New Surgeon At Ashvale A&E

‘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.’

He made a mock wince. ‘I can see that you believe in being forthright at all times. You’re not going to easily accept any changes that I decide to put in place, are you?’

Her expression softened. ‘Ah, now there you have it,’ she said. ‘You see, I do have the interests of the A&E department at heart, and I can promise you that as long as I’m working there I’ll do what I can to support my colleagues and steer things in the right direction.’

‘As long as you’re working there?’ He looked at her closely. ‘That’s an odd turn of phrase. I know your contract’s up for renewal at the end of the month, but I assumed you would be staying on. Are you beginning to have doubts about working alongside me? I know that you were a strong contender for the job. Perhaps that’s causing you some difficulty?’

She gave his question some thought. ‘The board chose you for the post,’ she said. ‘That was their prerogative, and I accept their decision, although as a follow on from that I’m not altogether sure that you and I will ever see eye to eye. This afternoon has been informative, in more ways than one.’

‘That’s true,’ he murmured. ‘It works both ways. And I tend to believe that forewarned is forearmed. I have to respect the way that you spoke your mind back there. I hope you’ll go on doing so.’

She gave a short laugh. ‘Oh, you can count on it. I usually manage to make my feelings clear, one way or another.’

Becky gurgled, her eyes growing wide as she reached for Ruby, her little arms outstretched, her fists opening and closing in hopeful demand.

‘I know, baby,’ Ruby said, looking at her. ‘You’ve been cooped up for long enough, haven’t you? We’d best get you home.’ She glanced back at Dr Boyd and saw that his expression was thoughtful once more. ‘I should go now,’ she told him.

He frowned. ‘Yes, of course. I imagine looking after a baby must take up a great deal of time and energy, and there are all sorts of provisions to be put in place, aren’t there? Along with difficulties that occur when things go wrong, such as meetings that crop up and problems with babysitting arrangements.’

‘Yes, that’s right.’

‘I suppose it’s understandable that people might have a change of heart when things don’t turn out quite as expected.’ He glanced at Becky. ‘Ambition has its place, but babies can be a job and a half in themselves, can’t they?’

She nodded, not quite following his drift. ‘I suppose so,’ she said. She was all too conscious that Becky was beginning to get restless and she needed to be on her way. She started to walk towards the door. ‘I’ll say goodbye, then, Dr Boyd.’

He nodded. ‘Goodbye. I’ll look forward to working with you in A&E…all being well.’

She hurried away from the conference room and whisked Becky out to the car. She wasn’t too sure what he had meant by that last turn of phrase…all being well.

It was only when she was halfway home that it occurred to her where Sam Boyd’s train of thought must have been heading.

He believed Becky was her child.

Chapter Two

‘THERE you are, young Becky,’ Ruby said with a smile, ‘you’re nice and clean and comfortable now, and I expect you’re ready for some fun.’ She lifted the infant into the air and gently rocked her from side to side, so that she giggled with excitement. ‘Exactly…that’s just what I meant. You are such a lovely baby.’

She drew her back down and held her close for a moment, enjoying the soft, warm feel of her and breathing in the light fragrance of fresh soap. ‘I’ll pop you into your bouncer, shall I, so that you can stretch your chubby little legs for a few minutes while I make your tea.’

Ruby had set up the bouncer in the doorway so that she could comfortably watch the child from the kitchen. Once Becky was happily settled, busy touching her toes to the floor and springing up and down within the harness, Ruby set about preparing her food.

It had been a very odd sort of day, so far, many happy moments with Becky interspersed with worry about her sister…and, on top of that, she was still reeling from the effects of coming face to face with her new boss.

How on earth was that going to turn out: working alongside Sam Boyd each day when they were dramatically opposed to each other’s ideas? Added to that, he already had the notion that she resented him for taking the job she had set her heart on, and she had to admit to more than a few niggles on that score.

After all, she’d worked hard to pass her specialist exams and qualify for promotion. Yet what had she actually managed to achieve? These last few years she’d been driven to succeed, spurred on to do her best for the emergency unit where she’d found joy and heartache in equal measure.

