A Consultant Beyond Compare

by Joanna Neil

  Katie moved to one side as he swivelled around and started off in her direction. He was a busy man, but he always seemed to be able to find the time to help people with their problems. He was never tense or out of sorts and that was one of his strengths. Even so, there was genuine warmth in the way he had spoken to Sarah and held her, and Katie couldn’t help wondering if he and the nurse were more than just friends. For some reason, the thought was disturbing, and a tight knot formed in her abdomen.

  He glanced at her. ‘Is there any news of Jessica?’

  ‘Yes.’ She straightened her shoulders. ‘She got back to me just a few minutes ago. She said something about missing the bus, but I’ve told her to make her way here to the hospital. She’ll have to wait in the doctors’ lounge and amuse herself for a while until I’m off duty.’

  ‘So, she’s all right. That must be a relief for you.’

  She nodded. ‘It is. I was out of my mind with worry for a while.’

  He frowned. ‘Yes, I could see that you were upset. We should be thankful that it all turned out to be nothing in the end.’ He studied her closely for a moment or two. ‘Did you get the MRI results back for Mrs Clark?’

  Katie sucked in a deep breath at his change of tack. Of course he needed to get back to hospital business as soon as possible. That was how it should be. What else had she expected? He had a department to run, and he couldn’t afford to spend any more time on the difficulties that popped up in her private life.

  ‘Yes, I did. I was just going to show them to you. It looks to me as though there’s an abscess on her spine. It appears to be quite large, and I think that would account for the chest pain she was experiencing. I imagine the abscess must be pressing on a nerve root.’

  ‘That sounds quite likely. Let’s go and take a look at the films.’

  ‘All right.’ They walked over to the light box and Katie displayed the films for him to see. ‘It’s there, around the T4-T5 level,’ Katie observed. ‘If it gets any larger, I’m afraid that it will threaten the spinal cord and she will start to suffer some degree of paralysis or at the very least weakness in her legs. That process already seems to be under way.’

  ‘I agree with you.’ Alex’s expression was grim as he studied the films. ‘It doesn’t bear thinking about what might have happened if you had sent her up to the medical ward. They might have simply accepted the diagnosis of meningitis and by the time they eventually realised otherwise, the damage would have been done and this problem would have been irreversible. Antibiotic cover alone isn’t a particularly satisfactory way of managing situations like these.’

  He turned to give her a sideways look. ‘It just goes to show that you can’t allow yourself to be distracted when you’re on duty.’ His mouth firmed. ‘Having your sister around is a responsibility that you could do without. She’s getting in the way of your ability to do your job.’

  Katie was taken aback by his blunt warning. ‘But I didn’t transfer the patient in the end, did I? Aren’t you judging me a little too harshly—in the same way that you condemn Jessica, too?’

  ‘Am I? You were debating whether to send the woman off to another department. Can’t you admit that you came within a hair’s breadth of doing that? The lesson is that you need to look at all the differentials when you’re dealing with patients, and if your mind is clouded by troubles at home then you might miss something and it could be that the patients are the ones who suffer.’

  ‘Wouldn’t you have agreed to the transfer? I thought we even had a discussion as to whether the MRI was necessary?’

  ‘That’s true, we did, but I wanted to see what you would do. My position here means that I have to oversee what goes on and actually, no, I wouldn’t have agreed to the transfer. I would have carried out other checks first.’

  Katie was in shock. So he had been testing her, and she had been found wanting. It was true that she had been anxious when she had learned that Jessica was not at the activity centre, but she had pulled herself together in time, hadn’t she? Why was he being so hard on her? Did she deserve all this disapproval?

  Her confidence was shot to pieces all over again, but she had no choice but to push her emotions to one side. Her patient’s well-being was at stake and she had to concentrate on that.

  ‘I’ll go and arrange for a neurosurgical consultation,’ she managed. The abscess would need to be drained so that the pressure on the woman’s spine could be alleviated.

  He nodded. ‘The sooner the better.’

