The results were good for most. But so far Thea and Lucas had seen two teachers and six pupils whose tests had been positive. Each was given a thorough examination to check whether there was any sign of active tuberculosis, and X-rays and blood tests were taken.
At three o’clock Thea took a moment for lunch at her desk. Which meant that she was looking straight at Lucas, whose desk had been pushed up against hers, directly opposite, to accommodate the growing team. She was just debating whether to concentrate on her sandwich or watch him work when the phone rang.
‘I’ll get it. Eat your lunch.’ He reached across and hooked the receiver up with one finger. ‘Lucas West.’
He listened intently and then nodded. ‘Okay, we’ll see her now.’
‘I thought we were finished?’ Thea laid her sandwich down on the napkin in front of her.
‘It’s the girl who didn’t show up for her appointment. I got the team secretary to ring the school and apparently one of the teachers has found her and brought her down here. I suppose we’d better see her before she tries to make a break for it. Want me to go?’
‘No, that’s okay. Finish your notes. And don’t touch my sandwich.’
‘Right. Finish your sandwich. Don’t touch my notes.’
‘Yeah. Funny.’
When Thea entered the consulting room the girl swung round in her seat to face her. She looked much older than sixteen. Her blonde hair showed signs of dark roots and her school uniform had been adjusted, the skirt shorter and the tie knotted three inches lower than it was meant to be. Thea could identify with the tie at least. Whoever had thought it was a good idea to make sixteen-year-old girls wear ties to school was just as mistaken now as when she’d been that age.
‘Isobel Grant?’
The girl’s gaze was cool and calculating. ‘Yes?’
‘I’m Dr Coleman. Would you like your teacher to be here while I examine you?’ Clearly Isobel’s parents weren’t here. It never failed to depress Thea that that wasn’t particularly unusual.
Isobel pressed her lips together. ‘No. I’m sixteen, I can make my own mind up about things.’
She knew the law, then. At sixteen she was considered competent to make medical decisions for herself. Even if she was little more than a child in some respects and a little parental support might have been nice.
Thea sat down on one of the chairs beside Isobel. ‘You know why you’ve been tested?’
Isobel gave her a look of mild derision. ‘Yes. And if the test swells up into a lump, I might have TB. But it hasn’t.’
‘Okay. I’m still going to need to see it, though.’ Thea shrugged. ‘Just to confirm.’
Isobel rolled up her sleeve. The area on her arm where the Mantoux test had been administered was red and sore looking but there was no hard lump, indicating a reaction to the tuberculin test.
‘Good. That’s very good. I’m happy to say that your test is negative, Isobel. Just as you said.’
‘Thanks. That’s good.’ Tears suddenly welled in Isobel’s eyes.
‘Were you worried about the test?’
Isobel stared at her, wiping her face with the cuff of her blazer.
‘Do you have any other symptoms? A cough?’
‘No.’
‘Do you wake up in the night, sweating?’
‘No. I never wake up in the night.’
‘And you’ve not lost any weight recently?’
‘No!’ Thea jumped as Isobel shouted the word. ‘There’s nothing. I’m okay. You said so, the test’s negative.’
‘Isobel, something’s the matter. You didn’t turn up for your appointment this morning, and now you’re crying.’
‘It happens.’ Isobel was rocking in her chair now, tears running down her cheeks. Thea tried to put her arm around her shoulders but Isobel batted her away.
Thea was at a loss. She’d done what she had to do and Isobel’s test was negative. But she couldn’t let her go, not while she was obviously so distressed. On the other hand, if Isobel decided to leave, she couldn’t think of a valid reason for stopping her.
A quiet knock sounded on the door. Thea called for whoever it was to come in, and Lucas’s head appeared. ‘Can I speak to you a moment?’
‘Yes.’ Whatever it was he wanted, Thea was grateful for the interruption. Time to think. ‘Isobel, will you wait here, please? Just one minute.’
