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‘I know. I’m sure we’re all aware of that.’ Ruby made a muted response to his bracing tone. Perhaps he was annoyed because they had been talking about him, and they needed to make allowances for that. She added softly, ‘And I expect the problems that follow will be for real, too. I’ll leave you to deal with the complaints from the patients, shall I, and from the management when we fail to meet targets?’
He acknowledged that with a rueful twist of his mouth. ‘I imagine those will be the least of my worries.’ He gave her an assessing glance, his gaze shimmering downwards over her curves outlined by the soft cotton blouse that clung where it touched and then draped itself loosely over the waistband of her calf-length skirt. ‘Besides, I’m sure I can rely on you to help smooth things over during these difficult times. I hear you’re good at dealing with most problems that come your way. You appear to have a knack for calming troubled waters. Perhaps that’s why the department operated so efficiently while Dr Stanford was winding down for his retirement.’
Ruby’s eyes widened a fraction. Where would he have gleaned that wedge of information? Was it possible that he had been talking to his predecessor? Or maybe one or two of the board members had filled him in on her way of working. They might not have given her the job, but it didn’t necessarily mean they were unaware of her capabilities. Her lips made a wry shape. Perhaps her calm attitude was what had lost her the position. They wanted a lion that would roar and show its teeth.
Sam glanced at James and Olivia. ‘I know this is difficult for all of you, but there’s no point in moping about the situation. What we have to do is prioritise, knuckle down and get on with the job and concentrate on providing the best service we can under the circumstances.’
He turned to James and held out a patient’s file to him, his manner totally businesslike. ‘You examined a man who came in earlier with a broken wrist and suspected head injury after a fall…is that right?’
James nodded. ‘Tony Barton…a young man in his late twenties. I treated him for the wrist fracture and assessed him for brain injury, but his neurological responses were fine. I was getting ready to discharge him.’ He glanced at the file. ‘Are you ready to sign off his notes for me?’
Sam shook his head. ‘His condition has changed, according to the nurse who was following up on him. I’d like you to come with me and take another look at him, please.’
‘Oh…of course.’ James’s colour faded, and Ruby could see that he was wondering if he was in trouble of some sort. He was usually thorough and conscientious in everything that he did, but Sam, being a newcomer, clearly didn’t know that.
Sam nodded towards Ruby and Olivia and then strode off with James in the direction of the treatment room.
Ruby’s gaze met Olivia’s, and the senior house officer rolled her eyes. ‘Does that man ever stop to engage in the niceties of getting to know his colleagues?’ Olivia asked. ‘He’s brisk and businesslike, and his whole attitude is “stop fussing and let’s get on with it”, though I must say he seems half inclined to pass the time of day with you…but as to the rest of us…’ Olivia sucked in a deep breath. ‘He’s only been here five minutes, and I’m already beginning to wish Dr Stanford had delayed his retirement.’
Ruby grinned. ‘I dare say we’ll get used to him, given time. He has a huge task ahead of him, and he’s probably still working on his strategies. I expect he has a heart of gold underneath it all.’
‘We’ll have to dig deep to find it,’ Olivia murmured, moving away in search of her next patient. ‘I have the feeling it’s buried under a ton of steel.’
She could be right in that. Ruby frowned as she riffled through the files in the wire tray. Their new boss didn’t appear to be making any concessions to the fact that he was a stranger in their midst, and that they might have difficulty getting used to this different way of working. It was all or nothing with him.
She glanced through the list of patients waiting to be seen. Her first job was to check on the patients from the traffic accident, and in doing that her time was taken up with a host of complications that had arisen from an assortment of broken bones and punctured blood vessels. Worryingly, one man went into cardiac arrest, and she had to use the defibrillator to shock his heart back into a safe rhythm.
‘He’s back with us,’ she said a few minutes later, addressing the nurse who was monitoring his situation. ‘Give the intensive care unit another call, will you, and see if we can move him over there as soon as possible.’
‘I’ll do that,’ the nurse said.
An hour later things settled down a little, giving her time to attend to a young boy who had been injured during a football match on his local playing field.
