Читать книгу: «A Courageous Doctor»

CHAPTER ONE

‘YOU’RE needed, Hugh. A and E.’

‘On my way.’ Dr Hugo Patterson straightened, looping his stethoscope around his neck and smiling at the elderly woman in the bed. ‘You’ve certainly picked up a bug, I’m afraid, Nancy. You’re rattling away like an old train.’ He patted the frail hand lying on the pale green coverlet. ‘We’re going to keep you on oxygen and start some antibiotics.’ He looked up at the nurse standing nearby. ‘Is the call urgent, Megan, or do I have time to pop in an IV line?’

‘Sounded urgent.’ Megan bit her lip. ‘There was some shouting going on in the background and Lizzie sounded stressed.’

The look they exchanged acknowledged the unlikelihood of anything minor making Lakeview Hospital’s nurse manager sound stressed. Hugo nodded as he reached for the chart to scribble instructions for the antibiotics he hoped would deal with his ninety-six-year-old patient’s pneumonia.

‘I’ll be back to see you just as soon as I can, Nancy. You behave yourself in the meantime.’

‘Thanks…love.’ The effort of speaking at all was obvious but the smile she gave Hugo was as lovely as always. ‘Go…they need you.’

‘Are you happy to get the line in and start the medication, Megan?’

‘I’ll have a go.’ Megan had to lengthen her stride to keep up with the doctor. ‘Her veins are horribly fragile, though.’

‘I’ll get back as quickly as I can. Have you heard how Nicola is getting on?’

‘Last I heard she was six centimetres dilated and getting tired. I think Joan’s a bit concerned about her.’

Hugo was moving faster now. ‘I’ll drop into Maternity on my way back here.’

It wasn’t far to the somewhat ambitiously named A and E department of the small rural hospital. Hugo strode along the corridor without more than a passing glance through the long windows opening onto a wide verandah. Some of Nancy’s fellow long-stay geriatric patients were ensconced in comfortable armchairs, enjoying the last fleeting warmth of the late winter’s afternoon sunshine. This winter would undoubtedly be Nancy’s last but Hugo was determined to pull her through this new bout of pneumonia so that she could enjoy for just a little longer the spectacular snow-covered peaks of the mountainous region she loved so much.

The double doors at the end of the wide corridor flapped in response to Hugo’s firm push. The trauma room he was now in was curiously empty. This was their assessment and resuscitation area for serious injuries or illness, so where was the urgent case he had been summoned for? Hugo kept moving, through to the four-bed treatment room which led to the small reception and waiting area. He could hear Lizzie now, speaking with all the sternness and authority she had gained over her many years’ nursing experience.

‘You’ll have to shift it. You’re parked in the ambulance bay and there’s an ambulance due to arrive any minute.’

‘I’m not shifting. This is supposed to be a hospital, isn’t it? Where’s a bloody doctor when you need one?’

‘Right here.’ Hugo slowed his pace as he entered the reception area. His gaze took in Lizzie’s arms, folded over her ample bosom, a man in belligerent stance with beefy hands gripping his hips, the open-mouthed fascination with which Anne, the receptionist, was watching the scene and finally the small tour bus parked in front of the ambulance loading platform.

‘I’m Dr Patterson,’ he added calmly. ‘What seems to be the problem?’

The telephone began ringing just as both Lizzie and the man spoke at precisely the same moment.

‘They’re sick—the whole bloody lot of them,’ the man announced impatiently.

‘It looks like mild food poisoning to me,’ Lizzie said. ‘There’s eleven of them.’

Anne’s voice cut into the pause as Hugo held up a hand to request one speaker at a time.

‘I’ve got Mr Payne on the phone, Hugh. He sounds very upset.’

‘Lizzie?’ Hugo tilted his head as he moved towards the desk, inviting the senior nurse to follow. ‘Just give me a second with Mr Payne and then you can fill me in.’ He took the phone from Anne. ‘Hugh Patterson.’ He listened for a few seconds. ‘Try and calm down, Tom. How long has she been missing? Has she been unwell in any way today?’ He listened again for a moment. ‘If you don’t find her in the next few minutes, call the police in to help. We can send an ambulance out as well if you need it.’

