Unknown (13 page)

'Poor you,' Sophie sympathised. She looked around. 'I need to do a tymp on Katy's ears.'

'It's over there.' Janet pointed. 'Beside the autoclave.' She ticked the last name oh her list and reached for another computer printout. 'I should have had these appointments made by Tuesday,' she muttered. 'I don't know how I've got so far behind. By the way, you've got Ruby Murdock sitting in the waiting room.'

'I know. She's my next patient.'

'Her daughter's come with her.'

Sophie caught the amused inflection in Janet's voice. 'And?' she prompted.

'And they're sitting with two empty chairs between them, both looking like thunder.'

'Oh, help,' Sophie groaned. 'Thanks for the warning.' She gripped the tympanometer. Maybe the few minutes it would take to complete Katy's ear examination would be long enough for the dust to settle between Ruby and her daughter.

When Sophie followed her young patient out a good ten minutes later, however, she could see that the situation was unchanged.

'Mrs Murdock? I'm ready for you now,' Sophie said, not quite truthfully.

Ruby heaved herself out of her chair with some difficulty. She was wheezing heavily. Felicity King continued staring at the floor.

'Did you want to come in, too, Felicity?' Sophie asked casually.

'I suppose I'd better.' Felicity stood up reluctantly and Sophie's heart sank further at her grudging tone. It looked like this would be a far from easy consultation.

It turned out to be far worse than Sophie had anticipated.

'You're not sounding too good today, Mrs Murdock.' Sophie had her hand on Ruby's wrist as she sat her patient down. 'Have you used your Ventolin inhaler?'

'No.' It was Felicity who spoke. 'She says it doesn't help. She hasn't been using her Flixotide inhaler either or monitoring her peak flow.' Felicity was looking directly at Sophie, ignoring her mother. 'I only found out this morning.'

Sophie was frowning. Ruby's pulse rate was 130. She moved to her cupboard and withdrew an inhaler. Flipping it open, she gave it a good shake, watching Ruby's respiration rate as she did so. Her patient was breathing very fast and the muscles on her neck looked strained.

'That's because you haven't...been near me for three days.' Ruby had to take another breath in the middle of her sentence.

'Breathe out, Mrs Murdock,' Sophie instructed. 'As deeply as you can.' She held the mouthpiece of the inhaler in position. 'Now breathe in.' Sophie depressed the medication canister to release the bronchodilator.

'I got sick of the arguments, Mum,' Felicity said angrily. 'Just like I'm sick of the extra workload. I've got enough to do with three kids and a husband to look after.'

'They're his kids, too,' Ruby shot back. 'He's as lazy as they come... Look at the fuss he makes when...I ask him to mow my lawns.' Ruby's breathing was becoming more distressed as she forced her sentences out. 'I'm your
mother,
Felicity... Or doesn't that count for anything these days?'

Sophie was still frowning. Felicity mistook her expression for criticism and became defensive.

'For God's sake, Dr Bennett. All I did was remind Mum that she'd promised to walk to the supermarket every other day for her exercise. It's only ten minutes away from her house, if that. It would save me giving up an afternoon once a week and it might even improve her health.'

'It was the
way
you said it,' Ruby puffed unhappily.

Sophie lifted her stethoscope from Ruby's back. She was horrified to see tears forming in the older woman's eyes. Her breathing was still deteriorating.

'Don't get upset, Mrs Murdock. We'll sort things out.' She gave Felicity a warning glance. 'I don't think this is a good time to go into it all. I'm a bit worried about this asthma attack.'

Neither woman seemed to hear her.

'There's a very easy answer to it all...and you know that...perfectly well.'

'You can't move in with us, Mum. I've told you it wouldn't work. Brent won't have it. He'd leave me. It's not fair to expect it. I'm doing all I can.'

'Not any more,' Ruby gasped. There was a bluish tinge to her lips that made Sophie step in more firmly.

She leaned down to make sure Ruby could see and hear her and she spoke loudly. 'I'm going to take you into the treatment room, Mrs Murdock. I think we need to start a nebuliser to get your breathing under control. I'm going to get one of our other doctors to look at you as well. Felicity, could you take your mum's other arm and help me, please?'

