Rescuing Dr Ryan

by Caroline Anderson

  'Yes.' She coughed convulsively, and Lucie frowned. She'd already noticed that the teenager had been short of breath when they'd come in, and, unlike her other practice, there were no stairs here to blame!

  'Tell me what seems to be wrong,' she coaxed, but the mother butted in again.

  'She should have gone back to school today, but she's been flopping about and coughing for the last week, and she's got exams coming up—she's doing her GCSEs and she can't afford to have time off!'

  'So what's the matter, Clare?' Lucie asked again. 'Tell me in what way you aren't feeling quite right.'

  'My cough,' she began.

  'She's not eating. She's starving herself to death— I think she's got anorexia or something. I think the cough is just a big put-on, but if you give her antibiotics she won't have any excuse, she won't be able to swing the lead. I've given her a good talking-to about this eating business. Dr Ryan, you tell her.'

  Will shook his head and smiled. 'Dr Compton is quite capable of making a diagnosis, Mrs Reid. We'll let her see what she comes up with first, shall we?'

  Lucie felt like a bug under a microscope. Will had thrown his support behind her, but almost in the form of a challenge, and now she had to find something wrong. She was just warming up to her 'we can't give out antibiotics like sweets' talk, when Clare coughed again.

  Listen to her chest, her common sense advised, and, to her huge relief, there was a crackle. Her face broke into a broad smile. 'There's your answer -- she's got a chest infection. No anorexia, no skiving, just a genuine sick girl who needs antibiotics.'

  'Well, that was easy. I thought you didn't dish them out these days?' Mrs Reid said sceptically, looking to Will for reassurance.

  'Only when necessary,' Lucie confirmed, 'and with all those crackles in her chest, trust me, it's necessary. It sounds like someone eating a packet of crisps in there.'

  Clare giggled, clearly relieved to have been taken seriously, and Lucie smiled at her. 'You'll soon feel better. You need to rest, drink lots and get back to school as soon as you feel right. When do you do your exams, is it this year or next?'

  'Next year, the real thing, but we've got end-of-year ones coming up after half-term, and Dad'll kill me if I don't do well.' She pulled a face. 'He's a teacher.'

  Lucie laughed. 'I know the feeling. My father's a teacher, too. He used to look at me over his half-glasses and say, "You don't seem to be doing very much homework these days." It drove me nuts— especially as I was working my socks off!'

  'I bet he's pleased with you now, though,' Clare said thoughtfully. 'I want to be a doctor, too, but I don't know if I'm clever enough.'

  'You know, there are lots of things you can do apart from medicine in the medical field. Wait and see how it pans out. Your grades might be good enough, and if not, there are lots of other options.'

  Will cleared his throat quietly in the background, and Lucie looked at him. He was staring pointedly at the clock on the wall, and she gulped guiltily and brought up the girl's details on the computer, printed off her prescription and sent her and her over-anxious mother away.

  Then she sat back and waited for the lecture.

  He said nothing.

  She looked at him. 'Aren't you going to criticise me?'

  He smiled smugly and shook his head. 'Oh, yes— but later. I think your next patient has had to wait quite long enough, don't you?'

  She stifled the urge to hit him.

  CHAPTER THREE

  It was lunchtime. Apart from Clare, her first case, she had seen another fifteen patients that morning— and overrun surgery by an hour.

  Now they were going on visits and, because she didn't know the way, Will was having to direct her.

  Which meant, of course, that his mouth was busy with 'Turn left, go up there, it's on the right,' instead of 'Why didn't you do such and such?'. That was a huge relief to Lucie, who was coping—just—with his presence, without the added burden of her sins being heaped upon her head.

  Actually she thought the surgery had gone quite well, but several times she'd caught Will rolling his eyes in the background or flicking glances at the clock. Had he been able to write, she knew he would have been making copious notes on her abysmal performance.

  Tough. Anyway, it wasn't abysmal. Just a tad slow. She told herself it was because she was being thorough.

  'Go along that road there to the end,' he instructed. 'It's the white house near the corner.'

  There were two white houses near the corner. Of course she pulled up outside the wrong one, and couldn't resist the smirk of satisfaction when he objected.