It was never going to be an easy option, working in A&E. They faced huge challenges every day, and now the whole department was facing the threat of closure. Did she really want to go through dealing with the stress of that on top of everything else? She was confused, restless, searching for something that she couldn’t quite define.

Perhaps the fact that her body clock was ticking away in the background had something to do with the way she was feeling. There was no man in her life any more, not since her relationship with Tom from cardiology had turned sour, and she was less hopeful than ever that there was ever going to be a man who would turn out to be everything she wanted. Maybe he simply didn’t exist, or perhaps she was just too cautious.

The trouble was, she had been spoiled by the example of her own extended family. Except for Sophie, who’d had an unfortunate foray into romance with a man who’d left her in the lurch, they were loyal individuals, happy and contented with one another, fulfilled in their relationships. And, as far as Ruby was concerned, no man had ever matched up to the examples she had grown up with.

A few minutes later, as she was spooning hot baby food into a dish, the outer door opened, and Sophie walked into the kitchen. She looked tired, her features pale and drawn.

‘Sophie, there you are, at last. I’ve been so worried about you.’ Ruby abandoned the mix of puréed chicken, vegetables and rice that she had been preparing and went to greet her sister. ‘What happened to you? I expected you back here ages ago.’

Sophie looked at her anxiously for a moment or two. ‘I didn’t…’ She frowned, trying to get her thoughts together. ‘I had to go out…’

‘Yes, you did, that’s true…to the doctor’s surgery, but then you were going to come straight back here, weren’t you?’

‘Was I?’ Sophie frowned, putting a hand to her head as though she was trying to make sense of what was going on. Her dark hair straggled across her cheeks, hiding her face for a moment or two. She reached for a chair and sat down, as though fatigue had overcome her whole body. ‘I’m sorry. It’s just that I can’t seem to think properly these days. I remember there was someone at the surgery…I was worried. I wasn’t sure what to do.’

‘Someone? The doctor, perhaps?’

Sophie frowned. ‘I don’t know. I had to get out of there.’

None of this made any sense to Ruby, and Sophie wasn’t making things any easier. Giving herself time to think things through, she went to fill the kettle with water at the sink and then set it down on the stovetop to heat. ‘I was supposed to go to a meeting. Did you forget about that?’

Sophie’s expression was miserable. ‘I’m sorry. It must have slipped my mind. I didn’t mean to let you down, honestly I didn’t.’

From the doorway, Becky became animated, signalling to her mother in eager baby talk that she was there to be noticed, and Sophie turned towards her.

‘Oh, baby, you’re so beautiful.’ Sophie gave her a sweet smile, her heart-shaped features softening as she looked at her daughter. ‘I love you to bits, angel. I’m sorry I’m such a bad mother to you.’ She glanced at Ruby. ‘It’s getting late, isn’t it? I expect she wants her supper. Shall I give it to her? I see you have it all ready prepared.’

‘Are you going to be able to manage it?’ Ruby sent her sister a concerned look, worried by the general air of weariness that appeared to have descended on her. ‘Maybe if I sit her in the high chair, you could feed her?’

‘Yes, I could do that.’

Ruby went over to Becky and released her from the harness, lifting her into the high chair by the table. Judging by Sophie’s fragile state, she doubted she would be able to do that safely on her own just now. She drew a clean bib out of a kitchen drawer and handed it to her. ‘Here, you’ll need this for her. I’ll make you a cup of tea, and maybe that will help you to feel a bit better.’

‘Thanks, Ruby. You’ve been so good to me, lately.’ Sophie sent her an earnest look. ‘I don’t know how I would have coped without your help these last few weeks. I’ve really appreciated being able to stay here with you.’ Sophie stopped to cuddle her daughter and plant a kiss on her cheek before fastening the bib carefully around her neck.

