The Perfect Treatment
Rebecca Lang
Intending to be a family doctor, Abby Gibson was presently doing her hospital training, and was thrilled to discover she would be working with Dr. Blake Contini, who had an excellent reputation.Thinking this would be a purely professional relationship, she was astonished by her reaction to Blake. But although it was obvious from his warm manner that Blake liked her, something was stopping him from offering more than friendship…
He read aloud
“‘Awarded to the student who has the highest academic standing in the senior school for the year…”’ Blake’s voice trailed off as he continued to read, then he turned to look at her. “Abigail Gibson…four years in a row. Well, I certainly have no reason to be overbearing with you, do I!”
Abby flushed. “I wish you could forget I said that,” she muttered.
“I shall probably get a little more mileage out of that, just for fun…Abby. With all these awards—” he nodded toward the wooden shield “—I think I might well need it.”
When he smiled, Abby found herself staring at him, their eyes locked together in a mutual regard that held a new tension in it. This was the first time he had given her his undivided attention in a personal way out of a hospital setting. The effect was devastating.
Rebecca Lang trained to be a state registered nurse in Kent, England, where she was born. Her main focus of interest became operating-theater work, and she gained extensive experience in all types of surgery on both sides of the Atlantic. Now living in Toronto, she is married to a Canadian pathologist, and has three children. When not writing, Rebecca enjoys gardening, reading, theater, exploring new places, and anything to do with the study of people.
The Perfect Treatment
Rebecca Lang
www.millsandboon.co.uk (http://www.millsandboon.co.uk)
CONTENTS
CHAPTER ONE (#u3f723437-de5c-58bb-83ac-dbc01ed62be3)
CHAPTER TWO (#uaa9130eb-c278-5f76-99be-525175bdc6fb)
CHAPTER THREE (#u746519a7-7465-55f7-8528-197740ee6a3d)
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)
CHAPTER ELEVEN (#litres_trial_promo)
EPILOGUE (#litres_trial_promo)
CHAPTER ONE
ABBY GIBSON, MD, was late for the general medical rounds at University Hospital, Gresham, Ontario. Her hair was still damp from the shower she had taken about twenty minutes earlier in the hospital medical residence; its dark tendrils clung wetly to her neck.
‘Morning, Dr Gibson. You in a hurry as usual?’ One of the other occupants of the crowded elevator, a male physiotherapist whom she knew reasonably well, grinned at her as they were crushed inelegantly together against a wall of the moving compartment. In the hospital this was one of the general meeting places of quick hellos and goodbyes.
‘Oh…hi, there, Ray!’ Abby said breathlessly. ‘Yeah, you could say that!’ While craning to look at her wristwatch, she dropped two heavy textbooks and a sheaf of papers that she was carrying.
‘More haste, less speed!’ Her companion grinned again as he eased himself down towards the floor gallantly to pick up her lost items.
‘Thanks,’ Abby said, taking the books from him. ‘How are you, Ray?’
‘Chugging along,’ he said. ‘Living from week to week, like everybody else.’
Abby sighed, conscious of the general atmosphere of stress that prevailed in the hospital these days like an almost tangible cloud; it was a cloud of uncertainty about jobs and teaching positions in a time of severe budget cuts.
‘Ray, do you know anything about the new head of the department of internal medicine?’ she asked. ‘It’s his rounds I’m going to be late for.’
‘Dr Contini? Mmm, met him a couple of times. Seems like a nice guy. A little young for the job, I would say…if he gets it. You know what this place is like for rumor. Every job has about two hundred applicants. Even at his level, I should imagine.’
‘I do know, Ray. Even so, I don’t want to be too late for this meeting. First impressions are important, aren’t they, if often wrong?’ She ran a hand through her damp hair. ‘Maybe he won’t notice me in the crowd…or my absence.’
‘Any red-blooded male would notice you in a crowd, Abby. Slept in?’
‘Yes. Crazy week. You’re very gallant this morning, Ray.’
‘I’m always gallant.’
Abby smiled warmly, though she was preoccupied with the meeting ahead. It was always more than a little nerve-racking meeting a new senior colleague who was in a position to judge you, give you professional evaluations. ‘Let’s hope the new guy will be, too,’ she said.
She did not want to give Dr Contini a negative first impression of her, if she could help it, as they were probably destined to spend a fair amount of time together professionally.
The old chief of the internal medicine department was away on an extended professional trip, she knew that. This new guy, Dr Blake Contini, who was taking his place during his absence, was slated to become the new head of the department when the chief retired, according to rumor.
‘See you, Abby. This is where I get off.’
‘Bye, Ray.’
The elevator emptied, leaving her the sole occupant.
As she came out moments later at basement level into the corridor that would take her from the east wing to the west wing of the hospital, she put her attachè case and books on the floor and took out her neatly laundered white lab coat to put on over her blouse and skirt.
She strode along the corridor purposefully, trying to look businesslike even though there was no one else there to see her. Down here, the vista was bleak—utilitarian, empty corridors with garish fluorescent lights.
Up ahead, just where the corridor began a slight incline, Abby could see that someone had dumped a bag of laundry, or something, on the floor. That was part of the problem around here, she thought, not enough maintenance staff now to keep the place clean and tidy, so many laid off.
Coming closer, she could see that the ‘bag of laundry’ was a person in a lab coat and white pants, slumped awkwardly against the wall. ‘Oh, hell!’ she said out loud.
It was a man, a middle-aged man with thinning grey hair and a pale, gaunt face—obviously one of the medical staff. Quickly Abby knelt down on one knee beside the recumbent figure, dumping her books and bag in one quick movement. As she heaved the man over onto his back so that she could see his face more clearly, he looked familiar. The lips had a bluish tinge; the eyes were half open, unseeing.
‘Mo!’ Abby said softly, recognising Dr Will Ryles, the chief of Radiology.
Automatically she felt for the carotid artery at the side of the neck and searched for a pulse, holding her own breath as she did so. Yes, there it was—the faint fluttering of a pulse, rapid, irregular.
‘Thank God,’ she said, shifting her position so that she was kneeling beside Will Ryles. ‘Not a cardiac arrest.’
With steady hands she unbuttoned his shirt and loosened his tie, then listened to his chest with her stethoscope, working quickly. After hastily dragging the necessary equipment from her bag, she took his blood pressure. The systolic blood pressure was only ninety. There was little doubt that he had suffered a myocardial infarct, a heart attack.
Abby looked around frantically. Where were other people when you really needed them? She had to get him to the emergency department at once before he sustained brain damage from low blood pressure—get him on oxygen, have cardiac enzyme tests done and get him on the life-saving, clot-dissolving drugs.
Compassion filled her as she looked down at the man’s face which was now an unhealthy yellowish colour and cyanosed from lack of oxygen. He looked exhausted. No doubt he was, she speculated. Beside him on the floor was a cellular telephone, plus a few other items which had obviously fallen out of his pockets. Maybe he had been trying to call for help.
Quickly Abby punched in the number of the emergency department triage station, not knowing whether the phone would function here in the basement. Thankfully, she heard it ringing. Most of the nurses knew her there—she had been there frequently as a medical student and had been one of the last young doctors to do a general training internship before the system had finally been abolished in favour of a new system of early specialization.
‘Hi,’ she said, when a nurse answered. ‘This is Dr Abby Gibson. I’ve just found Dr Will Ryles, the radiologist, collapsed in the east-to-west wing basement corridor. It’s a probable myocardial infarct. He needs oxygen pretty quickly. I need a couple of people here fast with a stretcher. He’ll have to be lifted.’
‘Right,’ the nurse said. ‘I’ll send a doctor and a nurse right away, with a couple of porters.’
‘Thanks.’ Abby disconnected the line. ‘Dr Ryles! Dr Ryles!’ She slapped his face gently, then slightly harder. ‘Open your eyes.’ Again she placed her fingers over his carotid artery, searching for the faint pulse that would indicate he was alive.
The man moaned, his eyes opening feebly. His expression was blank as he tried to focus on Abby’s face while she bent close to him.
‘Take it easy,’ she said, ‘you’re ok. You’re lying on the floor. You fell down, but you’re ok, sir. Just stay where you are, don’t try to move. Help is on the way. I’m Dr Gibson.’
