Rivals In Practice

“Liam?” Jennifer leaned closer and raised her voice

“Liam? It’s Dr. Jennifer Tremaine. Open your eyes for me.”

“He’s not responsive.” The deep male voice came from the back seat of the car. “Except to painful stimuli.”

Jennifer nodded. Liam’s mouth was closed around the end of the plastic airway.

“Here’s the oxygen.” A mask was passed in beside Jennifer. “It’s running on fifteen liters.”

Jennifer fitted the mask to Liam’s face. As she pulled the elastic strap, her hands brushed the arm of the man still supporting Liam’s head. She glanced up, registering the stranger’s appearance for the first time. She blinked and stared, her jaw dropping. The man smiled without amusement.

“Hello, Jennifer. Fancy meeting you here.”

“Andrew!”

Dear Reader,

Akaroa has to be one of the prettiest small towns in New Zealand. It’s one of my favorite places to visit because of its beautiful scenery and the distinctive essence that still remains from its French settlement. I’ve wanted to set a story here for a long time, and the fact that Akaroa’s geography lends itself to the potential of being cut off provided a good starting point.

Jennifer Tremaine has excellent reasons for her reluctance to leave Akaroa, and Andrew Stephenson finds his own compelling reasons to stay in such an attractive location. They could be perfect partners in more ways than one, but the circumstances that bring them together could just as easily drive them apart.

Separating a small rural hospital from high-tech backup provides opportunities for challenging situations. The challenges can become even more dramatic when two doctors who spent their training years as fierce rivals are forced to spend time with each other both professionally and personally.

I’m sure you’d love to visit Akaroa. I hope you enjoy Andrew and Jennifer’s story as much as I loved writing it.

With love,

Alison

Rivals in Practice

Alison Roberts

www.millsandboon.co.uk

CONTENTS

Cover

Excerpt

Dear Reader

Title Page

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

Extract

Copyright

CHAPTER ONE

THE crack split the airwaves as unnervingly as gunfire.

‘My God, what was that?’ The fear in the woman’s eyes had nothing to do with the reason she was lying on a hospital bed.

Dr Jennifer Tremaine turned away from the window with a reassuring smile. ‘Nobody’s been shot, Liz. It’s just a branch coming down on that old twisted willow by the front gate.’

Elizabeth Bailey settled back onto her pillows reluctantly. ‘Must have been a pretty big branch.’

‘It was. I think some of these wind gusts are getting over a hundred kilometres an hour.’

A nurse smoothed the final piece of clean linen into the bassinet with a satisfied pat. Then she straightened, turning suddenly as a fresh gust of wind rattled the window viciously and sent droplets of water against the glass with enough force to sound like a shower of small pebbles.

‘I thought this was supposed to be the tail end of that southerly storm.’ The nurse, Wendy Granger, peered out of the window. ‘It looks a lot closer to the head end to me.’

‘At least we had plenty of warning. The fishing boats should all be in and they closed the school early.’ Jennifer Tremaine frowned as she picked up the chart lying on the end of Elizabeth’s bed. The small rural community of Akaroa, nestled into a peninsula on the South Island of New Zealand, wasn’t used to winter weather of such severity but preparations had been a focus all day. The young doctor’s immediate concerns were much closer. If she needed back-up for any complications with Elizabeth’s labour, the nearest large centre was Christchurch. Evacuation by air was clearly out of the question already, and even in good weather transport by road took an hour and a half.

‘That branch has blocked the front driveway completely,’ Wendy announced. ‘I hope no one’s been injured.’

‘You and me both.’ Jennifer glanced at her watch. ‘I must ring home. I want to check that the children are all back from school safely.’ She frowned again, her attention still on her watch. ‘It’s over ten minutes since your last contraction, Liz. You’re slowing down again.’

‘Oh, no! Is this going to be another false alarm?’

‘I guess we’ll have to wait and see.’ Jennifer smiled at her patient. ‘One thing’s for sure, we won’t be sending you home in a hurry in this sort of weather. As I explained to you yesterday, the position your baby is in is likely to make the first stage of labour quite a lot longer than usual. The backache you’re getting is the other major disadvantage.’

Liz sighed heavily. ‘Trust Peter’s child to be difficult before it’s even born. Like father, like son—or daughter,’ she added.

