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CHAPTER ONE

TASHA rehearsed her speech as she walked through the busy emergency department towards the on-call room. Inside she was panicking, but she was determined not to let that show.

Hello, dear darling brother, I know you’re not expecting me, but I thought I’d just drop in and see how you’re doing. No, she couldn’t say that. He’d know instantly that something was wrong.

You’re looking gorgeous today. No, way too creepy, and anyway they usually exchanged insults so he’d definitely know something was up.

Josh, of all my brothers, you’ve always been my favourite. No. She didn’t have favourites.

You’re the best doctor in the world and I’ve always admired you. That one just might work. Her brother certainly was an excellent doctor. He’d been her inspiration. And her rock. When their father had walked out, leaving his four children and his fragile, exhausted wife, it had been Josh, the eldest, who had taken charge. Wild, handsome Josh, whose own marriage was now in a terrible state.

But at least he’d had the courage to get married, Tasha thought gloomily. She couldn’t ever imagine herself doing anything that brave.

Was it because of their parents, she wondered, that all the O’Haras were so bad at relationships?

Since her last relationship disaster, she’d given up and concentrated on her career. A career couldn’t break your heart—or so she’d thought until a few weeks ago.

Now she knew differently.

Terror gripped her

She’d messed everything up.

Hating the feeling of vulnerability, Tasha stopped outside the door. Fiercely independent, it stuck in her throat that she needed to ask her brother for help, but she swallowed her pride and knocked. She needed someone else’s perspective on what had happened and the one person whose judgement she trusted was her older brother.

Seconds later the door was jerked open and Josh stood there, buttoning up his shirt. His hair was dishevelled and he was badly in need of a shave. Clearly he’d had a night with no sleep but what really caught her attention was the stupid grin on his face. A grin that faded the instant he saw her.

‘Tasha?’ Astonishment was replaced by shock and he cast a fleeting glance over his shoulder before pushing her back into the corridor and closing the door firmly behind him. ‘What are you doing here?’

‘What sort of greeting is that?’ Badly in need of a hug, Tasha heard her voice thicken and the bruises of the last month ached and throbbed inside her. ‘I’m your little sister. You’re supposed to be pleased to see me.’

‘I am, of course, but—Tash, it’s seven-thirty in the morning.’ Josh let out a breath and rubbed his hand over his face to wake himself up. His free hand. The one that wasn’t holding the doorhandle tightly. ‘I wasn’t expecting— You took me by surprise, that’s all. How did you know where I was?’

‘I asked one of the nurses. Someone said they thought you were in the on-call room. What’s wrong with you? You look ruffled.’ It was the first time she’d seen her cool, confident brother anything other than immaculate. Tasha looked from him to the door that he was holding tightly shut. ‘Did I wake you?’

‘No. I— Yes, but it doesn’t matter.’

‘Busy night?’

‘Sort of.’ His gaze darted to the corridor and back to her. ‘What are you doing here, Tasha?’

Because she was watching his face, she saw the fevered expression in her brother’s eyes and the way the flush spread across his cheekbones. The signs pointed to one thing...

He had a woman in the room.

But why be so secretive about the whole thing? His marriage to Rebecca was over—there was no reason why he shouldn’t have a relationship. Surely he wasn’t embarrassed about her knowing he had a sex life? It was no secret that women found her brother irresistible.

Still, it was a relief to find an explanation for his weird behaviour and she was about to tease him unmercifully when she remembered that she couldn’t afford to antagonise him.

Instead, she gave him a playful punch on the arm. ‘I thought I’d just drop in and see you.’

‘Before breakfast?’

‘I’m an early riser.’

‘You mean you’re in trouble.’ His dry tone reminded her that her brother knew her too well.

Tasha thought about everything that had happened over the last month. Had she done the wrong thing? ‘Not trouble exactly,’ she hedged. ‘I just thought it was a long time since we’d had a good chat. Is there somewhere we can talk?’ She glanced at the on-call room but he jerked his head towards the corridor.

