Loe raamatut: «New Surgeon at Ashvale A&E»

Chapter One

‘WELL, poppet, here we are at last. A little later than I’d planned, but at least we’ve arrived.’ Ruby made a neat turn into the parking slot in the hospital grounds and turned off the ignition. From the rear of the car, a response came in the form of a soft gurgle, and she swivelled around to gaze for a moment at the baby. Becky was lying contentedly in her car seat, blowing bubbles while doing her best to grasp her toes with her fingers.

Smiling, Ruby slid out of the driver’s seat and went around to the rear of the vehicle to retrieve the infant.

‘It’s a good thing you’re such a happy soul,’ she murmured. ‘It makes life so much easier. After all, much as I love you, I hadn’t planned on bringing you with me today.’

Becky wriggled, her arms, legs and whole body moving in excited anticipation, a beaming smile lighting her chubby face at the prospect of her aunt coming close.

Ruby began to unclip the seat restraint. ‘I’ve no idea where your mother could have disappeared to,’ she said softly, ‘and yet she promised me faithfully that she would come and fetch you so that I could go along to my meeting.’ She lifted her palms in a questioning gesture. ‘But where is she? I haven’t a clue. Your guess is as good as mine.’

Becky chuckled, her blue eyes bright, as Ruby lifted the child seat out of the car. ‘As for you, you don’t have a care in the world, do you, little one?’ Ruby smiled indulgently. ‘What does it matter to you that I have to go and listen to my new boss challenge us to cut costs to the bone and find all sorts of impossible ways of doing it? And what’s he doing there anyway taking my place? I had my name pinned on that job, and I’m pretty sure I would have made things work for us without any of this argy-bargy and bad feeling.’

Becky studied her, a small frown appearing on the soft skin of her brow, as though she was trying very hard to make sense of the flow of words. Ruby laughed softly. ‘Yes, I know. Your auntie’s as mad as a hatter. Why else would she be going to a conference with a baby in tow?’ She leaned over and tickled the child, her chestnut-coloured hair falling in a silky swathe about her shoulders. Becky giggled and grasped a handful of hair.

‘Ow…ow…ow,’ Ruby exclaimed, pretending to be caught.

‘Mum…mm…mum.’ Six-month-old Becky blew raspberries from her pink lips and cooed, finally letting go of Ruby’s hair and beginning to suck on a small fist.

‘Yes, you’re absolutely right,’ Ruby murmured, straightening up. ‘Your mum’s not herself these days, and we just have to try to make the best of things, don’t we? When all’s said and done, we can probably slip in quietly somewhere near the back of the room. With any luck, no one will even notice that I’ve brought an uninvited guest along with me.’

By now she was approaching the main entrance of the hospital. People were coming and going, hurrying through the doors that continually swished open and closed. Some were dressed casually, visiting their relatives who were unfortunate enough to be hospitalised, perhaps, while one or two were more formally attired—doctors, maybe, or people who had appointments with consultants within the hospital.

Others, presumably taking a break in the warm afternoon sunshine, were sitting or standing to one side by a well tended shrub garden, breathing in the fresh air.

Suddenly, the doors opened up once more, and a man lumbered towards her, head down, a disgruntled expression on his face. Perhaps the collision that followed was inevitable. Either way, he slammed into Ruby with some force, so that she swung to one side and momentarily lost her balance. She kept a firm grip on the baby chair as it carved a wild arc through the air, and all the while her one thought was to protect the infant. Becky began to cry, frightened by the sudden jolt, and for a second or two, Ruby was afraid that she might have been hurt.

At the same time she was aware of pain slicing through her wrist, and as she fought to regain her balance, she realised that the man had rushed away, leaving her only with the impression of a scowling, grim countenance.

‘Are you all right?’ A man’s voice cut into her thoughts, the deep, warm tones edged with a drizzle of honey that smoothed over her shattered nerves. ‘Is the baby okay?’ He reached out and lightly grasped her arm, steadying her, at the same time laying a hand on the baby seat to ensure that it was safe.

‘I think so.’ Disorientated, she set the carrier down on the ground, checking swiftly that all was well with Becky. ‘Everything’s fine, baby,’ she murmured, reassuring the infant and distracting her with a brightly coloured teething ring that jangled and provided endless possibilities for exploration. ‘She seems to be none the worse for it.’ Then, once she was satisfied that the baby was safe, she looked up into the eyes of the man who had come to her aid.

They were beautiful eyes, a curious mixture of blue and grey, reminding her strangely of sea mist and sun-dappled water, and at the same time invoking a disturbing reaction within her, a strange restlessness that she hadn’t encountered in a long, long time.

