Best Practice

by Penny Parkes

  Holly nodded; she could understand why. After all, who would want a glimpse of their future so forcibly illustrated? ‘Why don’t you enjoy your thinking time then, and come back in for a chat in maybe ten days? Book a double appointment, Molly, and in the meantime, let me see what I can find by way of support. Something constructive, at least. For you and Matthew. I know Dan’s already on the case, but many hands and all that. How does that sound?’

  Molly dashed a small tear away from her eyelashes, unwittingly allowing her eyes to well up still further. ‘Well,’ she managed, ‘at least I can still have a little cry when someone’s kind to me. I suppose I ought to make the most of it.’

  As Molly left the consulting room, her sick note clutched firmly in her hand, making slow progress as the dyskinesia threw her off balance, Holly wasn’t entirely sure whether she meant the ability to produce tears, which would surely be one of the next things to go, or being shown patience and kindness, which apparently were in short supply in Molly Giles’s challenging world.

  She turned to her desk and made a note to research whatever support she could find for Molly and her family, doodling the words Invisible Disability across the page. Molly wasn’t alone in Larkford and Holly was determined to make sure that she knew that. Tea and sympathy only went so far; empathy and a shared experience might make all the difference to her state of mind.

  By the time Holly had updated Molly’s file and seen her next five patients, she was beginning to feel the after-effects of a late night with Elsie, followed swiftly by an unconscionably early start with the twins. She looked longingly at her treatment bed for a moment, craving just a few minutes’ uninterrupted slumber, before rallying herself and heading for the waiting room. ‘Jemima Hallow?’ she said, smothering a yawn and looking around for the local vet’s petite, elfin wife.

  As Jemima struggled to her feet, it was easy to see how Holly might not have recognised her. Gone were the neat tailored trousers and the four-inch heels, to be replaced by Birkenstocks and a soft cotton kaftan, which still strained around her bump at the seams. ‘Oh Mims,’ Holly said with a smile, holding out a hand to guide her through to some privacy in her rooms, ‘you might need to give in and buy some maternity clothes, you know.’

  Mims just shook her head. ‘Nope. I’ve told this little one that, bearing in mind the exit strategy, he’s not allowed to get any bigger.’ She sat down in the chair beside Holly’s desk with an obvious sigh of relief. Hot weather and pregnancy were not really an ideal combination. ‘Which is what I wanted to talk about, actually—’

  ‘Well, let’s check your blood pressure before we start talking about exit strategies, shall we?’ interrupted Holly lightly, having made this rookie mistake one too many times before. Once all the readings and measuring and dippings were done, she swivelled her chair to face Jemima. ‘Okay. All on track. All looking good. But I have to tell you, there’s plenty more growing to come in the next couple of months. Do yourself a favour and buy some stretchy clothes.’

  Mims frowned. ‘I can’t believe I can actually get any bigger.’ She stroked her bump tenderly. ‘This baby is going to be the biggest chunky-monkey, isn’t he?’

  Even behind the affection in her words, Holly could see her concern, although surely this was something that Mims must have foreseen when, at barely five foot four, she had married all six foot three of Rupert-the-vet. ‘Have you given any more thought to your birth plan?’ Holly asked, easing in gently to give Mims the opportunity to share whatever might be uppermost in her mind.

  ‘That’s what I need to talk to you about,’ Mims said, fidgeting in her chair. Holly said nothing, waiting for the not-uncommon request for an elective C-section, as the realities of birth suddenly began to loom large and unavoidable. Mims however continued to take her by surprise. ‘Rupert and I have been dead-set on a water birth from the very beginning. I don’t want that whole cycle of intervention you get in hospital and my midwife was really supportive about booking us into the centre at Rosemore. It’s all midwife-led and there’s just a lovely atmosphere. It’s where I want to have our baby.’ She stopped and placed a hand on her chest, obviously trying somewhat unsuccessfully to remain calm. After a moment she reached into her pocket and pulled out a crumpled letter and passed it across to Holly without a word. Not necessarily because she had nothing to say – the unspoken emotions in the room had certainly charged their conversation with a new and slightly uncomfortable tension – but probably because the letter spoke for itself.

