The notes were hard to follow—not only was the writing difficult to read, but pathology reports had been sticky-taped on to sheets entitled ‘MAYNARD, Noel’ and the sticky tape had pulled off, leaving a jumble of loose pieces of paper with fading results. Two blood tests showed liver function tests, with grossly elevated serum transaminases. There was one blood test with a handwritten patient name in the top right-hand corner, ‘Noel Maynard’, showing an almost undetectable level of serum ceruloplasmin.
Holly’s late-night revision had reminded her of the diagnostic testing for Wilson’s disease, low ceruloplasmin being one of the important findings. The tests were certainly consistent with Wilson’s disease but would hardly be considered definitive. She looked on further through the notes but there was no record of additional tests such as a twenty-four hour urine copper excretion, liver biopsy or a penicillamine challenge test.
She flicked back to the handwritten clinical notes. Wilson’s disease was an autosomal recessive condition—the patient had to have inherited an abnormal gene from both parents. The parents could have been carriers or actually have had the disease. Effective treatment for Wilson’s disease had only been developed in the mid-nineteen-fifties, but if either of Noel’s parents had had the disease, would they have been recognised or treated way down here in the sticks back then?
She went all the way back through the early entries in Noel’s notes, looking for any family history. There was none.
Karen came in with a small tray bearing a cup of tea and a couple of plain biscuits. ‘Here, this should get you going before the throng arrives,’ she said.
‘Thanks, Karen, that’s nice of you. Listen, do we have a medical record for Noel Maynard’s father? Do you know his first name?’
‘Noel Maynard’s father?’ Karen raised her eyebrows. ‘Warren Maynard? Why on earth do you want those? That whole family is nothing but trouble. Even the mother is a bit off the planet, though to be fair that’s to be expected, married to that psycho and then having her only son turn out to be a murderer. Who wouldn’t be a little crazy after that? She hides up in the hills like a hermit. Only the local pastor’s wife and the delivery guy from the bottle shop are allowed on the place. She waves a rifle at everyone else. Her husband Warren was murdered in a pub brawl and I’m not the only one around here who thinks he had it coming to him.’
‘I’d still like to see the notes if we have any,’ Holly said, ‘and his mother’s, too, and any siblings’.’
‘There was a sister but she left when Noel was arrested. Couldn’t cope with the shame, I suppose. She was a nice enough kid but I reckon that background has triggered her to turn out the same. They often do. I reckon it’s programmed into the genes.’
Holly was getting tired of Karen’s undiluted bigotry. ‘The notes, Karen?’ she reminded her again, her tone a little more demanding.
The receptionist pulled herself upright, her expression a little miffed. ‘I’ll have to dig them out of the archives. It could take some time.’
‘Fine, as long as I can have them some time today. There are some family details I want to check on. The doctor’s writing is almost impossible to read and I just want to make sure I haven’t missed anything significant in the family history.’
‘Dr Cooper’s, you mean?’ Karen asked.
‘Yes. I suppose he’s left the district by now?’
‘Actually, he’s a whole lot closer than you think,’ Karen said.
‘Oh?’
‘Dr Neville Cooper is a permanent resident in the nursing home wing of the clinic,’ Karen informed her. ‘After his stroke about eighteen months ago he needed full-time care. His only son lives in Sydney so it was decided Dr Cooper would be better amongst friends down here. But it would be pointless trying to talk to him. If you think his handwriting from twenty-five years ago is hard to understand, try listening to him speak.’ She gave a rueful grimace. ‘It’s so sad. His son visits him when he can but there’s never any change. God knows why he’s lasted as long as he has. He was the mainstay of this town for years—practically delivered my whole generation and even some of our kids. Now he’s reduced to a dribbling figure in a chair. Life’s cruel sometimes, isn’t it?’
‘Yes, indeed it is.’
The reception bell sounded and Karen reached for the door. ‘That will be Mrs Spaulding with gout. Finish your tea and I’ll send her in, shall I?’