Dr Ryles moaned again, letting out his breath on a long sigh and closing his eyes wearily.
‘Have you got much pain?’ Abby asked, putting her mouth close to his ear and keeping her fingers on his pulse. Poor devil, she thought, feeling her throat close up with emotion. She liked Will Ryles very much; in all his dealings with her he had been unfailingly courteous, very professional, superb at his job, good as a teacher.
He shook his head slightly, mouthed the word ‘Ok.’
As she looked at him, Abby also felt anger and frustration. She knew that his department was one of those that was being downsized, so she had heard. New computer technology was enabling X-rays to be read and diagnoses to be made off-site, away from the hospital where the X-rays were taken and the diagnostic procedures done. Businessmen were making decisions about how things should be done, rather than medical professionals, often making vital and important decisions on things they knew little or nothing about.
‘Hurry…please, hurry!’ Abby whispered the words to herself, looking expectantly down the corridor, praying that the emergency department staff would get a move on.
When she heard the elevator doors opening in the distance and the banging of a stretcher being hastily pushed out, she stood up and gathered up all the bits and pieces of personal belongings that had fallen out of Dr Ryles’s pockets. She shoved them into her attachè case to make sure that they didn’t get lost in the dash to the emergency department; she would get them to him later, or to his family.
It was Dr Marcus Blair, Head of the emergency department, a nurse and two porters who came hurrying towards her as she turned to greet them. In moments they had an oxygen mask, attached to the portable cylinder, on Will Ryles’s face.
‘I found him like this a few minutes ago,’ Abby explained to Dr Blair. ‘He has a pulse, he’s conscious. Breathing ok. Blood pressure ninety.’
Dr Blair nodded. ‘Right. Let’s get him onto the stretcher.’
With all of them helping, they rolled Will Ryles onto a canvas sheet with poles attached, then lifted him onto the wheeled stretcher. Dr Blair put a rubber tourniquet round their patient’s arm, preparatory to taking blood samples—he would do that in the elevator as they were going up to the emergency department on the main floor level. They would need blood for the cardiac enzyme tests, electrolyte levels and a hemoglobin test.
‘We’ve got someone holding the elevator for us,’ Dr Blair said. ‘Come on.’
‘Do you need me, Dr Blair?’ Abby asked.
‘No, we can manage now. Thanks, Dr Gibson. A good thing you came along. It’s like the Sahara desert down here.’ With that, they set off at a quick trot down the corridor. Abby stood to watch them until she heard the elevator doors close and the elevator move upwards. Only then did she realize how tense she was, like the proverbial bowstring.
‘Phew!’ She let out a breath she had been holding. ‘Thank God for that.’
If anything had happened to Will Ryles she would have felt personally responsible. She could have called a code—the cardiac arrest code, she supposed now—but really he hadn’t had a cardiac arrest. He would be all right now.
She felt drained, as though she had already done half a day’s work, as well as shaken up by this sad encounter with someone she knew fairly well as a colleague. Someone would now have the unpleasant task of calling his wife to let her know.
‘Not a good way to start the morning,’ she muttered to herself as she resumed her journey. There was no point now in rushing to the rounds—a good part of the first presentation would be over.
Usually two or three of the residents-in-training, young doctors, presented interesting cases to the department of medicine and anyone else who cared to attend the rounds for learning or interest purposes. As a trainee, she was expected to attend. Sometimes there were photographic slides to look at, sometimes microscopic slides as well if the patient had had a surgical biopsy or other lab work.
Perhaps she could just slip in unnoticed to the small lecture theatre where the rounds were being held this time. If not, she would just have to apologize to Dr Contini, who was running the rounds, and explain the delay.
No such luck, Abby thought resignedly as she entered the room just as one of the window blinds was being let up so that brilliant spring sunshine entered the room at the same time, as though to highlight her late appearance. A slide presentation was obviously just over, indicating that the first case had already been presented. There would probably be one or two more.
Quite a lot of people were present, juniors and seniors alike. Some turned to look at her as she came in. She moved to the back of the room to try to blend in with the small crowd around the coffee urn that was set up on a table.
Moments later she was sipping hot coffee thankfully, holding her bag and books awkwardly with one arm, her mind soberly on Will Ryles. By now they would have the life-saving drugs dripping into his veins via an intravenous line. Would he be relieved, knowing he was out of it for a while, out of the workforce, even though he had a serious condition? Or would he constantly fret about the work he was missing? He was probably one of those guys who pushed himself too hard, not wanting to admit that he needed a break.
Several of her close colleagues were there, those who were in the same training program, and she made her way towards them. It was then that a firm hand grasped her arm from behind, halting her progress.
‘Dr Abigail Gibson, I presume?’ a masculine voice said. It wasn’t, it seemed to her, a warm voice. It held a sardonic note, a note of censure, and Abby cringed inwardly as she turned to look at the owner of the voice.
As she turned, the heavy books once again slipped from her grasp and landed with a thump at the feet of the speaker, partly covering his shoes. Then, as she stared down at them, a few splatters of coffee from the Styrofoam cup she was holding dotted the cover of the uppermost book.
Feeling clumsy and disconcerted, her mind elsewhere, she found herself stammering. ‘Y-yes, I’m Dr Gibson,’ she confirmed, raising her eyes to the man who stood looking down at her.
With a sense of shock she looked into cool blue eyes, intelligent eyes that were regarding her with undisguised perceptiveness and not a little exasperation, tinged with surprise…perhaps from the weight of the books on his toes? Abby swallowed convulsively.
‘S-sorry,’ she added.
He had an attractive, very masculine face, with a fine chiselled bone structure. Instantly she thought of a racehorse, a thoroughbred, with its fine aristocratic frame, perfectly formed for its function. The face was not smiling.
So this must be Dr Blake Contini. Abby felt slightly breathless, rather as though she had been punched in the solar plexus, not least because he was now frowning at her in a way that did not seem justified by her lateness or by the fact that she was a junior doctor in a training position or by the weight on his feet. After all, she was not even in his department as such. It brought an odd feeling, this astute appraisal, coming as it did on top of a sense of mourning that she had for the plight of Will Ryles.
‘Sorry,’ she muttered again, unable to think of anything else. As she bent carefully at the knees to retrieve her books, a few more drops of coffee escaped from her cup.
‘Let me do it, Dr Gibson,’ he said, putting out a restraining hand. Abby flushed, feeling as though the entire room had gone silent, that she was the focus of attention. Keeping her gaze lowered, she watched his lean hands wipe the coffee off her books with a handkerchief and pick them up.
‘Here,’ he said, thrusting the books at her and helping her to tuck them under her arm. ‘Better get yourself another cup of coffee.’
‘Th-thanks.’ For a couple of seconds she thought she detected a touch of humour in his eyes as he looked at her when their hands touched warmly for a moment.
He took a sheet of paper, a computer printout, from the pocket of his lab coat, holding it so that she could see it. For a few seconds she gazed at it blankly.
‘This is the summary of the first case we’ve reviewed today, which you’ve managed to miss entirely,’ he said. ‘We’re about to start on the second case.’ He tucked the paper between the pages of one of her books. Abruptly he turned away.
‘Wait a minute,’ she said, recovering something of her habitual confidence and composure. ‘And you are? I didn’t get your name.’ He hadn’t given his name—that had been a bit boorish, she considered belatedly.
It was almost certain that he was who she supposed him to be, as he had been avidly described to her by several of her women co-workers, yet he could not make the assumption that she would automatically know who he was. The thought of such an assumption fuelled niggles of annoyance.
He turned back to her slowly, an expression of muted surprise on his face. Fixing her with a look that might have quelled a lesser mortal, he held out a hand to her. With his other hand he deftly plucked the coffee-cup from her. ‘Don’t want any more accidents, do we?’ he said sardonically, while Abby was only too aware that other people nearby were staring at them curiously. ‘I’m Dr Contini,’ he added dryly, gripping her vacant hand firmly. ‘Blake Contini—Acting Head of the department of internal medicine.’
‘Oh…I see,’ Abby said thoughtfully, as though she had had no idea. ‘That explains it.’
‘I’ll talk to you at the end of the session, Dr Gibson. Wait for me,’ Blake Contini said, turning away from her.
‘Yes, Dr Contini.’
