New Surgeon at Ashvale A&E
Joanna Neil
Swapping her white coat for wellies and a pram!Dr Ruby Martyn’s life is in chaos! She’s just been left holding her runaway sister’s baby and has shared one magical kiss with her new boss – the infuriatingly gorgeous Dr Sam Boyd! Leaving the bustle of the emergency room for her family’s remote farm is the hardest decision Ruby’s ever made.But there, she’ll be able to put her niece first. Without Ruby’s dedication and boundless energy, Ashvale A&E is in trouble. And so, Sam realises, is he! For Sam, convincing Ruby to come back to Ashvale might be important – but first on his agenda is winning her heart for ever!
Sam shook his head in wonder. ‘You’re a truly amazing woman, Ruby.’
His mouth curved, lightening his features in a way that made her heart begin to thump in an erratic rhythm. ‘You have a unique way of motivating everyone at work. They all miss you.’
She gave a soft sigh. ‘I’m sorry about that.’ He was stirring up emotions in her that she would rather lay dormant: restlessness, guilt, and a faint sorrow for what she had abandoned. She was torn by all the demands being made on her.
He wouldn’t let her turn away, though. Instead he drew her closer to him, so that she had no choice but to listen to what he had to say. She was all too aware of the warmth emanating from him, of the sheer male energy and drive that gave him an inherent authority over everyone who happened to come within his orbit. ‘That’s just it, Ruby,’ he murmured. ‘I’m discovering every day exactly how much the department needs you at its helm. I can only do so much, but with you on my team we can work wonders.’
She was finding it hard to think straight while he was holding her this way. His hands were slowly smoothing over the silk of her skin, as though he would mesmerise her and coax her into accepting what he had to say.
His gaze meshed with hers. ‘If I were to offer you a solution to all your troubles, would you consider coming back to the hospital?’
When Joanna Neil discovered Mills & Boon®, her life-long addiction to reading crystallised into an exciting new career writing Medical™ Romance. Her characters are probably the outcome of her varied lifestyle, which includes working as a clerk, typist, nurse and infant teacher. She enjoys dressmaking and cooking at her Leicestershire home. Her family includes a husband, son and daughter, an exuberant yellow Labrador and two slightly crazed cockatiels. She currently works with a team of tutors at her local education centre, to provide creative writing workshops for people interested in exploring their own writing ambitions.
Recent titles by the same author:
POSH DOC, SOCIETY WEDDING
HOT-SHOT DOC, CHRISTMAS BRIDE
THE REBEL AND THE BABY DOCTOR
THE SURGEON SHE’S BEEN WAITING FOR
New Surgeon At Ashvale A&E
by
Joanna Neil
www.millsandboon.co.uk (http://www.millsandboon.co.uk/)
Table of Contents
Cover Page (#ucd9941fb-29e0-5547-b70e-855e08a0a77d)
Excerpt (#u86599cd4-8586-5f10-83dc-fd8d8d995803)
About The Author (#ub63566a1-d474-5693-a00c-ad5ba3461929)
Other Books By (#ub2c4cf46-725f-58f9-ae43-b03f45c23469)
Title Page (#u46ce682e-87aa-5b9d-b581-8cf614d00374)
Chapter One (#u7157af42-ea35-50fc-8f6e-6dcb2fc258e6)
Chapter Two (#ud8fd4acb-bdc5-509f-bbcc-270a806864c0)
Chapter Three (#u204a188c-6763-5c6d-89a1-bc883b60c190)
Chapter Four (#litres_trial_promo)
Chapter Five (#litres_trial_promo)
Chapter Six (#litres_trial_promo)
Chapter Seven (#litres_trial_promo)
Chapter Eight (#litres_trial_promo)
Chapter Nine (#litres_trial_promo)
Chapter Ten (#litres_trial_promo)
Copyright (#litres_trial_promo)
Chapter One
‘WELL, poppet, here we are at last. A little later than I’d planned, but at least we’ve arrived.’ Ruby made a neat turn into the parking slot in the hospital grounds and turned off the ignition. From the rear of the car, a response came in the form of a soft gurgle, and she swivelled around to gaze for a moment at the baby. Becky was lying contentedly in her car seat, blowing bubbles while doing her best to grasp her toes with her fingers.
Smiling, Ruby slid out of the driver’s seat and went around to the rear of the vehicle to retrieve the infant.
‘It’s a good thing you’re such a happy soul,’ she murmured. ‘It makes life so much easier. After all, much as I love you, I hadn’t planned on bringing you with me today.’
Becky wriggled, her arms, legs and whole body moving in excited anticipation, a beaming smile lighting her chubby face at the prospect of her aunt coming close.
Ruby began to unclip the seat restraint. ‘I’ve no idea where your mother could have disappeared to,’ she said softly, ‘and yet she promised me faithfully that she would come and fetch you so that I could go along to my meeting.’ She lifted her palms in a questioning gesture. ‘But where is she? I haven’t a clue. Your guess is as good as mine.’
Becky chuckled, her blue eyes bright, as Ruby lifted the child seat out of the car. ‘As for you, you don’t have a care in the world, do you, little one?’ Ruby smiled indulgently. ‘What does it matter to you that I have to go and listen to my new boss challenge us to cut costs to the bone and find all sorts of impossible ways of doing it? And what’s he doing there anyway taking my place? I had my name pinned on that job, and I’m pretty sure I would have made things work for us without any of this argy-bargy and bad feeling.’
Becky studied her, a small frown appearing on the soft skin of her brow, as though she was trying very hard to make sense of the flow of words. Ruby laughed softly. ‘Yes, I know. Your auntie’s as mad as a hatter. Why else would she be going to a conference with a baby in tow?’ She leaned over and tickled the child, her chestnut-coloured hair falling in a silky swathe about her shoulders. Becky giggled and grasped a handful of hair.
