Twice as Good

by Alison Roberts

  Sandy Smith looked ready to cry. ‘I wish Toni was here,’ she told Janet mournfully. ‘I don’t think I’m ready to cope with this job on my own. I’m only a receptionist, not a practice manager.’

  ‘You’re not on your own,’ Janet told her. ‘I’m here. And this is as bad as it gets around here. Honestly! If you can cope with this, you can cope with anything.’

  Sandy sniffed dubiously and Janet patted her arm. ‘Open the windows in here for a while. As soon as I’ve finished with wee Toby I’ll come back and look after the desk and you can have half an hour for lunch. Take a walk by the river and get some sunshine and fresh air.’

  Sandy brightened. ‘I could go down to the shops. Outboard’s getting low on cat food and kitty litter.’

  Janet eyed the still firmly closed door of the toilet. ‘Get some water crackers as well. They’re supposed to be good for morning sickness.’

  Not that there was much of the morning left. Toby and his mother had been waiting for over an hour for their appointment.

  ‘I’m so sorry,’ Janet apologised again. ‘It’s been chaos this morning. I don’t think we had any idea how disruptive it was going to be, having both Josh and Toni away at the same time. And our locum didn’t show up.’

  ‘I’m not bothered,’ Margaret assured her. ‘It’s not often I get the chance to sit and read magazines. Where did Josh and Toni go for their honeymoon?’

  ‘They’re cruising the Caribbean,’ Janet said with mock bitterness. ‘If they send a postcard of some tropical paradise with ‘‘wish you were here’’ scribbled on the back, it will definitely be the last straw.’

  Both women laughed, and Toby beamed at the sound. Janet held out her hand.

  ‘Come and stand by the giraffe, sweetheart. Let’s see how tall you’ve got.’

  She recorded the measurement on Toby’s file. ‘He’s shot up,’ she told Margaret. ‘That’s a huge increase since his fifteen-month check.’

  ‘Goodness knows where he’s getting the energy to grow from. I can’t get him to eat a thing.’

  ‘Tell me about it,’ Janet said with a grin. ‘The fight I had this morning, trying to get my boys to eat breakfast!’

  ‘You mean they haven’t grown out of it yet?’

  ‘It gets worse when they start watching TV,’ Janet warned. ‘All the ads for the new high-sugar, high-fat, junk cereal they keep coming up with. It’s a constant battle.’

  ‘So what do you give the twins for breakfast?’

  ‘Porridge,’ Janet said defensively. ‘It was good enough for me when I was growing up and I wasn’t even allowed brown sugar and milk on it.’ She lifted Toby onto the scales.

  ‘Toby likes porridge.’ Margaret sighed. ‘It’s the meat and vegetables I can’t get into him.’

  ‘You’re obviously doing quite well enough.’ Janet steadied the toddler before checking the reading. ‘He’s right up the charts for both weight and height.’ She lifted Toby onto the bed and tickled a smile out of her small patient. ‘Do you like porridge, then, Toby?’

  Toby nodded happily.

  ‘I wish my boys did. They say it’s got too many toenails in it.’

  Toby looked nonplussed. So did Margaret. ‘Toe-nails?’

  ‘They’re just the oat husks,’ Janet explained. ‘I make the real stuff that you have to soak overnight. It’s healthier, not to mention a lot cheaper.’ She unbuttoned the fastening on the shoulder of Toby’s bright blue jersey. ‘We’ll take this off, shall we, darling? Dr Sophie is going to come and listen to your chest in a minute and look in your ears and down your throat. Do you think she’ll be able to see the porridge you had for breakfast?’

  Toby nodded gleefully. He stuck his arms up helpfully as Janet pulled the sleeves of his jersey clear. She excused herself to fetch Sophie but was waylaid by Sandy, who spoke in a whisper.

  ‘That funny little man that looks like a garden gnome just came in.’

  ‘Mr Collins?’

  Sandy nodded. ‘He hasn’t got an appointment but he says the doctors will want to see him urgently. What shall I say?’

  Janet sighed. Mr Collins was a regular patient. Too regular. ‘What are his symptoms today?’

  ‘He says he’s got a crushing central chest pain radiating to his jaw and left arm. He’s sweating and nauseated and he’s having palpy something or other.’

