Kitabı oku: «The Perfect Treatment»

CHAPTER ONE

ABBY GIBSON, MD, was late for the general medical rounds at University Hospital, Gresham, Ontario. Her hair was still damp from the shower she had taken about twenty minutes earlier in the hospital medical residence; its dark tendrils clung wetly to her neck.

‘Morning, Dr Gibson. You in a hurry as usual?’ One of the other occupants of the crowded elevator, a male physiotherapist whom she knew reasonably well, grinned at her as they were crushed inelegantly together against a wall of the moving compartment. In the hospital this was one of the general meeting places of quick hellos and goodbyes.

‘Oh…hi, there, Ray!’ Abby said breathlessly. ‘Yeah, you could say that!’ While craning to look at her wristwatch, she dropped two heavy textbooks and a sheaf of papers that she was carrying.

‘More haste, less speed!’ Her companion grinned again as he eased himself down towards the floor gallantly to pick up her lost items.

‘Thanks,’ Abby said, taking the books from him. ‘How are you, Ray?’

‘Chugging along,’ he said. ‘Living from week to week, like everybody else.’

Abby sighed, conscious of the general atmosphere of stress that prevailed in the hospital these days like an almost tangible cloud; it was a cloud of uncertainty about jobs and teaching positions in a time of severe budget cuts.

‘Ray, do you know anything about the new head of the department of internal medicine?’ she asked. ‘It’s his rounds I’m going to be late for.’

‘Dr Contini? Mmm, met him a couple of times. Seems like a nice guy. A little young for the job, I would say…if he gets it. You know what this place is like for rumor. Every job has about two hundred applicants. Even at his level, I should imagine.’

‘I do know, Ray. Even so, I don’t want to be too late for this meeting. First impressions are important, aren’t they, if often wrong?’ She ran a hand through her damp hair. ‘Maybe he won’t notice me in the crowd…or my absence.’

‘Any red-blooded male would notice you in a crowd, Abby. Slept in?’

‘Yes. Crazy week. You’re very gallant this morning, Ray.’

‘I’m always gallant.’

Abby smiled warmly, though she was preoccupied with the meeting ahead. It was always more than a little nerve-racking meeting a new senior colleague who was in a position to judge you, give you professional evaluations. ‘Let’s hope the new guy will be, too,’ she said.

She did not want to give Dr Contini a negative first impression of her, if she could help it, as they were probably destined to spend a fair amount of time together professionally.

The old chief of the internal medicine department was away on an extended professional trip, she knew that. This new guy, Dr Blake Contini, who was taking his place during his absence, was slated to become the new head of the department when the chief retired, according to rumor.

‘See you, Abby. This is where I get off.’

‘Bye, Ray.’

The elevator emptied, leaving her the sole occupant.

As she came out moments later at basement level into the corridor that would take her from the east wing to the west wing of the hospital, she put her attachè case and books on the floor and took out her neatly laundered white lab coat to put on over her blouse and skirt.

She strode along the corridor purposefully, trying to look businesslike even though there was no one else there to see her. Down here, the vista was bleak—utilitarian, empty corridors with garish fluorescent lights.

Up ahead, just where the corridor began a slight incline, Abby could see that someone had dumped a bag of laundry, or something, on the floor. That was part of the problem around here, she thought, not enough maintenance staff now to keep the place clean and tidy, so many laid off.

Coming closer, she could see that the ‘bag of laundry’ was a person in a lab coat and white pants, slumped awkwardly against the wall. ‘Oh, hell!’ she said out loud.

It was a man, a middle-aged man with thinning grey hair and a pale, gaunt face—obviously one of the medical staff. Quickly Abby knelt down on one knee beside the recumbent figure, dumping her books and bag in one quick movement. As she heaved the man over onto his back so that she could see his face more clearly, he looked familiar. The lips had a bluish tinge; the eyes were half open, unseeing.

‘Mo!’ Abby said softly, recognising Dr Will Ryles, the chief of Radiology.

Automatically she felt for the carotid artery at the side of the neck and searched for a pulse, holding her own breath as she did so. Yes, there it was—the faint fluttering of a pulse, rapid, irregular.

‘Thank God,’ she said, shifting her position so that she was kneeling beside Will Ryles. ‘Not a cardiac arrest.’

With steady hands she unbuttoned his shirt and loosened his tie, then listened to his chest with her stethoscope, working quickly. After hastily dragging the necessary equipment from her bag, she took his blood pressure. The systolic blood pressure was only ninety. There was little doubt that he had suffered a myocardial infarct, a heart attack.

Abby looked around frantically. Where were other people when you really needed them? She had to get him to the emergency department at once before he sustained brain damage from low blood pressure—get him on oxygen, have cardiac enzyme tests done and get him on the life-saving, clot-dissolving drugs.

