‘Yes, I suppose so. You just took me by surprise, that’s all,’ she admitted. ‘Like you say, I was expecting Monday…’
‘Ah, there’s no time like the present. You’ll be fine—there’s nothing like a fraught Friday afternoon surgery.’
‘You make it sound like an ordeal.’ Adele looked alarmed.
‘Not at all. You wait, it’ll be all slight symptoms folk think will exacerbate before Monday.’
In spite of Casey’s reassuring words, Adele found she was incredibly nervous as she sat in his consulting room, waiting for her first patient. It was the same room where she had sat beside him on numerous occasions since coming to Stourborne Abbas, the only difference being that now, instead of sitting alongside him, she was sitting at the desk while Casey sat behind her in the corner of the room.
‘You’re nervous, aren’t you?’ he said quietly after they had sat in total silence for several minutes.
‘Yes,’ she admitted at last, ‘I suppose I am.’
‘You’re a doctor, Adele—a fully qualified doctor. You’ve sat in this room with me for the last week. I promise you, there won’t be anything you can’t deal with and if there is, don’t forget I shall be right here behind you.’
‘Maybe that’s what scares me.’ Adele gave a nervous little laugh, looped her dark hair back behind her ear then looked up sharply as there was a knock at the door. ‘Come in,’ she called, and the door opened to admit a middle-aged man whose reaction on seeing Adele behind the desk was almost one of suspicion.
Adele took a deep breath. ‘Hello,’ she said. ‘Mr Reynolds, isn’t it?’
‘That’s right.’ The man’s gaze flickered to Casey.
‘I’m Dr Brooks,’ Adele went on. ‘How can I help you?’
‘Well, I’ve been getting this pain—right here.’ The man indicated a point below the centre of his chest at the top of his abdomen, but as he did so he was still looking at Casey.
‘What sort of pain is it?’ asked Adele.
‘I think it’s a sort of indigestion pain, but it gets very severe. Last time I had it, which was last night, I was rolling around. My wife gave me some indigestion mixture but it didn’t seem to work. In fact, it got worse and went right through to my back. I couldn’t seem to get away from it no matter what I did.’
‘Does the pain come on after you’ve eaten?’ asked Adele as she turned to the computer screen and studied John Reynolds’s medical history.
‘Yes, I suppose it does, although sometimes it can be as much as an hour or an hour and a half afterwards.’
‘I see from your records you have a history of high blood pressure,’ said Adele as she switched to the man’s medication chart.
‘Yes,’ Mr Reynolds nodded. ‘I saw Dr Fletcher for that and he prescribed them beta-blockers.’
‘I’d like to examine you, Mr Reynolds.’ Adele indicated the adjoining room. ‘If you’d like to go into the examination room, take off your jacket and shirt and lie on the couch.’
Casey remained silent as Adele continued to study the patient’s records then, taking her stethoscope, she made her way into the examination room where she found John Reynolds lying on the couch. Gently but firmly she carried out a thorough examination of his chest and abdomen, talking to him all the while and asking him to indicate the areas that felt tender to pressure. To complete her examination she checked his heart and blood pressure. When she had finished she straightened up. ‘If you would like to get dressed,’ she said, ‘then come back into the consulting room.’
Casey gave her an enquiring look as she re-entered the room. ‘Problems?’ he said softly.
‘Not really.’ She sat down at the desk. ‘I’m going to refer him for a gastroscopy and ultrasound but I would also like him to have an ECG today.’ She paused, looking at the monitor screen again. ‘Can I arrange that on the computer?’
‘Yes.’ Casey nodded. ‘Just go into“Nurses’ Clinics” and you can see what appointments are available.’
By the time the patient returned to the consulting room Adele had set the chain of events in motion for further investigation of his condition. All that remained was for her to explain to him what would happen.
‘Ah, Mr Reynolds, please, come and sit down,’ she said gently. ‘Now,’ she said, ‘I would like you to have some tests to try to find out what is causing your pain. I’m going to arrange for you to go to the local hospital to have a gastroscopy.’
