‘I – want- my - mummy!’ she sobs, as smelly wet strands of hair cling to her dress.
19
Ruth
May 2005
Dr. Alison Winterbourne sits at the computer table in Ruth’s office and pushes her spectacles through her hair. ‘I just need to run the confidentiality procedure past you again, given your involvement with the Professional Standards Committee.’ She smiles benignly, accentuating the latticed wrinkles round her eyes.
Ruth nods. She grasps Alison’s agenda. Getting ready for her appraisal has been a bit like gathering information for her tax return. She’s been so pre-occupied thinking about Dominic and Bella that procrastination has intervened until the last minute. She’s not sure she’s fully prepared. A sudden movement under the desk alerts her to a carrier bag, which is twitching like a motorised toy. She delves inside it and extracts her phone. Now is not the time for interruptions. Just as she presses the phone’s ‘off’ switch she can see a text from Dom, but her colleague’s eyes are boring into her. Bad timing. The screen goes black.
‘Right,’ says Alison, visibly relaxing as she takes a sip of her coffee. ‘Let’s get started then.’ She settles her spectacles on her nose again and leans forward towards the computer screen, near enough for Ruth to observe the grey roots raked across her scalp, like wood ash in a blackened grate.
Over the next couple of hours Ruth painstakingly goes through all the audits she’s completed, the tutorials she’s supervised with the trainee, the meetings she’s attended, the on-line modules she’s completed. The discussion is intense, punctuated solely by Ruth getting up to switch off the radiator and open the window when the air feels so dense with dialogue that it’s suffocating. The pineapple smell of the air freshener is making her nauseous. Briefly she thinks about her phone. She’s itching to check what Dominic has said. Can she excuse herself to go to the loo or offer her colleague another coffee? Her colleague continues unabashed. She pushes her spectacles back and forth on her head at frequent intervals and the conversation is supportive, her demeanour sympathetic.
‘I have to say,’ says Alison, as she shuffles sheets of paper on the desk, ‘despite all the stress you have been under over recent months, you’ve been very thorough in demonstrating your ability to keep up to date. It’s not often we get the chance, as doctors, to take stock of what we’ve done and applaud it but there’s a lot here to be commended. Well done.’
Ruth quickly shifts her focus to the photograph above the examination couch. She knows that if she looks directly at her colleague she may burst into tears. She can’t help it when people are being sympathetic towards her. The picture is a panorama of mountains and lakes, peaks with the lustre of icing sugar reflected in the blue lagoons like candied almonds. It reminds her of her childhood holidays in the Lake District.
She composes herself and mirrors the amiable smile.
‘Thank you.’
‘I can see you’ve completed a proposed learning log for next year. I have just one more recommendation to add. Child safeguarding. Am I right in saying that your last update would have been when you were in Australia?’
Ruth nods.
‘Fair enough. Not a bad idea to complete another module. Familiarise yourself with local protocols and current procedures.’
‘Yes, of course. I’m sure that can easily be arranged.’
‘Great. Well, just to round up, I’m aware that the investigation into Alan Tremayne’s complaint about his mother is still ongoing. However it’s very good news that the Professional Standards Committee is satisfied with your learning from the Prescribing complaint.’ She pauses briefly to extract a tissue from her sleeve and blow her nose.
Ruth’s pulse quickens. She braces herself for what might come next.
‘I understand that the Medicines Management Team has issued a reminder to all practices urging care when prescribing oral morphine solution. They’ve removed the concentrated solution from its formulary. So, as far as your involvement goes, that case is now closed.’
For Ruth, the relief is too much. Closed? Resolved? Concluded? She has kept her emotions in check until now but can’t hold back the tears any longer. She reaches under the computer screen for the box of tissues and sits in silence dabbing her eyes. It seems like an uncomfortably long interval before she looks up again, but when she does Alison is smiling.
‘It’s okay, Ruth,’ she says, propelling her chair, on its castors, to within an arm’s length. ‘I’m here to support you. It’s been a stressful time. Everything’s okay.’
Ruth has to look away again. She pinches the skin on her fingers until her flesh turns white.
