Best Practice

by Penny Parkes

  He laughed at his own joke, such as it was, and clapped Dan on the shoulder, dropping his voice so the departing delegates wouldn’t hear him. ‘Now, be honest, how glad are you that this is all nearly over?’

  Dan allowed him a small smile that spoke volumes. ‘What on earth makes you say that, Harry? Anything to help the PCT.’ He threw one arm around Harry’s shoulders and gave them a relieved squeeze.

  Harry grinned. ‘I’d be careful what you say around here, or they’ll have you volunteering for all sorts before you can blink.’

  ‘Hmm,’ said Grace with a chuckle, ‘now why does that sound familiar?’

  Harry had the decency to blush. After all, The Practice’s involvement in this Model Surgery programme hadn’t exactly been voluntary. ‘Right then, on that note, let’s get you packed up. There’ll be a few loose ends to tie up, but I think we can call the educational boxes ticked, don’t you?’

  He followed them outside to Dan’s Land Rover, chivalrously offering to carry Grace’s files. She politely demurred, as Dan watched on with amusement – it was hardly an arduous load to carry two lever arch binders after all.

  ‘I’ll be in touch,’ promised Harry, as they drove away.

  ‘I’m sure he means to give us feedback, yes? Not to ask any more favours?’ Grace said, as Dan deftly manoeuvred into Bristol traffic.

  ‘I wouldn’t hold your breath there, Gracie. I reckon this nomination is the gift that keeps on giving, don’t you?’ There was an edge to his voice, behind the smile.

  Grace reached into her bag and passed him a mini Mars Bar.

  They drove in comfortable silence for a mile or two, as three lanes of traffic merged into one, and they could honestly have walked faster. Abruptly, Dan signalled and pulled down a side road, swung in a three-sixty arc and joined the free-flowing traffic in the other direction.

  ‘Worth it though,’ Dan said, as though their conversation had never paused. ‘Having Alice and the extra nursing clinics has been a godsend.’

  ‘It has,’ Grace agreed. ‘And whether we want to admit it or not, having one less partner has put the books in a healthy position for the first time in a long time. We’re even in danger of running a surplus this quarter.’

  It wasn’t often that they spoke of Julia Channing. Occasionally, her name would crop up in the doctors’ lounge, so accustomed had they all become to her disparaging commentary on their dietary habits that nobody could eat a frosted doughnut without expecting to hear her voice. And of course, they would see her on television or in magazines from time to time, Unicef making full use of her media savvy to communicate their agenda on immunisation.

  Dan nodded. ‘We manage okay with three though, don’t we? I mean, I even forget Alice isn’t a partner at times. She’s so switched-on, that girl. I just—’ He hesitated. ‘I just worry that she hasn’t really settled in to Larkford.’

  Grace nodded. ‘I know what you mean, but I think someone like Alice is a slow-grower. Once she decides to settle, she’ll stick like glue, you’ll see.’

  ‘Hmm,’ replied Dan. ‘You might be right, but until then, I reckon she’s a bit of a flight risk.’

  ‘Not everyone is desperate to leave Larkford,’ Grace said gently, knowing all too well that Dan’s history with Julia was probably playing a part in his concern.

  He nodded, sweeping around a roundabout and taking the exit sign for the motorway.

  ‘Er, Dan, I’m all for avoiding the traffic, but this short cut of yours seems to be taking us in the opposite direction,’ Grace said tactfully.

  ‘Ah, about that . . . ’ said Dan, avoiding her inquisitive gaze and pretending to concentrate on the road with deliberate nonchalance, ‘I hope you don’t mind, but I thought we deserved a little rendezvous after all our hard work.’

  He glanced sideways to see the flush of unexpected pleasure on Grace’s face. ‘How very lovely.’

  Her newly pink cheeks and the twinkle in her eye gave Dan a momentary start. The last thing he had ever intended to do was to give Grace the wrong idea, even if actually, normally, it would have been exactly the right idea, if he wasn’t so focused on—

  His thoughts tumbled over one another quickly, making no real sense by the time he needed to open his mouth and actually say something.