She pulled herself together and straightened up, leaving the carrier where it was for the time being so that Becky would have an opportunity to examine her new toy and forget all about the incident. That left her free to rub gently at her wrist where it had been wrenched.

‘I have a feeling I might have seen that man somewhere before,’ she told him, frowning a little. ‘I can’t quite place him, and I only caught a glimpse, but there was something about him that was familiar.’

‘Really? He didn’t look too happy, did he? Maybe things hadn’t gone quite the way he expected in there.’ He looked towards the building, then glanced back at her, noting the way she was surreptitiously soothing her jarred wrist. ‘Do you think someone should take a look at that?’

‘No, it’ll be fine, thanks.’ She gave a short laugh. ‘Anyway, I’m in the right place if I change my mind, aren’t I? A&E is just around the corner.’

‘That’s true.’ A serious expression settled on his face as he appeared to ponder the wisdom of leaving things be, and she took a moment or two to study him more thoroughly.

He was way too smartly dressed to be a casual visitor to the hospital, or even a patient, she guessed. He wasn’t wearing a doctor’s name badge, so it was possible he was someone from a pharmaceutical company here to meet up with their chief pharmacist and his team. Ruby knew the hospital chiefs were worried about the drugs bill, and meetings were planned to discuss the issue.

He was wearing a suit, the immaculate, dark grey jacket sitting easily on broad shoulders, while the trousers fitted him to perfection, outlining a washboard-flat stomach and long, strong legs. Altogether, he made an immediate, disturbing impact on her.

‘Do you need any help to get to where you need to be? Perhaps I could carry the child for you?’ He was watching her closely, his gaze skimming over her, taking in her casual summer clothes, a button-through cotton top and gently flowing skirt, before coming to rest once more on her face.

She blinked, trying to pull her thoughts back on track. She shook her head. ‘No, thanks all the same. I’ll manage.’ She smiled. ‘Besides, I expect you have places you need to be…unless you’d finished your business here?’ Why else would he have been standing outside the hospital? He looked like a man who would be continually on the move, energetic, a force to be reckoned with. Perhaps it was the suit that gave her that impression. It somehow denoted a businesslike demeanour, a man at the height of his profession.

‘You’re right. I was just taking a break for a while, enjoying the sunshine and the cooling breeze. Hospitals can seem like soulless places at times, can’t they, even here in beautiful Buckinghamshire?’

‘That’s true.’ She nodded. ‘I wasn’t much looking forward to coming here today, but unfortunately I have a meeting to go to.’

He frowned. ‘Is that so? Nothing badly wrong, I hope—with you or the baby?’

She made a wry face. ‘Nothing at all. I’m fighting fit, and so is Becky, which is just as well, since I have to go and do battle, so to speak. It won’t do to let the chiefs have everything their own way.’

A puzzled look crossed his features, and it seemed as though he expected her to say more, but she didn’t try to explain any further. ‘I must go,’ she said. ‘I’m late already. Thanks very much for coming to help me. I do appreciate it.’

She had delayed long enough, and the meeting must be well under way by now. If she hurried, there was still time to make her presence felt. She picked up the baby carrier and, with a nod in his direction, she walked swiftly into the building.

James and Olivia, two senior house officers from her team, met her at the door to the room where the meeting was taking place.

‘Thank heaven you made it at last,’ Olivia said. ‘We were beginning to think you would never get here.’ She turned to greet Becky with a smile, picking up the baby’s rattle and gently waving it in front of the child, so that the infant tried to grab it and pull it to her mouth. Olivia laughed softly. ‘Okay, okay, you can have it. I was just teasing.’ She turned back to Ruby. ‘Everyone’s taking a break for coffee just now. We had to stop for a while…emotions were threatening to boil over.’

‘So I gathered.’ Ruby’s expression was sombre. ‘Is the new man making his presence felt?’

‘Oh, yes.’ James nodded. Lean and fit-looking, with dark brown hair that was cut in a short, neat style, he was an energetic, efficient colleague. ‘He’s definitely on the side of the board. Cuts, cuts and more cuts. That seems to be his mantra. That’s why I called you. I couldn’t believe you weren’t going to be here to argue our corner.’ He led the way towards the back of the room. ‘Some of the senior managers look as though they’ve been up half the night working out what they can chop next. The trust is in so much debt that they say drastic measures are called for.’

