A Consultant Beyond Compare

by Joanna Neil

  ‘So where is she today?’

  ‘She went into town with Sophie and another girl. I gave her money to buy clothes, so I expect she’ll be having a wonderful time.’

  He frowned. ‘Isn’t it her parents’ job to do that?’

  ‘Perhaps it is. My mother keeps saying she’ll send some money for her, but then she forgets. It doesn’t matter. She seems to have a lot on her mind right now. My stepfather is stressed because redundancies are in the air at work and he’s worried about whether he’ll be able to keep his job. They’re trying to work things out. Having my sister stay with me is giving Jessica a break from all the tension in the air, and it’s probably giving my parents the chance to sort themselves out, too.’

  ‘But you’re the one who’s having to take the strain. It can’t be easy for you. You must have come to the Lake District in order to set up a home for yourself and enjoy your independence, but that’s all changed now, hasn’t it?’

  ‘I don’t see it the way you do. I never intended to walk away from my sister or my parents.’ She studied him, trying to understand what made him tick. ‘You’re not a family person at all, are you? I can’t imagine what it would be like to have no family to gather around me. It seems terribly sad to me that you missed out on all that.’

  ‘Not really.’ He stopped to take a mouthful of apple pie and added, ‘You make it sound as though family is everything and that life without them is the worst thing you could imagine, but families can be trouble. I’ve seen what happens. People fight among themselves, they can be selfish and pick faults and complain if things don’t go their way. Like Jessica, each person has their own idea about how things should be, and it’s not always easy to keep everyone happy at the same time. I’m glad I don’t have to deal with all that.’

  Katie frowned. ‘I don’t really know what the matter was with Jessica. She isn’t usually like that. Perhaps she was still a little bit troubled about what’s been going on back home and she might have been wishing that it could all be resolved. I thought she would love the boat trip, and I know she enjoyed it, but she’s been in a bit of a strange mood ever since we came home.’ Katie took a sip of her ice-cold juice.

  ‘She’s probably just confused. Teenagers have a hard time trying to make sense of the world. They only see things from their own point of view, and perhaps Jessica’s problem is that she wanted to have your attention all to herself.’

  Katie put her glass down and stared at him. ‘I hadn’t thought of that. She seems to cope well enough when I’m out at work.’ Her brows drew together. ‘You’re very astute, aren’t you?’

  ‘Am I?’ He finished off his pie and laid down the spoon, reaching for his coffee cup.

  ‘Oh, yes. You profess not to need people, and you say you’re used to standing alone, but if that’s true, how is it that you understand others so well? With your background, how did you turn out to be so well balanced?’

  He laughed. ‘I’m glad if you think that’s the way I am. All I can say is that I learned about life the hard way. My parents weren’t there for me in the usual sense. They were around physically, but mentally they were in a world of their own a lot of the time. Instead of them looking after me, I was often the one who had to take care of them.’

  Her glance moved over him, her mouth making an odd shape. ‘That must have been hard for you. It was a huge burden for a young child to bear.’

  ‘I didn’t see it that way. I learned to look after myself. It made me stronger, and in the end it was all for the best.’ His gaze captured hers. ‘I’m thankful that I’m not like you, full of angst and concern. Men don’t deal in sentiment, Katie. We just get on with life as it is.’

  ‘Perhaps. I’m not convinced about that.’ She sipped at her fruit juice, looking at him over the rim of her glass. ‘Do you see very much of your mother? I know you said that your visits didn’t always work out too well, but she’s still your mother after all.’

  He nodded. ‘I go and see her every week to make sure that she’s OK. There are times when she seems as though she has things in hand. She was very young when I was born and I think I’m finally beginning to understand what made her the way she is. I’m doing what I can to get her the support that she needs. Up to now, the rehab programmes have only been successful up to a point, but I’m looking for something that will make a more definite change in her life.’