  Katie hurried away to make the call. It was becoming clear that Mrs Clark would have to be prepped for surgery and she hoped that the woman hadn’t had anything to eat or drink in the last few hours. Any delay could be dangerous.

  A short time later she called on Sarah to assist in getting her patient ready. ‘She’s going up to operating theatre number two,’ she told the nurse. ‘Will you stay with her? Things have taken a different turn quite suddenly and there may be a lot of questions she still needs to ask.’

  ‘I will.’ Sarah sent Katie a quick look. ‘I couldn’t help hearing some of what Alex was saying to you. I came back to get some papers—I must say I think he was a bit hard on you. You did the right thing in keeping her here and doing an MRI. I’m not so sure that any of the other doctors who took over the case would have picked up on the diagnosis. They would probably have just accepted meningitis and gone with that. Anyway, she’s Colin’s patient, isn’t she? He’s the one who would bear the ultimate responsibility.’

  ‘But the patient is the one who might have spent her life being paralysed,’ Katie said in a low voice. ‘I have to live with that and I can’t help thinking that Alex was right to point it out.’

  ‘Don’t let it get you down.’ Sarah’s gaze was sympathetic. ‘Alex isn’t usually so harsh. It might be that he’s concerned about the new unit. It’s due to open soon and they still haven’t made the decision about who’s going to run it. He has to work out how he’s going to handle things if he does get the job—and live with the aftermath if he doesn’t.’

  ‘I know. Thanks.’ It was good of Sarah to take the time and trouble to try to comfort her, but Katie was desolate. How many more mistakes were going to be laid at her door? She should never have come back into medicine.

  Jessica arrived at the unit a few minutes later. She appeared timid as she crept quietly through the double doors, as though she hoped she wouldn’t be seen. Katie was glancing through a chart that Alex had handed to her, but she looked up as the girl tried to blend in with one of the curtains that separated the main thoroughfare from the annexe.

  ‘There you are,’ Katie said, frowning. ‘I’ve been so worried about you. What happened? How did you come to miss the bus this morning?’

  ‘We—Sophie and I thought we had time to go over to the shop,’ Jessica mumbled. ‘We were going to buy some sweets, but there was a queue and it took longer than we thought. I didn’t ring you because you were at work and I thought you might worry if you knew that I wasn’t at the centre.’ She looked downcast. ‘I’m sorry, Katie, really I am.’

  ‘Couldn’t you have waited for the next bus to come along?’

  Jessica shook her head. ‘We wouldn’t have been there in time for the start of the day’s events. We were supposed to be going on a nature trail, and once we missed that we would have been on our own at the centre.’

  Katie could see the logic in her argument. ‘Stay at the bus stop next time, instead of wandering off to the shop,’ she said, ‘and if anything happens and you don’t get to where you’re supposed to be, give me a call.’ Seeing the girl’s unhappy expression, she relented and gave her a hug. ‘I won’t be angry. I just need to know.’

  ‘All right, I will, I promise.’

  ‘Good. Where is your friend, Sophie?’

  ‘She went home.’

  ‘I suppose that’s something at least, and I have you back here safe and sound.’ Katie glanced at the watch on her wrist. ‘There’s still some time left before the en
d of my shift. Have you had anything to eat?’

  Jessica shook her head. ‘No—well, except for a burger earlier on. I’m starving. When we realised we’d miss the bus, we walked around town for a while, and then we went to a burger stand and sat in the town square to eat.’

  ‘Go along to the hospital café and get yourself something,’ Katie said. ‘Then come back here and I’ll show you into the doctors’ lounge. You can sit in there for a while and wait for me.’

  Jessica smiled. ‘Thanks, Katie. I didn’t mean to cause any trouble, honestly.’ She made a face. ‘If this had happened with Dad around, he’d have gone mad. His temper’s awesome. I’m so glad you’re not like him.’

  Katie’s lips flattened. ‘Just don’t test me to the limit,’ she said, ‘or you might find that my nerves can be on edge, too. Now, I have to get on, so off you go to the café.’