‘Ow…ow…ow,’ Ruby exclaimed, pretending to be caught.
‘Mum…mm…mum.’ Six-month-old Becky blew raspberries from her pink lips and cooed, finally letting go of Ruby’s hair and beginning to suck on a small fist.
‘Yes, you’re absolutely right,’ Ruby murmured, straightening up. ‘Your mum’s not herself these days, and we just have to try to make the best of things, don’t we? When all’s said and done, we can probably slip in quietly somewhere near the back of the room. With any luck, no one will even notice that I’ve brought an uninvited guest along with me.’
By now she was approaching the main entrance of the hospital. People were coming and going, hurrying through the doors that continually swished open and closed. Some were dressed casually, visiting their relatives who were unfortunate enough to be hospitalised, perhaps, while one or two were more formally attired—doctors, maybe, or people who had appointments with consultants within the hospital.
Others, presumably taking a break in the warm afternoon sunshine, were sitting or standing to one side by a well tended shrub garden, breathing in the fresh air.
Suddenly, the doors opened up once more, and a man lumbered towards her, head down, a disgruntled expression on his face. Perhaps the collision that followed was inevitable. Either way, he slammed into Ruby with some force, so that she swung to one side and momentarily lost her balance. She kept a firm grip on the baby chair as it carved a wild arc through the air, and all the while her one thought was to protect the infant. Becky began to cry, frightened by the sudden jolt, and for a second or two, Ruby was afraid that she might have been hurt.
At the same time she was aware of pain slicing through her wrist, and as she fought to regain her balance, she realised that the man had rushed away, leaving her only with the impression of a scowling, grim countenance.
‘Are you all right?’ A man’s voice cut into her thoughts, the deep, warm tones edged with a drizzle of honey that smoothed over her shattered nerves. ‘Is the baby okay?’ He reached out and lightly grasped her arm, steadying her, at the same time laying a hand on the baby seat to ensure that it was safe.
‘I think so.’ Disorientated, she set the carrier down on the ground, checking swiftly that all was well with Becky. ‘Everything’s fine, baby,’ she murmured, reassuring the infant and distracting her with a brightly coloured teething ring that jangled and provided endless possibilities for exploration. ‘She seems to be none the worse for it.’ Then, once she was satisfied that the baby was safe, she looked up into the eyes of the man who had come to her aid.
They were beautiful eyes, a curious mixture of blue and grey, reminding her strangely of sea mist and sun-dappled water, and at the same time invoking a disturbing reaction within her, a strange restlessness that she hadn’t encountered in a long, long time.
She pulled herself together and straightened up, leaving the carrier where it was for the time being so that Becky would have an opportunity to examine her new toy and forget all about the incident. That left her free to rub gently at her wrist where it had been wrenched.
‘I have a feeling I might have seen that man somewhere before,’ she told him, frowning a little. ‘I can’t quite place him, and I only caught a glimpse, but there was something about him that was familiar.’
‘Really? He didn’t look too happy, did he? Maybe things hadn’t gone quite the way he expected in there.’ He looked towards the building, then glanced back at her, noting the way she was surreptitiously soothing her jarred wrist. ‘Do you think someone should take a look at that?’
‘No, it’ll be fine, thanks.’ She gave a short laugh. ‘Anyway, I’m in the right place if I change my mind, aren’t I? A&E is just around the corner.’
‘That’s true.’ A serious expression settled on his face as he appeared to ponder the wisdom of leaving things be, and she took a moment or two to study him more thoroughly.
He was way too smartly dressed to be a casual visitor to the hospital, or even a patient, she guessed. He wasn’t wearing a doctor’s name badge, so it was possible he was someone from a pharmaceutical company here to meet up with their chief pharmacist and his team. Ruby knew the hospital chiefs were worried about the drugs bill, and meetings were planned to discuss the issue.
He was wearing a suit, the immaculate, dark grey jacket sitting easily on broad shoulders, while the trousers fitted him to perfection, outlining a washboard-flat stomach and long, strong legs. Altogether, he made an immediate, disturbing impact on her.
‘Do you need any help to get to where you need to be? Perhaps I could carry the child for you?’ He was watching her closely, his gaze skimming over her, taking in her casual summer clothes, a button-through cotton top and gently flowing skirt, before coming to rest once more on her face.
She blinked, trying to pull her thoughts back on track. She shook her head. ‘No, thanks all the same. I’ll manage.’ She smiled. ‘Besides, I expect you have places you need to be…unless you’d finished your business here?’ Why else would he have been standing outside the hospital? He looked like a man who would be continually on the move, energetic, a force to be reckoned with. Perhaps it was the suit that gave her that impression. It somehow denoted a businesslike demeanour, a man at the height of his profession.
‘You’re right. I was just taking a break for a while, enjoying the sunshine and the cooling breeze. Hospitals can seem like soulless places at times, can’t they, even here in beautiful Buckinghamshire?’
‘That’s true.’ She nodded. ‘I wasn’t much looking forward to coming here today, but unfortunately I have a meeting to go to.’
He frowned. ‘Is that so? Nothing badly wrong, I hope—with you or the baby?’
She made a wry face. ‘Nothing at all. I’m fighting fit, and so is Becky, which is just as well, since I have to go and do battle, so to speak. It won’t do to let the chiefs have everything their own way.’
A puzzled look crossed his features, and it seemed as though he expected her to say more, but she didn’t try to explain any further. ‘I must go,’ she said. ‘I’m late already. Thanks very much for coming to help me. I do appreciate it.’
She had delayed long enough, and the meeting must be well under way by now. If she hurried, there was still time to make her presence felt. She picked up the baby carrier and, with a nod in his direction, she walked swiftly into the building.
James and Olivia, two senior house officers from her team, met her at the door to the room where the meeting was taking place.