‘That was an unlucky game for you, Matt, from the sound of things,’ she said, smiling at the seven-year-old and then inspecting the X-ray film displayed in the light box. ‘When you fell to the ground, you hit it with enough force to break your collarbone. That’s this one, here.’ She pointed out the area of the fracture to the boy and his mother. ‘There’s a line across here that shows the break in the bone.’
She turned to look at Matt once more. ‘The good news is, it should heal up quite well because the two pieces of bone are still in line and touching one another. You’ll need to wear a support sling for a week or two while the bone heals, and we’ll give you some painkillers to help you feel better.’
His mouth made a flat line. ‘If I’d done this in a couple of weeks’ time, when school starts again, I could have had some days off. And I don’t even get a plaster cast for my friends to sign.’ He looked thoroughly disgruntled.
‘Isn’t there any street cred in wearing a sling?’ Ruby lifted a brow. ‘I would have thought you could get some pretty good mileage out of that. And it’s the hand that you write with that’s out of action, isn’t it? I’ll bet you can impress your mates with a left-handed signature.’
His expression brightened. ‘Yeah, maybe.’
His mother smiled as they stood up to leave a few minutes later. ‘I’m sure he’ll milk this for all it’s worth,’ she murmured in an undertone to Ruby. ‘He’ll be playing the part of a wounded secret agent before too long, I’ll be bound.’
Ruby nodded agreement, and gave Matt a bravery certificate as he left the room. It seemed he was already working on his game plan. ‘Tyler didn’t get one of these when he sprained his ankle,’ he said. ‘He only got a badge that was this big.’ His fingers made demonstration of its tiny size.
Ruby laughed and watched them leave before going in search of her next patient. She worked steadily through the morning, dealing with a wide variety of injuries suffered by active young children intent on enjoying their summer holidays to the full, while at the same time keeping an eye on the work of the senior house officers in her charge. Sam was nowhere to be seen.
James had been missing for some time, too, but she caught sight of him when she was heading towards the ambulance bay. An infant with breathing difficulties was being brought in to A&E by ambulance, and she expected him to arrive in the next few minutes.
‘Is everything all right, James?’ she asked now, still continuing on her way. ‘You look as though you’re in shock.’
James fell into step beside her. ‘I’m fine,’ he said. ‘I just don’t know how my patient could have gone downhill so rapidly. One minute he was sitting there, talking to us, and the next his speech started to slur, and he began to sink into unconsciousness. And to think I almost sent him home.’
‘What happened?’
‘Sam—Dr Boyd—did a CT scan and then whisked him up to the operating theatre. He told me to scrub in. It turns out that he specialised as a neurosurgeon originally and then after several years of doing that decided to take up emergency medicine.’ He shook his head in wonder. ‘Everything happened so fast. It seemed like within minutes the anaesthetist was there and the patient was out for the count, and then Sam was cutting a segment out of his skull.’
‘So it was a blood clot causing pressure on the brain?’
James nodded. ‘That’s right. I actually got to suction it out, but then Sam took over and stopped the bleeding. He says we have to watch him for swelling on the brain and seizures, and I have to keep an eye on him. I’m just on my way to talk to the man’s wife. She came in to the hospital expecting to take him home, but now, of course, he’ll be admitted to the surgical ward.’
Ruby glanced at James. ‘You sound as though the experience has opened your eyes in some way. I don’t think I’ve ever seen you quite so shaken up.’
He nodded. ‘Well, he’s not out of the woods yet, and that’s a worry, but thinking about what might have happened, and seeing our new boss at work, has given me something to think about. Not only that, but it’s made me wonder if I ought to consider going in for a surgical specialty after my stint here. Watching him operate really made me see how much of a difference a surgeon can make to someone’s chances of recovery.’
‘Then something good has come out of this. I’m pleased for you, James.’
He made a brief smile and went on his way, while Ruby hurried to the ambulance bay, deep in thought. So Sam was more than just a force to be reckoned with on the hospital administration side of things. He was a first-rate doctor as well. It was more or less what she had expected, but somehow she had thought it might take more time for him to prove himself. At least he had managed to win James over to his side, brisk manner notwithstanding.
She went to meet the paramedics a short time later as they wheeled the infant out of the ambulance on a trolley bed.
‘This is Charlie, eighteen months old,’ the paramedic said. ‘He’s struggling to breathe, and there’s some nasal flaring. His blood oxygen level is low, and he’s in severe distress.’
