‘Of course they haven’t sent us a replacement,’ Sheree said, apparently oblivious to the atmosphere in the room as she put a mug of coffee on the cabinet for Charles. ‘There’s some kind of bug laying low the nursing staff, the auxiliary staff are holding stop-work meetings and the hospital administration has always had us at the very bottom of their priority list.’
Which was why Nick was always chasing wealthy businessmen who might be interested in making a donation to the clinic.
‘We’ll manage,’ Phoebe assured her, knowing Sheree would get worked up about lack of money if given half a chance. Then, without a backward glance at the man she’d fancied herself falling in love with since she’d first walked into the unit, she left the room.
She wouldn’t let Charles’s attitude bother her. She’d think of the funding problem instead.
‘It’s because people see skin as boring,’ Nick said when she raised the funding question later. They were grabbing a cup of coffee between patients. ‘Heart surgery, brain surgery, state-of-the-art machines to delve into the very centre of the human body—all those things can be made to sound exciting. All people want to do when I show them a picture of a malignant skin tumour is throw up.’
‘But skin is so important,’ Phoebe protested. ‘It protects the body against germs, and tissues from injury, provides a means of temperature control—’
‘Not to mention its use as the main organ of sensation,’ Nick added, sliding his forefinger along the underside of Phoebe’s arm. ‘Very sensual stuff, skin!’
She shivered, inadvertently providing an appropriate response to his statement. It had been the first thing she’d considered, but hadn’t wanted to add it to the list, thinking he might think—
‘I’ll bring in the next patient,’ she said, stepping towards the door as swiftly as she could manage without actually running.
But what little protection she’d managed to erect around herself had vanished with that touch, and working with Nick, bending over a patient’s leg to examine a small piece of skin, necessitated close proximity and inevitably involved physical contact.
‘Mrs Ramsey has been coming to us for some years now,’ Nick explained, when the first afternoon patient had fluttered into the room and kissed Nick far too heartily.
Phoebe told herself the pang she felt couldn’t possibly be jealousy—one had to be involved with someone in order to be jealous and she certainly wasn’t going to get involved with Nick! Nevertheless, she studied the woman who was chatting so familiarly to Nick.
Another blonde, but much older, perhaps a well-preserved fifty-something. Her hair, a burnished gold, swung lightly around an expertly made-up face. Her figure was slim and trim, a gym figure, exquisitely clothed in a mid-calf length skirt and matching blue-green shirt. Much the colour of Nick’s eyes…
‘Phoebe? Are you with us? This is your session, not mine.’
Phoebe ducked behind the screen where Mrs Ramsey was slipping out of the designer clothes. She handed the glamorous patient a gown then helped her up onto the examination table.
‘We’re onto legs at the moment,’ the woman said to her, smiling conspiratorially. ‘Either Nick or Charles have managed to remove most of the skin on my legs and arms already but they insist I keep on coming back. I think they’re afraid they’ll lose my husband’s regular donations if they completely cure me.’
‘Would that we could,’ Nick said, arriving to stand beside Phoebe. ‘I’d even give up Don’s financial support.’
He bent over to examine the scarred tissue on their patient’s legs.
‘Fair-haired, blue-eyed, pale freckled skinned—a recipe for disaster as far as sun damage is concerned,’ he muttered.
‘Add a lifetime playing tennis in little short skirts and sleeveless tops—that didn’t help,’ Mrs Ramsey told Phoebe. ‘Not to mention lying for hours on the beach in my teenage years, because of a craving to look tanned and fit, the golden Aussie archetype.’
‘Most of the tumours we’ve removed have been SCCs,’ Nick continued, ‘squamous cell carcinomas, with a few basal cell carcinomas, the slow-growing but potentially malignant sun-damage lesions, as well, so I remove a narrow margin of skin around the edges of anything suspicious and test it for involvement.’
