Tom immediately glanced up at Alex, silently communicating the urgency of the situation. Alex nodded and walked out of the room, his heart pounding in his chest - still only a relatively inexperienced medic, he still got very nervous in real emergencies.

He just hoped that this wouldn't turn into one of the bad ones.

"Alright you two" Tom turned back to address the pair in front of him, "by the looks of things, it looks like you've got yourself a spot of acute appendicitis."

Dec let out a pained groan at this, letting his head flop back against Ant's chest in despair.

"Alex has gone to get our stretcher from the car, but we can't bring it up the stairs unfortunately. So we're going to need a bit of help from the both of you to get downstairs" Tom continued, already wondering himself how they were going to manage it.

"Haven't you got a chair, or something?" Dec pleaded through gritted teeth, looking up at him desperately.

Tom shook his head - mentally cursing their stair chair for breaking earlier that morning, and them not being able to get back to the station to pick up a spare.

"Sorry - it kicked the bucket on the last job" he apologised sadly before continuing "Before we go: are you still feeling nauseous Dec?"

Dec gave a little nod.

Pulling the drug kit towards him, Tom rifled through its contents in search of a vial of ondansetron.

"Have you ever had a drug called ondansetron before?" he asked as he pulled a vial out, along with a cannulation kit.

Again, a nod.

"Once, when I got sick in Australia" Dec explained, wincing noticeably at the sight of the cannula.

Tom then remembered that Dec was not a fan of needles.

He briefly considered going IM for the injection, but then realised that the hospital would probably cannulate him anyway, so it would be better to just do it here - save poor Dec getting stuck with a needle twice.

Getting himself ready for the procedure in record time, Tom quickly swabbed Dec's wrist and took the cap off the cannula.

Hopefully you won't hate me TOO much for doing this Tom thought to himself as he readied to insert the needle.

"Alright, sharp scratch" was all the warning he provided before he slid the cannula into place - earning himself a hiss from Dec. Relieved when he saw the flashback he was looking for, he retracted the needle and blocked off the vein with his other hand. Applying the bung and removing the tourniquet, he taped the cannula in place before flushing it through with some saline.

Happy that his line was patent, Tom then grabbed the other syringe - which contained his prepared ondansetron.

"Okay, the ondansetron's going in now" he advised, screwing on the syringe to the bung and slowly pushing the drug through.

Once the contents of the syringe had been emptied into Dec's bloodstream, he removed the syringe and put it into his pocket to dispose of later.

"Okay, that should start working in a minute or so. But what we really need to do is get you up and down to the truck" Tom explained, sitting back to look at the boys.

"Have you got something to take this pain down a little?" was the next question he was asked.

Tom shook his head, biting his lip.

"Sorry Dec. Can't do that I'm afraid - it would mask your appendix bursting if we gave you any pain relief, unfortunately."

Dec gave a little nod in understanding, though Tom was hating himself at that moment. He cursed the nature of the human body in his head before he focused his attention back to the situation at hand.

"Alright, let's get you up then. Ant: if you could support him from behind, and Dec: let us do the work, okay?"

Both the boys gave a nod to show that they understood the instructions, and they all readied themselves for the bracing lift.

"Lift up on 3? 1, 2, 3" Tom led the countdown, watching his patient carefully as they lifted.

Slowly, they helped Dec off the floor and into a standing position. Almost immediately, he started to curl inwards and began to lean heavily into Ant, panting harshly through the intense pain that had just increased yet again - clearly close to screaming again.

It was times like this that Tom hated his job.

Or rather, he hated the fact that he had to do his job by not doing anything. And, when someone was in pain - particularly significant pain - it really struck a nerve with his own emotions.

Swallowing down his internal conflict, Tom let the boys stand quietly for a moment. In the moment of pause, a sudden brainwave occurred to him, and he turned to Ant.

"I've got an idea, but I'll need your help for this Ant" he started, brown eyes flickering between the two men in front of him.

Ant nodded gamely and straightened a little - ready to listen to the medic's idea.

