‘How about the rest of the family?’ Sally asked, carefully inspecting the skin over the painful area.
‘No, we’re all well really. At least, now we are. My daughter got divorced last year and that knocked us all back a bit, but other than that we’ve all been fine.’
‘What a shame,’ Sally said sympathetically.
‘Yes. Terrible, what with the kids and all. Still, she seems to be coping now.’
‘Any back trouble at any time?’ she asked, wondering if there was a possibility of intercostal neuralgia from a trapped nerve in his thoracic spine, but she thought it unlikely.
‘No, I never had any back trouble, Doc. Fit as a flea.’
Sally straightened. He had said his daughter had got divorced, and from his tone of voice he had found it very stressful. Stress was a typical trigger for herpes zoster, and in the absence of any other symptoms it was her most likely diagnosis, even without the rash.
‘I’m not sure,’ she told him,’ ‘but I think you might be getting shingles. You’ve got the classic symptoms. If I’m right, you should get a rash soon over the sore bit, small raised red spots that turn into chicken-poxtype blisters and then scab over. Now, I’m going to give you a presciption for an antiviral drug that should limit the severity of the disease, but there’s nothing I can do to stop it. If it is herpes zoster or shingles, you’ll find it will last about two to three weeks, and then you should be feeling much better.’
‘And if it isn’t?’
‘It could be pleurisy, but you haven’t got the classic pain radiating up to your shoulder when you breathe in and, frankly, I think it’s highly unlikely. Have you ever had chicken-pox?’
He nodded. ‘I believe so, as a child. I seem to remember my mother putting cotton gloves on me and smothering me in calamine lotion.’
Sally smiled. ‘Sounds like it, then. Right, here’s your prescription. Follow the instructions, and let me know if there’s any change. If you deteriorate, or if the rash doesn’t come out and the pain gets worse, give me a ring.’
As he stood to put on his shirt, Sally noticed a slightly reddened area under his arm.
‘Hang on,’ she said, and, lifting his arm again, she inspected the skin more closely. Sure enough, a very fine scatter of pink pinpricks was beginning to spread over a tiny area high up on his ribs near his armpit.
‘Yes, I can see the rash now, only very faintly but it’s starting. Right, get those antiviral pills started as soon as possible, and hopefully your symptoms won’t be too bad and they will limit the severity of the pain. You can take simple painkillers, like paracetamol, but if it’s too bad come back to me and I’ll give you something stronger. Hopefully we won’t need to do that.’
Sally glanced at her watch as he left. Six-fifteen. With any luck her last couple of patients wouldn’t take too long, and then she could escape. She was starving, and it seemed ages since that half-bowl of soup at lunchtime.
Her next patient, however, snookered her hopes of a quick escape.
Carol Bailey had the butterfly of an ear-ring embedded in the back of her ear-lobe, and the lobe had swollen and become extremely inflamed and infected.
‘Oh, dear,’ Sally said sympathetically. ‘That must be very sore.’
The girl nodded. ‘It is. I thought it was getting a bit tender, so I put a plaster on it. Didn’t think to take the ear-ring out, because I’ve worn them for years and quite often they get a bit sore. I had some cheap earrings on this time, and that’s when it happens. Anyway, I went to take it out and the back seemed to have disappeared. Then my mum said it was stuck in the back of my ear.’
‘Yes, it is. I’ll have to give you a local anaesthetic and make a tiny cut just to pop that out. Are you allergic to any local anaesthetics, do you know? Do you have an injection at the dentist?’
She nodded. ‘Yeah. No problems.’
‘Good. I’ll give you the injection, then I’m going to ask you to go and wait in the waiting-room while I see my next patient. That’ll give the anaesthetic time to work.’
She drew up a small amount of lignocaine, and injected the ear-lobe with it.
‘Ouch!’ Carol exclaimed.
‘Sorry. It can be a bit sore going in. Right, if you could send in the last patient for me—’
‘The last? There’s about four out there.’
‘Oh. Right. Well, the next, then. Thanks.’
