by Rebecca Lang
‘Ah, Dr Blake! Dr Seaton!’ A middle-aged nurse stood behind a reception desk in the main hallway, obviously delighted to see the two doctors. ‘And you’ve brought some helping hands with you! That’s just great.’
Signy noted that the nurse greeted Dan first, even though Max had been slightly ahead of them all. Perhaps, she thought, it was because Dan had a house in the community, that he spent more time there. Max had told them that he had a room in the hospital when he needed to stay there to look after his pre-op and post-op patients.
‘Go into the kitchen,’ the nurse went on, smiling a welcome to them all. ‘Get yourselves a bit of lunch. There should be someone there who can help you.’
‘Thanks, Maggie,’ Dan said. ‘Great to see you looking so good.’
The kitchen was for the preparation of food for both patients and staff. They were directed to help themselves to food that was already cooked, then to carry it into the adjoining staff dining room.
‘Well,’ Terri said to the other nurses when they were seated, ‘this hospital’s a cute little place. I wouldn’t mind doing a short stint here.’
‘That’s what you’re going to be doing,’ Dan said, having overheard her remark. ‘After lunch you, Terri, and you, Pearl, will go to the operating rooms with Max. He has a few surgical procedures to do there. Connie and Signy, you will be with me. I have some house calls to make out in the sticks.’
A sharp disappointment assailed Signy, which she strove to control, realizing that she had somehow taken it for granted that she would spend time with Max who, in spite of his gorgeous appearance, seemed less complex than Dan, and was less fraught with emotional nuances.
A look of pleasure lit up Terri’s face. ‘Just what I need,’ she said.
‘The sticks?’ Signy said, frowning at Dan.
‘Out in the backwoods,’ he said. ‘We have all-terrain vehicles and we go on logging roads. I have a pregnant woman out there and a man who has cancer of the colon. There isn’t any more we can do for him because he’s decided that he doesn’t want any more chemotherapy but wants to stay out in the woods with his wife. He knows he can come into the hospital here any time if he changes his mind.’
‘Doesn’t that make a lot of work for you?’ Terri queried.
Dan shrugged, his face serious. ‘Not really. That’s where he wants to be, so we must respect that. Mainly it makes work for the nurses who go in to see him more than I do, and his wife, of course. We do what we can for him. If he were here in the hospital his wife couldn’t be with him all the time, which is what they both want…at least, for now.’
‘What about the pregnant woman?’ Connie asked. ‘Is it her first baby?’
‘No, it’s her third,’ Dan said. ‘She’s agreed to come into hospital at the first sign of labour, or a week before the baby’s due, whichever comes first, or alternatively at the first sign of any trouble. I tell my pregnant patients that I’ll accommodate their wishes as much as I can, but if they won’t ultimately accept my professional advice from the outset, I won’t take them on.’
They were on the road again not long after lunch, riding in a well-worn Jeep, with Dan driving and Connie beside him. Signy sat in the back. It was where she preferred to be at that moment. Really, she wasn’t sure why she felt tense in Dan’s presence. Perhaps it was because he was astute, at ease with himself and this environment, not trying to impress anyone, while she felt somewhat like a fish out of water, even though what she was witnessing was fascinating in many ways.
They had stopped at Heron Cottage to pick up some medical equipment, then had gone on past Dan’s cabin. Although the rain had stopped, the air was heavy with moisture, while the mountains in the distance and some of the closer hills that they had seen earlier were now completely hidden by dense, low cloud.
‘This is one of the logging roads I was telling you about,’ Dan explained as he drove carefully along a wide lane. ‘Huge trucks used to come along here to bring logs from the forest down to the water, where they were floated down to a saw-mill. It used to be done with horses in the old days. Now there isn’t any logging in this particular spot—all the suitable trees have been used up. The people in Brookes Landing maintain the roads because people live along here now.’
He turned his head to look at Signy. ‘Ever seen anything like this, Signy?’ he said, his tone, slightly teasing, implying that she probably had never seen anything as rugged as this in her life.