‘Thank heaven you made it at last,’ Olivia said. ‘We were beginning to think you would never get here.’ She turned to greet Becky with a smile, picking up the baby’s rattle and gently waving it in front of the child, so that the infant tried to grab it and pull it to her mouth. Olivia laughed softly. ‘Okay, okay, you can have it. I was just teasing.’ She turned back to Ruby. ‘Everyone’s taking a break for coffee just now. We had to stop for a while…emotions were threatening to boil over.’
‘So I gathered.’ Ruby’s expression was sombre. ‘Is the new man making his presence felt?’
‘Oh, yes.’ James nodded. Lean and fit-looking, with dark brown hair that was cut in a short, neat style, he was an energetic, efficient colleague. ‘He’s definitely on the side of the board. Cuts, cuts and more cuts. That seems to be his mantra. That’s why I called you. I couldn’t believe you weren’t going to be here to argue our corner.’ He led the way towards the back of the room. ‘Some of the senior managers look as though they’ve been up half the night working out what they can chop next. The trust is in so much debt that they say drastic measures are called for.’
‘I wanted to be here right from the beginning,’ Ruby said. ‘You know I did…only I agreed to look after Becky while my sister went to see the doctor at the local surgery. There would have been plenty of time for me to come to the meeting afterwards, except that Sophie didn’t come home to take over from me. I waited and waited, and then I got to wondering whether there was any point in my coming along and saying anything at all at the meeting. After all, the new man is the one who’ll be making all the decisions from now on.’
‘And that was where the management made their big mistake.’ Olivia frowned. ‘You should have been the one to take charge, we all know that. You’ve been the mainstay of the A&E department for years, keeping things running smoothly while the boss readied himself for retirement. This job should have been the reward for all your hard work.’
Ruby made a wry smile. ‘Well, in the end it hasn’t happened, and there’s no use crying over spilt milk. Management have chosen the man they feel best to put all their changes into place.’ She gave a soft chuckle. ‘Perhaps they thought things would become a bit too contentious if they put me in charge. I wouldn’t have accepted that their way was the only way.’
‘More than likely. So what happened with Sophie?’ Olivia asked. ‘She must have known this was important to you.’
Ruby frowned. ‘I’m not sure. I was looking forward to hearing how things had gone at the surgery, but when she didn’t come back, I started to worry. Something must have gone wrong…but maybe I should have expected that. She’s definitely not herself these days. She’s not been well for quite some time, and I’ve been trying to persuade her for ages to go for some tests so that we can find out exactly what’s wrong. I suspect it’s a hormonal problem, with her body chemistry being out of synch ever since Becky was born, but she wouldn’t let me do anything to help. I was so pleased when I finally managed to get her to agree to go and talk to our GP.’
The SHOs nodded. ‘But something obviously didn’t go to plan?’ Olivia pointed out some available seats and they went to take their places.
Ruby shook her head. ‘I rang the surgery to see if she’d turned up there, and apparently she did, but then she didn’t wait for her appointment. I’ve absolutely no idea where she might be. I’ve tried ringing her, but she’s not answering her phone. Anything could have happened. She’s just not thinking clearly these days. I dare say I’ll find out later what went wrong.’
‘I’m glad you made it in the end, anyway,’ James murmured. ‘You of all people should be able to make the bosses see sense here. The way things are going, they’ll walk roughshod over all of us. How on earth do they expect us to give a viable service to the local area if they plan to get rid of staff and close units?’
‘I think that’s the least of their worries.’ Ruby set the baby down on the floor and glanced around as people began to troop back into the room. ‘What about the new boss, anyway? What’s he like? Has he not managed to come up with any reasonable suggestions?’
‘You have to be kidding.’ Olivia gave a short, humourless laugh. ‘He may well be an A&E doctor, but he’s management through and through, and reasonable isn’t in their vocabulary. No one seems to be paying any attention to what the people at the sharp end, those who actually have to do all the work, have to say.’
‘We’ll just have to do what we can to make them see sense.’ Ruby moved restlessly in her seat, then ran a hand through the length of her burnished hair, lifting it away from her nape to let a cool waft of air fan her heated skin. ‘It’s so warm in here,’ she commented, ‘with all that sunshine pouring in through the windows.’
She reached into the large linen bag she had brought with her and fished out the printed programme for the meeting. ‘Maybe this will do the trick.’ She leaned back in her seat and began to fan herself lightly with the paper.
‘Oh, that’s so much better.’ She murmured her appreciation of the cool drift of air just as she became aware of a stillness settling in the room. Glancing around, she saw that most of the board members had taken their places on the dais, while one seat remained empty.
A man came through a side door just then and strode purposefully across the back of the room. He turned into the corridor between the mass of seats, passing her just at the moment when she tilted her head back and lightly blew the tendrils of hair away from her brow. Becky gurgled contentedly, and he glanced briefly in their direction.
Ruby’s eyes widened, her senses responding to his presence with a faint frisson of dismay. His tall, lean figure was instantly familiar to her. He had that coolly confident air of a man who was in command of all he surveyed, the measured look of a man who was in control at all times. It was that suit that said it all, along with his authoritative demeanour, the assured way that he moved without faltering towards his goal.
His dark brows made an infinitesimal upward lift as he looked her over, and his expression showed…what was it…? Disbelief…recognition…along with a soupcon of amusement. There was definitely an element of wry humour in that glance, cleverly disguised so as not to be obvious, but it was there, all the same, in the faint twist at the corner of his mouth and in the dancing gleam in his blue-grey eyes.
Ruby stared at him, following his progress as he walked along the aisle and sprang up the steps to the dais with lithe ease. He took his seat at the table alongside the board members.
She frowned, dark brows meeting in her normally unfurrowed brow. Surely he wasn’t her new boss? A sinking feeling in the pit of her stomach told her that he most likely was.
