Neither did Jess, not now she’d sussed out the situation with Ezra. She felt decidedly chirpy when she accompanied Grace back to Reception and saw Will Grant deep in conversation with Tracy.
‘What brings you down into town, Will?’ She smiled, hearing the anaesthetist laugh at something her junior receptionist had said. ‘Bev giving you grief, or are you touting for business?’
‘Hoping to raise money, more like.’ He smiled back. ‘I wondered if you could sell some raffle tickets for us?’
‘Sure thing.’ Jess nodded. ‘Leave them with Tracy, and Cath will find a prominent space for them in the waiting room. What’s the raffle for?’
‘A new defibrillator for the lifeboat service. Their old one badly needs replacing.’
‘I wish we could hold a raffle for a resident surgeon,’ Jess sighed, reaching for her next patient’s file, and Will laughed.
‘I’ll suggest it at the next Friends of the Hospital meeting, shall I? Which reminds me,’ he continued, ‘Bev said she’d really like to talk to you about Mairi Morrison’s report. The one she sent over yesterday?’
Jess put down the file she was holding. ‘I haven’t received—’
‘Well, hello there, stranger.’ Will beamed, seeing Ezra’s dark head appear round the waiting-room door. ‘How’s the hectic life of an island GP suiting you?’
‘Fine, thank you,’ Ezra murmured, his eyes following Jess as she headed for Cath’s office, a decided frown on her forehead.
‘I heard about the operation you did on Simon Ralston’s hand. Nifty piece of work by all accounts.’
‘It was a pretty standard procedure—’
‘Not in our neck of the woods, it’s not,’ Will declared, clearly intent on praise whether Ezra wanted to hear it or not. Which he didn’t. ‘In fact, if you hadn’t been here the poor bloke would have needed to go to the mainland.’
‘Which is a ridiculous state of affairs,’ Ezra said, eagerly seizing on Will’s observation in the hope of changing the conversation. ‘The Sinclair Memorial should have a resident surgeon.’
‘Couldn’t agree with you more,’ Will said, ‘but the way things are going, we’ll probably not even have a hospital by the end of the year.’
Ezra’s eyebrows rose. ‘How so?’
‘Because, though we have an operating theatre with facilities second to none due to the generosity of the local population, one day soon somebody in authority is going to take a really good look at the patients Jess has been operating on, realise how minor the conditions are and close us down.’
‘But—’
‘I know.’ Will smiled grimly. ‘We’re in a catch-22 situation. We can’t do big operations because we haven’t got a resident surgeon, and we can’t get a resident surgeon because the operations we’re performing are too small to warrant one.’
‘Have you tried advertising?’ Ezra suggested. ‘I’m sure there must be a surgeon somewhere, wanting to escape the rat race.’
‘Even if there was, I doubt if he—or she—would be prepared to come to Greensay. Most of the work at the hospital is pretty routine, you see, which wouldn’t appeal to a top-notch surgeon. What we really need is a good all-rounder who would also be prepared to help Jess by working part time with her.’
Ezra nodded, only to suddenly realise that Will was gazing at him expectantly. ‘Don’t look at me. I’m not looking for a job.’
‘But you’d be perfect.’
‘And I’m not interested,’ Ezra said firmly. ‘The arrangement I made with Jess is purely temporary.’
‘I don’t suppose there’s any chance you might change—OK, enough said.’ Will sighed, seeing Ezra’s eyebrows snap down. ‘You’re not interested. Got the message.’
Ezra sighed, too, as he watched Will leave the health centre. The man meant well but how to explain to him that he was also in a catch-22 situation? That there was no way he could ever set foot in an operating theatre again, and even if he could, he most certainly wouldn’t be applying for a post as part-time surgeon at the Sinclair Memorial Hospital.
Not even for Jess? his mind whispered, and he groaned inwardly.
Lord, but he still didn’t know how he’d managed to keep his hands off her that night. Kneeling in front of her, all too aware of the outline of her full breasts through her T-shirt, the hard nubs of her nipples. And those damn knickers. They’d kept catching on her plaster cast, and he’d kept trying to pull them up, and she’d kept trying to hold onto the hem of her T-shirt so he couldn’t see, and he had seen, so that by the time he’d finished he didn’t know who was trembling most—him or Jess.