Lizzie was shaking her head as Hugo hung up. ‘The ambulance won’t be available for at least ten minutes. It’s on its way back from Coronet Peak with a ski trauma. Erin Willoughby’s broken her arm, snowboarding.’

‘Oh, no!’ It wasn’t the first time Hugo had had cause to regret working in such a popular location for adventure sports of all kinds. It was easy to attract staff, especially young nurses who had leisure pursuits such as skiing, but it led to a high staff turnover and complications such as staff shortages due to injuries like this. ‘We’re short-staffed as it is.’

‘I know,’ Lizzie agreed grimly. ‘And we’re heading into the winter peak season.’ She glanced over her shoulder, frowning. ‘Where’s that bus driver gone?’

Hugo could see where. Young Japanese tourists were climbing off the bus, some clutching their stomachs and some holding suspiciously full-looking paper bags. They were all heading for the pedestrian entranceway to the hospital.

Lizzie followed his gaze and sighed heavily. ‘I’ve told him that we can’t admit them all. I’ve talked to Jenny, who’s the GP on call for their hotel, and she’s happy to keep an eye on them. They’ll be fine if they go to bed and keep their fluid intake up.’

‘Have you checked them out?’

Lizzie gave Hugo a look that suggested he should know better than to ask such a question. ‘Only half of them are vomiting so far and the ones that have are feeling better already. None of them are showing any signs of dehydration.’

‘They’re all very young.’ Hugo smiled automatically at the first couple entering the reception area but received no response. One after another the tourists filed in, followed by the driver.

‘There you go,’ he told them with satisfaction. ‘They just need something to stop them throwing up and we’ll get out of your way.’

‘Stopping the vomiting will only keep them sick longer,’ Lizzie responded coolly. ‘Their bodies are just trying to eliminate the toxin.’

The girl who approached them was looking very pale. ‘Where is toilet, please?’

‘Through there.’ Lizzie pointed to the door at one side of the desk and the girl turned in the direction indicated. The queue for the single cubicle was instantly a problem.

‘Anne, could you hand out some vomit containers, please? You might need to show some people through to a ward if they need a toilet as well. We’re not going to cope with just this one.’ Hugo turned to the bus driver. ‘Are you the only one who isn’t unwell?’

‘Yep. That’s because I didn’t eat the picnic. I don’t go for weird things like seaweed. I went to the pub and got a pie instead.’

‘They stopped at Alexandra,’ Lizzie explained. ‘To eat the fish sushi they collected in Dunedin this morning. Everyone else ate the sushi and started getting sick within two hours. Five couples and the tour guide.’

‘It’s the “Western Wedding Experience”,’ the driver added helpfully. ‘They have the white wedding in the stone church in Christchurch with full video recording and then they get the four-day adventure honeymoon. Ice-skating in Alex, gold mining stuff in Arrowtown—’

Anne was waving at Hugo. ‘Mr Payne’s on the phone again. They’ve found Mrs Payne but she’s refusing to go home and she hit him in the face. He can’t stop his nose bleeding.’

‘Sounds like her Alzheimer’s is getting worse,’ Lizzie commented.

‘It’s too much for Tom to manage, no matter how much he wants to,’ Hugo sighed. ‘We’ll have to get her in for assessment and look at a rest-home placement.’

A young man near the door groaned loudly and dipped his face towards the white plastic bucket he held. Hugo felt like groaning himself but the bus driver was cheerfully ignoring any interruptions.

‘There’s two days in Queenstown to do the four-wheel-drive Skippers Canyon run with bungy-jumping, white-water jet-boat ride, skiing and so on. We’re due for a dinner cruise on the lake tonight and…’

Hugo sucked in a deep breath. ‘We’ll send the ambulance out to check on the Paynes as soon as it arrives. Put Erin in the trauma room and keep our other visitors in Reception or the treatment room if any of them look like falling over.’ His smile was apologetic. ‘I’ll have to leave you to it for the moment. We’ve got a delivery imminent that may need assistance and I’ve to check that Nancy’s antibiotics are under way. She’s got another dose of pneumonia.’

‘Oh, no.’ Lizzie’s expression confirmed Nancy’s status as one of the small hospital’s favourite residents. She nodded. ‘Don’t worry. We’ll hold the fort here.’