‘It’s a bit like parts of Kent,’ she said casually. Indeed, there were forests, albeit small, in parts of Kent and Sussex that she knew of. She didn’t want him to think that she had spent her life pounding concrete pavements, or that this place had a monopoly on ruggedness and hardship.
Dan gave her an assessing look, before concentrating on the driving.
‘Tell us more about this man with cancer of the colon, please,’ Signy asked.
‘His name’s Felix George,’ Dan said. ‘He had a gut resection for the tumour some time ago. He had some chemotherapy because some of the local lymph nodes were involved. We thought he was clear, then recently he showed up with metastases in the liver.’
‘Familiar story,’ Connie commented. ‘There should be more routine screening for colon cancer, since it’s relatively common.’
‘Yes, exactly,’ Dan said. ‘Felix started to lose weight, feel unwell, but didn’t do anything about it until there was significant spread. He’s been out of the province quite a bit, travelling, and didn’t do as he was advised about frequent check-ups. Now he’s back here for good and there’s nothing we can do for him except make him comfortable, unless he decides that he wants further chemo. It may be too late for that, of course. It’s very sad.’
Both Connie and Signy were silent. They had both met patients like the man being described. Maybe he’d decided that he didn’t want to live in fear for his life all the time, and would just carry on as usual.
After driving along the lane, which twisted and turned, for quite a while, Dan brought the car to a halt at a roadside cabin. ‘This belongs to a forest ranger,’ he said, looking at Connie and Signy in turn. ‘We have to walk a few yards up that track.’ He pointed to a narrow path that disappeared among some conifers.
Signy watched him as he unfolded his long legs and got out of the vehicle in one lithe movement, then embarrassingly became aware that she was staring at him and that Connie was already out. Truth to tell, she couldn’t make up her mind about him. Still seething from the shock she had felt at realizing that he had been in Africa at the same time that she had, she felt determined not to engage with him emotionally until she could find out more. It was easy to look for someone to blame, she knew that.
The first thing Dan unloaded from a zip-up bag was a shotgun. While Connie and Signy looked on silently, he quickly checked that the gun was loaded. ‘This is for any unexpected encounters with wildlife,’ he said. ‘Cougars or bears.’
They put on their rain jackets, then between the three of them they carried Dan’s bags of medical equipment, with him leading the way. ‘Ah, it’s good to walk!’ Connie said, taking several very deep breaths. ‘To breathe in the pure air, to be in silence so profound that one can almost hear it.’
‘Yes,’ Signy agreed appreciatively, doing the same thing. ‘You sound so poetic, Connie. I don’t know whether I could be so eloquent.’
‘If you think that’s eloquent,’ Connie said with a smile, ‘you should hear me when I’m bawling out a patient in an emergency department—you know, one of those obstreperous types.’
‘Oh, we can all be pretty good at that,’ Dan chipped in, and they all laughed companionably.
‘I can see why we need hiking boots,’ Signy said as they trudged on, looking at the rugged path that was liberally sprinkled with small, half-buried rocks.
‘Talking of boots,’ Dan said, ‘it’s the custom here to take your footwear off when you enter someone’s house or cabin, however humble, to prevent dirt from getting tracked in, especially as there’s so much
rain here. It gets a bit tedious, I’m afraid.’
The residence of Felix George and his wife proved to be a modest bungalow made of wood in a beautiful setting of evergreen trees and grey rocks. Flower beds and a small vegetable plot had been carved out of the rather sparse soil. The three of them were breathing rather heavily by the time they had climbed the steps to the front porch, as the footpath had gone uphill.
‘And I thought I was pretty fit,’ Connie said ruefully.
A woman opened the door before they knocked. She was middle-aged with a weather-worn face, her wavy grey hair pulled behind her head in a ponytail. To Signy she looked like what she was—the wife of a very sick man, tired and anxious. Now her face creased in a welcoming smile. ‘Dr Blake!’ she said. ‘I was hoping you’d come today. And you’ve brought visitors! That is nice. Come in.’
‘Good to see you, Donna,’ Dan said, smiling back.
