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‘No amount of paid substitute care, no matter how professional or good it is, can ever assuage a woman’s in-built biological guilt on that score.’
‘Mmm—damn waste it will be too. Jenny is one of the best, if not the best junior registrar I’ve ever had.’
‘Well, perhaps in future you should remember that and when you’re lecturing your students you should remind them all, but especially the male students, what sexual equality really should mean—and I’m not referring to a token filling up and emptying of the dishwasher now and then.
‘Do you realise, Rick, that, despite all this media hoo-ha about the “New Man”, women are still responsible for the major part of all domestic chores? Sorry,’ she’d apologised, with a wry smile. ‘I didn’t mean to start lecturing you, but …’
‘I know.’ Richard had smiled, standing up and leaning towards her to kiss her.
‘I saw Sir Arthur yesterday,’ Elizabeth told him now.
Sir Arthur Lawrence was the chairman of the hospital board, an ex-army major, rigidly old-fashioned in his views and outlook, with whom Richard had had so many clashes over the years.
‘Oh, did you? What did he have to say for himself? More complaints about overspending on budgets, I suppose,’ Richard grunted.
Elizabeth laughed. ‘No, as a matter of fact he was very complimentary, praising you for all the work you’ve done to help raise money for the new Fast Response Accident Unit.’
Richard grunted again. ‘You should have told him not to count his chickens. We need government funding if we’re to go ahead with it, and we haven’t heard that we’re going to get it yet. The Northern is putting up a pretty good counter-claim to ours. They maintain that they’re closer to a wider range of motorway systems than we are …’
‘And we’re closer to the centre of the region and we have better access to the motorway,’ Elizabeth reminded him. ‘And you’ve got a much better recovery record.’
‘Mmm … well, that’s no thanks to Sir Arthur; you should have heard the objections he raised when we opened our recovery ward …’
‘Admit it, you enjoy fighting with him.’ Elizabeth laughed.
Richard pulled a face. ‘He’s twenty years behind the times … more … Hell, is that the time? I’ve got to go. You’re at home today, aren’t you?’
‘Yes. I thought I might drive over and see Sara. She sounded a bit down when I spoke to her yesterday.’
‘Yes, it’s no picnic being a GP’s wife—nor being a GP, either.’ Richard kissed her, smiling at her as he suggested, ‘Why don’t we go out for dinner together tonight … Mario’s? Just the two of us,’ he added.
‘Just the two of us,’ Elizabeth responded, emphasising the ‘just’. ‘Mmm … that would be lovely.’
‘I’ll get Kelly to book us a table,’ he promised her as he picked up his briefcase and headed for the door.
After he had gone, Elizabeth made herself a fresh cup of coffee and picked up a buff folder from the dresser. The dresser had been an antiques fair find, which she and Richard had stripped of its old paint, a long and laborious job which she suspected had cost far more in terms of their time and paint-stripper than had she bought the ready-stripped, polished version from an antique shop.
There was a sense of satisfaction in having done the work themselves, though, and she had enjoyed those hours in Richard’s company. They had reminded her of the early days of their marriage, when it hadn’t seemed so unusual to see him wearing old clothes and getting dirty. ‘You’re so lucky, you and Richard,’ her friends often told her enviously. But their marriage had suffered its ups and downs just like any other. Where they had been lucky perhaps had been in that both of them shared the same deep commitment to their relationship, so that, at times when both of them might have viewed their individual roles within it from opposing and conflicting viewpoints, their joint desire to keep their marriage alive and functioning had continued to survive.
She had not always experienced the same contentment in their relationship, the same pleasure in being herself as she did now, Elizabeth admitted. There had been times, when Sara was young, when she had felt Richard growing away from her … when she had felt threatened by and resentful of not just the claims of his work but his evident involvement with it.
It had been an article in the local newspaper absently flicked through in the hairdressers which had initially sparked off her interest in community work. With a twenty-year-old degree and no professional skills whatsoever, she had humbly approached the local community liaison officer, explaining that she would like to give her services and that she had time on her hands with her daughter living away from home, but that she had no skills she could put to use.
‘No skills?’ the other woman had queried. ‘You run a home, you’ve brought up a family, you drive a car. Don’t worry, we’ll soon find something for you to do!’ And so they had.
Elizabeth smiled to herself now, remembering how terrified she had been that first day, manning the reception desk at the Citizens Advice Bureau, and then six months later when she had been asked if she would like to train as a counsellor. She had protested that she was not experienced enough to give advice to others, that her life, her relationships were very far from perfect, and certainly did not justify her handing out advice to others.