  ‘The Air Ambulance HQ is just up here,’ he began and saw her expression change almost imperceptibly. ‘So, I thought we’d just pop in and have a look around. Talk to the troops, as it were – if I’m going to get involved I want to see for myself what they’re dealing with, you know?’

  ‘Of course,’ said Grace with studied ease, turning to look out of the passenger window at the countryside flying by as they left the city.

  ‘A pub lunch afterwards would be nice though, wouldn’t it?’ Dan offered belatedly.

  ‘Let’s just play it by ear,’ said Grace, not angry, just quiet and a little withdrawn. He could sense the disappointment in her voice that his Big Idea wasn’t quite what he’d seemed to be suggesting. Who the hell referred to a work meeting as a rendezvous, he thought crossly – no wonder they were talking at cross purposes.

  It was only as they pulled up in the car park, the enormous aircraft hangars dwarfing them on both sides, that he realised something. Surely Grace would only be reacting this way if she had actually quite fancied the idea of skiving off work with him. He slipped out of the Land Rover with a secret smile and walked round to hold open Grace’s door. ‘After you,’ he said.

  No matter how old you were, there was still a sense of wonderment that came from peeking behind the scenes, thought Dan, as he took in the equipment and vehicles around him. The distinctive neon body of one of the helicopters caught his eye immediately, sitting silently on the tarmac, just waiting for the call.

  ‘Can I help?’ called a voice from over by the line of immaculate four-wheel-drive vehicles, and Dan turned to wave. The chap may have been decked out in the fluoro jacket of the Air Ambulance Team, but right now he seemed to be wielding a bucket and sponge rather than an oxygen mask. He strode towards them, only managing to get taller and more imposing as he approached.

  ‘I called ahead,’ Dan said, holding out a hand. ‘I’m Dan Carter, from The Practice in Larkford. This is our Practice Manager, Grace Allen.’

  ‘Chris. Chris Virtue.’

  Chris’s handshake was so firm that Dan began to wonder whether this man was actually cut out for the delicate procedures a paramedic needed to perform. That is, until he saw the gentleness with which he shook Grace’s hand.

  Ah, thought Dan instinctively, so it’s like that, is it? And then he gave himself a shake; he really needed to get his head in the game.

  ‘Come on up,’ said Chris easily. ‘Meet the team.’ He turned as they approached the staircase up to the offices. ‘We were so sorry not to be able to help on Saturday. Poor kid. Was she okay?’

  ‘She’s over at Frenchay now,’ Dan replied. ‘You know how it is with these head injuries. Bit of a waiting game.’

  He caught Grace looking at him strangely and realised that he’d automatically slipped back into his abbreviated Army style of conversation the moment he’d met Chris. There was something about the man’s demeanour that screamed ex-military and the subconscious part of Dan’s brain had obviously responded.

  ‘How long have you been with the team, Chris?’ Dan asked casually.

  ‘Just over two years, I guess. Makes a bit of a change to jinking about with the Taliban,’ he said, ‘but honestly, I think this job has turned out to be more harrowing.’ He stopped on the stairs and turned to look at them both. ‘We get more calls every day than we can possibly respond to, and we’re still pulling in two thousand sorties a year.’

  Pilot then, not paramedic, Dan realised.

  ‘Cup of tea?’ Chris said, switching gears without missing a beat and welcoming them into the Control Room. ‘I’ll get the kettle on and you can meet the team.’

  It was obvious that, here, it was all hands on deck, and Chris clearly
thought nothing of doing the tea run. No room for ego. Dan felt instantly at home and, if it wasn’t for the fact that Grace seemed so entranced by their guide, he conceded he might even be enjoying himself.

  They were certainly made to feel welcome. Pilots, paramedics, telephone operators and admin staff alike all took a moment to greet them, as Chris gave them the guided tour. He took a sip of his tea from an enormous mug bearing the ambiguous message ‘In Thrust We Trust’.

  ‘Listen, I know you spoke to one of the girls on the phone about the cutbacks, but it seems to me as though we’re all being told something slightly different,’ said Chris. ‘The maternity unit in Rosemore just had an unscheduled audit, apparently. We’ve had our maintenance budget slashed. There’s trouble ahead, if you ask me, even if nobody’s telling us the full story yet.’