Jess must have sensed his inner turmoil because she’d been distinctly cool and distant towards him these past few days. Which was good. Creating a barrier between them was good, because the last thing he wanted was an affair with her.
He snorted briefly. Hell, who was he trying to kid? Of course he did. He wanted to make love to her—badly—but Jess deserved better than him. A man with no job, no future.
‘Are you ready for Mr Guthrie now, Dr Dunbar?’ Tracy asked.
He wasn’t, but he took the file she was holding out to him and pasted a smile to his lips as the man Mairi Morrison considered ideal husband material for Jess limped slowly towards him.
‘Your foot doesn’t seem to be getting any better, Mr Guthrie,’ he observed, ushering him towards his consulting room.
‘That’s because it’s not,’ the portly farmer grumbled. ‘In fact, these last few nights I don’t think I’ve had a wink of sleep, and it’s really getting to me.’
Tell me about it, Ezra thought ruefully as Brian slipped off his shoe and sock. He hadn’t been getting much sleep recently either, and even less since a certain red-headed doctor had asked him to help her with her knickers.
‘I think it looks worse, Doctor.’
So did Ezra as he stared down at Brian’s foot with dismay. ‘Have you been keeping to the diet sheet I gave you—taking the pills I prescribed?’
‘Of course,’ Brian Guthrie protested.
‘You’ve not knocked your foot—dropped something on it?’
‘Doctor, if I’d knocked this foot, you’d have heard my scream down in Inverlairg.’
Ezra’s frown deepened, then a sudden thought flashed into his mind. ‘You haven’t been taking aspirin, have you?’
Brian Guthrie’s plump cheeks reddened slightly. ‘Just the odd one—now and again. I’ve been doing a lot of paperwork recently, you see, and that always gives me a headache.’
‘And I told you that you mustn’t take any aspirin,’ Ezra reminded him. ‘It lessens your kidneys’ ability to filter out uric acid, and that’s why your gout is worse.’
Brian looked distinctly belligerent. ‘Doctor, if I get a bad headache I’ve no intention of suffering it when a couple of aspirin will help.’
‘Even if that means you’ll eventually develop chronic gout?’ Ezra demanded.
‘I don’t see how much more chronic it can get,’ the farmer muttered. ‘It’s bloody sore enough as it is.’
‘Oh, it can get a lot worse than this, believe me,’ Ezra said. ‘If you don’t get your gout under control, crystals of uric salts will settle in your joints, leading to a condition very similar to osteoarthritis with all its crippling effects. And then you’ll undoubtedly develop kidney stones, not to mention doing permanent damage to your kidneys.’
Brian gulped. ‘It’s…it’s that serious?’
Ezra nodded. ‘It’s that serious. No aspirin under any circumstances, Mr Guthrie, OK?’ He reached for his prescription pad. ‘I’ll give you something you can take for your headaches, but even that must only be taken in moderation.’
Brian sat in silence while Ezra wrote out the prescription, but when he handed it to him he cleared his throat awkwardly.
‘I was wondering, Doctor—not that I’ve any complaints about your treatment so, please, don’t think so—but Jess—Dr Arden—she’s normally my doctor, and I was wondering when I mi
ght become her patient again?’
Ezra snapped Brian Guthrie’s file shut. ‘I really couldn’t say. Dr Arden will be in plaster for quite some time yet, and when her locum arrives—’
‘She’s getting another locum?’ The farmer’s surprise was clear. ‘But I thought—assumed—you’d be staying on until she was fit again?’
‘I’m afraid not, and when the locum arrives it will be up to Dr Arden to allocate her patients.’
Brian digested this information, then to Ezra’s dismay looked suddenly almost coy. ‘The thing is, I’m very fond of Jess.’ Quickly Ezra got to his feet, not wanting to hear any more, but Brian didn’t take the hint. ‘I—well, not to beat about the bush, Dr Dunbar—I’m hoping she and I might get married one day.’