  Jessica didn’t need a second bidding. She shot off in the direction of the restaurant and Katie went to find her patient.

  She discovered that Alex was waiting for her by the treatment-room door, and she approached him cautiously. What now? Was she in more trouble?

  He said quietly, ‘I saw that Jessica arrived. Is everything all right with her?’

  Katie nodded. ‘It was nothing out of the ordinary. She and her friend missed the bus because they were messing about and then they were afraid to let anyone know what had happened.’

  ‘Worry over, then. That’s good.’ He waved a hand towards the treatment room. ‘Would you mind if I come in with you while you take a look at this patient? She’s a young woman who has already been seen by one of the medical students. He did a physical examination and because her heart rate is faster than it should be he wants to check her out for heart problems. She’s been complaining of dull back pain, nausea, neck pain and headache.’

  A second patient with back pain? Katie glanced at him warily. ‘Is this another test?’

  He shook his head and gave a wry smile. ‘No, you can relax. I just want your opinion.’

  Was he joking? Somehow she didn’t feel in the least able to relax around him. She was churned up inside, filled with conflicting emotions as far as he was concerned. What was she to make of him? He was a strange mix, a vital, energetic version of the boy she had known all those years ago and an authoritative, powerful consultant in charge of a lively, growing emergency unit. She wasn’t at all sure how to react to him now that he was her boss.

  ‘All right, then. Shall we go in?’ She found it hard to accept that he had no ulterior motive, but she could hardly refuse his request, could she? Katie pushed open the door and he followed her into the room.

  ‘Hello, Jenny,’ she greeted the patient. The girl was in her early twenties and dark-haired. She looked distinctly unwell. ‘I hear that you’ve been feeling poorly for quite some time.’

  ‘Yes, I have, but it’s my back that’s bothering me.’ Jenny flopped back against her pillows in agitation. ‘The pain is much worse today. It’s really getting me down. I feel worn out.’ The young woman looked flushed and uncomfortable.

  ‘That’s understandable,’ Katie murmured. ‘Your heart rate is very fast and prolonged episodes of pain can certainly make you feel wretched.’ She glanced down at her notes. ‘It says here that you had thyroid surgery a few months ago.’

  ‘Yes, I did.’ The woman moved restlessly. ‘The other doctor said that everything had healed up well.’ She looked up at Katie. ‘Do you know what’s wrong with me?’

  ‘I’m working on it,’ Katie said with a smile. She glanced at Alex. ‘Are the blood-test results back from the lab?’

  ‘Not yet.’

  ‘I’ll give them a ring,’ Katie said. ‘They might have them now.’

  She went to the side of the room to make the call. As she waited for the lab technician to find the paperwork, she saw that Alex had drawn up a chair alongside the bed and was chatting to the girl in a friendly fashion. He managed to make her smile, and Katie wondered at his ability to charm everyone around him.

  A minute or two later Katie went to join him at the bedside. ‘Your blood tests show a low level of calcium,’ she told Jenny. ‘I think what’s happened is that since your thyroid surgery the levels of parathyroid hormone in your body have fallen, and in turn your blood calcium level is lower than it should be. That’s why you’re having so many uncomfortable symptoms. We should be able to sort that out for you quite easily by prescribing you some tablets.’

  Jenny’s face lit up. ‘You can? That’s wonderful.’

  Katie was pleased that she had managed to get to the bottom of the problem. When she left the room with Alex a few minutes later, he said, ‘I thought you handled that very well. It was good that you took the initiative and phoned for the results instead of keeping her in suspense.’

  ‘Does that mean that I’ve managed to redeem myself?’ Her expression was bemused. ‘After what happened this morning, I wondered if I might be on my way to looking for another job in the near future.’

  ‘That is very unlikely, isn’t it?’ He gave her a quizzical look. ‘You signed a contract, didn’t you?’

  ‘But it only lasts for a few months. When it comes to an end, I’m going to be faced with the dilemma of whether or not I’ll be kept on.’ She studied him from under her lashes. ‘Isn’t that why you were watching me…to see if I make any mistakes?’

