Authors: Caroline Anderson
âThat's rubbish, you tell me all the time!'
âBut not about something like this.'
âWell, what would you do?'
She smiled worriedly. âI'd listen to the doctor,' she replied. âIf he thinks it's a good idea, I'd believe him. Besides, you want to know what's going on, don't you?'
She hesitated another moment, then nodded. âAll right, then,' she agreed. âIf you're sure you need to do it?'
âI need toâand it's really not that bad.'
âHow do you know? Have you ever had it done?'
He shook his head and smiled. âNo, but I've done it to lots of people and, believe me, they'd tell me if it was too dreadful. They don't usually hold back.'
She gave a faint smile and nodded. âOK. But can you stop if I really don't like it?'
âYes, of course I can, but it's very quick. Probably less than five minutes. Two?'
He gave a little chuckle and shook his head. âNo, I can't promise, but I wouldn't lie to you.'
âWould you have it done?'
âOh, yes. No hesitation. It's very straightforward, and it doesn't hurt. It just feels a bit odd and makes you retch a bit. If you could go back to the waiting room, I'll make the necessary arrangements and then let you know if we'll be able to do it today.'
She hesitated again, then nodded, and he gave a silent sigh of relief as they left and reached for the phone. âKate, I've just seen Tracy Farthing. Can I have a word about her?'
âSure. I'm free for a second. Come on in.'
He went next door to her consulting room and perched on the desk. âI'm guessing wildly, but her hair's a bit sparse and she fiddles with it. Her mother says she's done it for years.'
Kate frowned curiously. âA trichobezoar? I don't think I've ever seen oneâunless you count the hairballs my mother's cat used to bring up!'
He chuckled. âNo, I haven't either. Certainly I've never seen one large enough to cause this kind of obstruction. I'd like to do a gastroscopyâwhat are the chances this afternoon?'
âRing Endoscopy and tell them you're bringing her upâunless you want me to do it?'
He laughed softly. âYou really don't trust me with her, do you?' he murmured, and was fascinated to see a little brush of colour on her cheeks.
âOf course I trust you. I'm just not used to being able to delegate to such an extent,' she said, trying to talk her way out of it. âAre you going to sedate her or use the anaesthetic spray?'
âSpray,' he said firmly, having done both and having assessed that Tracy was basically calm, reasonable and likely to be compliant. He much preferred working with an alert, cooperative patient so he could explain things as he went along.
âIn which case there shouldn't be a problem,' Kate said. âRing them now. I'll carry on working through the clinic patientsâbut feel free to call me if you want a second opinion.'
âKate, I'm fine,' he said firmly, and he took Tracy and her mother up to the endoscopy suite, talked them through the procedure and showed Mrs Farthing out, then sprayed the back of Tracy's throat and quickly and easily passed the tube down into her stomach.
Her full, distended, hair-filled stomach.
âWell, I've got your answer,' he told her when he'd removed the tube and called her mother into the room, showing them the tiny bit of hair he'd teased off.
âWhat is it?'
âHair,' he said. âYou've probably been pulling it out and swallowing it in your sleep. The trouble is the hair gets in a knot, then it can't move on, and it just gets bigger and biggerâ'
âOh, gross,' Tracy said, wiping her mouth on a tissue and gagging slightly. âThat's disgusting.'
âIt's one of those strange things that people do for no very good or known reason. It's called trichophagia, which means literally hair-eating, and it often starts in childhood and can persist into adulthood totally subconsciouslyâyou probably do it in your sleep.'
She pulled a horrified face and looked near to tears. âI want it out.'
âThat's the plan, because it's not doing you any good at all. You need to stay here in the waiting area until your throat's feeling normal again and you can swallow properly, Tracy, then come back to the clinic and see me and I'll run through what we're going to do.'
He left them with the endoscopy nursing staff and went back to the clinic, tapping on Kate's door. She looked up and smiled.
âPerfect timing, I was just about to call my next patient. Soâwhat do you know?'
âSpot on. It's massive. I want to admit her as a matter of urgency and remove it before she starts to suffer with gastric bleeding from the abrasion.'