‘Have you heard from Peter again?’

‘He rang half an hour ago. The airport at Dunedin is closed because of the weather. There’s no chance of him getting back tonight. I hope it is another false alarm.’

‘How’s your back feeling?’

‘Sore, but no worse than it’s been since I came in yesterday morning. What was it you called the position?’

‘It’s called a right occiputo posterior position. It means that the baby’s facing the front. The most normal presentation is when the back of the head is pressing on the abdominal wall. The back of your baby’s head is pressing against your sacrum.’ Jennifer smiled wryly. ‘Commonly known as ‘‘backache labour’’, I’m afraid.’

‘What’s going to happen?’

‘The baby will most likely turn itself around at the very end of the first stage or the beginning of the second and then things will go a lot more smoothly and quickly.’

‘How long will it take?’

‘I can’t say,’ Jennifer apologised. ‘You’re still only three centimetres dilated so we can’t even be sure whether labour is established yet or not. Try moving around as much as you can for the moment. If you stay upright, it will tip the baby down and might ease the pressure on the small of your back. Kneeling, being on your hands and knees and lying on your side, curled up, might help the pain and encourage the rotation of the baby. We’ll give you a hot pack, and ask Wendy for a massage any time you like.’ Jennifer turned to her nurse. ‘Why don’t you put the kettle on first, Wendy? I think we could all use a cup of tea. I’m just going to pop up to the office and give Saskia a ring. She should be back from collecting the children by now.’

The wide, wood-panelled hallway and the impressive height of the ceiling could have graced a stately home. The small hospital had been built in an era when function and budgets couldn’t overrule aesthetic considerations. More recent additions were modern, and Jennifer was proud of their maternity suite, treatment and consulting rooms but she loved the older part of the hospital. The rooms were spacious, most opened onto verandahs that were more than welcome in the hot, summer months and the marginal plumbing could be forgiven because they were never stretched to use their entire ten-bed capacity.

The hospital office was near the front of the old weatherboard building and the room was large enough to accommodate Jennifer, her older partner, Dr Brian Wallace, and the secretary who worked weekday mornings. The ancient carpet was still thick enough to muffle the sound of Jennifer’s approach and she stopped in the doorway with a small groan of dismay. The room had enough windows to give a clear view of the worsening storm and the impressive pile of debris from the willow tree could be seen covering the driveway, but Jennifer wasn’t looking outside. Her dismay was directed at the man sitting in front of a computer screen.

‘How bad is it, Brian?’

Brian Wallace shoved a desk drawer shut with a startled bang. ‘Bloody awful,’ he growled. ‘I’ve lost the report I’d just finished because of some power disruption and the damned thing’s vanished. I’m sure I saved it.’

‘That’s not what I’m talking about.’ Jennifer crossed the room quickly. ‘I saw you drop your spray into the drawer. Why didn’t you tell me you had your angina back again?’

The older man sighed with resignation. ‘I didn’t want to worry you, Jen.’ He looked up and smiled. ‘It’s not so bad—really.’

‘And it came on while you were sitting here quietly at the computer?’

‘It came on thanks to the stress these infernal machines are capable of generating. I’ve spent a week on that report. We should never have tried to get so modern. We did just fine in my day before technology started to take over. I want my typewriter back.’

‘Oh, sure.’ Jennifer grinned. ‘You use the Internet more than any of us do. You’d be totally lost without it.’ Her smile faded. Jennifer wasn’t going to allow complete distraction. ‘Come with me. I want to do a twelve-lead ECG.’

Brian scowled. ‘Let me have another go at finding this report first. I’ll reboot the computer and see if that helps.’

Another loud crack outside made Jennifer flinch. The lights in the office flickered, went out for several seconds, then came on again with slightly diminished strength. The menu on the screen in front of Brian vanished.

‘Shut down,’ Jennifer advised firmly. ‘It looks like our emergency generator has kicked in and the less power we use, the better. The computer’s out of bounds.’

‘So’s the ECG machine, then.’

‘It’s battery-powered,’ Jennifer reminded her partner crisply. Her expression softened. ‘Please, Brian, let me check you over.’

