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DOCTORS IN CONFLICT

Drusilla Douglas

O-o-o-h -- that man!
Catriona MacFarlane was thrilled with her new medical registrar post, the only fly in the ointment seemed to be orthopaedic surgeon Michael Preston! He’d wanted a friend for the job, and thought Yona had got it because of her famous father. But Yona’s skills spoke for her, so when she thought she’d run over Mike’s foot in the car park he promptly took the opportunity to get closer to her. The attraction was definitely mutual, but when they both has such ideas, how would they learn to compromise?

'I
don't know
,' said Dr Catriona MacFarlane to anybody who asked, when she returned home to Edinburgh after the interview. 'It seemed to go all right, but there were three others on the short list, so I honestly don't know.

'And I'll not mind too much if I don't get the job,' she added for insurance. 'I do want a change from Edinburgh, but I didn't much care for Salchester. It may be England's second city, but it's still a great, sprawling, ugly place.'

'Yona, why do you always have to make the best of everything?' asked her best friend. 'Why not bang on about sex discrimination or anti-Scots feelings—like any normal person?'

'You call that normal?' asked Yona with a chuckle. 'I'd rather believe that Professor Burnley will choose the one he thinks will be best for the job.'

'Is that a fact?' queried her friend. 'Then how come you think that any job you've got so far is all down to being your father's daughter?'

'I do not,' denied Yona, 'but there's a sight too many folk who do. That's one reason for getting right away—to prove that I can make good on my own.' Her other reason—the recent defection of her long-time boyfriend— she'd be keeping to herself.

'I wouldn't have your principles for the world,' sighed the friend. 'Too damned inconvenient by half.'

'Decision time,' said the same friend a week later, when the letter came, offering Yona the appointment. 'You'll turn it down, of course—Salchester being such a ghastly place.'

'Oh, come on!' Yona laughed. 'Surely you guessed I was only hedging my bets. Of course I'm going to accept! It's much too good a chance to turn down.'

'If you say so—but don't say I didn't warn you,' returned Yona's Mend, who believed in having the last word.

So the new job was accepted. Goodbyes were said to family and friends and four weeks later, on a wet and windy Monday morning in March, Yona MacFarlane parked her car for a second time in the deplorably rutted and ill-kept staff car park at Salchester Royal Infirmary. Full of hope and anticipation, she made a dash for the department of Rheumatology.

'Are you new?' asked the receptionist of the tall, slender, chestnut-haired girl with the arresting periwinkle-blue eyes who approached her desk.

'You could say that,' said Yona with a smile. 'I'm Dr MacFarlane, Professor Burnley's new registrar. He is expecting me.'

The girl looked rather embarrassed as she said, 'I'm sorry—but I thought you'd be older. The thing is, he's in a meeting, but Mrs Lee, his secretary, said to put you in his room and let her know. This way, please.'

'Would you not like some proof of identity?' asked Yona, as her guide seemed about to leave her alone.

She got a look of surprise for that. 'Oh, no, that's all right, Doctor. If you weren't who you say, you wouldn't know you were supposed to be coming today, would you? Mrs Lee won't be long.'

'It's good to know I look honest as well as young,' murmured Yona, glancing round her new boss's consulting room. It was much like any other, with the standard examination couch, tray of instruments, impressive array of textbooks and a solid-looking desk stacked with paperwork. A sheet of paper, headed 'Southern General Hospital, Edinburgh' caught her eye. Could that possibly be one of her references?

Yona was bending over the desk, wrestling with the temptation to find out what had been said about her, when a deep male voice demanded roughly, 'And what do you think you're doing?'

She spun round, flushing with vexation at having been caught with her hand in the till, so to speak. Her gaze connected with a large white shirt-clad chest, then travelled up a good twelve inches, before meeting deep-set searching brown-to-hazel eyes in a tanned and rugged face.