  The paper was already softened from repeated reading and folding, but the NHS logo was clear in the top corner. ‘Thank you for your interest in Rosemore Maternity for your birth, but unfortunately—’ Holly scanned the letter, before Mims began reciting it word for word.

  ‘—due to a change in financial circumstances, the Maternity Unit at Rosemore will be closing with immediate effect and your designated centre is now Bath!’ Mims made a strangled sound of restrained frustration. ‘That’s a good half an hour away and consultant-led: there’s no guarantee of a water birth, no breast-feeding counsellor, no one-to-one midwife! What happened to my choice? And it looks like it’s a foregone conclusion! Please tell me this is a mistake?’ Mims asked plaintively.

  Holly felt utterly blindsided. Of course there had been murmurs, rumours of audits, but nothing concrete. Perhaps they should have viewed the problems with the Air Ambulance funding as merely an opening salvo? She wondered whether Dan had gleaned anything more after his impromptu visit there. Pausing before continuing to read, she pulled open her desk drawer and sacrificed her elevenses mini-muffins to the cause, knowing only too well how hard it was to think on an empty stomach when pregnant.

  Holly slowly read Mims’ letter from start to finish, as Mims demolished two mini-muffins in close succession, watching Holly’s expression wordlessly. ‘Well, this is a joke,’ Holly said in the end, tossing the letter onto the desk with the disdain it deserved. The rest of the letter went on to explain that many other birthing options in the county might not be available to them now, since they were ‘late to apply’.

  Jemima’s face was etched with concern and helplessness and Holly floundered for a moment as to what she could actually, realistically, do. She had honestly thought that her days of political protesting were behind her. But this? She felt a wave of nausea and impotent fury wash over her.

  Decisions being made with zero regard for their rural way of life, for their individual choices? She couldn’t help the prescient shiver that this was not going to end well for some of her patients, but there was no point expressing this position with her patient still in the room. She took a breath to calm her own immediate feelings about the indecent speed of the closure, not to mention the secrecy – steaming rage was a fairly close approximation, but she had no intention of fanning the flames.

  ‘You know,’ said Holly calmly, ‘even if Rosemore is closing, you don’t need to have all the drugs and whatnot just because you’re in hospital. You can still have the low-intervention birth you want, Mims. We can make sure of it. Let me have a word with your midwife and find out what’s really going on and then we can talk again. But please,’ she said, her words filled with affection and concern, ‘don’t go worrying yourself over this – you’ve still got to grow that chunky-monkey in there for a bit longer, remember.’

  Mims gulped down another mouthful of muffin. ‘It’s a cycle of intervention though, isn’t it, once you’re in the hospital? I heard all about it at my NCT class!’

  Holly silently cursed the bloody NCT for their birth propaganda – no drugs, no formula, breast-is-best or you’re failing your baby. Sure, the principles were sound, but the emotional fallout amongst the mothers for whom nature didn’t oblige was terrifying to witness. She wasn’t prepared to let Jemima’s birth become another casualty of that idealism.

  She took a gulp of her coffee and grimaced. Cold and disgusting. She glared at her mug for a moment, feeling unaccountably let down – after all, without coffee to
fuel the rest of her day, that notion of a power nap was becoming less of a fantasy and more like a necessity.

  Mims got to her feet. ‘Let me know what you find out, won’t you? Until then, I suppose I should keep looking on the bright side. After all, who knew that one night away for our anniversary would succeed where all that fertility treatment failed?’ She attempted a wobbly smile. ‘You want to be careful having Elsie’s fertility icon on your bookshelf there, Holly. He certainly worked his magic for me and Katie House. Borneo witchdoctor two: IVF zero, isn’t it now?’ Holly laughed and shook her head as she saw Jemima out of the room, before sitting back down in her chair feeling utterly drained and yawning widely.

  She reached for her coffee on autopilot and gagged a little at the smell, tiny pieces of her mental jigsaw rearranging themselves in her head as she did so.

  Chapter 9

  ‘Porridge, Dr Walker?’ said Taffy, as he walked into the doctors’ lounge for his morning break. ‘Do you have to be such a cliché?’

