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of the consultants free at the moment?’

      The nurse shook her head. ‘One of the trauma cases has arrested. It’s a circus in Resus.’

      ‘I need a paediatric anaesthetist here,’ Pip said. ‘And we need to get Dylan to Theatre. I’m pretty sure he’s got epiglottitis and his level of consciousness is dropping.’

      Suzie’s eyes widened. ‘I’ll find someone.’

      ‘Get me an airway trolley in the meantime?’

      ‘Sure.’

      Pip could only hope that intervention could be avoided until Dylan was safely under the care of an expert anaesthetist.

      ‘I think Dylan has something called epiglottitis,’ she told Jenny a moment later. ‘It’s a nasty bacterial infection of the epiglottis, which is at the back of the throat. If it gets inflamed it can interfere with breathing, which is why Dylan has started making these noises.’

      ‘What will you do?’

      ‘We treat it with antibiotics but we have to protect the airway in the meantime. I’m going to get Dylan taken to an operating theatre if possible to have a tube put down his throat.’

      ‘He needs an operation? Oh, my God!’

      ‘Not an operation,’ Pip said reassuringly. ‘Not unless it’s difficult to get a tube in place. In that case, it might be necessary to create a temporary external airway by—’

      Suzie was back with a trolley. ‘Someone’s on the way,’ she interrupted Pip. ‘Shouldn’t be long.’

      It was going to be too long for Dylan. The small boy’s eyes suddenly rolled and then closed. Jenny felt him go even floppier and when she moved the oxygen mask to look at her son, they could all see the blue tinge to his lips.

      ‘Dylan?’ Pip rubbed his sternum. ‘Wake up!’

      There was no movement to be seen. Including the chest wall. The toddler was in respiratory arrest. Pip plucked him from his mother’s arms and laid him on the bed.

      ‘Oh….God,’ Jenny gasped. ‘He’s not breathing, is he?’

      ‘No.’ Pip was pulling on gloves and hoping she sounded much calmer than she felt. Where on earth was that consultant? ‘We’re going to have to put the tube in here. Could you hyperventilate him, please, Suzie?’

      While the nurse used the bag mask to try and pre-oxygenate Dylan, Pip pulled the tubing from the suction kit and switched the unit on. She clipped a straight blade to the laryngoscope and picked out the smallest, uncuffed endotracheal tube from the sterile drape she had opened on the trolley.

      ‘Hold his head for me, Suzie.’ Pip peered over the blade of the laryngoscope moments later. ‘Can’t see a thing,’ she muttered.

      ‘Secretions?’ Suzie asked.

      ‘Yes. And the epiglottis is very swollen.’

      ‘I’ll give you some cricoid pressure.’ Suzie pressed on Dylan’s neck and Pip tried to take a deep breath and banish her mounting alarm. She knew how critical it was to get this airway secured and it was not going to be easy.

      Jenny was sobbing loudly enough for another nurse to put her head around the curtain.

      ‘I can’t bear to watch,’ the young mother gulped.

      ‘Come with me for a moment, then,’ the nurse said. ‘I’ll look after you while the doctors look after your little boy.’

      Pip was barely aware of Dylan’s mother being led from the cubicle due to her intense concentration on the urgent task, but even with the pressure on the neck, the secretions sucked away as much as possible and her best efforts, there was no way to get the tube past the obstruction of swollen tissue.

      ‘It’s no go,’ Pip said tersely.

      Suzie sounded just as tense. ‘What do you want to do?’

      Pip had to think fast. She couldn’t rely on a senior doctor arriving in time to take over. If she didn’t do something herself, now, this little boy could die.

      ‘Ventilate him again for me, Suzie.’ She ripped open another kit on the trolley. ‘I’m going to do a cricothyrotomy.’

      Stripping off her gloves and reaching for a fresh pair, Pip had to fight a moment of pure panic as the consequences of not succeeding with this next procedure forced themselves into her mind.

      Then, for some strange reason, she thought of Toni Costa.

      Well, not so strange, really, because Dylan would probably end up being the paediatrician’s patient.

      And she had been thinking of Toni at rather disconcertingly frequent intervals over the last week anyway.

      For whatever reason, Pip could almost sense his presence in the cubicle right now, and it brought an underlying confidence to her determination to succeed. So that Dr Costa would be impressed at the emergency care a patient of his had received.

      Her fingers were as steady as a rock as she palpated the cricothyroid membrane on Dylan’s neck. There was no need for local anaesthetic as the child was deeply unconscious, and there was no time in any case. Pip stabilised the ring of cartilage with one hand and made a single, decisive incision with the scalpel.

      Part of her brain registered the movement of the cubicle curtain and the fact that someone had entered the space and was now standing behind her. A large figure. Maybe it was Brian Jones, one of the emergency department consultants, answering her plea for back-up. She couldn’t look up at this point, however, or hand over to anyone else, even if they were far more experienced.

      Reversing her hold on the surgical instrument, Pip inserted the handle of the scalpel and rotated it ninety degrees to open the airway. Then she slid the tube into the incision, removing the introducer and replacing it with the tip of the suction apparatus tubing.

      She attached the bag mask to ventilate Dylan and listened with her stethoscope to make sure both lungs were filling adequately with air. Then she checked for a pulse and looked up just as the curtain twitched back for the second time, allowing herself an audible sigh of relief.

      A sigh that was abruptly terminated. It was Brian Jones who had just entered the cubicle, so who had been watching over her shoulder for the last few minutes? Pip’s head swivelled for a second to find Toni Costa standing behind her.

      ‘What’s been happening?’ Brian queried.

      ‘Epiglottitis,’ Pip informed her senior colleague succinctly. ‘Respiratory arrest. Intubation failed due to the amount of inflammation.’

      Dylan was making a good effort to breathe on his own now and was stirring. He would need sedation and the assistance of a ventilator urgently, but the consultant took a moment to nod with satisfaction.

      ‘Well done, Pip’ was high praise from a doctor known for being taciturn. ‘Let’s get him on a ventilator. Where’s his family?’

      ‘I’ll find his mother,’ Suzie offered.

      ‘And I’ll make sure they’re ready for this young man in ICU.’ Toni moved to follow Suzie but turned a second later. ‘Bravo, Pippa,’ he said quietly. ‘You certainly didn’t need my assistance.’

      Warmth from that single, unusual word of praise stayed with Pip until she ended what had been a memorably long day. When her last patient, Elena, had finally been admitted for observation in the chest pain ward and Doris was in Theatre, having her hip joint replaced, Pip took a few minutes to visit the paediatric intensive care unit. She wanted to check up on Dylan and, if she was honest with herself, she wanted to enjoy that sensation of having done something special. And if she was really honest with herself, the possibility of meeting Toni Costa again had to be a distinct bonus, so she was more than happy to find him talking to Jenny and a man she assumed to be Dylan’s father.

      ‘Oh…it’s

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