‘What’s that?’ John Reynolds frowned, his glance travelling rapidly from Adele to Casey then back to Adele.
‘It’s a procedure where a tube is passed down into your stomach. Don’t worry,’ she hastened to add when she saw his expression change from one of suspicion to one of alarm. ‘You’ll be sedated so you won’t know what’s going on. I also want you to have an ultrasound, which is a very simple procedure and completely painless but it does tell us anything untoward which may be going on inside you.’
‘Will I have to stay in hospital for these?’ Mr Reynolds still looked worried.
‘No.’ Adele hastened to reassure him. ‘They can both be carried out in the outpatient department and neither should take very long. I’ll write to the hospital and you should receive an appointment through the post. Now, the other thing I would like you to have is an ECG—an electrocardiogram.’
‘That’s for my heart, isn’t it? You don’t think it was a heart attack, do you?’ The man looked thoroughly alarmed now.
‘No,’ Adele replied firmly, ‘I don’t. But in view of your blood-pressure problems I want to make absolutely certain. Don’t worry, you can have that done here. I’ve checked with our nurses’ clinic and they have an appointment for later this afternoon at four-fifteen. Could you come back for that?’
‘I suppose so.’ Mr Reynolds looked bewildered. ‘I think I’ll go and phone my wife first.’
‘I think that’s a good idea.’ Adele smiled at him. ‘And, please, try not to worry. We’ll find the problem for you and we’ll deal with it. In the meantime I’m going to prescribe a course of tablets that should help to control the symptoms and I would like you to try and stick to a fat-free diet for the time being.’
‘What do you mean by fat-free?’
‘Animal fats really,’ Adele explained. ‘Things like butter, cheese, cream or full-fat milk. If you ask at the reception desk on your way out, one of the receptionists will give you a diet sheet which will explain things more fully.’ As she finished speaking she tore off the prescription she had just printed out and handed it to him. ‘Now, is there anything else you want to ask me?’
‘I don’t think so, Doctor. I can’t think straight at the moment.’
‘I’ll come along and see you after you’ve had your ECG,’ said Adele with a reassuring smile.
‘Right.’ John Reynolds nodded. ‘Well, thank you, Doctor.’
As the patient left the consulting room Adele glanced at Casey. ‘Well, that was hardly a trivial, last-minute Friday afternoon appointment.’
‘Absolutely not.’ He paused. ‘Did you come to any conclusions?’
‘I think we’re probably looking at gall-bladder disease,’ said Adele slowly. ‘His abdomen was certainly very tender in that area and the pain and symptoms he was describing seem to point to that, but with his history of hypertension I want to make absolutely certain.’
‘You did well.’
It was but slight praise but somehow, and in spite of the fact that she was still acutely aware of Casey’s presence in the room, it made her feel more confident to face the next four patients, who ranged from a toddler with severe eczema and a young man with diarrhoea and vomiting to a woman with flu-like symptoms and an elderly man with gout.
By the time she reached the last patient on the list she felt totally at ease with the situation, but as she reached out and pressed the buzzer Casey leaned forward and, peering at the computer screen, sucked in his breath sharply.
‘What is it?’ Adele frowned.
‘Elvira J
ackson,’ he said. ‘Not the easiest way to end a week.’
‘Elvira Jackson?’ said Adele quickly. ‘Where have I heard that name—Elvira?’
‘It’s OK,’ said Casey quickly, as without even the sound of a knock the door was suddenly pushed open ‘I’ll tell you later.’
A woman stood in the doorway, laden with several bags and plastic carriers. Her age was difficult to determine but she could have been anywhere between thirty-five and forty-five. Her long, straggly, dark hair was streaked with grey, her eyes were strangely light-coloured and in spite of the warmth of the September afternoon she was dressed in a grey, ankle-length knitted coat over a long skirt of the same colour with several dark-coloured scarves wound around her neck.
‘Hello, Elvira.’ It was Casey who spoke first, which surprised Adele for until then he had remained silent as each new patient had entered the room, allowing her to conduct the consultation.
‘Who’s she?’ Those curiously coloured eyes moved to Adele.
