Cruel Legacy (21 page)

Richard grimaced and flexed bis muscles tiredly. Strange how sitting in a chair could make his bones ache so much more than operating.

The atmosphere in the room was tense and slightly dangerous. David enjoyed creating that kind of mental tension and aggression, Richard suspected.

As he glanced round the table he was aware that of the seven men there he was the oldest.

He frowned slightly, not wanting to acknowledge what lay behind that awareness. Leslie Osbourne wasn't that much younger than he—only a handful of years—and Brian was only a few years younger than Leslie, but he still couldn't help being aware that the three representatives present from the Northern were all younger, closer in age to David than to himself.

Leslie Osbourne, their senior anaesthetist, was making some comment to him. Leslie had travelled separately to the meeting, having spent the last couple of days at a conference.

As Richard turned his head to respond to his comment he was aware of David watching him.

David was a thin, tense man, slightly smaller than average height, which perhaps was at least part of the reason he felt such a need to exercise so much control over others and to challenge them to flout his authority, Richard reflected. He had pale blue eyes and a slightly underhung jaw. There was something almost weasly about him, even down to his quick, edgy body movements.

He would never have made a good surgeon; he was too impatient, too quick. It baffled Richard that anyone could ever have thought that such a man was the right person to head a health authority. He might be a brilliant accountant, but he knew nothing about people, their vulnerabilities, their needs.

As their glances engaged, Richard saw the dislike flicker briefly in David's eyes before he looked away.

No, I don't like you either, he acknowledged mentally.

It pleased Richard to see that David was the first to look away and turn towards Brian. It was petty of him to feel that small sense of victory, he knew, but that was the effect that David had on him.

'Yes, Brian, I agree that you're putting forward an excellent case for the accident unit to go to the General,' he heard David saying. 'And you've certainly spoken very emotively about the benefit that would accrue to the public as well as the General. However, in this instance we can't allow ourselves to be governed by our emotions. There are other things to consider. As chief administrator my prime concern is how effectively we can justify the financial outlay for such a service, and I'm afraid that on its present record the General is not proving to be very good at sticking to its financial targets.

'I don't want to start making specific criticisms or allocating specific blame. This meeting, after all, is to discuss the siting of the new unit, not to go over the old ground of budgets, but...' he paused and across the table his eyes met Richard's for a moment '.. .1 cannot stress how important it is that the new unit is run efficiently financially, and I'm worried about the General's present showing, especially on the surgical side. Of course we're all agreed that the essence of a good accident unit is speed and efficiency, value for money, especially as far as the Department of Health is concerned. On paper I admit that your figures look good, but with your surgical budget already disastrously overspent... The public needs to feel confident that such a unit can deliver what it promises... How can either it or I have that confidence when you can't keep your existing departments within their budgets and your operation level up to their quotas?

'I'm sorry to say this, but on your present showing I'm afraid that you're beginning to fall very much behind the Northern's figures.'

Richard had heard enough.

"This unit is about saving lives, not money,' he told David sharply. 'Any good surgeon will tell you about the risks you take with people's lives once you start treating them like conveyor-belt products; they are each and every one of them individuals with individual needs.'

'Yes, I'm sure,' David stopped him angrily. 'But the days of surgeons playing God are, I'm afraid, Richard, gone forever. We are a public service and as such we are financially accountable to the public, a public who have every right to demand to know for instance why one hospital manages to perform almost twice as many hip replacements in a given period as another, and why that same one is somehow managing to reduce its drugs bill in addition to increasing its number of operations...'

'I judge the success-rate of my work not on how many operations I perform or how cheaply I deal with my patients' aftercare, but on providing the best chance of recovery and a good quality of life,' Richard told him quietly.

Inwardly he was seething with anger at the injustice and ignorance of David's criticisms. He might not be an accountant, but when it came to his own field of surgery...

'And I could ask you why, if this other hospital is doing as well as you think, GPs and their patients appear to prefer to come to us... ?'

The tense, uncomfortable silence which followed his outburst left Richard wishing he had not allowed David to provoke him.

'Not every patient prefers the General, Richard,' David contradicted him silkily. 'In fact I received a letter only this morning from one of your patients complaining about the fact that you have postponed her operation on two successive occasions and asking that she be referred to another hospital. I didn't mean to bring this up in public, but since you yourself have focused the meeting on more personal issues I feel that in defence of the Northern's surgical unit I owe it to them to mention this complaint.'

The last time he had been humiliated so publicly had been when he was still a raw medical student but his reaction to David's comment was much the same now as it had been then: the sense of shock and discomfort, the awareness of other people's attention being focused on him with varying degrees of pity and amusement, the ear-burning sense of shame and the immediate and fierce desire to vindicate himself.

Only he wasn't a student any more, and the thought of having to justify himself to David Howarth of all men met with such a wall of resistance from his pride that he was powerless to do anything other than simply sit there.

It was left to Brian to say uncomfortably, 'I'm sure there's some logical explanation for delaying this patient's operation, David... Sometimes these things happen with nonurgent surgery... It's unfortunate, I know, that it should have happened more than once, but...'

'Are you telling me that it's common practice at the General to delay non-urgent operations more than once? You know how the Minister feels about this sort of thing, Brian, and it certainly doesn't augur well for the General's claims that it is the better choice for the new unit... I'm not sure too many accident victims would be happy to be told that their surgery had to be delayed,' he added sarcastically.