Ruby checked the dish of baby food to see if the temperature was cool enough, and then she passed it to Sophie. ‘I phoned the surgery, and they told me you hadn’t kept your appointment,’ she said. ‘What happened?’

Sophie frowned. ‘I can’t remember. I think I felt sick and had to go out for some air. I’m not too sure what happened after that. I just started to walk and kept on walking.’

Ruby studied her for a moment or two. ‘You haven’t been sleeping very well, lately, have you? Perhaps you’ll feel better after you’ve had some rest. Then, when you’re up to it, we really need to take you back to the surgery so that the doctor can find out what’s wrong. You can’t go on like this.’

She had the feeling, though, that Sophie was no longer listening to her. Looking over, she saw she was gently coaxing Becky to eat the food, making soft, encouraging noises, as though she was savouring the meal herself.

Ruby sighed inwardly. How were the pair of them going to cope when she wasn’t there to watch over them? She thought briefly about taking a day or two off work, but the image of Sam Boyd crept into her mind, and she imagined those dark brows lifting as he contemplated her lax attitude. She’d been late for the meeting, and if she added time off to that lapse, he would surely have her marked down as unreliable. No, she had to face him on equal terms. It was a matter of pride.

Perhaps she could persuade the next-door neighbour to keep an eye on Sophie and Becky while she went out to work tomorrow? Claire had turned out to be a good friend who was usually glad to help in any way she could.

Either way, it was a worrying situation that had been building up for some time, and it had to be sorted out once and for all. She made up her mind that next time she would go along with her sister to the surgery. That way she could make sure that things went according to plan.

‘Do you think you might be happier going to stay with Mum and Dad for a while?’ she asked, coming to sit down at the table and beginning to pour tea. ‘I think you need someone to look after you properly until you’re feeling better.’

‘Oh, I don’t think that would work out very well,’ Sophie said, shaking her head. ‘Mum and Dad are way too busy. Mum has her job at the office, and Dad has to concentrate on pulling the business into shape. Besides, don’t you remember—they asked me if I would look after the smallholding while Gran and Grandad are away for the next few weeks. I said I would do it…only it would be so much better if you were there with me, and there’s plenty of room at the old farmhouse. I’m not sure I could handle things very well on my own, though. I don’t seem able to think too clearly these days.’

Ruby nodded. ‘I remember.’ The trouble was, Sophie was probably right in thinking she wouldn’t be able to cope, and Ruby didn’t have an easy solution to hand.

Sophie was dejected. ‘I know this place is too small for all of us. I don’t mean to be a burden.’

Ruby frowned. ‘I wasn’t suggesting that I didn’t want you here with me. That wasn’t what I meant at all. I love having you and Becky here…you must know that. It’s just that I think you’re unwell and you need more help than I can give you while I’m working. Of course I’ll come along and stay with you at the old farmhouse, but I don’t think you’re in any state to be left there on your own while I’m out at the hospital.’

Maybe she could make arrangements for someone to keep an eye on her at the smallholding. The local vet, perhaps? He was more of a friend to the family than a professional that they looked to for help on occasion. Ruby and Sophie had even been at school with him. He had his practice close by her grandparents home, and his work often brought him to the farm, where he would check up on the animals.

Sophie didn’t acknowledge any of what she was saying. She seemed depressed, her shoulders slumping as though she was weighed down by an ominous black cloud.

‘I’ll play with Becky for a while, and then I’ll take her upstairs and get her settled down for bed,’ Sophie said a few minutes later as she wiped her daughter’s face clean. ‘After that, I think I’ll have an early night. I’m very tired.’

‘That’s a good idea, but maybe you should have something to eat first. I made a salad, and there’s crusty bread and cheese to go with it.’

‘Okay.’

They ate together in the kitchen, and Sophie perked up enough to ask Ruby about her job at the hospital. ‘You have a new boss taking over from the man who’s retiring, don’t you? Have you met him yet? Do you think things are going to work out for you in A&E with him in charge?’

