Where The Heart Is

Luke’s mouth was set in a thin line. ‘I’ll give you the lecture later. Just stand back—I don’t want anyone else falling in. I’ll get him.’ He stripped off his jacket and then plunged into the lake.

Rowena put her arm round the young woman and guided her back from the edge. The rest of the group was silent. ‘You’re Melissa, aren’t you?’

‘Yes. I…We didn’t mean it. I didn’t know those drinks were so strong. They tasted…Well, it was a laugh. He just lost his footing.’

‘He can swim,’ one of the others put in.

‘Yes, but this is glacial water. It comes from an ice field,’ Rowena pointed out. ‘Look, can one of you run back to the refugio and get some blankets and towels? We need them now.’

‘I’ll go,’ one of them said, and immediately raced towards the refugio.

‘Why do you need blankets?’ another asked.

‘The air temperature is cold—his body’s not going to be able to cope with the shock of it on top of the cold water,’ Rowena said.

‘He’s not going to die, is he?’ Melissa wailed.

‘It’s likely that he’s going to have at least a mild case of hypothermia—’ the risk increased with every minute he was in the water ‘—so he’s in for a rough night.’

‘Hypothermia? Isn’t that what you get when you’re old, or if you’ve been on a mountain all night?’

‘It means your body’s core temperature is a couple of degrees lower than normal,’ Rowena explained. ‘It happens more quickly in cold water. As your body cools, your brain and nerves work more slowly and your muscles start to cramp. That means Stephen’s not going to be able to swim properly, and his heart might not beat properly either.’

‘So he’s going to be really ill?’

‘It depends on how fit he is and how cold the water is. And drinking alcohol increases the risk of developing hypothermia,’ Rowena added.

Melissa looked frightened enough. Rowena decided not to add that if Stephen’s temperature went too low, his heart rate would drop, he could slip into a coma, and he might even die. ‘I think in future it might be a good idea to decide to have a few drinks or to have a night-time stroll round the lake—not both.’

‘We never meant this to happen. We were just having a laugh, enjoying the stars and that. He slipped on the rocks and fell in,’ Melissa said, her voice shaky. ‘I thought he was messing about at first. You know what blokes are like.’

The blankets arrived at the same time that Luke emerged from the lake, supporting Stephen and half dragging him.

Luke nodded approval at the blankets and towels. ‘Quick thinking. We need to get him out of this wet stuff and dry him, and get him back to the refugio.’

‘You’re wet as well,’ Rowena pointed out as she helped Luke strip the wet clothing from the groggy man and blot the water from his body with towels.

‘I’m a doctor and I’m used to the climate.’

‘Don’t be so ridiculous. If you stay out here in wet clothes, you’ll develop hypothermia as well! We need the trek medical officer at peak fitness,’ Rowena snapped.

‘I’ll change when we get in,’ Luke said.

She didn’t bother arguing, simply helped him wrap Stephen in the blankets and supported him on the way back to the refugio. The young man was too cold and disorientated to talk to them—he simply accepted their help with mumbled thanks and stumbled along between them.

‘Shall I get him a hot drink?’ Melissa asked.

‘No, if you try to warm him up too quickly you could burn him,’ Rowena answered. ‘Where’s your medical kit, Luke?’

‘In the refugio. It’s safer there than in my tent.’

Stephen’s girlfriend clearly needed something to do to make her feel as if she was doing something to help. ‘Melissa, can you run ahead and get the kit? And have you got a room or were you sleeping in tents?’

‘I’ve got a room,’ she said.

‘Good. We’ll need it for him tonight,’ Rowena said.

‘I’ll get the stuff,’ Melissa said.

When they got to the refugio, Melissa was waiting with the medical kit.

‘Got an ear thermometer in there?’ Rowena asked.

Luke nodded. ‘Stephen, I’m just going to put this in your ear and take your temperature, OK?’ he asked. The young man nodded. ‘Thirty-three degrees.’

Low, but manageable, Rowena thought. So they wouldn’t need to call out the air ambulance. Yet.

‘That’s good. You’ve got mild hypothermia, Stephen, so we’ll be able to help you right here, with something called passive rewarming. That means we’ll wrap you in warm blankets to reduce the amount of heat your body’s losing to the air.’ Luke gave Melissa a tight smile. ‘Don’t look so scared. He should warm up again in three to four hours.’

‘We need to avoid afterdrop, so we’ll keep his arms and legs uncovered, but we’ll cover his head and neck,’ Rowena added quietly. Because the body’s extremities cooled faster than the torso, if they warmed his arms and legs, the colder blood in Stephen’s limbs would re-enter his circulation and make his hypothermia worse. Heat was lost more quickly from the head, so keeping Stephen’s head covered would help.

Luke’s eyes narrowed. ‘You know about hypothermia?’

Oh, no. She’d been bandying technical terms about without thinking. It must be obvious to him that she was a medic. ‘I’ve done some first aid,’ she admitted. It just happened to be part of her job as an emergency department registrar. Though he didn’t need to know that much detail.

‘Do I get him a drink now?’ Melissa asked.

‘Not until he stops shivering,’ Luke said. ‘But shivering’s a good sign. It means your body’s warming up again,’ he added to Stephen.

‘When you get too cold, your body loses the shiver reflex,’ Rowena explained.

‘Right,’ Melissa said, biting her lip. ‘So he’s going to be OK?’

‘We’ll keep an eye on him but, yes, he should be fine,’ Luke reassured her.

‘Go and get changed,’ Rowena told him. ‘I can cope here for a few minutes.’

Again, Luke gave her that assessing stare, but he nodded and left. When he returned, he was wearing jeans—old, faded, but snug enough to make Rowena feel a surge of lust—and a black fleece.

‘Should I get you a warm drink?’ Melissa asked.

‘That’d be kind. Yes, please,’ Rowena said, before Luke could say anything. When the young woman had left the room, she glanced at Stephen. He looked drowsy; the chances were he wasn’t going to pay that much attention to what she was saying. She added quietly to Luke, ‘She needs something to do—something to make her feel as if she’s helping. She’s feeling guilty about what’s happened.’

His eyes were hard. ‘So she damned well should. Of all the stupid things—drinking and then going near the edge of the lake! It’d be bad enough on a warm night in a hot country, but to do it here, on the edge of a glacial lake in the middle of winter…’

‘Hey. She’s young, she’s frightened. She knows she’s done wrong, and if you shout at her you’re likely to make that whole bunch aggressive towards you.’ Rowena had seen it happen before too many times on a Saturday night—a lot of the Saturday night emergency cases could be traced back to the effects of alcohol. The ones who came in with the emergency case had usually been drinking, too, and from her first weekend in the ED Rowena had been taught to defuse the situation, keep it light and make sure any aggression didn’t spiral out of control. ‘Keep it calm.’

‘But it was such a stupid—’