‘My office. Let’s go.’

Feeling like a schoolgirl on detention, Tasha slunk after him through the department, aware of the curious stares of the staff. The main area was packed with patients, including a young girl lying on a trolley, holding her mother’s hand. Noticing that the child was struggling to breathe, Tasha moved instinctively towards her just as a doctor swept up in a white coat. With a murmur of apology, Tasha moved to one side, reminding herself that this wasn’t her patient. Or even her hospital. She didn’t work here, did she?

She didn’t work anywhere.

Her stomach lurched. Had she been impulsive and hasty? Stupid?

It was all very well having principles, but was there a point where you should just swallow them?

Trapped by sudden panic, she paused. The conversation drifted towards her. ‘Her hay fever has suddenly made her asthma worse,’ the mother was telling the young doctor. ‘Her breathing has been terrible and her eyes and face are all puffy.’

Tasha gave the child a sympathetic smile, wishing she was the one taking the history and searching for the problem. The fact that her hands ached to reach for a stethoscope simply renewed her feeling that she might have done the wrong thing.

Medicine, she thought. She loved medicine. It was part of her. Not working in a hospital made her feel like a plant dragged up by its roots and thrown aside. Without her little patients to care for, she was wilting.

Biting her tongue to stop herself intervening, she followed her brother down the corridor but something about the child nagged at her brain. Puffy eyes. Hay fever? Frustrated with herself for not being able to switch off, she quickened her pace. It wasn’t her business. This wasn’t even her department. And anyway, what did she know? She was feeling so battered and bruised by the events of the past few weeks she didn’t trust herself to pass opinion on anything, not even the adverse effects of a high pollen count. Feeling really dejected, she followed her brother into his office.

It was stacked with books and medical journals. In one corner was a desk with a computer and an overflowing tray of paper. Tasha noticed that the photograph of Rebecca had gone and she felt a stab of guilt that she hadn’t asked how he was. Was she was turning into one of those awful people who only thought about themselves? ‘How are you doing? How are things with Rebecca?’

‘Cordial. Our separation is probably the first thing we’ve ever agreed on. It’s all in the hands of the lawyers. Sit down.’ Josh shifted a pile of medical journals from the chair to the floor but Tasha didn’t feel like sitting down. She was filled with restless energy. The stability of her brother’s life contrasted heavily with the instability of her own. She’d been sailing along nicely through life and now she’d capsized her boat and she had no idea where the tide was going to take her.

The lump in her throat came from nowhere and she swallowed hard.

Damn.

Not now.

As the only girl in a family of four older brothers, she’d learned that if you cried, you never heard the last of it.

Fighting the emotion, she walked to the window and opened it. ‘I love Cornwall.’ She closed her eyes and breathed deeply. ‘I’ve lived in so many places since I became a doctor and yet this is still home. I can smell the sea. I can’t wait to pick up my surfboard. I’ve been trapped in a city for too long.’ The plaintive shriek of a seagull made her open her eyes and for a moment the memories threatened to choke her.

Home.

‘So, what brings you banging on my door at this unearthly hour—what have you done?’ Josh sounded distracted. ‘Please tell me you haven’t killed a patient.’

‘No!’ Outrage was sharp and hot, slicing through the last of her composure. ‘Far from it. I saved a patient. Two patients, actually.’ Tasha clenched her fists, horrified to realise just how badly she needed someone else to tell her she’d done the right thing. That she hadn’t blown her career on a childish whim. ‘I had an incident—sort of. You know when you just have a feeling about a patient? Perhaps you haven’t actually had test results back from the lab, but sometimes you don’t need tests to tell you what you already know. Well, I had one of my feelings—a really strong feeling. I know it wasn’t exactly the way to go about things, but—’

‘Tasha, I’m too tired to wade through hours of female waffle. Just tell me what you’ve done. Facts.’

‘I’m not waffling. Medicine isn’t always black and white. You should know that.’ Tasha’s voice was fierce as she told him about the twins, the decisions she’d made and the drug she’d used.

