New Surgeon at Ashvale A&E (15 page)

Ruby’s sensuous glow began to rapidly cool, and perhaps it was just as well that she had come back down to earth. He wanted her, but that didn’t mean that he longed for her to be part of his life, that he would love and cherish her for ever, did it?

The sound came again, a faint murmuring, and she gazed around, mystified.

‘It must be the baby monitor,’ he said at last. ‘Did you clip it somewhere?’

She drew in a deep breath. ‘I put it on the desk when we came in here,’ she murmured. ‘I’ve nowhere to clip it to on this dress.’

The sound came again, but this time it was a ‘doh, doh, doh’ that they both heard. Ruby slowly eased herself away from him and went to check the video monitor.

She gave a faint smile. ‘I think she must be dreaming of dogs and puppies,’ she said. ‘Look, her lips are moving, but her eyes are closed.’

He came to look down at the video screen. Sarah, his housekeeper, had come into the dining room and was checking the baby, soothing her with gentle words, so that Becky lapsed into a deep slumber once more.

‘Yes, you’re probably right.’ He glanced at Ruby. They both knew that the moment of closeness between them was lost, but Ruby still had those warm embers of pleasure to boost her spirits. ‘Dogs and puppies,’ he echoed. ‘You and Becky have both been pulled into that well of emotion that makes you want to care for everyone and everything, haven’t you?’

‘Does that seem strange to you?’ she countered. ‘It’s the breath of life to me. It comes from being brought up that way,’ she told him.

He shook his head. ‘I don’t get it,’ he said. ‘I don’t hold with all this need for closeness and dependency…with animals or people. Why can’t people just live for the moment and enjoy what’s on offer, without getting sentimental about everything? Even Sarah has that gooey look in her eyes.’

She sent him a guarded look. So what had just happened between them? Was it purely a physical thing as far as he was concerned? Was there no deeper meaning to his kisses, no subtle invitation to share something special with him, no unspoken word to say that he cared for her?

She floundered for a moment or two then said hesitantly, ‘We…Sophie and I…always had pets around us, and Becky
will more than likely follow suit. We were shown from a very early age how to look after those who needed us.’ She threw him an oblique glance. ‘Didn’t you and your brother have those same experiences? You must have had pets at some time…a cat maybe, or even a guinea pig or a rabbit?’

‘No, we didn’t.’ He moved away from her, and she sensed the sudden tension that had risen up in him. What had happened to bring about the stiff manner in the way he stood or to cause the tautening of his features? Had she done or said something to cause this change in his mood? Was he disturbed because of the way they had been interrupted? ‘Did your parents not like having pets around the place? I suppose they might tend to run amok, or be a bit smelly on occasion—but there’s usually somewhere outside where cages could be positioned.’

‘The occasion would never have arisen,’ he told her. ‘We weren’t here for all that long. At least, I don’t remember much about being here when we were young…and then I went away to boarding school for several years, so the question didn’t come up.’

‘I’m sorry,’ she said, going over to him. Was he uncomfortable because she was reminding him of things that had been missing in his life…the feelings of love and security and all the things that went along with close family relationships? Was that what this was all about?

‘I keep putting my foot in it, don’t I?’ she murmured. ‘I didn’t mean to rake up bad memories. I just wanted you to know that I care about you, and I want to understand what makes you the way you are. I hoped that you might feel closer to me in some way.’ She laid her hand gently against his chest, wanting to establish that warmth of connection once more.

‘You didn’t rake up any bad memories,’ he said, moving away from her, ‘and it would be better for you if you didn’t try to understand me or get closer to me. I don’t have anything
to offer other than what I am. I’ve never promised anything more, and I don’t have any plans for the future other than to secure the A&E unit.’ He pulled in a quick breath. ‘As to the rest, like I said, boarding school was okay. We had a good education, and we were privileged to be able to experience that. It stood both my brother and me in good stead for later years.’

He glanced around the room. ‘Shall we go back to the field and see what’s going on out there? I have to draw the tickets for the raffle in half an hour or so, and I expect you want to spend some time talking to Craig and your friends from A&E.’

Ruby gave him a bewildered look. It hurt that he was pushing her away, in both a literal and a physical sense. It was like a rejection, and she wasn’t sure whether he was rejecting her or the notion of close emotional ties.

She didn’t want to show her despair. Instead, she nodded. ‘Yes, of course. I said I’d pick out the winner of the treasure trail map too.’