Grudgingly, Signy admired Dan’s ease and gentleness with people, his empathy and warmth. Yet he hadn’t, so far, stepped out of line, hadn’t become familiar. He’d remained professional, even when he’d had quizzed her on the ride to the camp and when he’d danced with her. In turn, people responded to him, she’d noticed.
‘Meet two nurses who are with the World Aid Nurses programme,’ he said to Donna George. ‘I hope you and Felix don’t mind if they’re with me. I mentioned it last time. They’re here to learn about community work.’
‘No, that’s great,’ Donna said, shaking hands with Connie and Signy in turn. ‘I really admire what you people do, going out to those places where no one else wants to go. I’ve read all about the work you do, and I do my bit here to raise money for the organization. In your case, it isn’t a matter of where fools rush in, is it? Quite the opposite.’
‘I like to think so,’ Signy said, smiling, warmed by the other woman’s greeting yet at the same time feeling a peculiar twinge of something like conscience.
Now she wasn’t sure that she had always behaved and reacted in the most mature fashion when in danger. In the very short time that she had been in this part of the world, listening to the talks given by Dan, Max and others, she found herself thinking about her work experiences in a somewhat different light. No doubt, that was what they intended—the process had begun. Even though she had undergone a training before, this time it would be backed up by the invaluable practical experience that she had received in the field, which shed an entirely different light on any theoretical training. It was all part of the maturation process.
Dan had stepped over the threshold and was bending down to unlace his boots. ‘How’s Felix, Donna?’ he asked quietly. ‘Any change from last week?’
The woman hesitated slightly. ‘I don’t think so, really,’ she answered quietly. ‘At least, not physically. I do think he might be a little depressed…More so than he was before. He sometimes takes the painkillers you left for him. He’s not a man to complain, you see, so I’m wondering if he might be in more pain than he’s letting on—or just depressed. I think it’s that.’
‘I see,’ Dan said. ‘He’s a bit down, is he?’
‘Yes, he just gets very quiet. Nothing you could really put your finger on. I’ve been wondering if he would be better off with some medication for his moods as well,’ she went on. ‘But the suggestion would have to come from you, I think, Dr Blake. I don’t want him to know that I’ve been talking about that behind his back…he’s very sensitive that way…’
Signy’s heart went out to this woman, this tired, loving woman who was nursing a seriously ill man in an isolated place. As she looked around her she could see that they at least had electricity, weren’t cut off from that point of view. As far as she could see, they had all the modern conveniences.
‘I’ll talk to him,’ Dan said, a warm, reassuring note in his voice that moved Signy to a further somewhat reluctant empathy with him and the work he was called upon to do here.
‘Thanks, I’d appreciate it,’ Donna said, sounding relieved.
Glancing quickly at Connie as they followed the woman into the house, Signy sensed that she, too, had the impression that Donna was close to breaking point, that at the drop of a hat she would burst into tears. They also sensed that she was a strong, sensible, capable woman, who would go on here as long as she possibly could, if that was what her husband wanted, but that she would make the decision to move him out to hospital if or when the situation warranted it.
Their patient was sitting beside a desk in a small side room off the kitchen, through which they passed. He faced a large picture window which gave him a view of wilderness, apparently untouched by human hand. Beautiful conifers, in varying shades of green, dotted a rock-strewn hillside, where shrubs and grasses also grew in profusion. As they entered, he turned his eyes away from it, as though reluctantly.
On the large desk, which took up most of the space in the room, Signy saw a computer and printer, a fax machine and two telephones. The computer was switched on. At least this man and his wife weren’t isolated from the local community, or from the world, as far as communication was concerned. They could call for help and expect to get it. Those gadgets put a whole new interpretation on the concept. That wasn’t how it had been for her and her colleagues in Africa…not for Dominic.
As Felix looked at them, Signy could see that the conjunctiva of his eyes had a faint yellowish tinge. This was evident in the colour of his skin also, although barely, so that to the unpractised observer it could appear as the unhealthy pallor of a chronically sick man. To her, it signified liver disease.
‘Well, Dan,’ he said, smiling, ‘it’s good to see you again.’ He was a big man, well over six feet tall, on whom the flesh hung loosely, as though he had lost a lot of weight, and his cheeks were hollow, his eyes dull.