Josh listened and questioned her. ‘You didn’t wait for the results of the blood cultures? And if it wasn’t on the hospital-approved formulary—’

‘They had it in stock for a different indication. You remember I went to the conference of the American Academy of Pediatrics last year? I told you about it when we met for supper that night. The data is so strong, Josh. We should be using it in Britain, but it’s all money, money, money—’

‘Welcome to the reality of health-care provision.’

‘The drug is at least fifty per cent more effective than the one I was supposed to use.’

‘And three hundred per cent more expensive.’

‘Because it’s good,’ Tasha snapped, ‘and research of that quality comes at a price.’

‘Don’t lecture me on the economics of drug development.’

‘Then don’t lecture me on wanting to do the best for my patients. Those babies would have died, Josh! If I’d waited for the results or used a different drug, they would have died.’ In her head she saw their tiny bodies as they lay with the life draining out of them. She heard their mother’s heartbreaking sobs and saw the father, white faced and stoical, trying to be a rock while his world fell apart. And she saw herself, facing the most difficult decision of her professional life. ‘They lived.’ She felt wrung out. Exhausted. But telling her brother had somehow made everything clearer. Whatever happened to her, whatever the future held, it had been worth the price. She didn’t need anyone else to tell her that.

‘The drug worked?’

‘Like magic.’ The scientist in her woke up and excitement fizzed through her veins. ‘It could transform the management of neonatal sepsis.’

‘Have you written it up for one of the journals?’

‘I’m going to. I just need to find the time.’ And now she had time, she thought gloomily. Oodles of it.

‘But the hospital authorities didn’t approve and now you’re in trouble?’

‘I didn’t exactly follow protocol, that’s true, but I’d do the same thing again in the same circumstances. Unfortunately, my boss didn’t agree.’ Tasha turned her head and stared out of the window. ‘Which is why I resigned.’ Saying the word made her heart plummet. It sounded so—final.

‘You did what?’ Josh sounded appalled. ‘Please tell me you’re kidding.’

‘No. I resigned on principle.’ The anger rose, as fresh and raw as it had been on that morning when she’d faced her boss after two nights without sleep. ‘I said to him, What sort of department are you running when your budget comes before a baby’s life?’

‘And no doubt you went on to tell him what sort of department he was running. Tactful, Tasha.’ Josh rubbed his hand over his jaw. ‘So you questioned his professional judgement and dented his ego.’

‘A man of his position shouldn’t need to have his ego protected. He shouldn’t be that pathetic.’

‘Did you tell him that as well?’

‘I told him the truth.’

Josh winced. ‘So...I’m assuming, given that he was the sort of guy to protect his ego, that he didn’t take it well?’

‘He’s the sort of person who would stand and watch someone drown if health and safety hadn’t approved a procedure for saving them. He said the manufacturer did not present a sufficiently robust economic analysis.’ Tasha felt the emotion rush down on her and forced herself to breathe. ‘So then I asked him if he was going to be the one who told the parents they’d lost both their babies because some idiot in a suit sitting behind his desk had crunched the numbers and didn’t think their children’s lives were worth the money.’

Josh closed his eyes briefly. ‘Tasha—’

‘Sorry.’ The lump in her throat was back and this time it wasn’t going anywhere. ‘I know I should have been unemotional about the whole thing but I just can’t be. Honestly, I’m steaming mad.’

‘You don’t say? Are you about to cry on me?’

‘No, absolutely not.’

‘The only time I’ve ever seen you cry was when Cheapskate died.’

They shared a look. Cheapskate had been the dog their mother had bought after their father had walked out. Tasha remembered hugging his warm body and feeling his tail thumping against her leg. She remembered thinking, Don’t ever leave me, and then being devastated when he’d done just that.

‘He was a great dog.’

‘He was a lunatic.’ But Josh’s eyes were gentle. ‘Tell me about those babies you saved. Are they still doing well?’