The words ‘over my dead body’ sprang to Ezra’s lips, and he bit them back with an effort. It was none of his business if Jess married Brian Guthrie. Nothing she did, or how she chose to live her life, was any of his business. So why did the thought of her in Brian Guthrie’s arms make him want to hit something—someone?
Because he was going crazy, he decided as he accompanied the farmer back to the waiting room. A few weeks on Greensay and he’d gone from a man who’d always abhorred physical violence to a man who would now—if he’d given in to his instincts—be under arrest on two charges of grievous bodily harm.
And something had obviously got under Jess’s skin, too, judging by the sound of angry, raised voices coming from Cath’s office.
‘Cath seems to have lost something important,’ Tracy whispered breathlessly, her eyes sparkling with keen interest. ‘A report—or a letter—from Bev Grant. I can’t make out what they’re saying—’
She didn’t need to. Cath’s office door was suddenly thrown open and Jess appeared, her green eyes blazing.
‘What is it—what’s wrong?’ Ezra asked, seeing Cath shoot off in the direction of the toilets, her cheeks red and tearstained.
‘Not here,’ Jess replied tightly. ‘In my consulting room.’
He followed her silently, but the minute her door was safely closed he couldn’t help but say, ‘Jess, I don’t know what’s happened, but bawling out Cath—’
‘Look at the dates on these!’ she interrupted, thrusting two letters into his hands. He glanced down at them, then up at her, and she nodded. ‘Yesterday. Mairi Morrison’s sputum results came back from the lab yesterday, and so did Bev Grant’s report on her X-rays. Cath says they must have got lost amongst all the bumph which comes into the health centre but, dammit, she’s my senior receptionist and practice nurse. It’s her business not to lose things!’
‘I agree,’ he said, ‘but don’t you think you might have gone a little bit over—?’
‘Read them, Ezra,’ she demanded. ‘Read what’s wrong with Mairi.’
He stared back at her for a second, then sat down and obediently began to read them. He read them through once, then he read through them again, and when he eventually looked up at her, shock and amazement were plain on his face.
‘Mairi’s got TB? But—’
‘I know.’ Jess nodded. ‘It’s a disease you normally associate with the end of the nineteenth century, not with the twenty-first. And did you notice that the sputum sample showed up as thin red rods after the application of the Ziehl-Nielsen stain? It means she hasn’t simply got TB, she’s also highly infectious.’
‘Jess…Jess, that means we’re going to have to do tuberculin tests on everyone on the island!’ Ezra exclaimed.
‘Now do you see why I was so angry?’ she declared. ‘Every hour is vital in a case like this.’
He stared down at the letters in his hand, and a slight frown creased his forehead. ‘I can see the need for haste, Jess, but I think you should apologise to Cath. OK, so she was in the wrong—’
‘And not for the first time,’ she interrupted. ‘There was that fiasco over the condoms—’
‘And you told me yourself she’s under a lot of pressure at the moment,’ he pointed out. ‘Look, she’s probably feeling pretty wretched right now, and we really need her with us on this. She’s a fully qualified nurse and three people can test for the presence of TB faster than two.’
She bit her lip. He was right, on both counts. She shouldn’t have lost her temper but she’d been so worried about Mairi, and when she’d discovered what was wrong with her…A surge of panic welled up inside her. ‘Ezra, how are we going to cope? There’s over six hundred people on Greensay, and to screen them all quickly—’
‘We’ll tackle them one day at a time.’
‘But you’ll be leaving soon.’
‘Do you think I’d run out on you at a time like this?’ he protested. ‘I’m going nowhere—not even when your locum arrives—until we’ve tested everyone on the island.’
It was what she’d hoped—prayed—he might say, but to hear him actually say it…A prickle of tears clogged her throat. ‘I…I don’t know what to say.’
‘How about “Yes, please” and “Thank you, Ezra”?’ He smiled.
It was what he’d said to her once before. Heavens, was it only three weeks ago? It seemed like a lifetime. As though she’d known him a lifetime. But before she could say anything his face suddenly grew serious.
‘Jess, you’ll have to get Mairi down here fast—this afternoon if possible. Get her down here, give her the results of her tests and get her started on her treatment immediately. Once we start sending out screening invitations there’s bound to be a certain amount of public panic, and the last thing we want is Mairi turning into a social leper.’