  ‘Palpitations.’ Janet chuckled. ‘You’ll have to borrow Mr Collins’s textbook some time. He doesn’t need it any more. I think he’s learned off every symptom by heart.’ Janet pondered the situation briefly. ‘Tell him to have a seat. Maybe I can keep him happy by taking his blood pressure and doing an ECG. He hasn’t picked a very good day to come looking for a bit of attention, has he?’

  Sophie hadn’t quite finished with her patient. She still looked wan as she came into the treatment room ten minutes later.

  ‘I like powwidge,’ Toby informed Sophie. ‘Wiv toenails.’

  Sophie gave Janet a despairing glance and rushed out of the room. Janet had to laugh. ‘I don’t believe this. Let me see if Oliver can come and see Toby. Sophie might be held up for a while. She’s in a rather delicate state.’

  It was another fifteen minutes before Margaret was able to take Toby home for his lunch. Sandy took the opportunity to escape for her break and Janet tidied up the treatment room, before moving back to the main office to man the telephones. It was only then that she remembered Mr Collins. He was sitting quietly in the corner of the waiting room. Too quietly.

  ‘Oliver!’ Janet shouted. ‘Sophie! Come quickly!’

  Janet Muir’s strength was out of proportion to her slim build. She had no real difficulty transferring Mr Collins to the floor. She had tilted his head back to open his airway and was feeling his neck for the carotid pulse as both doctors rushed in.

  ‘No pulse, no respirations,’ she reported. Pinching the elderly man’s nose, Janet covered his mouth with her own and inflated his lungs with two deep, full breaths.

  Oliver positioned his hands on Mr Collins’s chest to begin cardiac compressions. ‘Grab the life pack,’ he directed Sophie. ‘And a bag mask unit.’

  Sophie was back within seconds. She stuck the electrodes in place and Oliver stopped compressions while they looked at the screen.

  ‘Ventricular fibrillation,’ Oliver muttered. Sophie had the large sticky pads ready as Oliver cut through Mr Collins’s clothing. He positioned the paddles. ‘Everybody clear,’ he instructed.

  Janet lifted the mask away from skin contact. Sandy walked in just as Mr Collins’ body jerked in response to the electrical shock.

  ‘Oh, my God!’ she said in horror.

  ‘Grab the oxygen cylinder from my room, Sandy,’ Janet called. ‘And then call an ambulance. Mr Collins has had a cardiac arrest.’

  Sandy dropped the tins of cat food and the large bag of kitty litter by the front door. She ran to collect the oxygen cylinder.

  ‘Good girl,’ Janet said calmly. ‘Now call the ambulance.’

  Sandy backed away, staring as Oliver raised the paddles again. ‘Charging to 360 joules,’ he stated. ‘Sophie, get an IV line in as soon as you can and draw up one milligram of adrenaline. Janet, find some lignocaine and some more adrenaline.’

  Janet opened the drug cupboard in the treatment room hurriedly to locate the requested drugs. She could hear the wail of the ambulance siren in the distance. She could also hear the loud knocking on the front door. Hoping that Sandy would have the initiative not to allow an early afternoon patient to stumble in on the emergency, Janet grabbed some extra IV supplies and headed back.

  ‘I’m sorry,’ she heard Sandy calling loudly, ‘but we can’t see any patients just yet. We’re in the middle of an—’

  Janet saw the door being pushed open firmly. ‘I’m not a patient,’ she heard the visitor assert. ‘I’m the locum. My God, what’s going on in here?’

  ‘Cardiac arrest,’ Oliver stated tersely. ‘Come and take over the compressions, would you?’

  T
he newcomer moved swiftly. Janet found herself staring at his back as he crouched over Mr Collins. His hands were positioned unerringly, his compressions smoothly confident. ‘How much adrenaline has he had?’

  ‘Three doses of one milligram so far.’

  ‘What about a bolus dose of lignocaine?’

  Janet handed the ampoule to Oliver and stepped back. Sophie was ventilating Mr Collins, using the bag mask unit, now attached to high-flow oxygen. Janet stood behind the newcomer, listening to his verbal exchanges with Oliver, thankful she wasn’t needed any closer just now. She was aware of her skin prickling all over. Every word uttered by this man sent a new shiver down her spine.

  ‘How long has CPR been in progress?’

  Oliver glanced at the clock. ‘Ten minutes.’ He injected the dose of lignocaine.