Ruby could see at once that Charlie was very ill and the muscles of his rib cage were sucking inwards. ‘Let’s get him into the treatment room,’ she said. The toddler was breathing in oxygen through a mask, but she could hear him wheezing, and it was clear he needed urgent help.
Once in the treatment room, she called for a nurse to assist with giving oxygen while she examined the boy. Running the stethoscope over his chest, she heard crackles in his lungs and a wheeze whenever he breathed out.
His mother looked on anxiously the whole time, and after a while Ruby said, ‘He’s feverish and obviously struggling. I believe his air passages could be inflamed, so we’ll try him with a medication to help ease his breathing.’
‘What’s wrong with him?’ his mother asked. ‘He’s had a runny nose for a few days now, but suddenly he seemed to go downhill, breathing fast and getting tired and irritable. He’s been off his food too.’
‘It’s probably a viral infection of some sort,’ Ruby explained. ‘I’ll do a nasal swab and send it to the lab to be sure what we’re dealing with, but in the meantime we’ll concentrate on supporting his breathing. We’ll keep him in our observation ward for the next twenty-four hours, and then we’ll most likely have to move him to the paediatric ward for a few days. The nurse will explain everything to you and make arrangements for you to stay with him if that’s what you want to do.’
‘Yes, I do. Thank you.’ The young woman leaned over and stroked her child’s hand, offering him comfort, but the boy was too ill to respond. He just lay there, unmoving, strands of his hair curling damply over his forehead.
‘Here, take a seat,’ the nurse said, pulling a chair to one side of the bed. Michelle was a capable girl, slender and pretty, with dark hair that fell in a sleek bob to the nape of her neck. ‘I’m sure he knows that you’re here with him, and that will help to ease his distress.’
Ruby knew that she was leaving the mother and child in good hands. She wrote up the boy’s chart, detailing the medication to be given, and then arranged for the nasal swab to be sent to the lab. ‘I’ll look in on Charlie again soon,’ she told the mother, knowing that the nurse would let her know if any problem came up in the meantime.
‘So there you are,’ Sam greeted her as she walked back into the main area of A&E. ‘I’m afraid we have to prepare for another intake of crash victims. There are expected to be around ten of them, according to the paramedics at the scene. The first will be arriving in about fifteen minutes, they say.’ He shook his head. ‘I can’t imagine what’s happening out there on the roads today.’
‘People are travelling to the coast for holidays, or driving back home,’ she guessed. ‘I suppose that means there’s a lot more traffic out there.’
‘Maybe.’ He paused. ‘Before we get ourselves immersed in the chaos of dealing with the intake and I lose sight of you again for the next hour or so, I wanted to ask if you know anything about what the situation is here with the domestic staff. We don’t seem to have a proper clean-up crew—to attend to mishaps and the like in the waiting room. There just seems to be a couple of ward assistants who bring round the coffee, or tend to the book trolley, and descend on the unit if and when they’re called for. I’ve been asking various people, but no one seems to want to give me a proper answer.’
‘Hmm.’ Her brow knotted. ‘I believe you’re talking about Dolly and Mabel. Don’t you go upsetting either of them. They’re our in-house treasures. We rely on them for all sorts of odd jobs, and I don’t think people would take kindly to you striking them off the staff list.’
‘No, probably not.’ He studied her thoughtfully. ‘You’re frowning,’ he said. ‘I have the strong feeling that it’s because of me, or something I’ve said. I’ve been getting a lot of that today. Would you care to enlighten me?’
‘Well, I know the situation here is serious,’ she murmured. ‘Times are hard, and we all have to pull together to get the job done and all that…but I think you really need to try and loosen up a bit.’ She hesitated, not wanting to go too far. He was the one in charge, after all.
‘I do?’
She shrugged her shoulders, giving in to his gentle prompting. What would it matter if she were the one to tell him a few home truths? No one else would consider doing it. ‘Quite definitely. We really shouldn’t lose sight of the human touch, you know. We aren’t in the boardroom now, and even the most difficult of tasks can be made sweeter with a modicum of pleasantry.’
He raised a dark brow. ‘You’re saying you think I’m too abrupt?’
She made a vacillating kind of movement, as though she was weighing things in the balance. ‘I’m afraid you run the risk of alienating the people you depend on,’ she said.
