The Perfect Treatment
‘Um…no…of course not. I have a good reason for being late.’ And she was getting cynical, too.
‘Great,’ he said. ‘Er…Dr Gibson, are you really with me? I have a distinct impression that you’re operating on another plane.’
Blake Contini was aware that he was staring, but couldn’t help himself. The girl in front of him—she seemed like a girl to him—had thick, dark chestnut brown hair with bronze highlights and a slight curl to it all over. Little wisps of hair clung attractively to her creamy neck. He had an absurd desire to touch that neck, to breathe in the scent of her hair…
He also recognized the veiled sarcasm in his own voice. That seemed to have become habitual with him these days when he met attractive women—intelligent, capable, womanly women, who were not afraid of their own femininity—who might pose some sort of threat to his outward calm.
Kaitlin had been like that once. Her unwelcome image floated before his mind’s eye—blonde, pale, like an icemaiden now. With the image came the familiar sharp regret…
He disliked himself for his sarcasm as it represented him as something he was not. It reminded him of his own need. Yet it was a useful defense. He knew instinctively that Abigail Gibson was not a man-hater.
Several rejoinders came to Abby’s mind, but she bit them back. ‘Let me explain,’ she said. With few words, she described what had taken place after she had found Dr Ryles collapsed in the corridor, ending with, ‘Since you’re new here, you may not know Dr Ryles.’
‘On the contrary,’ he said, his face suddenly stiff with concern and shock, ‘I know him well. I knew him before I came here to University Hospital. Have you checked up on how he is?’
‘No, of course not. I came straight here.’ And you’ve been harassing me ever since, she wanted to add.
‘Poor old Will.’ He murmured the words, as though to himself. ‘And an unfortunate experience for you first thing in the morning.’ To her surprise, he reached forward to touch her arm commiseratingly. ‘You probably saved his life.’
‘People were rather scarce.’
‘I might have known something like this would happen,’ he added thoughtfully. ‘He’s been under so much stress lately, and he pushes himself much too hard.’
‘He looked so exhausted when I found him,’ she agreed, ‘I felt so desperately sorry for him.’
‘Yes, he would be exhausted,’ Dr Contini said softly, almost as though he had predicted that Dr Ryles would have a heart attack, making Abby speculate on whether they were actually close friends.
‘What do you mean?’ she asked, picking up nuances. ‘Were you, perhaps, aware that he was ill, that he might have an infarct?’
‘No…’ he said, almost absently, ‘Not that. He’s been under a lot of strain.’
Blake Contini regretted his sarcasm even more. The eyes that looked back at him frankly were green, large and expressive in a heart-shaped face; there was none of the calculation that he so frequently saw in the expressions of many women he met for the first time.
Across her pert nose, almost classic-shaped, was a faint band of freckles that spilled over onto her cheeks, giving her a mischievous look, rather like a female Huckleberry Finn…one of his boyhood heroes, who now seemed very far away. He found his eyes moving automatically to her mouth, to her lips that were full, beautifully shaped, soft-looking. The impression of her, of softness, produced a sense of dissonance, imposed, as it was, on his acute concern about Will Ryles.
‘Um…the first case, the one that I missed,’ Abby said, looking at the computer printout he had given her, now feeling the pressure of time. ‘I’m sorry about that. I would like to catch up—’
‘The patient is on 2 East, so maybe you can get to see him today. I shall be seeing him myself at about eleven o’clock—maybe you can manage to meet me there, Dr Gibson,’ he said. ‘I can go over a few things with you. I may want to test your group on this particular case later in the year.’
‘Thank you. I would appreciate that,’ she said formally. ‘General practice isn’t exactly easy, Dr Contini, even though you specialists might think so. We’ve got to be good at everything, not just one thing. And keep up to date on it all.’
‘I didn’t say it was easy, neither do I think so,’ he countered. If he was surprised by her remarks, he hid it well.
‘Start as you mean to go on,’ her mother had always told her. While she understood that to be an aphorism generally referring to marriage, it was, she considered, a good bit of advice to keep in mind at the start of any relationship.
‘I’ll try to get there,’ Abby said stiffly, very conscious suddenly that they were alone in the room, that she was inappropriately attracted to him. ‘I am expected at a family practice clinic right now—Dr Wharton’s clinic in Outpatients.’
