New Surgeon at Ashvale A&E (5 page)

‘I do?’

She shrugged her shoulders, giving in to his gentle prompting. What would it matter if she were the one to tell him a few home truths? No one else would consider doing it. ‘Quite definitely. We really shouldn’t lose sight of the human touch, you know. We aren’t in the boardroom now, and even the most difficult of tasks can be made sweeter with a modicum of pleasantry.’

He raised a dark brow. ‘You’re saying you think I’m too abrupt?’

She made a vacillating kind of movement, as though she was weighing things in the balance. ‘I’m afraid you run the risk of alienating the people you depend on,’ she said.

He made a face. ‘I dare say you’re the one to put me right on that score. From what I’ve gathered this morning, I’m sure you’ll be well able to assist me in pulling things into shape. You’re the one topic people are prepared to talk about. I’ve been hearing nothing but glowing accounts of your capabilities in this department.’

‘I’m sorry about that,’ she said with a laugh. ‘You sound as though it’s beginning to grate on your nerves.’

‘Not at all. It’s good to know that we have such a diamond in our midst. I’ll be glad of all the help I can get.’

‘We’ve always been a happy crowd here at Ashvale A&E.’ She didn’t add, before he came along, but he probably caught her meaning.

‘I guess I’ve a lot to learn.’ It didn’t seem to bother him, though. He glanced at the watch on his wrist. ‘Anyway, back to the immediate problem. I’ve asked Michelle to do triage, the senior house officers will take the urgent cases, and you and I will deal with the most seriously injured. It means we’ll be running at full tilt with a minimum of staff.’

He checked the whiteboard, assessing the number of patients still in attendance and needing to be seen. ‘I’ll have a word with the nursing sister on duty and see if we can have some of her specialists attend to the less serious cases in the waiting room. That should clear the backlog.’

He glanced at her as though looking for confirmation, and she raised a brow. ‘Are you asking if I agree? I told you, if you were trying to save money, I think you should have looked to cutting down on the maintenance contracts before you went ahead and dispensed with nursing services. We don’t need to have the light bulbs checked once a month, or have laundry sent to an outside company when we have perfectly adequate
facilities on the premises. Nor do we need to order paper plates on a regular basis when we have dishwashers and crockery on site.’

His mouth made a crooked shape. ‘I wasn’t looking for a debate on the whys and wherefores. A simple “yes, that sounds about right” would have done.’ His eyes took on a glimmer of amusement. ‘I was attempting to keep you in the loop, so to speak, since it’s fairly obvious you’re the lynchpin around here. Is there anything else you think we need to have in place?’

She thought about it. ‘Yes,’ she murmured after a second or two. ‘We need doughnuts.’

‘I beg your pardon?’ He looked at her as though for a moment she’d lost the plot.

‘You won’t get by without them,’ she said on a firm note. ‘If you expect your staff to work through their lunch breaks and keep going without flagging, you’ll have to do something to boost their energy as well as their morale.’ She gave him a bright smile. ‘I’ve always found that doughnuts hit the spot. Mark my words. A little bit of sugar goes a long way.’

‘I’ll try to remember that,’ he said. He threw her a teasing look as his gaze wandered over her softly feminine curves. ‘You’re not on any kind of diet, are you? So if I were to feed you sugary sweet doughy treats, would that help to bring you on side? I could rely on you to be my right-hand woman?’

She sent him a direct grey glance. ‘I certainly won’t say no to the food…but as for any other outlandish expectations you might be harbouring, I wouldn’t push your luck, if I were you. I’m only ever on the side that looks to be about right.’

He tilted his head back in a resigned gesture. ‘I might have known,’ he murmured. His mouth curved. ‘Still, it was worth a try.’

‘I
T’S
really good of you to help me out like this.’ Ruby thanked the woman who was running the creche at the hospital. ‘I don’t know what I would have done if you hadn’t been able to find a place for Becky at such short notice.’

‘Well, you did say it was just for a few days, and we have a couple of vacant places available while people are away on holiday.’ The woman smiled, watching Becky as she lay gurgling on the mat, trying to clasp the plastic toys that dangled overhead from the play gym. ‘She looks as though she’s a contented child.’

