Best Practice

by Penny Parkes

  ‘Night, Jamie,’ she said instead, unable to disguise the smile in her voice at his suggestion. ‘Thank you though.’

  ‘You’re very welcome,’ he said, registering the change and seemingly content that all was now well. ‘Phone me if you get bored of Julia Roberts.’ He hung up with a click and Alice stared at the receiver in her hand, the dialling tone loud in the darkness.

  She sighed. There was something about Jamie Yardley that made her smile every time; he seemed to know without prompting exactly what she needed. Just like every best friend should.

  She scrunched up her eyes tightly in the darkness, as though by doing so she could ignore the room around her, the chaos around her.

  And therein lay the solitary problem with Jamie – he was altogether too local. And if Alice’s dating life had one parameter, it was distance. Not so much the old adage that absence made the heart grow fonder, more that the likelihood of somebody sharing her personal space was dramatically reduced.

  She opened her eyes, ignoring the shapes looming in the darker recesses of her bedroom, and stared intently at her laptop screen, clicking on the windows until her Match.com profile appeared and she could access her messages. Her heart did a small flip-flop as she saw that Ollie was already online.

  Hey – she typed – how was the surf this morning?

  They had nothing in common.

  They would, in all likelihood, never meet.

  But chatting with Ollie Turner online was the closest that Alice got to dating these days.

  And, of course, it helped that Sydney, Australia was just far enough away to discourage any thoughts of sleepovers or spontaneous visits.

  Chapter 5

  Holly shook her head as Dan continued to rage on Monday morning, pacing up and down her consulting room at The Practice, being forced to make a turn every four strides. It wasn’t just that she didn’t agree with him; she simply couldn’t understand the scale of this reaction. She’d tried, without success, to interrupt him and explain the reality of the situation, but obviously Dan was so worked up that he wasn’t going to let something as boring as the facts get in the way of a good argument.

  ‘I mean, they have every right to be fucking furious, don’t they? The partners were all there – on the scene, literally as it happened – but we let Alice, our junior, take the lead?’ He rubbed his eyes tiredly and, whilst Holly could understand how spending the whole of Saturday night at the hospital with Jessica’s distraught (and litigious) parents might have taken its toll, she still owed him the truth.

  ‘Look,’ she reminded him gently, ‘it wasn’t as though Jessica was the only casualty. And I was there beside Alice until you took over her care. In many ways,’ she ventured, ‘we should be proud that Alice had the wherewithal to clear Jess’s airway so promptly and cautiously, or we could be looking at an entirely different outcome.’

  They’d been going round in circles for ages, their coffees grown cold on the desk and their Monday morning anything but a fresh start. ‘Lavinia’s on the warpath, Holly. How this has become the fault of the people who saved her daughter, rather than that idiot pilot, or the Major for booking the bloody plane in the first place, I do not know.’ He sat down abruptly, as though somebody had cut his strings. ‘That poor kid,’ he said.

  Holly nodded. There was no avoiding the fact that Jess had a long road to recovery ahead of her. The Traumatic Brain Injury team would be assessing her in the next few days, once the swelling had subsided. They could only be grateful at this point that there was no spinal injury or brain bleed. Only time would tell what young Jess Hearst was actually dealing with.

  There was a gentle tap at the door and Grace, their Practice Manager and all-round saviour, poked her head into the room. ‘I’ve brought fresh coffee and a heads-up.’ She deftly placed two steaming mugs on Holly’s desk. ‘You two are giving the patients in the waiting room quite the show.’

  Holly flushed instantly at the idea of their patients hearing their heated debate, as time had obviously run away with them, but Dan looked unperturbed.

  ‘Perhaps it’s a good thing they know they shouldn’t rely on the Air Ambulance around here,’ he said. ‘Do you know what the ground crew said, when I followed up? Budget cuts! Can you believe it? They only have one operational bird at the moment, because the other one’s in the workshop, awaiting funds for repair. Do you ever wonder how many other patients are missing out?’ He looked up bleakly. ‘It’s a vast area they cover too.’ Picking up his drink, he nodded his thanks to Grace and wandered dejectedly out of the room.