  ‘That’s not the case at all.’ He walked with her over to the central desk.

  ‘Isn’t it?’ She wasn’t convinced. ‘Weren’t you keeping an eye on me earlier to see if I was about to mess things up?’

  His glance flitted over her. ‘You really need to have more faith in yourself and your abilities. I think you might have misunderstood my intentions. I wasn’t putting you on trial earlier, or trying to catch you out in any way. I wanted you to work things out for yourself. Afterwards, I was pointing out that if you come to a situation where something bothers you, and threatens to get in the way of you doing your job properly, you need to be able to admit to it and hand over to someone else. No one will think any less of you, but you can’t give your best to patients when you’re under stress.’

  ‘Oh, I see.’ She blinked. ‘At least, I think I do…’

  He laid a hand on her shoulder. ‘Katie, you have to understand that for the most part I trust your judgement, and it occurred to me that if things work out well, you might be considered as someone who could mentor individual medical students. We’re always looking for good, skilled doctors who can provide extra support for others throughout their training.’

  Her brows lifted in astonishment. ‘I had no idea. I thought I was in big trouble.’

  His palm slid down over her bare arm in a silken caress. ‘It’s time that you start to believe in yourself. I don’t know what happened to make you feel this way, but you can’t simply crumble at every hint of criticism. Can’t you tell me what went wrong to make you so anxious about doing your job?’

  Katie pulled in a quick breath. Her mind was racing. Should she tell him what had happened at her former hospital? How would he look on her if she did that? Would he ignore her side of the story and simply condemn her? She couldn’t bear it if he did that.

  ‘Working in A and E is such a huge responsibility,’ she said huskily. ‘All day long we’re making life and death decisions. I think the strain was too much for me.’

  ‘You’re not on your own, Katie. You should remember that. There’s always going to be someone who will support you and help you to work through any worries you have. As for me, I’m your supervisor, but I hope I’m a lot more to you than that…we can’t simply ignore the friendship we had in the past, can we?’ His grey-blue glance meshed with hers. ‘We shared the bad times together and came through them unscathed, so surely we can face up to the future without falling apart?’

  ‘I suppose so.’ His hand on her arm was warm and supportive, drawing her near to him so that she was breathtakingly conscious of his long body next to hers. He was strong a
nd supple, full of vibrant energy, and more than anything she wanted to stay by his side, caught up in his warm embrace.

  ‘I think you need cheering up,’ he murmured, his gaze drifting over her. ‘You’ll be off duty tomorrow, won’t you? We could take a boat trip out on Lake Windermere, if you like. The weather’s been beautiful these last few days and it’s forecast to go on being sunny and warm, so we could take advantage of it. I’m sure it would do you good to leave this place behind you for a while.’

  She drew in a quick breath, startled by his spontaneous invitation. It was a tempting thought—that she might seize the chance to spend a few hours with him, enjoying the fresh air and sunshine without a care in the world.

  ‘That’s a lovely idea,’ she said softly, ‘only I don’t think I can go along with it. I have Jessica living with me now. I have to fit my life around her.’

  ‘Won’t she be going off on one of her organised days out?’

  ‘No. We only arrange those for when I’m at work. The rest of the time we like to spend together. I want to make up to her for the times when she felt alone.’

  He was thoughtful for a second or two. ‘Well, it’s no problem. We’ll all go. We could go on board one of the steamboats and take a leisurely trip along the length of the lake. We could even get something to eat and drink while we’re on board.’ He looked at her, his eyes wide and dancing with light. ‘What do you think?’

  When he gazed at her that way, she felt her insides go into meltdown, and she smiled up at him. ‘I’d like that. I’m sure Jessica will, too.’

  He looked pleased with himself. ‘I’ll call for you in the morning, around 11 o’clock, if that’s all right with you?’

  ‘That’s fine.’

  Alex was as good as his word, and arrived some fifteen minutes early. Jessica was still in the process of getting ready for their day out, but Katie had everything in hand and was in the middle of watering the plants in the garden when she heard his car pull up.