Children's Doctor, Society Bride

CHAPTER TWO

‘I WASN’T expecting to find you still here, Louise,’ Alice said, coming over to the central desk and putting packages in the box that was to go to the laboratory for testing. ‘Don’t you have somewhere else to be?’

‘Yes, a management meeting.’ Louise grimaced before adding her signature to her own set of laboratory forms. ‘I just wanted to finish off a few things before I go—tidy up the loose ends, so to speak.’

Alice laughed. ‘I’ll translate that to mean that you’re playing for time and trying to avoid the issue.’

Louise wrinkled her nose. ‘I have to admit, I’m not actually looking forward to a confrontation with the executives. This whole business of possible closure has messed everything up and made me feel as though we’re in limbo. It’s difficult to plan for the future when you don’t know if there’s going to be one.’

Alice nodded in sympathy. ‘I know what you mean. There are staffing problems to contend with, and you were thinking about doing something to brighten the place up a bit, weren’t you? I suppose that will have to be put on hold now.’ She frowned. ‘Actually, I meant to ask you how the interviews for the Senior House Officer went last week, but it slipped my mind when we were talking about the old gentleman you met in the park. You were worried about him, as I recall.’

‘Yes, I was. In fact, even now, some days later, I still find myself thinking about him. I only met him for a short time, but he was such a lovely man. I can’t help wondering if his grandson is taking proper care of him, but it seemed to me that he must have been more concerned about his business interests than looking after his grandfather’s welfare.’

‘To be fair, he did come as soon as you called him.’

‘Yes, I suppose that’s true.’ Louise picked up a file from the table and glanced through it. ‘As to the interviews, things didn’t go all that well, as it happens.’ Her mouth made a brief downward turn. ‘There weren’t any candidates who had sufficient paediatric experience, as it turned out, and those who were well qualified made an excuse and dropped out. I expect they heard about the threat of A&E being closed down and thought better of their applications.’

‘That’s going to make life difficult for you, isn’t it?’ Alice was frowning.

‘It will be hard on all of us,’ Louise murmured. ‘We all have to take on the extra workload, and yet there could be months of uncertainty ahead of us. We won’t know for some time whether the closure will go ahead, because today’s meeting is just the first stage of proceedings. The proposal has to go through the review process, and all the options for change have to be considered by various committees before a final decision can be made.’ She pulled a face. ‘Though, the way people in charge have been talking, it sounds as though it’s pretty much a foregone conclusion. How do you fight a steamroller when it’s bearing down on you?’

She studied the file, analysing the notes made by the triage nurse, and then went over to the light box to check the X-ray film that accompanied the notes. ‘I think I just about have time to go and look at this next patient,’ she told Alice. ‘She’s a twenty-two-month-old infant who’s been vomiting for the last few days, poor thing. After that, I’ll be off upstairs.’

She sent a quick smile in Alice’s direction. ‘It’s good to have you working with me here in the A&E unit, Alice. I always feel that I can rely on you. Things seem to run that much more smoothly when you’re around.’

Alice’s mouth curved. ‘I’m glad to be here, although I must say I do like the variety of alternating between the children’s ward and A&E.’ As an afterthought, she added, ‘Though whether the children’s ward will survive without A&E is another matter. It seems to me that we’re all going to be looking for new jobs.’ She made a face. ‘It looks as though we’re counting on you to defend the territory.’

‘I’ll do my best.’ Louise left her to organise the transfer of samples to the laboratory and went along to the treatment room, where her patient was waiting with her mother. The child was lying on a bed, looking frail, and her mother was sitting beside her, holding the little girl’s hand.

‘Hello, Mrs Watson,’ Louise said in a friendly fashion, going over to the bedside. ‘I’m Dr Bridgford. I understand Millie has been unwell for a few days, is that right?’

The child’s mother nodded. ‘I think she’s getting worse. Apart from being sick, she keeps crying, and she just isn’t herself. I think she must be in pain.’

‘I’ll take a look at her.’ Louise gently checked the infant over, speaking to her all the while in a soft voice, trying to put her at ease. The little girl was lethargic, though, and her eyes had a sunken appearance. She was fretful and when Louise examined her tummy there appeared to be some tenderness there. ‘Does that hurt? I’m sorry, baby. We’re all done now.’

She covered the infant with the sheet once more. She wanted to soothe Millie and let her know that she would take care of her, but first they had to find out what was causing the problem.

