‘Quite a variety from the look of it, although I do wonder if the GP has tried an alternative remedy for that case of carpal tunnel syndrome,’ she said quietly, obviously determined to stick to work matters.
‘I wondered about that, too,’ Dylan agreed, trying his hardest not to make the situation more fraught than it was. It wasn’t fair to Joanna to put her under any kind of pressure, but it was difficult to hide his feelings when she was near him. ‘I felt that he might have been jumping the gun with a couple of the patients he’s referred to us recently, to be honest.’
‘In that case we’d better monitor the situation. It isn’t unknown for a busy GP to pass patients along because he hasn’t the time to work out a suitable course of treatment for them.’
‘It happened in my last post, too. Mind you, the GP was also sending patients to the accident and emergency unit rather than seeing them himself.’ He sighed. ‘It turned out that he had a drink problem and couldn’t keep up with his workload.’
‘There’s tremendous pressure on GPs nowadays, especially in a city like London where the population is increasing all the time. However, much as I sympathise, there is no way that we can pick up another doctor’s work.’
‘I’ll keep a check on how many new patients are coming from the health centre,’ he assured her.
‘Thanks.’ She gave him a quick smile then went to the door. She paused and glanced back. ‘I’ll be as quick as I can but page me if you get snowed under. Brian tends to be extremely long-winded once he gets started.’
‘I’ll give you half an hour then send for the cavalry,’ he assured her, grinning.
Joanna chuckled. ‘You may need to, believe me!’
She left and Dylan got back to what he’d been doing. He liked to have some idea of the cases he would be seeing before the patients arrived so tried to spend some time beforehand going through their notes. He was just reading up on the carpal tunnel syndrome case when his beeper sounded and he grimaced when he discovered it was A and E paging him.
He phoned the department to find out what was happening and agreed immediately to look at a ten-year-old boy who had been run over by a bus. He quickly left the consulting room and stopped at the reception desk to tell the staff where he was going. There was already a queue of patients waiting to be seen but they would have to wait a while longer because this call took priority.
The child was very badly injured and Dylan didn’t hesitate as he phoned Theatre to inform the staff that he would be operating. He then phoned the clinic to alert them to the fact that he wouldn’t be able to see any of his appointments for at least two hours. It would probably mean them rebooking appointments if Joanna wasn’t able to cover for him, but it couldn’t be helped.
Dylan apologised for the inconvenience and hung up. He hurried to the lift, working out which way to approach the coming surgery. A and E had provided him with a full set of X-rays so he knew the boy’s pelvis was broken in three places and suspected from the traces of blood in the child’s urine that his bladder had been damaged. It would be a test of his skill to put everything back together but he was confident that he would make a success of it. As Tom was so fond of saying, false modesty was a waste of time and he was well aware of his own strengths. He wouldn’t do this job if there was the slightest doubt in his mind that he wasn’t any good at it.
The lift arrived almost as soon as he pressed the button for once. He was just about to get in when he spotted Joanna coming along the corridor and he put out his hand to stop the lift door closing.
‘I’ve an emergency,’ he informed her quickly. ‘Ten-year-old boy who had an argument with a bus. Pelvis is broken in three places and I suspect his bladder has been damaged as well. I’m not sure how long I’ll be, probably a couple of hours minimum.’
‘Oh…um…Fine. Don’t worry. I’ll cover for you.’
Dylan frowned when he saw how abstracted she looked. It was obvious that she had something on her mind. ‘What’s wrong? Did Brian Maxwell give you some bad news about the department?’
‘No. Just the opposite, in fact.’ She summoned a smile but he couldn’t help noticing how she avoided looking directly at him. ‘I’ll tell you all about it later. You’d better get off to Theatre and I’d better make a start before the natives get restless.’
He laughed at the quip but he couldn’t help feeling a little unsettled because something obviously wasn’t right. ‘Heaven forbid! I’ll see you later, then.’