‘I’m going to Outpatients myself. I’ll call Dr Wharton and arrange for you to have time off at eleven o’clock,’ he said. Then, making up his mind about something, he looked at his watch with a quick flick of the wrist. ‘If you would like to see Dr Ryles as much as I would, I can call the outpatient clinic, tell them you’re going to be late, then we could visit him briefly in the coronary care unit.’
Abby nodded. ‘Yes. Thank you. I would like to see him, find out what’s happened.’
‘Sorry about my obtuseness earlier.’ He had the grace to apologize. ‘I had, of course, no idea.’
‘No,’ Abby said quietly, managing to imply by her tone that one should not make flash judgements. He was very attractive, she acknowledged again, lowering her eyes to the paper she held. There was even a hint that he would, perhaps, have a natural charm if he were to let himself go a bit. Not that she was one to talk…
‘I’ll see if I can set it up,’ he said, ‘and find out where Dr Ryles is.’
‘I hope he’s survived,’ she ventured.
‘So do I.’
As he strode over to a telephone in the room she watched him, her mind active. His reaction to her news, for someone new to the hospital, had been greater than she had expected. She wondered where he would have met Dr Ryles, who had been at University Hospital for at least twenty-five years.
All at once, she had a very odd, very powerful premonition that Dr Contini would figure large in her life…and not just on the professional level. The feeling was so strong, so peculiar, that she shivered. Telling herself that she was being ridiculous, she turned away from him to stare out the window, away from his disturbing presence.
It wouldn’t do for her to feel anything of that nature for her senior colleague. She had made a pact with herself not to get involved with anyone before she had at least finished her post-graduate training and got herself established in her first permanent job as an MD. There was no time for real romance; she had to earn a living, had to give something back to her parents who had supported her so unselfishly all her life, among other things helping to meet the financially crippling fees for medical school. They were going to need it. Her dad often joked that if they could remain the working poor, rather than the non-working poor, they would be all right. She seldom forgot that ‘joke’ for long.
Not that she would be Dr Contini’s type. She frowned down at the paper in her hand, the words a blur. Probably he would go for a high-society woman. Anyway, she found herself speculating, he would no doubt be married—he must be in his mid-thirties.
Maybe she found him disturbing because he reminded her of what she had never had…real love, passion. Maybe that was it, when such a large part of her own life was, through necessity, focused on work. At the same time, she felt a certainty that he could be a formidable enemy.
She walked to the door to wait for him, all at once wanting to get out.
‘I spoke to the emergency department,’ he said, coming over to join her. ‘He’s in the coronary care unit now. Still all right.’
‘That’s great,’ she breathed, relieved of a sense of responsibility.
They collided as he moved to open the door for her and she moved to open it for herself. ‘Steady,’ he said, smiling. ‘Tell me, Dr Gibson, are you usually this…er…’
‘Klutzy?’ she offered.
The smile on his face broadened slowly, lightening his attractive features, ironing out subtle signs of strain. Abby found herself transfixed, staring at him at close quarters, as he held his arm in front of her to secure the heavy door. With his face only inches from her own, she had the absurd urge to lean forward and place her lips against his firm mouth.
‘That isn’t the word I would have used,’ he quipped, ‘but it’s as good as any, I guess. I don’t mean to be unkind.’ He added the last words softly, in such a way that Abby felt as though she were melting, leaning towards him. Don’t be ridiculous, she told herself yet again…
‘I am frequently this way,’ she conceded, forcing a jokey tone. ‘My friends tell me it’s a sign of genius, the absent-minded-professor syndrome, so naturally I take them at their word.’
‘Hmm…let’s hope they’re right. Such a trait could be a professional liability.’ Still he smiled, his eyes exploring her face.
‘Oh, they are right!’ she insisted, pushing past him to get out, aware of him physically with every sense in her being.
‘Just to be on the safe side, Dr Gibson, let me carry those books,’ he said.
CHAPTER TWO
THE coronary care unit was quiet, peaceful, set up in an area of the acute-care floor of the hospital where there was no through traffic and where noise could be kept to a bare minimum. They entered through a heavy door that closed silently behind them.