  Alice grinned as she deliberately sprinkled salt rather than sugar onto her breakfast. ‘I do try,’ she said, ramping up her usual soft Scottish burr to roguish proportions.

  ‘Are you also secretly pining for a fjord?’ he asked with interest.

  ‘A loch, possibly,’ Alice replied, without missing a beat at his dodgy Monty Python impression. ‘And cold tap water that feels as though it’s run straight from the ben. You don’t get that here,’ she said wistfully.

  Taffy nodded. ‘I know what you mean. It’s the same at home.’

  ‘Surely not,’ Alice protested. ‘I mean, you’ve some lovely hills in Wales, but they’re no match for Ben Nevis.’

  ‘What’s the odd three hundred metres between friends anyway?’ Taffy said defensively. ‘Have you ever actually climbed Snowdon? Well I have, and it’s not for the faint-hearted.’

  Alice shook her head. ‘I haven’t actually, but I’ll take your word for it. I’d just started Munro-bagging with my dad when he died.’ A flicker of pain passed across her face at saying those words aloud. Words that she normally preferred to allude to with euphemisms. She wasn’t sure what it was about Taffy’s sincerity that made such evasiveness seem unnecessary, aloof even.

  Taffy, to his credit, didn’t push the point. ‘I didn’t know you knew your way around a crampon. We could do the Three Peaks Challenge, you know? Ben Nevis for you, Snowdon for me and Scafell Pike for The Practice.’

  Alice paused for a moment, their easy banter suddenly changing pace. ‘That’s not such an entirely crazy idea, you know,’ she said slowly.

  ‘It’s a little bit crazy,’ Taffy countered happily. ‘But entirely doable – if you think you’re fit enough.’

  He laid down the gauntlet with a grin and waited for her to respond.

  Alice knew that he was testing her, waiting for her to bow out, but she really didn’t feel like giving him the satisfaction, although chances were they were just mucking about. Even taking into account the trouble that her overconfidence might have caused of late, it was a difficult habit to break. Could she imagine keeping pace with Taffy Jones? No, not really. Was she prepared to say sod it and give it a try? Absolutely.

  ‘I’m in if you are,’ Alice said. ‘And if you’re up for getting sponsors, I know the charity that’s helping train Coco would be only too delighted with a big fat cheque.’ Alice chose not to say that the big fat cheques might buy her a little more time, before deciding on Coco’s commitment to the cause, but it certainly factored in her own enthusiasm for the challenge.

  Taffy rubbed at the back of his neck, his shirt collar fraying slightly and his hair tousled from an early start. Alice wondered how he found the energy some days. He was forever on the move: with the twins, or training with Dan, or hustling through the corridors at work like a mini-tornado. Watching him mainline an entire packet of Penguins gave her some idea of the sugar rush behind the scenes and a moment of jealousy assailed her.

  What she would give to view food as pleasure, rather than fuel to be calibrated. What she would give to pick up a menu and order whatever the hell she liked, without totting up how much exercise she’d already done that day and compensating accordingly.

  Over the last year, Taffy had become like the big brother she’d never had, teasing her, calling her out on dodgy outfits or experimental hairdos. The only thing he never mentioned was her diabetes. It was almost as though he had decided that it was a taboo subject, a step too far in their fledgling friendship. But for Alice, it was such an integral part of her life that it felt wrong to dance around the topic. She ought to have ‘Love me, love my diabetes’ stencilled on a mug.

  In the calm before the storm of the next influx of patients, not to mention caffeine-seeking doctors, Alice tried to pluck up the nerve to ask the question that had been haunting her for days. Who better really to give her a straight answer than Taffy?

  ‘Did I mess up? At the show on Saturday, with Jessica Hearst?’ she asked, seemingly out of nowhere and rather blindsiding him, judging by his shocked reaction.

  He shook his head. ‘I don’t think so. You did everything by the book, Alice. And I know there’s been some argy-bargy with the parents—’

  ‘That’s one word for it,’ Alice interrupted.

  ‘But,’ continued Taffy with a hard look, ‘that doesn’t mean you did anything wrong. It’s more an issue of hierarchy, I suppose.’