She wished things hadn’t ended on this restrained, sour note. Everything had been going so well, but now Sam had reverted to his former self, keeping his emotions locked in, and the barriers were firmly in place. The shutters were down, and it dawned on her that she was right to have kept a guard on her innermost feelings. He had kissed her and drawn her close and made her feel wanted, but he would not let her into his heart, the one place where she wanted to be.

‘I
HEARD
that the fund-raiser made a huge amount of money for the A&E unit,’ Olivia said as her gaze skimmed the details on her patient’s chart. ‘That’s terrific news. I expect Sam’s enjoying telling the hospital board all about it this morning. They’re bound to reconsider the need to close us down after that, aren’t they?’

‘I hope so,’ Ruby answered. ‘Especially when you add to that all the savings we’ve made by cutting down on supplies, changing the prices we pay for medicines, and bringing in-house servicing contracts on board…and that’s without taking the staffing changes into consideration.’

She looked at the list of patients the triage nurse had given her. ‘I’ll go and look at the baby with the heart murmur,’ she told Olivia. ‘Perhaps you could see to the woman with the blurred vision?’

Olivia nodded. ‘I’ve looked at her notes, and I’m thinking migraine,’ she said. ‘I don’t believe there’s any need for a CT scan, do you?’

‘It doesn’t appear so from what we’ve learned so far, but do a thorough neurological check up and make certain the history is correct. Come and find me if there’s anything you’re not sure about.’

‘Okay, I’ll do that.’ Olivia glanced at Ruby. ‘I heard you
had some problems when you went home after the fund-raiser. James told me your neighbour thought she had seen Sophie at the house…I thought that would be good news.’

‘It would, under normal circumstances…but Mary, my neighbour, wasn’t exactly sure what she had seen. She said she saw someone coming out of the house, and that could only have been Sophie, surely, since she’s the only other person who has a key—apart from my parents—and there was no sign of a break-in. When we looked around later, it seemed that some of Becky’s clothes had been moved from where I left them, almost as though Sophie had picked them up and not put them back in the right place. Anyway, since then there’s been no sign of her.’

Olivia frowned. ‘James said there was something else wrong…a man had been seen hanging around the house and farm.’

‘That’s right.’ Ruby frowned. ‘I’ve no idea who he was, but one of the workers from a farm some half a mile away brought over some feed for the ponies and left it in the barn. He said he disturbed a man who had been hanging about by the orchard. He didn’t see him well enough to get a description, but he said he was definitely alone, and when the man saw him, he took off. I don’t see how he would have been able to get into the house. None of it really makes sense.’

‘It must be upsetting for you.’ Olivia’s gaze was sympathetic.

Ruby nodded. ‘It’s more worrying than upsetting. It would be good to think that Sophie was close by, but I can’t help thinking that the man being there was just a fluke—maybe he planned on stealing fruit or taking some of the animals. Either way, I wish Sophie had stayed to make proper contact. It’s unnerving not knowing what’s going on.’

‘Perhaps she’ll come back. It does sound as though she wants to do that.’

‘Yes, it does.’ Ruby sighed inwardly as she thought about
the events of that day. Sam had stayed around to help her search for any sign that Sophie was still around, but though he’d been concerned for her, the barrier between them had stayed in place. He had made no attempt to bring back the closeness that they’d had before.

It was a mystery to her, and it left her feeling at a low ebb. She didn’t know how to find the key to unlock his heart.

She busied herself with the day’s work, referring the baby to a cardiac specialist, although she suspected that the heart murmur was not of great significance. The rest of her patients were easy enough to deal with, mostly uncomplicated fractures or gashes that could be sutured without throwing up too many problems.

Sam came back from his meeting with the hospital chiefs around midday, and she glanced at him, expecting him to be in a good mood. Instead he was grim-faced, and when Ruby tried to speak to him, he was brisk and efficient.

‘I can’t stop and talk right now,’ he said. ‘There’s a twelve-year-old boy being brought in by ambulance, and I need to prepare for him. He’s been referred to us with suspected meningitis by the local GP.’

His words put her on immediate alert. ‘What can I do to help?’

‘You can ask Michelle to get the isolation room ready for him. He’s being given oxygen by mask, but I’ll probably need to intubate him and put him on a ventilator. The paramedics say his blood pressure is low. I probably won’t do a lumbar puncture right away because there are signs that his intracranial pressure is raised. Perhaps you could take blood samples for cultures and send them off to the lab while I start the intravenous lines and administer wide-spectrum antibiotics. The GP has already given him benzylpenicillin, so that’s a start.’

