by Mairi Chong
Over the following few days, Fraser’s excitement intensified. He spent the evening in Sarah’s company. She quietly read a magazine, while he researched his prospective employers. There was a long paragraph in the British Journal for General Practice about Dr James Longmuir. It seemed that over the years he had been on just about every committee there was going. It concerned Fraser to a degree, for it showed that the man was no fool. Fraser secretly hoped that their paths would rarely cross if he did get the job. As for Dr Mark Hope, he had written a number of dry articles for the publication: Guidelines in Practice, mostly about cardiovascular disease. He had also answered a set of personal questions for Pulse Today, in a tongue-in-cheek manner about his love for skiing and champagne. Fraser shook his head in disgust as he read that Dr Hope’s greatest turn-off was arrogance. From what he had heard about the man, he was the very epitome of this.
Moving on, Fraser discovered that Dr Cathy Moreland had indeed taken a particular interest in addictions psychiatry, having a short piece published in Psychiatry UK about ‘The Silent Addicts;’ people she described as being of an older generation and therefore passing under the radar due to their apparent ability to continue leading stable lives without the disruptive behaviour of many of their younger counterparts. Fraser read the article with interest and moved on to other points of note; her article in GP Guidelines on the psychological impact of cervical cancer, and a few other bits of family planning business. It seemed that none of the GPs were on social media, or if they were, their accounts were private. Finally, he moved on to Linda, the GP retainer, who now seemed to work as a locum of the practice. Linda had published nothing as far as he could see, but her Twitter account was brimming with self-help quotes and messages of endorsement for suicide awareness days and help-lines. Fraser thought it possible that she had either lost someone close to mental health issues, or she herself had suffered from a bout of depression in the past.
This was all food for thought, and when he turned to Sarah who had returned from the kitchen, having made him and herself a cup of tea, he smiled up at the girl.
‘It all sounds impressive,’ she said after he gave her a precis. ‘They’re sure to be pleased that you’ve done your homework. I don’t think you should hesitate. Write the application off and send it.’
His cover letter, after much revision, was as professional as he could make it without sounding too stiff. He briefly explained his past employment, his strength in management as demonstrated by his current appointment, and his keen interest in staying in the area due to the strong bonds with staff and clients alike. He made special mention of his interest in the treatment of addictions. His attached CV had not taken as long for he had revised it only the previous year and it required the smallest of amendments to take into account his current employment. As referees, he gave his past two employers, knowing that what they had said before had earned him the job in the shop already, so must surely be good enough to do the same for a GP practice. He had already sent both supervisors a friendly email explaining his situation and excitement at having seen this new job advertised. Hopefully, his efforts would prove enough.
By ten in the evening, the thing was done and Fraser lolled back in his chair, satisfied. It would be posted in the morning and then it was out of his hands. Once he had the interview date, for which he must surely get shortlisted, he would once again begin his revision and preparation.
To Fraser’s astonishment, only four days later, he received a reply in the post; an invitation to interview the following week, on Tuesday at eleven o’clock. Fraser had little time to think, but he telephoned and confirmed that he would be delighted to attend, and then began the work to secure the job he had now become convinced was his alone.
‘You’ve spoken about your interest in the management of drug misuse patients, Fraser. I wonder if you can tell us a little more?’ Dr Longmuir asked.
Fraser shifted in his seat. ‘Of course,’ he said, spreading his hands wide, and maintaining eye contact with the older man. ‘I’m sure you’re all too aware that in a town such as Glainkirk, as with many other places, we can hardly avoid the issue of drug abuse. In my experience, in the community, I’ve built up something of a rapport with these people. We, as a point of contact, see our customers, no matter what their circumstances, as equals. Almost like family, particularly the regular ones.’
The younger male GP called Hope, who had clasped Fraser’s hand far too tightly when he initially shook it, snorted. Fraser looked across in surprise, but he hastily returned to the other doctor.
‘Yes, I’ve placed it high on our agenda, to be as community-spirited as possible. No problem should be suffered alone, and many of these people lack the regularity of a stable relationship with someone reliable.’
