New Surgeon at Ashvale A&E

by Joanna Neil

  ‘That’s right.’ Ruby frowned. ‘I’ve no idea who he was, but one of the workers from a farm some half a mile away brought over some feed for the ponies and left it in the barn. He said he disturbed a man who had been hanging about by the orchard. He didn’t see him well enough to get a description, but he said he was definitely alone, and when the man saw him, he took off. I don’t see how he would have been able to get into the house. None of it really makes sense.’

  ‘It must be upsetting for you.’ Olivia’s gaze was sympathetic.

  Ruby nodded. ‘It’s more worrying than upsetting. It would be good to think that Sophie was close by, but I can’t help thinking that the man being there was just a fluke—maybe he planned on stealing fruit or taking some of the animals. Either way, I wish Sophie had stayed to make proper contact. It’s unnerving not knowing what’s going on.’

  ‘Perhaps she’ll come back. It does sound as though she wants to do that.’

  ‘Yes, it does.’ Ruby sighed inwardly as she thought about the events of that day. Sam had stayed around to help her search for any sign that Sophie was still around, but though he’d been concerned for her, the barrier between them had stayed in place. He had made no attempt to bring back the closeness that they’d had before.

  It was a mystery to her, and it left her feeling at a low ebb. She didn’t know how to find the key to unlock his heart.

  She busied herself with the day’s work, referring the baby to a cardiac specialist, although she suspected that the heart murmur was not of great significance. The rest of her patients were easy enough to deal with, mostly uncomplicated fractures or gashes that could be sutured without throwing up too many problems.

  Sam came back from his meeting with the hospital chiefs around midday, and she glanced at him, expecting him to be in a good mood. Instead he was grim-faced, and when Ruby tried to speak to him, he was brisk and efficient.

  ‘I can’t stop and talk right now,’ he said. ‘There’s a twelve-year-old boy being brought in by ambulance, and I need to prepare for him. He’s been referred to us with suspected meningitis by the local GP.’

  His words put her on immediate alert. ‘What can I do to help?’

  ‘You can ask Michelle to get the isolation room ready for him. He’s being given oxygen by mask, but I’ll probably need to intubate him and put him on a ventilator. The paramedics say his blood pressure is low. I probably won’t do a lumbar puncture right away because there are signs that his intracranial pressure is raised. Perhaps you could take blood samples for cultures and send them off to the lab while I start the intravenous lines and administer wide-spectrum antibiotics. The GP has already given him benzylpenicillin, so that’s a start.’

  ‘Do we know what other symptoms he’s showing?’

  ‘It started with a bad headache and dislike of light. He’s very upset, apparently, confused and generally unwell. There’s evidence of neck stiffness and cold hands and feet.’

  ‘Any rash?’

  ‘Not so far. Let’s hope we’re in time. We should warn the intensive care unit to expect him.’

  The boy arrived just a minute or so later, and Ruby assisted as Sam and the paramedics rushed him to the isolation ward. The child was semi-conscious, able to say a few words to them, but his condition was deteriorating rapidly.

  ‘I want my Mum,’ he managed in a wretched, broken voice. He kept saying it, over and over, mumbling the words to himself.

  ‘Of course you do,’ Ruby tried to console him. ‘We’ll make sure they know where you are. Don’t you worry about anything. Dr Boyd is looking after you, and you’re in good hands. He’s the best there is.’

  She glanced at the lead paramedic, moving away from the trolley bed momentarily. ‘Are the parents coming in?’ she asked quietly, but he shook his head.

  ‘We haven’t been able to contact them,’ he said in a low voice. ‘Nathan was on a residential school trip, and his parents are away for the week in the Andes Mountains. Apparently he’s been asking for them ever since he was taken ill a few hours ago.’

  He glanced at the boy, making sure that he couldn’t hear what was being said. ‘The headmaster has been trying to get in touch with them, but they’re not at their hotel, and either their mobile phones are switched off or they’re in a bad signal area. It sounds very much as though they set off early for a day’s outing. Of course, now the headmaster is feeling guilty for not contacting them sooner, but he reasoned that it would be the early hours of the morning in South America when the child first complained of feeling ill, and no one knew how serious his condition was at that time.’

