The London Doctor Page 2

  Her gaze faltered. It hurt to remember those childhood years. ‘Ryan did, from time to time. His parents managed to unscramble themselves on occasion, as I recall, but he was happy with our foster-mum. She gave him stability of sorts.’

  ‘That’s true, I suppose.’An ambulance siren sounded in the distance and he got to his feet in one fluid movement. ‘We should get back to work. There might just be time for me to show you around before we get caught up in the melee once more.’

  He left her to meet up with the paramedics a few minutes later, and she worked steadily through the rest of the morning, trying to keep her mind firmly on the job in hand. It had been a shock, meeting up with him like this, and she wasn’t at all sure what was the best way to handle the situation. It looked as though he was going to be supervising her work for a good deal of the time, and things were by no means settled between them. Perhaps they never would be.

  His father had dismissed Ryan from his job on the estate, and that knowledge still rankled. No one had actually ever labelled Ryan a thief, but the implication had been there, and her foster-brother had never come to terms with that. It had hurt him to be branded a ne’er-do-well, and Hannah recognised that and had been fiercely loyal to him to the last.

  He wasn’t a blood relation to her, but they had been brought up together for a good many years, and she treated him as though he was her brother. Adam’s part in the whole sorry episode had unsettled her and had destroyed their tenuous relationship. He had sided with his father, and Hannah felt bad about that.

  Colin came and found her after the lunch break. ‘How are you holding up?’ he asked. ‘You look as though you’re a bit out of your depth. Can I help at all?’

  ‘Thanks. I might need propping up before too long.’ Her mouth made an odd quirk. ‘Everything’s so immediate, and there’s hardly a moment where you can stop and think. I still haven’t quite found my bearings. The whole place is like a warren, and I’ve lost my way on more than one occasion.’

  She grimaced, recalling how Adam had sharply intervened when she had nearly taken a patient down to the basement instead of up to Theatre, and she was still smarting from his cool admonition when she had been about to start treatment on a patient before waiting for lab results to come back. It had appeared to her to be totally necessary, but how could she have known that the man was a drug user who was known to the department for his wily subterfuges?

  She hurried over to the paramedics as they brought in another patient. The man on the trolley was semiconscious, with an oxygen mask over his face, and Hannah gave him a cursory glance, anxious to examine him and find out what needed to be done. She could see that his breathing was shallow and barely perceptible. He was slipping deeper into oblivion.

  ‘What happened to him?’ she asked.

  ‘It looks like a co-proxamol overdose,’ the paramedic said. ‘There was a bottle of tablets on his bedside table and, judging by the date they were prescribed, there are a lot missing. His neighbour found him.’

  ‘OK, thanks.’ Hannah supervised the patient’s transfer to a cubicle, and prepared to intubate him, but as she removed the mask from his face, she drew back in sudden alarm. ‘I know this man,’ she said, throwing Sarah a quick glance. ‘He lives in the flat opposite mine.’

  Dean looked in a bad way, and she had to quickly overcome the jolt to her system to make sure that she did whatever was possible to save him.

  ‘I’m going to put in an intravenous line and give him naxolone to try to reverse any cardiorespiratory effects,’ she told Sarah. ‘I’ll add N-acetylcysteine in dextrose as well, but we’ll need to check the prothrombin time and repeat the infusion accordingly.’

  ‘Are you going to do a gastric lavage?’ Sarah asked.

  Hannah nodded. ‘Yes, I’m going to put in a nasogastric tube. Let’s get him into a head-down position, and I’ll need two litres of warm water.’

  Inside, Hannah was feeling shaky. She ought to have known that something was wrong when she had spoken to Dean this morning. If anything happened to him, she would feel responsible. Guilt washed over her. She had to save him…she had to…

  She glanced up as her friend Abby appeared in the doorway. She looked fraught, concerned, as though she was in shock.

  ‘They said he was in here,’ Abby managed. ‘Is it all right if I stay? I need to know that he’s going to be all right. I had to get the landlord to come and open his door so that we could get in, and it took ages. I felt sure that something was wrong.’