  Katie’s heart warmed to him. There was a lot more to Alex than met the eye. He denied that he had any softer feelings, but she didn’t believe that. His background had led him to grow a tough outer shell, and that was the image he presented to the world. He didn’t want anyone to see what he was really like inside because that might be a sign of weakness and that would never do. He wasn’t even prepared to drop his guard with her.

  ‘I should get back to work,’ he said a few minutes later.

  Katie nodded. ‘I’ll walk with you.’

  Back in A and E, she struggled to put thoughts of Alex out of her mind. She had a long list of patients to see, and thinking about Alex would only get in the way and cloud her judgement.

  ‘Would you have time to look at another patient?’ Sarah asked her some time later. Katie had gone over to the central desk and was signing off on her charts, getting ready for the handover at the end of her shift. Alex was doing much the same thing.

  ‘I know it’s getting late,’ Sarah murmured, ‘but there’s a woman waiting to be seen in treatment room four. She’s been here for quite a while. The registrar was going to take a look at her but he’s been called away to another patient.’

  ‘All right,’ Katie said. ‘I’ll go and see her. What seems to be the problem?’

  ‘She has a bad headache. She seems to be very anxious and is complaining about tenderness in her scalp. Her GP treated her for tension headache earlier, but her husband brought her in to get a second opinion.’

  Sarah turned to Alex. ‘And there’s a patient in the room next door with a wound to his face. Would you have time to take a look at him before you go off duty? I know it’s a bit late to ask, but we’re building up quite a backlog and I think he needs to be seen now.’

  Alex nodded. ‘OK. We were busy dealing with the patients from the traffic accident earlier, so it’s unfortunate that other people have had to wait. Just explain to them that we’ll get round to everyone as soon as possible. The next shift should be able to handle the majority without too much trouble.’

  He put his charts to one side and began to head in the direction of the treatment room. Katie took the patient’s notes that Sarah handed to her and began to study them as she walked alongside him.

  Monica Jenkins, she discovered, was a slender woman in her mid-forties, who appeared to be quite agitated. ‘I can’t get rid of this pain in my head,’ she said. ‘It woke me up this morning and it just won’t go away. I don’t know what to do. This has well and truly stopped me in my tracks. I’ve a thousand and one jobs to be getting on with, and I have the family coming round this weekend for a celebration meal.’

  ‘Do you?’ Katie smiled at her. ‘What’s the occasion?’

  ‘A special wedding anniversary. Some people are coming from miles away, and I’m supposed to be getting rooms ready for them. I can’t afford to have a headache.’

  ‘I can see how all the tension would get to you,’ Katie said. ‘Have you ever suffered from migraines?’

  ‘No. I get the odd headache from time to time, but nothing like this. This is awful and the pain is practically unbearable.’

  Katie began to examine her, checking for signs of neurological change. ‘Have you been feeling sick at all?’

  ‘I was sick just half an hour ago.’

  ‘And is there any neck pain, any problems with your eyes?’

  ‘It hurts if I move my head. It feels as though it’s being held in a clamp.’ Monica slumped back against her pillows. ‘I’m so tired. Could you just give me something for the pain? I took some tablets a few hours ago, but they didn’t do an
y good.’

  ‘Yes, I’ll see to that. I’m going to arrange for you to have a CT scan so that we can find out what’s going on. I’ll ask the nurse to come and make you more comfortable and then I’ll take you down to Radiology.’

  Katie left the room and found Sarah waiting for her. ‘There’s a phone call for you,’ she said. ‘It’s Jessica—she sounds a bit upset.’

  ‘OK, thanks.’ Katie frowned. What now? Was Jessica in trouble again?

  Alex had finished seeing his patient and was heading towards the desk. He placed the chart in a tray and said to Sarah, ‘Mr Gray in room three needs to have his wound cleaned and sutured by a specialist surgeon. Would you ask Mr Grainger to come and look at him, please?’

  Sarah nodded. ‘I’ll get on to it.’

  ‘And as soon as you’ve done that,’ Katie said hurriedly, ‘would you take Mrs Jenkins down to Radiology for a CT scan? I was going to go with her, but I need to deal with this first. I’d rather there wasn’t any delay in sending her down there.’

