Page 2 of Duplicity

‘Excellent. Great.’ Adrenaline is a dangerous drug. I’m not panicked—I’m invincible. I’ve got this. ‘Put me onto Mrs Hopkins.’

Mrs Hopkins, the receptionist, is first-aid trained and a huge fan of Tabs.

‘She’s here,’ Tabby tells me faintly.

‘Mrs Hopkins?’ I sprint, unseeing, through the stunning foyer of Burlington House, where the Royal Academy is housed, and emerge out into the spectacular courtyard. ‘Do you have the oximeter?’

‘Yup.’ Her confident tone is music to my ears. ‘Hold tight, Miss Winters.’

Tabby is still holding onto her teacher’s phone, though she’s not doing a great job of keeping it still. My current view as I cross the courtyard and take a left on Piccadilly is of the school crest on her royal blue sweatshirt and a segment of her plaited hair, long and blonde like mine.

‘Seventy-nine,’ Mrs Hopkins announces.

Fuck, fuck, fuck. Those oxygen levels are way too low. ‘Knees to your chest, sweetie. What were you doing when you started to feel bad?’ I ask Tabs as I speed-walk along Piccadilly. I’ll duck underground as soon as I’ve handed her over, but we’ll need to give the paramedics as much context as possible.

I get a shaky image of her pulling her bare knees up to her chest. By curtailing blood flow to the lower half of her body, her heart can focus on directing more of its limited supply to her lungs.

The TA’s voice sounds through my phone. ‘We were just rehearsing for the class assembly. The kids were doing a dance routine, and Tabby said she felt dizzy.’

Tabby’s condition, Tetralogy of Fallot, sounds like something from the Legend of King Arthur but is, in fact, a congenital heart defect. The pulmonary valve sending blood from her heart to her lungs was too narrow at birth, constraining her oxygen supply. She’s endured two open-heart surgeries to replace the valve, one at birth and one aged three, but she’s once again outgrown her current valve. Right now, it only takes a small amount of physical exertion to bring on what Tabs and I call a “blue spell”, where blood flow to the lungs decreases and oxygen levels plummet.

‘Got it. Mrs Hopkins, can you grab a fact sheet, please?’

‘Absolutely,’ I hear. ‘Don’t you worry. We’ve got this little pixie, don’t we, Tabs?’

Thank God for people like Mrs Hopkins, who treat everyone else’s kids with as much love and attention as their own. Shekeeps a stack of printed sheets that I’ve put together and filled with all of Tabby’s salient information—contact details for me, an overview of her condition and surgical history, her meds, and contact details for her cardiac team at Great Ormond Street Hospital, or GOSH, London’s preeminent and wildly under-resourced children’s hospital.

If my maths is right, we’ve handed over eight fact sheets since January, and it never gets easier.

The hours following my arrival at the hospital are the usual blur of doctors and machines and beeping. Tabby was given beta blockers and an oxygen mask when she was admitted, and both her oxygen saturation and heart rate have normalised, thank fuck. She’s had a chest X-ray as well as an ECG to assess the functionality of her pulmonary valve.

Between treatments, I’ve sung to her softly, and we’ve read from theAnne of Green Gablespaperback we keep in her hospital backpack. We’ve been given a bed in one of the main A&E wards so that the doctors can observe Tabby before discharging her.

As I read to her, my gaze keeps drifting to a little girl in one of the bays across from us. She’s probably a couple of years younger than Tabby. I’m not sure what’s wrong with her, but she was vomiting and crying in pain earlier. She’s happier now, thank God, but the thing that grabs my attention over and over is the two parents flanking her. Her mother and father sit on plastic chairs on either side of her bed like two adoring guardian angels. They haven’t left her side. As I watch, they interlace their fingers on her lap, and the gesture is so tender, so natural, thatI have to look away. Those three are thick as thieves, and it couldn’t be any more obvious.

It’s not that I want someone here forme. I’m an A&E expert by now, and I’m used to being the grown-up, to acting like I’m not falling apart without having anyone to rubmyback and tell me it’s all going to be okay. But it’s not fair that a little girl as brave and amazing as Tabs should have to make do without a father figure in her tough little life.

It’s not fucking fair.

Fucking Joe.

The only silver lining is that I’ve had no time at all to ruminate over being fired. I had a text from my colleague Jake—You can appeal this, you know—but I’m too damn exhausted, as the adrenaline vacates my nervous system, to even consider that option. I’m too overwhelmed with emotion to have any capacity for the financial worries that I know are waiting to flood my brain.

Right now, my only focus is the frail little girl on the bed next to me. The colour has returned to her cheeks, and that terrifying blue tinge has faded for now. Miss Lewis told me when I arrived that the dance they’d been rehearsing for their assembly wasn’t even particularly high energy, and the knowledge terrifies me.

I don’t need a doctor to tell me what I already know, but a paediatric cardiologist swings by and pulls me aside just to ram home the incontrovertible truth anyway.

‘The ECG has shown a further deterioration in her pulmonary valve,’ she tells me gently. ‘We spoke to her cardiac team at GOSH. I understand she’s waitlisted for a valve replacement surgery, but not until November?’

‘That’s right.’

November is six months from now, and the doctor’s grimace says it all.

It’s too far away.

‘If this pattern continues, I’d expect she may be in need of an emergency replacement sooner than that. So far, the right ventricle is holding up remarkably well, but I’d expect to start seeing a thickening of the wall given the strain it’s under. If you find that her tolerance for exertion declines further, or the tet spells become more severe or frequent, or her sats start to worsen when she’s resting, we’d conclude that the heart is struggling to cope.

‘An emergency surgery is far from ideal for many reasons that I’m happy to expand on, but I’m afraid Tabby’s heart may not be equipped to last another six months with a profoundly inadequate valve.’

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