Alison’s spectacles are back on, as she scrutinises her watch. ‘Ten past one,’ she says. ‘Okay now, is there anything else we haven’t discussed that you would like covered?’
Ruth is about to ask her if she would like another cup of coffee, but there’s a knock at the door. She looks at Alison and shrugs her shoulders, as if to say ‘I’m sorry, I told the staff I didn’t want any interruptions,’ but before she can continue the door opens and a receptionist has her head round the door.
‘Dr. Cooper, I’m sorry to interrupt. I know today’s your half day but all the doctors are out on their visits. There’s a lady who’s turned up saying her baby’s not very well. I’ve told her that the surgery is closed for lunch but she insists on being seen. I wouldn’t normally do this, but the child doesn’t look well. I’m worried it might be an emergency. Could you come and look, please?’
Ruth looks at her doctor colleague who nods. Alison stands up and gathers her papers, which she arranges in her briefcase. ‘Please. Go ahead. We’re finished here.’
Ruth turns to the receptionist. ‘Okay, Julie,’ she says. ‘Can you take her into the Treatment Room, please, and I’ll come along in a sec.’ She turns to Alison. ‘Thanks again. Actually it’s been a huge relief to talk through some of my issues.’
‘You’re welcome. I hope it was helpful. I can hang around a bit, if you like, in case you need a hand.’
‘Thanks,’ says Ruth, her features softening into a magnanimous smile. ‘Well if you’re not in a hurry and don’t mind?’
Ruth picks up her ID card to lock her computer and, gathering a few pieces of equipment, leads Alison out of the room. They walk along the corridor towards the open door of the Treatment Room but Ruth quickens her pace when she hears the desperate pleas for help coming from within. Both doctors race into the room. A woman, Ruth guesses to be in her twenties, is pacing up and down with a blanketed bundle in her arms. Ruth peels back the crocheted cover to reveal a baby, probably between six and twelve months old. Its fragile frame is pale and mottled, it has a tense, bulging soft spot on top of its skull and a speck of froth at the corner of its mouth.
‘Hi,’ she says to the young woman, whom she doesn’t recognise. ‘I’m Dr. Cooper. This is Dr. Winterbourne. We’re here to help,’ she says immediately taking hold of the child and placing it on the examining couch. Its little body feels as rigid as a board and it’s making so much effort to breathe that it grunts. Ruth feels a momentary flash of panic but reaches over to the resuscitation trolley, slides open the top drawer and pulls out some equipment to assist the baby’s breathing.
‘How old is this little one?’ she asks the woman. ‘What’s happened today?’
The woman says her little boy Elliot is seven months old, has had a temperature for twenty four hours, been off his food and she was getting him out of the car in the surgery car park when his eyes rolled back and he started jerking. Ruth’s hands are a blur of movement, as she listens to the mother, whose name she learns is Bryony. Ruth looks up at the receptionist, who is hovering on the periphery.
‘Julie, can you ring 999 for me,’ she says. It surprises her to hear her own voice sounding so unruffled and authoritative. With a nod of her head she indicates towards the mother and continues,
‘And please take Bryony with you and get all the patient details off the computer. Tell ambulance control that an immediate response is required.’ She looks at Alison, as Julie hastens out of the room. ‘No point in wasting time.’ She has placed a mask over the baby’s face and Alison assists by attaching the connecting plastic tubing to an oxygen cylinder.
‘There’s a pulse oximeter on the counter there,’ says Ruth, gesturing in the direction of the sink. Alison picks up the plastic clip, with its winking red display, and peels back the covers on the baby to expose his legs. A blotchy rash is encroaching the creases of his chubby thighs. Purple and red blooms on a torpid landscape. The doctors lock eyes with one another. They are both thinking exactly the same thing. Meningococcal septicaemia.
‘The emergency drugs cupboard is over there,’ says Ruth, signalling in the direction of the far wall, as she secures the oxygen mask over the baby’s face. ‘Actually, could you take over here and I can get the antibiotic ready?’