‘Do we know what other symptoms he’s showing?’

‘It started with a bad headache and dislike of light. He’s
very upset, apparently, confused and generally unwell. There’s evidence of neck stiffness and cold hands and feet.’

‘Any rash?’

‘Not so far. Let’s hope we’re in time. We should warn the intensive care unit to expect him.’

The boy arrived just a minute or so later, and Ruby assisted as Sam and the paramedics rushed him to the isolation ward. The child was semi-conscious, able to say a few words to them, but his condition was deteriorating rapidly.

‘I want my Mum,’ he managed in a wretched, broken voice. He kept saying it, over and over, mumbling the words to himself.

‘Of course you do,’ Ruby tried to console him. ‘We’ll make sure they know where you are. Don’t you worry about anything. Dr Boyd is looking after you, and you’re in good hands. He’s the best there is.’

She glanced at the lead paramedic, moving away from the trolley bed momentarily. ‘Are the parents coming in?’ she asked quietly, but he shook his head.

‘We haven’t been able to contact them,’ he said in a low voice. ‘Nathan was on a residential school trip, and his parents are away for the week in the Andes Mountains. Apparently he’s been asking for them ever since he was taken ill a few hours ago.’

He glanced at the boy, making sure that he couldn’t hear what was being said. ‘The headmaster has been trying to get in touch with them, but they’re not at their hotel, and either their mobile phones are switched off or they’re in a bad signal area. It sounds very much as though they set off early for a day’s outing. Of course, now the headmaster is feeling guilty for not contacting them sooner, but he reasoned that it would be the early hours of the morning in South America when the child first complained of feeling ill, and no one knew how serious his condition was at that time.’

She pulled a face. ‘That’s not a good start, is it? Thanks,
anyway, Tom, for that. Do we have anyone from the school here?’

He nodded. ‘The teacher in charge of the residential group is here, and the headmaster has been liaising with them.’

‘That’s something, at least.’

She concentrated on collecting the blood samples, all the while trying to soothe the boy, who was becoming increasingly distressed.

Sam was working calmly and efficiently as usual, putting in intravenous lines to deliver life-saving fluids and medications, all the while checking the monitors to see how the boy was coping. Things were not looking good. The boy was having difficulty breathing, and the pressure inside his head was increasing as the meninges, the protective membranes around his brain, became more inflamed.

Sam made the decision to put a tube into the boy’s throat to secure his breathing when Nathan slid into unconsciousness. ‘I’m giving him corticosteroids to bring down the inflammation,’ he said, ‘and later we’ll think about adding mannitol.’

His expression was bleak, and Ruby knew that he was desperately worried about this child. They had done all they could for him over the last hour, and now all that remained was for him to be transferred to Intensive Care. Until they found a bed for him there, Nathan would remain under observation in A&E.

‘Do you want to go and get a drink?’ Ruby suggested. ‘You look drained of energy. Have things gone badly for you today? I know you were working here before you went off to your meeting.’

‘I’m okay. Michelle’s gone over to ICU, so I’ll stay with the boy for as long as I can,’ Sam said, ‘at least until she gets back.’

‘All right…but if you need a break, I can take over for you.’ She studied him closely, wondering what it was that had brought the bleak expression to his face. It wasn’t like him to
be this way. He always fought for his patients. He never worried about the outcome, but worked with whatever hand he was dealt. Meningitis could be a devastating illness, but young Nathan still had a chance to come through this.

‘Thanks. I’ll be fine.’ He stood by the bed, looking down at the boy, and Ruby tried to work out why he should feel such an affinity for this child above all others.

She said softly, ‘I went to look in on young Jason, the boy who was injured in the car crash some time ago…do you remember? His airway was ruptured, and he had to have emergency surgery.’

‘Yes, I remember.’ His mouth flattened. ‘I asked you why you went over to ICU to see him. I can be an arrogant know-it-all sometimes, I realise that. You don’t have to rub it in.’ He pulled up a chair and sat down, briefly glancing at the monitors as though to reassure himself that all was well.

‘I wasn’t going to do that. I was just about to say that he was discharged from the hospital with his mother a week or so back. His father’s out of Intensive Care and on the mend, too. And then there was the boy who fell from the bridge…he had multiple injuries, but now he’s recovering nicely. So you see, there’s always hope…but you know that, don’t you? I’m not even sure why I’m telling you this.’