  ‘Yes, of course you can stay,’ Hannah said. ‘It won’t be pleasant, though. You might want to look away. As soon as I’ve washed out his stomach, I’m going to give him charcoal to prevent any more absorption of the drug he’s taken.’

  ‘Is it very dangerous, what he’s taken?’Abby asked. ‘I mean, how bad is it?’

  ‘The drug contains paracetamol,’ Hannah explained as she worked. ‘It can cause irreparable liver damage, or even liver failure, if the overdose is large enough and we don’t clear it from his system.’

  She turned to Sarah and said anxiously, ‘I need to find out why he took so many tablets.’

  ‘Should we get a psychiatric consultation?’

  ‘Possibly. I’ll wait until I know more.’ She glanced at Abby. ‘Do we know if there are any relatives we should contact?’

  Abby grimaced. ‘I’m not sure. He said something to me about his parents—I think they live somewhere in Kent. I’ll see if I can find out exactly where.’

  ‘Thanks. I think that would be a good idea.’

  Abby stayed for a while, but she was increasingly restless, and after an hour had passed, she looked at her watch and said, ‘I can’t wait any longer. I have to go and fetch Ellie from nursery school or she’ll wonder where I am.’ She bit her lip. ‘There’s been no change in his condition, has there? Is he going to get through this?’

  Hannah glanced at her. ‘We’re doing everything we can, Abby, but it could take several hours before we can say for certain that he’s out of danger. I’ll let you know what’s happening, I promise.’

  ‘Thanks.’ Abby left, looking worried, and after a minute or two, Adam put his head round the door.

  ‘You’re still keeping watch over him, I see. Perhaps you should take a break, and then go and see to some of your other patients. There are a lot of people out there who need your attention, and the queue is getting longer by the minute.’

  She looked at him, her face pale. ‘But I know him. He lives in the same building as me, and I have to see him through this.’

  ‘You’re doing everything that you can. When Sarah comes back from suturing her patient, she’ll observe him and let you know if there’s any change.’

  He was right, of course, but it tore her to pieces to leave Dean like this. She said anxiously, ‘Are you sure there’s nothing more that I can do for him? I’ve been trying to think of alternatives that I might have missed.’

  He glanced at Dean’s chart. ‘It looks as though you may have found out why he took so many painkillers. He has an infected wound on his knee…is that right?’

  She nodded. ‘Yes, he does. He had an operation recently to repair the ligament, and somehow it became infected. I’ve taken a swab for the lab and I’m giving him antibiotic cover in the meantime.’

  ‘Then you’ve done enough for now. When you get the results back from the lab you’ll be able to choose a more specific treatment.’

  She didn’t have any more arguments to put forward, and there was no denying he was right when he said that she had other patients to attend to. Reluctantly, she followed Adam out of the cubicle as Sarah came back to check Dean’s blood pressure and pulse.

  ‘You know, you’re going to have to find a way of distancing yourself from your patients,’ Adam said. ‘If you get too deeply involved with them like this, you’ll be nothing but a shadow of yourself by the time you finish your stint here. You can’t afford to expend all that emotional energy.’

  ‘I don’t s
uppose you ever let that happen to you, do you?’ she remarked flatly. ‘You make it sound as though it’s easy to let go.’

  ‘I realise that it must be hard for you, but it’s something we all have to learn. Emotionally, we’re all vulnerable and you have to find a way to keep part of yourself detached, or you simply won’t be able to do your job.’

  ‘And you manage yours perfectly, don’t you?’ Her gaze challenged him. ‘You don’t let things bother you. You don’t worry about what happens afterwards, when the damage has been done. You simply let go and you move on as though it’s none of your concern.’

  Wasn’t that what he had done when Ryan had been in trouble? It had hurt all the more because she had idolised Adam, worshipped him from afar, compelled by his strength and firm character, and it had been as though he had let her down when she’d most needed his support.

