by Anne Fraser
‘Goodnight, then,’ he said. ‘I’ll see you tomorrow.’ As Meagan closed the door behind him, he cursed under his breath. How could he have made such a mess of his life?
CHAPTER FOUR
THE next few days were so busy that Meagan had little time to think. If she had ever believed that being a general practitioner on a small island would be an easy option, she had been mistaken. Her surgeries were busy, although Meagan suspected that some of her patients were there just to have a look at the new doctor. But there were plenty of genuine cases to keep her constantly challenged. She didn’t see much of Cameron, and when she did he was friendly but distant, and that suited her perfectly.
She was having a quick cup of coffee between patients when the practice nurse came in to see her, her brow puckered with worry.
‘Meagan, do you have a moment?’ she asked.
‘Sure, Sophie. What is it?’
‘Could you see someone for me? I’ve been doing the baby clinic and I noticed that one of the mothers isn’t well. She’s breathless—more than I’d expect—and I don’t know…she just doesn’t look right. She says she’s been like this for a week or two, and its just flu or something. Dr MacDonald gave her antibiotics when he saw her before he left, but she’s no better. She’s insisting that she doesn’t need to see a doctor but would you mind having a quick look at her for me? I would have asked Cameron, but he’s at the hospital. I’m worried if I let her leave without seeing a doctor, she won’t come back.’
‘Of course, Sophie. Show her in.’
A moment or two later, the nurse ushered in a young exhausted-looking woman in with her baby. Sophie handed Meagan the woman’s notes. A quick glance told Meagan that the patient had three children. Her youngest was five months old.
‘I’m sorry, Doctor. I don’t mean to be a bother. I told Sophie that it was nothing. I’m just a bit rundown. Nothing a whole night’s sleep wouldn’t put right.’ The young woman looked tired, as well she might with three children under five, but she also looked as if she had lost weight recently. Her trousers and blouse looked at least one size too big for her.
But it was as she spoke that alarm bells began to ring in Meagan’s head. The woman was having to stop to catch her breath every few words.
‘Have a seat, Mrs Munro. Since you’re here I may as well take a quick look.’
‘It’s Rhona,’ she replied, giving Meagan a tired smile, reluctantly taking a seat and settling the baby on her lap. ‘It’s just that I have another two kids at home. A neighbour is looking after them for me, but I need to get back. They can be a bit of a handful.’ Rhona smiled ruefully. ‘Its no wonder I’m exhausted.’
Meagan lifted the child from Rhona’s lap. The little girl protested, reaching chubby arms towards her mother.
‘Well, this little one is fine at any rate. Do you mind if Sophie holds her while I have a quick listen to your chest?’
As Meagan listened to Rhona’s lungs, her anxiety deepened. There was something wrong.
‘Any history of asthma? TB?’ she asked.
Rhona shook her head. ‘Dr MacDonald thought I might have a chest infection when I came to see him a couple of weeks ago. He put me on antibiotics.’
‘And have they helped?’ Meagan asked. She looked at the notes Colin had made in his neat hand. He hadn’t been totally convinced that Rhona had had a chest infection, but had prescribed a course of antibiotics and asked her to come back and see him in a week. There was no suggestion that Rhona had been back to see him.
‘Did you finish the course of antibiotics?’ Meagan asked.
Her patient nodded. ‘Dr MacDonald was insistent,’ she said. ‘But they didn’t help.’
‘I see that he asked you to come back and see him last week,’ Meagan said.
‘I know. And I meant to come, but I couldn’t find the time. The kids keep me so busy.’
After talking a thorough history and giving her another examination Meagan was beginning to suspect she knew what was wrong with her patient and she didn’t like it one bit.
She turned to Sophie, who had managed to placate the baby. ‘Sophie, would you mind seeing if Dr Stuart is back? If he is, could you ask him to come in for a minute?’
‘What is it?’ Rhona was beginning to look anxious. ‘Why do you need Dr Stuart? I told you, a day or two’s rest, although how I am going to manage that is beyond me—is all I need. I don’t want you to go to any more trouble. I’ve taken up enough of your time as it is.’
Meagan was disappointed when Sophie returned without Cameron. Although she was pretty sure her diagnosis was correct, she wanted another opinion. And if she was right, she needed to arrange further tests.
‘Dr Stuart is still at the hospital. I’ve got him on the line, though,’ Sophie told Meagan.
Meagan excused herself to Rhona and went into Cameron’s room to take the call.
‘Hello, Meagan,’ he said without preamble. ‘You have a problem?’
Meagan quickly outlined her findings and then, with a slight hesitation, her fears.
‘I think she may have a tumour, Cameron. And she’s only 26—my age—with three young children.’ There. It was out. She had said it.
‘You could be right,’ Cameron said, his voice soft. ‘But there’s no point in imagining the worst until we know more. Send her along here for a chest X-ray. Ask her to come straight to the hospital and I can have a look at her before my visits this afternoon.’
‘Thank you. The sooner we know what’s going on, the better. I’ll come too. I’d like to see the X-ray.’
‘It’s your afternoon off. Why don’t you go home and I’ll call you once I’ve had a look at the film?’