‘I wanted to be here right from the beginning,’ Ruby said. ‘You know I did…only I agreed to look after Becky while my sister went to see the doctor at the local surgery. There would have been plenty of time for me to come to the meeting afterwards, except that Sophie didn’t come home to take over from me. I waited and waited, and then I got to wondering whether there was any point in my coming along and saying anything at all at the meeting. After all, the new man is the one who’ll be making all the decisions from now on.’

‘And that was where the management made their big mistake.’ Olivia frowned. ‘You should have been the one to take charge, we all know that. You’ve been the mainstay of the A&E department for years, keeping things running smoothly while the boss readied himself for retirement. This job should have been the reward for all your hard work.’

Ruby made a wry smile. ‘Well, in the end it hasn’t happened, and there’s no use crying over spilt milk. Management have chosen the man they feel best to put all their changes into place.’ She gave a soft chuckle. ‘Perhaps they thought things would become a bit too contentious if they put me in charge. I wouldn’t have accepted that their way was the only way.’

‘More than likely. So what happened with Sophie?’ Olivia asked. ‘She must have known this was important to you.’

Ruby frowned. ‘I’m not sure. I was looking forward to hearing how things had gone at the surgery, but when she didn’t come back, I started to worry. Something must have gone wrong…but maybe I should have expected that. She’s definitely not herself these days. She’s not been well for quite some time, and I’ve been trying to persuade her for ages to go for some tests so that we can find out exactly what’s wrong. I suspect it’s a hormonal problem, with her body chemistry being out of synch ever since Becky was born, but she wouldn’t let me do anything to help. I was so pleased when I finally managed to get her to agree to go and talk to our GP.’

The SHOs nodded. ‘But something obviously didn’t go to plan?’ Olivia pointed out some available seats and they went to take their places.

Ruby shook her head. ‘I rang the surgery to see if she’d turned up there, and apparently she did, but then she didn’t wait for her appointment. I’ve absolutely no idea where she might be. I’ve tried ringing her, but she’s not answering her phone. Anything could have happened. She’s just not thinking clearly these days. I dare say I’ll find out later what went wrong.’

‘I’m glad you made it in the end, anyway,’ James murmured. ‘You of all people should be able to make the bosses see sense here. The way things are going, they’ll walk roughshod over all of us. How on earth do they expect us to give a viable service to the local area if they plan to get rid of staff and close units?’

‘I think that’s the least of their worries.’ Ruby set the baby down on the floor and glanced around as people began to troop back into the room. ‘What about the new boss, anyway? What’s he like? Has he not managed to come up with any reasonable suggestions?’

‘You have to be kidding.’ Olivia gave a short, humourless laugh. ‘He may well be an A&E doctor, but he’s management through and through, and reasonable isn’t in their vocabulary. No one seems to be paying any attention to what the people at the sharp end, those who actually have to do all the work, have to say.’

‘We’ll just have to do what we can to make them see sense.’ Ruby moved restlessly in her seat, then ran a hand through the length of her burnished hair, lifting it away from her nape to let a cool waft of air fan her heated skin. ‘It’s so warm in here,’ she commented, ‘with all that sunshine pouring in through the windows.’

She reached into the large linen bag she had brought with her and fished out the printed programme for the meeting. ‘Maybe this will do the trick.’ She leaned back in her seat and began to fan herself lightly with the paper.

‘Oh, that’s so much better.’ She murmured her appreciation of the cool drift of air just as she became aware of a stillness settling in the room. Glancing around, she saw that most of the board members had taken their places on the dais, while one seat remained empty.

A man came through a side door just then and strode purposefully across the back of the room. He turned into the corridor between the mass of seats, passing her just at the moment when she tilted her head back and lightly blew the tendrils of hair away from her brow. Becky gurgled contentedly, and he glanced briefly in their direction.

Ruby’s eyes widened, her senses responding to his presence with a faint frisson of dismay. His tall, lean figure was instantly familiar to her. He had that coolly confident air of a man who was in command of all he surveyed, the measured look of a man who was in control at all times. It was that suit that said it all, along with his authoritative demeanour, the assured way that he moved without faltering towards his goal.

His dark brows made an infinitesimal upward lift as he looked her over, and his expression showed…what was it…? Disbelief…recognition…along with a soupcon of amusement. There was definitely an element of wry humour in that glance, cleverly disguised so as not to be obvious, but it was there, all the same, in the faint twist at the corner of his mouth and in the dancing gleam in his blue-grey eyes.

Ruby stared at him, following his progress as he walked along the aisle and sprang up the steps to the dais with lithe ease. He took his seat at the table alongside the board members.

She frowned, dark brows meeting in her normally unfurrowed brow. Surely he wasn’t her new boss? A sinking feeling in the pit of her stomach told her that he most likely was.