‘Anything the matter?’ He waited until Thea had closed the consulting-room door behind her. ‘I heard shouting.’
‘I don’t know. Her test’s negative, but she’s very distressed. She won’t say what’s wrong, but I think it may be something to do with being tested.’
He pursed his lips. ‘You want me to bring some tea for her?’
‘I don’t know. Maybe.’
‘Would you like me to try her?’
Thea shrugged. ‘Well, you can’t do any worse than I’ve been doing so far.’
‘I’ll get some tea, then. Go and sit with her.’
Isobel didn’t seem any more inclined to talk when Thea returned to the room, and she was still crying. Quietly and steadily, like a long wail of anguish. In Thea’s experience, that kind of crying came from despair.
Five minutes later Lucas appeared, three cups of tea balanced in his hands. He sat down behind the desk, pushing two of the cups towards Thea and Isobel and keeping one for himself.
‘Right. Isobel.’
Isobel looked at him mutely.
‘I’ve brought you a cup of tea because we might need to wait here for a while.’ Clearly Lucas reckoned that he could outlast Isobel. Maybe he could.
‘I can’t. I have to get home. I can’t be late.’ Isobel sniffled at him.
‘All right. So we’ve got a problem. I reckon you can do with some help. I’d like to help you, but I can’t unless you tell me how.’
‘There’s nothing you can do.’ Isobel jutted her chin at him defiantly.
‘Try me.’ Lucas batted the challenge right back at her.
‘It’s nothing… I’m just…’ Isobel heaved a sigh. ‘My mum’s ill. I was worried about my test because I didn’t want to pass anything on to her.’
Thea exchanged a quick glance with Lucas. ‘What’s the matter with your mum, Isobel? Does she have a cough?’
Isobel rolled her eyes. ‘No. She has cancer.’
‘I’m sorry to hear that.’ Thea bit her lip. So much for jumping to conclusions. There were enough kids in this area whose parents didn’t care enough to accompany them to a hospital visit, but it seemed that Isobel wasn’t one of them.
‘If I had TB, then I’d have to stay away from her. She has a compromised immune system, due to the chemo. Then she’d have no one to look after her.’
‘Is it just you and your mum?’ Lucas asked.
‘Yes. I can manage, we don’t need anyone else.’
‘It must be pretty hard for you, though.’ His voice was calm, gentle, but Isobel burst into great racking sobs. When Thea put her arm around her shoulders, she clung to her, crying like a baby.
* * *
‘She’s okay?’ When Thea walked back into the office an hour later, Lucas was sitting at his desk.
Thea shrugged. ‘As well as can be expected, in the circumstances. I took her up to Maggie, the hospital social worker, and she’s going to take her home. I think Isobel understands that we’re not going to try and take her away from her mother, and she knows that there are some practical ways that we can help her.’
Lucas shook his head. ‘She needs help. She’s only sixteen, and trying to look after her mother and keep up with her schoolwork. It’s too much, both physically and emotionally. Is that why she didn’t say anything? Because she was afraid that she’d be taken into care?’
‘Yeah. And she turned sixteen last week. So perhaps the thought that she was safe from that now, coupled with the worry over the Mantoux test, just pushed her over the edge.’
‘Whatever it was, it was good that she’s finally said something.
How long has she been doing this?’
‘Six months.’
‘And no one knew? Not even her school?’
‘Nope. No one.’
Lucas nodded. ‘Well done, you, then. For picking it up and getting her to talk.’
‘It wasn’t exactly rocket science. And I think it was you and the cup of tea that got her to talk, wasn’t it?’
He grinned. ‘You think so?’
‘Well, I got the impression that you were willing to sit there until two o’clock in the morning.’
‘I was. Only that probably wouldn’t have helped much. I was wondering whether she was going to call the police and accuse us of kidnapping.’
An involuntary shiver ran down Thea’s spine. ‘Don’t say that.’
He gave her a querying look. ‘Just a joke.’