She rang Jackie. ‘Have I got extra patients?’
‘Yes—sorry, I was about to ring you. There are two of them. They’ve got their notes with them.’
Sally sighed under her breath, smiled at the next patient and carried on.
Fortunately they were all simple cases: tonsillitis, an abscess that would need excision in the morning, and a urinary infection. She dealt with them all accordingly, called the girl with the ear-ring back in and quickly excised the butterfly clip.
‘Can I have it back?’ Carol asked. ‘Only the earrings are useless without it.’
‘I should chuck them out, if I were you,’ Sally advised. ‘The butterfly’s very small and could easily get stuck again. I should let this heal for at least a week before you try and put another ear-ring in.’
‘But it’ll heal!’
Sally hung on to her temper with difficulty. ‘That’s rather the idea.’
‘But I don’t want the hole to heal up. Here, I’ve brought a gold ring with me—could you put that in? It’ll keep the hole open and the rest can heal. It’s happened before.’
Sally looked at her ears, festooned with several studs. She didn’t doubt she’d had problems.
‘I’m sorry,’ she said firmly. ‘There’s no way I’m putting anything in that ear, and if you do I can’t be held responsible for the consequences. You’ve got a very nasty infection, and you really ought to take it seriously. I’m giving you some antibiotics to take, and I want you to be sure and take them so that infection doesn’t spread.’
‘Antibiotics?’ Carol asked, clearly amazed.
‘Antibiotics,’ Sally repeated firmly.
The girl reluctantly took her prescription and left, and Sally stood up and scooped up the notes, took her handbag out of the drawer and headed towards the office.
Jackie greeted her with a little sheaf of messages.
‘Three calls—two in town, quite close, and one out in a village on your way home.’
‘Wonderful. Just what I needed. How urgent are they?’
Jackie shrugged. ‘Depends if you’re the doctor or the patient, I guess. Nothing critical, I don’t think. I’m going home to my husband and children.’
Sally smiled at her wearily. ‘You do that. I’ll see you tomorrow. Thanks.’
She did the calls on the way home, if only to get them out of the way before the rest started. As Jackie had said, they weren’t critical. Two of the people could easily have made it to the surgery earlier, and the third could have waited till the morning. Still, at least they wouldn’t get her out in the middle of the night…
It was nearly nine before she got home, and Sam was dozing in the middle of the settee in the sitting-room when she got back, a sleeping child under each arm.
They looked gorgeous: Molly with her dark hair straggling across one cheek, her lashes black against her pale skin; Ben, his face thinner now as he began to mature, a carbon copy of his father; and Sam, long legs stretched out, his dark gold hair tousled, his mouth soft and full and very kissable.
She blinked. Kissable? That was an unfamiliar urge. It had been ages since she’d wanted to kiss him, really kiss him till she blew his socks off.
And now was hardly the time.
‘It’s lovely to see you all so busy,’ she said softly.
One by one their eyes opened and they struggled to wakefulness.
‘Hello, Mum,’ Ben mumbled.
‘We waited up for you,’ Molly said sleepily.
She met Sam’s heavy-lidded eyes, and he quirked his brows. ‘I didn’t think you’d be this late.’ His voice was husky with sl
eep, and it made her tingle.
‘I had three calls after surgery, and it was one of those long evenings. Is there anything to eat? I’m starving.’
‘Yes, in the oven. Let me get the kids into bed and I’ll join you. Come on, kids, up the wooden hill to Bedfordshire.’
She kissed the children, then watched as he scooped the sleepy Molly into his arms and followed Ben slowly up the stairs. He looked stiff, from sitting still for so long, presumably.
Bless them. Fancy waiting up for her. Her eyes prickled with tears and she dashed them impatiently away and kicked off her shoes, sinking down on to the settee in Sam’s place.
It was warm from his body, soothing, and she reached out for a cushion and tucked it under her cheek, snuggling into the back of the settee. She didn’t sleep, just lay there in his warmth and tried to relax.
No wonder he so often came home for lunch and dropped off to sleep. Napping was very healthy, she knew, but it was something she’d never learned to do.
