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Jess’s frown deepened. Grace must be worried if she was prepared to risk incurring Mairi’s wrath by asking for a home visit on her behalf. There wasn’t a person on Greensay who didn’t know that Mairi never asked for or expected help from anyone.
‘Something wrong?’ Ezra asked as she grasped her crutches.
‘Maybe—I don’t know,’ she replied absently, then pulled herself together. ‘My first call is to Harbour Road. Toby Ralston—four years old—juvenile arthritis. His parents initially thought he had meningitis. I confess I did, too, when they called me out in the middle of the night and I discovered his temperature was over 39°C, and he had stiffness in his joints and a rash.’
‘Systemic juvenile arthritis, then, affecting the small joints rather than pauciarticular or polyarticular arthritis?’ he said, then smiled slightly as she stared at him in surprise. ‘I did tell you I used to be a doctor, remember?’
He had, and she’d believed him—of course she had—but she’d have been a fool if a little part of her hadn’t wondered about his qualifications. She wasn’t wondering any more.
‘I’ve got him on non-steroidal anti-inflammatory drugs to relieve the pain and swelling, but they’re not working very well,’ she continued once Ezra had stowed her medical bag in the boot of his car and they were driving down the narrow streets from the health centre towards the whitewashed houses that lined the harbour. ‘I suppose I could start him on corticosteroids but…’
‘You’re reluctant to do so because of his age.’ Ezra nodded. ‘I’d try to keep it under control for the moment. Most children recover from juvenile arthritis within a few years and are left with little or no disability. Only a very small minority go on to develop an adult form of arthritis.’
She’d been telling Toby’s parents that for weeks, but the minute Simon and Elspeth had heard the word ‘arthritis’ they’d instantly assumed their son would be crippled for life, and nothing she’d said had persuaded them otherwise. Which was why, when Ezra drew his car to a halt outside the Ralstons’ home, she found herself turning to him and saying on impulse, ‘Would you like to come in—see him yourself?’
‘I’m not a doctor any more.’
‘I know, but I wondered—’
‘No!’ He bit his lip as she stared up at him, startled by his vehemence. ‘No,’ he repeated more evenly. ‘I’ll wait outside in the car if you don’t mind.’
Jess didn’t mind at all. It wasn’t as though she didn’t know what was wrong with Toby, but what really intrigued her was why Ezra had reacted as he had. OK, so he didn’t practise medicine any more but he’d seemed not only angered by her suggestion but also strangely upset by it.
It didn’t make any sense, but she had no time to think about it. Elspeth was already on the doorstep and Toby was bouncing towards her, his white-blond hair gleaming in the sunlight, his large blue eyes alert and full of mischief.
‘It’s his chest, Doctor,’ Elspeth explained, ushering her son back into the sitting room, concern plain on her face. ‘He got up this morning with the most dreadful cold, and I know we have to be careful, what with his condition and everything.’
Jess would have been amazed if Toby’s abundantly runny nose had meant anything other than one of the many colds which were plaguing the islanders this winter, and a quick check with her stethoscope revealed she was right.
‘You don’t think he needs a chest X-ray, then?’ Elspeth said after Jess had given her the good news. ‘Or perhaps some antibiotics?’
‘Elspeth, he has a cold,’ Jess said firmly. ‘If I give him antibiotics every time he’s snuffly, they won’t work when he really needs them. How’s the physiotherapy going?’ she continued, determinedly changing the subject.
‘All right, I guess. He’s not very happy about the night splints.’
Which meant he probably wasn’t wearing them, Jess thought with a deep sigh. ‘Elspeth, you know he has to wear them in bed, whether he wants to or not. The physiotherapy he’s getting will maintain muscle strength and joint mobility, but the splints are equally important to prevent joint deformity.’
‘I suppose so,’ the woman muttered. ‘I still don’t know how he’s got this juvenile arthritis. Simon’s phoned round all our relatives—even contacted his uncle in Australia—but none of them can remember anybody in the family ever having had it.’
‘Elspeth, I only said it might be inherited,’ Jess reminded her. ‘The initial joint inflammation can also be triggered by a viral infection, but the truth is we really don’t know why some children are affected and others aren’t. But as I told you before, there’s every chance he’ll grow out of it.’
And Elspeth still didn’t believe her, Jess thought wearily when she left the house and Ezra drove her to her next call. Neither did Denise Fullarton after she’d examined her, but at least the local dentist’s wife had more cause to be concerned.
‘She’s had three miscarriages in five years?’ Ezra exclaimed when she explained the situation. ‘No wonder she was too terrified to walk to the surgery for a confirmation of her pregnancy. How far on is she?’
‘Seven weeks.’
‘Has she ever carried a baby to full term?’
Jess shook her head. ‘I’ve had her tested for everything—fibroids, uterine abnormality, genetic abnormalities—but the muscles of her cervix just seem to be too weak to support her uterus when she’s pregnant. I’ve told her I’ll put a stitch in her cervix to keep it closed when she reaches the end of her first trimester, but the trouble is she doesn’t usually make it to twelve weeks.’