Phoebe knew he was explaining all this for the patient’s sake, not hers, and, as she always did when working closely with him, admired the way in which he provided information so it was easy for the lay person to understand. Squamous cell carcinomas affected the top layer of the skin and usually began as solar keratosis with patches of raised or scaly skin. BCCs presented as small raised pink papules, which developed tiny craters in their centres.
She nodded as if the information was meant for her alone.
‘I told you he’d practically skinned me,’ Mrs Ramsey said.
Then Nick stepped back.
‘OK, it’s your turn, Dr Moreton. Have a look and tell me what you’re going to do.’
Phoebe felt a spurt of unfamiliar panic fire through her body.
Why?
She’d taken clinics on her own dozens of times, and not panicked. Was it Nick’s presence today, or the feeling that this might be some kind of test?
She put the unanswerable questions aside, put on her glasses, and bent to examine Mrs Ramsey’s legs.
The scar tissue where lesions had been cut out or burnt off using liquid nitrogen was obvious, but there was another mark on the woman’s left calf, embedded deep in old scarring.
Phoebe turned to the computer where the introductory page of Mrs Ramsey’s file was on the screen.
‘I just want to check something,’ she said, although their patient was so deep in conversation with Nick, Phoebe doubted whether she’d heard.
She scrolled down until she came to images taken on the patient’s previous visit. She enlarged the area she wanted to study and searched in vain for a pinkish spot like the one now visible on Mrs Ramsey’s leg.
Turned back to the patient.
‘I think there’s a new problem here,’ she said, indicating the site with her gloved finger.
Mrs Ramsey sighed, but Nick drew closer.
‘OK, what will you do with it?’ he asked.
Phoebe turned towards him. He was so close she could see pinpoints of gold in his blue-green eyes.
‘I think it’s a new BCC or perhaps a regrowth of an old one, but the skin is too thin to make another incision to remove it here and now. It’s on the calf muscle and the slightest movement will aggravate the wound and complicate healing.’
‘So?’ he prompted.
She frowned, thinking through all she’d learned since she’d joined the team.
‘Mohs’ surgery? Excision of fine layers microscopically, under a light anaesthetic and a local nerve block. That way we can stain the tumour and only take extra tissue from around it if the malignancy has spread to cells beyond the wound. Then a skin graft, because the scar tissue would resist simple stitching.’ She thought for a moment. ‘But again, there could be problems with the graft taking on that part of the leg. Hospitalisation, restricted movement, plastic skin to protect the graft?’
Nick straightened up and touched her lightly on the shoulder.
‘We might make a dermatologist of you yet,’ he said. The words caused even more skittish reaction than the touch—if that was possible.
When she’d been employed by the clinic, it had been on the understanding that the position wasn’t connected to the specialist dermatology programme. ‘Because, as we don’t do all the general skin complaints, we’re not considered a teaching unit,’ Nick had explained.
It hadn’t bothered Phoebe at the time, as she hadn’t been certain she wanted to specialise. In fact, she’d almost certainly decided not to take on a specialty. But a general practitioner with specialist knowledge in skin cancer could do a lot of good in the course of his or her normal work.
Now she wanted to query Nick about the remark, but he was talking to Mrs Ramsey�
�Elizabeth, he called her—explaining the surgery. The skin graft would use her own skin which would be cut from a site probably on her thigh, then, clever organ that it was, the skin would replenish itself on both the donor site and on her leg.
He finished the examination Phoebe had begun while she watched the sure way his hands moved, noticed the slimness of his fingers, the fine dark hairs at the wrists, curling around the rolled edge of his gloves.
‘Would you ask Sheree to fix some coffee and take it into my office?’ he said to Phoebe as they left the patient to dress. ‘I’ll make the hospital arrangements for the surgery while Mrs Ramsey is here. I can leave you in charge?’
Phoebe nodded. Disappointment had risen like a tide in her throat, although that was stupid. So what if Nick had chosen to work the clinic because he’d known Mrs Ramsey had an appointment? It was none of Phoebe’s business what he did!
