Fern hadn’t. She’d sat in the back seat with her young neighbour, holding the mask and attempting reassurance, and all the while asking herself what could be wrong.
Bill was three years younger than Fern but she knew him well. He’d always had asthma but it hadn’t seemed to slow him down. He played football and cricket and put in a hard day’s labour with the best of them. Now, though…
Now Bill’s big frame seemed to have shrunk. Fern’s arm was around his chest, supporting him, and it seemed that he must have shed almost half his weight.
Pneumonia…This weight loss didn’t fit with one bout of pneumonia and then a relapse. It was more typical of terminal cancer.
Quinn would have eluded cancer-surely. So what was going on?
Legionella? AIDS? Psittacosis?
He didn’t seem a candidate for any of those things-but who knew?
Possible diagnoses were still running through her head as the car screeched to a halt and Quinn hauled open the back door.
He had oxygen ready. Quinn’s mask replaced Fern’s in seconds and Fern moved swiftly to assist in lifting the absurdly light farmer to a stretcher.
She’d have to stay. A quick glance at Quinn had found his face grim and drawn and maybe she had something to do with that but the situation Quinn was facing with Bill was enough to make any doctor look grim.
This was no ordinary asthma attack.
For the first time, Fern found herself feeling what it must be like to be a lone doctor in a place like this. There was no fall-back position at all-except for a plane to take patients to the mainland in dire emergencies. The plane couldn’t get here for hours and even then patients could choose not to go. Many of the islanders chose just that.
Like Aunt Maud…
‘I’ll live and die on the island, thank you very much. I don’t want mainlanders muddling my insides with heaven knows what.’
How many times had Fern heard words like that from elderly islanders, even when there was no doctor on the island at all.
Quinn Gallagher was therefore a heaven-sent blessing for the islanders. Even if he was a toad, at least he was a medically competent toad.
‘What’s happening here?’ Fern asked softly as together they pushed the trolley down the corridor. ‘Do you have any idea what’s going on?’
Quinn glanced down at Bill and his face set, if possible growing even grimmer. ‘God knows,’ he said frankly. ‘Bill’s been ill for months-though never so critically as this. I’d appreciate a bit of your time here, Dr Rycroft.’
She couldn’t refuse. Given the same scenario, Fern would be terrified.
A critically ill man with no clear diagnosis…
In Sydney she’d call in the big guns. The top physicians.
Here there was Quinn and Fern.
‘I’ll wait for you outside, Fern,’ Al said unsteadily. Fern’s uncle had been steering at the foot of the stretcher while Fern walked beside Quinn at the head. At the door to the ward he stopped dead.
‘No need. I’ll run Fern home-or one of the nurses will,’ Quinn said shortly, and Al cast Quinn a look of real gratitude.
He’d done his duty. Now he wanted out.
Fern couldn’t protest She couldn’t be concerned that she was forced to spend yet more time with Quinn Gallagher.
The tension between Fern and Quinn had to be put aside. Bill’s needs took precedence. He was losing ground. Even after five minutes of oxygen the young farmer appeared cyanosed and limp.
‘Adrenaline, I think,’ Quinn muttered, his hands already adjusting tubing.
‘I’ll do it.’
Thankfully, emergency trays were set up the same everywhere. Whoever had set the standards knew what they were doing. It meant that a doctor strange to a hospital could work at almost maximum efficiency straight away.
She reached for the syringe and her uncle blenched.
‘See you at home, Fern,’ Al muttered and bolted.
Fern’s escape route was cut.
Fern had to fight an almost overwhelming urge to bolt right after her uncle.
She had to stay. She and Quinn were Bill’s lifeline.
She had no choice.
It was a good two hours before Bill decided to live-for the moment-and at the end of that time Fern was exhausted. Her skills had been stretched to the limit and the fact that Bill was a childhood friend didn’t help one bit.
Finally, Bill drifted into a near-normal sleep, his breath still rasping and laboured but at least it was steady.
‘For now,’ Quinn said bitterly as they left the ward. The night sister was sitting by the bed and would stay there until morning. ‘The pneumonia’s obviously taken hold again-but why? Why?’