The older doctor complied reluctantly and Jennifer’s smile was sympathetic as she led the way down the dark hallway towards the consulting room. Brian Wallace was well into his sixties and probably should have retired two years ago after suffering his first heart attack. Like herself, Brian had been born and raised on the peninsula but it had been his first choice of career to come back here to practise medicine and become an integral part of the small community.

Jennifer’s return hadn’t been entirely voluntary and her time here as a doctor couldn’t begin to compare with Brian’s years of service, yet she could already feel the strands of the web the ties created. And they weren’t unpleasant ties. The bond was protective as well as demanding. She was a part of so many people’s lives. A piece of the fabric of this old building and an equal partner of this GP who had been her friend and mentor for as long as she could remember.

The ECG was reassuring. ‘There’s no sign of any ST depression or other changes.’ Jennifer showed the trace to Brian. ‘How’s the chest pain at the moment?’

‘Gone.’

‘Did it feel the same as your previous angina?’

‘Pretty much.’

‘Any associated symptoms?’

‘No.’

‘Have you had your aspirin today?’

‘Yes, Doctor.’ Brian smiled at Jennifer. ‘Can I go now?’

‘No. I want to take your blood pressure and listen to your chest. If they’re OK then you can go. Home—for a rest.’

‘It’s only three p.m.’

‘It’s dark enough to be six p.m. and I want you safely home before this storm gets any worse.’ Jennifer wrapped the blood-pressure cuff around her colleague’s arm.

‘We might get extra work.’

‘If we do, Wendy and I will cope.’ Jennifer reached for the stethoscope hanging around her neck. ‘We’ve only got the two inpatients and Lizzie’s labour could well be another false alarm.’

‘Well, Wendy’s an excellent nurse and I have complete faith in you to cope with anything that needs a doctor.’ Brian looked thoughtful. ‘And I did promise to check on Jack Currie’s ulcer on the way home.’

Jennifer sighed. ‘And how many other house calls did you promise to make?’ She released the valve on the bulb. ‘Your blood pressure’s fine. One-forty over ninety.’ She placed the disc of the stethoscope on Brian’s chest. ‘Take a few deep breaths for me.’

The pot of tea was cold by the time Jennifer arrived in the hospital kitchen. She threw a teabag into a mug and waited for the kettle to boil again. Wendy came into the kitchen carrying a tray of empty cups and saucers.

‘Mrs D. says she wants another biscuit.’ Wendy reached for a tin on the shelf above the toaster. ‘And she’s already had two!’

‘The storm’s not bothering her, then?’

‘I don’t think she’s noticed.’

Jennifer grinned. Mrs Dobson had become a long-term inpatient. At ninety-seven, she required more medical attention than the local rest home was able to manage, and it had seemed cruel to send her out of the area she had lived in all her life even though she was now often unaware of her surroundings.

‘How’s Lester?’

‘Quiet. He was asleep so I didn’t disturb him.’

‘Pain relief must be working, then.’ Jennifer added a spoonful of sugar to her tea. Lester Booth was suffering from an extremely painful dose of shingles. ‘What about Liz?’

‘The contractions are following the same pattern. One strong one and then one really feeble one.’ Wendy was stacking cups and saucers into the dishwasher. ‘She’s really fed up and her back pain is getting worse.’

‘Have you checked the foetal heartbeat?’

Wendy nodded. ‘Nothing’s changed. There’s no sign of foetal distress.’ She grinned at Jennifer. ‘Only the maternal variety.’

Jennifer sipped her tea thoughtfully. ‘At this rate Liz is going to be worn out well before we get anywhere near the second stage. If I’d sent her into town yesterday she could have been managed more effectively. They could have speeded things up and done a Caesarean if a forceps delivery failed.’

‘Liz wanted to wait to give Peter a chance to get home,’ Wendy added. ‘She was quite pleased when things ground to a halt. Are we likely to run into trouble, do you think?’

‘I hope not. It’s been a while since I did a forceps rotation and delivery, though.’ Jennifer glanced towards the small kitchen window as a wave of hail assaulted the glass. ‘I’m worried about the road being cut off. Having that on top of a potential complication makes us feel rather isolated. Let’s just hope the baby decides to co-operate and turn itself around.’