âI agree. We're operating tomorrow. I've got a couple of patients I've seen today who are much more urgent than their referrals suggest, one of them the Crohn's case I was telling you about, so stick her on the list with them and we'll just have to hope we aren't too busy overnight.'
âI'll tell her to come in later today, then,' he said. âWhat do you want me to do now? More outpatients?'
She frowned. âActually, no, I'd like you to talk to Mrs Symes. She's waiting for you.'
He felt his heart sink, and swallowed. âOK. I'll talk to her now, and then see Tracy when she's back down.'
He walked along the corridor to the waiting area, saw Amanda Symes staring out of the window blankly and went over to her.
She turned, her hand on her chest, and gave him a very half-hearted smile. âYou made me jump, I was miles away.'
In hell, he thought, judging by the look of her. âI'm sorry. Come on, let's go and have a chat. Fancy a cup of tea?'
âHave you got time, James? I don't want to be a bother.'
âIt's no bother, I could murder for one. I haven't had time to stop yet this afternoon.'
He paused by the reception desk. âAny chance of two cups of tea in my consulting room?' he asked, and the receptionist nodded.
âI'll get them brought through to you,' she said, reaching for the phone, and he took Amanda to his room and sat her down.
âSoâhow can I help?' he asked gently.
âI don't know that you can. I don't know that anyone can, butâOh, James, I don't want him to die,' she said, and started to cry.
was nothing he could do except let her talk, and he did that, for as long as he felt it was productive, but when they started going round in circles he stopped her.
âYou really need to talk to the oncology nurse. She's trained to deal with this situation, and she has lots of practical things she can offer to help you both. I'm not trying to get rid of you, but I'm not really the best person to help you now. I've done all I can to make things better for him, unless he needs further bowel surgery in the future, but the onco nurse has an amazing range of things she can offer to make things easier. Talk to her. Make friends with her, and with the Macmillan or Marie Curie nurses. They'll look after you, Amanda. They won't let you deal with this alone.'
Her face crumpled again, and she made a valiant effort to control the threatening tears. âI am, though. I feel so alone. It's crazy. It's as if in a way he's already gone, and I feel so
with him for leaving me.'
He nodded, aching for her, knowing that distancing himself was impossible because he was with her every step of the way. âThat's the start of the grieving process,' he explained, his voice a little gruff. âAccept it for what it is, and just remember that, however hard it gets, it's not going to go on for ever, and you can get through it, and you're not alone. And although I can't really help you, if you want to talk to me again, at any time, I'll always find time to see you.'
He showed her out, a little surprised when she hugged him, and then shut the door and leaned on it.
I feel so alone. It's crazy. It's as if in a way he's already gone.
He swallowed hard, trying not to get sucked in by the memories, and after a moment he eased himself away from the door and sat down again.
Poor woman. Poor man. Poor all of them. He hauled in a steadying breath, closed his eyes for a moment and then picked up the receiver.
âIs Tracy Farthing back in the clinic?'
âHow did the Farthings react?'
James ran his hand round the back of his neck and frowned. âOK. She's gone home to get some things and she's coming back in this evening.'
âHave you set up a psych referral?'
He shook his head. âI was going to ask you about that. I don't know what your protocols are here, but she'll need counselling and psychotherapy or she'll just do it again. I think there's a lot going on in her life that her mother doesn't know about.'
Kate laughed. âShe's a teenager. Of course there is. I'll sort Psych out. What about Amanda Symes?' she added, and watched a shadow pass over his face.
âI've referred her to the onco nurse and the Macmillan or Marie Curie people and given her a couple of websites to look up.'
âGood. Thank you. Right, we're on call tonight. I'm just going to shoot up to the ward and check things are OK for tomorrow, then I'm going home to read up on the hairball op. Can you give me a ring if anything comes in that I need to know about? Jo's hereâshe'll help you.'
He nodded, and she thought she could see tension around his eyes. âWill do,' he said, and, picking up the notes for Tracy Farthing, he headed out of the door.