He leaned back in his chair and studied her, a heavy sigh escaping him. ‘I appreciate what you’re trying to do, but I just need to be here, Ruby. You don’t have to stay.’

She frowned, her brows drawing together in a fine line. ‘Is this anything to do with the fact that his parents aren’t able to be with him? I’m sure they would want to be here if they knew what was happening.’

‘Yes, I’ve no doubt that’s right, but in the meantime he slipped into unconsciousness, asking for them.’

‘We’ll be here to take care of him and see to his emotional well-being when he comes round again—if they aren’t here
by then. I don’t know how long it takes to fly over here from South America.’

‘At least half a day, around twelve hours or so, and that’s just the flight.’

‘That’s not good, is it?’

‘No.’ He stretched out his legs in front of him. ‘Not for a boy who’s seriously ill.’

She pressed her lips together. ‘Did this, or something similar to this, happen to you at some time?’

He nodded. ‘I was taken ill at the same age. All I knew was that I felt really awful, and I knew it was something bad. I was on my own at boarding school at that time…my brother was only ten years old, so he hadn’t joined me then, thank heaven, or he might have gone down with the same illness.’

His mouth twisted in a grimace as he thought back over those years. ‘I remember feeling unbelievably lonely. There was no family around, no one from home to comfort me and tell me that I would be fine, they would take care of me…just virtual strangers, the teachers and the boys. There was the matron, of course, but she was an austere, no nonsense kind of woman. “You have a sore throat, boy, and a bit of a headache? Trying to get out of doing our maths homework, are we?”’

‘Did you have the same illness as Nathan? Was it meningitis?’

‘Yes, it was. Of course, they didn’t realise that at first, but then I collapsed, and they called for an ambulance. I recall being lifted up and placed on the trolley bed. The paramedics were wonderful, so calm, caring and friendly. I think they were my salvation, along with the doctors and nurses who looked after me. I think they were the real reason I turned to medicine as a career.’

He smiled. ‘The paramedics even came to see me each day as I was recovering in hospital.’

‘And your parents?’ Ruby was still frowning. No wonder he felt such a bond with Nathan.

‘They were half the world away. They came as soon as they were able, but I think it took several days—it was a while before the school managed to get in touch with them, and then flights had to be arranged. My grandparents were away, too, but I recall they made it to the hospital before my parents.’

‘It must have been awful for you, feeling so ill and being isolated from those you loved.’ Ruby went to stand beside his chair, laying a comforting hand on his shoulder.

He shrugged. ‘It wasn’t so bad. I was used to being away from them by then, though I did miss my little brother. When you’re away from home, you learn to steel yourself against any adversity. It doesn’t do to confide your feelings to anyone. That’s the quickest way to be laughed at, sneered at, generally made to feel a fool, so you toughen up fast.’

‘Oh, Sam, that’s too hard to bear…a vulnerable child so far away from everyone who means anything to him.’ She leaned over the back of his chair, nestling her cheek against his head and wrapping her arms around him. ‘I just need to hug you.’

He made a soft laugh. ‘I’m a grown man, Ruby. There’s no need to hug me better.’

‘I’m not hugging
you.
I’m hugging that lost and lonely boy.’ She kissed his cheek tenderly, and then nuzzled her face against his, so that he turned in his seat and stood up, coming to hold her close.

‘You’re very sweet,’ he said, ‘and I thank you for that, but I’m okay, really. The boy inside is okay. You don’t need to worry about either of us.’

He slowly released her, and she realised that someone was approaching from outside the room. Then Michelle walked in, and Ruby guessed that Sam must have heard her coming.

‘ICU should have a bed for Nathan later this evening,’ Michelle said, ‘and the headmaster has finally managed to get a message through to his parents. They’re booking the next flight back.’

‘That’s good,’ Sam murmured. ‘Let’s hope he’s on the mend by the time they get here.’

Michelle glanced through the instructions on the medication chart. ‘That looks straightforward enough,’ she said. ‘You can leave him with me now, and I’ll let you know if anything changes.’ She gave Sam a concerned look. ‘You must be devastated by the news this morning…I’ve just seen the chief executive officer in ICU, and he says the hospital trust is still planning to close this place down, even after all you’ve done. I don’t understand how they can be so blinkered.’