‘The more problems our counsellors have faced in their own lives, the better they are at listening compassionately to the problems of others,’ she had been told crisply.
She sat down and opened the folder.
She had recently attended a national conference on the effects of long-term unemployment and redundancy on people. She frowned as she read through the notes she had made. They were certainly getting an increased number of people coming to them for advice on how to cope with their unemployment—women in the main, anxious not just about the loss of income but the effects of their husband’s redundancy and consequent loss of self-esteem on the men emotionally, and on the family as well.
If the gossip going round following Andrew Ryecart’s suicide was correct in suggesting that it had been caused by financial problems with Kilcoyne’s, it seemed likely that the town would soon have more men out of work. The company was one of the town’s main employers, one of the last light engineering companies left in the area. There would be no alternative jobs for people to go to.
Elizabeth nibbled the end of her pen. She had suggested at last week’s general staff meeting that it might be an idea to put together a special package formulated specifically to help such cases. People were individuals, of course, with individual problems, but …
‘It’s a good idea,’ her boss had agreed. ‘But we simply can’t spare anyone to work on it at the moment, unless …’
‘Unless I do it at home in my spare time,’ Elizabeth had offered wryly.
‘I’m sorry, Elizabeth,’ her boss had apologised. ‘But you know how things are: we’re all suffering cutbacks and underfunding, just like everyone else.’
That was true enough. Richard had been complaining that the hospital now seemed to employ more accountants to watch over its budgets than they did nurses to watch over its patients.
‘Richard, have you got a minute?’
Richard paused, frowning as he glanced at his watch.
‘Barely,’ he told the hospital’s chief executive. ‘My clinic starts in half an hour and I’ve got a couple of phone calls I need to make first.’
‘I really do need to talk to you, Richard,’ the other man insisted. ‘We’ve got a committee meeting coming up soon and we still have to go through your budgets.’
Richard grimaced, suppressing his instinctive response, which was to say that he was a surgeon, not an accountant. It was pointless losing his temper with Brian; he was just as much a victim of the financial cuts being imposed on them as he himself was.
‘Look, let’s go into my office,’ Brian suggested, taking advantage of his silence.
Irritably Richard followed him, shaking his head when Brian offered him coffee. ‘No, I forgot for a moment—you’re a tea man, aren’t you?’
‘I drank too much coffee when I was a student and a young intern,’ Richard told him. ‘They talk about working long hours now, but when I first qualified … Still, we didn’t have the same pressures on us then that they do now, nor the huge diversity of skills and facts to learn. These days there seems to be a new drug on the market every day and a new set of complications to go with it, never mind all the new operating techniques, and then of course there’s the paperwork …’
Brian Simmonds watched him sympathetically. He had remarked at last month’s meeting to the new area health chief administrator that it was perhaps unfair to expect some of their senior and older medical staff to be able to absorb the intricacies of the new technology and the tighter control of finances as speedily as the younger ones.
‘If that’s the case, then perhaps you ought to be thinking about pensioning a few of them off,’ had been David Howarth’s cold response. ‘It appals me to see how much money we’re wasting paying top salaries to people who could quite easily be replaced by someone younger—and cheaper.
‘The whole area health system needs reorganising and rationalising. We’ve got far too many small specialist units competing with one another. It would make much more sense to nominate specific hospitals to deal with specific areas of expertise. Out of the eighteen hospitals in this area, a good number of them have specialist heart units, and both your hospital and the Northern have specialised microsurgery units. Older surgeons like Richard Humphries …’
‘Richard Humphries was the first local surgeon to specialise in his field,’ Brian had protested defensively. ‘He really pioneered the treatment in his area …’
‘But Richard Humphries is a man not far off sixty who, no matter how excellent a surgeon he might be, has made it plain that he just isn’t equipped to deal with the financial implications of working in an independent hospital. Christopher Jeffries at the Northern, in contrast, has already shown that he has an excellent grasp of the way we’re going to need to operate in future to make sure we’re financially viable, and he’s twenty years younger than Richard.’
Brian hadn’t repeated their conversation to Richard. Richard and David had taken a dislike to one another virtually at first sight, and Brian already knew from past experience that Richard was simply not a man to compromise on what he believed were the best interests of his patients for any mere financial reasons.