She worked through the rest of the day, excising tiny tumours, curetting the simpler lesions by scraping the surface with a fine glass spoon-shaped instrument, then using an electric needle to seal the edges. When it came to problem tissue on patients where the cartilage might be damaged by other methods, she used cryotherapy.
‘Noses and ears,’ she said to Mr Bryant, as the spurt of liquid nitrogen froze the margin around the BCC on his ear lobe. ‘They’re nearly always exposed to the sunlight—on men, anyway. That’s why those bits of the body are so vulnerable.’
But although she talked and joked with the patients, her mind still niggled away at Nick’s behaviour. Or, more truthfully, at her reaction to Nick’s behaviour.
At day’s end, she went through to the small laboratory. Though short of a nurse, Ellen, their trusty lab assistant, had been on hand, setting, labelling and packaging the diseased tissue Phoebe had removed, dispatching one specimen from each lesion to Pathology for testing, leaving a second for the doctor’s use.
Phoebe studied each in turn, making notes for herself which later she’d compare with the pathology reports. It was her way of testing herself, of checking that she was retaining the new knowledge she absorbed each day.
Nick guessed she’d be there, and although he had a mountain of paperwork to tackle in his office, and ward visits to make, he found his feet carrying him towards the lab. He paused in the doorway, studying the white-coated form bent over the microscope. Apart from the glossy dark hair, it could have been anyone, yet he felt if he’d been blindfolded he would still have known it was Phoebe.
The thought made him frown, and he had to remind himself of all the reasons why he didn’t want to get involved with anyone at the moment. Particularly not an anyone like Phoebe Moreton. Though…
At that instant she must have sensed his presence for she glanced up, and he caught a glimpse of what looked like pleasure in her eyes before she blinked it away and asked, ‘Do you want to do some work? Need the microscope? I’m just about done. I’ve been looking at today’s slides.’
Did the rush of words indicate confusion? He rather hoped it did—it would make them a matched pair in that department.
Only his confusion, or so he told himself, was over whether or not to explain to Phoebe about Jess’s past relationship with Charles. But whenever he considered the pain he’d see in Phoebe’s dark eyes, he shied away from the idea.
‘Well?’ the object of his consternation demanded.
He felt his frown returning.
‘I’m sorry. Thinking of something else. What did you say?’
She smiled at him, and he felt a sizzle of heat in his abdomen. It’s pretend, he reminded himself. And she’s not the kind of woman with whom you can play games. Added to which, she’s already been hurt by one male in this department.
‘I asked if you’d sorted out a date for Mrs Ramsey’s op?’
Medical talk—that was better.
‘Yes. I had to wangle theatre time and trade off some of our non-existent nurse’s hours to staff it, but I’ll operate next Monday. I’ll do that lentigo maligna—Mr Webster—at the same time.’ He sounded quite rational, and was congratulating himself on regaining control when he heard words he hadn’t intended to say coming from his lips. ‘Do you want to assist with Mrs Ramsey?’
Her face lit up as if he’d offered her a rare gift, so he could hardly take back the offer, but his physical reaction to that smile reminded him that sharing an operating microscope with Phoebe was going to put her body in very close proximity to his—not a good idea since the kiss.
Kisses—plural…
‘I’d love to,’ she assured him, stacking away the slides she’d been studying. ‘I’ve never seen extensive Mohs’ surgery performed.’
Well, she certainly wasn’t worried by bodily proximity so he’d better get over it.
‘How did Jessica’s meeting with Mr Abrams go? Did you hear?’
The work-related question helped, and by the time he’d explained what Jess had suggested, using a digital camera to transfer images direct to a computer, he was more or less back in control.
‘That’s great,’ Phoebe said, and she smiled again. Although he could have lived without the smile, he was intrigued by her obvious delight.
‘Does it please you so much, to have a patient’s fears lessened?’
She looked surprised, then nodded decisively.