  He frowned. ‘This isn’t a little cottage hospital where you get to know your patients and probably even live near them. This is the city, and our intake runs into the thousands. You can’t afford to let yourself care so much about everyone who comes through here.’

  She lifted her head, her mouth straightening. ‘No, I suppose you can’t. That wouldn’t do at all, would it?’

  His gaze ran over her. ‘I said that you don’t belong in the city, and it’s true, isn’t it? I’m not sure that you’re anywhere near tough enough to stand the pace—and it will overwhelm you, unless you manage to build up your confidence somehow, so that you’re better able to cope with everything that comes your way.’ He grimaced. ‘Perhaps you’d have done better to stay in the countryside, where you could work in a close-knit, rural community.’

  She looked into his eyes. ‘But I’m here now, and I plan to stay. I’m sorry if that doesn’t fit in with your plans.’

  He watched her, his expression cloaked, but she moved away from him and went in search of her next patient. No matter what he said, or thought, she wasn’t going to back down. She was here for a special reason…she was here to find her natural mother, and there was no going back. It was something she needed to do. If he didn’t like it that she was here, that was too bad.

  Hannah just didn’t know, right now, how exactly she was going to cope, working alongside him day after day. Once she had held a torch for him, and the flame had burned brightly, fiercely, until a cold, harsh wind had blown it out. Now their differences were too deeply ingrained for things to be easily resolved.

  CHAPTER TWO

  ‘DID you manage to get in touch with Dean’s parents?’ Hannah asked, glancing across her tiny kitchen to where Abby was standing in the doorway. She added water to the coffee machine and set the jug on its base to heat up.

  Abby nodded. ‘Sort of. I found their phone number, but they were out when I called, so I left a message, telling them what had happened. I gave them my number in case they wanted to get in touch.’ She frowned. ‘Do you think Dean will come through this all right?’

  ‘I hope so. It was a good thing that you looked in on him at lunchtime, or things might have been much worse for him. As it was, in the end we admitted him so that we could go on with his treatment, and his medical team will work to try to clear up the problems with his knee. They were taking him up to one of the wards as I came off duty and he seemed to have roused a little by then.’

  She didn’t tell Abby that there was still the danger of a relapse. She didn’t want to upset her friend, but in these situations there were sometimes ongoing problems, depending on the action of the drug that had been taken.

  ‘I’m just glad that Ellie was at nursery school—it would have been really upsetting for her to see him in that state.’ Abby glanced behind her, looking through to the living room where Ellie was playing with her dolls.

  Hannah nodded and poured coffee into two mugs, setting them out on a tray with cream and sugar. ‘We could take these through to the living room,’ she suggested. ‘There’s hardly room to move in here.’ She sent a brief glance around the room, taking in the single drainer sink, the cooker and the fridge. There was nothing more. It was what, in estate agent’s terms, they called cosy or compact…which meant that there was barely room in there for her, let alone enough space for two people to stand about, chatting.

  The living room was bigger, but the furnishings were sparse—there was a settee, a table and chairs, and her bed. Perhaps she would buy a decorative screen to hide that part of the room and set it apart from the rest.

  What would Adam make of her poky flat if he were ever to see it? She didn’t know where he was living in London, but it was close to the hospital, from what she had heard, and his accommodation was more than likely something special. His father’s house was a mansion, compared to this, and she guessed he was used to the best.

  Occasionally, she had been to events held in the extensive gardens on the family estate, and Adam had shown her around on her seventeenth birthday, giving her the full tour. She had been overwhelmed by the splendour of it.

  They went and sat with Ellie, watching her play as they sipped their coffee. The little girl was totally absorbed in her game, her face intent and purposeful as she wiped her doll’s cheeks with a paper towel and then combed her hair. Watching her, Hannah smiled, before turning her attention to Abby once more.

  ‘Do you see much of your parents?’ she asked.