Ruby’s mouth made a wry twist. ‘I met him today, and he seems to be very determined to push through the changes he has in mind, even though they’re not at all popular. I’m not sure how it’s all going to work out. I expect life in the A&E department is going to be quite rocky from here on.’

A short time later, Sophie helped to clear away the supper dishes and then took Becky upstairs to bathe her and settle her for the night. Ruby went to check on them from time to time to make sure that all was going smoothly, but Sophie seemed to be coping well enough. Once she and the baby were both tucked up in their beds and fast asleep, she slipped next door to ask if Claire would keep an eye on them the following day.

‘I’ll find an excuse to keep popping round,’ Claire said. She was a friendly woman in her early forties, with teenage daughters who simply adored Becky. ‘Don’t you worry. Everything will be fine.’

It was a relief to know that they would be in good hands, and Ruby set out for work next day feeling a little more reassured. She would be able to concentrate on the job in hand, and her biggest worry was whether things would run smoothly in A&E now that Dr Stanford had retired and the new boss was taking his place. With any luck, it would be a seamless transfer.

All was not well, though, she discovered. When she walked into the emergency unit later that morning, after spending some time reviewing patients’ progress in the observation ward, she found that there was a general air of discontent about the place.

‘Okay, so what’s the matter with everyone?’ Ruby asked, taking a quick look around the resuscitation area and then inspecting the assembled crowd in the waiting room. ‘There are far too many long faces around here.’

‘I think you’ve just seen for yourself,’ James murmured. He drew a chart from the pile on the desk and cast a quick glance over the notes. ‘It’s still relatively early in the day, and we’re already stretched tight at the seams.’

‘We’ve had five people brought in by ambulance from rush-hour traffic accidents,’ Olivia added, going over to the whiteboard and writing up more names. ‘And the waiting room is heaving with an assortment of fractures, sprains, nasty infections and people with chest pains.’

‘Sounds like everything’s perfectly normal, then,’ Ruby said with a laugh. ‘It’s a case of heads down and let’s get on with it, to my way of thinking.’

‘Hah! You’d think so, wouldn’t you?’ James’s mouth made a downward turn. ‘Except that two of the nurses are off sick, one of the doctors has gone home to deal with a domestic crisis, and we have no one to replace them.’

Ruby raised her brows. ‘No agency nurses or a locum doctor?’

‘None,’ he answered. ‘Not a one.’

‘Hmm. That certainly is going to make life difficult.’

‘Apparently we’re banned from bringing them in on account of it being too costly, and all overtime beyond a certain level has been stopped.’ James’s tone was edged with annoyance.

‘I almost paged you at one stage, but Dr Boyd said you were dealing with an emergency in the observation ward and we’d cope.’ Olivia pulled a face. ‘I suppose he was right, and we did manage, but we’re run off our feet, and patients are already complaining about waiting times.’

‘I guess Dr Boyd is behind the restriction on agency staff,’ Ruby mused. So he had kept tabs on her while she was working in the observation ward, had he? He obviously had his finger on the pulse of how the department ran, but she could certainly see why the two doctors were feeling under pressure. ‘He didn’t waste any time putting his plans into action, did he? He must be very keen to pull the department into shape.’

‘That’s right. I’m the one who put a stop to the extra staff. It costs way too much to bring in staff from outside.’ A now familiar voice came from behind her, and she swivelled around to see the man himself standing just a couple of feet away. Ruby studied him briefly. He was immaculately dressed, as before, in a dark grey suit and crisply laundered shirt, with a silk tie that was perfect in its understated elegance. ‘What do we have here,’ he asked, ‘a union meeting?’

‘Dr Boyd,’ Ruby acknowledged him. ‘It’s good to see you again…albeit in difficult circumstances.’

‘Call me Sam,’ he said in a brisk tone. ‘No need to stand on ceremony.’ He frowned. ‘As to the circumstances, you should all know from the outset that I don’t believe in letting the grass grow under my feet. It’s important to start as we mean to go on if we’re to have any chance at all of saving the A&E unit. We’re not playing at this. It isn’t a game. It’s for real.’