The GP's Marriage Wish

CHAPTER TWO

‘SO IT’S all change, then, is it?’ Karen Lightfoot, the practice nurse, stared with round, rather bulging eyes at Victoria and Connor. ‘Talk about gob-smacked! I can’t believe Betty and John are getting married after all these years! And now you two are taking over?’ She shook her head dolefully. ‘Any minute now I’ll wake up and find it’s been a dream.’

‘As long as it’s not a nightmare, Karen,’ said Connor drily. ‘We’re going to try and make it work, but we can only do it with your, Maggie’s and Pete’s help. As a receptionist for some years, Maggie knows every patient in the practice, and although Pete’s only been practice manager for a few months, I’m sure we’ll be able to manage the finances as well as my father and Betty did.’

A week after her return to England, Victoria and the rest of the surgery staff were sitting in the office behind the frosted window of the reception area before surgery started. Betty and John had told them the week before of their departure and it was plain that they all felt as shocked as Victoria and Connor.

Victoria took a sip of strong black coffee, feeling rather like a condemned prisoner. The cold realisation that she was committed to share the running of The Cedars Medical Centre with someone she would never had chosen to work with was starting to sink in.

She looked across at Connor. She may have spent two years with him at school, but in many ways he felt like a stranger. She was still amazed that anyone could change so much physically—the callow youth with attitude had become a man with an air of authority about him, still undeniably attractive—but not to her, she thought fiercely. She’d learnt what he was really like—how could one feel anything kindly for someone like him? She bit her lip and doodled absently on a piece of paper. She was still raw from the sadness of breaking up with Andy so recently and that had made her more sensitive perhaps.

The thought of Andy reminded Victoria of the depressing news she’d received in the post that morning. It had been all she could do to force down a few cornflakes when she’d read it, reviving painful memories of her time in Australia. Its effect on her mood was going to make it a very long day indeed.

She was dragged back from her reverie to the present by the loud voice of Maggie Brown, the receptionist. She was a round-faced, pleasant woman with a wild bun of hair, which was escaping from numerous large hairpins.

‘If we’re making a fresh start, I want to put in a plea for another receptionist to help soon. I know we have Lucy, but she’s only part time, and sometimes I’m run off my feet—I really do need some more backup. I’ve been telling John for ages that we’re understaffed, but he never took any notice.’ She gave a half-laugh to soften her words. ‘If I have a breakdown soon, don’t say I didn’t warn you.’

‘We’ll bear that in mind, Maggie,’ said Connor gravely. ‘Do you have any comments, Pete?’

Pete Becket, bespectacled and burly, nodded emphatically. ‘We urgently need to run over the number of domiciliary visits and dermatology reports the practice has been racking up—we’re going to be well over budget this year if we aren’t careful. Of course it’s been difficult to pin John down in the last few months,’ he said, putting a large folder on the table. ‘But we don’t want to start off on the wrong foot.’

‘And while we’re on the subject,’ broke in Karen, ‘John did mention that we should think about getting a phlobotomy nurse—it would save so much time when we need blood samples, instead of sending patients all the way into Sethfield.’

‘That’s something that will have to be discussed with the other practices in our cluster,’ said Pete. ‘Now we’re involved in practice-based commissioning it’s important we put these points forward at the next meeting. And, of course, the biggest issue is the closure of the local community hospital, St Hilda’s, to make way for commercial building in the town. Some of them are for it, others not.’

Connor and Victoria glanced at each other and he put up a hand. ‘Hey! Give us a chance to take breath—we’ve only just got here! We’ll certainly look into your concerns—I’ve been making notes so that Victoria and I can study them and then we’ll have a proper meeting.’

‘Asap, I hope,’ said Maggie, ‘otherwise I may come to a full stop!’

Karen stood up, her blue nurse’s uniform straining over her plump body. ‘Right—if that’s all, I’d better get going and start doing the BP tests on the oldies now. I can hear the waiting room filling up.’ She went to the door and then turned back to say brightly, ‘Oh, and by the way, we need more coffee and biscuits, we’re right out. Can someone get them before our break?’

‘Well, I’ve no time to get any,’ said Maggie firmly, as everyone began to leave the room. ‘I’m just about to load the morning lists onto Connor and Victoria’s computers—and I’ve got to switch the phones through now.’