‘We’re looking for a pharmacist, not a befriender,’ Dr Hope said.
Fraser turned and smiled, but the GP only raised his eyebrows and refolded his arms across his chest. Fraser clasped his hands tightly in his lap. ‘Of course. I simply meant to demonstrate my eagerness to act as a reliable member of your team. As it happens, I do have a genuine interest in helping people …’
‘Can I ask about the inquest?’
Fraser’s twitching hands froze. His eyes darted around the room and finally settled on the only female GP, Dr Moreland, who, having shot her partner a withering look, smiled encouragingly at Fraser.
Fraser swallowed. ‘The inquest?’ he asked.
‘Yes. Surely you can’t have forgotten so soon. The young drug addict who was on your books. I believe some of the blame was placed on your pharmacy?’
Fraser looked at Dr Hope who now smiled at him nastily.
‘An innocent question,’ the GP continued. ‘Of course, if you’d prefer not to …’
‘Oh, I don’t mind,’ Fraser stammered, and then gathering himself, he took a deep breath and forced his shoulders down. ‘Look,’ he said, scanning the faces of all the GPs. ‘I’ll admit that I’ve been naive in the past, perhaps. The inquest was terribly upsetting to me, as it happens. I felt a good deal of responsibility for the man’s death, but the coroner, as you no doubt recall yourself,’ Fraser said, beginning to warm to his cause, ‘He said that although lessons could indeed be learned, no blame could be attributed to any one agency. Ultimately, although I deeply regret the whole thing, I feel as front-line technicians, we are inevitably going to find ourselves in muddy water at times. Perhaps that’s why I was so keen to come and work for you. A team is very important. Team-spirit, and a nurturing, non-judgemental work environment. That’s what I hope to find here, and contribute to, if you’re looking for it.’
‘Thank you for being so frank, Fraser,’ Dr Moreland said, glancing at her colleague before he could interrupt. ‘I think we all appreciate your honesty. That’s just the sort of ethos we too, hope to achieve.’
9
‘There seems little doubt about who we should choose,’ Dr Mark Hope said, leaning forward at the large desk in the boardroom.
The three GPs had been seated for the past two hours in a line along the polished table, with Brenda positioned to the side, so that she could pass the candidates paperwork and greet them at the door. They had shortlisted only two from the twelve applications they had received. Cathy and her partners had spent the past few evenings going over the CVs and composing questions. Each partner would ask a total of three questions and Brenda had been told that she might interject any comments throughout the interviews also.
The two candidates had arrived an hour apart, but the initial one had taken longer to interview, so the second had been shown into the library across the corridor to wait. He had shaken up the plans a good deal, however, waiving the initially planned questions with a promise to answer anything they wished but requesting if they accommodate a short presentation that he had prepared. Dr Hope had been a bit haughty about this suggestion, somewhat riled by the audacity of it and had snorted, as was his habit, but it seemed that the young pharmacist had persuaded e
ven him in the end. The presentation had indeed been well-rehearsed and meticulously planned. His questions following this, had been answered with intelligence and humility, in spite of Mark’s truculence.
‘He was certainly convincing,’ Brenda said.
‘Perhaps too much,’ James said. ‘I’ve seen many like him before. He’s intelligent, I’ll give you that. Imagine arriving with a PowerPoint presentation on why we should employ him. I’ve never seen it done before. I wonder if he’ll bore quickly though.’
‘It was impressive all the same,’ Cathy interjected. ‘He’d done his homework for sure. When he mentioned his interest in cardiovascular disease management, Mark, and then quoted the paper you had had a hand in writing, I nearly spat my coffee out. Very clever, and he had done his research on all of us. I know what you mean though, James. You’re worried about the butterfly factor, aren’t you?’
James nodded. ‘It never looks good, does it? How many years and how many changes?’
Brenda ran her finger down the candidate’s CV. ‘Over the last five years, he’s been in three positions. Granted, it looks like he has shifted around, but he did explain that too, didn’t he?’