When Abby caught sight of her colleagues in the family practice program looking at her commiseratingly, grinning, she felt her face flush anew. That guy was something else! As soon as these rounds were over she would give him a piece of her mind if he was high-handed with her when she explained about Dr Ryles. As it was, he hadn’t even given her an opening to apologize out of politeness. Some of the other staff men would have turned a blind eye to her lateness. Maybe because some of them didn’t care, she had to admit in all honesty. Some were good teachers, some were mediocre, some were downright bad.
‘What was that all about?’ Her colleague and friend Cheryl Clinton approached her. ‘Was he mad at you for missing the case?’
‘Yeah, I guess so.’ Abby shrugged. ‘What a high-handed guy. And what a nerve, in front of the whole room.’
‘I wouldn’t mind getting that sort of attention from him,’ Cheryl said, her eyes searching the room for the object of their discussion.
‘At least he’s got a firm handshake.’ Abby tried to laugh it off. ‘I can’t stand guys whose hands feel like a slab of cheese or the proverbial dead fish. He wants to see me after…I can’t wait to give him an earful.’
Cheryl laughed. ‘Attagirl!’ she said delightedly. ‘Put him in his place.’ Then she added, sotto voce, ‘Pretty dishy, though, eh?’
Cheryl’s head turned again towards the tall figure who was now across the room talking to the medical residents who had presented the case Abby had just missed.
‘Mmm,’ Abby said absently as she turned to follow Cheryl’s line of vision, looking at the aquiline profile of Dr Contini. Her thoughts were returning sharply to Dr Will Ryles, wondering what was going on right now with him in the emergency department, whether the staff had informed his wife yet, whether she was at this very moment driving to the hospital with a terrible fear in her heart of what she might find there. As soon as possible she would get down there herself and find out.
‘I’m sorry I missed the first case,’ she murmured. ‘Something happened. I’ll tell you about it later, Cheryl.’
The next case was about to be presented. Maybe by the time she got out of this room Dr Ryles would have already been transferred to the coronary care unit.
Dr Contini, as though sensing her eyes on him, turned sharply to look at her over the heads of his new colleagues. His eyebrows rose slightly, questioningly, as their eyes met. Probably, he didn’t even know Will Ryles, she told herself angrily.
Refusing to be the first to look away, Abby held his gaze. There was no way that she was going to be intimidated by him. For the second time in the space of a few minutes she felt a sense of shock, a sudden unwelcome stab of acute sexual attraction. Then all attention was focused on two young residents who stood up at the front of the room to present the second case of the rounds.
When the rounds were finally over and the others had gone, Abby lingered in the room, waiting. All the others had left abruptly, having to resume their normal working day. She watched as Dr Contini walked over to the door and closed it, shutting out the sounds of chatter from the retreating staff.
‘Well, Dr Gibson,’ he said, coming over to her, ‘why were you late? And am I right that you’re in the second year of the family practice training program?’
‘Yes,’ she confirmed, looking at him but trying not to stare. ‘I’ve just started the second year.’
Blake Contini had thick, dark hair, cut fairly short, which contrasted dramatically with a pale skin that had only a very faint tan. From a winter holiday, perhaps? Although Abby was quite tall herself, five feet eight inches, he was considerably taller, forcing her to look up at him as she stood there in her sensible flat shoes.
‘Are you planning to work as a general practitioner when you’ve finished training?’ he asked, not waiting for her to answer his other question.
‘Of course, Dr Contini,’ she said, surprised. ‘Why else would I be doing it?’
‘Plenty of young women doctors get married shortly after training,’ he said dryly, ‘and don’t actually do much practice.’
‘Not me,’ she said. She managed to keep her tone from sounding rude, although she didn’t like his attitude. She had come to these rounds prepared to like and accept him. Now she felt herself to be uncomfortably on the defensive, a feeling which was reasonably alien to her. Yet at the same time she had an instinctive feeling that he had made that remark to find out if she were married. Don’t be ridiculous, she told herself fiercely. What’s the matter with you? Usually her internal dialogue was not as intense as this…He must be getting to her. Or she was getting broody…or something.
Maybe he, too, was one of the new breed, Abby thought, with a surge of bitterness as the image of Dr Ryles’s exhausted features came even more vividly into her consciousness. Maybe he was one of the slash-and-burn brigade who got rid of people without any human considerations, treating them like items in statistical tables.
‘I expect residents to be here on time, Dr Gibson,’ he was going on. ‘Even the family practice residents. I trust that is not too much to ask?’ he continued.
‘Um…no…of course not. I have a good reason for being late.’ And she was getting cynical, too.
‘Great,’ he said. ‘Er…Dr Gibson, are you really with me? I have a distinct impression that you’re operating on another plane.’
Blake Contini was aware that he was staring, but couldn’t help himself. The girl in front of him—she seemed like a girl to him—had thick, dark chestnut brown hair with bronze highlights and a slight curl to it all over. Little wisps of hair clung attractively to her creamy neck. He had an absurd desire to touch that neck, to breathe in the scent of her hair…
He also recognized the veiled sarcasm in his own voice. That seemed to have become habitual with him these days when he met attractive women—intelligent, capable, womanly women, who were not afraid of their own femininity—who might pose some sort of threat to his outward calm.
Kaitlin had been like that once. Her unwelcome image floated before his mind’s eye—blonde, pale, like an icemaiden now. With the image came the familiar sharp regret…
He disliked himself for his sarcasm as it represented him as something he was not. It reminded him of his own need. Yet it was a useful defense. He knew instinctively that Abigail Gibson was not a man-hater.
Several rejoinders came to Abby’s mind, but she bit them back. ‘Let me explain,’ she said. With few words, she described what had taken place after she had found Dr Ryles collapsed in the corridor, ending with, ‘Since you’re new here, you may not know Dr Ryles.’
‘On the contrary,’ he said, his face suddenly stiff with concern and shock, ‘I know him well. I knew him before I came here to University Hospital. Have you checked up on how he is?’
‘No, of course not. I came straight here.’ And you’ve been harassing me ever since, she wanted to add.
‘Poor old Will.’ He murmured the words, as though to himself. ‘And an unfortunate experience for you first thing in the morning.’ To her surprise, he reached forward to touch her arm commiseratingly. ‘You probably saved his life.’
‘People were rather scarce.’
‘I might have known something like this would happen,’ he added thoughtfully. ‘He’s been under so much stress lately, and he pushes himself much too hard.’
‘He looked so exhausted when I found him,’ she agreed, ‘I felt so desperately sorry for him.’
‘Yes, he would be exhausted,’ Dr Contini said softly, almost as though he had predicted that Dr Ryles would have a heart attack, making Abby speculate on whether they were actually close friends.
‘What do you mean?’ she asked, picking up nuances. ‘Were you, perhaps, aware that he was ill, that he might have an infarct?’
‘No…’ he said, almost absently, ‘Not that. He’s been under a lot of strain.’
Blake Contini regretted his sarcasm even more. The eyes that looked back at him frankly were green, large and expressive in a heart-shaped face; there was none of the calculation that he so frequently saw in the expressions of many women he met for the first time.
Across her pert nose, almost classic-shaped, was a faint band of freckles that spilled over onto her cheeks, giving her a mischievous look, rather like a female Huckleberry Finn…one of his boyhood heroes, who now seemed very far away. He found his eyes moving automatically to her mouth, to her lips that were full, beautifully shaped, soft-looking. The impression of her, of softness, produced a sense of dissonance, imposed, as it was, on his acute concern about Will Ryles.
‘Um…the first case, the one that I missed,’ Abby said, looking at the computer printout he had given her, now feeling the pressure of time. ‘I’m sorry about that. I would like to catch up—’
‘The patient is on 2 East, so maybe you can get to see him today. I shall be seeing him myself at about eleven o’clock—maybe you can manage to meet me there, Dr Gibson,’ he said. ‘I can go over a few things with you. I may want to test your group on this particular case later in the year.’
‘Thank you. I would appreciate that,’ she said formally. ‘General practice isn’t exactly easy, Dr Contini, even though you specialists might think so. We’ve got to be good at everything, not just one thing. And keep up to date on it all.’
‘I didn’t say it was easy, neither do I think so,’ he countered. If he was surprised by her remarks, he hid it well.