He let go of the door and the last thing he saw before it closed was the frown on Joanna’s face. He was dying to know what was bothering her but it would have to wait. Still, it couldn’t be anything that dreadful because she would have told him there and then. It was probably some sort of management crisis, maybe to do with the figures everyone was so keen on nowadays.
He sighed. When folk started measuring the effectiveness of a department by the number of operations performed there then the whole system had well and truly broken down! No wonder Joanna had looked so dismayed.
‘I’m going to write to your GP, Miss Rogers, and suggest that he injects a small dose of corticosteroid drugs under the ligament in your right wrist. That should relieve the pain, but do follow my advice and use a splint at night to rest your hand.’
It had been a hectic couple of hours and Joanna hadn’t stopped as she had worked her way through the list of patients who’d been booked in that day. Adding Dylan’s list to her own had taken some juggling but she had managed to keep up, mainly because she had worked like a Trojan rather than given herself time to think about the bombshell Brian Maxwell had dropped.
A shiver ran through her and she had to consciously blank the thought from her head because she couldn’t deal with it at that moment. Debbie Rogers, the patient suffering from carpal tunnel syndrome, was obviously relieved to learn there was an alternative to surgery and said so.
‘I’ll try anything if it means that I don’t need to have an operation! I was terrified when Dr Brooks told me he was referring me to the hospital. I only went to ask him for some painkillers, and before I knew what was happening, he was talking about me having surgery!’
‘I see.’ Joanna managed to hide her dismay because it seemed that Dylan’s suspicions were correct. The new doctor at the health centre was referring patients to them to ease his own workload.
‘I really think it’s a bit too soon to think about surgery, Miss Rogers. Carpal tunnel syndrome can be very painful but it can be treated by other means. The pain is the result of pressure on the median nerve where it passes into the hand through the carpal tunnel. It’s quite common in people who work for long periods of time on word processors or computers, although that isn’t the only cause, by any means.’
‘It’s probably what’s caused my problem, though,’ Debbie stated glumly. ‘I design websites for a living and spend hours a day working on a computer.’
‘Then do make sure you have the very best, ergonomically designed equipment to help ease the pressure on your wrists. And try to take frequent breaks away from your computer.’ She smiled when the young woman grimaced. ‘I know it isn’t easy when it’s your job but if your wrist gets too painful then you won’t be able to do any work at all.’
‘I suppose you’re right,’ Debbie agreed reluctantly. She stood up. ‘I’ll try to be sensible about it from now on. And I’ll make another appointment with my GP and ask him for that injection you mentioned.’
‘I shall write to him and let him know to expect you,’ Joanna assured her.
Debbie Rogers left and Joanna saw two more patients, one of whom was another referral from the health centre who should have been treated with the right combination of drugs rather than surgery. Once again she explained that she would contact the GP about a suitable course of treatment although this patient obviously wasn’t as happy about the idea as Debbie had been.
She sighed as the man stamped out of the room, muttering about the state of the NHS and doctors who were more interest
ed in feathering their nests than doing their jobs properly. There was no point explaining that he should never have been referred to her in the first place because he wouldn’t have believed her, but it was frustrating. When the nurse who was assisting her that afternoon suggested that she might like a cup of coffee, Joanna eagerly agreed. A break would give her time to unwind.
She was just sipping the hot coffee when there was a tap on the door and Dylan poked his head around it. ‘Coffee? I thought you’d be in dire need of a stiff whisky by now.’
‘I am, but I don’t think the powers that be would approve of me drinking alcohol on the job.’
She summoned a smile as he came into the room, trying to calm the sudden thundering of her heart. He’d obviously come straight from Theatre because his hair was still wet from the shower. Joanna felt her pulse race as she imagined how his hair would feel if she ran her fingers through it. It would be like stroking damp black satin, she thought, and the idea made her insides spasm with longing.
