Children's Doctor, Society Bride

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‘Our most valuable resource is manpower,’ one man said, after some general discussion. ‘We should see to it that we have the best, most skilled specialists gathered together at the Royal Forest site. That’s where the cutting-edge equipment is based—high-performance scanners, new operating suites, and an up-to-the-minute range of telecommunication devices. Specialists can even offer advice over video links without having to travel from one base to another.’

‘That won’t be a whole lot of use if the departments in outlying hospitals have been closed down, will it?’ Louise murmured. She could feel herself getting prickly already.

‘We’re not talking about taking away necessary resources,’ the man answered. ‘We’re just redistributing them in order to provide a better service.’

Her mouth twisted. ‘You mean you’re tidying up as part of a cost-cutting exercise.’

Beside her, James Ashleigh stirred. ‘Not at all,’ he intervened. ‘It’s more a question of making the best of what we have. Now that we have to comply with directives about junior doctors’ working hours, it’s becoming even more difficult to maintain full coverage of departments. It makes sense to concentrate them in one centre of excellence.’

Louise gave him a narrow-eyed stare. ‘I would have thought the community deserved excellence from all quarters.’ Warming to her theme, she added, ‘And what will happen to patients who come from outlying regions and don’t have a chance to make it to this magnificent centre you’re proposing? It’s a well-known fact, backed up by research, that people with serious breathing difficulties are less likely to survive a journey to hospital if it’s more than six and a half miles away. It’s quite likely that patients will die if this plan goes ahead.’

James frowned. ‘Do you think you might be in danger of overlooking the part our ambulance personnel have to play in all this? After all, every day they make life-saving interventions while they transport sick people to hospital.’

‘Some do, I’ll grant you,’ she answered in a clipped tone. ‘But what happens if you’re unfortunate enough to be transported by a technician who isn’t allowed to carry out invasive clinical procedures or administer the necessary drugs? There’s a high percentage of ambulance personnel who aren’t trained to the same extent as paramedics.’

‘That’s an issue that’s being addressed.’ His tone softened as though he would appease her in some way. ‘You have to take on board the fact that advances in technology are being made all the time, and we need to centralise resources in order to keep pace with what’s happening.’

Sparks flared in her green eyes. ‘Are you suggesting that I’m out of touch? I can assure you, Dr Ashleigh, that I work with state-of-the-art equipment every day. I suppose you think the community would be better served if it were to be reallocated, in its entirety, to the Royal Forest Hospital along with my patients?’

He made a negligent movement of his hands. ‘I didn’t say that. I wouldn’t like you to feel that this is in any way personal, Dr Bridgford. I’m merely pointing out that we all have to accept that things can’t always stay the same, no matter how much we might want them to.’

Louise drew breath, ready to come back at him, but Mr Jeffries cleared his throat and stalled her.

‘Of course your opinions will be taken into account, Louise. This is merely a preliminary meeting to discuss the various alternatives. We all know how concerned you are about the effect these changes might have on your department. That’s why we need to be particularly careful in how we decide on what options are to be presented to the committee.’

Louise subsided, but inside anger was simmering. She might have known that James Ashleigh would be in favour of destroying what she had built up over these last few years. What did he know about the way she worked? Her patients meant everything to her. They were a huge part of her life, almost like family to her, and she protected the paediatric A&E unit she had shaped as if it sheltered her own little brood. He was all theory and management-speak.

The meeting progressed, and she contented herself with directing a frosty glare in James Ashleigh’s direction. He might think that this wasn’t personal but, when all was said and done, it wasn’t his carefully nurtured project that was being demolished, was it? After that, she made a concentrated effort to push him out of her mind altogether.

Her good intentions only lasted up until they adjourned for a coffee break in an adjoining room. She would have liked to distance herself from him, but he thwarted her by coming to stand next to her in the queue by the coffee machine and engaging her in conversation.

‘Can I get you something to eat along with your coffee?’ he volunteered. ‘I seem to be a little closer to the refreshments than you are. I can offer you biscuits, or there are even sandwiches and pasties, if you’d prefer.’

She shook her head. ‘Coffee will be just fine for me, thank you.’

‘Do you take it black, or with cream and sugar?’

‘Cream and sugar, please.’ She accepted the cup he offered her and moved away from the side of the room, looking around for a table where she could sit and mull over what had been said at the meeting. The consensus of opinion among the region’s chiefs was still that the paediatric A&E could be wound down, and the objections of the various doctors present had been nudged to one side.

‘Do you mind if I join you?’

She looked up to see that James Ashleigh’s hand was resting lightly on the chair next to hers. She inclined her head. ‘Feel free.’