‘I’ve already called Steve in to do the X-ray for Erin,’ Anne told Hugo.

‘Good girl.’ For a recent school-leaver, Anne was proving very capable. She dimpled at Hugo’s praise.

‘I can help Lizzie look after this lot till you get back,’ she added. ‘Do you want me to call any of the other GPs in?’

‘We’ll see how we get on in the next half-hour or so,’ Hugo decided. ‘If things get any more chaotic than this, I’ll definitely need some help.’ He turned back to the driver who was, remarkably, still continuing his monologue.

‘Then it’s off to Te Anau, and the Milford Sound and dolphin bit, before heading back to Christchurch and the plane back to Japan.’

‘Shift your bus,’ Hugo instructed curtly. ‘You’ll find a parking area outside Outpatients to the right of the ambulance bay.’

The maternity suite beckoned like an oasis of calm in a day that had deteriorated at an alarming rate. The midwife, Joan Pringle, was outside the door of the delivery room when Hugo arrived. Her white uniform looked as crisp and fresh as it had first thing this morning and her long blonde hair was still neatly coiled at the back of her head, with no errant tendrils to spoil the young woman’s aura of competence. Joan’s even features were as pleasing as the rest of her appearance, and her pale blue eyes never failed to be a little surprising. At present, however, the midwife’s smile was strictly professional.

‘Good timing, Hugh. I think the pethidine is wearing off. The entonox doesn’t seem to be providing enough additional relief any more.’

‘How’s it looking?’

‘Seven centimetres last time I checked, maybe eight. And that was twenty minutes ago so we shouldn’t be far off transition. She’s getting very tired, though. I think she might need some help. I’ve got the ventouse and forceps kits ready but I won’t call you until I know for sure.’

‘I’m glad you’re in charge here, Joan. It’s going mad everywhere else at the moment. Roll on Friday.’

‘I’m looking forward to it as well.’ Joan’s smile was less professional this time and it took Hugo a second to realise she was referring to their customary Friday night date and not the end of his week on full-time hospital cover that he had been referring to. He returned the smile, feeling a trifle guilty that the date hadn’t been a priority.

Nicola Cross, doing her best to deliver her second child, was delighted to see Hugo.

‘I’m so glad you’re still on duty, Dr Patterson.’

‘I would have come in for this anyway, Nicky. And I’m never far away.’ His smile was a little wry as he noted the healthy rate of beeping from the foetal heart-rate monitor. ‘Sometimes I think I should have bought a house a bit further on around the lake.’

‘You got part of the old Spencer farm, didn’t you?’ Nicola seemed eager to distract herself from the prospect of another contraction.

‘Yes. I was lucky enough to get a stretch of lakeside with the old shearers’ quarters and the woolshed.’

‘Is it true that some hotel chain offered Mrs Spencer millions for it?’ Nicola’s husband, Ben, was sitting beside the bed.

‘She certainly could have done a lot better than selling it to me, but she knew how much I loved the place.’ Hugo smiled fondly. ‘I inherited her dogs last year. Maybe she wanted them to live out their lives on a patch of their own land.’

‘Hugh’s converted the shearers’ quarters,’ Joan added. ‘It’s a beautiful little house now.’ She turned away to wash her hands and Hugo couldn’t help wondering if it had been the mention of the dogs that had prompted such laudable thoroughness in her technique. Despite some valiant efforts, Joan had never been able to hide her dislike of any domestic pet’s less hygienic attributes.

Nicola wasn’t listening any more. She had put the entonox mask to her face and was sucking in long breaths of the pain-relieving mix of oxygen and nitrous oxide.

Hugo waited until the contraction was over to examine Nicola. ‘You’re almost fully dilated,’ he told her. ‘So it shouldn’t be too much longer. It means I can’t give you any more pethidine, though, because it might affect the baby’s breathing.’

‘I’ll cope,’ Nicola said wearily. ‘As long as I know it’s going to be over soon.’ She groaned and pulled the mask to her face. ‘Here we go again.’

‘I thought it would be easier the second time around.’ Ben had risen to put his arm around his wife’s shoulders for support. Nicola wrenched the mask clear.

‘It was no picnic the first time, mate.’

