In His Loving Care

‘A lot of patients we see don’t actually need to be seen by a doctor. They could visit the local pharmacy and buy something over the counter for their cough or their cold. If we could be more selective when making appointments then we could spend extra time on the people who really do need our help.’

‘And how do you propose we sort out who does and who doesn’t need an appointment?’ she shot back.

He shrugged. ‘Most general practices use their reception staff to separate the wheat from the chaff, so to speak.’

‘I’m sure they do. However, the reception staff aren’t medically qualified so how can they assess if a patient really needs to see one of us? If we ask them to make decisions like that, there is the risk of someone who is really sick not getting an appointment.’

‘That’s a valid point. However, the reception staff could be trained to ask a few simple questions when people phone for an appointment,’ he pointed out, although he suspected there was little hope of persuading her to adopt a different policy. However, it seemed wrong to him that their lists should be cluttered up with people who really didn’t need to see a doctor when it put added pressure on everyone.

Helen, for instance, could spare herself a lot of work if she would make a few simple changes to the way the practice was run. In the week he’d been there, he’d discovered that she was the first to arrive each morning and the last to leave each night. She didn’t even take an afternoon off like the rest of them did. She worked far too hard and it seemed wrong to him that she felt that she had to devote her every waking minute to the job.

‘I’m afraid I wouldn’t be at all happy with that idea.’ She pushed back her chair, making it clear that she didn’t intend to discuss the matter further. However, now that he’d got this far, Lewis wasn’t prepared to let it drop without a fight.

‘If it’s change that worries you then it’s always the first step that’s the most difficult.’ He shrugged when she looked sharply at him. ‘It gets easier after that.’

‘Thank you for that sage advice, Dr Cole. However, I’m the senior partner in this practice and I shall decide how best to run it.’

‘But Lewis has made a legitimate point,’ Harry interjected. ‘Take this morning, for instance. I saw three people who had colds and nothing else wrong with them. It’s a waste of our time to have to deal with things like that when folk would be better off at home in bed.’

‘Thank you for your contribution, Harry, but I think I’ve made my feelings on the matter perfectly clear. The Beeches has been run on an open-house basis ever since it was opened and I can see no reason to change the system at this point in time.’

She marched to the door, pausing to shoot an icy look over her shoulder. Lewis winced when he received the full brunt of her displeasure. ‘I’ll see you in the car park in ten minutes’ time. We have a full list of calls to get through so I’d appreciate it if you didn’t keep me waiting.’

With that she swept out of the door, leaving behind her a small but potent silence, broken when Harry cleared his throat.

‘Ahem! That went down rather well, don’t you think?’

‘Like a lead balloon.’ Lewis downed the rest of his coffee then got up to leave, knowing it would be unwise to keep Helen waiting. It had been her idea to accompany him to any home visits during his first week. She’d offered to introduce him to the patients and make sure that he knew where he was going. However, he couldn’t help wishing that she’d left him to his own devices. The thought of spending an afternoon with her after what had happened was less than appealing.

‘I still think you were right to say what you did.’ Harry gathered up their cups and took them to the sink. ‘Don’t you, Amy?’

‘I do. We need to cut down the amount of work we do otherwise we’re going to sink under the sheer number of patients we’re expected to see each day. I was hoping things might improve when Helen took over, but she’s not changed a thing. She runs this place along exactly the same lines as Ian and his father always did.’

‘Why is she so reluctant to alter the routine?’ Lewis asked curiously.

‘I’m not sure.’ Amy shrugged. ‘Maybe it’s her way of keeping Ian’s memory alive. If she changes things then it might seem that she’s trying to get rid of everything he held dear. But something needs to be done otherwise she’s going to run herself into the ground. Since the twins took off for Australia on their gap year trip before university, Helen has been working harder than ever. I think she’s lonely, although she’d never admit it.’

‘Her children are old enough to go to university?’ he exclaimed in amazement.

‘Oh, they’re not actually her kids, not biologically anyway,’ Amy explained hurriedly. ‘Ian was married before and when his wife died, Helen helped him look after the twins. They were only toddlers at the time and a real handful from what my mum has told me. She used to be the practice nurse before she retired and she was here when it happened. Helen was doing her GP training at the time but she stayed on after Ian’s first wife died and married Ian a couple of years later.’