‘There certainly seems to be some tenderness in her tummy now,’ she told the mother. ‘We’ve taken blood tests and done a chest X-ray, but we still don’t have sufficient information at the moment to be able to make a correct diagnosis. There is some sign that there is pressure at the base of her left lung, but there could be a number of reasons for that.’

‘Do you think it’s an infection of some sort?’

‘I don’t think so. She’s not particularly feverish, and there are no indications of wheezing to point in that direction, but we’ll know more on that score once we get the results back from the lab. In the meantime, I’m going to order some more tests, including an abdominal X-ray so that we can get a better idea of what’s going on. She’ll be given a barium drink to swallow so that everything will show up on the X-ray as the fluid passes through her intestines. The procedure won’t cause her any pain but it will help us to discover if there’s anything amiss.’

Mrs Watson still looked anxious and Louise comforted her, saying, ‘Don’t worry. We’ll find out what’s causing the trouble.’

They spoke for a little while longer, and then Louise gave Millie an encouraging smile in the hope that it would help to reassure her. There was still no reaction from the little girl. The child was miserable, clearly too ill to respond.

Louise started to write out the test forms for the nurse in attendance.

‘I’ll leave that with you, Jenny, if I may?’ she told the nurse. ‘Will you let me know the results when they come through? I’ll be in a meeting with management, but you can bleep me.’

Jenny nodded. ‘I will.’ She was a reliable young woman, with fair hair swept back into a ponytail and blue eyes that missed nothing. Louise knew that she was leaving the child in good hands.

To the mother, Louise added, ‘If you have any questions, just ask our nurse here. She’ll be able to tell you anything that you want to know.’

‘Thank you.’

A moment or two later, Louise was ready to make her way to the top floor room where management was holding its meeting. She stopped off in the doctors’ lounge to pull a brush through her long hair, satisfied that it gleamed with health and was pinned back satisfactorily with a couple of clips. She added a light touch of lipstick to her mouth, and then smoothed down her skirt and checked that her cotton top was neat beneath the light jacket she was wearing. The jacket nipped in at the waist, making the most of her slender form, and she contented herself with making a last adjustment to the collar before she felt confident that she looked all right.

A few minutes later, she tapped on the door of the conference room and took a deep breath to steady herself before walking in.

‘Ah, Dr Bridgford, do come in.’ The chief executive of the hospital Trust board rose from his seat to greet her. ‘I’m so glad that you’ve managed to find time to come and join us. We do value your input.’

She acknowledged him in a friendly enough manner, although inwardly she absorbed his remarks with a fair degree of cynicism. Since he was the one who had instigated the call for closure, she wasn’t about to go overboard with enthusiasm for anything he had to say, was she?

‘I think you know most of the people here, don’t you?’ the chief went on, waving a hand around the room in the direction of the assembled management team.

‘I believe so,’ she agreed, glancing briefly at the men and women who were seated around the large rectangular table. Some were other executives from around the region, but there were a number of people who she had been working with in this hospital for a few years now. For the most part they were much like herself, doctors or managers who were doing the best job they could, trying to cope in difficult circumstances.

‘Please, do come and sit down,’ Mr Jeffries urged her. ‘We were just about to go over the options for change.’

She glanced to where a seat had been left empty for her and started forward, but as her glance skimmed the people on either side of that chair she came to an abrupt halt, the breath snagging in her lungs. There was one man there who surely didn’t belong amongst this collection of medical chiefs.

James Ashleigh flicked a glance over her, his grey gaze wandering along the length of her shapely legs to the tips of her fashionably designed shoes, and back again to rest thoughtfully on the oval of her face. She faltered momentarily.

Mr Jeffries must have noticed her hesitation because he said helpfully, ‘Ah, of course you won’t have met Dr Ashleigh, will you? He’s been working overseas for a while on secondment, but we are really pleased to have him back amongst us.’

Louise blinked. So James Ashleigh was a doctor? He must be a pretty successful one, by all accounts, if he drove a top of the range Mercedes. Unless, of course, he wasn’t that kind of doctor. Perhaps he had a degree in economics. That would certainly explain his presence here. Was he one of the wretched money-counters who were intent on eliminating her A&E unit?

She frowned and stared at him once more.

‘Dr Bridgford and I have already met.’ James Ashleigh returned her gaze with a faintly quizzical expression. Had he guessed what she was thinking?

‘Good, good,’ Mr Jeffries approved.

Louise inclined her head in acknowledgement and then went and sat down beside James, put out by the way his glance shimmered over her, and out of sorts that he was here at all.