Compassion filled her as she looked down at the man’s face which was now an unhealthy yellowish colour and cyanosed from lack of oxygen. He looked exhausted. No doubt he was, she speculated. Beside him on the floor was a cellular telephone, plus a few other items which had obviously fallen out of his pockets. Maybe he had been trying to call for help.

Quickly Abby punched in the number of the emergency department triage station, not knowing whether the phone would function here in the basement. Thankfully, she heard it ringing. Most of the nurses knew her there—she had been there frequently as a medical student and had been one of the last young doctors to do a general training internship before the system had finally been abolished in favour of a new system of early specialization.

‘Hi,’ she said, when a nurse answered. ‘This is Dr Abby Gibson. I’ve just found Dr Will Ryles, the radiologist, collapsed in the east-to-west wing basement corridor. It’s a probable myocardial infarct. He needs oxygen pretty quickly. I need a couple of people here fast with a stretcher. He’ll have to be lifted.’

‘Right,’ the nurse said. ‘I’ll send a doctor and a nurse right away, with a couple of porters.’

‘Thanks.’ Abby disconnected the line. ‘Dr Ryles! Dr Ryles!’ She slapped his face gently, then slightly harder. ‘Open your eyes.’ Again she placed her fingers over his carotid artery, searching for the faint pulse that would indicate he was alive.

The man moaned, his eyes opening feebly. His expression was blank as he tried to focus on Abby’s face while she bent close to him.

‘Take it easy,’ she said, ‘you’re ok. You’re lying on the floor. You fell down, but you’re ok, sir. Just stay where you are, don’t try to move. Help is on the way. I’m Dr Gibson.’

Dr Ryles moaned again, letting out his breath on a long sigh and closing his eyes wearily.

‘Have you got much pain?’ Abby asked, putting her mouth close to his ear and keeping her fingers on his pulse. Poor devil, she thought, feeling her throat close up with emotion. She liked Will Ryles very much; in all his dealings with her he had been unfailingly courteous, very professional, superb at his job, good as a teacher.

He shook his head slightly, mouthed the word ‘Ok.’

As she looked at him, Abby also felt anger and frustration. She knew that his department was one of those that was being downsized, so she had heard. New computer technology was enabling X-rays to be read and diagnoses to be made off-site, away from the hospital where the X-rays were taken and the diagnostic procedures done. Businessmen were making decisions about how things should be done, rather than medical professionals, often making vital and important decisions on things they knew little or nothing about.

‘Hurry…please, hurry!’ Abby whispered the words to herself, looking expectantly down the corridor, praying that the emergency department staff would get a move on.

When she heard the elevator doors opening in the distance and the banging of a stretcher being hastily pushed out, she stood up and gathered up all the bits and pieces of personal belongings that had fallen out of Dr Ryles’s pockets. She shoved them into her attachè case to make sure that they didn’t get lost in the dash to the emergency department; she would get them to him later, or to his family.

It was Dr Marcus Blair, Head of the emergency department, a nurse and two porters who came hurrying towards her as she turned to greet them. In moments they had an oxygen mask, attached to the portable cylinder, on Will Ryles’s face.

‘I found him like this a few minutes ago,’ Abby explained to Dr Blair. ‘He has a pulse, he’s conscious. Breathing ok. Blood pressure ninety.’

Dr Blair nodded. ‘Right. Let’s get him onto the stretcher.’

With all of them helping, they rolled Will Ryles onto a canvas sheet with poles attached, then lifted him onto the wheeled stretcher. Dr Blair put a rubber tourniquet round their patient’s arm, preparatory to taking blood samples—he would do that in the elevator as they were going up to the emergency department on the main floor level. They would need blood for the cardiac enzyme tests, electrolyte levels and a hemoglobin test.

‘We’ve got someone holding the elevator for us,’ Dr Blair said. ‘Come on.’

‘Do you need me, Dr Blair?’ Abby asked.

‘No, we can manage now. Thanks, Dr Gibson. A good thing you came along. It’s like the Sahara desert down here.’ With that, they set off at a quick trot down the corridor. Abby stood to watch them until she heard the elevator doors close and the elevator move upwards. Only then did she realize how tense she was, like the proverbial bowstring.

‘Phew!’ She let out a breath she had been holding. ‘Thank God for that.’

If anything had happened to Will Ryles she would have felt personally responsible. She could have called a code—the cardiac arrest code, she supposed now—but really he hadn’t had a cardiac arrest. He would be all right now.

She felt drained, as though she had already done half a day’s work, as well as shaken up by this sad encounter with someone she knew fairly well as a colleague. Someone would now have the unpleasant task of calling his wife to let her know.

‘Not a good way to start the morning,’ she muttered to herself as she resumed her journey. There was no point now in rushing to the rounds—a good part of the first presentation would be over.