A lot he knew. It was all too easy to get into trouble when you crossed the line between doctor and social worker. But this time it had been okay. This time Lucas had been there. She wondered if he knew just how much she appreciated that, but decided not to tell him.
CHAPTER SEVEN
Week Five
THE MONDAY MORNING meeting dealt with the practicalities, what correspondence needed to be sent out and a review of the previous week’s test results. Lucas and Thea had then retreated to their desks to ponder the less straightforward matters.
‘It’s puzzling.’ He was frowning, staring at the white-board on the wall, which listed all the people at the school who had tested positive.
He was in what Thea privately called ‘overview mode’. She was beginning to get used to his knack of pulling back from the personal, disregarding the individual and looking at the big picture. At first she’d thought it cold—but there was an obscure symmetry in the way that Lucas’s mind worked now, which she was still struggling to pin down.
‘I don’t know if I can help you there.’
He raised his eyebrows. ‘What makes you think that?’
‘Because…I’m just a working doctor. I can’t see what you see in charts and paperwork.’
‘The chart’s meant to make it all simpler.’ He studied the complex maze of blobs for individuals and different coloured lines, representing contact. ‘I’ll agree that it really needs to be in 3D.’
Thea chuckled. 3D wasn’t going to help. ‘I meant that you seem to see trends and meanings. All I see is circles and lines.’
He shrugged. ‘Helps if you let your eyes go slightly out of focus when you look at it.’ He narrowed his eyes to demonstrate.
‘No. It helps if you have the ability to have a kind of detachment.’
‘Is that what you think?’ He jerked around to face her. It was obviously still something of a sore point in Lucas’s eyes. ‘That I’m detached?’
‘That you have the ability to step back and look at the whole problem, instead of just parts of it. I don’t have that gift.’
‘You have the gift of keeping me honest. You always did.’ His eyes seemed to be seeing someone else. The Thea he’d first met maybe.
‘You never needed to be kept honest, Lucas. You were always an idealist.’ Thea wondered if she’d get the same answer that he’d given before. ‘I got real.’
‘If you want to change the world, it helps if you know the right strings to pull.’ He sighed, as if something had been lost. Shook his head slightly, as if he’d decided that it was beyond his reach. ‘Returning to the matter in hand, I can’t see which strings to pull here.’
Thea followed his gaze, looking at the chart again. ‘Okay, so one active case, that’s Derek. And eight probable latent cases, all of whom had regular contact with him.’
‘And where did Derek get it from? We’ve confirmed that this is the same strain as the Birmingham outbreak.’
‘Birmingham’s not so far. People travel between there and here all the time.’
‘True, but that’s not the point. Which person in particular? I’ve been through all the contact information from the cases up there, and I can’t find anything that links with Derek.’
‘So there’s someone else out there that we haven’t found yet who gave it to Derek. And he gave it to these new cases at the school.’
‘Maybe. But just because the new cases are latent, it doesn’t mean that they haven’t had the infection for as long as Derek—just that he developed active TB and they didn’t. Could be that there’s another contact for one of the latent cases, who also gave it to Derek.’
‘Hmm. It’s a lot more difficult with these long timescales. If you get a cold you can be pretty sure that it’s the person who sneezed on you last week who gave it to you.’
He laughed. ‘Maybe. Or maybe that’s just our perception.’
‘Don’t start, Lucas, it’s already complicated enough. So what do we do now?’
His eyes took on the bright gleam that was Lucas’s characteristic response to a challenge. ‘We try harder.’
* * *
Trying harder didn’t yield any immediate results, apart from allowing them to inform two of the pupils and their families that, in the light of further tests, they were free of any infection. Which left six people, who had to be advised and reassured, and for whom an individually tailored drug regime had to be structured. It was the start of long and arduous treatment and the TB nurses would need to provide support all the way.
‘You’ve seen Isobel?’ Lucas arrived at the hospital late on Friday afternoon, after being called to a meeting elsewhere.
