by Sam Archer
‘Sorry I haven’t had a chance to catch up with you before now.’
She shook her head, still smiling. ‘That’s quite all right. I prefer getting thrown in the deep end.’
‘Not much actual surgery for you today, I’m afraid,’ he said. ‘If we get a chance, I’ll have you assist me tomorrow. See what you’re made of.’ Fin raised his eyebrows. ‘You come highly recommended. In the top three of your graduating class at Oxford, and references from Professors Murray and Gordon that aren’t so much glowing as solar.’
‘Thank you, Mr Finmore-Gage –’ she began.
‘Fin. Please. Though you’ve probably heard by now that I get called that.’
‘Fin.’ She seemed to taste the name on her tongue and find it to her liking. ‘It’s an honour to be here.’
She shifted in the chair and her white coat fell open a little, revealing the gentle curve of her breasts under a thin sweater. Fin kept his eyes on her face.
‘You’ve also probably heard, or noticed, that I run a tight ship. I expect nothing but the very highest standard of work from my trainees. In return, I promise to provide you with nothing but the very best training in trauma surgery.’ He softened the rather austere comment with a smile. ‘I’m aiming to produce surgeons who’ll knock me off my perch one day, odd though that might seem. I have a responsibility to the future of the specialty.’
‘I won’t disappoint you.’
They discussed practicalities for a few minutes. All the while, Fin was absorbing details: the shape of one slender leg as she crossed it over the other, her pump dangling off the toes; the discreet way the tip of her tongue moistened her full lips; the habit she had of smoothing the hair on one side of her head with a slim-fingered hand as though it wasn’t already tied back.
From far off, muffled through the walls, came the sound of Big Ben chiming ten o’clock. Fin stood.
‘Time you were heading home. Busy day ahead tomorrow.’
She rose and offered her hand again. Close up, he detected the faintest trace of perfume, the aroma of musk. He tried but failed to glance at her back as she left, noticing the soft sway of her hips beneath the coat. Fin stood for a moment after the door had closed, her scent lingering like a memory.
He walked over to the window and gazed out. It wasn’t a river view but over to the left he could just make out the spires of the Houses of Parliament.
Melissa Havers was going to have a tough time. Not only was she young, she looked even younger than her 29 years. Youthfulness was a handicap in medicine, with both patients and other staff members associating it with inexperience and lack of ability. She was also a woman, competing in an aggressively male-dominated arena. Regardless of the respect she was due for having come this far at all, her every decision would be to some extent judged in the light of her sex. It was stupid, it was grossly unfair… but it was the way things worked.
And she was beautiful. She’d be subject to all manner of crude remarks and behaviour, though that was something she’d no doubt faced and learned to cope with already. But as with her youth, her looks would affect her credibility. People would assume she was just a pretty face.
Fin certainly had no intention of making things easy for her. If anything, he’d have to drive her harder, hold her to an even higher standard than he had his other trainees. Anything less wouldn’t be fair on her. It would give her a false impression of the task ahead and just how difficult it was going to be.
In any case, he couldn’t in any way be seen to be favouring her or treating her with kid gloves because people would assume he was being swayed by her beauty. He’d seen it before: the male mentor losing all his objectivity and being reduced to a soppy wreck when in the presence of a pretty face. And it was pathetic.
Melissa was, though, attractive. Fin didn’t believe in self delusion and he knew it was as well to confront the fact at the start. She was an attractive, sexy young woman and he was stirred by her. If he couldn’t ignore it, neither did it have to mean anything significant. She was his senior trainee, entrusted to his mentorship, and his personal feelings for her were academic. There was no way he could ever take things further with her, even if he was so inclined, because of the nature of their professional relationship. Boundaries had to be observed.
And of course there was the… other reason he could never get together with her. The more important one.
Fin closed his eyes against the pain for ten long seconds. Then he took a deep breath, putting his thoughts to one side, and dropped into the swivel chair at his desk to attack his paperwork.
Chapter Two
‘Mrs Reynolds?’