He sat down, stretching out his long legs underneath the table. The movement was distracting, to say the least. She would have preferred to ignore the fact that he was close by, but he was altogether too masculine a figure and her intentions were doomed from the outset. Her heart began to thump in a chaotic rhythm and her mouth went dry. He was long and lean and totally disturbing to her peace of mind.

As before, at the park, he was dressed in an immaculate, beautifully tailored dark suit, with a crisp mid-blue shirt that looked as though it had come fresh from an exclusive store. His tie was perfectly coordinated, subtle and carefully knotted, as though he was a man who paid a great deal of attention to detail.

She made an attempt to recover herself. ‘Has your grandfather been ill for a long time?’ she asked.

He nodded. ‘Unfortunately, yes. His consultant is doing what he can to ease things for him, by giving him tablets to regulate the heart rhythm, and diuretics to ease his lungs. The trouble is, my grandfather finds it hard to accept his limitations. I dare say that’s why he went walkabout last week.’

A small line indented her brow. ‘I don’t quite follow. He said that you left him to go and make your phone calls. I was under the impression that you didn’t go back for him.’

James’s mouth made a wry shape. ‘I wondered if that was the notion you were left with. No wonder you were a little distant with me.’ He stirred his coffee, the action concise and methodical. ‘The fact is, I was on call that day, and my Senior House Officer phoned for advice. I stepped outside for a few moments to deal with the situation but, when I returned, my grandfather had disappeared. He does that sometimes. I think he gets a kind of wanderlust and forgets that he isn’t able to do what he used to.’

For a moment she was taken aback by this new piece of information, and she wondered distractedly whether she ought perhaps to reassess her opinion of him. He had everything going for him, after all—charisma in bucket-loads and a charm that could melt stone. Maybe she could allow herself to relax a little and get to know him better.

But then she recalled the way he had talked the committee around to his way of thinking just a few minutes earlier and she hardened her heart all over again. Perhaps he had been called away unexpectedly that day but, as a doctor, he should have paid more attention to his grandfather’s needs.

‘Perhaps you should take him out and about more often. That way he won’t feel as though he’s housebound and become desperate to escape. I rather had the impression that he feels he’s missing out on life sometimes, but I suppose, if you’ve been away, you won’t have realised that.’

She took a sip of her coffee, watching him over the rim of her cup.

He gave her a faint smile. ‘I can see that I’m not going to redeem myself in your eyes, whatever I say. I suppose it doesn’t help much that we’re at opposite sides of the fence when it comes to this business of the hospital.’

‘There is that,’ she agreed. She frowned, putting down her cup. ‘From what you said, I gather that you work here, at the hospital, but you do tend to come across more as management than as someone from the medical staff.’

She had noticed that people tended to listen carefully to what he had to say. They treated him with respect, as though he was someone in authority, someone who had the power to make sweeping changes.

She studied him thoughtfully for a moment or two. ‘I’ve been here at the hospital for a number of years,’ she added. ‘Even so, I don’t recall seeing your name on the list of physicians working at the hospital, but perhaps that’s because you’ve been away.’

He nodded. ‘I’ve been studying different management systems in Europe for the last year. Before that, I was one of the executives at the Royal Forest Hospital. Still am, for that matter, but I tend to divide my time between there and here. I still do hands-on medicine, but to a much lesser degree. I found that I could make more of a difference by being part of the management system.’

Surely he was very young to have reached the pinnacle of his career so soon? She sent him a sceptical look. ‘You opted out,’ she said.

His mouth twisted. ‘I don’t see it that way.’

She might have answered him, but her bleeper went off just then and she excused herself to make a call from her mobile phone. ‘Hello, Jenny,’ she said. ‘Do you have some news for me?’

‘I do. Millie’s results are back from radiology, and the report says that there is a diaphragmatic hernia which has allowed part of the child’s intestine to push through to the chest cavity.’

‘Oh, dear. No wonder the poor child is suffering. She’ll have to go for surgery to have that put right. Put out a call for Mr Simons, will you, and see if he can add her to this afternoon’s theatre list. I’ll come back right away. I’d better explain things to the mother. In the meantime, we need to make sure Millie’s fit to be operated on.’

‘I’ll do that. Thanks, Louise.’

She cut the call and looked around, to see that James was still there across the table from her. He finished off his coffee and said quietly, ‘Problems?’

‘A toddler who needs urgent surgery,’ she told him. ‘I’ll have to go back down to paediatric A&E to make sure that everything’s in order.’

‘You won’t be coming back to the meeting?’

‘I doubt it,’ she said, slanting him a direct glance. ‘Some of us have to deal with the sufferings of patients up-front. Fortunately for them, there are still doctors who care enough for their well-being to keep on with the hands-on side of medicine. We leave it to others to move us about like chess pieces on a board.’

She didn’t stay to witness his reaction to that, but she could feel his gaze boring into her spine as she walked away from him.