‘Sure.’ Holly chewed one end of a biscuit and took a sip of tea once the receptionist had left the room. She looked down at the open file in front of her and frowned. She drummed her fingers absently on the desk, then, with a little sigh, closed the file and put it to one side.
Once the afternoon clinic was finished Holly made her way to the kitchenette where Cameron was already seated, one ankle crossed over his thigh in his customary casual pose, the newspaper spread out before him, a cup of coffee in one hand. She hadn’t run into him so far that day. He’d been called out to a home visit over lunch and the rest of the afternoon had kept her occupied with a variety of routine consultations which had filled in the time rather than providing any sort of challenge.
‘I see in spite of your doctor’s orders you’ve apparently made a remarkable recovery,’ he said as she came in.
Holly gave him a chilly look, sat down and reached for a chocolate biscuit even though she had no intention of eating it. ‘You are not my doctor.’
‘Maybe not, but I still think you shouldn’t be using that leg to drive. Your car is a manual, right?’
‘Yes.’
‘You’re taking a risk driving with a damaged knee. If you have to slam on the brakes in a hurry you could lose control of the car.’
‘I am perfectly capable of driving. The crutches were total overkill. I’m not even limping.’
Cameron tossed the paper to one side and, uncrossing his leg, stood up and came around to where she was sitting.
‘Lift up your skirt and show me.’
‘I beg your pardon?’
‘You heard me, Holly. Let me see how the swelling is.’
Holly tucked her legs under the table and smoothed her skirt even more firmly over her knees. ‘I told you, I’m fine.’
He went back to his side of the table and picked up the newspaper again. ‘“Gemini”,’ he read out loud. ‘“Today you should take care not to be fooled by people who insist on pulling the wool over your eyes.”’ He lowered the paper and gave her one of his disarming grins. ‘Pretty accurate, huh?’
She rolled her eyes and stuffed the chocolate biscuit in her mouth so she didn’t have to answer.
‘Listen to yours,’ he went on as his gaze returned to the newspaper. ‘“There are uncertain stars around you at present. You need to check details very carefully in case you overlook something vitally important.”’
‘You’re making that up,’ she said, not quite able to control a little shiver that traversed the length of her spine.
He passed the paper over to her. ‘Read it yourself. You’re Sagittarian, aren’t you?’
She took the paper but didn’t look at it. ‘How do you know I’m Sagittarian?’
‘Your birth date was on your application form.’
‘You surely don’t take this stuff seriously, do you?’ she asked.
‘Not really, but I have a sister who’s into all this stuff in a big way. A couple of days with her and I defy any sceptic to maintain integrity.’ He reached across for one of the biscuits. ‘According to Freya, your star sign is the luckiest of the zodiac.’
‘Not so far,’ Holly couldn’t help inserting a touch cynically.
‘Unlucky in love?’ he said, taking a wild guess.
She met his eyes. ‘I would appreciate it, Dr McCarrick, if you would not refer to my personal life.’
He threw back his head and laughed. ‘Touché. Well done, Holly. I’ve been well and truly hoist with my own petard.’ He took another chocolate biscuit off the plate, took a generous bite and, after he’d swallowed it, asked, ‘S
o what was his name?’
‘Whose name?’
‘The guy who broke your heart.’
‘No one broke my heart.’
‘So for the heck of it you just put a pin on a map and randomly came up with Baronga Beach?’
‘It wasn’t quite like that…’
He surveyed her flustered features for a long moment. ‘But you’re running away, aren’t you?’
She wanted to deny it but something about his softened tone and intent gaze found her confessing, ‘It was eight weeks before my wedding. I had the dress made and the caterers booked.’ She began to toy with a tiny crumb on the table. ‘Julian decided we weren’t suited after all.’
‘There was someone else?’
‘Isn’t there always?’
She heard him release a sigh. ‘Yeah, you could be right.’