A nurse sat at a desk in the nursing station, looking at a bank of individual computer screens which were monitoring the four patients who were in her section. Each patient was connected up to leads going to the electronic equipment which would relay the information to the screen. Any irregularities of heartbeat, blood pressure and oxygen levels of the blood would immediately be known.
Although all was peaceful, Abby knew that she would not want to be a patient here, lying in bed, wondering if your heart would stop at any moment. Walking beside Dr Contini, she looked around her as they approached the nurse silently.
‘Is Dr Ryles here?’ he asked. The nurse gestured towards an area down a short corridor where there were a few individual rooms.
‘Room three,’ she said with a smile.
‘How is he?’ Abby said.
‘Pretty good, considering. He’s stable now. His wife’s with him at the moment,’ the nurse said. ‘He’s sleeping, so we don’t really want him to be disturbed.’
‘Sure,’ Dr Contini said. ‘We won’t wake him.’
In room three, Dr Ryles lay on his back in the narrow bed, the monitor leads attached to his bare chest. A small computer screen by the bed showed the spiky graph of his heartbeat, as well as the heart rate and blood pressure. Abby’s eyes went automatically to that screen as they entered silently. What she saw there confirmed that he was stable, his blood pressure near normal, the heartbeat good.
He was still on oxygen, his colour good now, while intravenous fluids dripped slowly from a litre plastic bag hung beside the bed. Abby felt her anxiety diminish somewhat. The team from the emergency department had been in time after all.
Mrs Ryles, who looked about the same age as her husband, was sitting beside the bed, her face turned to him. She rose to her feet as they stopped at her side. Her pale face showed evidence of tears, the eyelids swollen and red, and she registered surprised pleasure at seeing Dr Contini.
‘Hello, Ginny,’ he said softly, holding out his arms to her. ‘I’m sorry to be meeting you again so soon under these circumstances.’
‘Oh, Blake.’ The woman’s voice trembled as she went gratefully into the arms that Dr Contini offered her. They embraced in a silent hug. ‘Thank God you’re here.’
So they were friends after all. Abby stood aside, watching them, her own emotions very close to the surface as she saw the tears again on the wife’s face. When they had satisfied themselves that Dr Ryles was indeed all right, Dr Contini gestured that they should go outside to the main corridor where they could talk without disturbing anyone.
‘This is Dr Gibson,’ Blake Contini introduced her when they were outside. ‘She was the one who found Will.’
Mrs Ryles grasped Abby’s outstretched hand with both her own. ‘I want to thank you,’ she said, her voice trembling. ‘I understand that he was in the basement, where he might not have been found for some time. If you hadn’t found him…hadn’t known what to do, or what you were looking at…he might not have survived. Thank you. You saved his life.’
‘I—I’m very glad that I was there,’ Abby said. ‘I…really didn’t do a lot. I was just able to call someone.’
‘You were there—that’s the main thing!’ Ginny Ryles said emphatically. ‘It’s all this business about the downsizing that’s going on here, you know, that has brought this on with Will…all the budget cuts.’
‘That’s most likely a contributing factor,’ Abby agreed wryly, as the distraught woman articulated more or less what she had been thinking herself that morning.
‘It’s all the underhand business of deliberately running down departments, without telling the professional staff what has been planned, so that private companies can take over the radiology work of this hospital,’ Ginny Ryles went on with bitter passion, as though she had been waiting to speak to someone about it for a long time.
Abby nodded, while Dr Contini stood silent. ‘I don’t doubt that for one moment…not for one moment,’ Mrs Ryles went on. ‘He’s talked about nothing else for weeks. All the stress…It has to get to someone. It has to.’
‘Yes,’ Abby agreed, picking up the frustration in the woman’s words.
Blake Contini took the woman’s arm. ‘Come with me to the hospital cafeteria, Ginny,’ he said kindly. ‘I’ll buy you coffee, or anything you want. We can talk there. Dr Gibson has to get to Outpatients.’
‘Thank you, Blake. You’re very kind, and I do appreciate it,’ Ginny Ryles said.
‘Dr Gibson.’ Blake Contini turned to Abby. ‘I’ll see you in Outpatients in a little while. I have some patients to see there. I’ll square things for you with Dr Wharton about taking time off.’
‘All right. Thank you,’ Abby said. ‘Well, goodbye, Mrs Ryles. I expect I’ll see you again, I’ll probably look in later…He’s in good hands.’