CHAPTER THREE

‘IT WAS good to see Millie looking so much better, wasn’t it?’ Louise made a swift check of the list of patients waiting to be seen and then glanced across to where Jenny was collecting fresh dressings from a cupboard. ‘The surgeon discovered a twisting in her intestines as well as the diaphragmatic hernia, so the operation was a little more complicated than we might have expected. I thought it would take longer than a few days for her to recover.’

Jenny smiled. ‘I was so pleased when Mrs Watson brought her in. I didn’t know whether you would get the chance to see her. I know that you’ve been busy in the treatment rooms all day.’

‘Her mother waited until I was free,’ Louise explained, noting down which patients were to be allocated to each of the doctors on duty. ‘She said she wanted to thank us for looking after her little girl. It was so lovely to see the child looking well and happy.’

‘That’s one of the delights of the job, isn’t it…seeing the little ones back up on their feet again, ready to cause mayhem.’

Louise chuckled. ‘It is, definitely.’

A moment or two later, the phone at the central desk started to ring. It was the line that warned them of incoming patients and Jenny hurried away to answer it, just as James Ashleigh walked into the department. He was dressed immaculately, as ever, in a grey suit and a crisp pale shirt.

Louise paused briefly in writing up her allocations on the board and half turned towards him, sending him a swift glance before straightening up to face him properly. Why was it that he always managed to make such an impact on her? He had an undeniable presence, a way of grabbing her attention and stopping her in her tracks.

What was he doing here? She braced herself. He was management, and that probably meant trouble.

‘I wasn’t expecting to see you around here,’ she murmured. ‘Is there something you wanted?’

He hesitated momentarily, his gaze flicking over her, and from the slightly arrested look in his eyes, it gradually dawned on Louise that her stretch cotton top had shifted a fraction as she had reached up to the board. She quickly smoothed it back into place, ensuring that her midriff was adequately covered and that her pencil-slim skirt was tidy.

He had obviously gathered himself together during that small space of time, because he smiled faintly and there was a glint of humour in the depths of his grey glance. ‘Now there’s an interesting question,’ he said in a husky drawl, his gaze coming to settle on the gentle curve of her hip. ‘But, given that we haven’t started off our relationship in a particularly good way, I think I’d better forgo the answer that springs to mind.’

Her eyes widened and her knees went weak. Was he actually saying what she thought hewas saying? Was he making a pass at her? She felt a surge of heat flow through her entire body as the after-shock of awareness rocked her. The way he looked at her was purely male…discreetly disguised, but full of masculine appreciation, all the same, and she didn’t know how she felt about that. After all, he was the enemy. Why was she even contemplating howit might feel to get to know him better?

Covering her confusion, she said shortly, ‘I believe we have a patient coming in by ambulance, as well as a waiting room full of children needing to be seen. If you’re here to pass the time of day, I’m afraid we’re rather busy.’

He inclined his head a fraction. ‘I had anticipated that. Until we devise foolproof preventative measures where traffic and accidents are concerned, A&E is always going to be a hectic place.’

He glanced around the central area. ‘I must say, this is one of the more cheerful departments I’ve seen. It’s colourful and child-friendly, with all the jungle scenes painted on the walls. I noticed that you have toys in the waiting areas too, and tables set aside for activities.’

‘I’m glad that you approve,’ she said in a calm manner. ‘I was thinking of adding a couple of pictures to the treatment rooms that still look a bit bare… With all the worry about closure, I had put it on hold, but I think I’ll go ahead anyway. I don’t see why the children should miss out just because the adults are squabbling.’

‘I can understand why you would want to do that.’ He took another look around the central area, noting the rooms that led off all around. They were glass fronted to allow for easy viewing. There was an uncluttered appearance about the place, and Louise had done her best to make it pleasant for parents who had to wait for news of their sick children, as well as for the youngsters themselves.

‘We also have a play leader, to make sure that the little ones are occupied and diverted through what might be a difficult time.’ Her gaze narrowed on him. ‘You seem to be quite interested in the layout of the place. Is that why you’re here? To look around?’

‘I’d like to do that. Would it be all right with you?’

She frowned. ‘I suppose so.’ He obviously had time on his hands if he was able to hang about here, taking note of the surroundings and the general atmosphere. Or was there a hidden agenda to his presence in her department? He was one of the executives, after all, and it went with the territory that they were always on the lookout for any changes that could be made.

Just then, Jenny hurried over to them, saying urgently, ‘It looks as though we have an incoming emergency on our hands. He’s a three-year-old who’s having seizures—apparently he swallowed some of his mum’s antihistamine tablets.’

Louise was immediately on the alert. ‘Do we know what kind of tablets and how many?’

‘Yes. It was dimenhydrinate. The paramedics have taken full note of everything. They’re not sure quite how many he took, but they guess it was a substantial amount and it was some time before the mother realised what had happened.’

