New Surgeon at Ashvale A&E (6 page)

Turning to the girl’s mother, she said, ‘I’d like you to bring her in to our orthopaedic department in a week’s time so that the specialist can take a look at her. In the meantime, I’ll give you a letter to pass on to your GP.’

‘Thanks.’

The morning passed swiftly, and Ruby caught sight of Sam from time to time as he dealt with the more seriously injured people who were brought in. She knew from helping Dr Stanford to run the department that he had a lot to contend with. His time was taken up with everything from treating trauma victims, and giving lectures to eager young medical students, to arranging for faulty equipment to be serviced. He was a very busy man.

He didn’t usually stop to chat with his fellow workers for very long in between attending to his patients, which meant that they tended to view him as someone who stood apart from them.

Ruby frowned, thinking about that. Was he ever bothered by a sense of isolation from his colleagues? It was all very well for him to decide that he was an independent soul who didn’t need anyone, but that way of going on could lead to disaster; no man was an island. Maybe she should do whatever was possible to try to save him from himself.

‘Do you need any help?’ she asked when she saw him attempting to deal with an infant who was crying inconsolably. The child was lying in his mother’s lap, and Ruby guessed he was about a year old. He was pulling up his legs and screaming as though he was in pain. ‘I guess we have no nurses to spare at the moment. They’re all busy helping out with orthopaedic problems and lacerations.’

He gave her a harassed look as though bringing up the subject of staff shortages was a low blow. ‘Thanks. If you’re not embroiled in anything, I really need to examine this little
fellow, but he absolutely doesn’t want me to do that.’ He glanced at the child’s mother, who gave him an apologetic look in return.

‘He’s been like this for a while,’ the young woman said softly. ‘It’s as though he gets a cramping pain and doubles up. He’s been vomiting, as well.’

Sam nodded. ‘His tummy is swollen too, but I don’t think I’m going to get a chance to have a proper look at that.’

‘I could try distracting him,’ Ruby said, going to rummage in a nearby cupboard. ‘Wait till the cramping pain goes away and he settles a bit, and then I’ll show him our teddy bear while you do your bit.’

He smiled. ‘Sounds like a good idea to me.’

‘It usually does the trick,’ she said, bringing out an assortment of toys in a plastic tray. ‘If it doesn’t, we’ll try a musical diversion…as long as the battery’s working.’ She pressed a button on a small box connected to a miniature carousel, and the strains of a lullaby filled the room.

The baby stopped crying and instead began to make small sobbing sounds as he turned his head to see where the tinkling music was coming from. Then he reached out a hand as if he wanted to grab this fascinating new toy. Ruby unhooked one of the plastic horses from the carousel and gave it to him.

Between them they managed to divert his attention long enough for Sam to complete the examination. He was gentle but thorough and, above all, swift. As she watched him with the baby, Ruby felt an unfamiliar knot come into her throat. He was such a strong, focussed man, yet with this infant he was tender, caring, unwilling to add in any way to his pain. All the time he was examining him, he was conscious of the boy’s responses, and he spoke to him in a soft, soothing voice.

He was thoughtful for a while afterwards, reading through the notes on the child’s history, and then he told the mother, ‘I want to do some further investigations, Mrs Franklyn—an
ultrasound scan, first of all, and then maybe a CT scan after he’s had a drink of something that will show up on the images.’

‘Is it serious, then?’ The woman looked worried.

‘We don’t know anything for sure right now,’ he said softly. ‘Let’s do the tests and see if we can find out what’s going on. Either way, I promise you we’ll take good care of him.’

‘Thanks.’

A few minutes later, they left the room, leaving the woman to sit with her child and take his mind off his discomfort with the toys.

Ruby asked, ‘Are you thinking it’s some kind of obstruction to the intestine?’

‘Maybe. It could be a twisting of the intestine, in which case we have to act fast and send him to theatre for surgery before he loses the blood supply to the affected part. His heart rate and breathing are rapid, so I think it’s a fair assumption that this is not a minor problem.’

‘You’re probably right.’ She sent him a fleeting glance, assessing the taut lines of his face and the straight-backed, determined way he was moving towards the central desk to go and set things in motion.

‘When you’ve sorted all that out, you should perhaps go and take a break. You’ve been on the go all morning, and it would do you good to spend some time in the staff lounge, maybe getting to know people better, and finding out about everything that’s going on.’