‘This is Dr Brooks.’ Again it was Casey who spoke and Adele decided it was high time she intervened.
‘How can I help you?’ she asked firmly.
‘I’m pregnant,’ the woman declared as she dumped the various bags she was carrying onto the floor and sat heavily down on a chair.
‘You know that isn’t true, Elvira.’ Again Casey intervened.
‘I might be. I want a test.’
‘Very well,’ Adele said soothingly. She was beginning to get a little irritated with Casey’s interruptions. Either she was taking this surgery or she wasn’t. ‘I’ll give you a specimen pot and you can bring in an early morning sample and we’ll have it tested for you,’ she went on firmly, ignoring Casey’s apparent attempts to attract her attention.
The woman shot a triumphant expression towards Casey as Adele handed her a specimen pot.
‘Now, is there anything else?’ asked Adele.
Elvira shook her head then stood up and gathered up her bags. Making no attempt to leave the room, she continued staring at Adele. ‘I know you,’ she said at last.
‘Do you?’ Adele was a little taken aback by something in the woman’s attitude and at the same time conscious of a sudden, unexpected feeling of discomfort which she immediately tried to dismiss. She was a doctor, wasn’t she, for heaven’s sake? And if she was going to be a GP she had to get used to all types of people and every possible situation that could present itself.
‘You’re the one who’s living in my flat.’ The woman’s tone was dull, devoid now of the passion that had been in her voice when she’d announced that she was pregnant. Before Adele could respond she turned and without another word walked out of the room.
Adele turned to Casey. ‘What did she mean?’ she said uneasily as the door clicked shut.
‘She’s the one who was living in your flat before you,’ Casey replied simply.
‘The troublemaker?’ Adele raised her eyebrows as she recalled the comments Casey had made when he’d first shown her up the stairs to her flat.
‘One and the same.’ He gave a little shrug.
‘In what way was she a troublemaker?’ Suddenly Adele needed to know.
Casey sighed and Adele gained the impression that he was reluctant to talk about Elvira Jackson. ‘Let’s just say it was a mistake in the first place to allow her to have use of the flat.’
‘So who’s fault was that? Who was responsible?’
‘Unfortunately it was Toby,’ Casey admitted. ‘Elvira was his patient. She has a long history of psychiatric problems, together with a personality disorder. When she was evicted from her previous flat Toby felt sorry for her and told her she could stay temporarily in the flat, which is now yours. When the local council found alternative accommodation for her she didn’t want to move out. We had to get a bit tough in the end.’
‘But in what way was she a troublemaker?’ Adele frowned.
‘She has some very strange ways. For a start she has a fascination with fire. We didn’t know that until after she’d moved in and left candles burning which set fire to the curtains and almost burned the whole place down.’
‘But surely that could have been an accident,’ Adele protested.
‘She also developed a fixation with Toby,’ Casey went on calmly. ‘She followed him everywhere, wouldn’t leave him alone. On one occasion she even parked herself in his examination room and stayed there while he took a surgery. He didn’t know she was there until a patient went in to get undressed—it quite unnerved him.’
‘Yes, I’m sure it did, but—’
‘On another occasion she started sending anonymous mail to the reception staff, accusing them of heaven knows what, then sticking up posters in the waiting room listing things they were supposed to be doing.’
‘Were the police involved?’
‘Only in a very superficial way. Elvira is well known to the police, unfortunately because of her medical conditions. There seems to be little that can be done apart from warnings…but she appears to be reasonably harmless. Strange maybe, but harmless.’
‘Is she still registered with Toby?’ asked Adele slowly.
‘No, she’s with Jeanette now. We thought it for the best to move her. You probably only got her today because I’m duty doctor and she was an extra.’ Casey leaned back in his chair. ‘Maybe we should have removed her from the list entirely but if we did it would mean she would have to travel miles to another practice.’
‘Why did you think she couldn’t be pregnant?’ asked Adele curiously.
‘Because in the past she’s had two terminations, which have left her infertile.’
‘Oh.’ She stared at Casey. ‘Why didn’t you say? I feel a fool now, telling her to do a specimen.’