He was right but, after finding Cath, apologising to her and asking her to phone Mairi, never had a morning surgery seemed both so long and yet too short.
She diagnosed yet another case of measles, bringing the latest total to ten, treated Mrs Wilson for a bad case of thrush and confirmed that Sybil Martin’s youngest most definitely had croup. But always at the back of her mind was how she was going to break the news to Mairi.
The woman thought she had lung cancer, and for her now to learn she had TB and was a real health risk to the people of Greensay…It was a consultation she didn’t want to have.
‘But I can’t have TB!’ Mairi exclaimed, staring across at her in disbelief. ‘Jess, you’ve known me since you were a little girl. I’ve scarcely had a cold or a day’s illness in my life!’
‘Did anyone in your family ever have TB, Mairi?’
‘One of my aunts did, but she died over forty years ago, and it’s not the sort of thing you can have for forty years and not know about, is it?’
‘Well, actually, yes, you can. Look, let me try to explain,’ Jess said as Mairi looked even more confused. ‘Most people growing up in Britain in the past would—like you—have come into contact with someone with tuberculosis. If the person they came into contact with coughed a lot then it’s likely they inhaled a small amount of the bacteria into their own lungs. It wouldn’t have been enough to give them tuberculosis, but it would have been enough to give them an infection that we call primary TB, which actually helped to build up a partial immunity to the disease.’
Mairi frowned. ‘You mean sort of like when you get a vaccination against smallpox or measles, and they actually give you a small dose of the disease?’
‘Rather like that, yes.’
‘But if I was immune to it before, why have I got tuberculosis now?’ Mairi demanded.
Jess sighed. ‘I’m afraid that’s the million-dollar question. Occasionally—and we don’t yet know why—the immunity to the original infection becomes weaker and the TB bacteria break out of their original site and go on to develop into full-blown tuberculosis.’
‘And that’s what I’ve got now?’ Mairi asked.
Jess nodded. ‘That’s what you’ve got now.’
Blind panic appeared in Mairi’s eyes as she took this in. ‘Jess, my aunt had to go into a special isolation hospital on the mainland, and she was there for years!’
‘Things are very di
fferent now, Mairi,’ Jess said quickly. ‘In fact, with modern treatment, we can actually stop the progress of TB within a few days of starting treatment, although a complete cure usually takes a bit longer.’
Actually, quite a lot longer, but she saw no need to tell Mairi that. Not when she knew how devastated Mairi was going to be when told that the entire community would have to be screened because she was highly infectious.
‘Ezra, it was awful, really awful,’ Jess said miserably when he returned from his home visits and drove her into town to do their weekly shop. ‘All she kept saying over and over again was that she’d put the lives of the island children at risk, and nothing I said made any difference.’
‘Jess—’
‘I couldn’t even get her to go home,’ she continued, as though he hadn’t spoken. ‘She insisted on being taken into the Sinclair Memorial despite me saying there was no need—’
‘Jess, forget it—at least for the rest of the day,’ he said gently. ‘You’ve started her treatment and she’ll eventually recover, so there’s nothing else you can do for her at the moment. You’re going to need all your strength once we start sending out screening letters tomorrow, so make the most of the fact you’ve no surgery tonight and try to relax.’
He was right, of course, and she tried—really tried—to do as he suggested, showing an interest in the food he bought, the meals he was planning for the week ahead, but it was a relief when he suggested she wait by the car while he and Nazir packed all their groceries into carrier bags.
How many tuberculin tests could they reasonably do in a day? One every ten minutes—one every five? But they’d have normal surgeries as well, plus home visits, and then they’d have to wait for the results from the mainland. Thank God for Ezra. If he hadn’t agreed to help, she didn’t know what she would have done.
‘Excuse me, miss?’
Jess turned with a slight frown to see a young man in his mid-twenties gazing at her uncertainly.
‘The man you were just talking to in the shop,’ he continued. ‘You wouldn’t happen to know if his name is Ezra Dunbar, would you?’ She nodded, and his eyes lit up. ‘I thought it was him, but the beard—it completely threw me. Does he live here now, do you know?’
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