Meagan shook her head before realizing he couldn’t see her.
‘If it’s all the same to you, I’d rather come to the hospital,’ she said, praying she wouldn’t have to argue with him. Rhona was her patient now.
‘Of course. I’d do the same in your shoes. I’ll see you shortly.’
Meagan hung up and went back to her patient. She explained about the X-ray.
‘Are you sure it can’t wait? You’re not worried about me, are you?’ Rhona managed a shaky laugh.
‘It could wait, but Dr Stuart is there now, so I see no reason for us to delay. Have you got your car? I could give you a lift, if you like.’ Rhona seemed to realise that Meagan was determined to get her to the hospital, and gave in with a weary smile.
‘Its OK, I’ll take mine. It has the baby seat. I’ll just phone my babysitter and let her know I’ll be late. You don’t think it will take too long, do you?’
As Meagan drove to the hospital she tried to swallow her anxiety. If she was right, what would the diagnosis mean to Rhona and her young family? It was the worst side of medicine, and the bit about general practice Meagan was beginning to realise she’d find the toughest—knowing the people you were about to deliver bad news to. She was already beginning to think of her patients as an extended family.
When she arrived at the hospital, she found Cameron in the emergency reception area, his dark head bent over patients’ notes. She watched him for a second. Strangely, she felt comforted knowing he was here and would be helping her look after her patient.
He looked up and, seeing her, stood and crossed the space between them. He brushed her shoulder with a hand as if he knew instinctively that she needed some reassurance.
‘Rhona’s arrived and is having her X-ray. She won’t be long, then we can have a look. But you do know there are a number of things it could be?’
Meagan took a deep breath and returned his look steadily. She didn’t want him to think she was the type of doctor who couldn’t remain professional at all times.
‘I know. But I did take a full history. And it’s not that I’m being over-cautious because of Robert Maclean.’ She couldn’t help but slide a glance in his direction.
‘You’re just being thorough. That’s good. But let’s just wait and see. Take it step by step.’ Cameron s
miled down at her. ‘Shall we go and see if they are finished?’
Ten minutes later Cameron had Rhona’s X-ray up and Meagan’s heart sank. All over the chest were large white circles, indicative of tumours. She looked at Cameron, shocked. He was frowning, his mouth set in a grim line.
‘Looks like you were right. It seems pretty clear she has metastasis in her chest,’ he said. But Meagan felt no satisfaction at his words. She wished desperately that she had been wrong.
‘We need to talk to her,’ Cameron said.
‘I need to tell her,’ Meagan said quietly. ‘She’s my patient. Although how I’m going to tell a young woman with three small children that it looks as if she has a terminal illness is beyond me.’
Cameron looked thoughtful. ‘We’ll talk to her together. I’ve known Rhona for years. I delivered her last two babies. I wonder what the primary source of the tumours are? I’d like to examine her again.’
‘Why? What are you thinking?’
‘It’s a long shot, but you said she’d been nauseous. Has she missed a period?’
‘She said she’s not had a period since the birth of her baby. She’s been breastfeeding, so it’s understandable that she hasn’t, isn’t it? Are you thinking that she’s had a tumour through her last pregnancy and that the pregnancy accelerated its growth?’
‘No,’ Cameron said. ‘She was sterilised when she had her last baby. They did it at the time of her C-section. It’s something else. See these tumours—the size of them? They are referred to as cannonball tumours.’
Meagan was puzzled. She didn’t know where Cameron was going with his thinking.
‘I’m going to examine her. I’ll ask one of the nursing staff to do a pregnancy test.’
Meagan confusion deepened. Hadn’t he just said himself that Rhona couldn’t be pregnant? And what was the point in delaying talking to their patient? The sooner they spoke to her, the sooner she they could arrange for her to start treatment. It probably wouldn’t give her much more time, but every minute longer she had with her young children would be precious. She felt her throat close and she blinked away tears. However upset she felt, she didn’t want Cameron to see it. But it seemed she couldn’t hide her feelings quickly enough.
‘Hey,’ he said, ‘let’s not get ahead of ourselves.’ For a moment it looked as if he was going to reach out to her, but he let his hands drop to his side.
‘But she has three young children. How can any woman cope with the thought of leaving them? Why is life so cruel?’
‘We’ll do out best for her, Meagan. You picked it up, and at least she has a chance to prepare herself. Let’s go and see her and then we’ll talk again.’
Rhona was waiting in the consulting room, feeding her baby. The baby was sucking contentedly and the three adults watched as her eyes closed and she fell asleep.
‘Well?’ Rhona asked as she settled her child in her buggy. ‘Can I go?’
‘I’m afraid you can’t. Not yet at any rate,’ Cameron said gently.
‘Why? What is it?’ She looked at the two doctors. ‘What is it?’ she said again, her voice rising. ‘There’s something you’re not telling me. C’mon, Cameron Stuart. You’ve known me for years. You know I like straight talking.’ Despite her brave words, Meagan could hear the fear in her voice.
‘We found something on your chest X-ray that worries us a little.’ Cameron said. ‘I want to examine you again, if that’s all right? But first do you think you could manage to give us a urine specimen?’