‘Discharged home. You should have seen it, Josh. You know what it’s like, trying to calculate these paediatric doses—they never have trial data in the right age of child, but this...’ She smiled, the doctor in her triumphant. ‘It’s why I trained. To push boundaries. To save a life.’

‘And you saved two.’

‘And lost my job.’

‘You shouldn’t have resigned.’

It was a question she’d asked herself over and over again. ‘I couldn’t work with the man a moment longer. He was the sort who thought women should be nurses, not doctors. Basically he’s a—a—’ She bit off the word and Josh gave a faint smile.

‘I get the picture. Has it occurred to you that you might be too idealistic, Tasha?’

‘No. Not too idealistic.’ The conviction came from deep inside her. ‘Isn’t that why we’re doctors? So that we can push things forward? If we all did what doctors have always done and no more, we wouldn’t have progress.’

‘There are systems—’

‘And what if those systems are wrong? I can’t work for someone like that. Sooner or later I would have had to inject him with something seriously toxic...’ Tasha gave a cheeky smile ‘...but first I would, of course, have made sure it was approved by the formulary committee.’

‘You’re incorrigible.’

‘No, I’m a doctor. I can accept that there are some patients I can’t help. What I can’t accept is that there are some patients I’m not allowed to help because someone has decided the treatment is too expensive! I mean, who decides what’s important?’ Tasha paced across his office, her head swirling with the same arguments that had tormented her for weeks. ‘I told him that if the chief executive took a pay cut we’d be able to easily fund this drug for the few

babies likely to need it.’

‘I’m beginning to see why you felt the need to resign.’

‘Well, what would you have done?’

‘I have no idea.’ Her brother spread his hands. ‘It’s impossible to say if you’re not in that situation. Why didn’t you wait for the blood cultures? Or use the first-line choice?’

‘Because the twins were getting sicker by the minute and I felt that time was crucial. If we’d waited for that one drug, only for it to fail... My instincts were shrieking at me, Josh. And even while I was running tests, my consultant was telling me it wasn’t sepsis and that the twins were suffering from something non-specific caused by the stress of delivery.’ And she’d spun it around in her head, over and over again, looking for answers. ‘Sometimes you see a patient and you’re going through the usual and it all seems fine, except you know it isn’t fine because something in here...’ she tapped her head ‘...something in here is sending you warnings loud and clear.’

‘You can’t practise medicine based on emotion.’

‘I’m not talking about emotion. I’m talking about instinct. I tell you, Josh, I know when a child isn’t well. Don’t ask me how.’ She held up her hand to silence him. ‘I just know. And I was right with the twins. But apparently that didn’t matter to Mr Tick-All-The-Boxes Consultant. He has to play things by the book and if the book is wrong, tough. Which is a lame way to practise medicine.’

‘And no doubt you told him that, too?’

‘Of course. By the time he’d had all his evidence, he would have had two dead bodies. And he was angry with me because I saved their lives. He could have had a lawsuit on his hands, but did he thank me?’ The injustice of it was like a sharp knife in her side, digging, twisting. ‘Haven’t you ever used instinct when you treat a patient?’

‘If by instinct you mean clinical judgement, then, yes, of course, but, Tasha—’

‘Wait a minute.’ Tasha interrupted him, her brain working and her eyes wide. ‘That little girl—’

‘What little girl?’

‘The one waiting to be seen in the main area. I heard the mother say that hay fever was making her asthma worse, but her eyelids were swollen and her face was puffy. I thought at the time that something wasn’t right—just didn’t seem like allergy to me—and—’

‘That little girl is not your patient, Tasha.’

‘She was wheezing.’

‘As she would if she had asthma.’

‘As she would if she had left-sided venous congestion. I knew there was something about her that bothered me.’ Tasha picked up his phone and thrust it at him. ‘Call the doctor in charge of her, Josh. Tell her to do the tests. Maybe she will anyway, but maybe she won’t. In my opinion, that child has an underlying heart condition. Undiagnosed congenital anomaly? She needs an ECG and an echo.’