She pushed the programme down into the linen bag. The action served at least to release some of the tension that had sprung up inside her and gave her time to think. Had she really told him that she was ready to do battle? Surely the means to winning any dispute lay in keeping an element of surprise to confound the enemy? And yet she had inadvertently given the game away. He must know that she was out to stop him. Had she cooked her goose already? She had the horrible feeling it was well and truly burnt, and he was going to be the man to carve it up.
‘Shall we make a start, ladies and gentlemen?’ The chairman rose and addressed the assembled crowd. ‘I hope that you’ve had time to calm yourselves and approach this situation in a clearthinking manner. We’re all going through difficult times, and I think we all know that none of our problems are going to be easily resolved. Even so…’ he turned towards the man who had come to her aid ‘…I have to say, I believe my colleague, Sam Boyd, is the person who will help us steer our way through choppy waters. Dr Boyd, would you care to address the meeting once more?’
‘Thank you, I would.’ Sam Boyd stood up and looked confidently around at the sea of faces before him. ‘I’m aware of how strongly feelings are running on this issue,’ he began, his deep voice flowing over them as smooth as silk. ‘I know that the measures we have to put in place will not sit easily with many of you. No one wants to see units closed down and services reduced.’
He let his gaze roam freely, as though he was addressing each person individually, and for a second or two his glance touched on Ruby. Her jaw lifted, letting him know that she would not be sweet-talked. He might have helped her out a short time ago, but this was business, and he was the enemy.
‘That’s why we’re here today,’ he went on, ‘to discuss the best way to deal with the problem. As you know, the trust is saddled with huge debts, and savings have to be made wherever possible…even at the cost of people’s jobs.’ He paused momentarily to let that sink in. Then he added, ‘This is your chance to put forward your opinions and suggestions. We want to know what you feel about the choices ahead of you.’
The room was silent as the doctors and nurses slowly absorbed what he was saying, and Becky chose that moment to blow a clear and succinct raspberry, followed by a gurgle of excitement as she discovered one of the plastic keys of her teething ring. More raspberries followed.
Sam Boyd appeared to be taken aback for a moment or two. Then his brows rose, and he said on a faintly humorous note, ‘Well, that wasn’t quite the response I was expecting, but I suppose it’s a start, at least.’
A general titter of amusement spread around the room. Embarrassed to be at the centre of attention, Ruby decided that attack was the best form of defence. She stood up and glanced around.
‘My apologies for the interruption,’ she said. ‘I’m Dr Ruby Martyn. As you’ve probably gathered, I’m having domestic problems at the moment, which means that I have had to bring the baby with me today. I know that on occasion allowances are made for such situations. I do hope that won’t be a problem for anybody here, but I was keen to attend this meeting.’ She glanced at Becky before adding, ‘As you can see, she’s not afraid to air her opinions.’ She hesitated, allowing time for the audience to settle.
‘I have to say, though, I entirely agree with Becky’s sentiments on the subject of staff reductions. You cannot remove key personnel and expect things to go on as normal. The doctors and nurses who work here are the lynchpins of this organisation. They are the ones who keep the system going, and reducing numbers will only result in stressed, overworked staff members. The end result will be to bring down morale even further than it has fallen already.’
Sam shook his head. ‘The alternative will be to close units down altogether. Is that what you want to see? These debts will not simply fade away. It may be an unpalatable fact, but savings have to be made somehow.’
‘And how did those debts come about?’ Ruby’s grey eyes challenged him. ‘I’ll remind you, shall I? It was because of the finance deals entered into by the trust board to ensure that the building of the brand new Heritage Hospital could go ahead…the state-of-the-art, be all and end all of hospitals.’
‘Yes, that’s true.’ His tone was appeasing, smoothing over the arguments she’d made as though all was perfectly in order. ‘It was a costly venture, I grant you, but many, many lives will be saved because of its existence and because of the up-to-the-minute, high-tech equipment it enjoys.’
‘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.’
‘I know. I’m sure we’re all aware of that.’ Ruby made a muted response to his bracing tone. Perhaps he was annoyed because they had been talking about him, and they needed to make allowances for that. She added softly, ‘And I expect the problems that follow will be for real, too. I’ll leave you to deal with the complaints from the patients, shall I, and from the management when we fail to meet targets?’
He acknowledged that with a rueful twist of his mouth. ‘I imagine those will be the least of my worries.’ He gave her an assessing glance, his gaze shimmering downwards over her curves outlined by the soft cotton blouse that clung where it touched and then draped itself loosely over the waistband of her calf-length skirt. ‘Besides, I’m sure I can rely on you to help smooth things over during these difficult times. I hear you’re good at dealing with most problems that come your way. You appear to have a knack for calming troubled waters. Perhaps that’s why the department operated so efficiently while Dr Stanford was winding down for his retirement.’
Ruby’s eyes widened a fraction. Where would he have gleaned that wedge of information? Was it possible that he had been talking to his predecessor? Or maybe one or two of the board members had filled him in on her way of working. They might not have given her the job, but it didn’t necessarily mean they were unaware of her capabilities. Her lips made a wry shape. Perhaps her calm attitude was what had lost her the position. They wanted a lion that would roar and show its teeth.
Sam glanced at James and Olivia. ‘I know this is difficult for all of you, but there’s no point in moping about the situation. What we have to do is prioritise, knuckle down and get on with the job and concentrate on providing the best service we can under the circumstances.’
He turned to James and held out a patient’s file to him, his manner totally businesslike. ‘You examined a man who came in earlier with a broken wrist and suspected head injury after a fall…is that right?’
James nodded. ‘Tony Barton…a young man in his late twenties. I treated him for the wrist fracture and assessed him for brain injury, but his neurological responses were fine. I was getting ready to discharge him.’ He glanced at the file. ‘Are you ready to sign off his notes for me?’