‘Have you tried taking blood tests at the start of her menstrual cycle to see whether her progesterone levels are raised?’ Ezra suggested. ‘I believe there’s some evidence to suggest women who miscarry a lot don’t produce enough progesterone after ovulation to help the embryo.’
She looked up at him enquiringly. ‘I thought that was usually linked to polycystic ovarian disease?’
‘It is,’ he said nodding, ‘but I also remember reading that giving gonadotrophin-releasing hormones to women who repeatedly miscarry can help. It’s obviously too late to try that now, but if—and hopefully it doesn’t happen again—your patient has another miscarriage it might be worth a try.’
It would, just as she’d dearly have liked to have asked him what kind of doctor he’d been before he’d decided to stop practising medicine.
Not a GP, that was for sure. This was a man who was used to giving orders—orders that were instantly obeyed.
A special registrar, perhaps? But, then, why had he given it up? He didn’t look like the kind of man who would throw in the towel on a whim. Dedicated, she would have said. Focused.
Could she ask him—did she dare?
Awkwardly she cleared her throat, but before she could say anything someone called her name and she turned to see Louise Lawrence striding determinedly across the road towards her, her youngest daughter in tow.
‘I wish you’d take a quick look at Sophy’s head, Doctor,’ Louise said irritably. ‘Scratch, scratch, scratch. She’s been doing it for a couple of days now and it’s driving me mad.’
Obediently Jess parted Sophy’s long black hair and saw the cause immediately. ‘I’m afraid your daughter has lice, Mrs Lawrence—head lice.’
Sophy’s mother was outraged. ‘But she can’t have! My daughter has clean hair—’
‘Which is just the sort lice prefer,’ Jess interrupted gently. ‘They generally travel from head to head when children share combs or hats—’
‘But Sophy never does that,’ Louise protested. ‘I’ve warned her time and time again about the dangers, and I can assure you she doesn’t do it.’
Sophy’s swiftly averted gaze suggested that the warning had gone unheeded, but Jess saw no point in commenting on it. The most important thing now was to treat the condition.
‘Do people often do that—ask you for a consultation on the street?’ Ezra asked, clearly bemused, as an obviously furious Mrs Lawrence bore Sophy off in the direction of the village shop with instructions to buy a special head-lice shampoo and to remember to treat everybody in the family.
‘And how!’ Jess chuckled. ‘My most potentially embarrassing case happened not long after I came back to the island. It was an old fisherman who thought he had a hernia but didn’t want to take time off work to come into the surgery to confirm it. Honestly, if anyone had seen the two of us down this side street—me on my knees in front of him—well, you can just imagine what they would have thought!’
Unfortunately Ezra discovered he could—only too vividly—and was even more dismayed to feel his groin tighten at the image.
Lord, but Tracy had been right. One week of living on his own at Selkie Cottage and already he was getting weird. He had to be if he was finding himself envying an unknown, elderly fisherman with a hernia.
And the ridiculous thing was that he didn’t even like Jess Arden. OK, so in the winter sunshine her red hair shone like spun silk, and her eyes became an even deeper green than they’d been before, but when all was said and done she was just a woman.
And a blackmailing one at that, he reminded himself as he drove her out of Inverlairg to the first of her outlying home visits.
So if she wanted to hobble from patient to patient all afternoon, he had absolutely no sympathy for her. And if she was clearly growing more and more exhausted by the minute, then it was her own fault.
Which was why it made no sense at all when he drew his car to a halt outside Woodside croft for him to demand angrily, ‘Look, how many more of these damn house calls have you got to make?’
Of course she bristled immediately, as any idiot would have known she would.
‘I’m sorry if you’re bored, Dr Dunbar,’ she said, her voice ice-cold, ‘but I’m not about to rush my visits just to please you.’
‘I’m not bored—’
‘This is my last call,’ she continued, completely ignoring his protest, ‘but, believe me, it will take as long as it takes.’
And it would, she thought, even though she was obviously the last person Mairi Morrison wanted to see when she opened her front door.
‘Not much of a talker, your new locum,’ Mairi observed when Ezra stalked off towards the barns after the very briefest of greetings.
‘People on the mainland don’t tend to talk as much as we do, Mairi, and I’m afraid I might have rather steamrollered him a bit today, and…’ And what the hell was she doing, defending him? Jess wondered, feeling her cheeks redden under Mairi’s curious gaze. Ezra Dunbar was big enough and cussed enough to look after himself. ‘Grace asked me to drop by,’ she continued quickly. ‘She’s a bit worried about you.’
Mairi shook her head as she led the way into the house. ‘I’d have thought she had enough to worry about with her own angina, instead of poking her nose into other people’s business. I’m just getting old, like everybody else.’
‘Fifty-three’s hardly old,’ Jess protested with a laugh. ‘In fact, I’d say you were just in your prime!’
The Mairi Morrison Jess knew of old would have made some witty retort. The same Mairi Morrison would also have had something considerably more stringent to say about interfering neighbours, but this Mairi Morrison accepted her offer of an examination without a murmur and to Jess’s dismay seemed lethargic and uninterested, almost strangely resigned.
‘How long have you had that cough?’ Jess asked after she’d sounded her.