‘Yes, I said I’d go with her to see Maggie as she didn’t want to go on her own. It was a good session. Maggie’s doing what she can to provide emotional and practical support for Isobel and her mother.’
‘But you’ll be seeing her again.’ Lucas grinned at her. He already knew the answer to that.
‘Yes. We have an informal arrangement. She’s got my number and she’ll call me and I’ll take her somewhere nice for lunch. Or if she doesn’t call me in the next week, I’ll call her.’
‘Ah. Befriending.’
‘No, I like Isobel. She’s got guts.’
Lucas shrugged. ‘That’s what befriending is, isn’t it? Part of a support structure?’ He was teasing her now.
‘Oh, be quiet. You want an unstructured coffee break? I haven’t had lunch yet.’
‘Thought you’d never ask. You go on ahead, I’ll just check my emails.’
* * *
Thea had only just sat down on the bench outside the cafeteria, which was rapidly becoming their place to sit. The thought unsettled her, and she wondered whether she should move. She and Lucas were just working together, and it was a temporary arrangement. They didn’t have their own special places any more.
Lucas came striding towards her, frowning vigorously. He’d obviously walked straight through the cafeteria, without stopping to get himself anything to drink.
‘What’s up? I thought you wanted coffee?’
‘There’s another case.’
‘What?’ This was never good news, but from the look on Lucas’s face it was the very worst. ‘I thought we had no outstanding tests.’
‘This one was picked up by her GP. He referred her on to a different hospital and the paperwork’s only just come through and been connected up with our cases.’
His hand shook as he took a printed copy of an email from his pocket and handed it over. ‘Her name’s Safiyah Patel. Safiyah’s got active pulmonary TB. It’s a hard course of treatment for anyone, but at her age… She’s only fourteen.’
Thea scanned the paper. ‘This is Ava’s school, isn’t it? You know the family?’
‘Yeah. I know Safiyah and her family.’ There was something that Lucas was trying very hard not to say.
‘Then she’s a friend of Ava’s.’ Something cold crept into Thea’s heart. Every case was personal, but this time she saw the raw edges of fear in Lucas’s eyes.
A pulse beat at the side of his temple. Then suddenly he broke, all the stiff resolution seeming to drain out of him. ‘I’m thinkin
g that I should put Ava under the care of a private doctor. To avoid any conflict of interest.’
Conflict of interest didn’t sound like the real reason. ‘You mean that if Ava’s having private treatment, she’ll get better care.’
‘I know what you’re thinking, Thea. But Ava’s my child, and I have to do the best for her that I can.’
‘And what exactly am I thinking?’
He rolled his eyes. ‘You’re thinking about all the times we said that medicine was about need and not ability to pay. About how we said we should stick by those values.’
‘I’m not thinking that at all. I’m wondering why you think that Ava’s going to be better off having private treatment. Are you saying that we aren’t doing the best we can for our patients?’
‘No, of course not.’ Anger and desperation flooded his face. ‘But I don’t care what’s fair or what’s right when it comes to Ava. I have to do what’s best for her.’
‘And what is best for her? In your considered opinion?’
He was silent for a long time. ‘I can’t lose her, Thea.’
‘You’re not going to lose her.’
‘I didn’t expect to lose Sam and Claire.’ The haunted look in his eyes wrenched at Thea’s heart.
‘I think…’ She paused for a moment to decide what she really did think. ‘I think that’s a separate thing.’
Lucas looked down at his shaking hands. ‘In that case…’ he took a deep breath ‘…take me through it. Step by step. What should I do?’
‘You want me to tell you? That’s one hell of a responsibility, Lucas.’ This was serious. Questioning Lucas’s motives was one thing. Being asked to share in a decision that involved Ava was quite another.
He nodded. ‘Yeah. Tell me about it.’
‘I’m not used to this.’
‘Practice doesn’t always make it easier.’
‘All right.’ She took hold of his hand, not sure whether it was to comfort him or steady her own racing heart. ‘What do you think Ava would want?’
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