Sam shook his head. ‘His condition has changed, according to the nurse who was following up on him. I’d like you to come with me and take another look at him, please.’
‘Oh…of course.’ James’s colour faded, and Ruby could see that he was wondering if he was in trouble of some sort. He was usually thorough and conscientious in everything that he did, but Sam, being a newcomer, clearly didn’t know that.
Sam nodded towards Ruby and Olivia and then strode off with James in the direction of the treatment room.
Ruby’s gaze met Olivia’s, and the senior house officer rolled her eyes. ‘Does that man ever stop to engage in the niceties of getting to know his colleagues?’ Olivia asked. ‘He’s brisk and businesslike, and his whole attitude is “stop fussing and let’s get on with it”, though I must say he seems half inclined to pass the time of day with you…but as to the rest of us…’ Olivia sucked in a deep breath. ‘He’s only been here five minutes, and I’m already beginning to wish Dr Stanford had delayed his retirement.’
Ruby grinned. ‘I dare say we’ll get used to him, given time. He has a huge task ahead of him, and he’s probably still working on his strategies. I expect he has a heart of gold underneath it all.’
‘We’ll have to dig deep to find it,’ Olivia murmured, moving away in search of her next patient. ‘I have the feeling it’s buried under a ton of steel.’
She could be right in that. Ruby frowned as she riffled through the files in the wire tray. Their new boss didn’t appear to be making any concessions to the fact that he was a stranger in their midst, and that they might have difficulty getting used to this different way of working. It was all or nothing with him.
She glanced through the list of patients waiting to be seen. Her first job was to check on the patients from the traffic accident, and in doing that her time was taken up with a host of complications that had arisen from an assortment of broken bones and punctured blood vessels. Worryingly, one man went into cardiac arrest, and she had to use the defibrillator to shock his heart back into a safe rhythm.
‘He’s back with us,’ she said a few minutes later, addressing the nurse who was monitoring his situation. ‘Give the intensive care unit another call, will you, and see if we can move him over there as soon as possible.’
‘I’ll do that,’ the nurse said.
An hour later things settled down a little, giving her time to attend to a young boy who had been injured during a football match on his local playing field.
‘That was an unlucky game for you, Matt, from the sound of things,’ she said, smiling at the seven-year-old and then inspecting the X-ray film displayed in the light box. ‘When you fell to the ground, you hit it with enough force to break your collarbone. That’s this one, here.’ She pointed out the area of the fracture to the boy and his mother. ‘There’s a line across here that shows the break in the bone.’
She turned to look at Matt once more. ‘The good news is, it should heal up quite well because the two pieces of bone are still in line and touching one another. You’ll need to wear a support sling for a week or two while the bone heals, and we’ll give you some painkillers to help you feel better.’
His mouth made a flat line. ‘If I’d done this in a couple of weeks’ time, when school starts again, I could have had some days off. And I don’t even get a plaster cast for my friends to sign.’ He looked thoroughly disgruntled.
‘Isn’t there any street cred in wearing a sling?’ Ruby lifted a brow. ‘I would have thought you could get some pretty good mileage out of that. And it’s the hand that you write with that’s out of action, isn’t it? I’ll bet you can impress your mates with a left-handed signature.’
His expression brightened. ‘Yeah, maybe.’
His mother smiled as they stood up to leave a few minutes later. ‘I’m sure he’ll milk this for all it’s worth,’ she murmured in an undertone to Ruby. ‘He’ll be playing the part of a wounded secret agent before too long, I’ll be bound.’
Ruby nodded agreement, and gave Matt a bravery certificate as he left the room. It seemed he was already working on his game plan. ‘Tyler didn’t get one of these when he sprained his ankle,’ he said. ‘He only got a badge that was this big.’ His fingers made demonstration of its tiny size.
Ruby laughed and watched them leave before going in search of her next patient. She worked steadily through the morning, dealing with a wide variety of injuries suffered by active young children intent on enjoying their summer holidays to the full, while at the same time keeping an eye on the work of the senior house officers in her charge. Sam was nowhere to be seen.
James had been missing for some time, too, but she caught sight of him when she was heading towards the ambulance bay. An infant with breathing difficulties was being brought in to A&E by ambulance, and she expected him to arrive in the next few minutes.
‘Is everything all right, James?’ she asked now, still continuing on her way. ‘You look as though you’re in shock.’
James fell into step beside her. ‘I’m fine,’ he said. ‘I just don’t know how my patient could have gone downhill so rapidly. One minute he was sitting there, talking to us, and the next his speech started to slur, and he began to sink into unconsciousness. And to think I almost sent him home.’
‘What happened?’
‘Sam—Dr Boyd—did a CT scan and then whisked him up to the operating theatre. He told me to scrub in. It turns out that he specialised as a neurosurgeon originally and then after several years of doing that decided to take up emergency medicine.’ He shook his head in wonder. ‘Everything happened so fast. It seemed like within minutes the anaesthetist was there and the patient was out for the count, and then Sam was cutting a segment out of his skull.’
‘So it was a blood clot causing pressure on the brain?’
James nodded. ‘That’s right. I actually got to suction it out, but then Sam took over and stopped the bleeding. He says we have to watch him for swelling on the brain and seizures, and I have to keep an eye on him. I’m just on my way to talk to the man’s wife. She came in to the hospital expecting to take him home, but now, of course, he’ll be admitted to the surgical ward.’
Ruby glanced at James. ‘You sound as though the experience has opened your eyes in some way. I don’t think I’ve ever seen you quite so shaken up.’
He nodded. ‘Well, he’s not out of the woods yet, and that’s a worry, but thinking about what might have happened, and seeing our new boss at work, has given me something to think about. Not only that, but it’s made me wonder if I ought to consider going in for a surgical specialty after my stint here. Watching him operate really made me see how much of a difference a surgeon can make to someone’s chances of recovery.’