Usually two or three of the residents-in-training, young doctors, presented interesting cases to the department of medicine and anyone else who cared to attend the rounds for learning or interest purposes. As a trainee, she was expected to attend. Sometimes there were photographic slides to look at, sometimes microscopic slides as well if the patient had had a surgical biopsy or other lab work.

Perhaps she could just slip in unnoticed to the small lecture theatre where the rounds were being held this time. If not, she would just have to apologize to Dr Contini, who was running the rounds, and explain the delay.

No such luck, Abby thought resignedly as she entered the room just as one of the window blinds was being let up so that brilliant spring sunshine entered the room at the same time, as though to highlight her late appearance. A slide presentation was obviously just over, indicating that the first case had already been presented. There would probably be one or two more.

Quite a lot of people were present, juniors and seniors alike. Some turned to look at her as she came in. She moved to the back of the room to try to blend in with the small crowd around the coffee urn that was set up on a table.

Moments later she was sipping hot coffee thankfully, holding her bag and books awkwardly with one arm, her mind soberly on Will Ryles. By now they would have the life-saving drugs dripping into his veins via an intravenous line. Would he be relieved, knowing he was out of it for a while, out of the workforce, even though he had a serious condition? Or would he constantly fret about the work he was missing? He was probably one of those guys who pushed himself too hard, not wanting to admit that he needed a break.

Several of her close colleagues were there, those who were in the same training program, and she made her way towards them. It was then that a firm hand grasped her arm from behind, halting her progress.

‘Dr Abigail Gibson, I presume?’ a masculine voice said. It wasn’t, it seemed to her, a warm voice. It held a sardonic note, a note of censure, and Abby cringed inwardly as she turned to look at the owner of the voice.

As she turned, the heavy books once again slipped from her grasp and landed with a thump at the feet of the speaker, partly covering his shoes. Then, as she stared down at them, a few splatters of coffee from the Styrofoam cup she was holding dotted the cover of the uppermost book.

Feeling clumsy and disconcerted, her mind elsewhere, she found herself stammering. ‘Y-yes, I’m Dr Gibson,’ she confirmed, raising her eyes to the man who stood looking down at her.

With a sense of shock she looked into cool blue eyes, intelligent eyes that were regarding her with undisguised perceptiveness and not a little exasperation, tinged with surprise…perhaps from the weight of the books on his toes? Abby swallowed convulsively.

‘S-sorry,’ she added.

He had an attractive, very masculine face, with a fine chiselled bone structure. Instantly she thought of a racehorse, a thoroughbred, with its fine aristocratic frame, perfectly formed for its function. The face was not smiling.

So this must be Dr Blake Contini. Abby felt slightly breathless, rather as though she had been punched in the solar plexus, not least because he was now frowning at her in a way that did not seem justified by her lateness or by the fact that she was a junior doctor in a training position or by the weight on his feet. After all, she was not even in his department as such. It brought an odd feeling, this astute appraisal, coming as it did on top of a sense of mourning that she had for the plight of Will Ryles.

‘Sorry,’ she muttered again, unable to think of anything else. As she bent carefully at the knees to retrieve her books, a few more drops of coffee escaped from her cup.

‘Let me do it, Dr Gibson,’ he said, putting out a restraining hand. Abby flushed, feeling as though the entire room had gone silent, that she was the focus of attention. Keeping her gaze lowered, she watched his lean hands wipe the coffee off her books with a handkerchief and pick them up.

‘Here,’ he said, thrusting the books at her and helping her to tuck them under her arm. ‘Better get yourself another cup of coffee.’

‘Th-thanks.’ For a couple of seconds she thought she detected a touch of humour in his eyes as he looked at her when their hands touched warmly for a moment.

He took a sheet of paper, a computer printout, from the pocket of his lab coat, holding it so that she could see it. For a few seconds she gazed at it blankly.

‘This is the summary of the first case we’ve reviewed today, which you’ve managed to miss entirely,’ he said. ‘We’re about to start on the second case.’ He tucked the paper between the pages of one of her books. Abruptly he turned away.

‘Wait a minute,’ she said, recovering something of her habitual confidence and composure. ‘And you are? I didn’t get your name.’ He hadn’t given his name—that had been a bit boorish, she considered belatedly.

It was almost certain that he was who she supposed him to be, as he had been avidly described to her by several of her women co-workers, yet he could not make the assumption that she would automatically know who he was. The thought of such an assumption fuelled niggles of annoyance.

He turned back to her slowly, an expression of muted surprise on his face. Fixing her with a look that might have quelled a lesser mortal, he held out a hand to her. With his other hand he deftly plucked the coffee-cup from her. ‘Don’t want any more accidents, do we?’ he said sardonically, while Abby was only too aware that other people nearby were staring at them curiously. ‘I’m Dr Contini,’ he added dryly, gripping her vacant hand firmly. ‘Blake Contini—Acting Head of the department of internal medicine.’

