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CHAPTER TWO

LIEN WAS WAITING for him when he arrived back after dropping Regan at the school. He’d obviously been nervous about leaving his son at the strange school in an unfamiliar city, but the place had given him good vibes. The nursery teacher had shown them into a bright, welcoming environment filled with a host of happy-looking children chattering in different languages.

Regan had tugged at his hand after a few minutes, anxious to go and join in the fun, so Joe had left with reassurances that they would call the hospital if there were any concerns.

By the time he got back to the hospital it was a few minutes before eight o’clock. Already the place was a hive of activity. The waiting room had only a few seats left. Lien was wearing a pale blue shirt and navy trousers, and her hair was in a ponytail again. There was no sign of the traditional white coat.

He’d swithered for a few moments this morning over what to wear, before settling on a pair of dark trousers and a simple short-sleeved white shirt. The temperature here was much warmer than he was used to, and he wasn’t sure if the hospital had air-conditioning or not. He hadn’t noticed last night. He gave a sniff. He wasn’t quite used to the aroma of the insect repellent he’d covered both himself and Regan in this morning. Maybe he should have tried to drown it out with more aftershave?

Lien gave him a brief nod as he walked back through the main entrance. ‘Good. Is Regan settled?’

He gave a brief nod and she started speaking again straight away. ‘Come with me, and I’ll give you a walk around. I’ll show you our systems and our supplies and when Mai Ahn, our translator, gets here, I’ll assign her to you for the rest of the day.’ She walked him over to a sink and started washing her hands. He quickly followed suit. She’d already mentioned norovirus problems. Hand washing was one of the key practices to help prevent the spread.

Joe barely had time to draw breath. ‘First thing,’ Lien said as she kept scrubbing her hands, ‘you should really wear long sleeves. If your shirts are too warm, I’ll show you a place where you can buy some lighter weight clothing. Do you have your insect repellent on?’

He nodded and she kept talking. ‘With Khiem and Hoa away, we’re two doctors down. I can’t afford for our latest recruit to pick up something from a mosquito bite.’

It felt like a bit of a reprimand and he wasn’t quite sure how to react, but Lien was already talking again. ‘Hoa covered antenatal and maternity care, so we’ll all have to pick up her role while she’s gone.’

Joe didn’t miss the way that she’d phrased that. She hadn’t asked him about his experience, or if he was happy to cover this area. She was letting him know what was expected of him. It seemed her directness last night hadn’t been unusual but the norm.

As they finished scrubbing their hands she kept talking while she dried hers. ‘Okay, I’m sure you’ve done some general reading on the health issues in Vietnam.’ She shot him a sideways glance. ‘Or at least I hope you have.’

He nodded quickly. ‘Of course. Main issues are malaria, tuberculosis, HIV and AIDS, with some cases of dengue fever and ongoing issues with Agent Orange.’

She gave an appreciative nod and held out her hands. ‘Biggest killer of kids in our area is malnutrition, coupled with diarrhoea and vomiting. They have no extra fat layers to fall back on. It hits hard and fast.’

‘So a norovirus outbreak is your worst nightmare?’

‘Pretty much.’

She led him down one corridor and then up a set of stairs. ‘Okay, downstairs is basically our clinic area. Upstairs we have six four-bed rooms with a variety of patients. Children and adults.’ He could see how the layout of the traditional colonial house had been adapted to work as a hospital. There were a number of nursing staff upstairs to whom she introduced him quickly. The staff seemed friendly, and the patients well-cared-for. Most were on IVs. Lien caught his gaze.

‘We have a mixture of dehydration in both the young and the elderly. Lots of chest complaints too. Anyone suffering from diarrhoea is cared for separately in one of the single rooms at the other end of the corridor.’

Joe nodded. He’d known whole hospital wards closed because of winter vomiting bugs. They couldn’t ignore, or not treat, people affected, but, because it was infectious, it had a real chance of being passed to other patients or staff. Hygiene issues had to be the top priority.

‘Anyone today that you’re worried about?’

She gave him a half-smile. ‘I’ve already done a ward round this morning, but we’ll do another one later so you can familiarise yourself with the patients. Today we start downstairs at the clinic.’

They washed their hands again, and moved back down the stairs.

