New Surgeon at Ashvale A&E

by Joanna Neil

  Sophie’s expression was miserable. ‘I’m sorry. It must have slipped my mind. I didn’t mean to let you down, honestly I didn’t.’

  From the doorway, Becky became animated, signalling to her mother in eager baby talk that she was there to be noticed, and Sophie turned towards her.

  ‘Oh, baby, you’re so beautiful.’ Sophie gave her a sweet smile, her heart-shaped features softening as she looked at her daughter. ‘I love you to bits, angel. I’m sorry I’m such a bad mother to you.’ She glanced at Ruby. ‘It’s getting late, isn’t it? I expect she wants her supper. Shall I give it to her? I see you have it all ready prepared.’

  ‘Are you going to be able to manage it?’ Ruby sent her sister a concerned look, worried by the general air of weariness that appeared to have descended on her. ‘Maybe if I sit her in the high chair, you could feed her?’

  ‘Yes, I could do that.’

  Ruby went over to Becky and released her from the harness, lifting her into the high chair by the table. Judging by Sophie’s fragile state, she doubted she would be able to do that safely on her own just now. She drew a clean bib out of a kitchen drawer and handed it to her. ‘Here, you’ll need this for her. I’ll make you a cup of tea, and maybe that will help you to feel a bit better.’

  ‘Thanks, Ruby. You’ve been so good to me, lately.’ Sophie sent her an earnest look. ‘I don’t know how I would have coped without your help these last few weeks. I’ve really appreciated being able to stay here with you.’ Sophie stopped to cuddle her daughter and plant a kiss on her cheek before fastening the bib carefully around her neck.

  Ruby checked the dish of baby food to see if the temperature was cool enough, and then she passed it to Sophie. ‘I phoned the surgery, and they told me you hadn’t kept your appointment,’ she said. ‘What happened?’

  Sophie frowned. ‘I can’t remember. I think I felt sick and had to go out for some air. I’m not too sure what happened after that. I just started to walk and kept on walking.’

  Ruby studied her for a moment or two. ‘You haven’t been sleeping very well, lately, have you? Perhaps you’ll feel better after you’ve had some rest. Then, when you’re up to it, we really need to take you back to the surgery so that the doctor can find out what’s wrong. You can’t go on like this.’

  She had the feeling, though, that Sophie was no longer listening to her. Looking over, she saw she was gently coaxing Becky to eat the food, making soft, encouraging noises, as though she was savouring the meal herself.

  Ruby sighed inwardly. How were the pair of them going to cope when she wasn’t there to watch over them? She thought briefly about taking a day or two off work, but the image of Sam Boyd crept into her mind, and she imagined those dark brows lifting as he contemplated her lax attitude. She’d been late for the meeting, and if she added time off to that lapse, he would surely have her marked down as unreliable. No, she had to face him on equal terms. It was a matter of pride.

  Perhaps she could persuade the next-door neighbour to keep an eye on Sophie and Becky while she went out to work tomorrow? Claire had turned out to be a good friend who was usually glad to help in any way she could.

  Either way, it was a worrying situation that had been building up for some time, and it had to be sorted out once and for all. She made up her mind that next time she would go along with her sister to the surgery. That way she could make sure that things went according to plan.

  ‘Do you think you might be happier going to stay with Mum and Dad for a while?’ she asked, coming to sit down at the table and beginning to pour tea. ‘I think you need someone to look after you properly until you’re feeling better.’

  ‘Oh, I don’t think that would work out very well,’ Sophie said, shaking her head. ‘Mum and Dad are way too busy. Mum has her job at the office, and Dad has to concentrate on pulling the business into shape. Besides, don’t you remember—they asked me if I would look after the smallholding while Gran and Grandad are away for the next few weeks. I said I would do it…only it would be so much better if you were there with me, and there’s plenty of room at the old farmhouse. I’m not sure I could handle things very well on my own, though. I don’t seem able to think too clearly these days.’

  Ruby nodded. ‘I remember.’ The trouble was, Sophie was probably right in thinking she wouldn’t be able to cope, and Ruby didn’t have an easy solution to hand.