  Abby shook her head. ‘We didn’t get on,’ she said. ‘There were lots of arguments, and then things finally came to a head when they didn’t approve of my boyfriend—Ellie’s father. I was young and headstrong, and deeply in love, and I followed him to London, despite their protests. In the end they were right, though. He didn’t have any staying power—he wasn’t the man that I thought he was.’ Her expression was sad, and Hannah felt uncomfortable that she had brought the subject up in the first place.

  ‘I’m sorry,’ she murmured. ‘I didn’t mean to rake up bad memories.’ She sent Abby a swift glance. ‘Is there any chance that you will make things up with them?’

  ‘I don’t think so. I waited a while, and then I started to send them cards and letters from time to time, but they didn’t get in touch, so I’ve let it go. I thought they might want to get to know Ellie, but obviously I was wrong.’ She made a face. ‘I sometimes think Ellie’s missing out on so much—her grandparents, and family life, and all the green open spaces where I used to live. There’s no garden here for her, and I feel that I’m letting her down.’

  Hannah didn’t know what to say. There was no way that things could be put right in a short space of time, and Abby was clearly still troubled by the long-standing estrangement from her parents.

  She said, ‘Perhaps what we all need is a break, a chance to get away from being cramped up in these flats. Maybe we could arrange an afternoon out some time. We could have a picnic in the park, or we might try a boat trip along the Thames.’

  Abby brightened. ‘A boat trip would be lovely. I’m sure Ellie would enjoy that.’

  ‘That’s what we’ll do, then. I’ll try and sort something out for next weekend, if you like—unfortunately, I have to work tomorrow and Sunday.’

  ‘That would be great. It will give us something to look forward to.’

  Hannah remembered their conversation on Sunday morning, when she was travelling on the tube on her way to work. It would do them all good to have some time out. She found herself longing for the green fields and the beech woods and the sleepy village she had left behind when she had come to work in London. Most of all, she missed her adoptive mother and father.

  There was no time to dwell on these things, though. As soon as she arrived at the hospital, she went to check on Dean, and discovered that he was at least responding to the medication. He wasn’t talkative, but he looked in better shape than he had been yesterday or the day before.

  Things were chaotic when she walked into A and E, and she was plunged straight into work. Mr Tremayne was nowhere to be seen, and Adam was the senior man in his place, the one who decided on who did what and
when.

  ‘I think I prefer it when Adam’s in charge,’ Sarah commented, grabbing supplies from the storeroom. ‘You know where you are with him. He’s efficient and confident, and you can rely on him. He always seems to know what to do, and he never dithers or mulls things over for too long when you need an instant answer.’

  Hannah was more guarded in her reaction to him. Her feelings were too raw where he was concerned, but she found herself watching him compulsively. Today, he was wearing a beautifully tailored grey suit, and there was no denying he looked good. His hair gleamed under the overhead lights, and he had that mark of authority, tempered with compassion towards his patients.

  He was decisive, but thorough, and he seemed to thrive on the constant rush of adrenaline, whereas it had the opposite effect on her. She wilted at the mere prospect of instigating life-changing procedures. She sometimes wondered whether she was cut out for work in A and E.

  ‘There’s a patient in cubicle two who is waiting to be seen,’ Adam said. ‘I want you to take a look at her. She’s complaining of abdominal pain, and she’s been vomiting. We’ve had one or two people in this morning suffering from food poisoning, so you should look out for that, and check whether she’s had any food from the same source as the others. We’ll need to liaise with environmental health if she has.’

  He didn’t acknowledge her in any other way, and part of her was glad of that. She was far too conscious of him as it was, and it was going to be difficult enough working with Adam over the next few months, with their past history getting in the way.

  She tended to the patient in cubicle two and then spent the next couple of hours dealing with a wide variety of cases that challenged her abilities at every turn.

  When Adam caught up with her, he asked briskly, ‘What happened with your abdominal patient?’ He glanced at his chart. ‘It says here that you’ve put her on IV fluids and sent her up to Theatre.’

  ‘There was a degree of tenderness in the right iliac fossa, and her history suggested appendicitis.’ She looked at him, expecting trouble, but he simply nodded and moved on.