The tiny, stout lady struggled to her feet, her husband helping her. Melissa smiled and held the door open for the couple to shuffle through. Mrs Reynolds glanced curiously at her as they went in.
Melissa offered chairs for the two of them before seating herself at her desk. The elderly woman’s clinical records were on the computer screen before her but Melissa didn’t need to give them much more than an occasional glance. She’d studied the notes of all today’s outpatient clinic attenders the night before and familiarised herself with the histories and the treatment plans. They were all people whom Fin or his staff had treated for traumatic injury at some point, and most would attend for follow-up only until they were deemed either fully recovered or at least stable.
Mrs Reynolds had been in a car accident as a passenger two months earlier, and had sustained a deep laceration to her neck. The ambulance crew had kept her alive until she reached St Matthew’s, where Fin had operated in time to repair the carotid artery on the right-hand side. She’d had other injuries, including a broken leg which accounted for her limited mobility, but the neck wound was the one that would have proved fatal. Post-operatively she’d healed well, and all things being equal, Melissa was anticipating discharging Mrs Reynolds today.
After an initial exchange of pleasantries, Melissa was running through a standard checklist of questions – had there been any new swelling in the area, was there any lingering dizziness or lightheadedness – when she noticed Mrs Reynolds casting glances at her husband.
‘Is something wrong?’ Melissa asked.
‘It’s just…’ The older woman looked at her husband again, who shrugged slightly. Mrs Reynolds faced Melissa.
‘It’s nothing personal, dear. I’m sure you’re a lovely doctor, and a very good one. But… I really was hoping to see Mr Finmore-Gage.’
‘I know.’ Melissa smiled. It was a familiar request. Patients always wanted to see the most senior doctor, and who could blame them? Melissa herself would probably be the same if she needed medical help. ‘But I’m afraid he’s busy with his own clinic right now.’
The silence stretched out. Mr Reynolds coughed awkwardly, looking at his feet.
Mrs Reynolds said, ‘He is here, though. And he said to me that if he’s here when I come up, he’ll see me personally.’
Melissa kept her smile. ‘I’m really sorry, Mrs Reynolds. But I’m perfectly qualified to see you.’
Immediately she regretted saying it, thinking it must have come across as insufferably pompous. Mrs Reynolds tottered to her feet again, her husband jumping to help her.
‘I’m sorry, doctor,’ she said primly. ‘But I’d rather wait outside until Mr Finmore-Gage is free.’
Melissa rose, nonplussed. Mrs Reynolds’s husband gave her an apologetic grimace over his shoulder.
Melissa followed them out into the waiting room. At that moment Fin emerged several doors down, escorting a patient out. His face broke into a broad smile.
‘Mrs Reynolds! Good to see you.’ He frowned, peering down at the side of her neck. ‘It’s looking great.’
‘Mr Finmore-Gage, is there any chance I could see you, if you have a moment?’
Fin glanced across at Melissa, who stood helplessly outside the door of her examination room. He gave her a wink and said, ‘Yes, of course.’ Putting out an arm, he supported Mrs Reynolds into his
room.
Melissa went back into her own room, closed the door, and slumped at her desk, glaring at the computer screen. Her face burned.
What was Fin doing? He must have realised what happened, that Mrs Reynolds had been seeing her, Melissa, and been unhappy about it. The very least he might have done was to express his full confidence in his registrar and urge Mrs Reynolds to consult her, even if he did have the time to see her himself.
She stared glumly at the display on the monitor. Had she displeased Fin in some way? She’d been in the post eight days, and had completely immersed herself, arriving at the crack of dawn and staying late, and even coming in on Sunday when she wasn’t scheduled to be at work. She had crammed several weeks’ worth of experience into that time, learning an immense amount assisting Fin in theatre and following his patients after surgery. He’d always been courteous towards her, acknowledging her contributions, and hadn’t criticised her or pointed out any obvious mistakes. So why was he undermining her like this?
Perhaps he was just another macho surgeon, part of the smug old boys’ club, who saw her very presence as a threat to his masculinity. Perhaps he genuinely believed she lacked the competence to carry out so routine a task as to evaluate the progress of a patient’s healing, two months after the operation.