‘I suppose so,’ James assented. ‘He wanted to gain experience in all areas of pharmacology. The referees might be of some interest if we’re really tipping in his favour. Brenda, would it be yourself that would ring?’
Brenda nodded. ‘If that’s what you’re wanting, I’ll do it,’ she said. ‘I wondered myself about the young girl. I know that she doesn’t have half the experience but she would fit in with the team far better. I’m just trying to picture him day-in-day-out, I suppose and I can’t quite see it. The other concern is hours. He wasn’t keen on the proposed number we had suggested and wanted more. I guess we could adjust as needs be.’
Mark shook his head. ‘The girl was too airy-fairy,’ he said shortly. ‘You saw how she interviewed. Granted she knew her stuff but she’ll be pregnant within two years and mugging us for maternity pay. No, I’m not having her.’
‘You’re essentially ruling out half the candidates then,’ Cathy said. ‘Forgive me, Mark but it is totally sexist and as it happens, fundamentally in contradiction to employment law to rule someone out in case they might have a baby.’
Mark snorted. ‘Getting twitchy, Cathy? I hope you’re not planning on it anytime soon. We could well do without the hassle of finding a bloody locum.’
Cathy’s face burned. She glanced at James, who was shaking his head. ‘I find that really offensive, Mark,’ she said. ‘What sort of a way is that to speak to someone?’
‘Just joking. Don’t get on your high horse. I’m only saying what everyone else is afraid to,’ he smiled.
James raised a hand. ‘Don’t rise to it,’ he said quietly to her. ‘Back to this Fraser chap. I rather liked the way he responded to Mark’s question about the death of that young heroin addict earlier in the year. He didn’t make excuses or get defensive about the thing. He admitted that he had been too naive. I thought that was quite telling about his character. Are we in agreement then, that his references are at least worth checking now? Depending on what comes from it, we’ll make a further decision. Does that sound reasonable? I know we only shortlisted the two candidates, but we can always go back a step and look through the other CVs if he’s not right.’
‘I’ll ask around a bit and see if I can hear anything about him, although, my decision is already made,’ Mark said.
‘I think that’s a good plan,’ Cathy said. ‘You are both still happy with the idea in principle? I really think it’s the only way forward. You heard what both the applicants said about their expertise in tidying up prescription patterns and taking the weight of the chronic disease prescribing from us. The number of hours saved would make the appointment pay for itself in freed up man-hours within no time. There have been too many mistakes recently. Simple prescribing errors and other things that indicate we’re too stretched.’
James smiled. ‘Yes, I do agree,’ he said. ‘I know I was the most reticent about the whole idea but I think we need to move with the times. Many other practices are taking on in-house specialists. It saddens me that we’re becoming supervisors, merely consultants in undifferentiated care, triaging our patients and directing them elsewhere. Thirty years ago, I would have been the person to ask about chronic disease management. Now we have nurses to do that, and they do it very well. They see our patients and follow them through their journey, altering medication and we simply sign the prescriptions. I suppose the pharmacist is much the same.’
‘You’re getting old,’ Mark said. ‘Cathy’s right. It had to be done. We’re a bloody mess at the moment. We’re never going to meet our targets this year, what with Cathy being off those months. That silly girl Linda hasn’t coded a single significant illness since she’s been here. God knows why she’s still with us, other than the fact that we can’t get anyone else. Even the nurses aren’t faultless. Irene, although I know is very good, failed to bring to my attention a post CABG the other week. It’s a sure way to drop revenue if we balls up that sort of thing.’
‘Good grief, Mark,’ Brenda said forcibly. ‘It seems you’ve shot down just about everyone in the practice in one fell swoop today. Can we stick to the matter in hand for now instead of going off at a tangent again?’
Mark chuckled. ‘You’re for it next, Brenda. Have you been through the running costs and overheads yet? I need to meet with you at some point and discuss things?’
‘Not now, Mark,’ Brenda said, like a mother might to her wearisome child.
Mark turned to Cathy. ‘I know it’s not your area of expertise, all this money talk. You’re too busy with your sexual health nonsense and your alcoholics, which to be fair are a small proportion of the practice’s income.’