  She pulled a face. ‘That’s not a good start, is it? Thanks, anyway, Tom, for that. Do we have anyone from the school here?’

  He nodded. ‘The teacher in charge of the residential group is here, and the headmaster has been liaising with them.’

  ‘That’s something, at least.’

  She concentrated on collecting the blood samples, all the while trying to soothe the boy, who was becoming increasingly distressed.

  Sam was working calmly and efficiently as usual, putting in intravenous lines to deliver life-saving fluids and medications, all the while checking the monitors to see how the boy was coping. Things were not looking good. The boy was having difficulty breathing, and the pressure inside his head was increasing as the meninges, the protective membranes around his brain, became more inflamed.

  Sam made the decision to put a tube into the boy’s throat to secure his breathing when Nathan slid into unconsciousness. ‘I’m giving him corticosteroids to bring down the inflammation,’ he said, ‘and later we’ll think about adding mannitol.’

  His expression was bleak, and Ruby knew that he was desperately worried about this child. They had done all they could for him over the last hour, and now all that remained was for him to be transferred to Intensive Care. Until they found a bed for him there, Nathan would remain under observation in A&E.

  ‘Do you want to go and get a drink?’ Ruby suggested. ‘You look drained of energy. Have things gone badly for you today? I know you were working here before you went off to your meeting.’

  ‘I’m okay. Michelle’s gone over to ICU, so I’ll stay with the boy for as long as I can,’ Sam said, ‘at least until she gets back.’

  ‘All right…but if you need a break, I can take over for you.’ She studied him closely, wondering what it was that had brought the bleak expression to his face. It wasn’t like him to be this way. He always fought for his patients. He never worried about the outcome, but worked with whatever hand he was dealt. Meningitis could be a devastating illness, but young Nathan still had a chance to come through this.

  ‘Thanks. I’ll be fine.’ He stood by the bed, looking down at the boy, and Ruby tried to work out why he should feel such an affinity for this child above all others.

  She said softly, ‘I went to look in on young Jason, the boy who was injured in the car crash some time ago…do you remember? His airway was ruptured, and he had to have emergency surgery.’

  ‘Yes, I remember.’ His mouth flattened. ‘I asked you why you went over to ICU to see him. I can be an arrogant know-it-all sometimes, I realise that. You don’t have to rub it in.’ He pulled up a chair and sat down, briefly glancing at the monitors as though to reassure himself that all was well.

  ‘I wasn’t going to do that. I was just about to say that he was discharged from the hospital with his mother a week or so back. His father’s out of Intensive Care and on the mend, too. And then there was the boy who fell from the bridge…he had multiple injuries, but now he’s recovering nicely. So you see, there’s always hope…but you know that, don’t you? I’m not even sure why I’m telling you this.’

  He leaned back in his chair and studied her, a heavy sigh escaping him. ‘I appreciate what you’re trying to do, but I just need to be here, Ruby. You don’t have to stay.’

  She frowned, her brows drawing together in a fine line. ‘Is this anything to do with the fact that hi
s parents aren’t able to be with him? I’m sure they would want to be here if they knew what was happening.’

  ‘Yes, I’ve no doubt that’s right, but in the meantime he slipped into unconsciousness, asking for them.’

  ‘We’ll be here to take care of him and see to his emotional well-being when he comes round again—if they aren’t here by then. I don’t know how long it takes to fly over here from South America.’

  ‘At least half a day, around twelve hours or so, and that’s just the flight.’

  ‘That’s not good, is it?’

  ‘No.’ He stretched out his legs in front of him. ‘Not for a boy who’s seriously ill.’

  She pressed her lips together. ‘Did this, or something similar to this, happen to you at some time?’

  He nodded. ‘I was taken ill at the same age. All I knew was that I felt really awful, and I knew it was something bad. I was on my own at boarding school at that time…my brother was only ten years old, so he hadn’t joined me then, thank heaven, or he might have gone down with the same illness.’