Or perhaps, Melissa thought, shamefully, she was reading far too much into the situation. There might be an innocuous explanation. Well, there was only one way to find out.
She’d have to bring the subject up with him.
***
Fin strode briskly down the corridor from theatre towards the wards, Deborah at his side. Deborah Lennox was the sister in charge of the trauma wards, a cool-headed bastion of efficiency who was at the same time a firebrand when it came to getting the best possible care for the patients under her charge. She was updating Fin on the latest developments with his post-traumatic pancreatitis patient when he felt somebody fall into step at his other flank.
He glanced round, and saw it was Melissa.
‘Fin, do you have a moment?’ she asked, slightly out of breath.
He slowed, nodded to Deborah. ‘I’ll catch up on the ward.’ Turning to Melissa he said, ‘What’s up?’
‘Is there somewhere we could talk in private? It’s not urgent, but there might not be a chance after the ward rounds.’
He’d wondered if she might want to talk. Their outpatient clinic had finished six hours earlier and it had been a long afternoon in theatre, where she’d assisted him with a bowel resection. Over the surgical mask her eyes had met his from time to time, even when he wasn’t addressing her. He’d sensed something was on her mind.
‘Yes, of course.’ They reached the door of a small seminar room not currently in use and Fin led the way in. He turned to face her. She looked slightly uneasy and yet defiant at the same time, her posture straight, her chin tilted up a little, her gaze direct. He felt drawn to move closer to her but kept his distance, respecting her personal space. He waited for her to speak.
‘Earlier today, in outpatients.’ She faltered, and he gave an encouraging nod, having no idea what she was leading up to. ‘I felt quite uncomfortable about something.’
‘Oh, really?What was that?’
‘Mrs Reynolds. The carotid injury patient. She said she preferred not to see me and insisted you see her instead.’
‘Yes. That worked out well, because I happened to be just in between patients.’
She spoke more confidently now, building up steam. ‘It’s the principle, Fin. With respect. I was perfectly capable of managing her, and I’d already told her it wasn’t possible for you to see her because you were with another patient.’ She hesitated, flushing deeply. The colour in her cheeks set off the blue of her eyes and he felt a slow warmth spread through his chest and belly. ‘I felt quite undermined, as though you agreed with her that I wasn’t up to the job of caring for her.’
He waited to see if there was more. She was a little breathless, as though she felt she’d gone too far. Fin tried to ignore the rise and fall of her breasts under her coat.
At last he said, ‘Fair enough. I can see how you might have felt, and I’m sorry. But if we’re talking principle, then consider this. The patient’s needs come first. Always, in every circumstance. Now, of course if I genuinely hadn’t been available then Mrs Reynolds would have to have seen you. And –’ he went on as she opened her mouth once more, ‘by that I don’t mean you were the second best option. Far from it. In fact, Mrs Reynolds was very complimentary about your manner when I saw her. But wherever possible, we accede to the patient’s request. I’m not saying we give in to the patient’s every whim and demand, not when we know it wouldn’t be in their interests. But in this case Mrs Reynolds had a reasonable request, and it all turned out fine.’
Melissa blinked, appearing lost for words for a moment. Then she sighed. ‘It just felt as if I was being belittled, that’s all.’
‘You disagree with what I just said?’ He watched her eyes carefully, aware that he was being deliberately provocative. Again she floundered for a second. Then her expression tightened and she looked defiant again.
‘Yes. I disagree. Not with the point about the patient’s needs taking priority, but about how that was applied in this case.’
‘Good.’
She looked utterly taken aback, as if she’d been preparing for his anger, his outrage that he was being challenged. ‘Good? I don’t –’
‘It’s good that you’re sticking to your guns. Being honest about how you feel. About what you believe.’
She tilted her head to one side a fraction, a smile touching her lips. ‘Then you accept I’m in the right.’