  ‘Was the collapse witnessed?’

  ‘Not exactly.’ Sophie was squeezing the bag on the mask automatically. ‘Mr Collins was sitting in the waiting room for a while by himself. He was pulseless but not cyanosed when he was found.’ Sophie glanced up at Janet who bit her lip.

  She knew how it would sound. Patients dropping dead in a doctor’s waiting room unnoticed wasn’t exactly a great recommendation for a medical centre. It would seem even worse when it was known that Mr Collins had come in describing the classic symptoms of a heart attack. How could she explain that this patient had turned up repeatedly over the years with the classic symptoms of every ailment known to man. That he’d had baseline cardiological investigations only weeks ago which hadn’t revealed any pathology. That their experienced practice manager, who would have instinctively picked up a genuine emergency, was at present on the other side of the world. The bare facts of the emergency would present a picture of a medical centre that wasn’t up to scratch. Janet didn’t want this locum to have that as his first impression of St David’s.

  ‘Let’s give this another shot.’ Oliver pushed a button on the life pack. ‘Charging to 360 joules again. If this doesn’t do anything, we’ll intubate.’

  The ambulance crew arrived as the interference on the monitor screen settled. The spikes of an effective heart rhythm drifted slowly into view. They all watched for several seconds. Janet moved further back as the number of personnel and supplies of equipment increased. Sandy was standing under the archway, sobbing. Janet put her arm around the young girl.

  ‘I can’t do this job,’ Sandy groaned. ‘If Mr Collins dies it will be all my fault.’

  ‘Nonsense,’ Janet said firmly. ‘I’m the one who should have checked on him, and I don’t think he’s going to die. His heart’s started again now. As soon as they’re happy it’s going to keep going, the ambulance will get him into the emergency department and the experts will be able to take over.’

  Mr Collins was being lifted onto a stretcher. Janet gave Sandy’s arm a comforting squeeze. She smiled gently at the tearstained face in front of her. At thirty, Janet was only twelve years older than Sandy Smith, but right now she felt old enough to be her grandmother. ‘You go and have a cup of tea and talk to Outboard for a wee while. I’ll help them clear up in here.’

  Janet opened the front door to allow the stretcher to be carried out. She reached down and picked up the bag of kitty litter which was still lying where Sandy had dropped it. Oliver was standing up now. He had his hand extended towards the newcomer.

  ‘Not the ideal way to welcome even a temporary colleague,’ he said dryly, ‘but we’re delighted to see you. I’m Oliver Spencer and that’s my wife, Sophie, who’s about to disappear off to hospital with Mr Collins.’

  Sophie was walking beside the stretcher. She looked back and gave an apologetic wave, before heading out the door.

  ‘I’ve arrived at a bad time. Might it be better if I came back later?’

  ‘No.’ Oliver shook his head firmly. ‘This morning was total chaos and Mr Collins has just finished it off in style. We’re in dire need of assistance.’ He paused. ‘You didn’t tell us your name.’

  No! Janet wanted to shout. Don’t say it. She couldn’t believe this was happening. She had never even remotely prepared herself for this possibility. She stood, frozen to the spot, blindly clutching the bag of kitty litter, using it as a shield against the confirmation she knew she couldn’t avoid.

  ‘I’m sorry,’ the locum apologised. ‘I thought the agency would have been in touch. I’m Dr James McFadden. Jamie,’ he added as an afterthought.

  Of course it was Jamie. Janet had known that the instant she’d heard the accent and tone of the once so familiar voice. The emergency had simply postponed the impact of the knowledge. Jamie McFadden. Past colleague. Past lover. The father of her twin sons. What had she told Sandy Smith so confidently? That this morning was as bad as it ever got around here?

  Janet Muir had been terribly wrong.

  Things had just become immeasurably worse.

  CHAPTER TWO

  ANY second now, Janet Muir warned herself.

  The eye contact between them had all the dreadful inevitability of a slow-motion car crash. You saw the collision coming, knew the impact would be disastrous, but there wasn’t a damned thing you could do to avoid it.

  Would Jamie McFadden recognise her? Would he acknowledge the recognition? Would the memory be as overwhelmingly gut-wrenching as that which she was experiencing? Janet could feel the hard plastic handle of the bag she was clutching biting into her collar-bone. She welcomed the physical discomfort. It was something real she could focus on in this developing nightmare.