She pushed the programme down into the linen bag. The action served at least to release some of the tension that had sprung up inside her and gave her time to think. Had she really told him that she was ready to do battle? Surely the means to winning any dispute lay in keeping an element of surprise to confound the enemy? And yet she had inadvertently given the game away. He must know that she was out to stop him. Had she cooked her goose already? She had the horrible feeling it was well and truly burnt, and he was going to be the man to carve it up.

‘Shall we make a start, ladies and gentlemen?’ The chairman rose and addressed the assembled crowd. ‘I hope that you’ve had time to calm yourselves and approach this situation in a clearthinking manner. We’re all going through difficult times, and I think we all know that none of our problems are going to be easily resolved. Even so…’ he turned towards the man who had come to her aid ‘…I have to say, I believe my colleague, Sam Boyd, is the person who will help us steer our way through choppy waters. Dr Boyd, would you care to address the meeting once more?’

‘Thank you, I would.’ Sam Boyd stood up and looked confidently around at the sea of faces before him. ‘I’m aware of how strongly feelings are running on this issue,’ he began, his deep voice flowing over them as smooth as silk. ‘I know that the measures we have to put in place will not sit easily with many of you. No one wants to see units closed down and services reduced.’

He let his gaze roam freely, as though he was addressing each person individually, and for a second or two his glance touched on Ruby. Her jaw lifted, letting him know that she would not be sweet-talked. He might have helped her out a short time ago, but this was business, and he was the enemy.

‘That’s why we’re here today,’ he went on, ‘to discuss the best way to deal with the problem. As you know, the trust is saddled with huge debts, and savings have to be made wherever possible…even at the cost of people’s jobs.’ He paused momentarily to let that sink in. Then he added, ‘This is your chance to put forward your opinions and suggestions. We want to know what you feel about the choices ahead of you.’

The room was silent as the doctors and nurses slowly absorbed what he was saying, and Becky chose that moment to blow a clear and succinct raspberry, followed by a gurgle of excitement as she discovered one of the plastic keys of her teething ring. More raspberries followed.

Sam Boyd appeared to be taken aback for a moment or two. Then his brows rose, and he said on a faintly humorous note, ‘Well, that wasn’t quite the response I was expecting, but I suppose it’s a start, at least.’

A general titter of amusement spread around the room. Embarrassed to be at the centre of attention, Ruby decided that attack was the best form of defence. She stood up and glanced around.

‘My apologies for the interruption,’ she said. ‘I’m Dr Ruby Martyn. As you’ve probably gathered, I’m having domestic problems at the moment, which means that I have had to bring the baby with me today. I know that on occasion allowances are made for such situations. I do hope that won’t be a problem for anybody here, but I was keen to attend this meeting.’ She glanced at Becky before adding, ‘As you can see, she’s not afraid to air her opinions.’ She hesitated, allowing time for the audience to settle.

‘I have to say, though, I entirely agree with Becky’s sentiments on the subject of staff reductions. You cannot remove key personnel and expect things to go on as normal. The doctors and nurses who work here are the lynchpins of this organisation. They are the ones who keep the system going, and reducing numbers will only result in stressed, overworked staff members. The end result will be to bring down morale even further than it has fallen already.’

Sam shook his head. ‘The alternative will be to close units down altogether. Is that what you want to see? These debts will not simply fade away. It may be an unpalatable fact, but savings have to be made somehow.’

‘And how did those debts come about?’ Ruby’s grey eyes challenged him. ‘I’ll remind you, shall I? It was because of the finance deals entered into by the trust board to ensure that the building of the brand new Heritage Hospital could go ahead…the state-of-the-art, be all and end all of hospitals.’

‘Yes, that’s true.’ His tone was appeasing, smoothing over the arguments she’d made as though all was perfectly in order. ‘It was a costly venture, I grant you, but many, many lives will be saved because of its existence and because of the up-to-the-minute, high-tech equipment it enjoys.’

‘And what of the lives of the people who come here to the Ashvale Hospital, expecting first-rate treatment?’ She was warming to her subject, more than ready to tackle him head on. ‘How are they going to fare when we’re short of doctors and nurses simply because of the measures you’re about to take?’

He didn’t answer straight away. Instead, he was thoughtful for a moment or two, taking his time in contrast to her quick-fire opposition. ‘All right, let’s look at that,’ he said. ‘I can understand perfectly well why you’re concerned. But let’s take an instance, shall we?’ He paused once more, thinking things through. ‘Suppose a child is brought here by ambulance, suffering from a severe, life-threatening asthma attack. How many people do you suppose would be involved in his care?’