‘No,’ he said. He noticed that her smile died a little. Fin shrugged. ‘I’m right. As long as I’m in charge, as long as the ultimate responsibility for what goes on in this department falls on my shoulders, then I’m right. That’s not to say you can’t have your own opinions. As I just said, I encourage it. But my decision’s the final one. Always.’ He smiled broadly. ‘Anything else?’
‘No.’ He suspected her voice came out more quietly than she’d hoped, and she looked annoyed at herself.
‘Good. Now let’s hit those wards.’
She didn’t quite stalk off, but she made sure she was a couple of paces ahead of him on their walk down the corridor, maintaining an actual as well as a symbolic distance between them. Again Fin felt the urge to gaze at her figure beneath the shapeless white coat, and again he fought it.
It was the first time he’d seen Melissa close to anger, and the first time he’d really seen her assert herself with him. He was pleased. Standing firm was as essential with colleagues as it was when making clinical decisions. Fin was bothered, though, by Melissa’s sensitivity about the whole issue. Patients always wanted to see the consultant, it was a fact of life, and there was little point in a registrar getting worked up about the matter. There was quite enough to be stressed about in the practice of medicine, especially a field as demanding as trauma surgery, and you needed to know what genuinely to fret over and what to simply let slide.
He watched Melissa disappear through the doors of the ward ahead, letting them swing closed behind her, and he thought: you’ve got a lot to learn, Ms Havers. Not just about surgery, but about toughening up too.
***
Melissa was on her way back from a follow-up visit to one of her patients on the general medical ward when her pager exploded into a blare of noise, and although the voice was so distorted by static as to be unintelligible she knew it meant one thing.
She began to hurry.
The Accident and Emergency Department was three floors down. She bypassed the lifts with their crowds of people milling before the doors and took the fire stairs two at a time. Barging through the doors to A&E she saw the usual Saturday afternoon scene: hobbling football players with sprained ankles being supported into seats by their teammates, amateur DIY enthusiasts clutching wrapped and bleeding hands, a few early p
ub casualties barely able to sit upright. All deserving of attention and care, but all small fry compared with what she was about to have to deal with.
The blue strobing of the ambulance’s flasher announced the vehicle’s arrival. A minute later a wheeled stretcher came through the doors, surrounded by three paramedics. One of them recognised Melissa and nodded.
‘Definitely one for you, doc.’
She moved into step beside the trolley as they wheeled it towards the ‘majors’ room, where the urgent cases were brought. Strapped securely to its metal frame was a burly man in workman’s overalls, an oxygen mask fastened over his nose and mouth and an intravenous line extending form one arm and attached to a saline drip. His right leg was held immobile by a series of blocks providing a temporary splint. The overalls were soaked with blood from torso to legs.
‘Sunil Khan, aged forty-three,’ the paramedic recited, with the terseness of someone who was used to packing as much information as possible into the fewest words. ‘Fell approximately fifty feet when the scaffolding collapsed under him. Multiple trauma to head, chest and right lower limb, which looks like a femoral fracture. GCS seven. Latest BP 115 over 63.’
GCS – the Glasgow Coma Scale – was a measure of a patient’s responsiveness after a head injury. Fifteen was normal. Seven wasn’t good at all. Melissa noticed another man hovering alongside the stretcher.
‘Are you a friend or relative?’ she asked.
He was in overalls too, his face streaked with grime and sweat, a man of about forty. ‘I work with Sunil,’ he said. ‘I was there when the scaffolding collapsed. Helped pull him out.’
‘Are you hurt?’ said Melissa.
He shook his head. ‘Nah. Just caught a light tap from one of the poles.’ He nodded at his friend. ‘Is he going to be all right?’
As a group of nurses helped the paramedics to transfer the patient on to the bed in one of the cubicles, Melissa snapped on a pair of latex gloves and set to work. She assigned tasks to two other nurses and requested that the portable CT scanner be brought across. Her gloved hands moved expertly across the patient, probing and tapping, examining for penetrating injuries, unusual percussion notes suggesting air or fluid where it shouldn’t be. With a tiny torch form her pocket she established that the man’s pupils were equal and reactive to light, a promising sign.