Her choice of words was enough to prompt Hugo to move on. He would have to race up to the ward to check Nancy and then get back to see how Lizzie and Anne were coping with the aftermath of the sushi picnic.

Nicola’s mother was outside the delivery room. She appeared to be having difficulty retaining her hold on a two-year-old boy’s hand.

‘We’ve been around the car park three times,’ the older woman sighed. ‘There aren’t any more aeroplanes taking off over the road and Henry’s bored.’

‘Wanna go in the bus,’ Henry informed Hugo.

‘No.’ Hugo shook his head firmly. ‘It’s a nasty, smelly bus. You wouldn’t want a ride in that.’ He smiled at Henry’s grandmother, ignoring her faintly astonished expression. ‘It shouldn’t be too much longer before Henry’s brother or sister turns up. I’ll be back soon.’

‘Soon’ was fortunately an elastic expression. Megan hadn’t managed to get an IV line into Nancy so Hugo spent nearly fifteen minutes in the ward, coaxing an ancient vein to accept a cannula large enough to carry fluids and the hopefully life-preserving medication. Back in A and E, the break in Erin Willoughby’s forearm had been X-rayed by Steve, the technician.

‘Nice clean break,’ Hugo pronounced. ‘We can reduce and set that, no problem, so we won’t have to ship you off to the big smoke.’ He shook his head sadly. ‘How could you do this to us, Erin? You know how short-staffed we are.’

‘Sorry, Hugh.’ Erin’s wide smile removed some of the sincerity from her repentance. ‘But you should have seen the air I was getting with my jumps before I canned out. It was awesome!’

Thanks to the entonox, Erin’s smile was still apparent even when Hugo and Lizzie straightened her arm and applied the first layers of plaster bandages.

‘I’ll leave you to finish, Lizzie, and get another X-ray done. Sorry—it’s going to make you a bit late getting off duty.’

‘No problem,’ the older nurse assured him. ‘Can you just make sure Anne’s coping in Reception before you disappear again?’

Anne was coping admirably. She had provided a cup of tea for the bus driver and they were having an animated conversation in front of the silent, pale audience that filled all the seating the reception area had to offer.

‘So they come all the way to New Zealand just to do the white weddings?’

‘They have another ceremony in Japan later. Or maybe they do it first.’ The driver’s shrug indicated the unimportance of the order. ‘It’s great business, anyway. I do the honeymoon run every couple of weeks now.’

Hugo ran an experienced eye over the exhausted and somewhat bewildered-looking audience. ‘Things seem to have settled down here.’

‘Nobody’s been sick in the last twenty minutes.’ Anne nodded. She lowered her voice. ‘I think Jess might need danger money when she comes in to clean the loos tonight, though.’

‘Can’t say I’m looking forward to cleaning up my bus either.’ The driver drained his mug. ‘All part of the job, I guess, so I’d better get on with it. Thanks for your help, Doc.’

‘You’re welcome. I don’t think anybody will be wanting to go bungy-jumping or jet-boating tomorrow. They all need a good rest and an intake of clear fluids. Tell the tour guide to call a doctor if she’s worried about anyone later. The hotel management will be able to help.’

Walking down the corridor again, Hugo could see the young honeymooners shivering as they climbed back onto their bus. Night had fallen with winter’s dramatic suddenness and, judging by the spectacular red glow silhouetting the top of the craggy mountain range, it was going to be an icy one. Winter Festival participants would be happy with the fine day that tomorrow would undoubtedly bring. Apart from Erin, of course, who would no longer be participating in any freestyle snowboarding competition.

No summons had come from Maternity and Hugo was not surprised to find that Joan had managed a potentially difficult birth without his assistance. He arrived at the delivery suite again to find an extended and happy family crowding the room.

‘It’s a girl,’ Ben informed him solemnly. ‘I got to cut the cord.’

‘Congratulations—she’s gorgeous.’ Hugo’s admiring gaze gave no indication that he was assessing the new baby’s condition. ‘Have you chosen a name?’

‘Mannie!’ Henry shouted.

‘Melanie,’ Nicola corrected with a tired smile. ‘Do you want to give your sister a kiss, Harry?’

‘No.’ Henry wriggled in his grandmother’s arms. ‘Mannie’s dirty.’