  Sophie was dejected. ‘I know this place is too small for all of us. I don’t mean to be a burden.’

  Ruby frowned. ‘I wasn’t suggesting that I didn’t want you here with me. That wasn’t what I meant at all. I love having you and Becky here…you must know that. It’s just that I think you’re unwell and you need more help than I can give you while I’m working. Of course I’ll come along and stay with you at the old farmhouse, but I don’t think you’re in any state to be left there on your own while I’m out at the hospital.’

  Maybe she could make arrangements for someone to keep an eye on her at the smallholding. The local vet, perhaps? He was more of a friend to the family than a professional that they looked to for help on occasion. Ruby and Sophie had even been at school with him. He had his practice close by her grandparents home, and his work often brought him to the farm, where he would check up on the animals.

  Sophie didn’t acknowledge any of what she was saying. She seemed depressed, her shoulders slumping as though she was weighed down by an ominous black cloud.

  ‘I’ll play with Becky for a while, and then I’ll take her upstairs and get her settled down for bed,’ Sophie said a few minutes later as she wiped her daughter’s face clean. ‘After that, I think I’ll have an early night. I’m very tired.’

  ‘That’s a good idea, but maybe you should have something to eat first. I made a salad, and there’s crusty bread and cheese to go with it.’

  ‘Okay.’

  They ate together in the kitchen, and Sophie perked up enough to ask Ruby about her job at the hospital. ‘You have a new boss taking over from the man who’s retiring, don’t you? Have you met him yet? Do you think things are going to work out for you in A&E with him in charge?’

  Ruby’s mouth made a wry twist. ‘I met him today, and he seems to be very determined to push through the changes he has in mind, even though they’re not at all popular. I’m not sure how it’s all going to work out. I expect life in the A&E department is going to be quite rocky from here on.’

  A short time later, Sophie helped to clear away the supper dishes and then took Becky upstairs to bathe her and settle her for the night. Ruby went to check on them from time to time to make sure that all was going smoothly, but Sophie seemed to be coping well enough. Once she and the baby were both tucked up in their beds and fast asleep, she slipped next door to ask if Claire would keep an eye on them the following day.

  ‘I’ll find an excuse to keep popping round,’ Claire said. She was a friendly woman in her early forties, with teenage daughters who simply adored Becky. ‘Don’t you worry. Everything will be fine.’

  It was a relief to know that they would be in good hands, and Ruby set out for work next day feeling a little more reassured. She would be able to concentrate on the job in hand, and her biggest worry was whether things would run smoothly in A&E now that Dr Stanford had retired and the new boss was taking his place. With any luck, it would be a seamless transfer.

  All was not well, though, she discovered. When she walked into the emergency unit later that morning, after spending some time reviewing patients’ progress in the observation ward, she found that there was a general air of discontent about the place.

  ‘Okay, so what’s the matter with everyone?’ Ruby asked, taking a quick look around the resuscitation area and then inspecting the assembled crowd in the waiting room. ‘There are far too many long faces around here.’

  ‘I think you’ve just seen for yourself,’ James murmured. He drew a chart from the pile on the desk and cast a quick glance over the notes. ‘It’s still relatively early in the day, an
d we’re already stretched tight at the seams.’

  ‘We’ve had five people brought in by ambulance from rush-hour traffic accidents,’ Olivia added, going over to the whiteboard and writing up more names. ‘And the waiting room is heaving with an assortment of fractures, sprains, nasty infections and people with chest pains.’

  ‘Sounds like everything’s perfectly normal, then,’ Ruby said with a laugh. ‘It’s a case of heads down and let’s get on with it, to my way of thinking.’

  ‘Hah! You’d think so, wouldn’t you?’ James’s mouth made a downward turn. ‘Except that two of the nurses are off sick, one of the doctors has gone home to deal with a domestic crisis, and we have no one to replace them.’

  Ruby raised her brows. ‘No agency nurses or a locum doctor?’

  ‘None,’ he answered. ‘Not a one.’

  ‘Hmm. That certainly is going to make life difficult.’

  ‘Apparently we’re banned from bringing them in on account of it being too costly, and all overtime beyond a certain level has been stopped.’ James’s tone was edged with annoyance.

