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Considering that they hadn't touched at all, it was incredible how her skin crawled and her pulses jumped and the heat coiled inside her.

The sound of the ambulance siren keening outside didn't fully impinge on Malcolm's consciousness at first on this Monday morning. Much of the time it wasn't something he needed to know about, and he could continue, as he was doing now, with the administrative work that occupied a significant percentage of his time.

He'd learnt to follow an almost instinctive interpretation of the sounds he heard to decide whether or not he would be needed, and he was rarely wrong about it these days. There would be an urgency in the pace of footsteps, the pitch of voices, the bump and squeak of equipment and trolleys, and he had usually reached the nerve centre of his department before he was summoned.

That wouldn't happen this time, he suspected.

Yes, the siren had been switched off already, and the ambulance wasn't even coming to his entrance. It had gone past, probably on its way to the outpatient building. He returned his attention to the papers on his desk and began to grapple, once more, with a thorny budgetary problem.

Ten minutes later another siren sounded, and this time it was different. He wasn't surprised when he had to abandon the column of figures he was adding on a calculator, and he only just had time to mark where he was up to with a quick blue slash of his ballpoint pen.

'Patient wheelchair-bound, lost control on a ramp at a shopping centre,' Lucy summarised, repeating what the ambulance officers must have told her. 'He's unconscious, but they don't know why. Doesn't look good.'

As Lucy spoke, Dr Heather Woodley was quickly stripping off the man's clothes, looking for any obvious sign of an injury that could have resulted in loss of consciousness. She was a third-year resident in emergency medicine, and she was competent if occasionally a little narrow in her focus, Malcolm considered.

His mind was running on two levels at that moment. He was very aware of both Lucy and Heather. He didn't like the fact that having them both hovering over this patient provided a disturbing juxtaposition. Intense Heather, and tranquil, good-humoured Lucy. And he was thinking as a doctor, too, with a level of experience that made even this sense of crisis familiar and incapable of making him lose his cool.

The unconscious man looked to be about twenty, give or take a couple of years. He was short, and he wore baggy cargo pants and a loose T-shirt which came down almost to his knees and was printed with lettering. The white block capitals on the purple background read,
What's it to You?'

It was the fashionable, in-your-face dress of a young man, but his body wasn't well proportioned. He was slightly overweight and the outfit probably served as camouflage as well. There was a marked contrast between the strongly developed shoulders, arms and torso, the curved spine and the under-developed leg muscles, and as soon as his clothes were off they knew why.

'Spina bifida,' Heather Woodley said. 'Look, the scarring at his lower spine is quite obvious. He must have had further surgery since the initial closure of the opening there.'

He had a very pleasant and quite handsome face, though, set off by short mid-brown hair. Malcolm took in fair, slightly freckled skin, thick dark lashes, a high forehead, a strong nose and a sensitive mouth, all looking relaxed.

'The wheelchair ran down the ramp, out of control, and hit a wall,' Lucy was saying. 'He's got grazing on his face and a bruised shoulder. Look.'

'Is he unconscious due to the crash into the wall?' Malcolm asked.

'Presumably,' Dr Woodley said. 'Apparently, no one was really watching until they realised the wheelchair was out of control.'

She was touching him with her gloved hands.

'OK.' Malcolm nodded.

But he had a bad feeling about this one. It didn't seem right, and his mind was moving at lightning speed. Yes, there were some slight bruises and scratches to the young man's face and shoulder, consistent with a hefty scrape and bump against a brick wall, but the rest of the picture didn't fit.

He took a few seconds to step back mentally, and said half under his breath, 'We're jumping in too soon here. What have we missed? Why are we assuming that he's unconscious because of the fall?'

He added aloud, 'He had no ID? Because he looks vaguely familiar to me...'

'Just some cash in his hand, apparently,' Lucy answered. 'He must have popped out for milk or something.'

'Cigarettes,' Malcolm suggested. 'You can tell by the smell of his clothes that he's a smoker. And I'm sure I know him.' He felt that if the young man would only open his eyes, it would click.

'Previous admission? I wonder what for,' Heather Woodley said. 'Presumably somehow related to his condition?'