‘She just hasn’t had her bath yet.’ Joan caught Hugo’s eye. ‘Apgar score at one minute was nine and it was ten at both five and ten minutes.’

Hugo smiled at Melanie’s proud parents. ‘Sounds like she’s fine,’ he said. ‘I’ll check her properly when you’ve had some more time for a cuddle.’

‘Nicky might need a couple of stitches but it’s only a small tear.’

‘Placenta intact?’

‘Appears to be. It’s over there if you want to check.’ Joan nodded towards a covered basin on the trolley. Hugo reached for a pair of gloves as Henry began drumming his small heels against his grandmother’s legs.

‘Wanna get down.’

If Hugo had been a little quicker he might have rescued the basin before Henry tripped and fell against the trolley, which tipped over with a resounding crash. The small boy howled with fright, his new sister took up the cry and the rest of the family looked alarmed. Joan’s smile was tight. She picked up the toddler and deposited him firmly onto the chair beside the bed.

‘Sit on this chair, Henry. And don’t move!’ She leaned down. ‘If you’re a good boy and stop crying right now, I’ll see if I can find you an ice block.’

Henry hiccuped as the sobs subsided. Hugo scooped up the mess on the floor, silently applauding Joan’s ability to deal with small children. It was disturbing to find he was now looking forward to leaving work so eagerly but there was just so much a man could take in one day. Grandma took Henry home, Hugo stitched up Nicola’s tear and Joan took the baby to the nursery to clean her up. Hugo joined her and pronounced the baby fit and healthy after a thorough paediatric check. He watched as Joan expertly applied a tiny disposable nappy and then swaddled the tiny girl in a soft cotton blanket.

‘You make that look so easy.’

‘It is easy.’ Joan tucked the baby into the crook of her elbow and smiled at the infant. ‘Isn’t she gorgeous?’

‘Absolutely.’ Hugo couldn’t quite put his finger on the reason for his sudden unease. Maybe it was because it was taking so long for him to escape.

‘Do you know, I’ve delivered more than a hundred babies since I came here?’

‘Really? I guess you would have. You’ve been here nearly three years and we get about ninety births per annum.’ He smiled admiringly. ‘You’re doing your fair share, that’s for sure. Are you still enjoying your job?’

‘Oh, I love it.’ Joan’s smile was rather wistful, however.

‘But?’

Joan hesitated. The glance she gave Hugo seemed almost shy. ‘I guess sometimes I wonder how many more of these bundles of joy I’ll deliver for other women before I get one of my own.’

Hugo’s unease deepened perceptibly. ‘You’re only thirty, Joan. There’s plenty of time…isn’t there?’

‘Of course.’ Joan had hesitated just long enough to let Hugh know that, as someone who cared, it was his duty to investigate this matter further. His sigh of relief as his pager sounded was fortunately not audible.

‘I’d better get that.’ The atmosphere became safely professional again. ‘I’ll catch you later when I check on Nicola again. Maybe we’ll have time for a coffee before you go home.’

‘You’d better get your skates on, then.’ Joan glanced up at the wall clock. ‘I’ve got my oil-painting class at eight o’clock and I can’t miss that again.’

Hugo didn’t really need to spend twenty minutes in the long-stay geriatric ward, making sure that Nancy was as comfortable as possible and that the night nursing staff would continue her close monitoring. Neither did he need to do such a thorough check on the four general medical patients they had at present. The trip to A and E to send Erin home with some pain relief and instructions on caring for her arm was not entirely necessary either, but each task he set himself seemed perfectly prudent. It certainly hadn’t been his intention to take so long getting back to Maternity.

‘Has Joan gone home, then?’ he asked the night nurse.

‘Twenty minutes ago. Did you want her for something?’

‘No.’ Hugo was disconcerted to find a hint of relief rather than disappointment lurking. He must be more tired than he’d thought. ‘How’s Nicola?’

‘Sound asleep—just like her daughter. Do you want to see them?’

‘I won’t disturb them. It’s high time I went home myself.’