  ‘I almost paged you at one stage, but Dr Boyd said you were dealing with an emergency in the observation ward and we’d cope.’ Olivia pulled a face. ‘I suppose he was right, and we did manage, but we’re run off our feet, and patients are already complaining about waiting times.’

  ‘I guess Dr Boyd is behind the restriction on agency staff,’ Ruby mused. So he had kept tabs on her while she was working in the observation ward, had he? He obviously had his finger on the pulse of how the department ran, but she could certainly see why the two doctors were feeling under pressure. ‘He didn’t waste any time putting his plans into action, did he? He must be very keen to pull the department into shape.’

  ‘That’s right. I’m the one who put a stop to the extra staff. It costs way too much to bring in staff from outside.’ A now familiar voice came from behind her, and she swivelled around to see the man himself standing just a couple of feet away. Ruby studied him briefly. He was immaculately dressed, as before, in a dark grey suit and crisply laundered shirt, with a silk tie that was perfect in its understated elegance. ‘What do we have here,’ he asked, ‘a union meeting?’

  ‘Dr Boyd,’ Ruby acknowledged him. ‘It’s good to see you again…albeit in difficult circumstances.’

  ‘Call me Sam,’ he said in a brisk tone. ‘No need to stand on ceremony.’ He frowned. ‘As to the circumstances, you should all know from the outset that I don’t believe in letting the grass grow under my feet. It’s important to start as we mean to go on if we’re to have any chance at all of saving the A&E unit. We’re not playing at this. It isn’t a game. It’s for real.’

  ‘I know. I’m sure we’re all aware of that.’ Ruby made a muted response to his bracing tone. Perhaps he was annoyed because they had been talking about him, and they needed to make allowances for that. She added softly, ‘And I expect the problems that follow will be for real, too. I’ll leave you to deal with the complaints from the patients, shall I, and from the management when we fail to meet targets?’

  He acknowledged that with a rueful twist of his mouth. ‘I imagine those will be the least of my worries.’ He gave her an assessing glance, his gaze shimmering downwards over her curves outlined by the soft cotton blouse that clung where it touched and then draped itself loosely over the waistband of her calf-length skirt. ‘Besides, I’m sure I can rely on you to help smooth things over during these difficult times. I hear you’re good at dealing with most problems that come your way. You appear to have a knack for calming troubled waters. Perhaps that’s why the department operated so efficiently while Dr Stanford was winding down for his retirement.’

  Ruby’s eyes widened a fraction. Where would he have gleaned that wedge of information? Was it possible that he had been talking to his predecessor? Or maybe one or two of the board members had filled him in on her way of working. They might not have given her the job, but it didn’t necessarily mean they were unaware of her capabilities. Her lips made a wry shape. Perhaps her calm attitude was what had lost her the position. They wanted a lion that would roar and show its teeth.

  Sam glanced at James and Olivia. ‘I know this is difficult for all of you, but there’s no point in moping about the situation. What we have to do is prioritise, knuckle down and get on with the job and concentrate on providing the best service we can under the circumstances.’

  He turned to James and held out a patient’s file to him, his manner totally businesslike. ‘You examined a man who came in earlier with a broken wrist and suspected head injury after a fall…is that right?’

  James nodded. ‘Tony Barton…a young man in his late twenties. I treated him for the wrist fracture and assessed him for brain injury, but his neurological responses were fine. I was getting ready to discharge him.’ He glanced at the file. ‘Are you ready to sign off his notes for me?’

  Sam shook his head. ‘His condition has changed, according to the nurse who was following up on him. I’d like you to come with me and take another look at him, please.’

  ‘Oh…of course.’ James’s colour faded, and Ruby could see that he was wondering if he was in trouble of some sort. He was usually thorough and conscientious in everything that he did, but Sam, being a newcomer, clearly didn’t know that.

  Sam nodded towards Ruby and Olivia and then strode off with James in the direction of the treatment room.