She followed slowly, contemplated staying around, and told herself not to be ridiculous. He was paid to do a job. Let him do itâhe was more than capable. And if he couldn't manage it because of his family commitments, then he'd have to go, kids or no kids. She couldn't carry him.
James headed up to the paediatric ward, wondering what the night would bring and if he'd manage to get through it without his children waking and refusing to let him out of the door if his pager went.
He introduced himself to the charge nurse, then told her, âI've got a fifteen-year-old coming in for tomorrow's list. She's got a trichobezoarâa hairball in her stomachâand we're going to remove it in the morning.'
She blinked and widened her already wide eyes. âWow. That's unusual.'
âAbsolutely. I've never done one and neither has Kate. Hopefully she'll be fine and won't need to go to ITU, but she'll need careful monitoring in case she gets gastric bleeding because of the abrasion of the hair on her stomach lining.'
The charge nurse nodded. âWe'll make sure she's got qualified cover for the first twenty-four hours. What about a psychiatric referral?'
âKate was contacting them.'
âOK. I'll follow it up. They can come and chat to her this evening, reassure her about the surgery.'
âThanks. She's called Tracy Farthingâoh, and mum's a bit unaware of her social life, I think. She looked relieved about the negative pregnancy test, but the mother was indignant.'
She laughed. âThey always are. Don't worry, we'll look after her. I'll put her with a girl who's having a knee op tomorrow. They can keep each other company in our teenagers' section.'
âThanks. Jo's around overnight, and I'm on call so I'll be in and out. Page us if you need to, and I'll pop in and make sure she's OK at some point.'
âCheers. I'm Trina, by the way. I'll be on again tomorrow morning so, if I don't see you later, I'll see you then.'
âGreat. Cheers, Trina.'
He walked away, wondering if that had really been an invitation in her wide and welcoming eyes, and if so how he felt about it.
Stunned, he decided. It was so long since he'd been in the marketplace he'd forgotten what it was like. Horrible, from what he could remember, but then for some reason an image of Kate flashed into his mind and took him by surprise.
No fluttering lashes there, no wide-open soft baby blues, just sharp shards of toffee slicing through him assessingly.
Not always, though. Sometimesâlike when she'd been in his house, watching cartoons with Rory, or after he'd painted the room and she'd lifted her hand and touched his hairâthen her eyes had been soft and warm andâ
No. She was his boss, and he'd do well to remember it. And, please, God, nothing would happen tonight to shake her faith in his ability or make her question giving him the jobâ¦
âFreya, I have to go, darling.'
âYes. I'm sorry, sweetheart. We'll do something lovely at the weekend.'
âNot go!' she sobbed, clinging to him, and he handed her, screaming, to his mother, ran down the stairs and walked out of the door, blinking back the tears that had come from nowhere.
Her wails followed him out to the car, and he shut the door and started the engine to drown out the heart-rending sound. She'd get used to it. The trouble was they'd had too much time together, and she wasn't used to him leaving her. She'd stop crying soon. She'd probably stopped already.
âPenny for them.'
He scrubbed a hand through his hair and sighed. âOh, nothing, Jo. Freya was a bit miserable when I left her,' he confessed.
âCan't your wife comfort her?'
He looked at the SHO, her eyes red with exhaustion as they snatched a much-needed coffee in a quiet moment, and for some reasonâtiredness, probablyâhe told her about Beth. Nothing much. Very little, really. The bare bones, but it was enough.
âThat's such a shame. I'm really sorry.'
âYeah. Thanks. My mother's with them, so it's not like leaving them with a stranger.'
âBut kids are funny. She'll get used to it, though.'
His pager sounded, then Jo's, and he sighed and glanced at the little screen. âFinish your coffee. I'll go down to A and E and see what we've got. I'll page you if we need Theatre.'
He made his way to A and E, and found Tom Whittaker, the consultant on duty, in majors. He was working on a young man, inserting a second IV line, and James glanced at the monitor and frowned at the blood pressure.