Connor and Victoria were left alone. They stared bleakly at each other for a second as if the reality of working together had begun to sink in. Then Connor pulled forward the pad he’d been making notes on and said tersely, ‘They don’t seem very happy!’

‘I’m afraid your father seems to have left a few problems behind him,’ observed Victoria. ‘As senior partner he had the final say in all the decisions. He should have ironed some of them out before asking us to take over.’

‘Excuse me? What do you mean?’ Connor frowned at her, his voice sharp. ‘There were two of them here, you know. My father has probably been off work quite a bit with his treatment. Betty knew what the position was.’

‘She was run off her feet—it’s not easy to cope being the only GP in the practice,’ Victoria pointed out forcefully. ‘They should have got a locum in. It seems to me John was trying to save money.’

‘That would have been a joint decision—and anyway perhaps some of things that have been mentioned aren’t cost effective. No good splashing money around.’

He stood up and stared down at her frowningly, his eyes a steely blue. It made her feel a little…well, unsettled, as if he was looking right into her mind and didn’t like what he saw there.

‘I’m not blaming anyone—just stating facts,’ she said.

‘No, you’re making suppositions, Victoria, jumping to conclusions about my father.’ He glowered at her again, his strong face a study in anger. ‘As I remember it from school, you do have a tendency to blurt out opinions without backing them up with evidence.’

Victoria laughed—it was such a preposterous statement. ‘What the hell are you talking about? For goodness’ sake, dragging up school days!’ She looked at him scornfully. ‘Perhaps it would be as well not to go back there.’

For a second he looked slightly abashed—perhaps he was remembering that night when he’d been so insulting to her, and she pressed home her point. ‘To be honest, I don’t know how we’re going to work together if you’re going to be so rude—in fact, I give our partnership a week or two at the most if this goes on.’

His strong face relaxed into a grin, making him look quite boyish, and he raised his hands in contrition. ‘OK, OK, so I spoke slightly out of turn. But it’s no good looking back at how the place was run and apportioning blame.’

Those blue eyes revealed a twinkle of laughter in them, holding Victoria’s with a teasing charm, and to her continued annoyance she felt a treacherous and brief flicker of response to the sexy aura he exuded. Something about his eyes and the amused quirk of his mouth, she supposed. He had a point about looking back, though—the only way they could work together was to deal with the present problems and not point a finger at either John or Betty for causing them. Connor shot a look at his watch.

‘Well, it’s time to take the plunge now. We’d better thrash over these problems later—in the pub after work tonight suit you?’

Victoria shrugged unenthusiastically. She knew she wanted this particular day to finish early, to digest the news she’d received in the post that morning and wallow in a bit of nostalgia for things past. Discussing the troubles of the practice at the end of the day sounded very unappealing. ‘OK, I suppose so…’ She sighed.

‘Don’t sound so keen.’ Connor put his hands on the desk and looked at her appraisingly with those startling blue eyes. ‘Look, I can tell you aren’t over the moon about working with me, but we’ve said we’ll give it a go, so in the circumstances we’ll have to make the best of things.’

‘I agree with you,’ she said coldly. ‘We need to pull together to make a success of the practice, and I’m quite prepared to do that. I’ll meet you tonight to discuss things, even though it’s not actually very convenient.’

‘Good,’ he said briskly, gathering up some papers and making for the door. He looked back at her before he went out. ‘By the way, if you need any help, let me know.’

Victoria’s face burned with irritation. He might have been trying to be helpful, but she interpreted his offer as slightly patronising. She controlled her voice with an effort.

‘I think I can manage quite well, thank you—after all, I’m just as experienced as you.’

He raised an eyebrow and gave a low chuckle. Victoria had become much more assertive than he remembered! ‘Just a suggestion, Freckles—lighten up a bit. No need to be so deadly serious!’

He’d gone before she could think of a timely retort and indignantly she snatched up her bag. This was a fine start to the first day of work at The Cedars!

Her heart was thumping angrily as she stalked out and made her way to her room. She was cross with herself for allowing him to get under her skin—but she was a grown up now and in future she would maintain a dignified and professional approach, however much he irritated her, she told herself sternly.