‘Yes, she is, for the most part.’ Which was just as well, because with all the problems that had cropped up of late, Ruby was sure she wouldn’t have been able to cope with a fractious infant. Things had been going reasonably well until the day before yesterday, when Sophie had gone out, saying she was going on an errand to the shops. When she didn’t return, Ruby had begun to worry.

There was still no sign of her, and Ruby was becoming increasingly anxious. She had tried contacting her by phone, and she’d searched high and low before frantically enlisting the help of the police. Sophie was now officially a missing person, and no one had any idea where she had gone.

It had all come as such a shock, and now Ruby was finding
it difficult to juggle work in A&E with looking after the baby. How was she going to cope when she had to move into the farmhouse over the weekend now that Sophie was gone? There would be a whole lot more problems for her to concentrate on then.

‘I’ll come back at lunchtime to see how she’s getting on,’ she said, reluctantly preparing to leave.

‘That’s good.’ The nursery matron gave Ruby a reassuring smile, probably sensing her underlying anxiety. ‘I’m sure she’ll be fine.’

Yes, most likely she would. Ruby cast a last, fleeting glance at the baby before she left the room. Becky had no idea of the disturbance that had ebbed and flowed around her since her mother’s health had begun to decline. And now Sophie was missing.

Bracing herself to face the rest of the day, Ruby made her way back down to A&E. She stopped by the central desk and made a few phone calls, first of all, checking up on the patients who had spent the previous day in the observation ward.

‘No problems to speak of,’ Lorraine, the nursing supervisor, told her. ‘We’ve arranged for two children with chest infections, query pneumonia, to be admitted, as you asked. Apart from those, everyone else looks fit enough to be discharged.’

‘That’s good to hear. I’ll drop by later this morning and finish the paperwork.’ Ruby hesitated. ‘Is there any news on Charlie—the infant with breathing difficulties? I put him on humidified oxygen, and then we had to add nebulised adrenaline because he wasn’t responding too well to treatment. Last time I went to see him he was showing a little bit of improvement.’

‘The boy with bronchiolitis? Yes, I checked for you. He was admitted to the paediatric ward from Intensive Care, and by all accounts he’s doing fine.’

‘Oh, that’s brilliant. Thanks for checking for me, Lorraine.’

‘You’re very welcome. See you later, then.’

‘Yes, I’ll come over to you in a couple of hours or so.’ Ruby replaced the receiver and began to hunt through a pile of papers in the wire tray on the desk.

‘Nothing’s going according to plan lately,’ Olivia said, coming to stand beside her. ‘I thought things were bad enough when I heard that we have two nurses off sick, but then I saw the management circular that was passed around first thing this morning. They’re talking about downgrading us to an urgent care centre…and that’s even before the meeting where it’s all supposed to be decided.’ She huffed, showing her annoyance.

‘I don’t know how our trauma victims would have fared if they’d been sent to the Heritage,’ Ruby commented. ‘Some of them were in a precarious condition when they arrived here.’ As it was, the patients who had been involved in traffic accidents a few days ago had either been operated on and were now recovering on the wards, or had been discharged.

Ruby glanced at the senior house officer briefly. Olivia was in a decidedly crotchety mood today, her usually serene face etched with lines of tension. ‘Is that all that’s bothering you?’

‘Not really. I took a look in the waiting room, and straightaway I wished I hadn’t.’

‘Oh, why’s that?’ Ruby glanced through a sheaf of lab test results, searching for a diagnosis on a small patient. If only her sister Sophie’s medical problems could have been properly diagnosed before she’d decided to take off. For that must be what lay behind her disappearance, surely? She didn’t think anything more sinister lay behind her failure to return, given that the police had let her know that she had been spotted boarding a bus in town on the day she had vanished without a trace.

Olivia started to answer, and Ruby dragged her mind back to the job in hand.