‘Tasha—’

‘Just do it, Josh. Please. If I’m wrong, I’ll give up and get a job in a garden centre.’

With a sigh, Josh picked up his phone and called the doctor responsible for seeing the child.

While he talked, Tasha stood staring out of the window, wishing she didn’t always get so upset about everything. Why couldn’t she be emotionally detached, like so many of her colleagues? Why couldn’t she just switch off and do the job?

‘She’s going to do a full examination, although she thinks it’s asthma and allergy combined. We’ll see. And now you need to relax.’ Josh’s voice was soft. ‘You’re in a state, Tasha.’

‘I’m fine.’ It was a lie. She’d desperately wanted a hug but was afraid that if someone touched her she’d start crying and never stop. ‘But I do find myself with a lot of free time on my hands. I thought...’ She hesitated, hating having to crawl to her brother. ‘You’re important. Can you pull a few strings here? Get me a job? The paediatric department has a good reputation.’

‘Tasha—’

‘Paediatrics is my life. My career. I’m good, Josh. I’m good at what I do.’

‘I’m not debating that, but—’

‘Yes, you are. You’re worrying I’ll mess things up for you here.’

‘That isn’t true.’ Josh stood up and walked over to her. ‘Calm down, will you? You’re totally stressed out. Maybe what you need is a break from hospitals for a while.’

‘What I need is a job. I love working with kids. I love being a doctor. And then there’s the practical side. I was living in a hospital flat so now I’m homeless as well as jobless.’ Tasha felt as though she had an enormous mountain to climb. ‘Resigning seemed like the only option at the time. Now I realise why more people don’t resign on principle. It’s too expensive.’

‘I can’t pull strings to get you a job at the hospital, Tasha. Not at the moment. We’ve spent a fortune opening a new paediatric burns unit. There’s a head-count freeze.’

‘Oh.’ Her stomach swooped and fell as another door slammed shut in her face. ‘No worries. I’ll sort something out.’ She tried to subdue the niggling worry that her last consultant wouldn’t give her a decent reference. ‘Sorry, I shouldn’t have asked you. I shouldn’t have just shown up here.’ The list of things she shouldn’t have done was growing.

‘I’m glad you did. It’s been too long since I saw you. All you’ve done for the past three years is work. Since things ended with Hugo, in fact.’

Hugo? Shrinking, Tasha wondered why her brother had chosen that particular moment to bring up her disastrous love life. Could the day get any worse? ‘I love my work.’ Why was he looking at her like that? ‘What’s wrong with loving my work?’

‘No need to get defensive. Maybe it’s time to take a break. Rediscover a social life.’

‘Social life? What’s that?’

‘It’s part of work-life balance. You were going to get married once.’

The reminder scraped like sandpaper over sensitive skin. ‘A moment of madness.’ Tasha spoke through her teeth. ‘Do you mind if we don’t talk about it? Just thinking about Hugo makes me want to put my fist through something and at the moment I can’t afford to pay for the damage. Anyway, you’re a fine one to talk. You’re a total workaholic.’ But he’d spent the night with a woman.

Tasha wondered if he’d confide in her, but Josh was flicking through some papers on his desk.

‘How flexible are you?’

‘I can touch my toes and do a back flip.’ Her joke earned her an ironic glance.

‘The job,’ he drawled. ‘How would you feel about a break from paediatrics?’

‘I love paediatrics, but...’ But she was desperate. She needed something. Not just for the money but to stop herself thinking and going slowly mad. She needed to be active. ‘What do you have in mind?’

‘I happen to know a man in desperate need of twenty-four-hour nursing care for the next month or so. He’s asked me to sort something out for him.’

Tasha instinctively recoiled. ‘You want me to give bed baths to some dirty old man who’s going to pinch my bottom?’ She frowned at the laughter in her brother’s eyes. ‘What’s so funny about that? You have a sick sense of humour.’