Her first patient that morning was Janet Loxton, middle-aged and immaculately dressed in a tan suit with a black scarf draped elegantly round her neck. She sat down on the edge of the chair and Victoria took a deep breath and tried to calm down while she listened to the woman. Mrs Loxton’s look was unnervingly hostile.

‘I wanted to see your mother—she’s my usual doctor,’ was the unpromising start. ‘I must say I’m shocked to hear she’s left the practice.’

‘She felt it was time to retire,’ explained Victoria. ‘She’s now married to Dr Saunders and they plan to go away for a rest.’

‘She might have given us more notice.’ A deep sigh. ‘Anyway, I suppose we’ll have to get used to you.’

I seem to be surrounded by rude people, thought Victoria wryly, but she fixed a smile on her face and said soothingly, ‘I’m sure when you get to know us better, things will be easier.’

Janet gave a cynical grunt, then said abruptly, ‘I need sleeping pills. I’m awake all night and I’m run off my feet all day, looking after my father…’

Victoria groaned inwardly. It was Sod’s Law that her first patient would start off with what she called a ‘heart-sink consultation’. Giving sleeping tablets was something she was very reluctant to do, feeling it was a fob-off for a quick result, and didn’t tackle the underlying causes—but in her experience the patient was usually adamant about having some!

‘And is this insomnia something new?’ asked Victoria.

‘Oh, no, I’ve had it before. I suppose it’s worry… Anyway, you’ll see that Dr Sorensen always gave me something for it. Just give me the same things, please.’

The woman’s tone was peremptory, trying to hurry the consultation along. Victoria peered at the patient’s notes on the computer and saw that her mother had indeed prescribed sleeping tablets in the past, but she was damned if she was going to just hand them out like sweets on demand.

‘Do you work as well as look after your father?’ she asked.

‘I have a part-time job at the dress shop in the village. It saves my sanity. The rest of my time is spent running after an old man who needs professional help.’

‘I take it he lives with you?’

‘Yes…has done for the last five years. He needs to go in a home, though, but that’s absolutely out as far as he’s concerned.’

Victoria leant forward and looked at the woman sympathetically. ‘It can’t be an easy situation for you…’

‘Of course it’s not!’ snapped Janet. For a second her mouth trembled, revealing very briefly the strain she was under. ‘That’s why I need these pills—I’ve got to get some rest.’

‘Have you spoken to Social Services about getting help?’

Janet gave a humourless laugh. ‘Oh, they’ve sent people in to give him baths, tidy him up a bit, but he’s just sent them packing—he can be very rude when he wants to. Refuses to have anything to do with them. Do you wonder that I can’t sleep?’

‘Mrs Loxton,’ said Victoria gently, ‘you can’t keep on these tablets for ever, and anyway the effect begins to wear off when you have them continually. You can develop a tolerance for them and need a higher dose to have the same effect.’

The patient leant forward and said intensely, ‘I know all the pitfalls—you don’t have to tell me. Your mother gave them to me, and I don’t see why you just can’t give me some without all these questions.’

‘I can’t just hand out prescriptions because my mother gave them to you,’ said Victoria firmly. ‘Your circumstances and health may have changed since you last saw her. However, I will give you a low dose of Triazolone—a ten-day course to try and get you back on an organised sleep pattern. But sleep disorders can be caused by a number of factors and I want you to try what we call sleep hygiene.’

Janet looked puzzled and Victoria smiled. ‘Nothing to do with being clean! It’s a kind of routine—wind down at the end of the day, don’t stimulate your brain with television or exciting reading, and obviously cut out caffeine, and have a warm drink before you go to bed.’

‘Yes, yes, I’ll do all that,’ said the woman impatiently.

Victoria looked at her patient reflectively. ‘You know, what you could do with is some respite care for your father. Perhaps he’d be amenable to going into a home for a few days. It would give you a break.’

‘I doubt he would—he’s as stubborn as a mule. He’s ninety-six and has always been like that, so I don’t think he’ll change now.’

‘Why don’t I come and see him and give him a general check-up? I could broach the subject to him then.’

Victoria printed off the prescription from the computer and gave it to Mrs Loxton, who put it in her handbag and rose from her chair.