She thought about that. ‘The paramedics, a triage nurse, maybe the senior house officer and a paediatric nurse. There would be a consultant on call to oversee the situation.’

‘And between them you expect they would be able to resolve the child’s difficulties? They are all essential to the child’s well-being?’

‘I believe so, yes. Provided that they were able to access him quickly enough and give the right treatment, he should stand a good chance of recovery. That’s our job; that’s what we’re here for, after all. But if there is a breakdown in the chain of personnel brought about by staff shortages, or because people are too busy dealing with other life-threatening emergencies, I can see how things could go drastically wrong.’

He nodded. ‘You’re right, of course. Having qualified people in place to deal with events as they occur is essential, and no one wants to see staff stretched to the limit, least of all me. But in our hypothetical situation, all the staff and equipment in the world might not have saved the boy…because without the necessary savings to the department, the A&E unit here would have been closed down, and the child would have been transported instead to the Heritage…a journey of a further fifteen miles or so. Given the time taken for that journey, the strong possibility is that he would not have survived.’

There was a combined intake of breath amongst the doctors and nurses in the room as his point sliced home.

Ruby frowned. That was not good. He couldn’t be allowed to persuade his audience to submit to his plans by laying out a worst-case scenario as if it were the accepted outcome.

She sent him a direct, lancing stare. ‘Do you really think that argument is going to sway me, or anyone here? You’re planning to cut the tree off at the roots and afterwards you’ll inspect it every now and again to see if it somehow managed to survive.’ She shook her head. ‘There are other ways to make savings, which don’t involve shrinking your prime resource. For instance, you could take a closer look at some of the maintenance and repair contracts that are up for renewal with private companies. You could look to reducing payments for supplies by checking that only essential items are ordered.’

He smiled. It lit up his features, softening his expression and enhancing the perfect angles of his face, and just for an instant, it took her breath away. He was incredibly good-looking, she acknowledged. She hadn’t expected to have the rug pulled out from under her in quite that way, and it was a low blow, throwing her out of synch, her nervous system responding with a keen fluttering of sensation, a soft ripple of excitement running along her nerve endings.

‘So you want me to cut down on the number of pens I order,’ he said, with a soft edge of mockery. ‘Well, that’s a start, I suppose. And we could talk to the contractors about maintenance and ask them to forego checking the equipment once in a while. I’m not sure how well that would sit with nurses trying to programme a faulty infusion meter, though. It could turn out to be a false economy.’

His answer riled her. ‘If you have your way, there might not be a nurse to administer the infusion in the first place,’ she retorted, throwing him a cool glance. ‘You know as well as I do that commenting on pens and infusion meters is just a cheap jibe. With perseverance, good intent and a willingness to examine all possibilities, we can make this work. There are savings to be made, but we have to choose our targets carefully. I don’t believe that units have to be closed, or that staff have to be let go.’

Becky interrupted with an excited babble of baby talk just then, and Ruby glanced down to see that she was shaking her teething rattle with sudden vigour. The tension in the room dissipated as rapidly as it had risen.

‘The baby obviously agrees with you,’ Sam said, his mouth curving. ‘She seems to be a staunch supporter.’

Ruby laughed. ‘I’m sure if she was able to speak, she would remind us that people are our greatest asset. We have to work together to make this happen the way we want.’

He nodded and then agreed to take comments from other people in the room. Ruby sat down and tended to Becky, all the while lending an ear to the proceedings. The discussion ebbed and flowed for some time, until eventually the chairman called an end to the meeting.

‘We’ve covered a lot of ground today,’ he said. ‘Clearly, there has to be a lot more work done before we can decide on our ultimate course, and we welcome suggestions for different strategies from anyone who cares to make them. I suggest we meet again in a few weeks to finalise matters.’

The meeting broke up, and Ruby chatted with James and Olivia for a while, before getting to her feet and preparing to leave the room.

‘Dr Martyn…do you have a moment?’

Ruby paused, turning at the sound of Sam Boyd’s voice. ‘Of course.’ She nodded to James and Olivia, and they continued on their way, leaving her free to talk to her new boss.

He studied her thoughtfully for a moment or two. ‘I didn’t realise, at first, that you’re one of the members of my team.’

‘Would that have made any difference to our exchange of opinions a while back?’

He shook his head. ‘I think you know that it wouldn’t. I recognised your name when you introduced yourself. You’re my specialist registrar, aren’t you?’

She nodded. ‘So you’ve been looking through the personnel files. Perhaps I should give you full marks for staying on the ball.’