‘Then something good has come out of this. I’m pleased for you, James.’
He made a brief smile and went on his way, while Ruby hurried to the ambulance bay, deep in thought. So Sam was more than just a force to be reckoned with on the hospital administration side of things. He was a first-rate doctor as well. It was more or less what she had expected, but somehow she had thought it might take more time for him to prove himself. At least he had managed to win James over to his side, brisk manner notwithstanding.
She went to meet the paramedics a short time later as they wheeled the infant out of the ambulance on a trolley bed.
‘This is Charlie, eighteen months old,’ the paramedic said. ‘He’s struggling to breathe, and there’s some nasal flaring. His blood oxygen level is low, and he’s in severe distress.’
Ruby could see at once that Charlie was very ill and the muscles of his rib cage were sucking inwards. ‘Let’s get him into the treatment room,’ she said. The toddler was breathing in oxygen through a mask, but she could hear him wheezing, and it was clear he needed urgent help.
Once in the treatment room, she called for a nurse to assist with giving oxygen while she examined the boy. Running the stethoscope over his chest, she heard crackles in his lungs and a wheeze whenever he breathed out.
His mother looked on anxiously the whole time, and after a while Ruby said, ‘He’s feverish and obviously struggling. I believe his air passages could be inflamed, so we’ll try him with a medication to help ease his breathing.’
‘What’s wrong with him?’ his mother asked. ‘He’s had a runny nose for a few days now, but suddenly he seemed to go downhill, breathing fast and getting tired and irritable. He’s been off his food too.’
‘It’s probably a viral infection of some sort,’ Ruby explained. ‘I’ll do a nasal swab and send it to the lab to be sure what we’re dealing with, but in the meantime we’ll concentrate on supporting his breathing. We’ll keep him in our observation ward for the next twenty-four hours, and then we’ll most likely have to move him to the paediatric ward for a few days. The nurse will explain everything to you and make arrangements for you to stay with him if that’s what you want to do.’
‘Yes, I do. Thank you.’ The young woman leaned over and stroked her child’s hand, offering him comfort, but the boy was too ill to respond. He just lay there, unmoving, strands of his hair curling damply over his forehead.
‘Here, take a seat,’ the nurse said, pulling a chair to one side of the bed. Michelle was a capable girl, slender and pretty, with dark hair that fell in a sleek bob to the nape of her neck. ‘I’m sure he knows that you’re here with him, and that will help to ease his distress.’
Ruby knew that she was leaving the mother and child in good hands. She wrote up the boy’s chart, detailing the medication to be given, and then arranged for the nasal swab to be sent to the lab. ‘I’ll look in on Charlie again soon,’ she told the mother, knowing that the nurse would let her know if any problem came up in the meantime.
‘So there you are,’ Sam greeted her as she walked back into the main area of A&E. ‘I’m afraid we have to prepare for another intake of crash victims. There are expected to be around ten of them, according to the paramedics at the scene. The first will be arriving in about fifteen minutes, they say.’ He shook his head. ‘I can’t imagine what’s happening out there on the roads today.’
‘People are travelling to the coast for holidays, or driving back home,’ she guessed. ‘I suppose that means there’s a lot more traffic out there.’
‘Maybe.’ He paused. ‘Before we get ourselves immersed in the chaos of dealing with the intake and I lose sight of you again for the next hour or so, I wanted to ask if you know anything about what the situation is here with the domestic staff. We don’t seem to have a proper clean-up crew—to attend to mishaps and the like in the waiting room. There just seems to be a couple of ward assistants who bring round the coffee, or tend to the book trolley, and descend on the unit if and when they’re called for. I’ve been asking various people, but no one seems to want to give me a proper answer.’
‘Hmm.’ Her brow knotted. ‘I believe you’re talking about Dolly and Mabel. Don’t you go upsetting either of them. They’re our in-house treasures. We rely on them for all sorts of odd jobs, and I don’t think people would take kindly to you striking them off the staff list.’
‘No, probably not.’ He studied her thoughtfully. ‘You’re frowning,’ he said. ‘I have the strong feeling that it’s because of me, or something I’ve said. I’ve been getting a lot of that today. Would you care to enlighten me?’
‘Well, I know the situation here is serious,’ she murmured. ‘Times are hard, and we all have to pull together to get the job done and all that…but I think you really need to try and loosen up a bit.’ She hesitated, not wanting to go too far. He was the one in charge, after all.
‘I do?’
She shrugged her shoulders, giving in to his gentle prompting. What would it matter if she were the one to tell him a few home truths? No one else would consider doing it. ‘Quite definitely. We really shouldn’t lose sight of the human touch, you know. We aren’t in the boardroom now, and even the most difficult of tasks can be made sweeter with a modicum of pleasantry.’
He raised a dark brow. ‘You’re saying you think I’m too abrupt?’
She made a vacillating kind of movement, as though she was weighing things in the balance. ‘I’m afraid you run the risk of alienating the people you depend on,’ she said.
He made a face. ‘I dare say you’re the one to put me right on that score. From what I’ve gathered this morning, I’m sure you’ll be well able to assist me in pulling things into shape. You’re the one topic people are prepared to talk about. I’ve been hearing nothing but glowing accounts of your capabilities in this department.’
‘I’m sorry about that,’ she said with a laugh. ‘You sound as though it’s beginning to grate on your nerves.’
‘Not at all. It’s good to know that we have such a diamond in our midst. I’ll be glad of all the help I can get.’
‘We’ve always been a happy crowd here at Ashvale A&E.’ She didn’t add, before he came along, but he probably caught her meaning.
‘I guess I’ve a lot to learn.’ It didn’t seem to bother him, though. He glanced at the watch on his wrist. ‘Anyway, back to the immediate problem. I’ve asked Michelle to do triage, the senior house officers will take the urgent cases, and you and I will deal with the most seriously injured. It means we’ll be running at full tilt with a minimum of staff.’