They were walking slowly down the corridor together, the tension between them put aside as both concentrated on Bill’s plight.
‘Malignancy?’ Fern suggested and Quinn shook his head.
‘There’s no sign. When Bill started losing weight I persuaded him to spend a couple of days in Sydney. I gave the radiologists carte blanche to find anything-and there was nothing. The antibiotic stops the pneumonia but this is the third bout he’s had. There has to be an underlying cause.’
He paused and dug his hands deep in his pockets. The lights in the corridor were dimmed but the strain around Quinn’s eyes was still obvious. He looked exhausted, Fern thought, her image of the indefatigable Dr Gallagher who never needed sleep fading fast. Now he leaned back against the corridor wall and ran his hand through his hair in a gesture of absolute exhaustion.
‘When Bill was in Sydney I had a physician look at him,’ Quinn continued. ‘He suggested Bill’s only problem was mycoplasma pneumonia and I hadn’t left him on antibiotics long enough the last time he’d had it. He’s been on antibiotics almost continually since then, though, and here he is crook again. I guess…I guess I should send him back to Sydney. Trouble is, I reckon the next we’ll hear of Bill will be of his death. The Sydney physicians don’t seem to have any more of a clue than I have.’
And his death would hurt, Fern knew, looking up at Quinn’s defeated face. This man might be a cheat to the women in his life but there was no doubting that he was a caring doctor.
He was worried sick now.
‘What’s causing the haemoptysis?’ she asked slowly. The plugs of bloody phlegm Bill was coughing were not normal for straight pneumonia.
‘The coughing might be causing it-or the continued infection.’ Quinn shrugged. ‘His cough’s so dry and consistent that he could be breaking small blood vessels. There hasn’t been much haemoptysis till now.’
‘There was a fair bit tonight.’ Fern frowned. ‘You’ve excluded things like AIDS?’
‘Of course.’ Quinn wasn’t offended. He seemed almost grateful to go through the options with another doctor and Fern knew how he was feeling. There was nothing worse than not knowing what was wrong when you were the only one qualified to do anything about it.
Quinn lifted a hand and wearily counted on his fingers. ‘It’s not HIV, or Q fever, or legionella or psittacosis. A CT scan of the thorax and abdomen were normal. Mycoplasma and Brucella serology were normal. He’s been on Aminophylline twice a day and bronchodilator and steroid inhalers for his asthma, and until six months ago his asthma was well controlled. It certainly isn’t now. He’s lost over four stone and is still losing. His sputum grows only a light growth of beta haemolytic Strep Group D and at last count his white cells were 7.38.’
Fern stared. For a country GP without specialist internal medicine training, Quinn’s search for a diagnosis was impressive.
But not conclusive.
There had to be something else.
‘Have you excluded TB?’ asked Fern thoughtfully. TB was rare in this country now-but not unheard-of. Mostly it occurred in migrants coming from more heavily infested areas, in AIDS sufferers or in elderly derelicts whose general poor health made then susceptible. Bill was certainly none of these.
‘His Mantoux test showed a positive
response,’ Quinn told her. ‘But we’ve sent off pleural aspirate for cytology with negative results. Pleural biopsy, bronchoscopy and bronchial washings have all shown nothing. If I send him to Sydney now, the hospital’s going to waste time repeating all those tests and meanwhile…’
‘Meanwhile he’ll be dead,’ Fern said brutally. ‘We’ve run out of time for tests.’
‘Bill’s run out of time for living, then.’
‘Maybe.’
Fern scuffed her toe on the polished wood of the corridor, a habit she’d started as a child when she was thinking hard.
Silence.
‘He’s running a fair temperature,’ she said at last.
‘He has all along. Even when we cleared the pneumonia he’s been spiking nocturnal temperatures of thirty nine plus,’ Quinn told her. ‘I saw him the day after your…after your attempt at a wedding…because I was concerned he might have eaten some of those damned oysters.