‘I don’t think he’d want to see you—he doesn’t hold with doctors and I don’t want him upset because I have to deal with the consequences,’ she said abruptly. ‘Anyway, there’s nothing wrong with him as far as I can see, except arthritis, poor eyesight and a beastly temper. Thank you for the prescription anyway.’

She disappeared and Victoria frowned as she updated the woman’s notes. She wished she knew more of the background to Mrs Loxton’s domestic affairs—was she married, and did she get any help for her father from her family? This was where her mother’s knowledge would have been invaluable. She tapped her teeth with her pen thoughtfully, then pressed the intercom to the office.

‘Maggie, could you spare a second?’

‘Sure—I’ll be with you in one second. I’m just sorting out some appointments.’

‘I just need a bit of background information…I won’t keep you.’

Maggie’s face, surrounded by her wild hairstyle, peered round the door. ‘How can I help?’

‘I’ve just seen a patient called Janet Loxton—can you tell me her father’s name?’

‘Of course. He’s Bernard Lamont. You may have heard of him.’

‘The name sounds familiar—isn’t he an artist?’

Maggie nodded. ‘Oh, yes—he’s one of Braithwaite’s celebrities. He exhibits at the Royal Academy, I believe.’

‘Ah, I knew you’d know about all the patients,’ said Victoria. ‘Can you tell me anything else about him?’

Maggie smiled—she looked quite pleased to be asked. ‘He’s a right curmudgeon, though of course he’s very old now. I believe he can’t paint any more, so that’s hard for him. He and his daughter don’t get on.’

‘He lives with his daughter?’

Maggie nodded. ‘Well, she moved into his house when her marriage collapsed—that was a few years ago when Bernard Lamont was OK. Now she’s got a new boyfriend and it can’t be easy to carry on a romance with a demanding parent in the background.’

‘Has she any family or siblings?’

‘Not that I know of. She used to work in London when she was married.’

‘Right. Thanks, Maggie, that’s very helpful. It’s good to get the background on patients’ lives—gives me a fuller picture. I’ll make a note to visit Mr Lamont.’

Maggie laughed. ‘You’ll be lucky—he won’t see anyone.’ She turned to go. ‘I’ll get back, then. Can’t leave the desk too long at this time of day—it’s like a jungle out there sometimes!’

They smiled at each other and Victoria pressed the intercom to summon the next patient with a sudden upsurge of spirits. She could see that Maggie had a sense of humour—someone she hoped she could have some fun with. Getting to know the patients and the day-to-day doctoring was part of being a GP, and if Maggie could help her fill in the backgrounds of these people, so much the better.

The morning spun by with a succession of patients with fairly mundane complaints from sore throats to bad backs, and by the time the last patient came in it was nearly eleven o’clock and Victoria could smell an enticing aroma of freshly brewed coffee drifting across from the little kitchen. She glanced at the clock—hopefully she’d be able to grab a cup in about five minutes.

A large, ruddy-faced man entered the room, leaning heavily on a stick, followed by an anxious-looking woman.

‘Please, sit down, both of you.’ Victoria smiled.

The man sat down heavily, his chest heaving in and out and a wheezing sound coming with every breath.

His wife started speaking quickly before he could say anything. ‘I’m so glad we were given this appointment, Dr Curtis, because I’m really anxious about Dan. He’s not been well for the last few weeks, but he wouldn’t come and see you. Today he seems really ill, and I’ve said if he didn’t come now, while he was in Braithwaite at the market, I’d throw his cigarettes away—and I meant it!’

Dan Wetherby shook his head, unable to speak, and Victoria got up and warmed her stethoscope in her hands. ‘I think I’d better examine you, although I can hear your breathing’s not good even before I look at you. Let’s undo your shirt.’

‘Susan’s just fussing—there’s nowt to worry about,’ he wheezed, and was convulsed by a racking cough.

‘I’m not fussing,’ protested his wife. ‘I knew your mother, Doctor—she’s such a lovely woman—and she said months ago he was to come for a check-up. She even came round to see him, but he’s that stubborn…’

Victoria waited until Dan stopped coughing and then put her stethoscope on his chest, front and back, listening intently. It sounded bad, as she had known it would, crackles and wheezes in all zones, and his heartbeat was very fast. The couple watched her face anxiously, trying to read from her expression what the diagnosis would be.