  He looked around his team with an expression of proud concern; it was obvious that he was deeply committed to his role here and anything that jeopardised that had best beware. There was a steady hum of activity in the atmosphere, even if the crew were currently taking a moment to relax, albeit poised for action.

  Dan was about to comment as such, when Chris cut him off. ‘Don’t say it. Preferably, don’t even think it.’ He laughed nervously. ‘We’re all a bit predisposed to the jinx around here.’

  Even as he finished speaking, a different telephone trilled loudly into their midst and the whole team slipped into action like a well-oiled machine. It seemed like mere moments before the blades on the helicopter outside were rotating and three people in high-vis vests were running across the tarmac to jump in.

  Dan and Grace stayed out of the way, watching the whole situation develop, crackling radios conveying the details of the disaster unfolding on the M5 even as the bird took flight.

  ‘You do realise we were on that exact stretch of road half an hour ago,’ whispered Grace to Dan, her eyes wide with the possibilities of what-might-have-been, as yet more details of the horrific pile-up came in by radio and telephone over the next few minutes.

  A young girl with a clipboard materialised beside them. ‘Chris sends his apologies, but he asked me to give you this.’ She held out an information packet for fundraisers.

  ‘Where is Chris?’ asked Grace, looking around, obviously impressed by the calm and well-ordered protocols that were clicking into action without drama or panic.

  The girl just pointed out of the panoramic window, at the neon bird disappearing out of sight.

  ‘Wow,’ said Grace, with more feeling than Dan thought was actually necessary.

  He reached out and took the fundraising pack. ‘Can I ask?’ he said. ‘The second helicopter? Any news on the repairs?’

  The girl shook her head. ‘It’s been months now. And with crashes like this, with multiple casualties . . . Or at the weekend, when there was a race meeting in Bath and the Larkford Show running at the same time . . . We can only be in one place at a time.’ She shrugged. ‘Saying it would be useful to have it back in action is a bit of an understatement.’

  Message received and understood, thought Dan, his mind already relishing the possibilities of what he might be able to achieve for this undoubtedly vital cause. Even if that meant inviting Chris Virtue into Grace’s orbit. Sometimes, you had to step back from your personal desires, to look at the bigger picture.

  Chapter 7

  The Practice always felt strangely adrift on the days that Dan and Grace were away at HQ, sharing their pearls of wisdom. Harry Grant from their Primary Care Trust had been true to his word and the clock on these time-consuming seminars was winding down, their commitments as a Model Surgery almost fulfilled. It seemed to Holly as though Grace in particular would actually miss these sessions when they were over, much as they all liked to moan about their inconvenience. She certainly seemed to make an effort to look her best when ‘on parade’.

  At least with Alice on board, they still had a full complement of doctors on duty when Grace and Dan had their ‘away days’, even if occasionally that meant Holly got lumbered with one of Dan’s somewhat misogynistic frequent fliers.

  She bumped into Taffy outside the waiting room. ‘Fancy taking my three o’clock?’ She pulled a face. ‘Rock, paper, scissors? I’ve got Gordon Lightly.’

  Taffy laughed. ‘No chance.’ Gordon’s reputation for being a pain in the proverbial preceded him.

  ‘Go on,’ Holly said, switching on the charm. ‘There have to be some perks from sleeping with one of the partners.’ She grinned. ‘I’ll even cook supper—’

  Taffy shook his head in defeat and held out his hand, reliably a pushover whenever it came to his girlfriend. ‘On the count of three then—’

  Holly stared at their hands in disbelief. ‘Best of three?’ she offered.

  Taffy leaned forward and kissed her with a smile. ‘He’s all yours, baby,’ he said as he retrieved his own patient and left her dithering in the doorway.

  Gordon Lightly scowled at her as he unwillingly followed her from Reception to her consulting room. Holly really wanted to say that, since he’d arrived for his appointment with only seconds to spare, perhaps going on the immediate offensive wasn’t his brightest idea.

  ‘Perhaps it’s just better if I come back another day? Like I said, I do usually see Dr Carter and I think a man’s perspective on this might be better. No offence, miss, I’m sure you’re a lovely doctor, but . . . ’ His voice petered out, unable to articulate his reasons.