‘In fact, he hadn’t eaten any because he was feeling off colour, anyway. He hadn’t tried to go to your wedding. I thought his temp was up then-but he wouldn’t come in for a check. Said he was as well as he’d been for a month and he was sick to death of being prodded and poked. I can’t say I blame him.’
‘But his Mantoux test showed positive…’
‘Half the population of the known world shows a positive Mantoux test,’ Quinn said brutally. ‘That doesn’t mean he’s consumptive.’
‘It means TB hasn’t been excluded, though…’
‘The tests were negative…’
‘They often come back with false negatives.’ Fern’s sandal scraped forward and back again. Her personal friction with Quinn was forgotten for the moment. Her mind was all on long-ago lectures.
‘Sometimes asthma treatments can stir up TB,’ she said thoughtfully. ‘It’s been documented.’
‘Yeah?’ Quinn was watching Fern’s face, trying to follow her thought processes. There was no denigration of a junior doctor here. If Fern had an idea that might help, Quinn Gallagher wanted to hear it.
‘It’s true. And somewhere…I remember one of my professors saying over and over, “Never let a patient die with an undiagnosed fever without at least considering TB and a trial of triple therapy”. He was an elderly professor who’d seen a lot of TB-but his advice is still sound. He didn’t trust tests. He trusted what his gut feeling was telling him.’
‘So…’ Quinn was still noncommittal, still watching.
‘So we either give up on Bill and send him to Sydney,’ Fern said. ‘And hope he survives the trip. Or we treat the pneumonia aggressively and at the same time we start him on treatment for TB. My gut feeling’s saying TB and I think we should go with that. We send more pleural fluid for culture but even if that comes back negative we keep him on the regime for a while-just to see.’
‘But if we’re not sure…’
‘Are we sure it’s anything else?’
‘No. But…’
‘Then what’s our choice here, Dr Gallagher?’
Quinn stared at the girl in front of him as if he was seeing her for the first time. Fern’s voice was steady. This was a considered choice and she was ready to accept the consequences if it failed.
‘What on earth’s your training?’ he asked. ‘I asked your aunt if you’d done anaesthetics and she said you’d done a resident rotation-but you don’t talk like any intern I’ve ever met.’
Fern smiled faintly and shook her head. ‘I’m a specialist medical registrar,’ she admitted. ‘I’ve done my first part of internal medicine. In twelve months I’ll be a qualified physician.’
‘A physician…’ Quinn’s eyes widened. ‘For heaven’s sake…’ He shook his head as if in disbelief. ‘You realise-once you’re fully trained-what we could offer here…?’
‘“We”?’
‘“We”,’ Quinn said, his voice firming as the ramifications hit home. ‘Fern, I’m a surgeon and I’m trained for accident and emergencies. You have enough anaesthetic training to support me-and you’re a physician, for heaven’s sake…’
‘Not yet.’
‘No. But if we found a locum to take over here…Dr Rycroft, all we lack is an obstetrician. With the hospital already operating and if the job was advertised only for twelve months we’d find a locum to take over from us. There are medicos who’d see twelve months here as a welcome break, as long as they weren’t pressured to stay at the end of it.
‘If we were to spend twelve months in Sydney-you finishing your physician training while I deliver every baby I can get my hands on and getting myself some paediatric training in the process-think of the service we could offer.’
‘And Jessie would come back to Sydney with us while we did it, I suppose?’ Fern said slowly, watching his face.
Quinn shook his head. ‘She’d stay here.’
‘Without her husband?’
The word hit Quinn almost as a physical slap. He took a step back and stared down at Fern.
His burst of enthusiasm faded and fatigue crept back.
‘Jessie wouldn’t mind,’ he said flatly.
‘Well, I’d mind for Jess.’ Somehow Fern made her voice brisk and businesslike but it wasn’t how she was feeling. ‘Do you want help writing up a drug list for Bill?’ she asked harshly. ‘If so, let’s do it and then ask someone to take me home. I really have other things to do than stand in hospital corridors and discuss plans by you to abandon someone who clearly loves you.’
* * *
The drug regime was tricky.
Fern had treated little TB in the past. It took time to sort through the texts and pharmaceutical lists and find just what she wanted.