‘I already know what’s going on,’ he said. ‘I take time to update myself every morning and read all the memos that my secretary puts my way. I know when all the meetings are taking place and who’s pencilled in on the rota. I don’t need to take time out when there are more pressing claims on my attention.’

‘Oh, that’s no fun at all.’ She looked at him askance. ‘James brought in some pasties in celebration of his patient with the
subdural haematoma making a good recovery—well, that was his excuse, anyway. I happen to know he likes the girl who works in the bakery…he always says it’s the smell of the food that draws him in there, but he spends way longer than necessary chatting to her.’

Sam laughed. ‘You know all about the secret lives of the doctors and nurses around here, don’t you? They all seem to confide in you.’

‘Ah, well, no one keeps a secret for long in here. This place is a hotbed of gossip, you know. And that’s another reason why you should go along to the staff lounge. They’re all longing to know everything there is to know about you and how you came to be at Ashvale. Rumour has it that you bribed all the members of the board to win your place here, and you promised them you’d deliver enough savings to keep the Heritage running for a year.’

His mouth dropped open. ‘You can’t be serious?’

‘Nah. Just kidding.’ She grinned. ‘But I think you should take my advice and go and mix with your colleagues a bit more. The pace here is hectic at times, and you’d do well to wind down whenever the opportunity arises. Besides, you’ll get along far better with your workforce if you try to relate to them outside of their everyday duties.’ She sent him a quick glance, trying unsuccessfully to gauge his reaction, before picking out a chart from the pile on the desk. She briefly skimmed the contents.

Sam, though, instead of taking her comments in the lighthearted fashion they were meant, was shaking his head in disbelief. She frowned. That didn’t bode too well, did it?

He reached for the phone. ‘Radiology,’ he said into the mouthpiece. ‘I need to send an infant to you for a scan.’ He turned to Ruby while the clerk at the other end of the line tried to contact the radiologist.

‘In case you’ve forgotten,’ he told her in a dry tone, ‘I’m
the head of department here. I didn’t get to this position without knowing how to conduct myself, and I’m sorry if I haven’t quite managed to come up to your expectations. You just have to remember that the whole unit is straining under a heavier than usual burden right now, and I have to prioritise my time to the best effect. Unfortunately, that doesn’t leave me a lot of time to socialize.’ He turned back to his phone call as the clerk came back on the line.

Ruby drew in a deep breath at the snub. She was taken aback by his attitude, but she couldn’t really blame him for his riposte, could she, even though she’d only been trying to help. Maybe she
had
gone too far.

In fact, she couldn’t really see why she was bothering at all attempting to help him settle into the department when she had problems of her own to contend with.

She walked away from the desk and left him to his phone conversation. Maybe she would give her neighbour, Claire, a ring and find out if her sister had turned up at the house. It would cheer her up no end to know that Becky’s mother was safe and well and planning on taking care of her little daughter.

No such relief was in the offing, though. Claire said there hadn’t been any news of Sophie, and Ruby then checked in with the police, who informed her there had been no more sightings. They wanted to know if there were any local places where Sophie would go to lie low, but Ruby simply couldn’t think of any. She had already tried looking in all the old familiar haunts from their childhood to no avail.

She went to check on Becky at lunchtime with a heavy heart. The nursery matron said that she had been fine, but the child was tearful when Ruby arrived, wanting to be picked up and comforted, and Ruby sensed that she didn’t want her to leave.

‘Mm…mm…mm…’ Becky mouthed against Ruby’s shoulder. She put her small fist into her mouth and pressed down on it, becoming agitated.

‘I think she must be teething,’ the woman said. ‘Perhaps her gums are a bit sore.’

‘Maybe.’ Ruby felt as miserable as the child. She didn’t want to leave her here with strangers, but in a short time she had to go back down to A&E, so what choice did she have? Meanwhile, Becky was clinging to her, unwilling to let go.

‘I’ll sit down with you and show you a picture book, shall I, poppet?’ she said after a while. ‘Let’s see if that will soothe you.’

She sat in a cosy armchair and nestled the infant in her arms, showing her the bright illustrations in a soft, waterproof bath book. ‘There’s a duck,’ she said, pointing to the mallard swimming on a reed-edged pond. ‘Just like the one at Gran’s country place.’