âBlunt abdominal traumaâwe haven't done a DPL but he's hypovolaemic. I think you've got time to get him upstairs, but not much else. He's crashing. Apparently he's been kicked.'
âCharming. Right, let's get him stabilised and we'll take him into Theatre. I'll page Jo and get her primed.'
âThe police'll want to talk to him.'
âWell, we'll have to make sure we keep him alive, then,' he said drily.
They set up fluids and then sent him off on his way to Theatre. Following the trolley, James paused at the door and turned to Tom.
âAre you OK?' he asked, looking at him keenly, and Tom gave a wry smile.
âAh, I just hate violence. Bit too close to home.'
James tilted his head questioningly, and Tom went on, âI was stabbed here by a patient last yearâin April. I nearly bled out. It's still a little fresh in the mind.'
A year ago last April. The month his own life had fallen apart. It was, as Tom said, still a little fresh in the mind.
âI can understand that,' he said. âThanks for your help. I'll keep you posted on this one.'
It was touch and go, once they'd opened him up, but there was no point in calling Kate. She wouldn't have got there in time, and anyway he and Jo could manage.
Jo's surgical skills were slight, but she was a fast learner and she did as she was told without question, which meant he could rely on her. Always an asset in a crisis.
He removed the man's spleen, stitched the tear in his liver and put him back together again. And then, once their patient was stable and everything was back under control, he phoned Tom and told him, then went home, crept in through the door and fell into bed, exhausted.
Three hours. That was all. Three hours, before he had to be up again and on the way out. At least his mother was here, so he didn't have to get the children ready first.
Three and a half, then.
âKate, I'm sorry, I'm going to be late. Can you start without me and I'll get in as soon as possible?'
She swung round and propped her feet on her desk, rolled her eyes and thought,
Here we go.
âDo I have a choice?'
She heard him sigh. âYes, you have a choice. If you can't cope without me, I'll come in now. But I'd rather not. It would beâ¦difficult,' he said after a pause.
âOh, I can
, McEwan,' she said, wondering if her voice sounded as bitter as she thought it did. âI just don't see why I should be expected to without any kind of explanation. Is it a problem with the children?' she added, softening her voice, and he sighed.
âYes, and no. It'sâ¦complicated. Don't worry, I'll deal with it. I shouldn't be too late.'
âJames, it's always complicated,' she said, exasperated by his refusal to open up. âWe've got a busy morningâTracy Farthing, for starters. Your patient. I need you here doing your job. Whatever's wrong, if it's not a matter of life or death, just sort it and get here asap.'
She hung up the phone with a bang and turned, to find Jo standing right behind her.
âHe's going to be late. I'll need you to help me.'
âOh. I wondered. His daughter was playing up in the night. It's such a shame about his wife. He's a lovely guy.'
âJo, don't gossip,' she said, sounding like a shrew again for the second time in as many minutes, but Jo was used to her, she could cope, and Kate swung her feet to the floor and stood up, putting James and his wifeâwhatever had happened to herâright out of her mind. âRight, let's have a look at what came in last night. Were you busy? I was half expecting a call.'
âOh, no, we coped fine. It was quite quiet in a frantic sort of way. James was amazingâwell, apart from being hassled. He's a brilliant surgeon.'
Kate said nothing, not really caring how amazing and brilliant he was if he couldn't manage to get here, still irritated by his refusal to tell her what was going on, and Jo went on, âThere was a straightforward appendix, and a couple of admissions for observation and assessmentâoh, and we had to open up Mr Reason again. His drain had dislodgedâhe'd pulled on it by accident a couple of days ago, he said, and he'd developed an abscess. And then there was a ruptured spleen and liver laceration from a fight. He'd been kicked in the abdomen and it was a bit tricky, but James was fantastic. He's fine, doing well, but the police want to talk to him once he's up to it, to see if he can identify his attacker.'
Oh, Lord. She felt a surge of adrenaline but pulled her mind back into focus. âGood. Right. We'll start with a look round them, then the pre-ops, and then if James still hasn't turned up, I'll go and talk to Tracy Farthing in Paeds.'