‘Thank you again, Dr Gibson. I’m planning to spend most of the day here with Will. I’ll only go out of my mind if I stay at home,’ Mrs Ryles said quietly.
‘There’s every indication that he’s going to be all right,’ Dr Contini reassured her gently, while Abby looked at him surreptitiously with new eyes.
Yes, it was clear that he could be charming. She wondered momentarily what it would be like to be the object of that charm, that warmth and undivided attention. Perversely, uncharacteristically, she found herself longing for it—almost as though the incident with Will Ryles had jolted her out of a deep sleep, like Sleeping Beauty in the fairy-tale—then brought her face to face with the prince. Snap out of it, Abigail Gibson, she admonished herself once again. Get real!
‘Thank you for saying that,’ Mrs Ryles said tremulously, trying to inject some hope into her voice. ‘Here I am, going on about our affairs, but what about you, Blake? How’s Kaitlin? Any change there?’
‘No, nothing,’ Dr Contini said heavily.
‘Is there likely to be?’
‘I doubt it very much.’
As Abby made her way to Outpatients a little later, she puzzled over that last brief verbal exchange. It was evident that Dr Contini had known Dr Ryles and his wife for quite a long time.
She sighed, looking at her wristwatch and making an effort to shift her thoughts to the work ahead in the clinic. She was looking forward to it.
It was only too easy to become obsessional about the internal politics of a hospital, which were so closely connected to the broader political scene. It could sap one’s energy. Although it was of concern to her, as much as she knew that one had to get involved in some degree, she did not have time for that right now.
Who, she wondered, was Kaitlin? The question nagged at her persistently…as did the tone of Blake Contini’s voice when he had replied, ‘No, nothing.’
The voice had sounded dead, devoid of all emotion.
Dr Wharton’s clinic was well under way when she got to Outpatients. The young family practice doctors like herself were given new patients to see so that they could take detailed histories, do extensive physical examinations, order blood tests, urine tests, X-rays if necessary, and anything else that might be required before the consultant in charge—in this case Dr Wharton—saw each patient to confirm, or call into question, the preliminary diagnosis. This system saved the senior GPs a lot of time, as well as being a good training exercise for the young doctors, who were themselves MDs.
‘Morning, Sue’ Abby smiled at the receptionist sitting behind the desk off the main waiting room in the family practice unit. ‘Sorry I’m late. Anything interesting for me? I have to leave again for a while just before eleven o’clock to see a patient on 2 East, one of Dr Contini’s patients that I missed at the rounds. Is he—does he—Dr Contini, that is—have many patients here this morning?’
Although Abby felt her face flushing as she asked the question, and still feeling somewhat disturbed by all that had happened already that morning, it was good to be in the relative peace of the family practice clinic. Abby felt herself beginning to relax, her habitual confidence returning. This was her territory.
‘Hi, Dr Gibson.’ Sue, the young, efficient receptionist smiled back. ‘It’s going to be one of those days, I think. Lots of interesting cases for you to get your teeth into. Here’s your first.’ She handed over a folder that contained the patient’s basic statistics and initial complaint. ‘Dr Contini has a couple of patients to see. He told me he’d be available for any consultations here if anyone wanted him.’
‘That’s really great! Maybe I’ll take advantage of that offer, if Dr Wharton’s busy. Thanks.’ Abby took the folder, glancing at it to see the patient’s name and feeling an upsurge of anticipation at working in the same unit with Blake Contini, even though it was an anticipation tinged with remnants of irritation.
Dr Wharton would be there in the unit, plus two other family practice MDs in training like herself. At the moment there was no sign of them—no doubt they were already in the offices assigned to them, seeing patients.
‘Mr Barlow,’ she called out across the waiting room, ‘Gary Barlow.’
A thin man, wearing an old raincoat, got up from a chair, nodding to Abby. ‘This way, sir,’ she said. Leading the way, she proceeded to the small examination room which was to be her office for the duration of the clinic.
‘Take your coat off, Mr Barlow. Have a seat there next to the desk. I’m Dr Gibson. I’ll be seeing you first—taking a history, doing an examination—then Dr Wharton will see you.’