Perhaps she just needed more practice!
She heard Sam’s footsteps, and lifted her head half an inch to smile wearily at him.
‘Hi.’
He sat down awkwardly beside her.
‘Hi.’
She peered at him. ‘You look stiff—what have you been doing?’
‘Oh, don’t. I went to your health club and chatted up one of the fitness instructors to let me use your membership for the next couple of weeks.’
‘And?’
‘She let me make a fool of myself.’
Sally tried to hide the smile. ‘But I thought you’d find it dead easy, playing about at the health club? After all, I do it—’
‘Don’t, Sally,’ he warned.
‘What’s the matter, baby? Your ego dented?’
‘Witch,’ he mumbled, and shifted painfully. ‘God, my legs hurt. That treadmill’s a killer.’
‘It gets easier,’ she promised.
He muttered something unprintable, and she chuckled.
‘Don’t wind me up or I won’t feed you,’ he warned. Her stomach grumbled, and Sam got painfully to his feet.
‘Come on, then,’ he said, and she could have sworn he was glad to get away from her—or the conversation? She wondered what had happened.
‘Who was the instructor?’ she asked idly, following him into the kitchen.
‘What? Oh, Amy.’
Sally nodded. Amy would be sensible, but she wasn’t above letting him make a fool of himself for fun. She turned away so Sam wouldn’t see the smile.
At three in the morning the phone rang, and she stumbled out of bed, threw on her clothes and told Sam to ring an ambulance and send it to Sue Palmer’s house.
She arrived there before the ambulance, but fortunately it wasn’t far behind her because Sue was pale, clammy and in a lot of pain. She had also noticed a small vaginal blood loss, and Sally was very worried that the placenta had separated from the uterus and that she was haemorrhaging. Often the mother’s condition was out of all proportion to the apparent loss, and Sue certainly looked as if she’d lost more than the small amount she reported.
While she waited for the ambulance Sally got an intravenous line in and began running in saline and 10 mg of cyclimorph for the pain.
The ambulance arrived just as she completed the injection, and she handed a hastily scribbled letter to them and rang the maternity unit on her mobile phone after the ambulance had left.
Please, God, she thought, let the baby be all right. Don’t let me have killed it because I didn’t act soon enough.
Shocked, worried, her professional confidence in tatters, she drove home to find Sam in the kitchen boiling the kettle.
‘How is she?’
‘Weak, shocked—oh, Sam, what if the baby dies?’
He squeezed her shoulder, well aware of what she was going through.
‘Don’t jump the gun,’ he advised gently. ‘Here, I’ve made tea. Let’s go in the sitting-room.’
She trailed after him. ‘Should I have admitted her earlier?’
‘I don’t know. I didn’t see her. Did you go back?’
‘Yes. Yes, I did, and she was no different—tired, perhaps, but nothing untoward.’
‘Then, no, I don’t think you could have been expected to admit her earlier. What for, as you said?’
Sally sighed heavily and curled her feet under her bottom. ‘A gut instinct?’
He shrugged. ‘Looks odd on paper. How was her husband?’
‘Calm, organised—marvellous, really. Very supportive, but worried to death.’
Sam pushed a mug into her hand and made her drink some tea. It lay heavily in her stomach, though, so she just cradled the cup for comfort.
‘Any more calls?’ she asked belatedly.
‘No. How’s it been going?’
She gave a hollow laugh. ‘Fine till now. Sam, what if the baby dies?’
‘Did you get a heartbeat at the house?’
‘I didn’t try—there wasn’t time, and I didn’t want to muck about.’
‘Ring the hospital.’
‘Should I?’
‘Of course. I would.’
She picked up the phone and dialled the hospital, and after a moment she was transferred to the theatre.
‘She went into surgery with a strong heartbeat from the baby, so hopefully—hang on, can you? I’ll go and ask.’
Sally heard footsteps walking away from the phone, murmured words in the background and then footsteps approaching again.
Her palms were clammy, her heart pounding.
‘Hello? The baby’s fine. The placenta was still partly attached. OK?’