Downstairs was separated into four areas. One was a general waiting room, one was for children, one for pregnant women and a fourth for X-rays, with a plaster room next door. It was a real mixed bag. A kind of cross between a GP surgery and community hospital back in Scotland.

Lien gave a little sigh as she showed him into an office and gestured for him to sit in the chair opposite her. ‘We have a real mixture of antenatal care. Only around sixty per cent of women in Vietnam attend antenatal care. Some women don’t present until late in pregnancy. Others present early, requesting their pregnancy be monitored all the way through for birth defects. It’s not unheard of for a pregnant woman in Vietnam to have up to twenty scans.’

Joe’s eyebrows shot upwards. The norm for the UK was two, unless there were any concerns. Something clicked in his brain. ‘Agent Orange?’

She nodded.

‘How often nowadays do women present with birth defects?’

Lien’s face was serious. ‘It’s more prevalent now in the south of Vietnam, but forty years on there are still children affected here. The spray that was used to destroy the crops obviously went into the soil. Poverty is a major issue in Vietnam and some families are solely reliant on growing their own foods. They have no other option but to eat the food they grow—whether the soil is damaged or not.’

She shook her head. ‘We have two other hospitals. One is in the outskirts of the city of Uông Bí city, in northeast Vietnam, and the other—the one Duc’s parents have just gone to—is in Trà Bồng District in the south of the country. At that one, we also take care of the kids in the nearby orphanage. A lot of them are affected. There’s poverty across Vietnam, just like there’s poverty in every country in the world, but it’s worse down in the south. Down there, families are reliant on farming. If their crops fail, it’s disaster for them. A lot of them rely on their kids to work alongside them. If their kids are affected by Agent Orange, or any other genetic or medical condition, often the family can’t afford to keep them.’

‘So they end up in the orphanage?’ Joe asked.

‘Exactly. We offer free medical care to the orphanage. Things have improved in the last few years, but we still aren’t where we should be.’

‘Sometimes I forget how lucky we are in the UK. Yes, things aren’t perfect. But the healthcare part of the job generally always gets done.’ He gave a slow nod. ‘And the first hospital you mentioned?’

‘The other is in Uông Bí in Quang Ninh province, in northeast Vietnam, more towards the coast. We’ll cover both hospitals at some point in the next six months—generally just for a week or two to cover holidays.’

‘Okay.’ He was beginning to get a general feel for the place, for the sort of patients he’d be seeing, and the kind of responsibilities he’d have here. None of it seemed beyond his ability, though he’d have to do a bit more background reading on some treatments.

Lien ran through the paperwork they used, how to order tests and their prescribing arrangements. She handed him a pre-printed list with Vietnamese names for some of the more commonly used drugs. It was clear she’d familiarised foreign doctors with the clinic workings before.

Joe leaned on one hand. Everything seemed straightforward enough. ‘This place,’ he said, ‘it’s like a cross between a community clinic, a cottage hospital and an ER.’

Lien was watching him with careful eyes. He couldn’t quite work out what was going on in her mind. He was sure she was part vetting him, part examining his motives. It was only natural. She was looking for someone she could rely on. Having to check another doctor’s practices would be almost as bad as not having a colleague at all. ‘Let’s hope you don’t have to cover it all at once,’ she said softly.

He could see the flash of worry in her eyes. But the only way to earn the trust of a colleague was to prove himself. Joe was willing to do that. Back home everyone trusted him in his current role, but he wasn’t back home any more. He was in an entirely different country, and while some health needs would be the same, there were others he’d need to query, and Joe wasn’t too proud to do that. He would never put patients at risk.

‘Where do you want me?’

Lien’s eyes brightened at the question. Was that relief he’d just spotted? ‘What do you prefer?’ she asked. ‘I need someone to cover the children’s clinic, and someone to cover the adult clinic.’

He gave a nod. The clinic work, whether it was for children or adults, would be very much like his GP role back home. He shot her a smile. ‘Happy to do either.’ Then met her gaze. ‘Put me wherever I can be of most use.’

She shifted a little in her chair, caught off guard at his words. He almost let his smile broaden. She liked being straightforward and so did he. ‘I’m not here to be a hindrance, Lien, I’m here to be a help.’

She reached up and brushed an errant strand of brown hair behind her ear that had escaped her ponytail. She was close enough that he could see just how smooth her skin was. She wore very little make-up. But she didn’t need any, her dark hair and eyes complemented her appearance beautifully. In another life, in another place, he would definitely have looked twice.