'Is she that bad?' Felicity looked alarmed. 'I thought she was putting it on—trying to make me feel guilty. It wouldn't be the first time and she's been upset ever since Monday when we talked about her wanting to move in with us.'

'This way,' Sophie ordered, ignoring the subject. 'Janet, can you set up a Ventolin nebuliser, please?'

It was ready by the time Sophie had Ruby propped up on pillows on the bed. The medicated mist filled the oxygen mask, pushed through the attached container by the flow of oxygen from a portable cylinder.

Sophie kept her fingers on Ruby's pulse and kept up a constant stream of verbal reassurance which she broke only to ask Janet to fetch either Oliver or Josh. Felicity stood at the end of the bed, looking very distressed.

'I'm sorry, Mum. I'm really sorry.'

Sophie felt a familiar wave of relief when Oliver entered the treatment room and calmly took charge of the situation. She could cope with anything as long as she had Oliver by her side. Felicity was sent to the waiting room. Janet squeezed another dose of Ventolin into the nebuliser mask and Oliver took Ruby's blood pressure and listened to her chest with his stethoscope. Then he patted Ruby's hand.

'I'm going to put a little needle into the back of your hand, Ruby,' he told her. 'Just in case we need to give you some stronger medicine.' He smiled reassuringly at Sophie. 'Set up an IV, would you, please, Sophie?'

Sophie was glad of the simple task. Severe asthma attacks were alarming for the doctor as well as the patient, she decided. It was an effort to remain calm to outward appearances. Ruby's breathing sounded a little quieter now. Did that mean she was improving or getting worse rapidly? A silent chest in a severe asthma attack was a serious sign.

Oliver swabbed the back of Ruby's hand and deftly slipped in a butterfly cannula, despite the fact that
Ruby's hand was shaking badly. Sophie had to admire his skill. She doubted that she could have gained IV access so easily. Oliver didn't seem at all worried.

'You're doing really well, Ruby. We'll get this under control in no time.' He looked across the bed at Sophie. 'Ruby's not on oral corticosteroid therapy, is she?'

'No. She has Flixotide and Ventolin inhalers.' Sophie found she could remember every detail of Ruby's file now that she had relaxed. 'Her best peak flow rate is around 340.'

'Good. We'll check that soon.' Oliver smiled at Ruby again as he picked up her wrist to check her pulse rate. 'How does your breathing feel now, Ruby? Any better?'

Ruby Murdock nodded, her eyes fixed, gratefully on Oliver. He put her hand down, gave it another reassuring pat and turned to Sophie.

'I think she's settling.' Oliver hooked his stethoscope around his neck. 'I'll leave her in your capable hands. Keep an eye on things for a while. Watch her respiration and pulse rate and do a couple of peak flows over the next half-hour or so. I won't be far away if you need me.'

'Thanks, Oliver.' Sophie suspected she looked as grateful as Ruby Murdock.

'Any time.' He slipped Sophie the ghost of a wink. 'You would have managed just fine without me around, you know.'

The praise warmed Sophie. She could almost believe it, though she knew it would take her years to acquire the skill and confidence that Oliver Spencer demonstrated so casually. She had been impressed by his professional abilities from the first day she had
started at St David's and her admiration had only grown since then. Dr Spencer was an impressive physician—exactly the type of doctor Sophie hoped to become. She turned back to her patient.

'Let's try and do a peak-flow reading, she said encouragingly. 'That way we'll be able to measure how fast you're improving.'

Ruby was improving, but it was well over an hour before Sophie was happy to stop watching her. Oliver had gone on with his list, working through his lunch-hour to make up for lost time. Sophie had no patients for the afternoon which had been set aside as a study period this week. She knew that Janet was finding it awkward, seeing her patients in the side room, but nobody wanted to send Ruby home too quickly.

'You're looking much better,' Sophie told Ruby finally. 'How do you feel?'

'Terrible.' Ruby lifted the oxygen mask. 'Is Felicity still here?'

'I'm not sure,' Sophie replied. 'I think she might have gone to collect Laura from kindy.'

'Oh, dear. I need to apologise.' Ruby lay back against her pillows and closed her eyes. 'I know I can't move in with them.' She opened her eyes again and looked sadly at Sophie. 'It's just that I'm so lonely since my Arthur died.' Ruby struggled for control and Sophie passed her a box of tissues.