  Ruby’s gaze met Olivia’s, and the senior house officer rolled her eyes. ‘Does that man ever stop to engage in the niceties of getting to know his colleagues?’ Olivia asked. ‘He’s brisk and businesslike, and his whole attitude is “stop fussing and let’s get on with it”, though I must say he seems half inclined to pass the time of day with you…but as to the rest of us…’ Olivia sucked in a deep breath. ‘He’s only been here five minutes, and I’m already beginning to wish Dr Stanford had delayed his retirement.’

  Ruby grinned. ‘I dare say we’ll get used to him, given time. He has a huge task ahead of him, and he’s probably still working on his strategies. I expect he has a heart of gold underneath it all.’

  ‘We’ll have to dig deep to find it,’ Olivia murmured, moving away in search of her next patient. ‘I have the feeling it’s buried under a ton of steel.’

  She could be right in that. Ruby frowned as she riffled through the files in the wire tray. Their new boss didn’t appear to be making any concessions to the fact that he was a stranger in their midst, and that they might have difficulty getting used to this different way of working. It was all or nothing with him.

  She glanced through the list of patients waiting to be seen. Her first job was to check on the patients from the traffic accident, and in doing that her time was taken up with a host of complications that had arisen from an assortment of broken bones and punctured blood vessels. Worryingly, one man went into cardiac arrest, and she had to use the defibrillator to shock his heart back into a safe rhythm.

  ‘He’s back with us,’ she said a few minutes later, addressing the nurse who was monitoring his situation. ‘Give the intensive care unit another call, will you, and see if we can move him over there as soon as possible.’

  ‘I’ll do that,’ the nurse said.

  An hour later things settled down a little, giving her time to attend to a young boy who had been injured during a football match on his local playing field.

  ‘That was an unlucky game for you, Matt, from the sound of things,’ she said, smiling at the seven-year-old and then inspecting the X-ray film displayed in the light box. ‘When you fell to the ground, you hit it with enough force to break your collarbone. That’s this one, here.’ She pointed out the area of the fracture to the boy and his mother. ‘There’s a line across here that shows the break in the bone.’

  She turned to look at Matt once more. ‘The good news is, it should heal up quite well because the two pieces of bone are still in line and touching one another. You’ll need to wear a support sling for a week or t
wo while the bone heals, and we’ll give you some painkillers to help you feel better.’

  His mouth made a flat line. ‘If I’d done this in a couple of weeks’ time, when school starts again, I could have had some days off. And I don’t even get a plaster cast for my friends to sign.’ He looked thoroughly disgruntled.

  ‘Isn’t there any street cred in wearing a sling?’ Ruby lifted a brow. ‘I would have thought you could get some pretty good mileage out of that. And it’s the hand that you write with that’s out of action, isn’t it? I’ll bet you can impress your mates with a left-handed signature.’

  His expression brightened. ‘Yeah, maybe.’

  His mother smiled as they stood up to leave a few minutes later. ‘I’m sure he’ll milk this for all it’s worth,’ she murmured in an undertone to Ruby. ‘He’ll be playing the part of a wounded secret agent before too long, I’ll be bound.’

  Ruby nodded agreement, and gave Matt a bravery certificate as he left the room. It seemed he was already working on his game plan. ‘Tyler didn’t get one of these when he sprained his ankle,’ he said. ‘He only got a badge that was this big.’ His fingers made demonstration of its tiny size.

  Ruby laughed and watched them leave before going in search of her next patient. She worked steadily through the morning, dealing with a wide variety of injuries suffered by active young children intent on enjoying their summer holidays to the full, while at the same time keeping an eye on the work of the senior house officers in her charge. Sam was nowhere to be seen.

  James had been missing for some time, too, but she caught sight of him when she was heading towards the ambulance bay. An infant with breathing difficulties was being brought in to A&E by ambulance, and she expected him to arrive in the next few minutes.

  ‘Is everything all right, James?’ she asked now, still continuing on her way. ‘You look as though you’re in shock.’

  James fell into step beside her. ‘I’m fine,’ he said. ‘I just don’t know how my patient could have gone downhill so rapidly. One minute he was sitting there, talking to us, and the next his speech started to slur, and he began to sink into unconsciousness. And to think I almost sent him home.’