He made a face. ‘I dare say you’re the one to put me right on that score. From what I’ve gathered this morning, I’m sure you’ll be well able to assist me in pulling things into shape. You’re the one topic people are prepared to talk about. I’ve been hearing nothing but glowing accounts of your capabilities in this department.’
‘I’m sorry about that,’ she said with a laugh. ‘You sound as though it’s beginning to grate on your nerves.’
‘Not at all. It’s good to know that we have such a diamond in our midst. I’ll be glad of all the help I can get.’
‘We’ve always been a happy crowd here at Ashvale A&E.’ She didn’t add, before he came along, but he probably caught her meaning.
‘I guess I’ve a lot to learn.’ It didn’t seem to bother him, though. He glanced at the watch on his wrist. ‘Anyway, back to the immediate problem. I’ve asked Michelle to do triage, the senior house officers will take the urgent cases, and you and I will deal with the most seriously injured. It means we’ll be running at full tilt with a minimum of staff.’
He checked the whiteboard, assessing the number of patients still in attendance and needing to be seen. ‘I’ll have a word with the nursing sister on duty and see if we can have some of her specialists attend to the less serious cases in the waiting room. That should clear the backlog.’
He glanced at her as though looking for confirmation, and she raised a brow. ‘Are you asking if I agree? I told you, if you were trying to save money, I think you should have looked to cutting down on the maintenance contracts before you went ahead and dispensed with nursing services. We don’t need to have the light bulbs checked once a month, or have laundry sent to an outside company when we have perfectly adequate facilities on the premises. Nor do we need to order paper plates on a regular basis when we have dishwashers and crockery on site.’
His mouth made a crooked shape. ‘I wasn’t looking for a debate on the whys and wherefores. A simple “yes, that sounds about right” would have done.’ His eyes took on a glimmer of amusement. ‘I was attempting to keep you in the loop, so to speak, since it’s fairly obvious you’re the lynchpin around here. Is there anything else you think we need to have in place?’
She thought about it. ‘Yes,’ she murmured after a second or two. ‘We need doughnuts.’
‘I beg your pardon?’ He looked at her as though for a moment she’d lost the plot.
‘You won’t get by without them,’ she said on a firm note. ‘If you expect your staff to work through their lunch breaks and keep going without flagging, you’ll have to do something to boost their energy as well as their morale.’ She gave him a bright smile. ‘I’ve always found that doughnuts hit the spot. Mark my words. A little bit of sugar goes a long way.’
‘I’ll try to remember that,’ he said. He threw her a teasing look as his gaze wandered over her softly feminine curves. ‘You’re not on any kind of diet, are you? So if I were to feed you sugary sweet doughy treats, would that help to bring you on side? I could rely on you to be my right-hand woman?’
She sent him a direct grey glance. ‘I certainly won’t say no to the food…but as for any other outlandish expectations you might be harbouring, I wouldn’t push your luck, if I were you. I’m only ever on the side that looks to be about right.’
He tilted his head back in a resigned gesture. ‘I might have known,’ he murmured. His mouth curved. ‘Still, it was worth a try.’
Chapter Three
‘IT’S really good of you to help me out like this.’ Ruby thanked the woman who was running the creche at the hospital. ‘I don’t know what I would have done if you hadn’t been able to find a place for Becky at such short notice.’
‘Well, you did say it was just for a few days, and we have a couple of vacant places available while people are away on holiday.’ The woman smiled, watching Becky as she lay gurgling on the mat, trying to clasp the plastic toys that dangled overhead from the play gym. ‘She looks as though she’s a contented child.’
‘Yes, she is, for the most part.’ Which was just as well, because with all the problems that had cropped up of late, Ruby was sure she wouldn’t have been able to cope with a fractious infant. Things had been going reasonably well until the day before yesterday, when Sophie had gone out, saying she was going on an errand to the shops. When she didn’t return, Ruby had begun to worry.
There was still no sign of her, and Ruby was becoming increasingly anxious. She had tried contacting her by phone, and she’d searched high and low before frantically enlisting the help of the police. Sophie was now officially a missing person, and no one had any idea where she had gone.