Holly lifted her head to meet his eyes once more. ‘What about you?’
‘What about me?’
‘I’ve told you my history. It’s only fair you tell me yours. After all, if you don’t, no doubt someone else around here will, with their own slightly embellished angle on it.’
‘Yes, you could very well be right,’ he conceded reluctantly. ‘All right, here goes. I imagined myself to be in love with a woman I met at a Family Medicine conference in Melbourne about eighteen months ago. It was difficult conducting a longdistance relationship but I really thought we’d make it work. In the end she pulled the plug. She couldn’t face a lifetime working in a country practice.’
‘And you wouldn’t compromise?’
He looked at her as if she’d just asked him to fly to Mars and back in a day. ‘No,’ he answered implacably.
‘But why not?’
‘It wasn’t an option for me.’
‘Why? Because you think a man’s career is more important than a woman’s?’ Holly asked, a hint of feminist angst hardening her tone. ‘That just because you’re a man you get to choose where to work and live and whoever is unlucky enough to marry you has to trail along behind with no allowances made for her own career aspirations?’
Cameron’s eyes turned a steely blue as he got to his feet. ‘For your information, Holly, the reason I chose to live and work in an isolated area is because I grew up in the country and personally witnessed the tragic consequences of inadequately trained medical practitioners.’ He gripped the back of the chair he’d just vacated and thrust it back under the table, rattling the cups and plates on its surface. ‘I was thirteen years old when I watched my older brother bleed to death after a hit-and-run accident. If I had known then even a fraction of what I know now I could have saved him. And so could the attending doctor, who was almost as useless as I was. Don’t tell me I’m the one who has to compromise. I promised Tyler I would do my best to never let something like that happen again and I swear to God no one, and I mean no one, will ever get me to change my mind or break my promise.’
Holly winced as he stormed out of the room, not quite slamming the door on his exit.
‘What was all that about?’ Karen came in a few seconds later carrying some patient files. ‘Cameron looked like thunder just then. He practically bit my head off. I’ve never seen him lose his temper before; he’s normally so easygoing. Did you say something to upset him?’
Holly took the files the receptionist had handed her. ‘I think I might have touched a raw nerve. I won’t do it again.’
Karen gave her a thoughtful look. ‘You know, I’ve never really noticed it before, but you look a little bit like his ex-fiancée, Lenore Forsythe.’
‘I do?’ Holly unconsciously clutched the files closer to her chest. ‘In what way?’
‘Your shape and colouring are different but you have that just-stepped-out-of-a-fashion-magazine look,’ she said. ‘Did you do some sort of grooming course?’
‘No…I just like make-up and nice clothes.’
‘Well, you won’t find too many fancy clothes down here,’ Karen said, giving her own plain outfit a disparaging glance. ‘The nearest boutique is in Jandawarra and it’s hardly what anyone would call designer wear. But if you’re looking for hard-wearing jeans and sturdy boots and industrial strength underwear then it’s the place to shop.’
‘Thanks for tracking down the files,’ Holly said, changing the subject.
However, Karen wasn’t so easily distracted. ‘He was really in love with her, you know. He pretends he wasn’t but we all know he’s trying to put it behind him and move on.’
‘What was she like?’ Holly found herself asking after the tiniest pause.
‘Lenore was outgoing and confident. Too confident, if you ask me, but then it takes all types, I guess. She works in Melbourne in a city practice. She’s even treated celebrities, but of course she wouldn’t say which ones due to patient confidentiality. She would have been an asset here with her connections but things didn’t work out that way. She found Baronga Beach too quiet. She had a fling with someone for a while but, who knows, she might come to her senses. As far as we know she hasn’t married anyone else yet.’