Wendy followed her glance with a grimace. ‘It’s probably snowing on the hilltop by now.’ She looked at her watch. ‘I’d better go and check on Liz after I’ve given this to Mrs D.’ Wendy picked up the plate with the chocolate biscuit. ‘Then I’ll take Brian a cup of tea. He wasn’t in the office when I went past.’

‘I’ve sent him home.’ Jennifer caught Wendy’s surprised expression and smiled a trifle grimly. ‘He’s getting angina again.’

‘Oh, no!’ The biscuit was in danger of sliding off the plate. ‘How bad is it?’

‘Hard to know. I suspect Brian hasn’t lost his touch at hiding symptoms. I checked him out and I’ll do another ECG in the morning, but I didn’t want him here just in case things do get busy.’

A faint noise reached the women above the howl of the midwinter storm. A noise that rose and fell with an easily recognised urgency. The warning siren was used to call the local volunteer fire officers in to their station. It was unlikely that their fire-fighting skills would be required right now, however. Far more likely that their role as first responders for ambulance or rescue work was being summoned. Even while the noise was being registered in the kitchen, a much closer signal sounded.

‘That’s the surgery bell. Shall I go?’ Mrs D.’s biscuit was abandoned on the bench.

‘No, I’ll go.’ Jennifer tipped out the rest of her tea. ‘You stay with Liz.’ She looked over her shoulder as she moved to the door. ‘And could you ring home for me when you’ve got a minute? I still haven’t checked on the children.’

The large man standing in the tiny waiting room was wearing an oilskin parka that streamed water onto the linoleum floor. He held one hand clutched to his chest and well-diluted blood was staining the rapidly growing puddle. ‘John! What’s happened?’ Jennifer held open the door of the treatment room. ‘Come straight in here.’

‘It’s a bit of a mess, Doc.’ John Bellamy sat down heavily on a chair as Jennifer pulled gloves on and reached for a pack of sterile dressings. ‘I was just making sure the boat was secure and this wave rolled right over the deck. I landed in my tackle box.’ His face twisted as Jennifer moved his hand to place it on a towel on the bed beside him. She pulled the head of the angle lamp out from the wall and clicked on the light. ‘I got one of the damned hooks out but there’s another one that’s too deep.’

‘Sure is.’ Jennifer looked at the fish hook buried in the calloused pad below John’s thumb. ‘And you’ve got a nasty tear where you pulled the other one out. It’s going to need a stitch or two. Let’s get your coat off and make you a bit more comfortable first.’

‘No point in getting dry.’ John shook his head firmly. ‘I need to get back and keep an eye on the boat. The tide’s not full in yet and we’ve got waves breaking on the road already.’

Jennifer was drawing up local anaesthetic into a syringe. ‘It’s going to be too dangerous to be anywhere near the boats, then.’ She looked at her patient with concern. ‘You’re not thinking of getting back on board, I hope.’

John shook his head wearily, releasing more droplets of water from his grizzled hair. ‘I just need to watch,’ he said quietly. ‘That’s my livelihood out there.’

‘I know.’ Jennifer’s tone was sympathetic. ‘Let’s hope things don’t get any worse.’

The surgery bell rang again just as Jennifer eased the fish hook from the incision she had made with a scalpel. She pressed a sterile gauze pad over the wound. ‘Hold that on for a second, John. I’d better see who that is.’

Two women stood in the waiting room. The younger woman looked anxious. ‘Mum’s had a fall, Dr Tremaine.’

‘I couldn’t see a thing when the lights went out!’ The older woman sounded annoyed. ‘I tripped over the coffee-table.’

‘Were you knocked out?’

‘No, but I’ve cut my leg and you know what my skin’s like.’

Jennifer nodded. Edith Turner had been on steroids for years to treat her lung condition. Even a slight knock could tear her papery skin badly. Judging by the blood-soaked towel around her lower leg, this accident had been more than a slight knock. She touched the towel to find the stain almost dry.

‘It’s stopped bleeding, anyway. Take a seat in the consulting room and I’ll be with you in a couple of minutes. I’ve just got a few stitches and a dressing to take care of.’ Jennifer was debating whether to open the internal door from the waiting room to call for Wendy’s assistance when the outside door opened again.

‘The front driveway is completely blocked!’ a cheerful voice informed Jennifer. ‘So I had to come in this way.’