‘Start as you mean to go on,’ her mother had always told her. While she understood that to be an aphorism generally referring to marriage, it was, she considered, a good bit of advice to keep in mind at the start of any relationship.
‘I’ll try to get there,’ Abby said stiffly, very conscious suddenly that they were alone in the room, that she was inappropriately attracted to him. ‘I am expected at a family practice clinic right now—Dr Wharton’s clinic in Outpatients.’
‘I’m going to Outpatients myself. I’ll call Dr Wharton and arrange for you to have time off at eleven o’clock,’ he said. Then, making up his mind about something, he looked at his watch with a quick flick of the wrist. ‘If you would like to see Dr Ryles as much as I would, I can call the outpatient clinic, tell them you’re going to be late, then we could visit him briefly in the coronary care unit.’
Abby nodded. ‘Yes. Thank you. I would like to see him, find out what’s happened.’
‘Sorry about my obtuseness earlier.’ He had the grace to apologize. ‘I had, of course, no idea.’
‘No,’ Abby said quietly, managing to imply by her tone that one should not make flash judgements. He was very attractive, she acknowledged again, lowering her eyes to the paper she held. There was even a hint that he would, perhaps, have a natural charm if he were to let himself go a bit. Not that she was one to talk…
‘I’ll see if I can set it up,’ he said, ‘and find out where Dr Ryles is.’
‘I hope he’s survived,’ she ventured.
‘So do I.’
As he strode over to a telephone in the room she watched him, her mind active. His reaction to her news, for someone new to the hospital, had been greater than she had expected. She wondered where he would have met Dr Ryles, who had been at University Hospital for at least twenty-five years.
All at once, she had a very odd, very powerful premonition that Dr Contini would figure large in her life…and not just on the professional level. The feeling was so strong, so peculiar, that she shivered. Telling herself that she was being ridiculous, she turned away from him to stare out the window, away from his disturbing presence.
It wouldn’t do for her to feel anything of that nature for her senior colleague. She had made a pact with herself not to get involved with anyone before she had at least finished her post-graduate training and got herself established in her first permanent job as an MD. There was no time for real romance; she had to earn a living, had to give something back to her parents who had supported her so unselfishly all her life, among other things helping to meet the financially crippling fees for medical school. They were going to need it. Her dad often joked that if they could remain the working poor, rather than the non-working poor, they would be all right. She seldom forgot that ‘joke’ for long.
Not that she would be Dr Contini’s type. She frowned down at the paper in her hand, the words a blur. Probably he would go for a high-society woman. Anyway, she found herself speculating, he would no doubt be married—he must be in his mid-thirties.
Maybe she found him disturbing because he reminded her of what she had never had…real love, passion. Maybe that was it, when such a large part of her own life was, through necessity, focused on work. At the same time, she felt a certainty that he could be a formidable enemy.
She walked to the door to wait for him, all at once wanting to get out.
‘I spoke to the emergency department,’ he said, coming over to join her. ‘He’s in the coronary care unit now. Still all right.’
‘That’s great,’ she breathed, relieved of a sense of responsibility.
They collided as he moved to open the door for her and she moved to open it for herself. ‘Steady,’ he said, smiling. ‘Tell me, Dr Gibson, are you usually this…er…’
‘Klutzy?’ she offered.
The smile on his face broadened slowly, lightening his attractive features, ironing out subtle signs of strain. Abby found herself transfixed, staring at him at close quarters, as he held his arm in front of her to secure the heavy door. With his face only inches from her own, she had the absurd urge to lean forward and place her lips against his firm mouth.
‘That isn’t the word I would have used,’ he quipped, ‘but it’s as good as any, I guess. I don’t mean to be unkind.’ He added the last words softly, in such a way that Abby felt as though she were melting, leaning towards him. Don’t be ridiculous, she told herself yet again…
‘I am frequently this way,’ she conceded, forcing a jokey tone. ‘My friends tell me it’s a sign of genius, the absent-minded-professor syndrome, so naturally I take them at their word.’
‘Hmm…let’s hope they’re right. Such a trait could be a professional liability.’ Still he smiled, his eyes exploring her face.
‘Oh, they are right!’ she insisted, pushing past him to get out, aware of him physically with every sense in her being.
‘Just to be on the safe side, Dr Gibson, let me carry those books,’ he said.
CHAPTER TWO
THE coronary care unit was quiet, peaceful, set up in an area of the acute-care floor of the hospital where there was no through traffic and where noise could be kept to a bare minimum. They entered through a heavy door that closed silently behind them.
A nurse sat at a desk in the nursing station, looking at a bank of individual computer screens which were monitoring the four patients who were in her section. Each patient was connected up to leads going to the electronic equipment which would relay the information to the screen. Any irregularities of heartbeat, blood pressure and oxygen levels of the blood would immediately be known.
Although all was peaceful, Abby knew that she would not want to be a patient here, lying in bed, wondering if your heart would stop at any moment. Walking beside Dr Contini, she looked around her as they approached the nurse silently.
‘Is Dr Ryles here?’ he asked. The nurse gestured towards an area down a short corridor where there were a few individual rooms.
‘Room three,’ she said with a smile.
‘How is he?’ Abby said.
‘Pretty good, considering. He’s stable now. His wife’s with him at the moment,’ the nurse said. ‘He’s sleeping, so we don’t really want him to be disturbed.’
‘Sure,’ Dr Contini said. ‘We won’t wake him.’
In room three, Dr Ryles lay on his back in the narrow bed, the monitor leads attached to his bare chest. A small computer screen by the bed showed the spiky graph of his heartbeat, as well as the heart rate and blood pressure. Abby’s eyes went automatically to that screen as they entered silently. What she saw there confirmed that he was stable, his blood pressure near normal, the heartbeat good.
He was still on oxygen, his colour good now, while intravenous fluids dripped slowly from a litre plastic bag hung beside the bed. Abby felt her anxiety diminish somewhat. The team from the emergency department had been in time after all.
Mrs Ryles, who looked about the same age as her husband, was sitting beside the bed, her face turned to him. She rose to her feet as they stopped at her side. Her pale face showed evidence of tears, the eyelids swollen and red, and she registered surprised pleasure at seeing Dr Contini.
‘Hello, Ginny,’ he said softly, holding out his arms to her. ‘I’m sorry to be meeting you again so soon under these circumstances.’
‘Oh, Blake.’ The woman’s voice trembled as she went gratefully into the arms that Dr Contini offered her. They embraced in a silent hug. ‘Thank God you’re here.’
So they were friends after all. Abby stood aside, watching them, her own emotions very close to the surface as she saw the tears again on the wife’s face. When they had satisfied themselves that Dr Ryles was indeed all right, Dr Contini gestured that they should go outside to the main corridor where they could talk without disturbing anyone.
‘This is Dr Gibson,’ Blake Contini introduced her when they were outside. ‘She was the one who found Will.’
Mrs Ryles grasped Abby’s outstretched hand with both her own. ‘I want to thank you,’ she said, her voice trembling. ‘I understand that he was in the basement, where he might not have been found for some time. If you hadn’t found him…hadn’t known what to do, or what you were looking at…he might not have survived. Thank you. You saved his life.’
‘I—I’m very glad that I was there,’ Abby said. ‘I…really didn’t do a lot. I was just able to call someone.’
‘You were there—that’s the main thing!’ Ginny Ryles said emphatically. ‘It’s all this business about the downsizing that’s going on here, you know, that has brought this on with Will…all the budget cuts.’
‘That’s most likely a contributing factor,’ Abby agreed wryly, as the distraught woman articulated more or less what she had been thinking herself that morning.
‘It’s all the underhand business of deliberately running down departments, without telling the professional staff what has been planned, so that private companies can take over the radiology work of this hospital,’ Ginny Ryles went on with bitter passion, as though she had been waiting to speak to someone about it for a long time.
Abby nodded, while Dr Contini stood silent. ‘I don’t doubt that for one moment…not for one moment,’ Mrs Ryles went on. ‘He’s talked about nothing else for weeks. All the stress…It has to get to someone. It has to.’
‘Yes,’ Abby agreed, picking up the frustration in the woman’s words.
Blake Contini took the woman’s arm. ‘Come with me to the hospital cafeteria, Ginny,’ he said kindly. ‘I’ll buy you coffee, or anything you want. We can talk there. Dr Gibson has to get to Outpatients.’