Alison moves forward. As they swap roles Ruth can see that the baby’s lips have pinked up a little. She senses her own pulse bounding. She steels herself to take slow, deep breaths.
Ruth swings open the cupboard door and picks up a vial of white powder, checking the label. ‘Benzyl penicillin. For intramuscular or intravenous use.’ She looks down at the tiny child on the bed. Her hands are shaking and she’s not sure she trusts her clinical acumen to administer that much drug into a tiny vein. Especially now that his circulation has virtually collapsed. It’ll have to be intramuscular. Swiftly she makes up the injection, just as a paramedic enters the room. Thank God. It’s okay. She’s not on her own. She can do this. She focusses on the task in hand, as the paramedic watches in silence. She draws the syringe back, as white liquid fills its chamber, and looks across at Alison. ‘Three hundred milligrams benzyl penicillin for intramuscular use. Check.’
Alison checks the vial and nods in agreement. ‘Yes. Three hundred milligrams benzyl penicillin. Correct.’ Ruth slides the needle into the baby’s thigh just as another paramedic appears, wheeling in a stretcher trolley. The female paramedic nods at her male counterpart.
‘All ready for you, Doc. What’ve you got here, then?’ Ruth glances up just in time to see the male paramedic flashing a look of consternation towards his female counterpart. Alarm spirals in Ruth’s stomach. These guys know an emergency when they see one. The paramedics both step forward, their gloved hands moving briskly over equipment. In a reflex action Ruth steps back. There’s a tacit understanding that they need to act swiftly.
‘Seven month old boy. Pyrexial illness for twenty four hours. On arrival possible convulsion in the car park. Temp thirty nine five. Capillary refill time more than two seconds. Sats ninety two in air. Heart rate a hundred and sixty. Tachypnoea of sixty.’ Ruth pauses for breath herself, her mind is racing, her face feels hot, but she feels in control, ‘Non-blanching purpuric rash on limbs. Suspected meningococcal septicaemia. Given oxygen. Sats now ninety seven. Three hundred milligrams benzyl pencillin administered left thigh.’ She checks her watch, ‘One twenty seven pm’
‘Thanks, Doc,’ says the green-suited healthcare professional, moving towards the baby’s head and observing the rise and fall of its tiny chest. ‘Sats are fluctuating,’ he says, looking at the pulse oximeter, and turning to his colleague. ‘Better keep the mask on, and this little fella’s going to need a drip. He turns to Ruth. ‘Have you rung the hospital?’ he asks, as he scoops the baby in his arms and gently transfers him to the trolley.
‘Not yet,’ replies Ruth. ‘Just about to.’
‘Is that mother in reception?’ the second paramedic asks. ‘She’ll be coming with us I take it?’ Ruth nods. Perspiration trickles down her back. She feels as if she’s just run a race.
‘I’ll follow you out to the ambulance,’ says Ruth, ‘then I can explain to Mum what’s going on, while you’re loading up. Thanks, guys, you were here really quickly.’
‘Luckily we were just round the corner at The Orchards when we got the call,’ says the man, flicking up the stabilising struts on the trolley with his foot. He looks at Ruth. ‘Better get a move on, then,’ he says and he disappears out of the room.
Ruth looks across at Alison, who is leaning back on the sink. She looks flushed but she smiles.
‘I’ll leave you to it then, Ruth.’ She picks up her bag. ‘I’ve only ever come across that twice in my career. Well done. You’ll be needing that second cup of coffee now.’
Ruth walks over to her and gives her a hug. ‘I’m glad you were here.’
‘Never forget, Ruth, you’re a good doctor.’
Ruth gives a half-hearted smile. ‘Well, that’s enough excitement for one day. I hope he’s going to be okay. I’ll let you know what happens. Thanks for the opportunity to talk today. I really appreciate it.’
Ruth’s legs have a gelatinous fluidity, as she leaves the room. She follows the ambulance personnel down the corridor, past the reception desk where the baby’s mother is standing. Bryony is on her phone but she immediately puts it down, and a look of panic darts across her face. She rushes over to the trolley and clutches at the little boy’s blanket.