‘Nan-nan,’ Becky said. ‘Nan-nan.’

‘That’s right. You remember, don’t you?’ She turned the page. ‘And there’s a bird sitting on the fence.’

Becky became excited looking at the pictures, her eyes widening with concentration, her arms and legs moving in eager expectation, her hands closing into small fists as though she would touch it and grasp it with her fingers.

‘You like that, don’t you?’ Ruby said. ‘I think you probably want to hold it yourself.’

She let Becky clutch the book, and after a while the infant drew it closer, testing its softness with her mouth. Ruby laughed softly. ‘I might have known you would try to eat it,’ she said.

Some time later, she settled the baby down in a crib, leaving her to explore the pages by herself.

‘You slip away while she’s preoccupied,’ the matron said. ‘I expect she’ll be ready for a nap before too long.’

Ruby nodded and went out to take the lift down to A&E. She was sad to leave Becky and a little overwhelmed by the tasks that lay ahead of her over the next few days: moving to the smallholding and waiting for Sophie to return.

Concentrating on her work would at least help to numb the edges of her unhappiness. She went in search of the lab results for the man who had felt his legs buckle under him and found that Nick Dryden’s blood test showed that his red blood cell count was low.

She went to check up on him. ‘Hello again, Nick,’ she said. ‘How are you feeling?’

He held out a hand palm down and moved it from side to side. ‘So-so,’ he said.

‘Hmmm. I’d like to check your blood pressure again if that’s okay with you,’ she murmured.

He nodded.

The pressure was falling, she discovered, and his pulse was faster than the last reading.

She asked him about his daily routine. ‘You’re not working at the moment, are you?’

He shook his head. ‘I was laid off after the car accident.’

‘And has anything happened to you in the last week or so?’

‘Nothing, really. The most exciting thing that happened to me was I went to a mate’s house with some friends the day before yesterday, and we watched the football match on TV. Our team won, so we were well made up.’

‘Sounds good.’ Ruby gave a brief smile.

‘Yeah. I stood up to cheer and lock arms with my mate and fell over the table. Caught myself right here.’ He ran a hand over the upper part of his abdomen and grinned. ‘Too much lager. Made me grunt a bit at the time, but it’s more or less okay now. It’s a bit sore.’

Ruby was beginning to be slightly concerned. ‘I think we’ll do an abdominal CT scan to see if anything untoward is going on,’ she told him. ‘I’ll arrange for the nurse to take you down to radiology as soon as she’s free.’

She left the room and made the arrangements with Michelle, leaving Nick in the care of the nurse while she
wrote up his radiology form. A few minutes later, as she was checking details of her other patients, Sam came to find her.

‘I’ve just seen Michelle preparing to take your patient down to radiology,’ he said. ‘She tells me that you’ve ordered an abdominal CT scan.’

‘That’s right. Why, is there a problem?’

He frowned. ‘You do know that he’s a regular here, don’t you? I’ve taken a look at his notes, and it’s clear that Dr Stanford believed he was simply a drug seeker. He may well have suffered an accident at some time, but there’s no evidence of permanent injury on all the scans and X-rays that have been done.’

‘Maybe so, but I prefer to do the tests anyway. Something about him doesn’t seem quite right. It doesn’t add up.’

He made a short laugh. ‘Yes, well, I can understand that. You do realise that he was the one who almost knocked you over the other day outside the hospital…don’t you remember? He didn’t even stop to apologise.’

Recognition dawned all at once, and her mouth dropped open a fraction. ‘Ah, I knew there was something about him that bothered me. Yes, I remember now.’

‘Good. Then perhaps you’ll think twice about wasting resources on someone who’s probably just here to get his hands on stronger painkillers. He’s done it before, several times. It’s more than likely he’s taking you for a ride, Ruby. He probably thinks you’re a soft touch.’

‘Well, it’s possible, I suppose.’ She looked him in the eye, her grey gaze smoky with annoyance. ‘Still, I decided to take his claims at face value and examined him accordingly, and my feeling is that there may be something wrong with him.’ She drew herself up to her full height. ‘Last time I looked, my qualifications said I was a specialist registrar—so I think that gives me enough leeway to act on my gut instinct, don’t you?’ It was a low trick, but he had pulled rank with her earlier, and she didn’t see why she should allow him to browbeat her on this.