‘I see. So does Helen have any children of her own, as well as the twins, I mean?’ he asked, wanting to form a clearer picture of the situation because it seemed important for some reason.

‘No. From what Mum has said, I don’t think Ian wanted any more children so he and Helen never had any.’ Amy sighed. ‘I think it was a bit mean of him, actually. I get the impression that she would have loved a baby of her own. She’s wonderful with the little ones—they all adore her.’

Very mean indeed, he thought grimly as he left the staffroom, although he took care not to say so. Helen’s reluctance to make any changes to the way things were done in the surgery was worrying, especially if it was bound up with loyalty to her dead husband. However, what really upset him was the thought of her disappointment at not being allowed to have a child of her own.

It seemed wrong to him that a woman who was as caring and as committed as Helen should be denied the one thing she wanted most of all. It also made him feel incredibly helpless to know there was nothing he could do to help her.

CHAPTER THREE

‘THE next case is an interesting one. The patient’s name is Ben Harmon. He’s a farmer and two months ago he had a serious accident while he was ploughing one of his fields.’

Helen withdrew Ben Harmon’s file from her case and handed it to Lewis then started the car. They were onto their fifth call of the day and the anger she’d felt in the surgery still hadn’t abated. She could scarcely believe that he’d had the temerity to tell her how she should run the practice after he’d been there for just one week. Why on earth did he think that he knew more about running the place than she did?

‘I’m sorry. I shouldn’t have said what I did at the surgery. You have every right to be annoyed with me.’

The apology caught her unawares so that the car swerved towards the ditch. Helen’s mouth compressed as she quickly righted it. She hated to feel so vulnerable. Lewis was the new partner in the practice—an incomer, as the people of Summerfield would have called him—and he shouldn’t have this effect on her. She had to nip these foolish feelings in the bud.

‘I’m not annoyed. You’re entitled to voice your opinion, just as I am entitled to veto any ideas I feel aren’t appropriate.’

‘Good.’

‘Good?’ She shot him a wary glance, taking care to keep her attention on the road this time. Fortunately, there was very little traffic about so there’d been no danger of her causing an accident earlier. However, she liked to be in control of everything she did, whether it was driving a car, diagnosing a patient or choosing a lover.

The last thought made her gasp and she bit her lip, hoping that he hadn’t heard the revealing little sound. She had never entertained such a salacious thought in the whole of her life and couldn’t understand why it had occurred to her now. It smacked of desperation and…and sexual frustration, and she could feel herself growing hot at the idea it was that which had prompted it.

The strange thing was that sex had never been that important to her. She’d had very little experience when she’d married Ian and their sex life had been rather disappointing at first until she’d realised that the bells and whistles she’d read about in books only happened in fiction, not real life. Once she had adjusted to the realities of married life, she’d grown to appreciate the feeling of closeness that love-making had engendered, and realised it was worth far more than the wild passion that was the staple of all those romance novels. However, that didn’t explain why it suddenly felt as though she’d been missing something.

‘What do you mean by “good”?’ she demanded, furious with him as well as with herself for getting carried away by such a foolish notion.

‘I meant it’s good that you aren’t annoyed and that you welcome input from your staff,’ he replied with a calm that merely highlighted her own waspishness.

‘I am always open to new ideas,’ she told him between gritted teeth. ‘However, as I made clear before, I shall decide how the surgery should be run.’

‘And whoever works there will just have to fit in.’

His tone was bland so she couldn’t blame that for the fact that she felt a bit ridiculous all of a sudden. It was completely contrary to her nature to lay down the law, yet that’s what she’d done both now and earlier on in the staffroom. She was sorely tempted to apologise for her behaviour, only she wasn’t sure if it would be wise to show any sign of weakness in front of him. It was a relief when he changed the subject by asking her about the patient they were about to visit.