He checked the whiteboard, assessing the number of patients still in attendance and needing to be seen. ‘I’ll have a word with the nursing sister on duty and see if we can have some of her specialists attend to the less serious cases in the waiting room. That should clear the backlog.’
He glanced at her as though looking for confirmation, and she raised a brow. ‘Are you asking if I agree? I told you, if you were trying to save money, I think you should have looked to cutting down on the maintenance contracts before you went ahead and dispensed with nursing services. We don’t need to have the light bulbs checked once a month, or have laundry sent to an outside company when we have perfectly adequate facilities on the premises. Nor do we need to order paper plates on a regular basis when we have dishwashers and crockery on site.’
His mouth made a crooked shape. ‘I wasn’t looking for a debate on the whys and wherefores. A simple “yes, that sounds about right” would have done.’ His eyes took on a glimmer of amusement. ‘I was attempting to keep you in the loop, so to speak, since it’s fairly obvious you’re the lynchpin around here. Is there anything else you think we need to have in place?’
She thought about it. ‘Yes,’ she murmured after a second or two. ‘We need doughnuts.’
‘I beg your pardon?’ He looked at her as though for a moment she’d lost the plot.
‘You won’t get by without them,’ she said on a firm note. ‘If you expect your staff to work through their lunch breaks and keep going without flagging, you’ll have to do something to boost their energy as well as their morale.’ She gave him a bright smile. ‘I’ve always found that doughnuts hit the spot. Mark my words. A little bit of sugar goes a long way.’
‘I’ll try to remember that,’ he said. He threw her a teasing look as his gaze wandered over her softly feminine curves. ‘You’re not on any kind of diet, are you? So if I were to feed you sugary sweet doughy treats, would that help to bring you on side? I could rely on you to be my right-hand woman?’
She sent him a direct grey glance. ‘I certainly won’t say no to the food…but as for any other outlandish expectations you might be harbouring, I wouldn’t push your luck, if I were you. I’m only ever on the side that looks to be about right.’
He tilted his head back in a resigned gesture. ‘I might have known,’ he murmured. His mouth curved. ‘Still, it was worth a try.’
Chapter Three
‘IT’S really good of you to help me out like this.’ Ruby thanked the woman who was running the creche at the hospital. ‘I don’t know what I would have done if you hadn’t been able to find a place for Becky at such short notice.’
‘Well, you did say it was just for a few days, and we have a couple of vacant places available while people are away on holiday.’ The woman smiled, watching Becky as she lay gurgling on the mat, trying to clasp the plastic toys that dangled overhead from the play gym. ‘She looks as though she’s a contented child.’
‘Yes, she is, for the most part.’ Which was just as well, because with all the problems that had cropped up of late, Ruby was sure she wouldn’t have been able to cope with a fractious infant. Things had been going reasonably well until the day before yesterday, when Sophie had gone out, saying she was going on an errand to the shops. When she didn’t return, Ruby had begun to worry.
There was still no sign of her, and Ruby was becoming increasingly anxious. She had tried contacting her by phone, and she’d searched high and low before frantically enlisting the help of the police. Sophie was now officially a missing person, and no one had any idea where she had gone.
It had all come as such a shock, and now Ruby was finding it difficult to juggle work in A&E with looking after the baby. How was she going to cope when she had to move into the farmhouse over the weekend now that Sophie was gone? There would be a whole lot more problems for her to concentrate on then.
‘I’ll come back at lunchtime to see how she’s getting on,’ she said, reluctantly preparing to leave.
‘That’s good.’ The nursery matron gave Ruby a reassuring smile, probably sensing her underlying anxiety. ‘I’m sure she’ll be fine.’
Yes, most likely she would. Ruby cast a last, fleeting glance at the baby before she left the room. Becky had no idea of the disturbance that had ebbed and flowed around her since her mother’s health had begun to decline. And now Sophie was missing.
Bracing herself to face the rest of the day, Ruby made her way back down to A&E. She stopped by the central desk and made a few phone calls, first of all, checking up on the patients who had spent the previous day in the observation ward.
‘No problems to speak of,’ Lorraine, the nursing supervisor, told her. ‘We’ve arranged for two children with chest infections, query pneumonia, to be admitted, as you asked. Apart from those, everyone else looks fit enough to be discharged.’
‘That’s good to hear. I’ll drop by later this morning and finish the paperwork.’ Ruby hesitated. ‘Is there any news on Charlie—the infant with breathing difficulties? I put him on humidified oxygen, and then we had to add nebulised adrenaline because he wasn’t responding too well to treatment. Last time I went to see him he was showing a little bit of improvement.’
‘The boy with bronchiolitis? Yes, I checked for you. He was admitted to the paediatric ward from Intensive Care, and by all accounts he’s doing fine.’
‘Oh, that’s brilliant. Thanks for checking for me, Lorraine.’
‘You’re very welcome. See you later, then.’
‘Yes, I’ll come over to you in a couple of hours or so.’ Ruby replaced the receiver and began to hunt through a pile of papers in the wire tray on the desk.
‘Nothing’s going according to plan lately,’ Olivia said, coming to stand beside her. ‘I thought things were bad enough when I heard that we have two nurses off sick, but then I saw the management circular that was passed around first thing this morning. They’re talking about downgrading us to an urgent care centre…and that’s even before the meeting where it’s all supposed to be decided.’ She huffed, showing her annoyance.
‘I don’t know how our trauma victims would have fared if they’d been sent to the Heritage,’ Ruby commented. ‘Some of them were in a precarious condition when they arrived here.’ As it was, the patients who had been involved in traffic accidents a few days ago had either been operated on and were now recovering on the wards, or had been discharged.