She was an attractive woman of about thirty, tall and dark with quite a strong jaw and shoulders, warm brown eyes and a slightly awkward, angular way of moving. When Malcolm reluctantly considered the idea that he really should start thinking about women again, asking someone out, Heather was one of the women who came to mind. He couldn't think about that vexing issue now.

'Let's not jump to conclusions,' he said quite abruptly, and lifted the patient's lids to look at his eyes.

Again, his spine prickled and he had a sense of foreboding and recognition. He definitely knew this patient. Those burning blue eyes, with their appearance, at this moment, consistent with compression of the optic nerve...

Heather had nodded and swallowed and looked a little hurt at the impatience in his tone. A final thought flashed through Malcolm's mind. I really must ask her out soon, if I'm going to.

Surely she didn't
care
about his opinion, though, did she? On a personal level? He didn't need that sort of pressure. Could any of that vague, reluctant awareness of her as a single, eligible woman have translated into signals?

The possibility weighed on him, even in the midst of this medical crisis, and it was a huge relief to hear Lucy say, 'He must have some mobility. He's not always in the wheelchair. I've just looked at the soles of his shoes, and there's dried mud in the treads.'

'That's consistent with the position of the scarring,' Heather was saying. 'His neural tube must have been open quite low down. Then I'm guessing he had surgery for spinal cord tethering at some stage.'

Then it clicked, just as Lucy said, 'What's happening to his face?'

'Get me the drill and the adrenaline,
now,'
Malcolm said urgently. 'I've just remembered who he is.'

The activity around the patient went into overdrive. Lucy had gone for the adrenaline, and they could all see now how the man's mouth was swelling and his breathing was becoming more laboured. His throat would be swelling rapidly as well, and his blood pressure would be plummeting. He was in full anaphylactic shock, and Heather said aloud what they all understood.

'He must be allergic to latex!' Her wide dark eyes were still fixed on Malcolm, as Nurse Sandra Corman ran for the drill.

'Severely,' Malcolm said. 'But that's not the only thing threatening his life at the moment.'

He didn't wait to watch as Heather prepared a syringe of adrenaline and injected it in the man's upper arm, into the fatty layer beneath the skin. Instead, he took the drill and positioned it on the patient's skull. If he didn't release the cerebrospinal fluid that was building to acute pressure at the brain stem, causing this unconscious state...

It was a spine-chilling sound, that high-pitched metallic whine, and Heather wasn't the only one to wince and hiss at it. It did the trick, though, and the clear fluid that had been building up inside Sam's skull—yes, his name was definitely Sam, Sam Ackland—began to drain through the two holes Malcolm had made.

Meanwhile, the symptoms of anaphylactic shock had subsided, and Lucy had hunted up a box of plastic gloves to replace the latex ones which had triggered the dramatic reaction. For the moment, the tension could ease a little.

'His name is Sam Ackland,' Malcolm said as he continued to work, setting up a drip so that a rapid infusion of fluids could correct the patient's dangerously lowered blood pressure. 'And he was in here with bronchitis and pneumonia and acute respiratory failure a couple of years ago. He had a dangerous weight problem then, and was very unfit, but he looks like he's in far better shape now.'

'Yes, look at his shoulders,' Heather said.

'That's one of the reasons I didn't recognise him at first,' Malcolm said, nodding. 'Hell, I feel angry with him! He's obviously done really well with the weight and exercise, but he must have been having symptoms of fluid pressure on the brain. He has a shunt, and it looks as if it must have failed for some reason. Why did he ignore the symptoms? He'd have been having some pretty uncomfortable ones—headaches, sleepiness, maybe even vomiting. Possibly other things like swallowing difficulties, neck pain, weakness in the arms. And he's by no means out of the woods yet.'

'You mean permanent impairment to the brain?' Heather Woodley frowned.

'Unfortunately, yes.' Malcolm nodded. 'We'll send him along to Radiology for a CAT scan, and then he'll be admitted to one of the neurosurgeons. Nick Blethyn, probably. Ultimately, he'll need to have that shunt checked out thoroughly, and probably replaced. We won't know for a few days whether he's escaped permanent damage or not For that matter, we won't know if he's going to survive...'