Cathy grimaced. ‘Mark, I see the hypertensives and diabetics just as you do. I do that on top of the coils and contraceptive implants. If you’re intimating that I haven’t pulled my weight in the past, then I think it’s a bit unfair. I seem to remember when you took me on, that you were overjoyed to have a female to do all of the women’s health, and as for the addiction psychiatry, you were one of the first to hand over your heart-sinks when I arrived. You know I see the majority of the drug addicts and alcoholics now?’
‘I thought we agreed that Cathy was taking a step back from all of this anyway,’ James said. ‘We’re trying to support one another and Cathy’s just returned to work. Have a bit of tact, Mark, for goodness sake.’
Cathy smiled. ‘I don’t mind in the least, James. I won’t use my ill-health as an excuse and like Mark has mentioned before, so crudely, if I am deemed fit to practice, then I should be allowed to do so. If you want to know, I did have another idea about practice revenue, seeing as we’re discussing it now. I think you’re putting all your attention onto the wrong side of things as it happens. All this talk about the cardiovascular patients, but we have another subset right in front of us and they might provide us with far more lucrative business and set the practice apart from many of the others in the area.’
Mark snorted. ‘My God, Cathy. What have the psychiatrists done with the old you? You used to balk at the talk of money when you first started and here you are now, coming up with a masterplan to save us from ruin.’
Cathy’s face burned.
‘Oh, don’t look embarrassed. I like the new side to you. It’s much more engaging. Go on then, what’s your idea?’
‘Well hear me out and don’t jump down my throat before I explain,’ Cathy said and glanced across at Brenda. The practice manager raised her eyebrows. ‘Methadone prescriptions,’ Cathy said and let it hang.
James was already shaking his head and Mark didn’t look that keen either but at least Mark, with the promise of revenue, would give her a chance.
‘Go on,’ he said.
‘It seems the right time,’ Cathy began. ‘I know we’ve discussed it briefly before in the past and rejected the idea, but the psychiatrist
s have been emailing me again since I’ve come back, making the request that we at least sit in on their clinics and see how things are done. My thought was that we could do that; the new pharmacist and perhaps myself. Then, if we were still in agreement, we might take on just a handful of the methadones, with the psychiatrists’ support, of course. I would have to come up with a plan, I know, to avoid practice disruption. I don’t want our staff, or our other patients, to feel uncomfortable either.’ Cathy looked across at James. ‘It was just an idea. The money, you see? We might make a good deal from taking on the service as it’s high-risk.’
James nodded but still didn’t look happy.
‘You’re conveniently forgetting your own little indiscretion, Cathy,’ Mark said quietly. ‘It hardly seems appropriate that you of all people should be dealing with this kind of thing.’
Cathy felt herself go cold. ‘No, no, it’s alright,’ she said to James, who had raised a hand. ‘No, he’s only speaking the truth. I agree, Mark, that I have a good deal to prove. I hope that as time goes on, you’ll trust me more and more.’
Brenda met her gaze and nodded.
‘I’ve seen the drug store,’ Cathy went on. ‘The new procedures in place. The locks on the drawers. I think you were right to do it. But I can promise you that I do not intend on slipping up. It was due to the hypomanic state I was in, that it happened at all. I didn’t want to discuss my own health at a practice meeting. It’s excruciating enough talking about it at all, but I can promise you this. I will be taking my psychiatrist’s advice from now on. Forget about the methadone prescribing. Forget all of that. I just want things to go back to the way they were. Please, Mark. James? If we’re going to continue working as a practice, you have to trust me.’
There was a long pause. Cathy looked from one partner to the other.
‘That’s where you’re wrong though, Cathy,’ Mark said quietly. ‘We don’t ‘have to trust you’ at all. You have to earn our trust. Don’t for a minute think that I don’t sympathise, because I do, but you stole. You took co-codamol from the store for your own use. You came into work drunk and you swore at one of the patients. I know you were unwell. Nobody is questioning that fact. I’m sorry, you’ve been ill. But it will take me a good deal of time to come to terms with what happened, even if James can waive it.’