avoiding her. She had told herself that she didn't figure so highly in his scheme of things that he would bother to avoid her. He was much too straightforward for that, wasn't he? And his life was hectic.

Back in the cubicle she prepared the antibiotic to go into the small bag of intravenous fluid that Nathan Hanks had up and running.

'You're going to have to lie here for a while, Mr Reese,' Dr Hanks said. 'We'll run this in slowly. Keep an eye on him, Liz.'

Back at the triage station a little later Lisa went through the cards of the waiting patients. All the cubicles were full. The next patient to be seen was a boy with a dog bite to his arm. That would have to be cleaned up, irrigated and a dressing put on. His mother had said that he was up to date with his tetanus immunization, but they would have to check it.

They had had children with burns, patients with sore throats, coughs, colds, chest pains, difficulty with breathing, abrasions, lacerations, foreign bodies inhaled or swallowed, bruises, concussions, dislocated shoulders, earache, stomach aches, backache, sprains and foreign bodies in eyes. Anything they couldn't deal with had been sent round to the section for serious cases—there had been a patient who had vomited blood, someone who had taken a lot of pills in order to commit suicide but was still walking—those had been transferred.

'What can I do next?' A young woman intern came into the triage station.

'Well, there's that woman with pelvic pain and an elevated temperature,' Lisa said. 'We're waiting for the senior gynae resident to see her. He should be here any minute. Otherwise it's the boy with the dog bite.'

'I guess she's got pelvic inflammatory disease,' the intern said, looking at the preliminary card. 'Probably venereal in nature, with half a dozen other things as well, and herpes thrown in. Those things are the devil to treat. They're resistant to all sorts of antibiotics.'

'Maybe you should settle for the dog bite,' Lisa said.

Just as she went out to check the waiting room a familiar voice hailed her. 'Hi... Mrs Stanton. Lisa, isn't it?'

It was Dr Rick Kates, the obstetrics and gynae resident, whom she had not seen since she had come in herself as a patient.

'Remember me?' he said, grinning.

'How could I ever forget you?' Lisa smiled.

'How are you and the baby?'

'We're both good.'

'Say...' He frowned. 'Aren't you married to Marcus Blair? He was with you that night.'

Looking around her hastily—not wanting to have her personal affairs aired in public—Lisa saw that there were several people in the waiting room who appeared to be listening to the hasty verbal exchange. 'Shh!' she said. 'Not so loud, Dr Kates.'

She took his arm and marched him towards the cubicle containing the woman with pelvic pain. 'We've been waiting for you,' she said. 'No, I am not married to Marcus Blair. It was just a subterfuge because he happened to be around when I needed someone. It's a long story.'

'OK.' Dr Kates grinned. 'I won't press you for details. Pity he's not married to you. I reckon that guy needs a wife.'

'Why?'

'Working in this place, you need some one to go home to.'

'Now, about this patient, Dr Kates. She's a probable pelvic inflammatory disease. There's a gynae examination tray in the cubicle. I'll be with you in a couple of minutes when you want to examine her.'

With that, she left him and went back to Ed Reese to check on the intravenous line to make sure it was still dripping and at the required rate. She felt breathless and a little irritated, wishing that Dr Kates hadn't recognized her, although she didn't doubt that he would say no more about it to her or anyone else.

The rest of her shift went by in a flurry of activity, with no time for a break. It was half past two when she finally hurried out of the main doors to go home, having made a hasty telephone call to her mother to say that she was on her way.

Preoccupied with thoughts of Emma Kate, she didn't at first see the woman who had stepped into her path on the sidewalk outside the emergency department until she came face to face with her.