For some reason Holly felt a sinking feeling deep inside. She couldn’t understand her reaction at all. It wasn’t as if she was the least bit interested in Cameron McCarrick…Well, maybe a little bit interested, she reluctantly admitted. There was so much about him that she found annoying—but after his recent revelation she was beginning to realise his laugh-at-life attitude was a cover-up for deep emotional pain. He had lost his older brother in tragic circumstances. It had permanently changed him, had made him determined to do his bit to change the world.
It was impossible not to compare him with Julian Drayberry who, in spite of his natural talent for the mechanics of life-saving surgery, had switched specialities in order to pursue a lucrative career in plastic and cosmetic procedures instead. He’d even offered to enhance her figure for her, promising to schedule her in well before the wedding so she’d look perfect for the photos. She’d been knocked sideways by his offer, her self-confidence hitting an all-time low. She could see with the benefit of hindsight that their break-up had been inevitable, but at the time it had completely thrown her. Was it really too much to ask a man to love her just the way she was?
‘You haven’t got another patient until four-thirty,’ Karen said, cutting across her private ruminations. ‘I’ll give you a buzz when they arrive.’
Holly gave her a weak smile and, taking the files back to her consulting room, sat at her desk and opened the first one.
It was marked: ‘Warren Maynard—deceased’.
CHAPTER TEN
HOLLY read through the notes with difficulty, finding sketchy comments regarding poor general health, alcoholism, cirrhosis of the liver and one comment: ‘examined in police cell—mentally unstable’. The last entry read: ‘phoned by police/ patient deceased/ stabbed in fight Jandawarra pub/ bled out’. So, formal pathology testing had never been done on Warren Maynard. No actual diagnosis of Wilson’s disease had been made.
She turned to the next folder—Betty Maynard’s. Apart from the birth of two children, Noel’s mother had visited the doctor rarely. There were a couple of notes regarding a sprained wrist and a black eye, and another a few months on documenting a cheek laceration needing stitches. Dr Cooper had scribbled a few notes here and there but there was no record of any general health testing being carried out, such as routine pap smears, mammograms or blood screens for thyroid function or haemoglobin. Betty Maynard hadn’t even been to see Cameron.
Holly sat back in her chair and gave the end of her pen a nibble. If Betty Maynard was a carrier of Wilson’s disease a blood test would prove it. Medical technology had progressed exponentially over the twenty-odd years since Dr Cooper’s notes and Noel’s diagnosis had been made. The genetics of Wilson’s disease was now known. It could be possible to detect the genetic abnormality for the disease in Noel’s blood. An abnormality in chromosome thirteen had been discovered in the nineteen-nineties, a gene which coded for a protein that transported copper
from the liver into bile. In Wilson’s disease this protein was defective—copper accumulated in the liver, causing cirrhosis, and eventually spilled back into the blood, allowing it to accumulate in the brain, causing tremors and mental instability, and into the kidneys and the cornea, causing kidney failure and a copper-coloured corneal ring called a Kaiser-Fleischer ring.
The chances of doing any genetic testing on Noel’s father, a man who had been dead for over twenty years, were slim indeed, but Holly couldn’t help hoping that she could somehow talk Noel into a blood test or a twenty-four hour urine sample at the very least. A liver biopsy would be more definitive, though from what she’d seen so far of him she didn’t like her chances of getting that. However, a home visit so she could meet his mother certainly wouldn’t go astray. She jotted down the address and placed it in her bag under the desk.
Tossing her pen to one side, she closed the files and locked them into her desk drawer just as Karen buzzed on the intercom about the arrival of her last patient for the day. Holly fixed a smile on her face and went out to the waiting room to greet the teenage girl who had served her in the General Store the first day she’d driven into town.
She glanced at the file she’d picked up from the reception desk to check the teenager’s name. ‘Hello, Jacinta. I’m Dr Holly Saxby; come through.’
She waited till the girl was seated in her consulting room before opening the file. ‘Now, what can I do for you?’
The girl gave her a very direct look. ‘I want to go on the pill.’
A Doctor Beyond Compare Page 9