'I knew I was making life difficult for her. I think I wanted Brent to leave and then maybe Felicity would need me as much as I need her.'

Sophie listened patiently. The asthma attack was under control. She had nobody waiting. Ruby could take as long as she liked.

Janet poked her head around the door. 'I need to grab some vacutubes and things for a blood test.'

'Come in, Janet.' Sophie stood up. 'Ruby's much better. I think we could take her butterfly needle out and then we could go into the side room for a while.' She smiled at her exhausted-looking patient. 'How would you like a nice cup of tea, Mrs Murdock?'

'That would be lovely, dear. And why don't you call me Ruby? The other doctors here do.'

'Let me help you, then, Ruby.' Sophie smiled a little shyly as she collected the oxygen mask and lifted the tubing clear. It was a small thing, but Ruby's acceptance of her position alongside Josh and Oliver meant a lot. She was a part of the St David's team. One of 'the doctors'. Maybe she would follow the others' example and stop bothering to wear a white coat to advertise her credentials.

The good feeling lasted through a weekend that Sophie put determinedly to good use with some in-depth studying. She wanted to fly through her exams at the end of the year and earn her GP registration. Now, more than ever, she knew it was where she belonged.

Ruby Murdock
was
an excellent example of a general practice patient and not simply because of her collection of common medical problems. The complexities of relationships and their effects on everybody involved were a vital factor to be considered in treatment.

Who would have guessed how devoted Ruby had been to her husband and daughter, to the exclusion of ever forming a support network of her own. It hadn't even been obvious after Arthur's unexpected and fatal heart attack. It had been the broken ankle that had made Ruby realise just how alone and vulnerable she now was. And the fear had set in, making her cling to her daughter and use her progressive medical conditions as an emotional bind.

Sophie had talked little and listened a lot on Friday afternoon. When Felicity had come back to collect her mother, the discussion had continued for another hour. Maybe things wouldn't come right all at once but there was a lot out in the open and both Ruby and Felicity desperately wanted an improvement.

Had she seen Ruby Murdock as an inpatient in a hospital ward, Sophie would have concentrated on treating the presenting disease. Taking a holistic approach simply wouldn't have been feasible. It needed time to build up a rapport with her patient and with her patient's family. Had she been at St David's for as long as Josh, or even Oliver, she might have known Ruby's husband, shared the joy the birth of her grandchildren would have brought and spotted the danger signals of Ruby's decline far before they hit crisis point.

Sophie felt quite inspired by Monday. She was looking forward to the trivia and bustle of the new start to the week. She was also looking forward to sharing how she felt with Oliver. He was the only person who would really understand the new insight Sophie had gained. Imagine how her father would react. Or even Greg. Maybe Josh would recognise it but, much as Sophie liked and respected St David's senior partner, she felt that he was skating through life at a level far too superficial for her liking. Oliver had more depth. He was capable of, indeed actively displayed, the kind of skill and commitment to his career that Sophie now aspired to.

She felt badly let down when she met Oliver in the car park when she arrived for work.

'God, I don't feel like getting into a Monday,' he complained. 'The weekend was way too short.'

Sophie's desire to share her new-found confidence in her career direction evaporated. 'You had a good time, then?' she asked with forced brightness.

'Good!' Oliver grinned broadly. 'Good doesn't come anywhere near it. It was great! Fantastic! Memorable! Absolutely...' He searched for a new superlative.

Sophie snatched up her bag and slammed her car door shut. 'I hope that your companion was equally satisfied.'

Oliver pursed his lips thoughtfully. 'I didn't hear any complaints.'

Sophie stalked ahead of Oliver. 'I'm sure you didn't,' she muttered under her breath. If the kiss she had experienced was any indication of Oliver Spencer's prowess in the bedroom,
she
wouldn't be complaining either.

Oliver caught up with her by the time Sophie reached the wheelchair ramp. 'You know, you might be wrong about me, Sophie.'

'Really?' Sophie asked waspishly. 'In what way, Oliver?'

Oliver smiled cheerfully and held the door open for her. 'I might not be just the same as other men. I think I'm beginning to share your ideals about commitment. About the things that are really important in a relationship.'

'Congratulations.' Sophie allowed herself to sound reluctantly impressed. 'I suppose the next thing we'll hear about will be your wedding plans.'