'Everyone at the General has worked very hard to help raise the extra cash for this new unit,' Brian began desperately. 'You know that '

'I'm sorry, Brian,' David interrupted him smoothly, standing up, 'but we really must leave it there. I've got a meeting this afternoon.' He was halfway to the door before he stopped and turned round, the cold pale blue eyes surveying Richard triumphantly.

'Richard, a word in my office before you leave if you please... and I'd like you there as well, Brian...'

'Now, this complaint... the first thing we need to establish is that Mrs Jennings is correct when she claims that her operation has been delayed on two occasions.'

David smiled coldly at Richard, obviously already sure of the answer.

'Yes, it has,' Richard agreed tersely. He was damned if he was going to explain or excuse himself to this jumped-up, undersized accountant, who didn't know the first thing about surgery anyway.

'I'm sure that Richard had a perfectly good reason for delaying the woman's operation, David,' Brian was saying palliatingly next to him.

'Yes, I'm sure he had,' David agreed smoothly. 'And since the surgery is non-urgent there is no question of any lack of surgical judgement...fortunately...'

Richard froze. He knew damned well what David was up to, trying to suggest that he had shown a lack of good judgement, trying to intimate that he was getting too old to stay on top of things.

'However, I'm sure we all have to accept that there was a certain degree of lack of perception, shall we say? Of course, we all know it's easily done,' David continued, steepling his fingers and looking at Richard over the top of them. 'Pressure of work, strain, stress. All of these things build up and tend to lead to such misjudgements... Fortunately, as I've already said, in this case no one's life was put in danger, but I shall have to write and apologise and I suspect from the tone of this letter that we'll be very fortunate if we can keep it out of the local Press—and you know bow the Minister feels about that kind of thing. I'm sorry to say this, Richard, but it only takes one mistake like this to prejudice people's minds against the efficiency of an entire hospital.

'As Brian said, I'm sure you had a perfectly good reason for this postponement...'

Angrily Richard stayed silent. He wasn't going to risk saying anything to David. He had already come dangerously, disastrously close to losing his temper with him once today, and there was no disguising the elation in David's manner towards him, now that he believed he had him wrong-footed.

'Can we assure Mrs Jennings that her operation will now receive priority?' he asked Richard. 'And an apology from you personally, Richard, might not be a bad idea.

'Oh, I'd like a word with you in private if you don't mind, Brian,' he continued, giving Richard a dismissive look.

As calmly as he could, Richard left his office.

The Health Authority's area offices, he decided bleakly as he went outside to wait for Brian, had as little to do with the saving of people's lives, with healing them and helping them, as the head offices of a bank. Money—that was what this place was all about. Money... not people...

'Brian, I wonder if you've given any more thought to suggesting to Richard that he take early retirement?'

Even though he had been semi-expecting it, Brian felt his heart sink.

'I doubt that he'd be interested, David. He's a first-rate surgeon. We're lucky to have him.'

'Are we?' David asked him drily. 'Mrs Jennings doesn't appear to think so.'

'We often have to alter operation times to make way for more urgent cases,' Brian appeased uncomfortably.

'This isn't just a matter of placating one angry patient; there's also the problems of the budgets and Richard's refusal even to try to stick to them. Quite honestly, Brian,

if he can't move with the times and accept tire way things are, then he is just going to have to make way for someone who can.

'I don't like to say this, but I really think you do need to keep a closer eye on him... for the patients' sakes if nothing else. I understand your loyalty to him, but I have to warn you that he could quite easily cost the General the new accident unit.'

'Richard's worked hard to help raise money towards it...'

'Yes...I know. Oh, by the way, your hospital's got someone to take over your psychiatric post. If he accepts you'll be very lucky. He's a first-rate psychiatrist, very highly qualified—over-qualified for the post really, but it seems he's anxious to come back over here for personal reasons... He's been working in the States for the last few years. I shall be writing to him later offering him the position.

'Now, about Richard... remember what I said, Brian. Quite honestly I think that, of all your options, persuading him to take early retirement would be the best... for the hospital's sake...'

The hospital's, or yours? Brian wondered cynically as he left David's office. It was obvious that the young man did not like Richard, but Richard unfortunately didn't seem to realise his own danger and exacerbated the situation instead of easing it.

From his office window David had a clear view of where Richard was standing in the car park waiting for Brian. Tail and broad-shouldered, with a thick head of strong dark hair, touched with distinguished wings of grey at his forehead, he was perhaps the epitome of every woman's fantasies of what a senior surgeon should look like, and the epitome of everything that he, David, most disliked and resented.

He could remember quite clearly the day he'd realised that he was never going to achieve such an enviable height, nor such almost film-star male good looks, and the bitterness that realisation had caused him, the jealousy and resentment.

But the tables were turned now and it was Richard and his type who were outsiders, doomed soon to be as extinct as dinosaurs, unable to adapt to fit into a world which had changed too fast for them.

Uncanny how much of a resemblance Richard bore to that long-ago schoolboy who had taunted him with his small stature and lack of macho maleness. He was smiling as he turned away from the window and went back to his desk to pick up Sophie Jennings' letter of complaint.

Today
was the day she had her appointment with the Citizens Advice Bureau, and in preparation for it, and also in an attempt to exert some kind of control and order over the chaos of Andrew's financial affairs, Philippa had spent the previous evening making lists of the positive and practical steps she could take to help herself. -