‘Of course it does,’ she said stoutly. ‘Isn’t the practice of medicine all about reassurance?’ She tossed her head so the weight of glossy hair shifted slightly, trapping light and throwing back gleams of red from its hidden depths.
‘I know all the “curing cancer” trials and experiments attract more media attention—and consequently more money from government and donors—but most patients are interested in the here and now. They want whatever is wrong with them fixed or, if it can’t be fixed, the pain of it alleviated. But more than anything else, they want reassurance.’
She spoke so seriously, Nick had to smile.
‘Cures for cancer might be relevant to people when they’re diagnosed with it,’ he teased, but his smile wasn’t reciprocated.
‘I don’t know about that!’ she said, and once again the appearance of a tiny frown between her eyebrows made him want to smooth the crease away. ‘I think people are becoming fairly cynical about the so-called miracle cures. Whenever something is hyped up on television, there are always white-coated scientists warning that it’s only early days and clinical trials could be ten years away.’
‘Clinical trials have begun on a vaccine for melanoma right here in this hospital,’ he argued, letting himself be drawn into the conversation in the hope it might distract him from his too-personal thoughts.
‘Vaccine!’ Phoebe scoffed. ‘When you use the word “vaccine” to the general public, they immediately assume they can go to their local doctor, ask for it and come out immune to melanoma for the rest of their natural lives.’
It was Nick’s turn to frown.
‘Do you really think that’s what they expect when they see the publicity? I mean—’
‘What’s happening here is a very early trial,’ she interrupted. ‘And being conducted on patients who have advanced melanoma which has not been halted by conventional means. Yes, I know that, and you know that, but to most people, the word “vaccine” means something you’re given to provide immunity. Generally for life.’
Immunity! Nick’s mind skipped to a remark Phoebe had made—before the kiss. She was immune to men like him. Why? Or should the question be how?
A man in the past who’d betrayed her?
No! Surely she’d be more worldly, even cynical, if that were the case.
For a moment he wished she were. It was her apparent innocence that so attracted him, yet warned him at the same time to stay clear.
‘But, in fact, all we’re currently doing is altering cells and injecting them back into patients’ bodies,’ she continued, ‘in the hope it might trigger the patients’ own immune systems into fighting the tumours.’
He forgot Phoebe’s immunit
y and innocence to take up the argument.
‘But eventually, using this technology, if we detect defective genes which suggest a predisposition to melanoma, we can alter them to provide immunity.’
She stepped towards him, smiling again, and shuffled some notes she must have been making into a file.
‘But who are you going to test? People with melanoma in their families, although only ten per cent of melanoma is familial?’
Nick shook his head.
‘Boy, are you in an argumentative mood! Don’t forget I was part of the research team involved in this project you’re treating with such disdain. I know it’s only a possible solution and success is a long way off as yet, but every new development has to start somewhere.’
She chuckled, probably at his defensive tone, and said, ‘I know, and it makes me angry that the work you did on the vaccine was then taken over by the oncologists so now it’s slotted into the general cancer funding, rather than the money coming to the clinic.’
Her voice belied her anger, at least for Nick, who found it soothing. He watched her close the folder and then hesitate, running her fingers down the edge of the cardboard.
‘They’re welcome to the money if they can find a cure,’ he said, distancing himself from thoughts of those fingers doing a similar tactile exploration of his skin. ‘All I’d like is enough funding to perfect some foolproof system of early diagnosis of the lesions which are likely to be dangerous. A nodular melanoma can arise very suddenly, then within weeks spread into surrounding tissues. From there it’s into the blood and off to develop further tumours in any organ of the body.’
‘Patient education—and public awareness campaigns. Surely that’s where we have to concentrate our efforts.’ She shut the folder into a drawer as she spoke, and looked directly at him. ‘But that just gets them to the doctor, doesn’t it? Isn’t that why the new computer program is so important?’
As the clear brown eyes looked into his, something else he should have told her niggled at his brain, but his body was overriding many of his mental processes, and he couldn’t think of anything but kissing her again.
A Very Precious Gift Page 5