She took a deep breath, struggling against feelings she had no right to feel. Dylan was a colleague. He was her senior registrar and she was his boss. Thinking about stroking his hair was a lot of foolish nonsense, especially after what Brian Maxwell had told her earlier.
The cup slipped from her fingers, spattering coffee onto the immaculate blotter before she managed to right it. Joanna reached for a tissue and quickly mopped up the mess but her heart seemed to have gone into her overdrive. She would have to tell Dylan what Brian had said although she had no idea how to set about it.
‘That was clumsy of me!’ she exclaimed, playing for time. ‘How did you get on, by the way? Was the boy in a very bad state?’
‘He was. It turned out that his bladder must have ruptured when he was hit by the bus. It’s pretty common with that kind of accident. I managed to sew it back together and pin his pelvis so I’m hoping there won’t be any long-term problems like incontinence or urine retention, but it’s too early to tell if there’s been much nerve damage.’ He looked at her enquiringly. ‘How did you get on? I was surprised to see so few people left in the waiting room.’
‘There were no real problems and that helped,’ she said quickly, not wanting to admit why she had worked with such gusto.
‘What about the carpal tunnel syndrome?’
‘It appears the GP referred her to us without suggesting corticosteroid injections, or much else for that matter.’ Joanna swiftly filled him in on what had happened both with Debbie Rogers and the other patient. She nodded when Dylan declared that something needed to be done about the situation.
‘I intend to get onto it as soon as I’ve finished here. We’re busy enough, without the GPs foisting extra patients onto us.’ She looked up when the nurse knocked to ask her if she was ready to see her next patient.
‘You can send the next one in as soon as you like,’ she told her.
‘And if you give me a couple of minutes to get myself sorted out you can start ferrying the rest to me, too,’ Dylan instructed. He sighed as he made for the door as soon as the nurse had left. ‘I’d better go and do my bit, I suppose. Thanks for covering for me, Joanna.’
He reached for the doorhandle then stopped. ‘By the way, you said you’d tell me what Brian Maxwell wanted. I hope he wasn’t complaining about the figures.’
‘He wasn’t. In fact, he had absolutely no complaints at all and was positively lavish with his compliments.’
Joanna hesitated but there was no way she could put this off any longer. Dylan had to know what had been said, although how he would react was anyone’s guess.
‘Apparently, Brian and the members of the trust are delighted with our performance. It turns out that we’ve performed more operations than any other surgical unit in our area in the past three months, and that our success rate is twenty per cent higher than anyone else’s as well.’
‘That’s brilliant news, Joanna! Well done. It’s all down to you that St Leonard’s has improved so dramatically.’
‘Thank you, but I see it more as a team effort. Every single person on this team is responsible for the improvement in the quality of the surgery we perform here.’ She took a small breath because this was the bit she was dreading telling him. ‘Brian is so delighted, in fact, that he wants us to attend the conference in Paris next month and present a paper on how we have raised the standards here so successfully. It’s an all-expenses-paid trip and we’ve been booked into one of the best hotels right next to the conference centre.’
‘We? I’m not sure I understand what you’re saying, Joanna,’ he said slowly.
‘It’s simple. Brian wants us both to go to Paris. Together.’
CHAPTER SEVEN
‘I SEE. And how do you feel about the idea?’
Dylan was rather proud of the fact that his voice sounded so normal. He fixed what he hoped would appear to be a professional smile to his mouth while he waited for Joanna to answer, but it was difficult to be sure that he wasn’t grinning like a kid who’d just been handed a treat. The thought of going to Paris with Joanna, for whatever reason, made his blood sing, but he had to get it into perspective.
It would be a business trip.
They would be in Paris purely and simply so they could present a paper to their learned colleagues.
If they had to socialise they would do so in the company of other professionals.