‘Thank you, Blake. You’re very kind, and I do appreciate it,’ Ginny Ryles said.
‘Dr Gibson.’ Blake Contini turned to Abby. ‘I’ll see you in Outpatients in a little while. I have some patients to see there. I’ll square things for you with Dr Wharton about taking time off.’
‘All right. Thank you,’ Abby said. ‘Well, goodbye, Mrs Ryles. I expect I’ll see you again, I’ll probably look in later…He’s in good hands.’
‘Thank you again, Dr Gibson. I’m planning to spend most of the day here with Will. I’ll only go out of my mind if I stay at home,’ Mrs Ryles said quietly.
‘There’s every indication that he’s going to be all right,’ Dr Contini reassured her gently, while Abby looked at him surreptitiously with new eyes.
Yes, it was clear that he could be charming. She wondered momentarily what it would be like to be the object of that charm, that warmth and undivided attention. Perversely, uncharacteristically, she found herself longing for it—almost as though the incident with Will Ryles had jolted her out of a deep sleep, like Sleeping Beauty in the fairy-tale—then brought her face to face with the prince. Snap out of it, Abigail Gibson, she admonished herself once again. Get real!
‘Thank you for saying that,’ Mrs Ryles said tremulously, trying to inject some hope into her voice. ‘Here I am, going on about our affairs, but what about you, Blake? How’s Kaitlin? Any change there?’
‘No, nothing,’ Dr Contini said heavily.
‘Is there likely to be?’
‘I doubt it very much.’
As Abby made her way to Outpatients a little later, she puzzled over that last brief verbal exchange. It was evident that Dr Contini had known Dr Ryles and his wife for quite a long time.
She sighed, looking at her wristwatch and making an effort to shift her thoughts to the work ahead in the clinic. She was looking forward to it.
It was only too easy to become obsessional about the internal politics of a hospital, which were so closely connected to the broader political scene. It could sap one’s energy. Although it was of concern to her, as much as she knew that one had to get involved in some degree, she did not have time for that right now.
Who, she wondered, was Kaitlin? The question nagged at her persistently…as did the tone of Blake Contini’s voice when he had replied, ‘No, nothing.’
The voice had sounded dead, devoid of all emotion.
Dr Wharton’s clinic was well under way when she got to Outpatients. The young family practice doctors like herself were given new patients to see so that they could take detailed histories, do extensive physical examinations, order blood tests, urine tests, X-rays if necessary, and anything else that might be required before the consultant in charge—in this case Dr Wharton—saw each patient to confirm, or call into question, the preliminary diagnosis. This system saved the senior GPs a lot of time, as well as being a good training exercise for the young doctors, who were themselves MDs.
‘Morning, Sue’ Abby smiled at the receptionist sitting behind the desk off the main waiting room in the family practice unit. ‘Sorry I’m late. Anything interesting for me? I have to leave again for a while just before eleven o’clock to see a patient on 2 East, one of Dr Contini’s patients that I missed at the rounds. Is he—does he—Dr Contini, that is—have many patients here this morning?’
Although Abby felt her face flushing as she asked the question, and still feeling somewhat disturbed by all that had happened already that morning, it was good to be in the relative peace of the family practice clinic. Abby felt herself beginning to relax, her habitual confidence returning. This was her territory.
‘Hi, Dr Gibson.’ Sue, the young, efficient receptionist smiled back. ‘It’s going to be one of those days, I think. Lots of interesting cases for you to get your teeth into. Here’s your first.’ She handed over a folder that contained the patient’s basic statistics and initial complaint. ‘Dr Contini has a couple of patients to see. He told me he’d be available for any consultations here if anyone wanted him.’
‘That’s really great! Maybe I’ll take advantage of that offer, if Dr Wharton’s busy. Thanks.’ Abby took the folder, glancing at it to see the patient’s name and feeling an upsurge of anticipation at working in the same unit with Blake Contini, even though it was an anticipation tinged with remnants of irritation.
Dr Wharton would be there in the unit, plus two other family practice MDs in training like herself. At the moment there was no sign of them—no doubt they were already in the offices assigned to them, seeing patients.
‘Mr Barlow,’ she called out across the waiting room, ‘Gary Barlow.’
A thin man, wearing an old raincoat, got up from a chair, nodding to Abby. ‘This way, sir,’ she said. Leading the way, she proceeded to the small examination room which was to be her office for the duration of the clinic.
‘Take your coat off, Mr Barlow. Have a seat there next to the desk. I’m Dr Gibson. I’ll be seeing you first—taking a history, doing an examination—then Dr Wharton will see you.’
With the folder open on the desk in front of her, she read the chief complaint that this patient had. ‘Chronic bronchitis’ it read, followed by a question mark, then ‘Persistent chronic cough.’ That would have been written by Sue from the patient’s own description of what was wrong with him. Many of their patients came there without any reference letter from any other doctor; they simply telephoned the hospital, asking to see a GP. Many had never had a family doctor.
Mr Barlow, in his fifties, was thin and tired-looking, with a drooping face of loose skin that reminded Abby of a bloodhound. The top of his head was bald. In general, he did not look particularly healthy. He sounded slightly breathless from the simple effort of having walked from the waiting room and taken off his coat. He sat down heavily in the chair next to her desk. Abby took some history sheets from the pile on her desk to add to the file, prepared to do a fair amount of writing.
‘It says here that you have a chronic cough, Mr Barlow,’ she began, her pen poised above the paper, ‘Tell me when that first started, and any other symptoms associated with it.’
For the next few minutes she wrote busily while he talked. It seemed to her that he was trying to minimize the length of time he had had the cough, as well as his level of concern about it. He said he had had a cough for about a year, then it had got worse over the winter, showing no signs of going now that spring was here. He was the sort of man, she suspected, who would not go to a doctor for many years, then would only go finally when symptoms were such that he could not ignore them and his level of anxiety got to a point where he could not think of much else.
‘And do you smoke, Mr Barlow?’ Abby looked up.
‘Yes,’ he said.
‘For how many years have you smoked?’ she asked, keeping her voice neutral with no hint of judgement. ‘And how many cigarettes a day?’
‘Well…’ he said, thinking back, ‘I reckon I had my first cigarette when I was about fifteen. Now I smoke about forty a day, give or take a few.’
My God! Abby thought, keeping her face impassive as she wrote again. It was difficult to imagine getting through that many in one day, yet some people, she knew, got through more than that. ‘For how many years have you smoked forty a day?’ she asked, looking at him and watching his pale, watery eyes go blank as he stared across the room, trying to remember back that long.
‘Oh…’ He hesitated. ‘I suppose it must be at least ten years…about that.’
She wrote down the statistics. ‘When did you last have a chest X-ray?’ she said.
‘A chest X-ray?’ He looked surprised. ‘I’ve never had one.’
It never ceased to amaze Abby that many people who smoked heavily could tune out all the publicity and the statistics that were everyday knowledge about smoking and lung cancer. It was as though by some mental gyration they could dissociate it all from themselves, almost as though for health purposes they lived on another plane. That ability, if one could call it that, was very common, of course…and not just with smoking and lung cancer. It certainly applied also to hepatitis and AIDS, particularly among the population taking street drugs.
Maybe she shouldn’t be surprised, really, as nicotine was a powerful drug of addiction, although it was frequently not thought of as such. It produced a craving from which it was not easy to break free. Again, she was careful not to inject any hint of judgement in her tone. Sometimes patients would get up and leave if there was any hint of negative judgement about their behavior, past and present.
‘When did you last see a doctor?’
He hesitated, calculating. ‘Not for a long time. Never needed to,’ he asserted, with a hint of defiance. ‘Must have been about ten years ago, I guess. Had a tooth abscess. Had to have it pulled out. The guy gave me a quick once-over, then sent me to a dentist.’
‘I see,’ Abby said, writing that down. ‘Any other health problems?’
‘Nope,’ he said.
‘What about your general health? Your appetite?’ For the next little while she questioned him about the present, then went on to his medical history, starting from as early in his life as he could remember. Apparently he was one of those men who took his bodily functioning, his health, entirely for granted, having only a very rudimentary knowledge of the anatomy and physiology of the human body.