Quinn deferred to her.
‘If I have a road crash to deal with then I’ll expect you to take orders from me, Dr Rycroft,’ he said brusquely, pointedly formal after Fern’s snapping rebuff. ‘This is internal medicine, though-and I know when to stand aside.’
With his medicine he knew when to stand aside, Fern thought grimly. With little else.
She reacted by ignoring him, preparing her list in grim silence.
Finally she finished and rose from the desk. He was still watching her-as a hungry cat watches a mouse-and Fern didn’t like it one bit.
‘I’ll drive you home,’ he said firmly.
‘And if Bill has a relapse?’
‘I’ll check him on the way but if his breathing’s settled he’s hardly going to wake and choke in the time it takes to get you home. The nurse will stay with him and I have the phone on my belt. I can get back fast.’
‘What about…What about the night sister taking me home-and leaving you here?’
‘What about the night sister?’ Quinn’s brows arched and for a moment Fern saw a trace of the old humour. ‘Sister Haynes doesn’t drive anything more powerful than a bicycle-and Jessie’s asleep. So it’s my offer or nothing.’
‘I’ll walk.’
‘You want to come peacefully or forcibly?’ Quinn asked politely, and through the exhaustion the laughter was back with a vengeance.
‘Is that a threat?’
‘How can you doubt me, Dr Rycroft?’ Quinn demanded, wounded that she had so little faith. ‘Of course it is.’
* * *
It was a charmed night.
If the island didn’t get rain soon the farmers would be in serious trouble, Fern knew, but it was hard to think about that on a night as perfect as tonight.
If Quinn wasn’t married it would be magic indeed.
Quinn was married, though. Fern sat as far away from him as possible, hunched over against the door as if she was afraid.
She was.
She was afraid of her own feelings. She’d never felt like this about a man before and to feel this way about someone who was living with his wife…
Quinn stayed silent, his face set and grim. From time to time he glanced across at the girl by his side but he said nothing until he pulled to a halt outside her uncle’s house and Fern put her hand on the doorhan
dle.
The doorhandle wouldn’t budge. The central locking had been activated.
‘Do you mind?’ Fern said icily. ‘Let me out.’
‘Not until you’ve talked things through with me for a little.’ Quinn glanced at his watch. ‘Fern, hear me out. I can’t be away from the hospital for long. You know that. I’m not about to make love to you-though God knows I want to. If I did you could scream loud enough from here to make your uncle hear. I just want to talk.’
Fern took a deep breath. Her fingers clenched into her palms.
‘So talk.’
‘That’s what I like about you, Dr Rycroft,’ Quinn said evenly, the laughter surfacing. ‘You’re always so amenable to suggestion.’
‘Just get on with it.’
He didn’t.
Instead, Quinn put his hands on the steering wheel and stared out into the night.
The laughter faded.
It was as if Quinn Gallagher was fighting some unpleasant internal battle and Fern just had to wait for the outcome.
She watched him and her anger slowly disappeared as she did. Fern’s fingers unclenched. She didn’t know what was going on-but she couldn’t maintain rage against this man. No matter how important it was that she did…
‘Fern, I want you to reconsider staying on the island,’ Quinn said at last. ‘It makes sense to everyone that you stay. Most of all, it makes sense to me.’
‘Not to me it doesn’t.’
‘Would it make a difference if I told you I’d fallen in love with you?’
Quinn didn’t turn to her. His eyes were still staring out through the windscreen at the black of the night road. ‘I fell for a bride in white satin,’ he went on softly, and it was as if he was talking to the night-not to Fern. ‘The most frightened bride I’ve ever seen, and the most beautiful. I was hit by bridal fever, you might say. It hit hard and since then I’ve been trying to find a cure. There isn’t one.’
‘I don’t believe you,’ Fern whispered. ‘You don’t fall in love like that.’
‘Oh, yes, you do,’ Quinn said grimly. ‘I didn’t ask for it to happen. I went to your wedding out of social obligation to your aunt and uncle-nothing else-and then I saw you…’
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