"What we're going to do is make a bit of a chair with our arms. I need you to hold onto my left arm with your right hand - that's it - and then my right arm with your left, and then your right hand needs to go up a bit higher - good, that's good - and left hand down a bit more."

The result was a rudimentary chair fashioned out of their own arms and hands. Essentially, this would be how they would carry Dec downstairs.

"Now Dec, I need you to sit down on our bottom hands - in about the middle, that's it" Tom explained, "now put your arms around our shoulders, and hold on!"

Dec did as he was told, though both Tom and Ant could feel the trembling in his hands as his fists gripped onto their shirts.

"Right Ant, on 3 we'll lift up and start walking to the door" Tom continued, to an answering nod from Ant.

"Okay: 1, 2, 3."

Dec had to bite his lip to keep another yell from escaping as the movement sent another stabbing pain through his side. Instead, all that came out was a pained whimper as he tightened his hold on Tom and Ant.

"Good, very good you two. Now let's get out of this room and down to the stairs" Tom encouraged, leading the way towards the door.

It took some rather creative maneuvering, but they somehow made it out of the judge's room and into the hallway.

Now the next challenge: getting down the stairs.

"Take it slow as we go down these stairs, otherwise we'll all end up as patients - and I don't think all three of us will fit on our stretcher" Tom advised, sneaking in a bit of humour at the end.

It was definitely appreciated by the other two - Ant let out a tension-relieving laugh, and even Dec chuckled a little.

"It would be a bit snug" Dec mused, grinning a little.

Tom gave a chuckle of his own in response - glad to have helped relieve some of the tension for the moment.

Slowly but surely, the three of them made it to the bottom of the stairs to where Alex was waiting patiently with the stretcher.

Once at the side of the gurney, they came to a halt as close to the bed as possible.

"Okay Dec, we're going to lower you down onto the bed now. I'd brace yourself - this is probably going to hurt" Tom warned, hating himself for having to put his patient through more pain.

Dec nodded gamely and bit down on his lip in preparation.

Tom and Ant shared a look before they slowly began to lower their charge onto the stretcher. Alex came in from the other side to help stabilise the stretcher and to provide some extra support.

Fortunately, Dec managed not to scream - although it was a very close call. His eyes were squeezed tight, his face seemingly permanently set in a pained grimace.

"Alright, that's it: you're on" Tom spoke up, putting a hand on Dec's shoulder - worried at just how he could feel it trembling.

He and Alex made short work of strapping on the seat belts of the stretcher - although they made sure to leave them a bit loose in case Dec needed to change position.

"Do you want the back of the bed up a little?" Alex asked, frowning in worry as Dec tried to curl up once more.

A weak nod was his only response.

Obliging, Alex raised the head of the bed so that Dec was now lying in a semi-recumbent position. He then walked around to the end of the stretcher and raised the knee point of the bed as well - so that his knees would be raised, and that would (hopefully) relieve some of the pain.

He and Tom then loaded the stretcher into the back of the ambulance, closing the back doors as the bed slid into place. Tom put a hand on his arm as he made to walk around to the driver's side door.

"Lights and sirens on the way back, you think?"

Alex nodded in agreement - they needed to get going to the hospital nice and quick.

"I'll give the ED a call and let them know we're coming in too" he added, to an approving nod from his colleague.

Tom gave him a pat on the back as they went their separate ways - Alex to the front and the driver's seat, Tom to the side door and into the back of the ambulance.

Pausing at the door, Tom turned back to Ant - who was lingering by the passenger's side door.

"Why don't you come in the back? I could probably use a hand in keeping him calm and comfortable" he suggested, pleased when Ant nodded and climbed up the step and into the van.

Tom shut the door behind him and gave the dividing barrier a quick tap to let Alex know that they were ready. His friend responded by starting the engine and pulling away from the curb - blue lights reflected in the windows of the nearby buildings, sirens echoing through the busy street.

Ant took a seat in the back-facing chair behind the stretcher, and immediately - as if sensing his friend's presence - Dec turned his head up to look at him.