‘I hope your grandfather is feeling better by now,’ she said in a low tone under the buzz of general conversation in the room.

‘His breathing’s better than it was,’ he answered as the assembly began to settle down. ‘His GP prescribed antibiotics, which helped a bit, but my grandfather’s heart has been failing for some time now, I’m afraid. He’ll never be the man he once was.’

Her mouth flattened. ‘I’m sorry to hear it.’ She was even more sorry that his grandson couldn’t be trusted to take proper care of him. He couldn’t possibly be a medical doctor, could he? Where was his sense of responsibility and commitment?

‘So, let’s get on with the business at hand, shall we?’ Mr Jeffries began, calling the meeting to attention. ‘The main proposition before us is that we work towards centralising key services at the Royal Forest Hospital. This is part of a rational planning process that we hope will improve the way we serve the region and I’m looking to all of you to help find the best way we can devise our strategy.’

There was a rumble of comment from around the table as people sought to add their views.

‘Our most valuable resource is manpower,’ one man said, after some general discussion. ‘We should see to it that we have the best, most skilled specialists gathered together at the Royal Forest site. That’s where the cutting-edge equipment is based—high-performance scanners, new operating suites, and an up-to-the-minute range of telecommunication devices. Specialists can even offer advice over video links without having to travel from one base to another.’

‘That won’t be a whole lot of use if the departments in outlying hospitals have been closed down, will it?’ Louise murmured. She could feel herself getting prickly already.

‘We’re not talking about taking away necessary resources,’ the man answered. ‘We’re just redistributing them in order to provide a better service.’

Her mouth twisted. ‘You mean you’re tidying up as part of a cost-cutting exercise.’

Beside her, James Ashleigh stirred. ‘Not at all,’ he intervened. ‘It’s more a question of making the best of what we have. Now that we have to comply with directives about junior doctors’ working hours, it’s becoming even more difficult to maintain full coverage of departments. It makes sense to concentrate them in one centre of excellence.’

Louise gave him a narrow-eyed stare. ‘I would have thought the community deserved excellence from all quarters.’ Warming to her theme, she added, ‘And what will happen to patients who come from outlying regions and don’t have a chance to make it to this magnificent centre you’re proposing? It’s a well-known fact, backed up by research, that people with serious breathing difficulties are less likely to survive a journey to hospital if it’s more than six and a half miles away. It’s quite likely that patients will die if this plan goes ahead.’

James frowned. ‘Do you think you might be in danger of overlooking the part our ambulance personnel have to play in all this? After all, every day they make life-saving interventions while they transport sick people to hospital.’

‘Some do, I’ll grant you,’ she answered in a clipped tone. ‘But what happens if you’re unfortunate enough to be transported by a technician who isn’t allowed to carry out invasive clinical procedures or administer the necessary drugs? There’s a high percentage of ambulance personnel who aren’t trained to the same extent as paramedics.’

‘That’s an issue that’s being addressed.’ His tone softened as though he would appease her in some way. ‘You have to take on board the fact that advances in technology are being made all the time, and we need to centralise resources in order to keep pace with what’s happening.’

Sparks flared in her green eyes. ‘Are you suggesting that I’m out of touch? I can assure you, Dr Ashleigh, that I work with state-of-the-art equipment every day. I suppose you think the community would be better served if it were to be reallocated, in its entirety, to the Royal Forest Hospital along with my patients?’

He made a negligent movement of his hands. ‘I didn’t say that. I wouldn’t like you to feel that this is in any way personal, Dr Bridgford. I’m merely pointing out that we all have to accept that things can’t always stay the same, no matter how much we might want them to.’

Louise drew breath, ready to come back at him, but Mr Jeffries cleared his throat and stalled her.

‘Of course your opinions will be taken into account, Louise. This is merely a preliminary meeting to discuss the various alternatives. We all know how concerned you are about the effect these changes might have on your department. That’s why we need to be particularly careful in how we decide on what options are to be presented to the committee.’

Louise subsided, but inside anger was simmering. She might have known that James Ashleigh would be in favour of destroying what she had built up over these last few years. What did he know about the way she worked? Her patients meant everything to her. They were a huge part of her life, almost like family to her, and she protected the paediatric A&E unit she had shaped as if it sheltered her own little brood. He was all theory and management-speak.

The meeting progressed, and she contented herself with directing a frosty glare in James Ashleigh’s direction. He might think that this wasn’t personal but, when all was said and done, it wasn’t his carefully nurtured project that was being demolished, was it? After that, she made a concentrated effort to push him out of her mind altogether.