‘Oh…I see,’ Abby said thoughtfully, as though she had had no idea. ‘That explains it.’

‘I’ll talk to you at the end of the session, Dr Gibson. Wait for me,’ Blake Contini said, turning away from her.

‘Yes, Dr Contini.’

When Abby caught sight of her colleagues in the family practice program looking at her commiseratingly, grinning, she felt her face flush anew. That guy was something else! As soon as these rounds were over she would give him a piece of her mind if he was high-handed with her when she explained about Dr Ryles. As it was, he hadn’t even given her an opening to apologize out of politeness. Some of the other staff men would have turned a blind eye to her lateness. Maybe because some of them didn’t care, she had to admit in all honesty. Some were good teachers, some were mediocre, some were downright bad.

‘What was that all about?’ Her colleague and friend Cheryl Clinton approached her. ‘Was he mad at you for missing the case?’

‘Yeah, I guess so.’ Abby shrugged. ‘What a high-handed guy. And what a nerve, in front of the whole room.’

‘I wouldn’t mind getting that sort of attention from him,’ Cheryl said, her eyes searching the room for the object of their discussion.

‘At least he’s got a firm handshake.’ Abby tried to laugh it off. ‘I can’t stand guys whose hands feel like a slab of cheese or the proverbial dead fish. He wants to see me after…I can’t wait to give him an earful.’

Cheryl laughed. ‘Attagirl!’ she said delightedly. ‘Put him in his place.’ Then she added, sotto voce, ‘Pretty dishy, though, eh?’

Cheryl’s head turned again towards the tall figure who was now across the room talking to the medical residents who had presented the case Abby had just missed.

‘Mmm,’ Abby said absently as she turned to follow Cheryl’s line of vision, looking at the aquiline profile of Dr Contini. Her thoughts were returning sharply to Dr Will Ryles, wondering what was going on right now with him in the emergency department, whether the staff had informed his wife yet, whether she was at this very moment driving to the hospital with a terrible fear in her heart of what she might find there. As soon as possible she would get down there herself and find out.

‘I’m sorry I missed the first case,’ she murmured. ‘Something happened. I’ll tell you about it later, Cheryl.’

The next case was about to be presented. Maybe by the time she got out of this room Dr Ryles would have already been transferred to the coronary care unit.

Dr Contini, as though sensing her eyes on him, turned sharply to look at her over the heads of his new colleagues. His eyebrows rose slightly, questioningly, as their eyes met. Probably, he didn’t even know Will Ryles, she told herself angrily.

Refusing to be the first to look away, Abby held his gaze. There was no way that she was going to be intimidated by him. For the second time in the space of a few minutes she felt a sense of shock, a sudden unwelcome stab of acute sexual attraction. Then all attention was focused on two young residents who stood up at the front of the room to present the second case of the rounds.

When the rounds were finally over and the others had gone, Abby lingered in the room, waiting. All the others had left abruptly, having to resume their normal working day. She watched as Dr Contini walked over to the door and closed it, shutting out the sounds of chatter from the retreating staff.

‘Well, Dr Gibson,’ he said, coming over to her, ‘why were you late? And am I right that you’re in the second year of the family practice training program?’

‘Yes,’ she confirmed, looking at him but trying not to stare. ‘I’ve just started the second year.’

Blake Contini had thick, dark hair, cut fairly short, which contrasted dramatically with a pale skin that had only a very faint tan. From a winter holiday, perhaps? Although Abby was quite tall herself, five feet eight inches, he was considerably taller, forcing her to look up at him as she stood there in her sensible flat shoes.

‘Are you planning to work as a general practitioner when you’ve finished training?’ he asked, not waiting for her to answer his other question.

‘Of course, Dr Contini,’ she said, surprised. ‘Why else would I be doing it?’

‘Plenty of young women doctors get married shortly after training,’ he said dryly, ‘and don’t actually do much practice.’

‘Not me,’ she said. She managed to keep her tone from sounding rude, although she didn’t like his attitude. She had come to these rounds prepared to like and accept him. Now she felt herself to be uncomfortably on the defensive, a feeling which was reasonably alien to her. Yet at the same time she had an instinctive feeling that he had made that remark to find out if she were married. Don’t be ridiculous, she told herself fiercely. What’s the matter with you? Usually her internal dialogue was not as intense as this…He must be getting to her. Or she was getting broody…or something.

Maybe he, too, was one of the new breed, Abby thought, with a surge of bitterness as the image of Dr Ryles’s exhausted features came even more vividly into her consciousness. Maybe he was one of the slash-and-burn brigade who got rid of people without any human considerations, treating them like items in statistical tables.

‘I expect residents to be here on time, Dr Gibson,’ he was going on. ‘Even the family practice residents. I trust that is not too much to ask?’ he continued.

‘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.