Abby filled in a requisition form for a chest X-ray, to be done that day in the hospital. If she didn’t get it done now he might never come back, especially if he got scared—any more scared than he was now. She did not want to give him a hint that he might have lung cancer, the possible diagnosis that was uppermost in her mind. He could also have chronic emphysema, a lung disease brought on by repeated chest infections, as well as by smoking. This disease also affected the heart.
She also filled in requisition forms for some basic blood work, to be done in the hospital labs. Chronic smokers were often anemic, as well as suffering from various vitamin deficiencies, as they were frequently poorly nourished. Smoking tended to dull the appetite and become a substitute for food.
‘I want you to have a routine chest X-ray this morning, Mr Barlow,’ she said, ‘as soon as we’ve finished seeing you here. I’ll call them to fit you in right away.’ There was no way she was going to let him get out of the hospital without one. ‘And I want to have some blood tests done as well, then we’ll see you here two weeks from now with the results.’
‘Ok,’ he said, a certain bravado in his voice. ‘Have I got bronchitis?’
‘I’ll be better able to answer that question maybe when I’ve examined you,’ she said, ‘which I’m going to do right now. I want to listen to your chest, take your blood pressure, and so on. I’d rather wait for the chest X-ray before saying anything definite.’
The lungs did not expand well. Abby listened to the breath sounds in those lungs as she placed her stethoscope here and there on her patient’s chest when he was lying on the examination couch a few minutes later. It was probable that he did have a chronic lung disease, bronchitis or emphysema, which did not rule out cancer as well. There was also the possibility of tuberculosis, which was increasing in prevalence these days.
When she had done a very thorough examination, she lifted the telephone to tell the receptionist that she was ready for Dr Wharton to see her patient.
‘He’s just gone in with one of the other young doctors,’ Sue informed her. ‘Dr Contini might be free between his cases. Would you like him?’
‘Oh…um…yes, if that’s all right with Dr Wharton.’ Abby felt herself to be a little flustered, not a state to which she was accustomed. Indeed, she prided herself on her sang froid.
‘Dr Wharton’s in full agreement,’ Sue said chirpily, giving Abby the impression that the receptionist was coming under the influence of the new head of medicine. ‘He’s running late, and Dr Contini wants to learn the ropes here.’
While waiting for Dr Contini, Abby called the X-ray department to make an appointment for Gary Barlow, stressing that she needed it done that morning, soon. As a chest X-ray could be done very quickly, they gave her a time which would coincide with the end of Mr Barlow’s appointment in Outpatients. Considering that he might leave the hospital without the X-ray she resolved to escort him to the X-ray department herself.
She was also keeping a close eye on the time, mindful of her obligation to go to 2 East.
Dr Contini came in after a peremptory knock. ‘What can I do for you, Dr Gibson?’ Again he reminded her of a racehorse, lean yet muscular, with a graceful, contained power.
‘Would you confirm my physical findings, please, Dr Contini?’ she said, handing him her written notes. ‘That’s what Dr Wharton does. Here’s the history.’
She watched his dark head as he bent over her notes on the desk, his arms propping him up as he stood reading intently, yet ready to take flight.
‘You take a good history, Dr Gibson,’ he said, looking up suddenly.
‘Of course,’ she said, pursing her lips a little. ‘I’m well known for my good histories…among other things. I’ve pencilled in my provisional diagnosis.’ Moving over next to him, she put her finger on what she had written, not wanting to say anything in front of Mr Barlow. Quickly, she moved back, oddly aware as she did so that Blake Contini knew she was distancing herself from him.
With an astute look, he smiled at her slightly—there seemed to be a sadness in that look. Instantly she regretted her pursed mouth, her touch of primness, which wasn’t really ‘her’. Then that name came to mind again…Kaitlin. Who was she? His wife, perhaps? A child? The words that Mrs Ryles had uttered echoed in her mind. ‘Any change there?’ the woman had said. His dead voice had answered, ‘No, nothing.’
Abby knew then that she did not want him to be married, to be committed. It meant that her own resolve was weakening. And she had another year to go of training. ‘I appreciate this,’ she said. ‘There might be something that I’ve overlooked.’
‘We’ll see,’ he said, taking a stethoscope from the pocket of his lab coat. ‘Hello, Mr Barlow. I’m Dr Contini. I understand you have a chronic cough.’
It was five minutes after eleven o’clock when she arrived breathlessly on 2 East, having managed to escort Mr Barlow to X-Ray, just to make sure he would actually go there, and to see two more patients as well.
‘If you’re looking for Dr Contini,’ a nurse said, ‘he’s down that way. Room six.’ She gestured down the corridor of the general medical floor.
‘Thanks.’
‘We’re keeping that patient, Mr Simmons, in isolation,’ the nurse said. ‘You’ll find the stuff you have to put on in the anteroom.’
There was a small glass panel in the door of room six, through which Abby could see Blake Contini, dressed in a gown, cap and mask, talking to the patient.
Mr Ralph Simmons, a man in his early sixties, had a diagnosis of acute myelogenous leukemia, a disease which left him anemic and generally debilitated and thus more susceptible than normal to infections which he might pick up from other people. Abby put on a gown in the small anteroom, covering her own clothes, then a disposable cap that covered her hair and a face mask. Last, she put on a pair of latex gloves.
‘Ah, Dr Gibson,’ Dr Contini said, as she let herself into the room, his eyes going over her quickly. ‘We’ve been waiting for you. I’ve told Mr Simmons to expect you.’
‘Good morning.’ Ralph Simmons smiled tiredly at Abby.
‘Good morning,’ she answered, moving to stand near Blake Contini at the bedside. He held the patient’s chart.
Mr Simmons lay on the only bed in the room. He was a large man, who had most likely once been very fit and muscular, Abby surmised as she looked at him. He seemed to be still in reasonable shape, although very pale and tired-looking.
‘Did you have time to read the computer printout I gave you earlier?’ Dr Contini asked.
‘Yes, I did.’
‘Good. Here’s the case-history chart.’ He handed it to her so that she could read about their patient in more detail, see the results of the blood tests that had been done so far in order to make the diagnosis and assess the degree of development of the disease. ‘Mr Simmons knows his diagnosis.’
He meant, Abby supposed, that they could talk reasonably freely about it in front of the patient.
‘How are you feeling, Mr Simmons?’ she asked.
‘Tired,’ he said. ‘Very, very tired.’
Before Abby had entered medical school she had been under the impression that it was children who commonly suffered from the various types of leukemia that were known—only later had she discovered that it was just as common in adults, right up to the elderly. In fact, the incidence of the disease peaked in the sixth and seventh decades.
She knew now that the prognosis for anyone over the age of sixty was not as good as for a younger person, mainly because the greater a person’s age the less likely they were able physically to tolerate the toxic effects of the very potent chemotherapy treatments that were required to put the disease into remission.
‘As I’m sure you know,’ Dr Contini said quietly, looking over her shoulder at the open chart, addressing both her and the patient, ‘the cause of acute leukemia is unknown, although some links with toxic chemicals have been demonstrated in some cases. We’ve been discussing possible future treatment, Dr Gibson.’
‘I see,’ she said.
Mr Simmons nodded his understanding, his eyes on Dr Contini. From before his admission to hospital, he had known the probable diagnosis from his GP, and had insisted on being told the truth. ‘I would like to know as much about it as I can,’ he said.
‘It’s a disease characterized by the proliferation of immature blood cells arising in the bone marrow, where blood cells are made,’ Abby’s colleague continued, addressing Mr Simmons. ‘All it takes is the transformation of a single bone marrow cell into a malignant form…From then on, this one cell produces clones of itself, which gradually spread to other parts of the body, especially to the spleen and liver, where they accumulate and cause problems.’
‘What sort of time frame are we talking about here?’ Mr Simmons asked.
‘Well, acute leukemia can develop in three months,’ Dr Contini said, while Abby kept her eyes on the chart, ‘which seems to be so in your case.’
What he did not say, Abby noted, was that some patients had a preleukemic syndrome, which could last for very much longer than three months. The ultimate outcome for patients who had that syndrome was not as good as for those who developed the acute phase more quickly. From the evidence before them, it seemed that Mr Simmons had had a fairly abrupt onset, if he were not glossing over any earlier symptoms.