Her good intentions only lasted up until they adjourned for a coffee break in an adjoining room. She would have liked to distance herself from him, but he thwarted her by coming to stand next to her in the queue by the coffee machine and engaging her in conversation.

‘Can I get you something to eat along with your coffee?’ he volunteered. ‘I seem to be a little closer to the refreshments than you are. I can offer you biscuits, or there are even sandwiches and pasties, if you’d prefer.’

She shook her head. ‘Coffee will be just fine for me, thank you.’

‘Do you take it black, or with cream and sugar?’

‘Cream and sugar, please.’ She accepted the cup he offered her and moved away from the side of the room, looking around for a table where she could sit and mull over what had been said at the meeting. The consensus of opinion among the region’s chiefs was still that the paediatric A&E could be wound down, and the objections of the various doctors present had been nudged to one side.

‘Do you mind if I join you?’

She looked up to see that James Ashleigh’s hand was resting lightly on the chair next to hers. She inclined her head. ‘Feel free.’

He sat down, stretching out his long legs underneath the table. The movement was distracting, to say the least. She would have preferred to ignore the fact that he was close by, but he was altogether too masculine a figure and her intentions were doomed from the outset. Her heart began to thump in a chaotic rhythm and her mouth went dry. He was long and lean and totally disturbing to her peace of mind.

As before, at the park, he was dressed in an immaculate, beautifully tailored dark suit, with a crisp mid-blue shirt that looked as though it had come fresh from an exclusive store. His tie was perfectly coordinated, subtle and carefully knotted, as though he was a man who paid a great deal of attention to detail.

She made an attempt to recover herself. ‘Has your grandfather been ill for a long time?’ she asked.

He nodded. ‘Unfortunately, yes. His consultant is doing what he can to ease things for him, by giving him tablets to regulate the heart rhythm, and diuretics to ease his lungs. The trouble is, my grandfather finds it hard to accept his limitations. I dare say that’s why he went walkabout last week.’

A small line indented her brow. ‘I don’t quite follow. He said that you left him to go and make your phone calls. I was under the impression that you didn’t go back for him.’

James’s mouth made a wry shape. ‘I wondered if that was the notion you were left with. No wonder you were a little distant with me.’ He stirred his coffee, the action concise and methodical. ‘The fact is, I was on call that day, and my Senior House Officer phoned for advice. I stepped outside for a few moments to deal with the situation but, when I returned, my grandfather had disappeared. He does that sometimes. I think he gets a kind of wanderlust and forgets that he isn’t able to do what he used to.’

For a moment she was taken aback by this new piece of information, and she wondered distractedly whether she ought perhaps to reassess her opinion of him. He had everything going for him, after all—charisma in bucket-loads and a charm that could melt stone. Maybe she could allow herself to relax a little and get to know him better.

But then she recalled the way he had talked the committee around to his way of thinking just a few minutes earlier and she hardened her heart all over again. Perhaps he had been called away unexpectedly that day but, as a doctor, he should have paid more attention to his grandfather’s needs.

‘Perhaps you should take him out and about more often. That way he won’t feel as though he’s housebound and become desperate to escape. I rather had the impression that he feels he’s missing out on life sometimes, but I suppose, if you’ve been away, you won’t have realised that.’

She took a sip of her coffee, watching him over the rim of her cup.

He gave her a faint smile. ‘I can see that I’m not going to redeem myself in your eyes, whatever I say. I suppose it doesn’t help much that we’re at opposite sides of the fence when it comes to this business of the hospital.’

‘There is that,’ she agreed. She frowned, putting down her cup. ‘From what you said, I gather that you work here, at the hospital, but you do tend to come across more as management than as someone from the medical staff.’

She had noticed that people tended to listen carefully to what he had to say. They treated him with respect, as though he was someone in authority, someone who had the power to make sweeping changes.

She studied him thoughtfully for a moment or two. ‘I’ve been here at the hospital for a number of years,’ she added. ‘Even so, I don’t recall seeing your name on the list of physicians working at the hospital, but perhaps that’s because you’ve been away.’

He nodded. ‘I’ve been studying different management systems in Europe for the last year. Before that, I was one of the executives at the Royal Forest Hospital. Still am, for that matter, but I tend to divide my time between there and here. I still do hands-on medicine, but to a much lesser degree. I found that I could make more of a difference by being part of the management system.’