‘Okay—let’s get him into the resuscitation room as soon as he arrives. We’ll need to hook him up to an ECG monitor and start him on benzodiazepines to control the seizures.’

‘I’ll go and start making preparations,’ Jenny said, hurrying away.

Louise glanced at James. ‘I need to head over to the ambulance bay. You’ll have to come along with me if you want to talk.’

‘That’s fine by me.’ He walked alongside her as she headed for the main doors.

‘Is this visit part and parcel of you wanting to check out the viability of the unit?’ She decided that it was better for her to come out with what was on her mind rather than fudge the issue.

‘That’s a rather harsh way of putting it, don’t you think?’ His mouth flattened.

Louise gave a faint shrug. ‘I don’t see any reason not to be blunt,’ she murmured. ‘That way we both know where we’re coming from.’

He acknowledged that with a faint twist to his mouth. ‘Let’s say that I prefer to see things firsthand. I really need to know what I’m talking about if I’m asked to give an opinion on the various proposals. It’s one thing to look at facts and figures that are laid down in reports, and quite another to get a feel for the place and see the way it actually runs.’

‘If I were to take that the way it sounds, I might be encouraged to believe there was some hope that you might change your mind about the move to the Royal Forest Hospital.’ She made a face. ‘On the other hand, I’ve seen the way these things work at other hospitals, and I suspect that in reality you could be looking into ways you might reorganise the facilities when we’re no longer around.’

He laughed. ‘You’re a cynic through and through, aren’t you, Louise?’

Her green eyes flashed. ‘Tell me I don’t need to be.’ It was a definite challenge but, as she expected, he wasn’t about to take it up. Perhaps her vehemence startled him, but this department meant everything to her. It was more than a place of work, and she felt an urgent need to defend it and the patients it served. In a way, they were like the family she never had, and she would protect them in any way she could.

She turned away from him as an ambulance siren sounded close by. ‘I have to concentrate on the job in hand,’ she said. ‘If you’re going to observe, I hope you’ll keep out of the way and let us get on with our work.’ It occurred to her that she was perhaps being too dismissive of him, but her priority was with her patients and if he didn’t like it that was too bad.

She hurried out to the ambulance bay and observed the small child who was being wheeled in through the main doors of the hospital.

He was in a bad way. He was still having seizures despite the attentions of the paramedics, and his skin was hot and dry. She listened to what the paramedic had to say, and then glanced at the chart he handed her.

‘Okay, take him into Resus Two, Andy,’ she told him. The young man nodded and did as she suggested. Then he stood back, out of the way, clearly unwilling to leave just then.

Once the child was safely in the room, Louise quickly obtained intravenous access and then administered the drugs that would help stop the seizures.

‘Is he going to be all right?’ the toddler’s mother asked in a shaky voice.

‘We’re doing everything we can for him,’ Louise told her. ‘If you’d like to stay by his side and hold his hand and let him know that you’re here, I’m sure that will help.’

‘Let’s get him on oxygen,’ she said, glancing at Jenny, ‘and we’ll do a blood glucose test.’

She worked with the child for several minutes, anxiously watching the monitors and infusing him with various medications as she tried to stabilize his condition.

The Specialist Registrar came to assist. ‘The ECG reading is showing a widening QRS complex,’ he told her.

She acknowledged him, saying, ‘Okay, Tim, we’ll start bicarbonate therapy and see if that will settle things down.’ Louise glanced anxiously at the monitors once more. ‘You had better notify the intensive care unit,’ she told Jenny. ‘He’ll need to be admitted. In the meantime, I’ll put in a nasogastric tube so that we can give him activated charcoal and then, as soon as we’re able, we’ll do a gastric lavage.’

Louise stayed with the child until she had done everything that was possible for him.

‘What’s going to happen to him?’ the boy’s mother asked. ‘Matthew’s so little and he looks dreadfully ill. I just never realised it could get this bad.’

She was naturally distressed, and Louise wished that she could reassure her in some way. ‘We’ll keep him in our observation bay until ICU can find a bed for him,’ Louise told her. ‘We’ve washed out his stomach in case there was any antihistamine still in there, and we’re doing what we can to minimise the effects of any of the drug that’s in his system. Other than that, it’s too soon to tell how things will turn out. We’ll know better in a few hours if we’ve managed to counteract the worst consequences.’

The paramedic was still waiting to see if there were any results. He was a fair-haired young man in his thirties, and Louise knew that he was dedicated to his job.

He was frowning, and Louise went over and spoke to him as she left the child in Jenny’s care. She didn’t want to leave him at all, but there were other patients who needed her, and all she could do for him now was to wait. ‘I’m sorry there isn’t any better news for you, Andy,’ she told him. ‘I suppose you have to get back to work now, don’t you?’