‘I think I mentioned that Ben was ploughing when the accident happened,’ she explained in a deliberately neutral tone. ‘He ploughed up some old oildrums which had been dumped in one of the fields, and when he got off the tractor to see what they contained, he ended up inhaling a massive dose of raw chromium fumes.’

‘How on earth did drums of chromium get into his field?’

‘Nobody knows.’ Helen shrugged. ‘The police are still investigating, but they think it might have been waste from the local tannery. It closed down a couple of years ago and the police are trying to trace the owners.’

‘I see. So what happened to Mr Harmon as a result of the accident?’

‘There was some damage to his nasal passages but the ENT specialist has sorted that out now. The real problem has been the burns on his arms. He’s been seeing a plastic surgeon at the local hospital so today I want to check how he’s progressing.’

‘So this visit isn’t because he’s actually ill?’

‘No. But it’s our policy to follow up on a patient, as I explained at your interview,’ she said, trying not to bridle at the implied criticism.

‘I remember. I also recall telling you that it was a policy I’d adopted myself. However, when I saw patients following their surgery, it was because I was still responsible for their care. If you’ve passed this patient over to a consultant, I would have thought your part in the proceedings had ended.’

‘Follow-up care doesn’t come with a cut-off point. I was and still am Ben Harmon’s first point of call for any future medical treatment. I like to be fully prepared so I know what I might be dealing with.’

‘An admirable sentiment but also a luxury few GPs can afford. Most are happy to hand over a patient to someone else to free up their time.’

‘Then that’s obviously where I differ from most GPs. I take my responsibilities to my patients very seriously,’ she shot back, stung into replying with more vigour than she’d intended.

‘Maybe too seriously,’ he suggested, his voice grating in a way that made the hairs on the back of her neck spring to attention.

Helen didn’t reply, afraid that if she said anything it might be too revealing. Letting him know about the power he had over her would be a mistake and she knew it, too. However, her silence didn’t appear to deter him, as she’d hoped it would.

‘There’s no doubt that you’re totally committed to the welfare of your patients, Helen, but is it right that you should put them first all the time and yourself second?’

‘I have no idea what—’

‘I’m talking about,’ he finished for her. ‘And that just makes it worse. You obviously can’t see that it’s wrong to work yourself into the ground the way you’re doing, and wrong to devote every waking minute to your job.’

He placed his hand on her arm and she had to make a conscious effort not to react when she felt the warmth of his fingers seeping into her skin. ‘When was the last time you took a holiday, for instance?’

‘That’s none of your business,’ she retorted, shrugging off his hand because if she allowed it to remain there she’d want to feel it on other parts of her body as well.

The thought was too much, coming on top of all the others. She drew up at the side of the road and turned to glare at him. ‘How dare you pass judgement on how I choose to conduct my life? You’ve been at the surgery for less than a week yet you seem to think that you know everything about me.’

‘It wasn’t difficult to formulate a fairly clear picture of your life.’

He didn’t back down, certainly didn’t apologise, and her heart spasmed in fear because she wasn’t sure if she was up to winning this argument. Reaching for the handbrake, she went to set off again but this time his hand closed over hers, hard and firm as he stopped her.

‘Your life can be summed up in one word, Helen: work. While it might be admirable to show a certain degree of dedication, you are taking it to extremes, and that isn’t good for you or the rest of the staff. A good manager leads by example.’

‘Thank you for that advice, Dr Cole. However, this isn’t London and while your theories might work there they don’t apply here. I don’t have the luxury of a team of staff at my beck and call. If I didn’t put one hundred per cent effort into my job, we wouldn’t be able to keep the practice running.’

‘Which is why it’s so important to cut down on any unnecessary work. The whole appointment system needs to be streamlined and made more selective. That way everyone will benefit. Patients who need extra care will get it and the staff won’t be run ragged, trying to do everything.’

‘Nobody else has complained. Maybe they are more used to hard work than you are.’

‘And maybe they don’t want to make your life any more difficult. Everyone can see that you’re doing too much, Helen. You need to ease off and find some outside interests. Working the number of hours that you do isn’t good for anyone.’

‘I’m not listening to any more,’ she murmured, but he ignored her and carried on stripping away her defences as though they were tissue thin.