Richard epitomised all that was best in the Health Service, its principles and its goals, while David on the other hand represented the new financial cutting edge that was being imposed on it to try to counteract the burden of a growing population and the rapid advances made in medical technology.
He sighed to himself, knowing that the problem was one thing, but finding the answers to it was something else again, and while David and his like believed that the answer was a far more hard-nosed response to the provision of health services, and while publicly Brian might feel it was politic to agree with him, privately he couldn’t help but sympathise with Richard’s totally opposite point of view.
Sympathising with him was one thing, failing to get across to him the message that if financial restraints were not self imposed then they would be imposed from outside was another matter, and one that could potentially prejudice the whole hospital’s future.
‘Our accountant was on the phone yesterday,’ he told Richard now. ‘It seems that she still hasn’t received your budget forecasts for the next quarter …’
‘What exactly is the hospital paying me for?’ Richard countered irritably. ‘Filling in forms or operating on patients?’
Brian sighed again. ‘Richard, I know how you feel, but try not to make too much of an enemy of people like David.’ He moved uncomfortably in his seat. ‘There are areas where savings can be made. The Northern——’
‘The Northern has a far lower post-operation recovery-rate than we do here,’ Richard interrupted, and added bluntly, ‘And you already know my opinion on the reasons for that …’
‘You’re getting too old and too idealistic, Richard,’ his GP son-in-law had told him drily the last time they had met. ‘And if you think you’ve got problems you should sit at my desk for a couple of days.’ Too idealistic he might be, but too old … Richard frowned, wondering why the thought should make him feel so edgy and defensive. He wasn’t even sixty yet. No age for a surgeon. Heavens, he could remember when he’d got his first internship: the senior surgeon had been close to seventy and everyone apart from the matron had gone in awe of him. It hadn’t mattered that you had to shout to make yourself heard because he was going deaf; watching him operate had been a privilege. In those days age and experience had been things to honour and respect—not like today, when the moment you got past forty-five you were considered to be past your best.
Back in his office, he found that his secretary, Kelly, had already sorted his mail into urgent and non-urgent piles. On the top of the urgent pile was a GP’s report on one of her female patients. As he studied it he pushed aside his conversation with Brian, frowning as he read the doctor’s findings.
A lump had been detected in the patient’s breast and an immediate operation would be necessary to perform a biopsy and removal if the lump was found to be malignant. She was a relatively young woman, only in her mid-thirties, and he knew from experience the trauma she would experience over the potential loss of a breast, but given the choice between that and losing her life …
His frown deepened as he reached into his jacket pocket for his diary, flicking it open until he found what he was looking for.
‘Kelly, how much emergency space have I got left on Thursday?’ he asked his secretary.
‘Thursday,’ she repeated, studying his lists. ‘None …’
‘Well, then, we’ll have to make some; Mrs Jacobs needs surgical attention straight away.’
‘But Thursday’s just two days away; you could afford to hold on until early next week.’
‘No, it has to be Thursday the tenth; the date is crucial,’ he told her. ‘Let me see the list, will you?’
When she handed it to him he studied it thoughtfully.
‘We’ll cancel Sophie Jennings’ non-urgent operation and put that in the beginning of next month,’ he announced.
Kelly pulled a small face. ‘We’ve had to cancel it once already due to another emergency, and you know how much she complained then …’
‘It can’t be helped,’ Richard told her. ‘Get her file out, will you, and I’ll write to her? Oh, and get me Mrs Jacobs’ file as well; I’d better phone her and speak to her personally.’
‘Problems?’ Elizabeth asked later that evening as they sat at their table in Mario’s and she watched Richard pushing his food unenthusiastically round his plate.
‘No more than usual,’ he told her drily. ‘All I ever seem to hear from Brian these days is money and budgets. What the hell is happening to the world today, Liz, that we judge the success of a hospital not on how many lives it saves, or on how much it improves the quality of its patients’ lives, but on how much money it can save?’
Elizabeth shook her head sympathetically. It was a familiar argument and very much a sore point with him at the moment.
‘The Health Service is under a great deal of financial pressure,’ she reminded him gently. ‘Look at the way you’ve had to go to the public to raise money to help fund this new Fast Response Accident Unit. At least that’s one cause that you and Sir Arthur are united on.’ She smiled. ‘He’s every bit as keen and determined to get the unit for the General as you are.’