  ‘He’s taking this pretty hard,’ Holly said to Grace unnecessarily.

  ‘He’s taking it pretty personally too, from what I can see,’ Grace replied, tucking her bobbed hair neatly behind one ear to reveal a silver twisted-vine cuff that merely hinted at Grace’s Ayurvedic tendencies. She might be the one to keep the ship firmly afloat at work, but her personal life was altogether more Zen. She stretched out her shoulders and sighed. ‘I gather the Hearsts really laid into him yesterday too. I know they were probably frightened out of their wits, but it sounded as though they were pretty brutal.’ She shrugged, ‘I guess the same rules don’t apply to everyone.’

  They both looked automatically towards one of the new posters that were now dotted throughout The Practice – ‘We don’t tolerate abuse’ – a zero-tolerance approach, allowing the staff to refuse treatment when confronted with angry, hostile or violent behaviour. It was such a shame they felt the need to display these, in Holly’s opinion, but it had become a necessity of late as the number of incidents had escalated. Normally drink- or drug-related cases, to be fair, but there was always the odd hothead that one couldn’t predict. They had drawn the line at a Perspex screen in Reception thankfully – none of them had any desire to work in a self-imposed prison.

  ‘He’ll be okay,’ Holly reassured her. ‘It’s probably a good thing you two are off-site today. Give him a little space and perspective rather than stomping around here like a bear with a sore head. Have you got supplies?’

  It was widely known amongst the staff at The Practice that both Dan and Taffy were much nicer human beings when regularly fed. Indeed, Dan’s outburst this morning was most likely the direct result of skipping breakfast in his haste to get to work.

  Grace nodded. ‘We’ll pick up some bacon sandwiches from The Deli before we leave. I’m not letting a h-angry Dan loose on a roomful of regional delegates!’

  Holly nodded, pushing the door closed with her foot. ‘Hang on a sec, we can raid my emergency stash, if you like?’ She pulled a file box down off the shelf, flipping it open to reveal bags of Jelly Babies, Fruit Pastilles and mini Mars Bars.

  Grace couldn’t help but look shocked.

  Holly shrugged. ‘When you live with Taffy, it always pays to be prepared. Between him and the twins, ninety per cent of my handbag is snacks these days!’

  Grace laughed. ‘Well, how Dan and Taffy eat that much crap and still look so great is beyond me, but I’m all for an easy life and it’s quite the drive to Bristol.’ She reached forward and picked out the family-sized bag of Jelly Babies. ‘Wish me luck then. One more day to get through and then that’s it! Last seminar done and dusted.’ The relief on her face at the prospect was plain to see and Holly didn’t dare mention that Derek Landers had already been pushing for more.

  She pressed a couple of mini Mars Bars into Grace’s hand – just as a precaution. ‘Knock ’em dead,’ she said with a smile.

  After a few hours of her regular Monday clinic, Holly could have been forgiven for thinking that all would be back to normal in no time. It was only when her last patient of the morning walked into the room that she realised she’d been kidding herself.

  ‘I’m so sorry to take up your time, Dr Graham, but I think I might need a little help with this.’ Charlotte Lansing slipped out of her quilted jacket and Holly tried hard not to look shocked. It was all very well that the Lansings prioritised their horses above all else, but nev
er had she expected this. As she peeled back the veterinary dressing on Charlotte’s arm, the true extent of the wound became clear.

  ‘Oh, Charlotte,’ Holly exhaled, compassion laced into every syllable.

  ‘I know, I know,’ Charlotte said with a sigh, ‘but there was so much going on after the show and some of the ponies had been injured too. It just seemed easier.’

  Easier in the short term maybe, thought Holly, as she examined the horseshoe-shaped gash in Charlotte’s forearm. She gently palpated the area around the open wound, checking the extent of the thickening and swelling. The angry redness of the wound itself told its own story. Simply packing a sterile dressing on a dirty cut was some kind of madness, but Holly tried not to judge her patients, aiming to guide them towards better choices if she possibly could. She couldn’t however completely hide her own stunned reaction to how appalling this wound was looking.