‘You’re the first to arrive each morning and the last to leave each night. Even on Sunday, when I drove past the surgery to show Kristy where I would be working, your car was parked outside. Despite what you might think, I worked damned hard in my last post, but I knew when I needed to take time off and I took it. It makes me very sad to think that you haven’t anything better to do with your life apart from work.’

He let go of her hand and she shrank back in her seat when he touched her lightly on the cheek because the feel of his fingers on her skin was every bit as potent as she’d imagined it would be.

‘You deserve more than a life that’s comprised solely of work, Helen.’

‘So how do you feel today, Mr Harmon?’

‘A lot better than I did.’ The young farmer smiled wryly. ‘I really thought my number was up when I breathed in those fumes. If it hadn’t been for Polly, it might have been, too.’

‘Polly?’ Lewis made a conscious effort to appear interested. Maybe it wouldn’t make up for what he’d done by telling Helen that her life was a mess, but it might make him feel a bit better.

‘The dog.’ Ben Harmon put his hand on the German shepherd’s head. The animal responded immediately, looking up at him with adoring eyes, and Lewis felt even worse.

Helen most certainly wouldn’t look at him like that in the foreseeable future! In fact, he wouldn’t be surprised if she told him that he no longer had a job when they left the farm. The thought of the disruption it would cause to Kristy’s life if they had to move again was more than he could face and he silently cursed himself.

‘It was Polly’s barking that alerted everyone, you see.’

‘Really?’ He forced himself to concentrate on what the farmer was saying. ‘It’s a good job she was with you.’

‘You can say that again. I’d have had it if Dad hadn’t heard the commotion Polly was making and come to see what was going on. I’d passed out by then, overcome by the fumes from those containers. Dad managed to drag me out of the way and phoned the surgery.’

Ben glanced at Helen and chuckled. ‘Dr Daniels soon got me sorted out. She drove me to hospital and rushed me straight through to the emergency unit. It’s all a bit hazy but I remember the fuss she made when some young doctor foolishly tried to stop her. Folk round here know better than to get in her way when she’s on a mission!’

Lewis joined in when Ben laughed but his spirits had sunk to an all-time low. Obviously, Helen was highly regarded in the town because of her dedication, yet he’d had the nerve to criticise her. Taking a pair of gloves out of his case, he mentally rehearsed what he would say to her later if she gave him the chance to apologise. Even though he stood by what he’d said about the way she ran the practice, maybe it hadn’t been his place to point it out.

‘I’d like to take a look at your arms,’ he explained. ‘I see from your notes that the district nurse has been to visit you but I’d like to check how they’re healing.’

‘It’s taken a bit of time to get this far,’ Ben admitted as Lewis gently peeled away the dressings. ‘The doctor I saw at the hospital wasn’t sure if there’d been some other chemicals mixed in with the chromium, possibly some kind of acid.’

‘They look very much like acid burns to me.’ He glanced at Helen, doing his best to slip back into his old persona. The cool, efficient surgeon was a role he’d played for many years and he sensed that she would respond better if he adopted it again. It was when she thought he was getting too close that the problems began.

The thought stunned him. It had never occurred to him before that Helen’s prickliness might stem from her feelings towards him. He had to make a conscious effort to continue. ‘What do you think, Helen? Do they look like acid burns to you?’

‘Very much so. There was a similar incident a couple of years ago when another drum of chemicals was found in a ditch. One of the boys who found it was badly burnt when the acid leaked onto his feet.’

Her tone was professional to a fault and he breathed a sigh of relief. Of course she would feel duty bound to respond in front of a patient but at least she was speaking to him, and that was something.

‘Did the consultant at the hospital suggest plastic surgery?’ he asked, turning to the farmer again.

‘He did, although I’m not sure if I fancy the idea.’ Ben grimaced. ‘He said something about taking skin from my thighs to cover the burns, but that would mean I’d have two lots of scars instead of just one.’

‘The plastic surgeons are very good so any scarring on your legs would be hardly noticeable. But it’s your decision so don’t let yourself be talked into it if it isn’t what you want. The flesh is healing so I’d guess the consultant suggested it for cosmetic reasons.’