With the folder open on the desk in front of her, she read the chief complaint that this patient had. ‘Chronic bronchitis’ it read, followed by a question mark, then ‘Persistent chronic cough.’ That would have been written by Sue from the patient’s own description of what was wrong with him. Many of their patients came there without any reference letter from any other doctor; they simply telephoned the hospital, asking to see a GP. Many had never had a family doctor.
Mr Barlow, in his fifties, was thin and tired-looking, with a drooping face of loose skin that reminded Abby of a bloodhound. The top of his head was bald. In general, he did not look particularly healthy. He sounded slightly breathless from the simple effort of having walked from the waiting room and taken off his coat. He sat down heavily in the chair next to her desk. Abby took some history sheets from the pile on her desk to add to the file, prepared to do a fair amount of writing.
‘It says here that you have a chronic cough, Mr Barlow,’ she began, her pen poised above the paper, ‘Tell me when that first started, and any other symptoms associated with it.’
For the next few minutes she wrote busily while he talked. It seemed to her that he was trying to minimize the length of time he had had the cough, as well as his level of concern about it. He said he had had a cough for about a year, then it had got worse over the winter, showing no signs of going now that spring was here. He was the sort of man, she suspected, who would not go to a doctor for many years, then would only go finally when symptoms were such that he could not ignore them and his level of anxiety got to a point where he could not think of much else.
‘And do you smoke, Mr Barlow?’ Abby looked up.
‘Yes,’ he said.
‘For how many years have you smoked?’ she asked, keeping her voice neutral with no hint of judgement. ‘And how many cigarettes a day?’
‘Well…’ he said, thinking back, ‘I reckon I had my first cigarette when I was about fifteen. Now I smoke about forty a day, give or take a few.’
My God! Abby thought, keeping her face impassive as she wrote again. It was difficult to imagine getting through that many in one day, yet some people, she knew, got through more than that. ‘For how many years have you smoked forty a day?’ she asked, looking at him and watching his pale, watery eyes go blank as he stared across the room, trying to remember back that long.
‘Oh…’ He hesitated. ‘I suppose it must be at least ten years…about that.’
She wrote down the statistics. ‘When did you last have a chest X-ray?’ she said.
‘A chest X-ray?’ He looked surprised. ‘I’ve never had one.’
It never ceased to amaze Abby that many people who smoked heavily could tune out all the publicity and the statistics that were everyday knowledge about smoking and lung cancer. It was as though by some mental gyration they could dissociate it all from themselves, almost as though for health purposes they lived on another plane. That ability, if one could call it that, was very common, of course…and not just with smoking and lung cancer. It certainly applied also to hepatitis and AIDS, particularly among the population taking street drugs.
Maybe she shouldn’t be surprised, really, as nicotine was a powerful drug of addiction, although it was frequently not thought of as such. It produced a craving from which it was not easy to break free. Again, she was careful not to inject any hint of judgement in her tone. Sometimes patients would get up and leave if there was any hint of negative judgement about their behavior, past and present.
‘When did you last see a doctor?’
He hesitated, calculating. ‘Not for a long time. Never needed to,’ he asserted, with a hint of defiance. ‘Must have been about ten years ago, I guess. Had a tooth abscess. Had to have it pulled out. The guy gave me a quick once-over, then sent me to a dentist.’
‘I see,’ Abby said, writing that down. ‘Any other health problems?’
‘Nope,’ he said.
‘What about your general health? Your appetite?’ For the next little while she questioned him about the present, then went on to his medical history, starting from as early in his life as he could remember. Apparently he was one of those men who took his bodily functioning, his health, entirely for granted, having only a very rudimentary knowledge of the anatomy and physiology of the human body.
Abby filled in a requisition form for a chest X-ray, to be done that day in the hospital. If she didn’t get it done now he might never come back, especially if he got scared—any more scared than he was now. She did not want to give him a hint that he might have lung cancer, the possible diagnosis that was uppermost in her mind. He could also have chronic emphysema, a lung disease brought on by repeated chest infections, as well as by smoking. This disease also affected the heart.
She also filled in requisition forms for some basic blood work, to be done in the hospital labs. Chronic smokers were often anemic, as well as suffering from various vitamin deficiencies, as they were frequently poorly nourished. Smoking tended to dull the appetite and become a substitute for food.