  He heaved a sigh, went to stab his hand through his hair and clonked his head with the cast.

  'You should have a sling on,' she reminded him.

  'I don't like slings. They mess my neck up.'

  'Your hand will swell.'

  'That's fine, there's room, it's still got the back-slab on.'

  'Only because you won't wear a sling!'

  Will turned to her, his eyes flying sparks. 'Lucie, it's my arm. If I don't want to wear a sling, I won't wear a sling. I most particularly won't wear two slings. And I won't be nagged by a junior doctor that I'm training!'

  'I am not a junior doctor,' she bit out through clenched teeth. 'I am a registrar. I am not a complete incompetent, whatever you might think, and how you got the job of trainer I can't imagine. You're patronising, unfairly critical and judgmental.'

  'I haven't said a word—'

  'Yet! No doubt it's coming.'

  He sat back and studied her curiously. 'So what did you think you did wrong this morning?' he asked with studied calm.

  'Apart from breathe?' Lucie muttered under her breath. 'Overran the surgery time.'

  'What else?'

  'Nothing,' she said defensively.

  'I would have got a sputum sample from Clare to make sure she'd got the right antibiotic.'

  Oh, would he? Damn. He was right, and she would have done if he hadn't put her off by clearing his throat pointedly and looking at the clock. She wondered if Clare had taken the first dose yet, or if she should ring—

  'I've rung and ordered it. They'll pick the pot up before she takes the first dose,' Will added, as if he'd read her mind. 'They live very close to the surgery. What else?'

  She stuffed her irritation into a mental pending tray to deal with later and scanned through her morning list. 'That man with indigestion-like pain—'

  'Mr Gregory.'

  'Yes. He's obese.'

  'Actually, technically he's just overweight. His body mass index is 29.4. He's working on getting it down, but he's aiming for a 10 kg weight loss. That's probably why he's got indigestion. Faddy diets and varied eating habits can cause that.'

  'It would have been helpful to know that before the consultation. I was wondering about the choice between angina and Helicobacter pylori, and it's probably just too much cucumber!'

  A flicker of guilt came and went in his eyes. 'Sorry. It's the painkillers. I'm not really concentrating. You're right.'

  Lucie's jaw nearly dropped. An apology? Good grief, wonders will never cease, she thought.

  'Since you're on a roll, I don't suppose you want to apologise for that remark about licking the bricks, do you?' she challenged, pushing her luck.

  He smiled. It was a dangerous, predatory smile. 'Not really,' he said, and opened the car door with a wince. 'Let's get on or we'll be late.'

  'So, are you going to tell me about this patient, or let me go in blind?' she asked his retreating form.

  He sat back, letting the door fall shut and looking at her over his shoulder. 'He's fifty-five or so, he's had a heart attack, he's been under a cardiologist but cancelled his follow-up appointment on a flimsy pretext. I reckon he's in line for bypass surgery but he won't stick to a diet or exercise programme and he keeps getting chest pain. This is just a routine check-up. I suggest you take routine obs while I talk.'

  'I thought I was taking on your patients?' she objected, but
he shook his head.

  'Not this one. His wife's too nice—she doesn't deserve all this worry. She needs moral support.'

  'And I can't give it?'

  'Not like I can. I've known her for years,' he pointed out fairly.

  'Not that many, Old Father Time. How old are you?'

  He shot her a grin. 'I've been here six years. We've gone through the menopause together, Pam and I. I know her well, trust me.'

  She gave a quiet and not very ladylike snort as he got out of the car. Retrieving her bag from the back, she locked the car and followed him across the road.

  A woman was standing in the front garden of the other white house, stripping off bright yellow rubber gloves, and he bent and kissed her cheek. 'Hello, Pam,' he said gently. 'How are things?'

  She rolled her eyes despairingly, then shot him a keen look. 'Never mind me—is that a cast on your arm? And a bandage on the other one—what on earth have you been up to?'

  He told her the story, played down the drama and played up the farce, and introduced Lucie as the cavalry. 'Very timely arrival, although, of course, if she hadn't been coming I wouldn't have been mending the roof of the cottage and I wouldn't have been up the ladder, so in a way it's her fault.'