‘Margaret!’ Jennifer was delighted to see another of her senior nurses. The uniform the older woman was wearing was a surprise. ‘You’re on night duty. You’re not due in for hours yet.’

‘Thought you might need some extra help what with this weather.’ Margaret Coates pulled a clear plastic hood clear of her grey hair.

‘You’re an angel,’ Jennifer told her. ‘Can you take Edith in to the consulting room and have a look at her leg? You might need to soak that towel off. I’ve got a bit of stitching to finish in the treatment room.’

The last stitch in John’s palm was being tied when Wendy came into the room. ‘Contractions are back to ten minutes apart,’ she reported to Jennifer. ‘Liz is asking for some pain relief.’

‘I’ll go and see her. Could you dress John’s hand? Put a plastic bag over it all when you’ve finished so it doesn’t get wet. John wants to go and have another look at his boat.’ Jennifer stripped off her gloves and stood up. ‘Did you get hold of Saskia?’

‘Sorry, the phone lines seem to be out.’ Wendy was ripping the covering off a crêpe bandage. ‘I’ll try again later.’

Margaret signalled to Jennifer as she stepped into the hallway. ‘Edith’s got a nasty avulsion,’ she said. ‘And the skin flap’s all scrunched up and torn.’

‘Put a moist dressing on it,’ Jennifer directed. ‘I’ll come and sort it out in a few minutes.’ She moved quickly towards the door further down the hallway as the surgery bell sounded again. Jennifer paused for a second, not wanting to enter the maternity suite until she was able to focus completely on her patient. Her level of tension needed lowering.

If the phones were out there was no way of ringing home, but Saskia was far more responsible than most girls her age. If there had been any problem getting all the children home safely, she would have found some way to contact Jennifer on her mobile. She could reach Brian on his own cellphone if absolutely necessary but calling him in to help deal with a stressful influx of casualties was the last thing Jennifer wanted to do. Wendy and Margaret were both very capable nurses. Surely even this storm couldn’t throw anything at them more than the three medical staff could deal with. There was nothing life-threatening about the injuries arriving so far and as long as Liz’s labour was straightforward, they should be fine. Jennifer took a deep breath and entered the maternity suite.

‘Sorry to have been gone so long, Liz,’ she told her patient cheerfully. ‘Let’s have a look at you and see what’s happening.’

Ten minutes later, Jennifer headed back to the treatment room. Wendy and Margaret now had Edith on the bed.

‘I’ve had a go at straightening this flap.’ Wendy looked up, the tweezers poised in her gloved hand. ‘What do you think?’

Jennifer eyed the wound. ‘Couldn’t have done better myself. Could you dress that, please, Margaret?’ She waited until Wendy had dropped her gloves into the rubbish bin near the door. ‘Liz is about six centimetres dilated so she’s definitely in labour. I’ve set up the Entonox for her to use for pain relief but it’s better if she keeps moving at the moment. Can you stay with her?’

‘Sure.’ Wendy nodded. ‘Sam McIntosh is in the consulting room with his mother. He needs looking at.’

‘What happened?’

‘Apparently the wind caught the garage door and it hit him on the head. Possibly unconscious but only very briefly. He seemed fine but rather quiet. Jill got worried when he vomited about half an hour ago. Looks like concussion.’

Jennifer knew Sam well. Six years old, he was the same age as the twins. Sam lived just down the valley from Jennifer’s property and often came to play after school. He looked pale and unusually subdued at present.

‘I’m going to shine a bright light in your eyes,’ Jennifer told the small boy. ‘Try and keep them open for me.’

She managed to complete a full neurological check and reassure Sam’s mother before another interruption occurred. This time it was her cellphone. The flash of panic that something had happened at home intensified when the caller identified himself as Robert Manson, one of the local fire officers.

‘We’ve got an accident near Barry’s Bay.’ Robert’s voice was difficult to hear over the crackle of static and the background noise of the weather and people shouting. ‘We need you on scene, Jennifer.’

‘How bad is it?’ Barry’s Bay was well away from the route the children would have taken and they had probably been home for hours by now.

‘We’ve got one of the drivers trapped. He’s unconscious. He’s the worst but we’ve got a couple more patients.’

‘I’m on my way.’ Jennifer moved fast. She was donning over-trousers and her oilskin parka by the time Wendy found her.