‘I’m out of sorts because that man’s in there again…the one who’s kept complaining of back pain ever since he was
involved in a car accident some time ago. He’s been in here several times over the last few months, but we never seem to be able to get to the bottom of what’s causing his problems. Dr Stanford said they’d done all the tests and found no lasting damage. He told him he should go and see his GP about any symptoms he has, but he always comes up with some reason why he has to be here in emergency. Today it’s because he almost passed out when he went to fetch something from the local garage, and the manager brought him straight to the hospital.’

‘Oh, I see.’ Ruby nodded. ‘Well, I’ll take a look at him if you like. We’re not exactly overrun with dire emergencies at the moment, are we?’ She clamped a hand over her mouth. ‘Oh, I can’t believe I just said that.’

‘Said what? Is there a problem?’ Sam came to join them at the desk, tilting his head slightly to one side as he cast a quizzical glance over her. His black hair was crisply styled, framing his strong-boned features to perfection. His blue-grey eyes studied her curiously. ‘You’ve not been your usual self these last few days, have you? Is something wrong?’

Ruby gazed at him in wonder, slightly thrown by his tall, dark presence. She ought to be used by now to the way he had of appearing out of nowhere, but perhaps she wasn’t fully on the ball. Somehow or other he always managed to make her heart leap into an odd, hasty rhythm.

As to her mood, she was startled that he had even noticed her frame of mind. He was always so busy tending to seriously ill patients or organising the day-to-day management of the unit. Because of the cutbacks he had been forced to make, there were new difficulties arising all the time.

She shook her head. ‘Nothing’s wrong. Everything’s fine.’ She wasn’t going to lay out all her troubles for him to pick over. He was a man, first of all, energetic, efficient and direct, everything appearing clearly black or white, and he would
probably have next to no understanding of the emotional side of things, the grey edges that tended to blur judgement.

‘Except that she just said how quiet it is in here today,’ Olivia pointed out. ‘You know what that means, don’t you? Lights will start flashing and sirens will be blaring within seconds, and the next thing you know, we’ll be swamped under a deluge of patients.’ She shook her head. ‘Even I know not to tempt fate that way.’ Her mouth made a flat line. ‘Still, we have to make allowances, I suppose. Ruby has to go and take over at her Gran’s smallholding this weekend, so she’s probably not thinking straight. Just contemplating the work involved would be enough to make me quake. Cleaning out the chicken run…mucking out after the ponies…and that’s before we even get to the goats.’

‘Goats? Good grief.’ Sam’s brows shot up. ‘You’re not seriously going to do all that, are you?’ he asked, looking at Ruby.

‘For a few weeks, yes,’ she told him. ‘My grandparents are going away for a while, and they’ve asked the family to help. There’s no one else who can sort it out for us. Not without it costing us a small fortune, anyway.’

She contemplated the prospect of living in the Chilterns for the next few weeks and gave a soft sigh. Perhaps it was just what she needed right now—a complete change. Time to be with Becky and attempt to smooth over the unhappy disappearance of her mother that had shaken the baby’s world. Life was incredibly hard for her just now. She was juggling too many things all at once: coming to terms with the fact that Sophie had gone away, learning how to cope with looking after Becky on her own…and trying to accept that she had lost the job she wanted to a man who had swept in on a wave of budget-cutting zeal. Add to that the fact that her grandparents needed her help, and the mix was well and truly bubbling, threatening to boil over.

She frowned. ‘Actually, I think it might be just the thing for
me…I still haven’t taken all of my annual leave this year, and there’s a certain appeal to sampling fresh country air and taking a break from all the frantic activity that goes on around here.’

She remained perfectly still for a while, mulling things over. The more she thought about it, the more the option of leaving her job altogether appealed.

‘Now, there’s a thought…my contract comes to an end in a fortnight’s time, doesn’t it? And I don’t necessarily have to renew it since I haven’t signed on the dotted line yet.’ Somehow, she hadn’t been able to bring herself to put in the necessary paperwork. ‘I do earn some income from the medical articles I write for magazines and so on. And there’s the online medical forum, as well—they pay me a retainer for doing that.’

It would be a difficult choice to make—after all, she needed money if she was to look after Becky—but the prospect of turning her back on the whirlwind of her career and leaving it to Sam to take up where she left off was becoming more interesting by the minute. He wanted the job—he had been given it at her expense—maybe he should be left to deal with it in its entirety.