  'That's right, blame me,' Lucie said, rolling her eyes and laughing. 'Although as I remember it, you were rescuing the cat, actually.'

  'She's doing all the physical stuff for me, I'm doing the talking,' Will explained, cutting her off with a grin. 'She's our new trainee registrar.'

  'Are you? Poor you,' Pam said comfortingly. 'He can be a bit of a slave-driver, I gather. His last one left in a hurry.'

  'His last one was useless,' Will pointed out fast. 'Don't slag me off, Pam, she already thinks I've got a broomstick stashed in the barn.'

  'Yes—a Swedish one,' Lucie chipped in. 'Estate version.'

  He laughed, not unkindly. 'It's a lovely car.'

  'It's too big.'

  'We're using it tomorrow. That thing of yours gives me backache and cramp.'

  'Poor baby.'

  Pam eyed them with curiosity. 'I think you'll survive, Lucie,' she said consideringly, and smiled at her. 'Welcome to Bredford.'

  'Thank you.' She returned the smile, comforted that at least someone was going to be on her side, and followed them in.

  Their patient was sitting in an upright chair, a folded newspaper on the floor at his side and a cup of what looked like very strong coffee on the table next to him.

  'Hello, Dick,' Will said easily, perching on the sofa near their patient's chair. 'I won't shake hands, I've mashed myself. This Is Lucie Compton, my new registrar.'

  Lucie shook hands with him, noticing the pallor of his skin except for the high flush over his nose and cheekbones, and wondered just how bad his heart condition was.

  'Lucie, why don't you run the ruler over him while we chat, to save time?' Will suggested, and she opened her bag and took out her stethoscope, listening to the patient's chest first to hear his heart.

  It was a little irregular, but without an ECG it was difficult to tell what was wrong about it. His chest was clear, at least. She took his pulse and respiration, while Will propped his arms on his knees and smiled at Dick encouragingly. 'So, tell me, how are you doing?'

  'Oh, not so bad.'

  'He's been getting chest pain.'

  Will looked from Dick to Pam and back again. 'On exertion, or at rest?'

  'At night. At least, that's when I know about it,' Pam confirmed.

  Will nodded. 'And how about the daytime, Dick? Anything then?'

  The man shrugged. 'Off and on.'

  'Are you taking the pills?'

  'Yes.'

  'No.'

  Will's eyes flicked to Pam again. 'He's not?'

  She shook her head. 'Not always. Not unless I nag him.'

  'Which she does all the time, of course,' Dick put in with a rueful, indulgent smile. 'Oh, I don't know, Will, I just feel there's no point. I'm a great believer in Fate. If my number's up, it's up. I'm not going to bugger up the rest of my life taking pills and watching what I eat and drink. It's like the old joke about giving up drinking, women and red meat. It doesn't make you live longer, it just feels that way!'

  Will chuckled obediently, and glanced at Pam again. 'I wouldn't suggest you give up women—at least, not this one. She's a star. But the food and drink are real issues, Dick. The next step down the line for you could be bypass surgery, and you really owe it to yourself to be as fit as possible for it.'

  'Oh, I know. You're going to tell me to lay off the booze, cut my fat intake and get off my backside and walk two miles a day, aren't you?'

  'Something like that. Sounds as if you've heard it before somewhere. And while we're at it, I'll throw in caffeine. Decaff tea and coffee, please.'

  Lucie bent down to her bag to remove the blood-pressure cuff, and hid a smile. Dick curled his lip. 'Decaff? Filthy stuff.'

  'Rubbish. You can't tell the difference.'

  'I can.'

  'So drink fruit teas or orange juice.'

  Will was treated to another withering look. 'Fruit teas,' Dick said disgustedly.

  'Unlaced.'

  He shook his head slowly. 'You're a hard man.'

  'I'm trying to keep you alive. No point in dying on the waiting list, Dick—always assuming you ever get on it. Have you made another appointment yet?'

  Something flickered in Dick's eyes—something that could have been fear.

  'Not yet. Keep forgetting.'

  Lucie slipped the blood-pressure cuff off his arm and chipped in.