The road curved around the edges of Lake Wakatipu and Hugo found himself nurturing his first real hope of winding down from a long and tiring day. The level of stress he was trying to escape was unusually high. He loved his job and his lifestyle and it was a rare occurrence to have a day as hectic as today’s had been. The busload of poisoned honeymooners had tipped the balance a little too close to chaos for comfort but the diverse range of illnesses and injuries that tourists to the area brought was part of what kept his life as a rural doctor so interesting.

And the tourists were flocking to Central Otago, and Queenstown in particular, in increasing numbers every year. More than once the alpine resort had received accolades of being the friendliest foreign city and it was the only New Zealand destination to rank amongst the world’s top twenty. A place of enormous scenic beauty, with a rich gold-mining history and award-winning vineyards, Queenstown had also earned a reputation as the adventure capital of the world. With a baseline population of fewer than twenty thousand people, peak summer and winter tourist seasons could take numbers to over forty thousand. That dramatically increased the workload of the available GPs and the local hospital where Hugo worked for most of his time as its on-call physician and medical administrator.

Two startled rabbits ran from the beam of the headlamps as Hugo turned to swing his Jeep into the covered space the old woolshed provided for his vehicle. Three old farm dogs competed for his attention the moment he stepped out, and Hugo bent to fondle three pairs of ears before making his way to the long, low house sitting only metres away from the lake-side shingle beach. Having reached the veranda, he paused for a moment despite the bone-chilling temperature to take in the shimmer of moonlight gilding the glassy, black surface of the lake. It was bright enough to make the lights of Queenstown on the far shore of little note.

The happy panting of the dogs and the gentle rub of shingle from tiny waves at the lake’s edge were the only sounds to break a deep and peaceful silence. Then a muted whine from one of the dogs reminded Hugo that he was very late producing their dinner. He moved inside, checked his phone for messages, opened the logburner to add wood and crank up the air flow and then filled the three bowls in the laundry with dog nuts. Reaching into the fridge to retrieve the remains of last night’s casserole for himself, Hugo spotted the half-finished bottle of white wine. One glass wouldn’t hurt, even if he was on call. The only message on his phone was from his mother and Hugo had an uneasy feeling that talking to Gwen Patterson might not be the best way to try and unwind.

In fact, it might be better if he put off returning the call until tomorrow. Leaving the bottle where it was, Hugo put the casserole in the microwave and hit the reheat button. The old leather armchair near the fire looked extremely inviting and Hugo took his plate in that direction a few minutes later. The phone was within reach, recent, unread copies of his favourite medical journals were on the coffee-table beside the chair and his dogs were lying contentedly in the circle of warmth. Hugo felt his stress levels declining rapidly. He was, once again, a very happy man.

At least, he was until the insistent call of the telephone jerked him from a very pleasant post-prandial doze.

‘Darling, you’re finally home! I rang earlier.’

‘I was just thinking about you,’ Hugo said in surprise. The half-dream had been a less pleasant aspect of the doze. He had been almost convinced that his mother was about to arrive on his doorstep for another extended visit—intent on finding the woman who would bear her grandchildren. As much as Hugo loved his mother, anything more than a three-day visit was a daunting prospect. ‘I’ve been incredibly busy today,’ he added hurriedly. ‘In fact, life is generally a bit hectic at the moment.’

‘Don’t worry, Hugo. I’m not planning a surprise visit. Queenstown’s far too cold for me in winter.’

‘It’s freezing,’ Hugo agreed. ‘But the mountains are looking glorious with all the snow.’ He relaxed a little. ‘How are you, Mum?’

‘Oh, I’m fine.’ The fact that Gwen had something more important on her mind than the list of minor, age-related physical ailments she loved to discuss with her son, the doctor, was a warning. That she had rung twice in the space of two hours made the matter of some urgency.

‘Is everything OK at home?’

‘Oh, yes. Everything’s fine. Apart from the fridge. It’s making a very funny noise. Sort of a clunk and then a dribbling sound. It always seems to happen in the middle of the night.’

‘Are you not sleeping well?’ Talking about fridges reminded Hugo of that bottle of wine. He pushed himself slowly to his feet.

‘I’m fine,’ Gwen repeated impatiently. ‘I didn’t ring up to talk about me, dear.’

‘Who did you ring up to talk about?’

‘Maggie Johnston.’

Hugo sat down again abruptly. And silently.