‘Mmm…that’s about right,’ their patient murmured. Apparently a very intelligent and perceptive man, he would have a good idea of his chances for recovery.
‘He’s had a lot of investigations,’ Abby commented quietly to Dr Contini as she carried the chart to the end of the bed and stood there, looking through it.
‘Yes,’ he murmured, having moved to stand beside her, his head close to hers as they looked at the hematology lab reports together. ‘As you know, it’s a guide in good medicine that when making a diagnosis one should think of the common things first, before going on to the more unusual and to the exotic. Hence all these blood tests.’
‘Yes,’ she agreed, conscious of his closeness.
‘You may know the saying with regard to making a diagnosis—“When you hear the sound of galloping hooves, think of horses, not zebras.”’
Abby smiled. ‘Yes, I have heard that. And certainly not unicorns,’ something prompted her to add.
‘No, not unicorns.’ He smiled slightly in return. ‘Not that leukemia is difficult to diagnose. We have to be sure of the type, though.’
Abby nodded.
Dr Contini turned again to their patient. ‘These immature cells—which never develop to full maturity, Mr Simmons—are unable to perform the functions of the mature cells that they gradually replace…thus the symptoms that you experience, especially the anemia,’ he said.
‘Yes.’
‘Because you have fewer and fewer normal red blood cells, with less and less hemoglobin as a result, you gradually become unable to carry as much oxygen on your red blood cells…which is why you get breathless on exertion.’
Their patient nodded. He seemed avid for information, as though that in itself might help him to fight this vicious disease, if only on a psychological level.
‘Mr Simmons has been in here for two days, Dr Gibson, waiting for the results of more blood tests. I’m here today to discuss treatment with him. Any questions you want to ask him?’
‘Has a bone-marrow biopsy been done?’ she asked.
‘Yes,’ Dr Contini said. ‘That, as you know, is the other diagnostic test, which shows up the abnormal bone marrow cells, the immature forms.’
Although most of the background information was already in the chart, Abby preferred to hear it directly from the patient. He would most likely have a need to talk. ‘What were your initial symptoms, Mr Simmons?’ she asked, moved by his air of abject exhaustion, his outward calm, she suspected, masking a great deal of underlying apprehension.
‘Well…I was pretty tired all the time, much more so, I suspected, than was warranted by my age,’ he said, ‘although I lead a hectic life. I teach at the university—political science—and this is a busy time, coming up to the end of the academic year. Even so, I suspected that something was wrong with my health.’
‘I see,’ Abby said kindly, encouraging him to go on.
‘Also, my skin was very pale and I got breathless easily on the slightest exertion, whereas before I could walk for miles. I felt unwell for a lot of the time and I got several colds, as well as chest infections, which I couldn’t shake off.’
‘Do you smoke?’
‘No. Never have done.’
‘Anything else?’
‘I noticed that I bruised easily, and I couldn’t remember having injured myself in any way to cause the bruises,’ the patient went on. ‘Then my dentist noticed that my gums were bleeding more readily than usual, so when I told him my other symptoms he advised me to see my doctor right away. Then when I went to my GP for a check-up he found out I was very anemic…Then things progressed from there.’
‘He had some nausea as well, which indicates some involvement of the gastro-intestinal tract—either infection or bleeding, or both,’ Dr Contini said quietly.
‘I see.’ Abby nodded. ‘And what is the planned treatment?’
‘I’m getting on to that now,’ Dr Contini said. ‘What I’m going to do, Mr Simmons, is build up your general resistance before we start you on a course of chemotherapy. If you agree, that is. Since you’re very anemic, I’m going to give you a blood transfusion of packed cells, plus some fresh plasma which will help the clotting function of your blood, which gets out of whack with this disease.’
‘When am I going to get that?’ Mr Simmons asked.
‘We’ll start this afternoon. The hematology lab is getting you cross-matched. When we’ve done that, we’ll discuss the treatment further. If we decide on chemotherapy later, you get a combination of drugs over a period of five to ten days—that’s called the “induction therapy”.’
‘I’ve read something about that,’ Mr Simmons said ruefully. ‘It kills off all the abnormal cells. Right? Or almost all? I guess it makes you feel pretty awful, as well as making your hair fall out.’
Blake Contini nodded.
CHAPTER THREE
WHEN the consultation was over and the two doctors were out in the wide corridor again, divested of their protective clothing, Blake Contini drew Abby to one side, out of the way of the pedestrian traffic, and queried her about aspects of the disease.
‘How would you make the final diagnosis here, Dr Gibson?’ he asked, fixing her with an astute glance from those rather unnerving blue eyes.
Abby cleared her throat, feeling a little like a student taking an exam. At the same time, she was grateful to have this opportunity for learning—even if her feelings towards her teacher were a little mixed. There was no time now to dwell on that.
‘Well,’ she began, ‘there are abnormal cells in the blood and in the bone marrow—tests for those would be decisive. The cells in the bone marrow never mature beyond the myeloblast level.’ Abby met his glance squarely, warming to her subject. ‘And, of course, the proliferating leukemia cells accumulate in the bone marrow, eventually suppressing the production of normal blood cells and the normal bone-marrow elements.’
‘Yes.’
‘He would have evidence of abnormal blood-clotting function—an elevated prothrombin time and low fibrinogen levels, as well as the clinical findings,’ she added decisively.
‘Right.’
Mr Simmons had manifested two common clinical signs. Abby had felt those distinctly when she had examined him as well—an enlarged spleen and an enlarged liver. They were signs indicative of a blood disease. ‘He has hepatomegaly and splenomegaly,’ she said, ‘two other diagnostic signs.’
He nodded. ‘Quite right. After the transfusions that we’re going to give him, how would you proceed with treatment, Dr Gibson?’
‘Well…’ Abby took a deep breath. ‘I would give him the remission induction chemotherapy that you mentioned—provided we think he’s a good candidate. We hope to induce a complete remission. We would need to really build him up first, including, probably, the giving of broad spectrum antibiotics to try to get rid of residual infection, particularly if he has some gastrointestinal involvement.’
‘Yes…good. I can see that you know your stuff Dr Gibson,’ Blake Contini conceded, raising his dark eyebrows at her and giving her a small smile, a gesture that transformed his lean face.
They had moved well away from the door of room six to discuss their patient, yet Abby glanced at it, feeling a familiar sense of pity. ‘I expect he was generally a very fit man before this,’ she said. ‘He doesn’t smoke, has always exercised regularly.’
‘Yes,’ he agreed. ‘We’ll see what the packed cells and the plasma do for him over the next day or two. I try to be as hopeful as I can with these patients. After all, what’s the point of trying to play God when each case is somewhat different from the next. We can only talk in probabilities. Do you agree?’
‘Yes.’
‘There’s nothing to stop him from getting hold of a medical book, of course, and reading about probabilities for himself,’ he commented dryly.
‘No, he’s obviously done some reading.’
‘Do you think he’s a candidate for a bone marrow transplant?’ he asked, looking at her quizzically again.
Abby shrugged, indicating her uncertainty. ‘Statistically speaking…I’m not sure,’ she said slowly. ‘His age is not on his side.’ She considered how well Mr Simmons would stand up to the effects of the toxic drugs that would be required prior to a transplant of bone marrow. ‘But I…I wouldn’t want to rule it out.’
‘Quite right, on both counts,’ he said crisply, ‘so I don’t think that’s an undisputed option. We’ll see. Before we start chemo, we need to do another liver function test and make sure his kidneys are in good working order.’
A small silence ensued, while other staff moved busily past them in both directions.
‘Well…’ Abby said, thinking of her outpatient clinic yet oddly reluctant to bring this teaching session to an end, ‘thank you for the time you’ve taken to go over this case with me, Dr Contini. I guess I ought to be getting back…’
Dr Contini looked at his wrist watch. ‘That’s the least I could do since you missed the presentation because of Will Ryles. A quick cup of coffee is in order, I think, don’t you?’
‘Definitely,’ she agreed.
‘Come to my office,’ he said lightly, ‘then I can quiz you about your attitudes and biases, Dr Gibson.’ The smile he gave her surprised her once again, as did his almost playful propensity to goad her in a gentle way, just out of the blue. Although he would not suffer fools gladly, she suspected, he would also be quick to burst any bubble of pomposity wherever he found it…and there was certainly plenty of pomposity in a hospital setting. For this reason, she found herself warming to him even more.