  ‘Yes, I’ll do that.’ Sarah looked surprised. ‘You don’t think it’s a tension headache or a migraine, then? Last time I checked her she wasn’t showing any signs other than a raised blood pressure. Even the registrar thought she was going through the beginnings of a migraine.’

  Katie nodded. ‘I know that, but I can’t be sure of anything until I have the results of the scan. I know she doesn’t have any focal neurological signs at the moment, but she says the headache woke her up and it seems to be particularly painful. I’d sooner err on the side of caution.’

  She looked at Alex and saw that he was frowning. Did he doubt that she was making the right decision, too?

  He glanced at Katie as she went over to the phone. ‘Do you need me to take over from you?’ he asked.

  ‘No, I’m on top of it.’ She didn’t want him thinking that she couldn’t cope or that she would go to pieces every time Jessica called.

  She picked up the receiver. ‘Hello, is that you, Jessica?’

  ‘Oh, Katie…you have to come and help me. They have me shut up in this room and they won’t let me go. They keep asking me questions. I didn’t know what to do. I tried to ring Nathan to see if he could help, but he wasn’t answering his phone.’

  ‘What do you mean, you’re shut up in a room?’ Katie felt the blood drain from her face. A shiver ran along her spine. ‘Where are you?’

  ‘I’m at the new superstore in town. You know, the one by the bridge. They’re saying I took something, but I didn’t. I don’t know how it got into my jacket pocket. I didn’t put it there.’ Jessica began to cry. ‘You have to come and help me, Katie, please. They’re being horrible to me.’

  ‘Who are they?’

  ‘The store people. There’s this woman who keeps being nasty to me.’

  ‘Is she there now—can I speak to her?’

  ‘No, there’s just me and Sophie and Jade. She went out to fetch someone and there’s a man standing guard outside the door.’ Jessica made a sobbing sound. ‘They won’t let us out of the room. The woman said we have to stay here until we admit to stealing.’

  ‘All right, I’ll come over to you as soon as I can. Try to calm yourself down. I have to see to my patient before I can leave here, but I won’t be too long, I promise.’

  Katie was thoroughly shaken by this news. Why would anyone accuse Jessica of stealing? It wasn’t like her to do anything like that. But then again, she hadn’t turned up at the activities centre the other day when she was supposed to. What was going on with her?

  Jessica made a small hiccuping sound. ‘What shall I do, Katie?’

  ‘Nothing, for the moment. Don’t say anything to anyone at the store and be quiet and sensible with your friends. I’ll get over to you as soon as I can.’

  She put down the receiver and tried to recover herself. All this had come as a shock, but she had to get herself together and concentrate on what was most important.

  She turned to Alex, who was still standing by her side. Sarah was nowhere to be seen. ‘Has Sarah taken my patient to Radiology?’

  ‘Yes, she left straight away.’ He sent her an assessing glance. ‘Are you all right? You look very pale.’

  ‘I’m fine. I just have to sort something out with Jessica as soon as I leave here.’

  ‘Yes, I gather that. I heard some of what you were saying. Is she in trouble again?’

  Katie nodded. ‘I don’t know all the details, but I think she’s been accused of stealing something from one of the stores. I can’t understand it. Jessica doesn’t do that kind of thing.’

  He made a face. ‘It’s beginning to sound as though Jessica does lots of things that you don’t expect of her. This must be the third time that she’s called you to get her out of some scrape or another. I can almost see why your parents were beginning to lose patience with her.’

  Katie sent him a sharp look. ‘You’re just assuming that she’s in the wrong. We don’t know that. She’s going through a difficult time, and she needs my support. I’m not going to let her down when she’s relying on me.’

  ‘I wasn’t suggesting that you should. I was just pointing out that this is getting to be a regular occurrence.’

  ‘And you think it’s getting in the way of my work?’ She gave a sigh of frustration. ‘Whatever is going on, it must be happening for a reason, and that makes me all the more concerned about doing the right thing.’