The man looked strong and capable and, with his sleeves rolled up to the elbow, she took him for a tradesman, here to mend a faulty windowcatch or something. 'I might ask you the same thing—bursting in like that without knocking,' she reproved Mm.

He looked thunderstruck. 'I work here!' he exclaimed.

'So do I,' Yona retorted evenly.

'Doing what?' asked the man, clearly sceptical.

Yona was furious with herself for blushing guiltily again. 'What ever Professor Burnley decides,' she said frostily. 'I'm his new registrar.' That's fairly taken you aback, she realised with satisfaction, watching his face.

'I should have guessed,' he said gruffly after a moment. 'Except that before I went on holiday the word was that you wouldn't be here before the beginning of April.'

If he'd been on holiday, that probably explained the tan, if nothing else. 'And now may I know who you are?' Yona asked coolly.

'Mike Preston, orthopaedic consultant. I do most of this unit's reconstruction surgery so I suppose we'll be seeing a fair bit of one another.' He didn't sound exactly overjoyed at the prospect. 'Where is Ted anyway?'

'Professor Burnley is in a meeting, I'm told. Would you like me to give him a message?'

'No—there's nothing urgent. Thanks all the same, Dr MacPherson.'

'MacFarlane,' she corrected as he turned to go.

'I knew it was something like that,' said Mike Preston as he closed the door.

Yona barely had time to decide that there was one new colleague she wasn't going to like before a small, plump blonde came bursting into the room. 'Remember me, Dr MacFarlane? I'm Sharon Lee. The professor hopes his meeting will be short, but meanwhile here's an outline of your orientation programme for you to look over while you're waiting. Would you like a coffee?' She seemed so anxious to please that Yona accepted, although it wasn't yet half past nine.

Sharon Lee rushed off to see about the coffee and Yona sat down to read, relieved to see that she wasn't being thrown in at the deep end. They were giving her time to get the feel of the place by sitting in on clinics and lectures, visiting the laboratory where the research was going on and, of course, ward rounds.

There was even the option of going to Theatre to see the rugged Mr Preston in action, but Yona resolved to pass on that if she could. Unfortunate first impressions apart, she'd never much liked the surgical side of things.

She thanked the girl who brought her coffee and was making a note of the dates and times of her own teaching sessions with students of the various disciplines when Professor Burnley came in, full of apologies for not being there to greet her on arrival.

'They do it on purpose, you know—these administrators.' He sighed. 'Fixing meetings at a moment's notice is their way of showing us who's in charge. Changed days since my great-grandfather's time here. Did you know there's been a Burnley at Salchester Royal Infirmary for four generations? Good journey down?' he asked before Yona could comment. 'And have you found somewhere decent to stay?'

Yona said 'Imagine' to his first question, 'Fast and uneventful' to the second and that she was putting up at the hotel she'd stayed at for her interview to the third. 'Just while I look round for a flat,' she explained.

'Sharon will be able to help you there,' he said. 'Her husband is an estate agent.' He then fixed Yona with a serious look. 'Before we go any further, I'd like you to know that I'm delighted you've decided to join us. The name MacFarlane is not unknown in medical circles.'

Yona hoped he wasn't aware of her dismay. Please, not another job secured on her father's reputation... 'Thank you, sir,' she managed. 'I was very pleased to have been selected.'

'Everybody happy, then,' he summed up. 'Now, let's keep it that way by getting up to the wards. Thursday is my usual day for a full ward round, but I thought a quick dash round now would be the quickest way for you to get acquainted with patients and staff.'

Sister Evans had been off duty the day of the interviews, but her senior staff nurse, who had showed the candidates round, had hinted at a dragon first class so Yona was prepared for the searching scrutiny she received.

'I run a very tight ship, Doctor,' warned the dragon when the prof had made the introductions.

'I'm very glad to hear it, Sister,' Yona responded crisply.

Sister eyed her suspiciously, as though wondering whether the new girl was being cheeky, decided to reserve judgement and turned away to tell the professor that everything was ready for his inspection.