‘You’re joking, aren’t you?’ Sam was frowning, looking at her intently as though he would like to be able to read her mind.

‘About the online forum? No.’ She shook her head. ‘We answer questions from people who have worries about their various symptoms or illnesses, or who want a little more detail than their GP is able to give them.’

‘I meant about leaving here.’ His voice was terse.

Ruby mused on that for a while. ‘I’m not altogether sure. In fact, the more I think about it, the more tempting it becomes.’ After all, what prospects were there for her here? With the possibility of the unit being downgraded, things were beginning to look quite bleak, one way or another. Sam would be all right whatever happened because he worked
from both hospital sites—the Ashvale and the Heritage. And the SHOs would find placements at other hospitals. It was the patients and the people who lived in the local area who would lose out most of all because of the effects of the closure.

She picked up the chart outlining the symptoms of the man who suffered from the painful back and the recent fainting spell. ‘I have to go,’ she said. ‘Just in case I have brought us bad luck, and we’re about to be inundated.’

Sam was still frowning as she walked away, but Ruby needed some space. Life was difficult, she was worried about her sister, and now she unexpectedly had a baby to care for. None of her problems was going to be easily resolved.

‘Mr Dryden—Nick,’ she greeted the patient as she walked into the treatment room. He was lying on a trolley bed, propped up by pillows. ‘May I call you by your first name?’

He nodded. ‘That’s fine.’

‘Good.’ She looked him over briefly before glancing at the notes on the chart. He looked vaguely familiar to her, and now she realised it was probably because he had attended the department on several occasions. He was lean, thin faced with pale features, his brown hair slightly dishevelled, and he appeared to be restless.

‘You say that you’ve been feeling a bit woozy,’ she said after a moment or two.

‘Yeah. I was at the local garage, trying to buy a spare part for my car, and my legs buckled under me. The manager gave me a lift here.’

‘I see. Do you have pain anywhere in particular?’

‘Nowhere specially just now—except my back’s always playing me up. Gives me quite a bit of gyp. I was a passenger in a car that was rear ended a couple of years ago.’

Ruby nodded. ‘I see you’re taking pain medication. You’re on quite a high dose of narcotic pain relief, aren’t you?’

He sent her a quick, challenging look. ‘You’re not going
to try to take that away from me, are you? If anything, I need a stronger prescription. You want to try living in constant pain.’ He frowned. ‘Well, you probably don’t, but take my word for it, it sucks.’

‘I wasn’t going to suggest anything of the sort,’ she murmured. ‘Although there are probably other medications that would be better for you—anti-inflammatories, for a start.’

He shook his head. ‘I’d prefer to stick to what I have. We’ve tried all the other stuff before.’

‘Hmm.’ Ruby was thoughtful for a while. Something about this man bothered her. He didn’t look quite right, and her instinct was telling her that his problems needed more investigation.

‘According to these notes, your blood pressure was low when the nurse took a reading earlier,’ she said. ‘I think I’ll check it again, and then I’d like to do a blood test to see if there’s an imbalance in your blood chemistry. You’re very pale, so it’s possible that you’re a bit anaemic. That can sometimes be a cause of dizzy spells.’

‘Sure, go ahead.’ He seemed perfectly relaxed about it, and it was Ruby’s feeling that he wasn’t in too much discomfort right then.

Even so, she had the idea that something about his condition didn’t quite add up, and so she went ahead and completed both procedures. His blood pressure was slightly lower than before, and his pulse was a little faster, but that was probably because he was here in the hospital being asked to answer questions.

‘I’ll leave you to rest for a while,’ she said. ‘As soon as we have the results of the blood test, I’ll come back and see you.’

‘Okay.’ He nodded and leaned back against his pillows.

She left him and went to see to her other patients. A young girl had suffered a badly sprained ankle, and she spent some time looking at the X-rays and examining her before arranging for it to be supported in a temporary cast. ‘I’ll give you
some medicine to take away the pain,’ she told the girl. ‘You need to keep your weight off it for a few days.’