New Surgeon at Ashvale A&E

Sam shook his head. ‘The alternative will be to close units down altogether. Is that what you want to see? These debts will not simply fade away. It may be an unpalatable fact, but savings have to be made somehow.’

‘And how did those debts come about?’ Ruby’s grey eyes challenged him. ‘I’ll remind you, shall I? It was because of the finance deals entered into by the trust board to ensure that the building of the brand new Heritage Hospital could go ahead…the state-of-the-art, be all and end all of hospitals.’

‘Yes, that’s true.’ His tone was appeasing, smoothing over the arguments she’d made as though all was perfectly in order. ‘It was a costly venture, I grant you, but many, many lives will be saved because of its existence and because of the up-to-the-minute, high-tech equipment it enjoys.’

‘And what of the lives of the people who come here to the Ashvale Hospital, expecting first-rate treatment?’ She was warming to her subject, more than ready to tackle him head on. ‘How are they going to fare when we’re short of doctors and nurses simply because of the measures you’re about to take?’

He didn’t answer straight away. Instead, he was thoughtful for a moment or two, taking his time in contrast to her quick-fire opposition. ‘All right, let’s look at that,’ he said. ‘I can understand perfectly well why you’re concerned. But let’s take an instance, shall we?’ He paused once more, thinking things through. ‘Suppose a child is brought here by ambulance, suffering from a severe, life-threatening asthma attack. How many people do you suppose would be involved in his care?’

She thought about that. ‘The paramedics, a triage nurse, maybe the senior house officer and a paediatric nurse. There would be a consultant on call to oversee the situation.’

‘And between them you expect they would be able to resolve the child’s difficulties? They are all essential to the child’s well-being?’

‘I believe so, yes. Provided that they were able to access him quickly enough and give the right treatment, he should stand a good chance of recovery. That’s our job; that’s what we’re here for, after all. But if there is a breakdown in the chain of personnel brought about by staff shortages, or because people are too busy dealing with other life-threatening emergencies, I can see how things could go drastically wrong.’

He nodded. ‘You’re right, of course. Having qualified people in place to deal with events as they occur is essential, and no one wants to see staff stretched to the limit, least of all me. But in our hypothetical situation, all the staff and equipment in the world might not have saved the boy…because without the necessary savings to the department, the A&E unit here would have been closed down, and the child would have been transported instead to the Heritage…a journey of a further fifteen miles or so. Given the time taken for that journey, the strong possibility is that he would not have survived.’

There was a combined intake of breath amongst the doctors and nurses in the room as his point sliced home.

Ruby frowned. That was not good. He couldn’t be allowed to persuade his audience to submit to his plans by laying out a worst-case scenario as if it were the accepted outcome.

She sent him a direct, lancing stare. ‘Do you really think that argument is going to sway me, or anyone here? You’re planning to cut the tree off at the roots and afterwards you’ll inspect it every now and again to see if it somehow managed to survive.’ She shook her head. ‘There are other ways to make savings, which don’t involve shrinking your prime resource. For instance, you could take a closer look at some of the maintenance and repair contracts that are up for renewal with private companies. You could look to reducing payments for supplies by checking that only essential items are ordered.’

He smiled. It lit up his features, softening his expression and enhancing the perfect angles of his face, and just for an instant, it took her breath away. He was incredibly good-looking, she acknowledged. She hadn’t expected to have the rug pulled out from under her in quite that way, and it was a low blow, throwing her out of synch, her nervous system responding with a keen fluttering of sensation, a soft ripple of excitement running along her nerve endings.

‘So you want me to cut down on the number of pens I order,’ he said, with a soft edge of mockery. ‘Well, that’s a start, I suppose. And we could talk to the contractors about maintenance and ask them to forego checking the equipment once in a while. I’m not sure how well that would sit with nurses trying to programme a faulty infusion meter, though. It could turn out to be a false economy.’

His answer riled her. ‘If you have your way, there might not be a nurse to administer the infusion in the first place,’ she retorted, throwing him a cool glance. ‘You know as well as I do that commenting on pens and infusion meters is just a cheap jibe. With perseverance, good intent and a willingness to examine all possibilities, we can make this work. There are savings to be made, but we have to choose our targets carefully. I don’t believe that units have to be closed, or that staff have to be let go.’

Becky interrupted with an excited babble of baby talk just then, and Ruby glanced down to see that she was shaking her teething rattle with sudden vigour. The tension in the room dissipated as rapidly as it had risen.

‘The baby obviously agrees with you,’ Sam said, his mouth curving. ‘She seems to be a staunch supporter.’

Ruby laughed. ‘I’m sure if she was able to speak, she would remind us that people are our greatest asset. We have to work together to make this happen the way we want.’

He nodded and then agreed to take comments from other people in the room. Ruby sat down and tended to Becky, all the while lending an ear to the proceedings. The discussion ebbed and flowed for some time, until eventually the chairman called an end to the meeting.