"Hey kidda" Ant murmured softly, reaching over the back of the stretcher and putting a hand on Dec's shoulder.

Dec barely managed a weak smile before another wave of pain sent his face back into a grimace. Instinctively, his hand grasped onto Ant's and squeezed it tight through the pain as tiny droplets of water leaked from the corners of his eyes.

"Aw, mate" Ant whispered, running his thumb over Dec's hand - all the while wishing that he could take his friend's pain away.

Once that wave had passed, Dec loosened his grip a little - although he kept Ant's hand in his hold and in close reach. Ant didn't want to move it away - if it could give his poor friend any sort of comfort, then he would happily give it to him.

Tom sat in the other seat and watched their exchange discretely. He was amazed that he was getting this special insight into the two's friendship, and he felt strangely honoured and privileged that he got to witness it.

He just wished that the circumstances were better.

No one really spoke for most of the trip - the only noise inside the truck were the occasional hiss of the blood pressure cuff as it wound up, or the beeping of the monitor as it took another ECG reading. Mostly, the trio was quiet, except for the occasional soft whimper of pain from Dec.

About two minutes from the hospital, a loud yelp of pain cut through the quiet as the ambulance went over a large bump in the road, and Ant found his hand being squeezed within an inch of its life.

"It's alright, Decs. We're nearly there" he tried his hardest to calm his feverish friend, but he feared that not much was getting through anymore as Dec's fever continued to rise.

"Anty, it hurts" Dec whimpered - sounding startlingly childlike - and nestling his heated forehead into Ant's hand, confirming his suspicions.

"Don't worry, son. It'll be over soon" Ant soothed, biting his lip and turning away as Dec just squeezed his hand harder.

*****

"Alright thanks, Alex; I'll make sure there's a team waiting for you when you get in."

Doctor Karen Hoffman's ears perked up at the sound of one of the nurses talking on the phone that connected them to the ambulances out on the road. Apparently there was a pretty critical case coming in.

"What's up?" she wondered aloud once the nurse - Janet - hung up the phone and looked down at her notes.

"That was Alex - he and Tom are bringing in a critical abdominal pain in about ten minutes" she replied, bending down to enter something into the computer at the triage desk.

Karen raised an eyebrow - now even more curious. During the last few weeks, she (and the rest of the team at the Royal London) had gotten to know the two newest paramedics quite well - and if there was anything any of them could be sure of relying on, it was the pair's instinct for picking up on a truly critical patient.

Which basically meant that if they said their patient was critical, then they were pretty damn critical.

"How critical are we talking?" she questioned, keen to know as much as possible about their incoming guest.

Janet kept typing for a second before clicking on the 'Upload Information' button on the screen. When the new page opened, she turned back and looked back down at her notes.

"Uh, 43 year old male: suspected acute appendicitis" she recited, "like - really acute. Alex told me that Tom reckoned that it was nearly fit to burst."

Karen winced - she just hoped that the ambulance could make it to the ED before the poor guy's appendix did burst, because otherwise they would be in for a whole host of new problems.

"Right, well let's get ourselves organised: get a surgical team ready, get everything ready for when they come in. If this guy is as critical as Tom and Alex say, there'll be no time for dallying about" she commanded grimly, watching as Janet nodded and walked over to where another group of nurses was returning from a break.

While she was doing that, Karen pulled out her work phone and called up her second in command in the surgical ward - Sarah.

"Hi Sarah" she greeted as soon as her good friend answered the phone.

"Well hi Karen, what's up?" Sarah replied, her Australian accent making her sound much more relaxed than Karen herself.

"Can you get the team ready up there? We've got a suspected acute appendicitis coming into the ED, and we'll need you lot to be on standby" Karen explained, relieved to hear Sarah immediately pull the phone away from her ear and address her team.

"We'll be ready" Sarah assured about two minutes later - after explaining the situation to her team. "When are they coming in?"

Karen looked at her watch.

"In about seven minutes. The crew said they were coming in lights and sirens, so hopefully they'll be pretty close by."

Unseen by her friend, Sarah nodded in approval.