  His mouth twisted in a grimace as he thought back over those years. ‘I remember feeling unbelievably lonely. There was no family around, no one from home to comfort me and tell me that I would be fine, they would take care of me…just virtual strangers, the teachers and the boys. There was the matron, of course, but she was an austere, no nonsense kind of woman. “You have a sore throat, boy, and a bit of a headache? Trying to get out of doing our maths homework, are we?”’

  ‘Did you have the same illness as Nathan? Was it meningitis?’

  ‘Yes, it was. Of course, they didn’t realise that at first, but then I collapsed, and they called for an ambulance. I recall being lifted up and placed on the trolley bed. The paramedics were wonderful, so calm, caring and friendly. I think they were my salvation, along with the doctors and nurses who looked after me. I think they were the real reason I turned to medicine as a career.’

  He smiled. ‘The paramedics even came to see me each day as I was recovering in hospital.’

  ‘And your parents?’ Ruby was still frowning. No wonder he felt such a bond with Nathan.

  ‘They were half the world away. They came as soon as they were able, but I think it took several days—it was a while before the school managed to get in touch with them, and then flights had to be arranged. My grandparents were away, too, but I recall they made it to the hospital before my parents.’

  ‘It must have been awful for you, feeling so ill and being isolated from those you loved.’ Ruby went to stand beside his chair, laying a comforting hand on his shoulder.

  He shrugged. ‘It wasn’t so bad. I was used to being away from them by then, though I did miss my little brother. When you’re away from home, you learn to steel yourself against any adversity. It doesn’t do to confide your feelings to anyone. That’s the quickest way to be laughed at, sneered at, generally made to feel a fool, so you toughen up fast.’

  ‘Oh, Sam, that’s too hard to bear…a vulnerable child so far away from everyone who means anything to him.’ She leaned over the back of his chair, nestling her cheek against his head and wrapping her arms around him. ‘I just need to hug you.’

  He made a soft laugh. ‘I’m a grown man, Ruby. There’s no need to hug me better.’

  ‘I’m not hugging you. I’m hugging that lost and lonely boy.’ She kissed his cheek tenderly, and then nuzzled her face against his, so that he turned in his seat and stood up, coming to hold her close.

  ‘You’re very sweet,’ he said, ‘and I thank you for that, but I’m okay, really. The boy inside is okay. You don’t need to worry about either of us.’

  He slowly released her, and she realised that someone was approaching from outside the room. Then Michelle walked in, and Ruby guessed that Sam must have heard her coming.

  ‘ICU should have a bed for Nathan later this evening,’ Michelle said, ‘and the headmaster has finally managed to get a message through to his parents. They’re booking the next flight back.’

  ‘That’s good,’ Sam murmured. ‘Let’s hope he’s on the mend by the time they get here.’

  Michelle glanced through the instructions on the medication chart. ‘That looks straightforward enough,’ she said. ‘You can leave him with me now, and I’ll let you know if anything changes.’ She gave Sam a concerned look. ‘You must be devastated by the news this morning…I’ve just seen the chief executive officer in ICU, and he says the hospital trust is still planning to close this place down, even after all you’ve done. I don’t understand how they can be so blinkered.’

  Ruby gasped. ‘That can’t be true, can it?’ she asked, sending Sam a shocked glance.

  ‘That’s what the chief said,’ he acknowledged. ‘But the hospital trust board is having a further meeting this afternoon at the Heritage, so I still have a chance to sway them.’ He looked at Ruby. ‘I need you to come with me to that meeting, Ruby. I know it’s short notice, but you’re off duty this afternoon, aren’t you? Between us, I think we can persuade the executives that they will be making a mistake in closing us down. Will you do it? I’m relying on you. I need you to be there.’

  ‘Yes, of course I’ll do it, but how will I be able to help?’ Ruby looked at him in consternation. Michelle had moved to the bedside to record observations on their patient and was noting down temperature, respiration and heart rate on the chart.