As she gave him a quick sideways glance, Abby reconfirmed her convictions about the false veracity of first impressions; she didn’t know what to think about Dr Contini. Two things were certain—he was an unusually attractive man, and knowing him was going to be a challenge, both personally and professionally.
‘You said you were good at other things, as well as taking histories,’ he said. It seemed that he was determined to shake off the slightly sombre mood that had been engendered by Mr Simmons’s condition. ‘Tell me what some of those other things are.’ His hand lightly under her elbow indicated that they should walk and talk at the same time.
‘Well…’ Enjoying his touch, she walked slowly. ‘I’m pretty good in a crisis.’ Looking at him sideways again, she challenged him to contradict her, her full lips curving up at the corners in an involuntary smile.
‘I expect you are,’ he conceded thoughtfully, his voice husky.
‘Even though you think I’m a bit klutzy?’ Her smile broadened.
‘You said that—I didn’t,’ he reminded her. ‘I would have come up with a word that was more complimentary.’
‘I’m not sure I believe that,’ she said.
As he led the way to a quiet side corridor off the main second-floor corridor, where the department of internal medicine offices were situated, Abby considered, a little nervously, what he might query her about, and she began to think that maybe she should have declined the offer of coffee.
‘Dr Wharton will be wondering what’s taking me so long,’ she ventured, as he led the way into his cosy office.
‘I spoke to Dr Wharton. It’s all right,’ her colleague informed her. ‘This is a teaching hospital after all. You haven’t told me what else you’re good at…outside work. I like to know who—and what—I’m dealing with in my new colleagues.’
‘Well…’ Abby racked her brains. ‘I’m good at gardening, and I make a pretty mean rum baba when I’m in the mood for it.’
Although she had not intended to make him laugh, his uninhibited amusement at her response was very gratifying.
‘Perhaps you’ll let me experience that some time,’ he said, still grinning. ‘I shall look forward to it. Coffee?’
‘Please. I’m desperate for coffee and was beginning to think you weren’t going to give me any after all.’ Trying to cover up overt signs of her growing attraction to him, she pushed her unruly hair away from her forehead and fussed around with her attachè case which she placed on his desk.
‘A coffee now in exchange for a rum baba at a date yet to be decided. Right?’ The tone was light.
‘Right,’ she said unthinkingly, aware only that her heart was beating faster than normal and that she wanted more than anything to be able to meet him outside a work setting—not thinking beyond that.
‘Back to serious things. Tell me about your personal ethics, Dr Gibson,’ he said, as he handed her a cup of coffee. ‘Would you like to sit—get more comfortable?’
‘I…I prefer to stand,’ she said.
‘So I’ve noticed,’ he said.
As her face flushed, he shook his head in a self-deprecating way. ‘I’ve done it again, haven’t I? As I said before, I don’t mean to be unkind. I’ve got into a habit of…insensitivity with women.’
‘It’s all right,’ she insisted. Then, like a litany, she mentally went over the many rules for good medicine which she had made for herself, trying to answer his question. While he poured himself coffee, his back to her, Abby took a swallow of hers and collected her thoughts.
‘As for my ethics…well, do not force or coerce a patient into having a treatment he or she does not really want, even if the prognosis without it would be poor,’ she stated. ‘Sometimes “treatments” can kill—many are not without risk. If a patient wants a second, or a third, opinion, before agreeing to a course of treatment or an operation, make sure he or she gets it.’
‘Hmm. Go on.’ He sipped coffee, eyeing her thoughtfully. Abby had no idea what he was thinking. This was a snatched interlude that must soon be over.
‘Know your biases. Even the very best doctors have them,’ she said, hoping that he would not press her further. What, she wondered, were Dr Contini’s biases and weaknesses? Maybe finding out would be interesting. ‘Try to know your strengths and weaknesses.’
‘What do you think of euthanasia?’ he asked unexpectedly.
For a few seconds Abby looked at him, sensing something other than curiosity about her opinions in his question, yet she could not have analyzed why she thought that.
‘I know that some doctors advocate euthanasia,’ she said slowly, averting her gaze from his shrewd perception. This was something that she felt very strongly about. ‘I’m not one of them.’
‘Tell me why,’ he said softly.
‘I—I’m not particularly religious,’ she said, stammering a little, ‘but the admonition “thou shalt not kill” figures very large in my personal philosophy, I guess. I haven’t really analyzed it very thoroughly…In my experience, people do not want to have their life taken from them—they want to be relieved of their pain. We all love life, we cling to it.’
‘Hmm,’ he murmured, watching her.
‘To…er…to take a life is extreme arrogance,’ Abby went on. ‘I deplore arrogance of any kind.’
‘I agree with you absolutely. It is not in our mandate to take a life. Not actively.’ There was a bleakness in his voice, as though this were a question that he had been forced to consider many times. Abby knew that must have been the case.
Encouraged, she went on and felt her cheeks tinge with warm colour as she disclosed her thoughts, struggling to find the appropriate words. ‘To me, the trust that a sick person has in his or her doctor is a sacred trust, never in any circumstances to be breached. As you say, it is not our mandate…We are not in a position to have, or to take, that sort of power over the life of another. It’s abhorrent…obscene.’
He nodded, saying nothing. The silence that ensued seemed to be charged with a peculiar understanding between them, as though there had been other questions silently asked and just as silently answered. Yet Abby had no idea, no idea at all, what those questions might be…or what the answers were. She remembered the premonition that she had felt at the medical rounds.
Abby bit her lip indecisively, looking down at the cup that she held in her hand. She wanted to leave, but could not seem to summon up the energy to make the move. Then she felt his fingers touch her own as he grasped the cup.
‘Thank you for talking to me,’ he said quietly. ‘Let me get you more coffee—that must be cold. I’ve been asking you too many questions, haven’t I?’ The touch had the effect of deepening the inertia that had come over her. She could not understand herself. Neither did she know why he was thanking her for talking to him.
He handed her back a full cup. ‘Here, I won’t say another word while you drink that.’
Automatically she added cream and sugar to the hot liquid.
‘You ask a lot of questions, rather personal ones, Dr Contini,’ she said bravely, not looking at him. ‘I wonder if you answer them so freely yourself.’
‘Drink your coffee, Dr Gibson,’ he said. ‘You may not get another chance.’ They looked at each other, as they both drank the welcome coffee, sizing each other up. Abby was the first to look away.
‘I’d be pleased to answer any questions that you might have,’ he offered quietly. ‘Another time.’
There were footsteps of someone approaching the door outside, then a knock. ‘Ah, there you are, Dr Contini.’ A secretary had put her head round the door. ‘There’s an outside call for you from the Gresham General Hospital. They want to talk to you right away.’ She glanced at Abby. ‘Shall I put the call through to you here?’
‘Yes, please,’ he said, after a fraction of hesitation.
When he answered the telephone a moment later, it seemed to Abby that he switched instantly to a totally different mind-set—that he tuned out the present situation, including her, and projected his thoughts totally to whoever was speaking to him. When he looked at her his expression was blank, as though he scarcely saw her, when she made to leave.
‘Thank you for coming, Dr Gibson,’ he said formally. ‘I’ll doubtless be talking to you in a few days about Mr Simmons.’
‘Thank you, Dr Contini,’ she said.
As she walked away from his office, she considered that he might have a cross-appointment at one of the other teaching hospitals in Gresham, the Gresham General, although she was surprised at that. The position at University Hospital was a very demanding one, which, she had assumed, would take up all his time. Maybe he was just being called to a consultation. Gresham General was a hospital that she went to occasionally herself as part of her training program.
Abby felt sober and thoughtful as she left the floor to make her way to Outpatients on the ground level. Going over the case of Mr Simmons in her mind, it was clear that everything possible was going to be done for him to effect a cure. He was in very good hands. There would be unwanted side-effects for him, of course—in order for chemotherapy to be effective, the first dose had to be followed up not long after by a second dose. Such toxic drugs left a person’s body susceptible to opportunistic infections.
Abby had to admit that Dr Contini was very good at his job—very good indeed.
Lunch was almost over in the cafeteria when Abby got there late, in the early afternoon, having seen a few more patients.
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