"Right. I'll come down and greet them when they arrive too - just send me a buzz when the ambos get here"

Karen had to smile - her friend's Australian lingo still snuck into their conversations every now and again, and it always put a smile on her face.

"See you then!" she agreed, before they rang off.

*****

Alex guided the ambulance into the bay at the Royal London Hospital just over six minutes later. They had actually gotten lucky with the traffic - all the sensible drivers had been out on the roads this afternoon, and they had actually gotten out of the way for them.

It was such a rare thing, and Alex was quickly learning to appreciate it.

As soon as the engine had cut off, he was out of the driver's seat and walking briskly around to the back of the truck to open the doors.

At first, he was concerned by the lack of noise or activity in the back, but then he quickly realised that it was simply because the constant pain and the increasing fever had started to really take its toll on Dec - who lay utterly exhausted on the stretcher, only squirming around occasionally in an attempt to get some relief.

He shot a worried look at Tom, who shook his head - looking equally concerned as he stepped down from the back of the truck.

A quiet whimper cut through the silence of the carpark, and the two paramedics watched as their patient began to squirm on the stretcher once more - face screwed up in pain.

"Ant" Tom summoned, and immediately the other man appeared at his friend's side - putting a comforting hand on Dec's shivering shoulder.

"I'm here, pal" he quietly reassured, thumb gently rubbing the fabric under his hand.

Dec's only response was a weak whimper as he turned over and latched onto his friend's hand once more.

Tom and Alex decided they'd best get moving, and started to wheel the stretcher away from the ambulance and towards the sliding doors of the emergency department, Alex locking the door over his shoulder as they walked.

Ant followed the stretcher into the ED, making sure to stay close by his friend in case he was needed.

Tom and Alex were immediately guided into a cubicle where a full team was ready to receive them. Upon seeing exactly who their patient was - and who was with them - they immediately straightened up, and Ant found himself the object of more than a few curious stares.

"Alright boys, what do we have?" A familiar voice - one that Ant hadn't heard in just over a year - finally broke the silence.

He glanced up and saw the face of Dr Karen Hoffman - who, last time they had been here, had been in charge of the Intensive Care Unit. They had crossed paths briefly after a horrific car accident the year before, which had left Dec in a coma and close to death.

Ant still hadn't quite forgiven her for nearly giving up on his friend and almost letting him die.

Karen's face also had a flash of recognition, and she felt the waves of lingering distrust emanating from the younger of the two. She mentally sighed - knowing exactly what the reasons for that were.

Biting her lip, she turned away to listen to Tom as he gave the team his handover.

"Right everyone: this is Declan, and he's been having some severe abdominal pain that started about 8:30 this morning and has been getting worse since. It started off as intermittent, well-localised to the umbilical region, and only exacerbated on movement. It's since moved to the right lower quadrant and has become constant since about forty minutes ago. Pain is described as a "sharp, stabbing pain" at 10/10, it's not relieved by positioning and is worse on movement."

One of the nurses was jotting down a series of notes onto a piece of paper on a clipboard - pen moving so fast it was almost a blur. The faces of the whole team were quickly dawning with comprehension as Tom's handover continued.

"There is definite rebound tenderness, as well as some noticeable localised swelling in the right lumbar and right iliac regions. He's also had some nausea and vomiting this morning, he's febrile at 39.0, and he's hypotensive and tachycardic. ECG was normal otherwise, and all his other obs were fine."

Karen breathed a quiet sigh of relief - they still had time to get in and remove the inflamed appendix before it burst.

"We haven't given any analgesia, but we have given 4mg ondansetron IV via the Intern's Vein, which has been effective. No allergies, no meds, no other relevant medical history of note - although Ant did say that there should be a file here at the hospital" Tom turned to Ant at this point, who nodded in affirmation.

The team took a moment to let the information register, before Karen and Sarah started to organise the troops.

"Right, we'll do a quick assessment, and then if we concur with your diagnosis Tom, we'll get straight on up to surgery" Karen explained, to nods of understanding from the rest of the team - who immediately started to bustle around to get their observations.