She put the stethoscope on the desk and folded her hands in front of her. ‘You know yourself you’ve got a very bad chest, Mr Wetherby. How long have you been like this?’

‘Weeks,’ said his wife. ‘I begged him to come and see you, but he wouldn’t—the obstinate old fool.’

‘Can’t leave the farm,’ wheezed Dan.

Victoria took a deep breath—she knew he wouldn’t like what she was going to say next. ‘You aren’t well, Mr Wetherby,’ she said gently. ‘Your lungs aren’t working as they should and I can hear all sorts of crackles. You need immediate hospitalisation to relieve your symptoms.’

‘Can’t you give me an antibiotic?’ he whispered. ‘That’s what I had last time I had an infection.’

Victoria nodded. ‘You certainly need antibiotics, but the hospital will give them intravenously to make them work more effectively, and in any case until you have a CT scan and a sputum test, we don’t know exactly what we’re dealing with…and we can’t give you those procedures here.’

‘I can’t go to bloody hospital… I won’t…’

Susan clasped her hands together and looked across at Victoria. ‘It’s bad, isn’t it?’ she said quietly.

‘As I say, I can’t tell exactly what’s going on until tests have been done—and that has to be done quickly, and in hospital.’

Dan struck his stick on the floor. ‘I’m not going—not without another opinion. Think of all the stuff I’ve got to do at the farm…’

Victoria looked at Dan’s stubborn expression and sighed. Perhaps he felt he was giving in to his illness if he did what she advised. ‘Look,’ she said with an encouraging smile, ‘what about if I asked Dr Saunders to look at you? If he confirms what I think, would you go then?’

‘Might do,’ he muttered.

‘Oh, yes, you will, Dan Wetherby.’ His wife looked at her husband fiercely. ‘I’m not having another night like last night, with you hardly able to breathe for that cough. We’ll see Dr Saunders as well, just to hammer home that he needs to go to hospital.’

‘I won’t be a minute, then. I’ll just see if he’s still here.’

Victoria went to the office to find out if Connor had started on his home visits or was still in surgery. He was sitting in front of the computer, peering earnestly at the screen and making notes.

‘Connor, can I have a word?’

He swung round. ‘Ah, Freckles…I mean Victoria. Don’t tell me you need help already?’

Victoria looked at him coldly. ‘Ha, ha. Very funny. Yes, I would like your help—and not because I don’t know what’s wrong with the patient,’ she said defensively.

‘I’m sure you do,’ Connor remarked lightly.

She ignored his remark and continued. ‘Mr Wetherby has chronic airway disease, very tachypnoeaic with widespread respiratory wheeze. I believe he should be admitted immediately for tests and therapy, but he’s adamant he won’t go until he has a second opinion, so…’

‘You’d like me to come and look at him?’

‘That’s it.’

‘Only too happy to oblige a colleague. Lead me to him.’

They went into Victoria’s room and she introduced Connor to the anxious-looking couple. ‘Dr Saunders will examine you, Mr Wetherby, and I know he’ll give an unbiased opinion on what should be the course of action,’ she explained.

‘Good morning, Mr and Mrs Wetherby.’ Connor gave them a charming smile and shook Dan’s hand, then drew up a chair to sit in front of them. ‘I believe you’ve been having some chest trouble. Dr Curtis tells me this has been worrying you for quite a while—am I right?’

His voice was kind and gentle, and the elderly couple, who had tensed noticeably as he’d come into the room, relaxed again. Victoria looked at him cynically. He could turn on the charm if he wanted to—his sympathetic manner showed a sensitivity she’d never experienced from him herself, she reflected.

Connor sat down in front of Dan, bending his head forward as he concentrated on the sounds coming through the stethoscope on the man’s chest. After a minute or two he looked up at Victoria.

‘Tachycardic and definite signs of consolidation at the left base,’ he murmured to her. Then added, ‘What was your advice?’

‘I think Mr Wetherby needs to go to hospital for immediate tests, nebulisers and intravenous antibiotics.’