It had all come as such a shock, and now Ruby was finding it difficult to juggle work in A&E with looking after the baby. How was she going to cope when she had to move into the farmhouse over the weekend now that Sophie was gone? There would be a whole lot more problems for her to concentrate on then.
‘I’ll come back at lunchtime to see how she’s getting on,’ she said, reluctantly preparing to leave.
‘That’s good.’ The nursery matron gave Ruby a reassuring smile, probably sensing her underlying anxiety. ‘I’m sure she’ll be fine.’
Yes, most likely she would. Ruby cast a last, fleeting glance at the baby before she left the room. Becky had no idea of the disturbance that had ebbed and flowed around her since her mother’s health had begun to decline. And now Sophie was missing.
Bracing herself to face the rest of the day, Ruby made her way back down to A&E. She stopped by the central desk and made a few phone calls, first of all, checking up on the patients who had spent the previous day in the observation ward.
‘No problems to speak of,’ Lorraine, the nursing supervisor, told her. ‘We’ve arranged for two children with chest infections, query pneumonia, to be admitted, as you asked. Apart from those, everyone else looks fit enough to be discharged.’
‘That’s good to hear. I’ll drop by later this morning and finish the paperwork.’ Ruby hesitated. ‘Is there any news on Charlie—the infant with breathing difficulties? I put him on humidified oxygen, and then we had to add nebulised adrenaline because he wasn’t responding too well to treatment. Last time I went to see him he was showing a little bit of improvement.’
‘The boy with bronchiolitis? Yes, I checked for you. He was admitted to the paediatric ward from Intensive Care, and by all accounts he’s doing fine.’
‘Oh, that’s brilliant. Thanks for checking for me, Lorraine.’
‘You’re very welcome. See you later, then.’
‘Yes, I’ll come over to you in a couple of hours or so.’ Ruby replaced the receiver and began to hunt through a pile of papers in the wire tray on the desk.
‘Nothing’s going according to plan lately,’ Olivia said, coming to stand beside her. ‘I thought things were bad enough when I heard that we have two nurses off sick, but then I saw the management circular that was passed around first thing this morning. They’re talking about downgrading us to an urgent care centre…and that’s even before the meeting where it’s all supposed to be decided.’ She huffed, showing her annoyance.
‘I don’t know how our trauma victims would have fared if they’d been sent to the Heritage,’ Ruby commented. ‘Some of them were in a precarious condition when they arrived here.’ As it was, the patients who had been involved in traffic accidents a few days ago had either been operated on and were now recovering on the wards, or had been discharged.
Ruby glanced at the senior house officer briefly. Olivia was in a decidedly crotchety mood today, her usually serene face etched with lines of tension. ‘Is that all that’s bothering you?’
‘Not really. I took a look in the waiting room, and straightaway I wished I hadn’t.’
‘Oh, why’s that?’ Ruby glanced through a sheaf of lab test results, searching for a diagnosis on a small patient. If only her sister Sophie’s medical problems could have been properly diagnosed before she’d decided to take off. For that must be what lay behind her disappearance, surely? She didn’t think anything more sinister lay behind her failure to return, given that the police had let her know that she had been spotted boarding a bus in town on the day she had vanished without a trace.
Olivia started to answer, and Ruby dragged her mind back to the job in hand.
‘I’m out of sorts because that man’s in there again…the one who’s kept complaining of back pain ever since he was involved in a car accident some time ago. He’s been in here several times over the last few months, but we never seem to be able to get to the bottom of what’s causing his problems. Dr Stanford said they’d done all the tests and found no lasting damage. He told him he should go and see his GP about any symptoms he has, but he always comes up with some reason why he has to be here in emergency. Today it’s because he almost passed out when he went to fetch something from the local garage, and the manager brought him straight to the hospital.’
‘Oh, I see.’ Ruby nodded. ‘Well, I’ll take a look at him if you like. We’re not exactly overrun with dire emergencies at the moment, are we?’ She clamped a hand over her mouth. ‘Oh, I can’t believe I just said that.’
‘Said what? Is there a problem?’ Sam came to join them at the desk, tilting his head slightly to one side as he cast a quizzical glance over her. His black hair was crisply styled, framing his strong-boned features to perfection. His blue-grey eyes studied her curiously. ‘You’ve not been your usual self these last few days, have you? Is something wrong?’