It had been so long since a thought like that had even entered his head that he automatically frowned. What was wrong with him? Where had that come from?

Lien tilted her head. ‘Something wrong?’

He shook his head too quickly. ‘No, nothing.’ He pushed himself up from the chair. ‘Where do you want me?’ He was anxious to get this day started.

The few seconds of silence was slightly uncomfortable. He flashed back to being a junior doctor and the nurse in charge of the ward shooting him a glance to say she doubted he should even actually touch a patient.

A figure appeared in the doorway and Lien stood up. ‘Perfect. Mai Ahn, this is Joe. Joe, this is Mai Ahn, your interpreter. She’ll help you with the children’s clinic.’

‘Children’s clinic it is,’ he said with a nod, before reaching out to shake hands with Mai Ahn. ‘Lead the way.’

She was unsure of him. Of course she was. Did he even notice he occasionally glanced at his mobile clipped onto his belt? It was only natural that he was worried about how his son was settling in on his first day of nursery, she only hoped it wouldn’t distract him from the job he had to do.

The children’s clinic wasn’t for the faint-hearted.

She couldn’t help but be automatically protective of the place she loved working in. At least he’d been honest last night. He’d told her that he and his son needed a change after losing his wife. He’d said it had been three years. But she’d seen the glint of pain in his eyes. Was he really ready to move on?

She still had doubts.

It was a shame. Because he was undoubtedly handsome. The burr of the Scots accent was almost melodic—even though she had to concentrate hard. And it was clear that he doted on his son. Just as she’d expect him to.

She gave herself a shake. It was a ridiculous observation. She was used to doctors coming here on short-term contracts, and she’d never considered any kind of relationship. She was too busy. Too dedicated to her work. She’d had her heart broken once, and that was enough for her.

Too poor. Not the words he’d used, but those were the words he’d meant. Lien had never pretended to be anything she wasn’t. As a child she’d always been well mannered and as well presented as she could be. She’d been bright, and her teachers had noticed. They’d encouraged her to study hard, and eventually helped her to seek out scholarships so she could attend medical school.

At medical school she’d got along with most of her classmates. Reuben had come from a rich family in another city. He’d never asked her where she lived—he’d just made assumptions. Then, when he’d found out, after two years, she’d been dumped quicker than a hot brick.

Her family was proud of her, and she was of them. She’d hated the way it had made her feel. Not good enough. Not rich enough.

She came from one of the poorest areas in the city. Her family still lived there—no matter how much she’d tried to assist them since she’d qualified as a doctor. But even now they wouldn’t accept any financial help from her.

They liked where they lived. They still worked hard. They didn’t want change, in any form.

Lien lifted the pile of patient notes from the desk. They were all people who were due back at the clinic today to be reviewed.

One of the nurses gave her a smile as she walked into the waiting room. There were already ten people waiting. She gave a nod of her head and smiled, speaking in Vietnamese. ‘Okay, who is first?’

The only person having trouble concentrating today was her. She kept casting her eyes through to the other waiting room. She knew that Mai Ahn, the interpreter, would come and find her if he had any concerns. But she didn’t. Instead, she saw an occasional glance of Joe carrying babies and toddlers through to the examination room for assessment or vaccinations. Through Mai Ahn, he chatted to the mothers. Most of them seemed happy to talk to him and from the looks on their faces the Scottish doctor was proving a hit.

After a few hours he came through and knocked on her door.

‘Lien, can we have a chat about a child?’

She nodded, pleased that he’d come to talk to her.

‘I think I’ve got a little one with complications of tuberculosis. I can’t find any previous notes, and there’s no X-ray.’ His brow wrinkled. ‘Don’t most babies get immunised against tuberculosis shortly after birth?’

‘They should. Unfortunately, tuberculosis is common around here. If babies are born in hospital they are immunised if the parents consent. But not all babies are born in hospitals. What do you think are the complications?’

He ran his hands through his hair. ‘She’s losing weight, even though she’s feeding. Her colour is poor, she’s tachycardic, and I suspect her oxygen saturation isn’t what it should be. Her lungs don’t sound as if they are filling properly. She has a temperature and a cough. I suspect a pleural effusion. Do you have a paediatric monitor I could use while I order a chest X-ray?’