‘Thank you,’ Sally said, and put the phone down with trembling fingers.
‘Sally?’
‘The baby’s fine,’ she said unsteadily, and turning, she threw herself into Sam’s waiting arms.
CHAPTER FOUR
POOR Sally. She’d had a tough night, worrying about Sue Palmer and her baby. Still, medicine was like that, totally unpredictable.
Personally he would have admitted her earlier, Sam thought, but it was hard to say. Judging by Sally’s account, there had been little to go on.
Still, no harm done. They probably wouldn’t have done much in hospital for the first twenty-four hours. A scan, perhaps, but that wasn’t always conclusive.
It was a beautiful morning. He dropped the children off at school and went to the health club, where Amy put him through a nice, steady routine that nevertheless made his aching muscles howl in protest.
When he got back he was greeted by a mountainous washing-basket in the utility-room. Unready to tackle it, he made a cup of coffee and took it out into the garden, walking round and studying the beds.
Sally was right; she had done a lot of work out here.
The front, though, needed some attention. He had noticed large areas which were infested with weeds, all at the seedling stage. If he hoed them out now for her, she wouldn’t have nearly so much to do later.
And then, after lunch, he’d tackle the washing.
Sue Palmer’s haemorrhage was a frightening lesson in the sharp end of medicine for Sally. Sam had been wonderful, kind and supportive, without a word of criticism or censure, not a trace of an ‘I told you so’, and yet she was sure he would have admitted the woman sooner.
Intuition, or experience? Experience, she was sure, because she had known something was badly wrong, so why hadn’t she acted more quickly?
Because she had no proof, and she didn’t want to appear trigger-happy.
Well, to hell with how she looked. From now on, if she had the slightest doubt, she would admit willy-nilly and regardless. Let the hospital make the tricky decisions and send patients home unfit.
She had rung the hospital again in the morning for an update, and was delighted to hear that both mother and baby—a girl—were doing well.
It was a good job someone was, she thought, because lack of sleep meant she was doing decidedly indiffe
rently. She struggled against weariness all morning, and when lunchtime came she headed for home, hoping for a lazy hour curled up on the settee in the sitting-room before her antenatal clinic at three.
Her tiredness was banished, however, when she turned into the drive to see Sam hard at work in the front garden with a hoe.
For all his other qualities, Sam was not a gardener— and he was hoeing right in the middle of her pansies!
She leapt out of the car and rushed over to where he was putting the finishing touches to the carnage.
‘Hi!’ he said cheerfully. ‘Looks better, doesn’t it?’
Her shoulders drooped. ‘Oh, Sam,’ she wailed ‘you’ve hoed up all my pansy seedlings!’
Lunch was conducted in a huffy silence, with Sam defensive and Sally tired, crabby and unreasonable.
‘Why didn’t you ask?’ she had yelled at him.
‘Ask what? They looked like weeds! What was I suppose to say? “Sally, can I dig this weed up?” Life’s too short.’
‘Clearly—for the pansies.’
‘Oh, stuff the bloody pansies,’ he had yelled, and stalked off into the house in a rage.
Now, after lunch, things weren’t a great deal better.
‘Just promise me something,’ she begged. ‘Don’t do anything else in the garden without asking me first, eh?’
‘Does that apply to my patients, as well?’
She sighed. ‘Sam, it’s hardly the same. At least I’m trained.’
‘Is that why you didn’t admit Sue Palmer until it was almost too late?’ he said softly.
The words hung in the air between them, vibrating in the silence.
Shocked, as much by the truth of his remark as by the pain of his criticism, Sally could scarcely drag the air into her lungs.
‘That was uncalled-for,’ she managed finally, her voice uneven.
He stabbed his hands though his hair and let his breath out in a gush. ‘Hell, I’m sorry. I don’t know why I said it.’
Sally swallowed hard. ‘Because it’s true?’ she whispered.
He sighed and closed his eyes. He couldn’t deny it, they both knew that. ‘You did what you thought was right at the time,’ he said eventually.
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