Casey shrugged. ‘I was going to stop you then I thought it was probably best to humour her—let her have what she wanted.’
‘But does she seriously think she could be pregnant?’ Adele stared at him in concern. ‘If so, I find that incredibly sad.’
‘Yes, it is. But with Elvira, who knows? Unfortunately, anything is possible.’
‘Doesn’t she have a psychiatric social worker?’
‘Yes, she does, a young woman by the name of Ruby Felton who monitors Elvira and who on the whole does a good job with her because most of the time she’s OK—it’s just when she gets some sort of fixation that the trouble starts.’
‘Like with Toby, you mean?’
‘Yes, poor old Toby—he didn’t know what had hit him.’ Casey sighed and stood up. ‘Well, that looks like the end of your first surgery,’ he said. ‘How are you feeling?’
‘All right,’ Adele replied. ‘But I think there’s going to be much more to being a GP than I had ever realised…it’s going to be a real challenge.’
‘Think you’ll rise to it?’ He raised his eyebrows and the scar on his face stood out sharply, making Adele once again want to ask him how he had got it.
‘Oh, yes,’ she said firmly. ‘I have no doubts about that.’
CHAPTER SIX
‘I’VE been called out. Want to come along?’
‘Yes, of course.’ It was Sunday afternoon and Adele was in her bathroom, having just washed her hair, but she didn’t hesitate when she took Casey’s call on her mobile phone. ‘Give me five minutes,’ she said.
As she left her flat she met Penny on the landing.
‘Oh, there you are,’ said Penny. ‘I was just coming to see you. I wondered if you fancied strolling down to the pub for a swift half.’
‘Penny, I’m sorry, I can’t—’ Adele began.
‘Never mind,’ Penny cut her short. ‘How about a quick coffee? It won’t take me long, the kettle has just boiled.’
‘No, you don’t understand,’ Adele explained. ‘I have to go out right away. Casey has had a call-out.’
‘And you’re going with him.’ It wasn’t a question, more a resigned statement.
‘Well, yes—he’s just phoned and suggested I might like to go.’
>
‘I see.’ A tight, almost shuttered expression had come across Penny’s face. ‘Well, not to worry. Some other time.’
‘Yes, some other time,’ Adele agreed hastily. ‘I’d like that.’ Edging past the other woman, she added, ‘I’m sorry but I must fly…’ She found herself almost apologising for the fact that she was going out with Casey, which was utterly ridiculous because, no matter what there might be between Casey and Penny, Casey was her trainer and this was her job. She fled down the stairs, aware that Penny was still watching her. Hurrying through the house and out into the courtyard, she found Casey sitting in the Land Rover with the engine running.
‘It’s a police call,’ he explained as she climbed in beside him, ‘and in view of the fact of where it is I decided the Land Rover would be more sensible than the bike.’ They drew out of the courtyard and onto the main road where there was very little traffic as most of the high street shops were closed on a Sunday.
‘Your hair is wet,’ Casey observed after driving in silence for a while.
‘It’ll soon dry.’ She shrugged.
‘You don’t have to come with me every time, you know. It isn’t compulsory.’
‘I know. I want to come. It’s the only way I’m going to build up any experience.’
‘Fair enough. I just didn’t want it said that I was putting you under any undue pressure, that’s all.’
‘Has anyone said that?’ Adele turned and looked at him but his expression as he studied the road ahead was implacable. He was casually dressed today in jeans and a sweatshirt and she was glad that she, too, was similarly clad.
‘Penny suggested you might have too much on your plate,’ he replied.
Adele frowned, irritated. ‘What does it have to do with Penny?’ she asked.
‘Nothing.’ He raised his shoulders. ‘I suppose she just knows that I can be a bit of a slave-driver, that’s all.’
And Penny would know that, of course. Penny would know him better than most. She took a deep breath, dismissing Penny from her mind but troubled slightly by their recent encounter, although she couldn’t say why. She also found once again that even the thought of Penny and Casey together disturbed her. ‘Where are we going?’ she asked in a concerted effort to change the subject.
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