  ‘You can say it, you know,’ said Charlotte. ‘It’s infected, isn’t it?’ She shook her head. ‘You’d think I’d know better.’

  Holly looked up, unable to offer a different perspective. ‘Did this happen at the show?’ she asked, trying to confirm a timeline that made sense.

  Charlotte nodded. ‘Can you believe I didn’t even notice until later though? I was trying to help one of our novices after the plane went over and the pony just panicked. It looked pretty clean at the time.’

  ‘It’s still a hoof, though,’ said Holly gently. She didn’t like to draw the parallels with a filthy hiking boot, but nevertheless, who knew what bacteria were currently festering in this cut? ‘Charlotte, there’s no way around this, you’re going to need stitches. And this cut is pretty deep and angry, so they’ll want to irrigate thoroughly at the hospital, maybe take some swabs for the lab.’ She paused, before deciding that forewarned was forearmed. ‘A targeted IV antibiotic wouldn’t be the worst idea.’ She let the idea sink in.

  Charlotte just shook her head though. ‘But that would mean staying in, wouldn’t it? I can’t do that – the horses—’

  Holly interrupted smoothly, ‘There’s a time to prioritise them, and a time to prioritise yourself, Charlotte. It’s boring but true that a stitch in time saves nine. An infection like this can be quite virulent and it’s already had quite a head start.’

  Charlotte nodded and Holly breathed a sigh of relief that she was now taking her own health seriously without Holly having to employ scare tactics. ‘I’ll just pop back to the farm and muck out and I’ll drive straight on to Bath, how’s that?’

  Holly closed her eyes for a moment. Just because she was tired, it didn’t excuse the unfamiliar wave of frustration with her patient washing over her. She typed the referral into the computerised system to take a moment to compose herself. ‘Charlotte,’ she said gently, as she turned back to face her recalcitrant patient, ‘this has to be your priority now. I don’t know what kind of infection this is yet, but it is not good. Seriously, not good. And you need to get straight to the hospital. In fact, I’ve half a mind to—’ She paused, not wanting to make a fuss, but unable to ignore the persistent alarm bells at the back of her mind.

  ‘What?’ asked Charlotte abruptly, actually looking bothered for the first time, as it dawned on her that she wasn’t being sent home with a tube of industrial-strength Savlon.

  ‘I think we need to get you there as promptly as we can,’ said Holly apologetically, picking up the phone and typing in a number by heart. ‘Hi, this is Dr Holly Graham in Larkford. I need a Priority Two transfer to the RUH – an infected wound, five inches, deep, small possibility of NF from initial observation, but the wound was sustained yesterday and not treated, so—’

  Holly looked up and could tell from the shocked expression on Charlotte Lansing’s face that she could hear the tone of the response at the other end of the line. ‘Is there someone you’d like to call to meet you there, Charlotte?’ Holly asked. ‘I think some company would be good, don’t you?’

  Charlotte shook her head. ‘Henry will need to take care of things at home.’ She visibly bit back tears. ‘Dr Graham, what’s NF?’

  Holly wanted to be evasive, to let the consultant at the hospital explore this possibility with her, but from what Holly had just seen, the likelihood of necrotising fasciitis – or flesh-eating bacteria as the media liked to call it – wasn’t out of the realms of possibility, especially in a filthy wound like this one.

  Holly took Charlotte’s hand as the clock ticked round and they waited for the paramedic team to transfer her to Bath. One of the first things she’d learned as a med student was that, if you hear hooves, think horses not zebras – the most common illnesses being by definition the most likely. But sometimes, thought Holly, you still had to be prepared for a bloody great zebra to gallop through your surgery and be open-minded enough to see it.

  Either that, or they were all on such high alert for drama after the weekend’s events that she was just looking for trouble. ‘It’s just a possibility, though, Charlotte. Better to be safe than sorry with this,’ she said reassuringly, as Charlotte’s grip tightened.

  ‘So you’ve scared me senseless for nothing?’ Charlotte said, her usually charming demeanour swamped by fear. ‘This is appalling, Dr Graham. You must see that?’