He heard Lucy give a shocked hiss.

'Does he have family we can contact?' she asked at once, and Malcolm thought that it was typical of the Lucy he'd known six years ago, who'd always been so quick to think of family and how other people felt. In those essentials, she obviously hadn't changed.

'There may be someone who's frantic at the moment because he didn't come home when expected,' she finished.

'Yes, the fact that he wasn't carrying a wallet, only that handful of cash...'

'Two five-dollar notes.'

'Suggests he wasn't planning to be out for very long,' Malcolm agreed.

He couldn't remember the young patient's personal circumstances. Someone would have to dig out a file. Why wasn't Sam wearing a medical alert bracelet? With his level of allergic response to latex, he had no excuse not to. There was a list a mile long of common products with latex in them. Balloons, tennis balls, wheelchair cushions, clothing elastic, chewing gum, carpet backing... It went on.

And studies were starting to show that up to forty per cent of people with spina bifida had some degree of allergy to the substance. Sam was one of the worst affected, and the allergy had probably intensified with earlier exposure during surgery.

Malcolm felt a wash of helplessness. He hated patients like this.
Hated
them, in a way that had nothing to do with his professionalism as a doctor and everything to do with his personal past. He knew why this patient, and this patient's eyes, had stuck in his mind for two years or more. Sam was exactly like Bronny. Full of fight and anger, but fighting all the wrong things.

He had to struggle mightily against the urge to get angry himself and just start yelling at the unconscious man, Do you know you could be dead before we can get a neurosurgeon to deal with that shunt properly?
If
that's the problem! You haven't exactly given us a lot of time to find out. You could have died of anaphylactic shock, too. Why the
hell
didn't you take your symptoms and your condition seriously?

He said all of this and more inside his head, but managed to resist saying it aloud. Not much point, when a man was unconscious.

Sam was wheeled off to Radiology a few minutes later, after a search through the files had given them his full name and address. His parents were preparing to come in at once, deeply alarmed. They'd told receptionist Caroline Tully that Sam wasn't living at home any more. He'd been living in a flat on his own for the past three weeks, and he'd forbidden them to get in touch with him or come over to see him more than once a day.

'I only hope he makes it,' Malcolm muttered as Sam departed. The matter was out of his hands now, and into the lap of fate...and the neurosurgeon. 'I'll be so
angry
with him if he doesn't!'

'Lucy, there's a three-year-old with a fracture just come in with his mother,' Malcolm heard behind him, the words spoken by another nurse. 'Playground accident, apparently. Can you deal with it? He'll probably have to go up to the children's ward before it can be set.'

'Of course,' Lucy answered. 'I'm finished here.'

'And then Mr Warren is supposed to go up to the cardiac ward, but they've just rung to say the bed's not available yet, so can you make him comfortable here for another couple of hours? And after that, you'll have to...'

He didn't hear any more of the continuing list of instructions, just heard Lucy's laugh floating back as she headed out to the waiting area at the front of the department. He suddenly realised that her voice and her laugh had already become two of the sounds he listened for most eagerly here each day, far more than he listened for Heather Woodley's voice, although he'd known and liked Heather now for over a year.

The long column of budget estimates mocked him when he returned to it several minutes later, and the untidy blue mark beside the thirty-fifth number positively jeered. He'd completely forgotten what it meant. Had he marked the last figure he'd added, or the figure he had to add next? For the life of him, he didn't know.

With a frustrated sigh, he pressed the 'clear' button on the calculator and started keying in the figures from the beginning.

'Are
you ever going to get married again, Mummy?' Charlotte asked, with her last mouthful of scrambled egg and toast still evident in her mouth.

Lucy was shocked—far too shocked to even think about the offence to good manners inherent in Charlotte speaking with her mouth full. 'I—Why—? Um, what makes you ask that, love?' she managed finally, trying to infuse it with the same calm, upbeat interest with which she greeted knotty questions about Adam and Eve or the meaning of infinity.