‘Yes,’ Richard growled. ‘Someone ought to tell him that he’d be doing everyone a better service if he concentrated more on his fund-raising and less on finding fault with everything we do … Everything’s changing, Liz—good men being pensioned off for no better reason than the fact that …’ He paused, shaking his head. ‘I feel so out of step somehow. Am I wrong to believe that we should put our patients first?’
‘No, you’re not wrong,’ Elizabeth assured him. She put down her knife and fork, feeling her way as tactfully as she could. ‘But knowing you’re right isn’t always … you can be very stubborn,’ she told him gently. ‘There are circumstances when it’s sometimes easier to get your point of view across by being a little more flexible.’
She knew what was really bothering him; she and Sara and been discussing it earlier.
‘How’s Dad going to feel if the General amalgamates with the Northern and they offer him early retirement?’
‘Offer him early retirement?’ Elizabeth had queried ruefully. ‘Your father is far more likely to see it as being pensioned off; he won’t like it at all.’
‘No, and it won’t help that your working and your career is just beginning to take off …’
‘Oh, Sara, you’re not being fair,’ she had protested. ‘Your father has always encouraged me in my work …’
‘Mmm … but his career has always taken priority, hasn’t it? Oh, I know how pleased he is for you, how proud he is of you, but if he was sitting at home all day while you——’
‘It won’t come to that,’ Elizabeth had interrupted her firmly.
‘No? Ian was saying the other day that two or three of the older, more senior men at the Northern have already been approached with a view to getting them to go, and Dad is only a few years off sixty …’
Now, as she watched him, Elizabeth’s heart sank a little. She knew how much his work meant to him and she knew what a blow it would be to his pride, his sense of self-worth if he was asked to retire before he was ready.
Perhaps if she subtly tried to underline the advantages of his not having to work as hard, just as a precautionary measure. Her mouth curled into a rueful smile. Burgeoning career woman she might be, but in many ways she was still very much caught up in the traditional role of the supportive wife. That was how her generation had been brought up.
‘Oh, did you manage to get over to see Sara?’ Richard asked her, changing the subject.
‘Yes,’ she told him. ‘She’s feeling a bit frazzled. I offered to have Katie for a few days to give her a break; I’ve still quite a lot of holiday leave to take.’
‘You always were a soft touch,’ Richard told her. ‘For all of us …’
‘I’m glad you’re honest enough to include yourself in that comment,’ she teased him.
‘How do you feel about getting out of here and going home?’ Richard asked her urgently, leaning across the table so that the hovering waiter could not overhear what he was saying.
Elizabeth looked at him quickly to confirm that she hadn’t misunderstood the subtle message he was giving her. In the early days of their marriage, when their passion for one another had still been new and exciting, it had been no strange thing for them to leave early from dinner parties and other social events, Richard claiming quite untruthfully that he was on call, when in fact what he had wanted, what they had both wanted, was to go home and make love.
Laughing together, they had hurried back to their small flat, their urgent eagerness for one another as intoxicating as a heady wine, but these days their lovemaking, although still pleasurable, tended to be a far more leisurely and considered affair, its spontaneity tempered originally by the demands of a growing family and more latterly by their individual career demands and a certain natural lessening of the intensity of their desire.
‘Does that mean what I think it means?’ she asked him in amusement, and then laughed as she saw the way he was looking at her.
‘We are not teenagers any more!’ she told him ten minutes later when he took hold of her in the street, kissing her firmly before hurrying her towards their car.
‘Who says we need to be?’ he whispered as he paused to kiss her a second time. ‘Just because we aren’t under thirty, it doesn’t mean that we automatically stop functioning properly, that we aren’t just as capable as our juniors. There are, after all, times when experience and knowledge count for a lot more than youth and enthusiasm …’
Elizabeth touched his face gently.
‘Oh, Richard.’ There’s no shame in growing older, she wanted to tell him, but how could she, when all around them was the irrefutable evidence that there was? Being old and ill and dependent—these were now the taboo subjects that sex and birth had once been.
Richard wasn’t alone in dreading retirement as an acknowledgement of the beginning of his own old age.
CHAPTER FIVE (#ulink_cfb92c64-bc73-53e7-97af-36f9d87127ee)
PHILIPPA opened her eyes and shut them again quickly as she remembered what day it was.
Outside it was still not properly light, but she knew she would not go back to sleep. She threw back the duvet, shivering as she felt the cool draught from the half-open window.
The cremation was not due to take place until two o’clock—plenty of time for her to do all the things she had to do …