'When is it not?' he asked, getting a slight smile and a queenly nod for his trouble.

They started in the women's ward, where Yona felt at home at once. Just as in Edinburgh, most of the patients were in their middle years and being treated for acute episodes of rheumatoid arthritis. However, since the incidence of rheumatoid arthritis was two or three times higher in females, it was no surprise to find a wider range of rheumatic disease among the male patients.

Without needing to refer to the notes, Professor Burnley gave Yona clear and concise accounts of the first few patients. Then they came to the bedside of a thin, pale young man in his early twenties.

'Can you remember when you first noticed trouble with your back?' asked the boss.

'Well, there was the accident at work last year, Doctor, but before that I was often stiff in the mornings—especially in wet weather.'

'Of which we get far too much in Salchester,' observed the prof. 'Any ideas, Dr MacFarlane?'

Yona had already noticed the man's poor chest expansion. 'I'd be thinking in terms of ankylosing spondylitis, sir,' she said quietly. Never alarm the patient unnecessarily.

'So far, so good. Now take a look at his X-rays.'

Yona did so and was unsurprised to find tell-tale changes in the sacroiliac joints.

'Is there anything else you'd be looking for?' wondered the boss.

'I'd check his peripheral joints, of course, although the incidence of such involvement is low. I'd be looking particularly at his eyes, though.'

'Why is Dr MacFarlane interested in our patient's eyes?' Professor Burnley demanded of the trembling houseman, who mumbled that he didn't know.

The professor then went into overdrive, delivering a mini-lecture on the incidence of iritis in this condition. 'Have you taken any blood samples yet?' he wound up.

'Oh, yes, sir—this morning, sir.'

'And what do you think the blood will tell us?' That question came next, when the little group had moved out of earshot of the patient.

'Whether he's anaemic, sir?' suggested the hapless houseman.

'We are looking at ankylosing spondylitis, not rheumatoid arthritis,' reproved the professor. 'We shall probably find little more than a raised ESR. What's the significance of that?'

'Infection, sir.'

'I prefer to say evidence of abnormal pathological activity in this case,' said his superior. 'How long have you been with us now?'

'A week, sir.'

'Hmm! Well, I suggest that you sit in on as many of Dr MacFarlane's clinics as you can, which shouldn't be difficult. This is a very easy number for house officers, compared with the acute general medical wards.' As they left the ward, he spun round to demand of Sister, 'Has Mr Carpenter been to look at our Felty's syndrome spleen yet?'

'I assume that Mr Carpenter is a general surgeon,' whispered Yona to the senior house officer, Dr Price, who had been hovering protectively at her side all the way round.

'That's right,' he whispered back, 'though Mike Preston reckons he ought to be an orthopod with a name like that. Mr Preston is the orthopaedic surgeon who works most closely with us,' he added.

'I've met him,' said Yona in a toneless voice, earning herself a speculative sideways glance.

The houseman had caught up on her other side to ask,

'Please, Dr MacFarlane, why is the spleen so important in Felt's syndrome?'

'Felty's, after the doctor who first described it,' she corrected automatically, before going on to describe a rare syndrome in which rheumatoid arthritis is complicated by lymphatic problems and enlargement of the spleen. 'And, if I were you, I'd make time to read up on all the rheumatic diseases before the next round,' she advised.

'I'm only here locuming for a month until I can get on Chests,' he grumbled.

'Well, don't let the boss hear you say that,' she advised. 'Besides, there's no such thing as too much knowledge in our profession,' she pointed out as they caught up with the rest of the procession.

'You've soon settled in,' murmured Dr Price, looking impressed.

'One rheumatic unit is much like another,' claimed Yona. 'More or less,' she added. There'd been nobody like the rugged Mr Preston on the Edinburgh unit.

'No operation required for the moment, then,' observed the professor when he'd read Mr Carpenter's report on the last patient to be seen. 'So, what shall we do for this lady, Dr MacFarlane?'