Lien stood quickly and gave him a serious kind of smile. ‘Let’s do this together.’

He raised one eyebrow. ‘Don’t you trust me?’ He didn’t seem annoyed by the fact she was effectively second-guessing him. He might even have looked a little amused.

‘You asked for a second opinion, Dr Lennox. I’m going to give you one.’

The amused look stayed on his face. ‘Absolutely. I haven’t seen many kids with tuberculosis in Scotland.’

She gave a nod as they walked through to the paediatric treatment room. As soon as they reached the door, Lien could almost verify his diagnosis. She switched to Vietnamese and introduced herself to the mother and her five-year-old daughter, who was clearly sick.

Joe’s notes were thorough. Three other members of the family had active tuberculosis. Only one complied with their treatment. It was no wonder the little girl was affected.

Five minutes later they were looking at a chest X-ray. Joe was right at her shoulder. She held her breath and caught a slight whiff of the aftershave he was wearing, even though it was overshadowed by his insect repellent. She wanted to know if he’d recognise what she needed him to on the X-ray.

She needn’t have worried. He lifted one finger and pointed to the film. ‘Pleural effusion without any parenchymal lesion.’ He didn’t finish there. ‘I know there’s some mixed feelings, but because of how this little girl has presented, I would be inclined to drain the effusion rather than leaving it.’

She took a few minutes to recheck things. This was the first time he’d seen a child with tuberculosis, never mind the added complications, and he’d picked it up straight away. She couldn’t help but be impressed.

She turned to face him. ‘I think you’re right. Let’s put our public health heads on and try to persuade the rest of the family to comply with their medications. We can use a sample of the effusion to diagnose the tuberculosis. A pleural biopsy would likely be too traumatic right now.’

He nodded in agreement. She paused for a moment, wondering whether she should question his skill set any further.

‘Any experience of doing a pleural effusion in a five-year-old?’

He nodded. ‘I specialised in paediatrics before training as a GP.’ He gave her a steady look. ‘I’ve got this. But I’m happy for you to stay if you’d like.’

He didn’t seem defensive or annoyed, but it felt like a bit of a line in the sand. He already knew she’d questioned his diagnosis. Now she’d asked about his experience. Lots of other clinicians that she knew might have been annoyed by this, but Joe just seemed to have accepted her actions without any discomfort. Still, the tone in his voice had changed a little, as if he was getting a bit tired of her.

She pressed her lips together. If he’d expressed any anxiety about the situation she would have been happy to take over. But he hadn’t, and she knew it was time to step back. She had enough patients of her own to see still in the waiting room.

She glanced at the nurse and interpreter. She had confidence in both of them. Either of them would come and find her if they were worried. She tried her best to look casual. ‘I’ll leave it with you. Shout if you need anything.’

Joe watched her retreat, knowing exactly how hard it was for her. Was his counterpart a bit of a control freak? Or maybe she just second-guessed everyone she worked with?

He tried to understand, even though he couldn’t help but feel a little insulted by her lack of faith in him. It’s not like he hadn’t experienced this himself. He’d worked with plenty of other doctors, in a variety of settings over the years, and it always took a bit of time to reassure himself about a colleague’s skills and competencies.

It was clear she loved this place. She’d more or less told him that already. There was also the added responsibility of her employers not being here right now, so the well-being of May Mắn hospital was really in her hands.

He gave some instructions to the nurse, who seemed to understand his English, then knelt down beside the little girl and her mother with Mai Ahn, the interpreter, to explain what would happen next.

Thirty minutes later the procedure was complete, with some hazy yellow fluid in a specimen bottle for the lab. The little girl’s cheeks and lips had lost their duskiness, the oxygen saturation monitor showed improvement, and when he listened to her chest he could hear the improved inflation of her lung. He gave instructions to the nurse for another X-ray, and to further monitor for the next few hours.

‘I’ll come back and have a follow-up chat about the medicines,’ he said. Something came into his head. ‘Do doctors make home visits here?’

The nurse frowned for a second as if she didn’t quite understand what he’d said, then shook her head. ‘No. Never.’

Joe sat back in his chair for a moment. He didn’t want to send this child home with just a prescription in her hand. The rest of the family were important too. The mother had already told him that both her husband and father-in-law kept forgetting to take their tuberculosis meds. Only her own mother remembered. If he could just see them, and persuade them how important it was, it might stop other family members being infected. He glanced out to the waiting room. He still had a whole host of patients to see, some of whom would need vaccinations, and some might need tuberculosis testing. He went to the waiting room with Mai Ahn to call the next patient, while his idea continued to grow in his head.