  Holly held her ground. ‘If I didn’t mention the possibility to you, Charlotte, you’d have every right to say that you hadn’t been kept informed about your treatment.’ Sometimes bureaucracy was a bitch that would trip you up whichever way you turned, Holly had long since decided. Her best parameter, since the very moment she became a GP, had been to treat her patients as she would her friends, even if some of their prickly behaviour made that incredibly challenging at times.

  Charlotte glowered, no longer apologetic for her part in the exacerbation of her infection.

  Taffy’s timing could not have been more impeccable, thought Holly, as he tapped on the door and strode into the room. ‘Hello, hello. Are we getting a bulk discount on ambulance transfers this week?’ he asked, his entire demeanour at odds with the tension in the room. He smiled at Charlotte and offered his arm chivalrously to help her to her feet. The expression on his face as he caught sight of the offending wound was like a caricature of shocked disgust – after all, even doctors were allowed to be squeamish. ‘So I gather we’re going to pop on a sterile dressing for transport and the team in Bath know you’re coming?’

  He looked meaningfully at Holly, clearly trying to transmit his own diagnosis without saying a word.

  ‘It’s alright, Dr Jones. You don’t need to bother with tact around here. Dr Graham has already given me a dressing-down for not taking care of it properly. The way she’s talking, I’ll be lucky to keep the arm!’ She glared at Holly, as though the whole conversation had been cleverly designed to chastise her for her flippant approach to her own health. The potential severity of her condition apparently still eluded her.

  Taffy, however, was not in the loop of their conversation. ‘Better to cross that bridge with the consultant, Mrs Lansing. We’ll have a much clearer picture of the degree of infection once your labs come back. It’s possible a simple surgery can—’

  ‘Surgery?’ screeched Charlotte, wheeling round to glare at Holly. ‘You never said anything about surgery!’

  Holly had never been so grateful to see the paramedics in the hallway. Never so grateful to pass the medical baton to somebody else. It was some measure of her own anxiety this morning that she could no longer see the whole picture here. Following her instincts was one thing, alienating her patients by overreacting was something else entirely.

  She genuinely had no idea in that moment whether she had just royally pissed off one of her favourite patients, or actually saved her life. The only thing she could be sure of, after Saturday’s fiasco, was that she would rather be safe and unpopular, than sorry and potentially negligent.

  As the ambulance pulled away, Holly leaned her head against Taffy’s chest. ‘I think Charlotte Lansing’s pretty furious with me right now.’
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  He leaned down and kissed the top of her head. ‘Yup. Until she talks to the consultant. Then I’m guessing she might just change her mind.’

  Chapter 6

  Dan clicked to the final slide of the presentation with relief. This was the very last of the fortnightly seminars and he had to confess that his enthusiasm had waned rather. With each repetition, the emotive and persuasive evidence that he and Grace put forward to their medical cohort had begun to sound somewhat pedestrian and uninspired. In light of the weekend’s drama, both of them appeared to be running on empty and he was a little embarrassed that today’s seminar would hardly count as his best work.

  ‘Was that okay, do you think?’ he asked Grace under his breath.

  ‘I think I may have zoned out actually,’ she replied sheepishly. ‘Sorry, but this is the twenty-fifth time we’ve done this now.’

  ‘Well done, you two,’ said Harry Grant, bustling over to congratulate them and completely missing their rather despondent mood. ‘That went extremely well, don’t you think?’

  Harry, their bespectacled and unlikely champion, was their like-minded mole inside the Primary Care Trust. It had been his idea to nominate The Practice as a Model Surgery the year before and, despite his senior rank, he had chosen to continue co-ordinating the programme himself. His main role these days, however, appeared to be providing a buffer between the team at The Practice and the ever-escalating demands of his own superior, in the shape of Derek Landers. Harry was what Grace liked to refer to as ‘a good egg’.

  ‘I’ve been getting some really fabulous feedback, you know,’ Harry said happily. ‘That last diagram you added to the handouts? The one with the statistics about staff integration in the decision-making process? Well apparently it’s hopping its way around the internet, because someone from Harvard left me a voicemail last night. So you must be doing something right!’