There would be no time for anything except work…
Unless they managed to sneak in a moonlit trip up the Seine and a walk around the Tuileries Gardens. And, of course, they couldn’t go to Paris without seeing the Eiffel Tower and the Louvre, could they? It would be tantamount to committing a cardinal sin to miss either of those! OK, so maybe he had been before and seen all the major sights, but he had never seen them with Joanna and that made a world of difference…
‘Obviously, I’m pleased that the trust appreciates all our hard work but I’m not sure I agree with the fact that they are prepared to spend so much money on this jaunt which could be put to better use elsewhere.’
Dylan blinked and the delightful images of Paris in the spring faded as he digested what she’d said. She had sounded so professional that he felt like an idiot for letting himself get carried away. It wasn’t a feeling he enjoyed so he fought to suppress it by taking the opposite tack. Maybe he wasn’t convinced it would be wise for them to go to Paris together but he wasn’t going to let Joanna think that he was incapable of handling the experience. If she wanted professional then that’s what she was going to get. In spades!
‘I disagree. The cost of the trip is a mere drop in the ocean when you weigh it against the benefits St Leonard’s will gain from it.’ His tone was calm, composed and completely convincing, and even he was faintly surprised by what a good actor he was turning out to be. Joanna was obviously taken aback by his performance because she was silent for a moment before she rallied.
‘What sort of benefits do you mean?’
‘That the department’s reputation can only be enhanced even further by the fact that we’ve been asked to deliver this paper.’
He was winging it now—snatching ideas off the top of his head so he could convince her that they should go ahead with the trip. If there were problems then he would get round them, he promised himself. He would find a way to make it work because he needed this time with Joanna more than he had needed anything in his entire life.
‘There’s been talk recently about more hospitals being designated as centres of excellence and St Leonard’s surgical department would be a prime candidate for extra government funding. Just imagine the massive boost that would give to the quality of care we provide here.’
‘Brian Maxwell did mention something along those lines,’ she admitted slowly. ‘He said that the board of Trustees was very keen to capitalise on our success and apply for extra funding. He also said that it could have a knock-on effect for the whole hospital so there might be extra funding made available to other departments.’
&
nbsp; ‘Exactly.’ He shrugged, feeling rather pleased that he had read the situation so well. He had never got too heavily involved with the politics of the job in the past because he’d not been in a position to do so. However, at his present level, he was more than willing to add his ten cents’ worth, and once he became a consultant he would definitely fight his corner.
His heart jolted because undoubtedly he would have to change jobs if he hoped to become a consultant. St Leonard’s already had a consultant on its surgical team, and a highly skilled one, too, by all accounts. He hadn’t met Diane Grant yet because she was currently on maternity leave, but he had been told that she would be returning to work very shortly. He hated the thought of having to leave Joanna for any reason and hurried on, not wanting to think about the downside of moving up the professional ladder.
‘Maxwell knows that the only way you can get hold of extra funding is by building on your reputation and that’s why he’s so keen that you should go to this conference. It makes a lot of sense.’
‘I suppose it does when you put it like that. And I would love to think that one day this department would have sufficient funding to be at the cutting edge of surgery.’ She grimaced at the unwitting pun. ‘Sorry, but you know what I mean, don’t you?’
‘I do,’ he agreed, chuckling.
‘So basically we both agree it would be the right thing for us to do professionally, but how do you feel about it personally?’ A wash of colour ran up her cheeks but she met his eyes. ‘It could prove to be a strain, Dylan, couldn’t it? D’you think we can handle a trip like this without it causing us both a great deal of…well, heartache?’
‘Yes,’ he said huskily, hoping and praying that he wasn’t being overly optimistic. Maybe Joanna was fairly confident about her own self-control but could he handle being with her, day and night, for the duration of the conference?
His heart began singing that aria, trilling away so loudly that he had trouble hearing himself think, but this was too important to him to make a mistake at this stage. Even if he suffered the tortures of the damned he needed to have this time with her.
The Pregnant Surgeon Page 8