‘He went where?’

Ping, one of the nurses, shrugged. ‘He talked kind of strange. Something about a home visit. Apparently they do them in Scotland a lot. He persuaded Mai Ahn to go with him.’

Lien walked over and looked at the notes, checking the address on the file, then grabbed her jacket. She’d nearly made it to the front door, when her brain started to become a bit more logical. All she was feeling right now was rage. She went back and scanned the rest of the notes, checking to see what other family members were affected. ‘Did he take prescriptions, or did he take the actual medicines?’ she asked Ping.

Ping gave her a smile as she carried on with her work and brought a single finger to her lips. ‘I couldn’t possibly say.’

Lien nearly exploded. It was obvious that the Scottish charm was already working on her staff. What on earth was he thinking? They had to account for every dose they used. They weren’t a dispensary. On a few occasions they gave out enough medicines to see a patient through the night, but they didn’t give out medicines on a regular basis.

She snatched up her bag and made her way out into the streets. It was around six now, and the pavements were filled with people making their way home from work, the streets filled with traffic. She did her best to dodge her way through the crowds and cross the few streets. The home address wasn’t too far away, but the walk did nothing to quell her temper.

By the time she’d reached the address her heart was thudding in her chest. This wasn’t exactly the best part of town. She had no idea how he’d managed to persuade Mai Ahn to bring him here, but she would make sure it wouldn’t happen again.

The house was on the second floor of an older block of flats, where each storey looked as if it squished the flats beneath it even more. She climbed the small stairwell and walked swiftly along, checking the number before she knocked on the door.

‘It’s Dr Lien, from the hospital,’ she said.

She held her breath for a few moments, and then frowned. Was that laughter she heard inside? The door creaked open and the elderly grandmother of the household gave a little bow as she ushered Lien into the house.

Lien walked through to the main room, where the majority of the family was sitting on bamboo mats on the floor, Joe amongst them.

Mai Ahn was by his side, translating rapidly as he spoke. He had laid the complicated drugs for tuberculosis out in front of the elderly grandfather, instructing Mai Ahn to draw a paper chart with dates and times.

Lien stopped the angry words that were forming in her mouth. Back when she’d worked in the US, dispensary boxes had been commonplace for patients who were on several drugs. But they weren’t widely used here at all. That was what he was doing. He was making a do-it-yourself chart and placing the individual tablets on it.

He looked up and caught her eye. ‘Lien, oh, you’re here.’ His eyes shot protectively to Mai Ahn, whose face revealed she thought she was in trouble. The little girl from earlier was sitting curled into her mother’s lap. She’d done well, had been sent home with a prescription for her own meds, and if they were administered to her, she should do well.

Joe stood up. ‘I was just explaining to the family the problems with drug resistance and how important it is to keep taking their medicines.’

There was a shout behind Lien and she turned to see another two children playing in another room. She swallowed and took a deep breath. ‘This might be common practice for Scotland, Dr Lennox, but it’s pretty unconventional for Vietnam.’

He stood up casually and shook hands with the grandfather, and then the little girl’s father, who also had a chart in front of him. He nodded towards Mai Ahn to get her to translate for him again. ‘Thank you so much for seeing me.’ He nodded to the little girl’s mother. ‘Make sure you collect that prescription tomorrow, and if you think there are any problems, feel free to come back to the clinic and see me again.’ He gestured towards the kids in the other room. ‘And remember to come in for the testing. Remember, we can vaccinate too.’

Lien didn’t know whether to be angry or impressed. He hadn’t just covered the delivery of the prescriptions, he’d covered the public health issues they’d talked about earlier, taking into account multi-resistant TB, contact tracing, further testing and immunisations.

She bowed in respect to the family and spoke a few extra words of reassurance before leading the way out of the house. She waited until the door had closed behind them, and Mai Ahn had hurried on ahead, before spinning around to face him. ‘What on earth were you thinking?’

His brow creased. ‘I was thinking about patients and their medicines. I was thinking about stopping the spread of disease.’

‘We don’t do this.’ She almost stamped her foot. ‘We don’t visit people at home.’