  'A patient at my last practice had a by-pass op. He felt like you—what was the point? If it was going to get him, there was no point in worrying. He felt so much better after the op, he realised it had been worth worrying about. I had a letter from him the other day. He's taken early retirement, moved to the country and started playing golf, and he feels great. He's lost two stone, he's fitter than he's been for years and he says there's a twinkle in his wife's eye that's been missing for ages.'

  Dick moistened his lips and cleared his throat. 'He feels better?'

  'Yes. He felt better straight away. His chest was a bit sore for a while, of course, but he said the hospital were excellent and it was more than worth it. He sent me a photo—he looks terrific. Why don't you give it the benefit of the doubt and find out more?'

  He looked thoughtful, and Lucie put the rest of her equipment away and straightened up. 'That all seems OK,' she said to Will. 'Anything else you want me to check?'

  He shook his head and stood up. 'Listen to us, Dick. We aren't all telling you the same thing by coincidence, you know. Give it a whirl.'

  Dick nodded grudgingly, and Will looked at Pam. 'Your garden's looking good. You must show me round it on the way out—I want to see your osteo-spermums. I can't believe you overwinter them outside. Mine all die without fail.'

  Gardening already, for heaven's sake! Lucie cleared her throat, and glanced pointedly at her watch. Will ignored her.

  'I've got some cuttings I've done for you—come down to the greenhouse and I'll give them to you,' Pam was saying.

  'You're a marvel.'

  Lucie sighed. 'I'll wait here,' she said, and sat down again with Dick. Maybe she could spend the time usefully after all...

  For a moment he didn't speak, then he looked at her searchingly. 'Now tell me the truth. How much will it hurt after the op?'

  Right for the jugular. 'A lot,' she said honestly, 'but less than another heart attack. The breastbone is the worst bit, and the leg can be quite sore for a few days, apparently, but they give you pain relief intravenously, and you have control over that. If it hurts, you can give yourself a shot, and it really does make it bearable. Everyone who's had it says it's worth it.'

  He nodded, and licked his lips nervously. 'I'm scared,! he confessed. 'I can't tell Pam—seems so silly, really, to be afraid of pain, but I've never been good with it, Pam wants me to have it done privately to cut the waiting time, b
ut I don't want to, even though we've got private health insurance as part of my work package. I suppose there's a bit of me that would rather wait longer and maybe die, so I don't have to deal with it. Does that seem strange to you?'

  Lucie shook her head and smiled. 'No. Quite normal. Most people aren't afraid of being dead. They're afraid of suffering. I think you're actually very ordinary like that. Nobody likes pain. The thing is, if you have another heart attack, there's no guarantee it will kill you, but it will make you less well for the operation and it will, of course, be very painful in itself. I think at the very least you should see a cardiologist and discuss it.'

  'I just—it scares me.'

  'I take it you've had an angiogram and aren't suitable for balloon angioplasty?' she said as an afterthought.

  He shook his head. 'No. They were talking about it, but I didn't know what it was.'

  'So ask.'

  'Everyone's always busy.'

  Lucie smiled. 'That's life for you. An angiogram is a diagnostic image of the heart with radio-opaque dye injected into the coronary arteries, so they can see just where the arteries are clogging.'

  'Oh, I had that. I never got the results, though I thought you meant the other thing. The pasty thing.'

  'Plasty. Angioplasty. If you're a suitable candidate, there's always the possibility that you won't have to have bypass surgery. Lots of people have balloon angioplasty instead. That's where they stick a little inflatable catheter in through a nick in the groin, track it with X-rays until it's in the right place and inflate it. It stretches the arteries and relieves the narrow point, if it's just one small constriction. And, of course, until you get the results of the angiogram, you won't know.'

  Dick nodded. 'You're right, of course. I'll go back. I will. Thanks.'

  'My pleasure. Have you got a computer? If you have, you could find out more about it on the internet. It's brilliant for things like that.' Lucie stood up. 'You will keep the appointment this time, won't you? It can't hurt to find out, and even if you ended up with surgery, you could have a whole new life ahead of you. Think of all the years you've worked, just to throw it all away before you retire.' She glanced at her watch again. 'I must go—we've got lots of other visits to do yet and I'm already running behind. It's only my first day.'