  Holly could empathise, she really could. It wasn’t always easy discussing intimate issues with a doctor of the opposite sex, but they were already overbooked for the next few days, so it was her job to put him at ease, not turn him away.

  She gestured to the seat beside her desk and sat down. ‘Well, why don’t we have a brief chat and you can outline the problem for me. And if you need any tests run, I can get those sorted and you can discuss the results with Dr Carter another day.’ She was already making a mental assessment of her patient, playing the probabilities of what he had come to discuss.

  Fifty or so, clearly overweight, balding.

  His forehead had a sheen of perspiration, whether from nerves or the effort of walking from the car park she couldn’t tell.

  Sallow skin, heavy jowls, broken spider veins on his cheeks.

  This was not a man in perfect health; equally, this was not a man to whom health was a priority. The nicotine stains on his teeth were a dead giveaway that he had not, in fact, quit smoking as his file suggested.

  Gordon looked so uncomfortable, though, that Holly could only surmise that they were looking at a problem in the trouser department. She’d put money on erectile dysfunction or trouble peeing, she decided.

  Gordon fidgeted. ‘Well, I suppose you are a doctor . . . ‘He sighed. ‘Look, it’s not me I’ve come about, it’s my wife. She refuses to come, you see. She says there’s nothing wrong and I should stop going on about it, but I worry, Dr Graham. She’s just not herself.’

  Holly had to quickly recalibrate her perceptions. Far from being the misogynist she’d pegged him as, might he in fact be a loving husband, a concerned husband at that? ‘Okay,’ she said. ‘Well, first of all, I can’t tell you anything about your wife’s health without her consent, but I am only too happy to have a chat about what’s concerning you and maybe a bit more information might encourage her to seek advice herself?’

  Gordon grunted his approval. ‘Dr Carter’s known me for years. And my wife. So he’d know what I’m saying is true.’

  ‘I’m not doubting you, Mr Lightly, but then you haven’t really told me anything yet. Let’s start with what’s worrying you the most.’

  Gordon’s neck immediately flushed scarlet. ‘Well, you see, I don’t know how to put this but . . . ’ He coughed awkwardly. ‘She’s lost all interest in the bedroom. No sex drive at all. Almost flinches at the very idea.’ Having blurted this news out in staccato sentences, Gordon was now on a roll. ‘And she doesn’t want to cook, doesn’t even care if the house is a mess. I think she�
�s depressed, Dr Graham. She keeps taking long walks and watching those endless bloody box-sets in the evening. It’s been like living with a different person these last few months.’

  ‘And her health?’ prompted Holly, trying to steer this consultation in a useful direction. ‘Has she lost her appetite? Is she having trouble sleeping? Is she down all the time – teary, perhaps?’

  He concentrated for a moment. ‘She’s been making lots of those vegetable smoothie things. And she’s always up before I’m awake.’ He frowned. ‘But she’s not crying all the time, Dr Graham, it’s more a distracted thing – as though she’s not really there.’

  Holly clicked through a few screens on her computer and pulled up poor Mrs Lightly’s file, angling the screen slightly so it was for her eyes only. Amanda Lightly was one of their rare patients without repeat prescriptions, ongoing health issues or indeed the odd appointment for coughs and sniffles. In terms of considering depression, though, it told her precisely nothing.

  She looked at Gordon, frankly considering him a much more likely candidate. ‘And how are you feeling about all this?’ she asked. ‘It must be difficult?’

  ‘It is difficult,’ he said, the surprise evident in his voice that she might appreciate that. ‘Since I’ve taken early retirement, I’m at home all the time, you see.’

  For Holly, the picture he was painting wasn’t necessarily one of medical causality; in fact it seemed perfectly possible to her that poor Amanda Lightly was utterly resenting her husband’s omnipresent retirement and doing her very best to look after herself in light of all the stress.

  ‘Have you and your wife been arguing a lot, Mr Lightly?’ Holly asked tentatively.

  ‘Too right we have. She just doesn’t want to see things from my point of view. When I rearranged the kitchen so it was more efficient, she told me I could, well, I’m quoting directly here, Dr Graham – told me I could cook my own fucking dinner myself then.’