‘Everybody’s got a cold, Jess. It’s winter.’
It was, but everybody’s chest didn’t sound like Mairi’s. Thick and congested and wheezy. And everybody hadn’t lost weight they could ill afford to lose.
‘I’d like to send you for an X-ray,’ she said, reaching for her notebook. ‘You’ve probably simply got a chest infection, but it’s best to check it out. I’ll give Bev a call and try to get you an appointment for the end of the week, if that’s OK?’
Mairi gazed down at her red, work-worn knuckles for a moment, then sighed. ‘I suppose so.’
There it was again. The same air of defeat, as though Mairi knew—or suspected—something she wasn’t telling her.
‘Mairi, if there’s something worrying you—’
‘When are you going to get married?’
Mairi had been asking the same question ever since Jess had turned twenty-two, but today Jess knew it was merely a means of changing the subject. She also sensed, however, that there was no point in pressing the matter, and she smiled. ‘Oh, this year, next year, some time, never.’
‘You’ve not met the man with the black hair and the cleft chin, then?’ Mairi observed, and Jess stared at her in amused amazement.
‘Good grief, fancy you remembering that! I must have been—what—fifteen, sixteen, when I told you all about my ideal man. No, I haven’t met him yet.’
Neither had she ever experienced that flip of her heart which she’d solemnly assured Mairi would indicate she’d fallen in love with The One.
Well, actually, yes, she had, she suddenly remembered, suppressing a chuckle. Last night, when Ezra had come back, her heart had lifted in a most disconcerting way. Which only served to show what romantic twaddle she’d believed when she’d been sixteen.
‘Maybe it’s time you looked closer to home,’ the older woman said, leading the way outside. ‘Brian Guthrie’s sweet on you, you know.’
‘Brian’s lonely, and has been ever since Leanne died.’
‘He thinks you’re sweet on him.’
He did, too, Jess thought glumly. She’d only gone out with him because he’d been so depressed after his wife had died, and she’d thought it might help if he had someone to talk to. And it had, but not the way she’d wanted.
‘OK, so he’s in his fifties,’ Mairi continued, ‘but at thirty-two you’re no spring chicken.’
‘Gee, thanks!’ Jess protested, her eyes dancing as Ezra walked towards them, ready to carry her medical bag.
‘And if you don’t fancy Brian Guthrie, there’s always Fraser Kennedy,’ the older woman continued. ‘He’s been in love with you for years, and he owns three fishing boats now so he’s well on the way to becoming a man of means.’
Jess shook her head and laughed, but she didn’t feel much like laughing when Ezra drove her back to Inverlairg and she saw how full her evening surgery was. She felt even less like laughing by the time she’d finished it.
‘Time to go home, Jess,’ Ezra declared firmly when she came out of her consulting room, and he saw the dark shadows under her eyes, the way she was leaning more heavily on her crutches.
For once she didn’t argue. All she wanted was to go home and crawl into bed, but even when they reached her cottage he was still in full organising mode.
‘Put your feet up, and I’ll get dinner,’ he said, steering her into the sitting room. ‘It’s nothing fancy—just some chicken I picked up from the shop—but I’ll make a proper list tomorrow—’
‘I’d rather just skip dinner tonight if you don’t mind,’ she said swiftly, only to see his eyebrows snap down. ‘Look, missing one meal isn’t going to do me any harm. It’s not as though I’m fading away—far from it—and I had a good lunch—’
‘So how come I smelt fish every time I lifted your medical bag?’
A tide of bright colour swept across her cheeks. She’d hoped he hadn’t noticed, but he clearly had, and she doubted whether he’d believe her if she said he’d simply been smelling Greensay’s fresh sea breezes.
‘I…I didn’t want to offend you when you’d obviously gone to so much trouble—’
‘You don’t like my cooking?’
‘No—I mean, yes, it was fine, great,’ she floundered. ‘I just felt a little queasy at lunchtime. Probably a side effect from the anaesthetic Will gave me last night.’
His eyes narrowed, and she could almost see his professional instincts working as he stared at the bruise on her forehead. ‘And do you feel sick now—headachy, dizzy?’
‘I’m just tired, that’s all.’
‘Then you’ll eat,’ he said firmly.
And she did, though he very much doubted whether she knew what she was eating.
Hell, but she looked awful. Half-asleep on her feet, her face chalk white with fatigue and pain. She couldn’t go on like this, and somehow he had to make her see it.
‘Jess.’
He’d spoken softly but her eyes flew open at once. ‘I’m not asleep. Just resting my eyes.’
‘Resting them, be damned. Jess, this arrangement we’ve got—it isn’t working.’
‘Of course it’s working,’ she exclaimed, panic plain on her face. ‘OK, so maybe we need to iron out one or two creases—’
‘You’re going to kill yourself if you go on like this,’ he said bluntly. ‘You’re not taking your painkillers—’
‘I am!’ she protested. ‘Just because you haven’t seen me—’
‘Jess, I know exactly how many you’ve taken,’ he interrupted, pulling her bottle of pills out of his pocket and waving them under her nose. ‘Two, that’s all, and you took those last night.’