  ‘You’re Scottish,’ Oliver observed, with an amused tilt to his mouth.

  ‘Aye.’ Jamie McFadden acknowledged the obvious with a brief nod. His wavy hair had darkened over the years, Janet noted. It was almost brown now. There were enough blond streaks left to make it catch the sunlight that streamed through the bay window of the waiting room. It was a glorious day outside. This really could not be happening to her.

  ‘What part are you from?’ Oliver queried.

  ‘Glasgow,’ Jamie responded. He stepped aside to allow an ambulance officer, burdened with equipment, access to the front door.

  ‘Really?’ Oliver sounded intrigued. ‘Just like Janet!’

  ‘Sorry?’ James McFadden’s total lack of comprehension was evident.

  ‘Janet Muir, our practice nurse.’ Oliver’s hand was coming up, ready to point her out. Jamie was turning even as Oliver finished his sentence. ‘Janet’s from Glasgow, too. Maybe you know each other.’

  Janet didn’t even attempt a smile. She knew it would have been a physical impossibility. She didn’t try to speak either. She needed to concentrate on simply drawing breath. The shock in those brown eyes was startling. Janet almost felt sorry for him. She’d had several minutes since she’d recognised his voice. Several long minutes in which to try and prepare herself for this moment. Jamie had been thrown in at the deep end.

  Janet’s question about whether he would recognise her had been answered. Her question about the effect of the recognition was also answered. For a split second, James McFadden looked as though he’d been violently assaulted. Stabbed. Or shot. Things didn’t come any more gut-wrenching than that—no matter how quickly the reaction could be shuttered.

  But what of the third question? How was he going to react? Would he acknowledge her? Janet waited. Jamie was the one who had stepped—uninvited and unwanted—into her world. It was his call. If he wanted to pretend they’d never met then that was fine by her. In fact, it would be infinitely preferable to … to the warmth in Jamie McFadden’s tone.

  ‘Janet! I don’t believe it! After all these years!’ Jamie’s hand was stretching towards her. Janet hugged the prickly bag of kitty litter more tightly.

  ‘Jamie.’ She tried to smile but her lips simply wouldn’t co-operate. Jamie’s hand faltered and then dropped to his side.

  ‘It was a long time ago,’ he said casually. ‘Maybe you don’t remember the last time we met.’

  Janet stared at him. Of course she remembered
. How could she possibly forget? Jamie hadn’t been smiling then and his tone had been anything but warm. ‘Thank God you’re not pregnant,’ he’d said coldly. ‘It could never have worked.’

  The awkward pause went unnoticed by Oliver as Sophie dashed back inside. ‘Could you grab Mr Collins’s file, please, Janet? We’ll need the test results.’

  ‘Of course.’ Janet was glad of the task. She deposited her burden on the counter and swiftly located the file. Running outside, she handed it to Sophie. The back door of the ambulance slammed shut and it drove away. Janet sighed with relief. Several bystanders and a couple of afternoon clinic patients were standing outside the medical centre, staring at the ambulance and speculating in hushed conversations about the reason for its presence. The sooner they got back into some semblance of normal routine, the better.

  By the time Sandy Smith returned from the staffroom, all evidence of the emergency had gone. Three patients sat, looking subdued, in a tidy waiting room. Janet had arranged the files for the scheduled afternoon appointments, switched the phone back from the answering machine and was returning the calls.

  ‘Everything’s under control,’ she assured Sandy. ‘Oliver should be ready for his first patient. I’ll be in my room for a while. I’ve got to start making appointments for this week’s recalls and chase up some results. Just call me if you need any help. I don’t have any patients booked until 3 p.m. and they’re just dry ice treatment for warts and some ear syringing.’ She looked more closely at Sandy’s face. ‘Are you OK?’

  Sandy nodded. ‘I feel better now.’ She lowered her voice. ‘I really thought he was going to die, you know? I’ve never seen a dead person.’ Sandy looked over the counter fearfully, as though she expected another patient to succumb. She relaxed visibly as one old lady smiled at her. ‘Who’s Oliver talking to in the staffroom?’

  ‘Our new locum,’ Janet answered tersely. She patted the bag of kitty litter still lying on the counter, now with the tins of cat food positioned beside it. ‘Would you like to go and put these away? They’re kind of in the way here.’