‘Sure,’ Rhona replied. ‘But I think you should tell me what this is about.’
‘Urine first,’ Cameron said firmly. Once the nurse had taken away the sample for testing, Cameron examined Rhona again while Meagan looked on.
‘Any lumps or bumps anywhere? In your breasts?’
‘Not that I’ve noticed.’
‘Any chance you could be pregnant?’ Cameron asked.
Rhona laughed. ‘You know as well as I do that the answer to that is no.’
Meagan was still none the wiser. Where was Cameron going with this? Could Rhona be pregnant? She had heard of cases where women had fallen pregnant even after having their tubes tied. That would make it all even worse. She couldn’t have treatment while pregnant. The pregnancy would have to be terminated.
‘Any other symptoms apart from the breathlessness?’
‘No, except for feeling tired all the time—but I put that down to years of sleepless nights.’ She laughed nervously. ‘You don’t think I could be pregnant, do you? Even if I hadn’t been sterilized, it wouldn’t be possible.’ She blushed furiously. ‘You know, with having three small children we haven’t…not since—I mean I am just so darned exhausted all the time. It’s not as if I don’t love my husband. Oh, dear…’ She tailed off.
‘No, I don’t think you’re pregnant,’ Cameron said. ‘I think there’s a chance it’s something else, but I won’t be sure until I get the result of the urine test. We’ll have the results shortly. In the meantime, you can get dressed. I’ll be back in to see you in a minute.’
Even more confused, Meagan followed Cameron out of the room. He looked satisfied, even cheerful. Didn’t he care that they were about to deliver a death sentence to a woman who had three young children depending on her?
Before she had a chance to question him, the nurse arrived back.
‘The pregnancy test is strongly positive,’ She told Cameron. ‘Good news?’
‘You could say that,’ Cameron said, smiling.
‘How can you possibly think it’s good news?’ Meagan burst out, unable to contain herself any longer. ‘If she decides not to terminate then she’ll die more quickly and then there will be four children left without a mother.’
Cameron placed a hand on Meagan’s shoulder. Something in his expression stopped her in her tracks.
‘Have you ever heard of a condition called choriocarcinoma?’ Cameron asked.
Meagan shook her head, although somewhere deep in the recesses of her mind the term sounded familiar.
‘Well, it’s a type of cancer that originates in the placental tissue after a pregnancy or miscarriage,’ Cameron explained. ‘As far as Rhona’s concerned, it is really good news. The tumours will respond quickly to treatment and there is every chance she will make a complete recovery.’
‘Are you sure?’ Meagan asked, wanting desperately to believe him. But what if he was wrong?
‘I’m positive. We’ll need to do further tests, of course, but I have no doubt that is what we are seeing here.’
Meagan felt herself sag with relief. If he was right and she had no reason to doubt him, there was every chance Rhona would be around for many years to come. She grinned at him.
‘What made you think of it?’
‘When I saw the X-ray and the magnitude of the tumours, it got me thinking. With that kind of invasion Rhona should have been much sicker than she is. Then when I examined her and there was no obvious primary source of the tumours, I began to think of choriocarcinoma. I remember reading about it in one of the medical journals a year or so ago. The positive pregnancy test all but confirms the diagnosis. It’s still a serious condition, but thankfully it responds extremely well to chemotherapy.’
‘Thank God you thought of it. Imagine if you hadn’t. We would have told Rhona she was going to die and put her through torment. She might even have decided not to have treatment, in which case she would have died.’ Meagan shivered. ‘She’s a very lucky woman to have you around. I would have missed it if it hadn’t been for you.’
‘Don’t beat yourself up. You did the right thing by discussing her with me and thinking of the chest X-ray. Someone else might just have given her more antibiotics and sent her home. If you hadn’t insisted on investigating further when you did, the condition could have advanced quickly to a point where we would have been too late to help Rhona.’
Meagan shuddered. It had been a close call. Thank God she had decided to investigate further and thank God Cameron h
ad been there to look at the X-ray with her. Otherwise she might be having an entirely different conversation with Rhona right now.
‘You did well, as did Sophie, by insisting Rhona see you. That’s what general practice is all about. A team effort where everyone pulls together. It seems we made the right decision taking you on after all. Well done. Again.’
When Cameron smiled at Meagan, she felt her stomach flip. She smiled back. She couldn’t help but feel pleased at his praise. More than anything else she wanted his respect and approval—as a doctor, of course.
‘Let’s go and tell her the good news, shall we?’ he said.
A few days later, on a Saturday afternoon, as Meagan sat outside her cottage, coffee in hand, marvelling at how the sun lit the sky and turned the sea pewter, she was surprised to see Cameron’s battered vehicle making its way up the track. He jumped out and walked towards Meagan with long strides. He was wearing faded jeans that moulded to his thighs and a thick dark sweater. At his side was an excited-looking Ian and ashy Effie.
‘Dr Galbraith.’ Ian ran up to Meagan. ‘We’re going out in the boat. And Daddy said I could ask if you’d come. You will come, won’t you? You said you would.’ The little boy was hopping excitedly from foot to foot. ‘We have a flask of orange juice and some scones from Jessie.’