‘It would be all right if I refused, then?’ Ben looked a bit sheepish. ‘I’m hopeless when it comes to anyone in authority. I never stand up for myself and say what I want. I just go along with whatever they suggest.’

‘Of course you can refuse!’ Lewis patted him on the shoulder. ‘Every patient has the right to refuse treatment so don’t let yourself be railroaded into doing something you aren’t happy about.’

‘Well, if you think it would be all right, I’ ll tell the doctor that I’d rather not bother.’ Ben sounded relieved. ‘I don’t want to be laid up any longer than necessary when it means my dad has to do all the work. You get a lot of knocks when you’re farming so a few extra scars aren’t going to make much difference to me!’

‘That’s one way to look at it.’ Lewis laughed. ‘Right, I think that’s it…Unless there’s anything you want to check, Helen,’ he added politely.

‘No. Everything seems to be progressing very nicely from what I’ve seen today.’ She smiled at the young farmer. ‘Don’t forget that you can ring me any time, Ben. You have my home phone number so you don’t need to go through the on-call service if it’s after surgery hours.’

‘Thanks, Dr Daniels. I really appreciate that.’

Ben saw them out, putting a restraining hand on the dog’s head when it tried to follow them to the car. Lewis fastened his seat belt, taking care not to look at Helen as she got in beside him. He couldn’t believe what he’d heard. Helen handed out her private phone number and told patients to call her at home rather than use the on-call service?

He sat in silence as they drove back to town. The situation was far worse than he’d imagined it to be, yet what could he do about it? By the time they arrived back at the surgery, he was seething with frustration. Stalking into his room, he tossed his case onto the desk with a thud that reverberated around the room. Amy happened to be passing and she stopped.

‘Everything OK, Lewis?’

‘Fine,’ he snapped, then sighed when he saw her start of surprise. ‘Sorry. I didn’t mean to snap at you. I’m just so bloody furious with Helen. She must be mad!’

‘Not a word I’d normally use to describe her,’ Amy said wryly, coming into the room. ‘Come on, tell me what’s happened now.’

‘I just found out that Helen has been telling patients to phone her at home if they have a problem outside surgery hours.’

‘Really?’ Amy whistled. ‘She’s kept that very quiet because I had no idea. Oh, I know she wasn’t keen on hiring an on-call service. It took us months to convince her that she couldn’t keep going out to visit patients every night and still do her job during the day. But I honestly thought she’d accepted the idea by now.’

‘It didn’t sound like it from what I heard.’ He thrust an impatient hand through his hair, wondering why he was getting so steamed up. It was up to Helen what she did, yet he couldn’t accept that it was none of his business when she was in serious danger of running herself into the ground. ‘How long have you been using an on-call service?’

‘About a year. Ian refused to use one when he was alive and I think that was why we had such difficulty persuading Helen to sign up.’ Amy shrugged. ‘It’s the old story, I’m afraid—what Ian decided is still law around here.’

‘But can’t she see that it’s time she moved on?’ he exploded. He swung round and walked to the window so that Amy couldn’t see how frustrated he felt. He didn’t want her to start wondering why he was so concerned about Helen’s working habits when he couldn’t explain it himself. He just knew it was wrong for her to be living this way.

‘I know it must have been awful for her to be widowed so young,’ he said over his shoulder. ‘But it’s time she got over it. And clinging to her dead husband’s beliefs isn’t the way to do it.’

‘Lewis,’ Amy said anxiously, but he ignored her, needing to vent the frustration that had been building up inside him all day.

‘She seems to be stuck in some sort of a time warp. That’s why we’re using such an outdated appointment system. It’s as though the world stopped when her husband died, but she needs to understand that it’s time she moved on!’

He glanced round, wondering if he’d said too much, and felt a jolt of alarm hit him when he saw how embarrassed Amy looked. Maybe his remarks had been a little too revealing?

A movement by the door attracted his attention and he turned. Helen was standing outside the room and he knew immediately that she’d heard every word. Her eyes met his for a second and his heart sank when he saw the pain they held. However, before he could attempt to make amends, she hurried away.