  ‘I can see that. I can also see that you’re under a lot of pressure, making it all the more important that I know what’s going on so that I can help you through it. Do you want to leave right away? I can arrange for someone to take over here and see to Mrs Jenkins for you, if you like.’

  Katie shook her head. ‘No, I need to see the results of the scan for myself. I hate to start treating a patient and then shunt them over to someone else just so I can get out the door.’

  ‘All right. I’ll come along and take a look at the films with you. We’ll go along to Radiology now, if you like. It will save time.’

  Did he doubt that she was capable of diagnosing her patient’s problem? Was he going to double-check her work every time she was under a strain of some sort? She could hardly insist that it wasn’t necessary for him to keep tabs on her, though, could she, when he was the one who was in charge of the unit?

  She walked with him to the lift. Monica Jenkins was still undergoing the scan when they arrived in the radiology unit, and Sarah was watching from the technician’s room where the films were being relayed to a computer monitor. Katie studied them as she stood alongside Alex and the technician.

  ‘There’s the problem,’ Alex murmured, trailing a finger across the screen. ‘It’s no wonder the poor woman has a headache.’

  ‘I was half expecting some kind of aneurysm,’ Katie said, ‘but that’s an AVM, isn’t it? Do you think it’s operable?’ An arteriovenous malformation, a mass of abnormal blood vessels, might sometimes be located deep within the brain, but this one looked as though it was relatively accessible.

  ‘It should be, and we need to deal with it right away before it ruptures. We’ll bring in a vascular neurosurgeon to do a cerebral angiograph, and then she’ll have to go up to Theatre.’ He turned to her. ‘That was a good call, Katie. I doubt if many people would have picked up on it being something more serious from her symptoms.’

  She managed a faint smile. ‘I’m thankful that I did.’

  Sarah was stunned. ‘I never expected to see that. I was convinced that she had a migraine. You must be thrilled to bits to have discovered what was wrong.’

  ‘I think relieved is more the word that I would use,’ Katie said.

  Sarah’s mouth curved. ‘Shall I go and call the surgeon now?’

  She nodded. ‘Yes, please. I’ll go and have a word with Mrs Jenkins when she comes out of the scan room. I think she may be a bit shocked by the result. She was still expecting to just be given some stronger painkillers and sent on her way.’

  Katie went a
nd spoke to the woman and tried to reassure her about the forthcoming surgery. Staying calm for her patient helped her to get over the underlying worry about Jessica, but she knew that when she left the hospital she had more difficulties to face.

  ‘I imagine that you will be going for surgery very shortly,’ she told Monica. ‘I’m off duty now, but I’ll try to get in to see you some time tomorrow. You’ve been very brave, but I’m afraid your anniversary celebrations are going to have to be put on hold for a while.’

  Monica’s husband was waiting for her when she came out of the radiology unit. ‘Dr Brooklyn explained to me what was going on,’ he said. ‘It makes me glad that we came here today. I daren’t think what might have happened if we’d just left it.’

  Katie gave him a brief smile. ‘You did the right thing.’

  A short time later she went along the corridor to the doctors’ lounge to retrieve her bag and jacket. She was glad that she had picked up on Monica’s problem, but she could so easily have followed another course and treated the woman as though her condition had been less serious. Wasn’t this the whole reason that she had decided to leave A and E? Every day she was called on to make life-or-death decisions, and even now she was uneasy about whether she was good enough to make that call.

  The sense of disquiet stayed with her as she turned her mind to Jessica and her problems. Somehow she needed to get to the bottom of the situation. She reached for her bag and straightened, trying to gather herself together.

  ‘You look as though you’re in a bit of a state,’ Alex said. ‘Why don’t you let me drive you into town? You could always leave your car here overnight and I’ll pick you up for work in the morning. It’s not out of my way so it would be no problem.’

  ‘I thought you didn’t have much sympathy for Jessica and her scrapes. You keep telling me that she’s trouble and I would be better off if she wasn’t staying with me, so why would you want to help me out?’