Ruby glanced at the senior house officer briefly. Olivia was in a decidedly crotchety mood today, her usually serene face etched with lines of tension. ‘Is that all that’s bothering you?’
‘Not really. I took a look in the waiting room, and straightaway I wished I hadn’t.’
‘Oh, why’s that?’ Ruby glanced through a sheaf of lab test results, searching for a diagnosis on a small patient. If only her sister Sophie’s medical problems could have been properly diagnosed before she’d decided to take off. For that must be what lay behind her disappearance, surely? She didn’t think anything more sinister lay behind her failure to return, given that the police had let her know that she had been spotted boarding a bus in town on the day she had vanished without a trace.
Olivia started to answer, and Ruby dragged her mind back to the job in hand.
‘I’m out of sorts because that man’s in there again…the one who’s kept complaining of back pain ever since he was involved in a car accident some time ago. He’s been in here several times over the last few months, but we never seem to be able to get to the bottom of what’s causing his problems. Dr Stanford said they’d done all the tests and found no lasting damage. He told him he should go and see his GP about any symptoms he has, but he always comes up with some reason why he has to be here in emergency. Today it’s because he almost passed out when he went to fetch something from the local garage, and the manager brought him straight to the hospital.’
‘Oh, I see.’ Ruby nodded. ‘Well, I’ll take a look at him if you like. We’re not exactly overrun with dire emergencies at the moment, are we?’ She clamped a hand over her mouth. ‘Oh, I can’t believe I just said that.’
‘Said what? Is there a problem?’ Sam came to join them at the desk, tilting his head slightly to one side as he cast a quizzical glance over her. His black hair was crisply styled, framing his strong-boned features to perfection. His blue-grey eyes studied her curiously. ‘You’ve not been your usual self these last few days, have you? Is something wrong?’
Ruby gazed at him in wonder, slightly thrown by his tall, dark presence. She ought to be used by now to the way he had of appearing out of nowhere, but perhaps she wasn’t fully on the ball. Somehow or other he always managed to make her heart leap into an odd, hasty rhythm.
As to her mood, she was startled that he had even noticed her frame of mind. He was always so busy tending to seriously ill patients or organising the day-to-day management of the unit. Because of the cutbacks he had been forced to make, there were new difficulties arising all the time.
She shook her head. ‘Nothing’s wrong. Everything’s fine.’ She wasn’t going to lay out all her troubles for him to pick over. He was a man, first of all, energetic, efficient and direct, everything appearing clearly black or white, and he would probably have next to no understanding of the emotional side of things, the grey edges that tended to blur judgement.
‘Except that she just said how quiet it is in here today,’ Olivia pointed out. ‘You know what that means, don’t you? Lights will start flashing and sirens will be blaring within seconds, and the next thing you know, we’ll be swamped under a deluge of patients.’ She shook her head. ‘Even I know not to tempt fate that way.’ Her mouth made a flat line. ‘Still, we have to make allowances, I suppose. Ruby has to go and take over at her Gran’s smallholding this weekend, so she’s probably not thinking straight. Just contemplating the work involved would be enough to make me quake. Cleaning out the chicken run…mucking out after the ponies…and that’s before we even get to the goats.’
‘Goats? Good grief.’ Sam’s brows shot up. ‘You’re not seriously going to do all that, are you?’ he asked, looking at Ruby.
‘For a few weeks, yes,’ she told him. ‘My grandparents are going away for a while, and they’ve asked the family to help. There’s no one else who can sort it out for us. Not without it costing us a small fortune, anyway.’
She contemplated the prospect of living in the Chilterns for the next few weeks and gave a soft sigh. Perhaps it was just what she needed right now—a complete change. Time to be with Becky and attempt to smooth over the unhappy disappearance of her mother that had shaken the baby’s world. Life was incredibly hard for her just now. She was juggling too many things all at once: coming to terms with the fact that Sophie had gone away, learning how to cope with looking after Becky on her own…and trying to accept that she had lost the job she wanted to a man who had swept in on a wave of budget-cutting zeal. Add to that the fact that her grandparents needed her help, and the mix was well and truly bubbling, threatening to boil over.
She frowned. ‘Actually, I think it might be just the thing for me…I still haven’t taken all of my annual leave this year, and there’s a certain appeal to sampling fresh country air and taking a break from all the frantic activity that goes on around here.’
She remained perfectly still for a while, mulling things over. The more she thought about it, the more the option of leaving her job altogether appealed.
‘Now, there’s a thought…my contract comes to an end in a fortnight’s time, doesn’t it? And I don’t necessarily have to renew it since I haven’t signed on the dotted line yet.’ Somehow, she hadn’t been able to bring herself to put in the necessary paperwork. ‘I do earn some income from the medical articles I write for magazines and so on. And there’s the online medical forum, as well—they pay me a retainer for doing that.’
It would be a difficult choice to make—after all, she needed money if she was to look after Becky—but the prospect of turning her back on the whirlwind of her career and leaving it to Sam to take up where she left off was becoming more interesting by the minute. He wanted the job—he had been given it at her expense—maybe he should be left to deal with it in its entirety.
‘You’re joking, aren’t you?’ Sam was frowning, looking at her intently as though he would like to be able to read her mind.
‘About the online forum? No.’ She shook her head. ‘We answer questions from people who have worries about their various symptoms or illnesses, or who want a little more detail than their GP is able to give them.’
‘I meant about leaving here.’ His voice was terse.
Ruby mused on that for a while. ‘I’m not altogether sure. In fact, the more I think about it, the more tempting it becomes.’ After all, what prospects were there for her here? With the possibility of the unit being downgraded, things were beginning to look quite bleak, one way or another. Sam would be all right whatever happened because he worked from both hospital sites—the Ashvale and the Heritage. And the SHOs would find placements at other hospitals. It was the patients and the people who lived in the local area who would lose out most of all because of the effects of the closure.
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