  Alice nodded. ‘With Holly and Dan on site, it should have been them, I know. But with all the chaos and the panicking . . . ’ She shrugged. ‘I guess I just didn’t stop to think.’

  ‘Have you been stressing about this?’ Taffy looked concerned.

  ‘A little bit. Okay, maybe a lot. But if I did anything that has consequences for Jessica . . . ’

  ‘Listen,’ said Taffy, balling up his Penguin wrappers and lobbing them expertly into the bin, ‘you wouldn’t be a half-decent doctor if you didn’t play the what-if game after an incident. Did I choose the right drug? Did I give the right advice? Was clearing the airway a priority, considering the risk of paralysis?’

  ‘Well, that’s awfully specific,’ said Alice quietly.

  ‘And a question without an answer. We all make mistakes, Alice, and at some point you will make the wrong call. The only thing we can do, as doctors, is respond to the best of our ability in that moment. And for the record, I think you did. I think it shows serious mettle, that you didn’t even hesitate to put yourself forward while that pony was still going berserk.’

  Alice frowned. ‘What do you mean? The pony was long gone.’

  Taffy paused in his pursuit of further snackage. ‘The pony was freaking out all around you, Alice. That’s why everyone else held back. Did you honestly not even notice it?’

  ‘Not even a little bit,’ she said, the confusion evident on her face as she mentally replayed her version of events. ‘The Pony Club lady caught the pony though, yes?’

  Taffy nodded. ‘Charlotte Lansing? Yeah – in the end.’

  ‘What do they say about stupid people being full of confidence, and intelligent ones full of doubts?’ Alice said wryly.

  Taffy laughed. ‘Oh, we are both so screwed if that’s true. But seriously, stop tying yourself in knots. What’s done is done – learn from it and move on. Our lesson is to remember that, all evidence to the contrary, you aren’t one of the partners here. Yet. It’s so easy to forget and we’d be letting you down if we did. It’s all this calm conviction that throws us off, you know.’ He grinned and left the room, snaffling a jumbo packet of crisps from the worktop that clearly had ‘Jason’ written on it in permanent marker and leaving her feeling just a little bit brighter.

  In the car with Jamie that evening, after yet another session at the training centre, that feeling was long gone and Alice wondered what Taffy would make of her supposed ‘calm conviction’ now. It was only really the presence of Jamie beside her that was keeping the tears at bay.

  ‘For what it’s worth,’ said Jamie, ‘I think J
udith had a bloody nerve putting you on the spot in front of everyone like that. She may be the head of acquisitions over there, but that doesn’t give her the right to talk to you like that. And I’m happy to tell her so.’

  Alice shook her head. It was very sweet of Jamie to be so incredibly supportive, but she knew that this was her decision to make, possibly her battle to fight. At least she had this time now, as they barrelled along the motorway together, Coco at her feet in the passenger footwell and Jamie at the wheel. This time without any other calls on her focus or attention.

  ‘I need a little longer to decide,’ she said quietly, as the realisation dawned.

  He glanced at her briefly, before returning his concentration to the road. The summer outbreak of caravans in the South West was only just beginning, but nevertheless slowing them down. ‘We can try that, of course, but I gather they feel they’ve been pretty patient already. And all you’re really doing is delaying the inevitable.’

  It was true, thought Alice, as she wove her fingers through the long fur on Coco’s head. But this was an impossible decision. A Sophie’s Choice. Whatever she decided was sure to break her heart a little.

  It had been months of toing and froing. Coco’s visits to the medical detection training facility only serving to prove what they already knew: she was a remarkable little dog. Her skill in detecting cancer cells just from the volatiles of one tiny urine sample, hidden amongst eight on the carousel, was almost one hundred per cent accurate. But now the time was looming where Alice had to choose: did she keep Coco as her own personal diabetes assistance dog, or did she release her into the cancer detection programme so that she could help hundreds, possibly even thousands of other people?

  It was no small wonder that Alice wasn’t sleeping properly. If she held on to her beloved dog, she felt she was being selfish; if she let her go, she would be lost. And not just emotionally. She had come to rely on Coco to help her manage her diabetes to such a degree that she had no idea how she would cope without her. There had been a small part of Alice hoping that, at each stage of selection, Coco would fail the criteria required.