  ‘You’ve kept a record of all the patients we’ve treated in the past three months, haven’t you…especially those who wouldn’t have made it if they’d had to be diverted to the Heritage.’ Sam pulled in a deep breath. ‘You’ll be able to tell them about the ones you treated personally…like young Jason, for instance. He’s still around because of you, and because he was brought here in good time.’

  ‘That sounds like a great idea. I keep the file in the office. I thought it might come in handy one day.’

  ‘Good. I’ll come and find you at three o’clock, and we’ll drive over there. Do you need to make arrangements for Becky?’

  She nodded. ‘Mary’s looking after her today. I don’t think she’ll mind having her for a bit longer, but I’ll ring up later and find out.’

  They left Michelle to observe young Nathan and walked together towards the central area of A&E. ‘It’s no wonder that you were feeling so bad about everything,’ Ruby commented. ‘Having to deal with a meningitis case immediately after that meeting must have been the final straw.’

  ‘It was just a temporary setback,’ he murmured. ‘I won’t let these things defeat me.’

  She sent him an oblique glance. ‘No, that’s not your way, is it? In fact, I think I’ve finally found the key to what makes you tick. I’ve been searching all this time and wondering why it is that you avoid deep, long-lasting relationships…because it isn’t by chance that you’ve never settled down, is it? It’s a choice, albeit maybe a subconscious one, that you made a long time ago. You don’t let anything get to you. It’s the reason you don’t fall in with the social scene at work…because if you avoid people and don’t get involved in meaningful relationships, nothing and no one can hurt you.’

  ‘Pure guesswork,’ he said. ‘It’s all nonsense.’

  She shook her head. ‘No, it isn’t. All those years ago, when you were a child, you learned how to protect yourself from being hurt. If boys were cruel and made taunts, you showed them you didn’t care. If your family was scattered over different parts of the globe, you told yourself it didn’t matter. And if any woman should be foolish enough to make any impact on your emotions, you put up the barriers and send her on her way. Why would you allow anyone to get close to you, when they might wrench your heart from you and then abandon you to oblivion once more?’

  He gave a short laugh. ‘You have it all worked out, don’t you? That clever, inquisitive mind of yours has been busy, and you’ve come to all the wrong conclusions.’

  She smiled, turning to face him and trailing a hand lightly over his arm. ‘No, I haven’t. They’re a
ll the right conclusions, and you’re trying to push me away again. You want me to think you don’t care, but I have the measure of you now, and I’m not going to be fobbed off that easily. I know you care about me, maybe even love me, but you’ll do your level best to stop me from getting too close.’ Her gaze meshed with his. Tt’s too late for those sorts of tactics, though. I’m forewarned and forearmed, and I’ll muscle my way in no matter what defences you try to put up.’

  ‘You’re living in a fantasy world,’ he said. ‘I told you a long while ago that I don’t do commitment. Why do things have to get serious when we can simply enjoy what we have for the moment? I tried to warn you, but it seems you didn’t listen. Don’t fall for me, Ruby. I’ll end up wrecking your life because I can never be what you want me to be. This job is what matters to me. It’s what I’ve fought for, worked for all these years. And now, when I have to concentrate fully on saving this unit, you’re distracting me with talk of loving and caring. It’s the puppy all over again…soft, romantic, mushy. That isn’t my world.’

  Ruby’s eyes widened. He didn’t really mean what he said, did he? She had stung him with her insight into what made him what he was, and he couldn’t handle it. That was it, wasn’t it? Why else would he say such hurtful, cruel things?

  He walked away, heading for the ambulance bay in search of his next patient, leaving her to stand forlornly in the middle of A&E, wondering why she couldn’t pull herself together. She was the laid-back one, the one who didn’t let life get her down, and here she was, feeling the sting of tears behind her eyelids. Soft, romantic, mushy…was that how he saw her? What was wrong with any of that?

  ‘Shouldn’t you be going off duty?’ Olivia interrupted her wayward thoughts, and Ruby glanced at her watch.

  ‘Oh, yes, you’re right. Only, I need to make a phone call first.’

  Olivia gave her a puzzled glance, but Ruby didn’t stop to explain. She went over to the booth where the phone for private calls was situated and dialled Mary’s number.