‘We’ve covered a lot of ground today,’ he said. ‘Clearly, there has to be a lot more work done before we can decide on our ultimate course, and we welcome suggestions for different strategies from anyone who cares to make them. I suggest we meet again in a few weeks to finalise matters.’

The meeting broke up, and Ruby chatted with James and Olivia for a while, before getting to her feet and preparing to leave the room.

‘Dr Martyn…do you have a moment?’

Ruby paused, turning at the sound of Sam Boyd’s voice. ‘Of course.’ She nodded to James and Olivia, and they continued on their way, leaving her free to talk to her new boss.

He studied her thoughtfully for a moment or two. ‘I didn’t realise, at first, that you’re one of the members of my team.’

‘Would that have made any difference to our exchange of opinions a while back?’

He shook his head. ‘I think you know that it wouldn’t. I recognised your name when you introduced yourself. You’re my specialist registrar, aren’t you?’

She nodded. ‘So you’ve been looking through the personnel files. Perhaps I should give you full marks for staying on the ball.’

He made a mock wince. ‘I can see that you believe in being forthright at all times. You’re not going to easily accept any changes that I decide to put in place, are you?’

Her expression softened. ‘Ah, now there you have it,’ she said. ‘You see, I do have the interests of the A&E department at heart, and I can promise you that as long as I’m working there I’ll do what I can to support my colleagues and steer things in the right direction.’

‘As long as you’re working there?’ He looked at her closely. ‘That’s an odd turn of phrase. I know your contract’s up for renewal at the end of the month, but I assumed you would be staying on. Are you beginning to have doubts about working alongside me? I know that you were a strong contender for the job. Perhaps that’s causing you some difficulty?’

She gave his question some thought. ‘The board chose you for the post,’ she said. ‘That was their prerogative, and I accept their decision, although as a follow on from that I’m not altogether sure that you and I will ever see eye to eye. This afternoon has been informative, in more ways than one.’

‘That’s true,’ he murmured. ‘It works both ways. And I tend to believe that forewarned is forearmed. I have to respect the way that you spoke your mind back there. I hope you’ll go on doing so.’

She gave a short laugh. ‘Oh, you can count on it. I usually manage to make my feelings clear, one way or another.’

Becky gurgled, her eyes growing wide as she reached for Ruby, her little arms outstretched, her fists opening and closing in hopeful demand.

‘I know, baby,’ Ruby said, looking at her. ‘You’ve been cooped up for long enough, haven’t you? We’d best get you home.’ She glanced back at Dr Boyd and saw that his expression was thoughtful once more. ‘I should go now,’ she told him.

He frowned. ‘Yes, of course. I imagine looking after a baby must take up a great deal of time and energy, and there are all sorts of provisions to be put in place, aren’t there? Along with difficulties that occur when things go wrong, such as meetings that crop up and problems with babysitting arrangements.’

‘Yes, that’s right.’

‘I suppose it’s understandable that people might have a change of heart when things don’t turn out quite as expected.’ He glanced at Becky. ‘Ambition has its place, but babies can be a job and a half in themselves, can’t they?’

She nodded, not quite following his drift. ‘I suppose so,’ she said. She was all too conscious that Becky was beginning to get restless and she needed to be on her way. She started to walk towards the door. ‘I’ll say goodbye, then, Dr Boyd.’

He nodded. ‘Goodbye. I’ll look forward to working with you in A&E…all being well.’

She hurried away from the conference room and whisked Becky out to the car. She wasn’t too sure what he had meant by that last turn of phrase…all being well.

It was only when she was halfway home that it occurred to her where Sam Boyd’s train of thought must have been heading.

He believed Becky was her child.

Chapter Two

‘THERE you are, young Becky,’ Ruby said with a smile, ‘you’re nice and clean and comfortable now, and I expect you’re ready for some fun.’ She lifted the infant into the air and gently rocked her from side to side, so that she giggled with excitement. ‘Exactly…that’s just what I meant. You are such a lovely baby.’

She drew her back down and held her close for a moment, enjoying the soft, warm feel of her and breathing in the light fragrance of fresh soap. ‘I’ll pop you into your bouncer, shall I, so that you can stretch your chubby little legs for a few minutes while I make your tea.’

Ruby had set up the bouncer in the doorway so that she could comfortably watch the child from the kitchen. Once Becky was happily settled, busy touching her toes to the floor and springing up and down within the harness, Ruby set about preparing her food.

It had been a very odd sort of day, so far, many happy moments with Becky interspersed with worry about her sister…and, on top of that, she was still reeling from the effects of coming face to face with her new boss.

How on earth was that going to turn out: working alongside Sam Boyd each day when they were dramatically opposed to each other’s ideas? Added to that, he already had the notion that she resented him for taking the job she had set her heart on, and she had to admit to more than a few niggles on that score.

After all, she’d worked hard to pass her specialist exams and qualify for promotion. Yet what had she actually managed to achieve? These last few years she’d been driven to succeed, spurred on to do her best for the emergency unit where she’d found joy and heartache in equal measure.