‘He’s going to be okay, isn’t he?’ she says to Ruth.
‘He’s very poorly,’ says Ruth softly, ‘but he’s in good hands. I’m just going to ring the children’s specialist at the hospital, to let them know you’re on your way. You can travel with Elliot in the ambulance, but it’s really important that you go now. It’s urgent.’
Bryony tugs at Ruth’s sleeve. ‘But he is going to be okay, isn’t he?’ The colour has drained from her face. ‘I need to speak to my partner.’ She lifts her phone back up. ‘I’m just trying to get hold of him. He’s at work. I need to see if he can meet me at the hospital.’
Ruth nodes encouragingly. ‘Phone him from the ambulance.’ She looks up at Julie who comes round the other side of the reception desk and puts a hand on Bryony’s shoulder.
There’s a clash of the front door and the female paramedic appears again. ‘We need to get going,’ she says and Ruth can hear the tension in her voice.
Quickly Ruth ushers Bryony to the front door and into the ambulance. As she moves away she can hear the young woman’s tremulous voice, ‘Yes, I need to speak to him now. Please tell him it’s an emergency. A desperate emergency. Yes. Please. Now. His name is Alan Tremayne.’
20
Ruth
Astillness descends in Ruth’s consulting room. The phone lines are silent. She slumps forward, her elbows on the desk, her head in her hands. It’s as if a high centrifugal force has been spinning her thoughts out of control, but now it’s stopped and her mind is in a state of collapse. The baby might die. The thought was unbearable. She’d done everything she could and acted quickly, but what if that wasn’t enough?
Elliot Tremayne, Elliot Tremayne. She hadn’t made the connection, until she heard Bryony utter her partner’s name down the phone. Alan Tremayne. Margaret’s son. Her complainant. Fear grips her. What if Elliot doesn’t survive? A double blow for the Tremayne family.
She switches on the computer and checks the Tremayne household details:
Bryony Marsh age 28
Alan Tremayne age 31
Morgan Tremayne age 3
Elliot Tremayne age 7 months
She needs to share this with somebody. But who? She needs more time to think. A rumbling in her gut reminds her she’s not had anything to eat since six this morning. She lifts up the carrier bag from under the desk and heads upstairs.
The staffroom is deserted. The slatted blinds are half drawn, the infringing afternoon sun kept at bay, but the room feels airless and humid. She walks over to the window and releases the catch. The radiator is on high and the sudden intake of fresh air causes her to sway a little, as she wedges the casement open. Steadying herself she walks over to the sink, and fills the kettle, which churn
s with flakes of disturbed lime scale.
She flops down on a low sofa. The coffee table is scattered with the scree of hasty tea breaks. Back copies of Woman’s Own, their pages jagged where recipes have been tugged out, litter the table top next to copies of the British Medical Journal. She picks up a magazine and flicks through the pages absentmindedly, her thoughts drifting to the turmoil the Tremayne family will be going through. First Margaret, now Elliot. Why is life so unfair sometimes? Take Bella, for instance. To grow up never knowing how it feels to be clutched to her mother’s bosom, to never experience her mother’s laughter, her pride, her tears. Instead she must vie for the attention of a father who is contending with his own grief and his demons from the past. Dominic’s revelation about his accident had come as a shock to her. But sympathy for him had soon given way to anger at his father, and revulsion at the injustice that had been caused. At least Dominic felt he could take her into his confidence. As they had got to know each other more intimately over the past few weeks she felt the feeling was mutual. They trusted each other. With time she hoped Bella would trust her too. Hopefully it wouldn’t be long before Dominic relented to letting her stay overnight at his house.
Dominic. Dominic. She’d forgotten about the text message. She scrabbles for her phone in the depths of the plastic carrier bag, extracting two satsumas and a soggy tomato sandwich as the door opens. Paul Franklin walks in and jerks his head back in surprise.
‘Ruth. I thought it was your half day?’
‘It is. I’m just having a quick breather but I’m finished for the day.’
‘How nice. I’ve got half an hour before my Minor Ops Clinic starts. Mind if I join you?’
Love Until It Hurts Page 10