When introductions had been made, and it had been ascertained that Felix didn’t object to having two visiting nurses review his case, Donna excused herself to make coffee. As Signy seated herself in an offered chair, she suspected that the woman couldn’t bear to listen to her husband go over his symptoms once again, to perhaps have to admit that he was deteriorating.
The two nurses listened and watched unobtrusively while Dan talked to the man. He asked him gently about his mental state and suggested a mood-elevating drug, to which Felix agreed. Then they helped while Dan took blood samples.
‘This computer is a godsend,’ the man said, ‘so is the fax. I’m in constant touch with anyone I want to be in touch with, including old friends I haven’t actually seen for many years. They all take time to send me messages. It means a lot, you know.’
Dan chatted to him about non-medical matters as he completed the taking of blood samples and filled in requisition forms for the hospital lab.
‘I’d like to examine you, Felix,’ Dan said. ‘The usual.’
‘All right.’
While they all shifted to make room, their patient moved over to a narrow day-bed that was against a wall in the room, where he obviously took a nap when he felt the need. Dan listened to his heart and lungs with a stethoscope, took his blood pressure, then gently palpated his abdomen. Both Connie and Signy, with the patient’s permission, palpated the abdomen also, feeling the irregular shape of the liver that had tumours in it.
Later, they drank coffee in the kitchen, while conversation ranged over topics of local concern to take the focus away from the import of the sickness. Then Dan left some containers of drugs that he had brought with him.
Soon they were taking their leave, setting off down the path, which would be an easier trek on the way back, towards the forest ranger’s hut. At a bend in the path they turned to wave back at Donna and Felix, who stood at the door to see them off.
‘That’s very sad,’ Connie commented when they were out of sight and earshot of the house. ‘Tempered by the fact that he can be at home where he wants to be, with all his electronic gadgets.’
‘Yes…he enjoys those things, as well as the scenery,’ Dan agreed, with just a hint of
tiredness in his voice to indicate that the visit had moved him more than his calm professional demeanour had indicated while he’d been examining the patient. He stopped on the path. ‘We may as well review the case here. I assume that you both felt the liver tumours and noted that he had some abdominal as-cites?’
‘Yes.’ Signy nodded in agreement. There had been fluid—ascites—in the abdominal cavity, indicating that the liver tumours had grown to a size that was obstructing blood and lymph vessels, impeding the drainage of fluid. ‘You’re going to keep him at home?’
‘As I said, it’s up to him, to a point…he knows that,’ Dan answered. ‘It’s his decision, or his wife’s decision if she can’t cope any more. If they turn the decision over to me, then I’ll make it. Prior to that, I’ll advise them, of course. We have to fine-tune his drugs to make sure he’s comfortable. There’s someone going in every day right now—a community nurse.’
They trudged on down the path, the images of the people they had just left and thoughts about the prognosis vying with the compelling landscape around them. ‘Nature seems so powerful here, doesn’t it?’ Signy blurted out. ‘One feels overwhelmed by it. It’s as though…it’s as though man doesn’t really have much of a chance.’
‘Yes,’ Connie said. ‘You have to know and respect nature here, otherwise it will get you, take you by surprise. But the winters are reasonable here, almost benign, compared with a lot of places in this country.’
‘I’m getting a sense of that,’ Signy said. ‘And there isn’t much history here, as we know it.’
‘True,’ Dan said. ‘I often think that we humans sit uneasily on the landscape.’
‘I like the way you put that,’ she said.
‘The history belongs to geology, the flora and fauna,’ Connie said.
‘Not like Kent after all,’ Dan said dryly, looking sideways at Signy with a slight raising of his eyebrows.
‘No…perhaps not,’ Signy said, flushing slightly. ‘There are a few poisonous snakes here and there.’
‘Look,’ he said, pointing up at two very large birds that suddenly soared above their heads, crossing their path, majestic and silent. ‘Those are eagles—bald eagles, so called because of the white head in contrast with the black body. From a distance they look bald.’
