The Country Doctor's Choice (6 page)

Mr Kydd, having done his vital work, left the suturing to Shelagh, while McDowall stayed at the mother’s side, doing his own observations of her condition. They worked in silence until at a quarter to ten Shelagh placed an adhesive dressing over the line of stitches, wiped her forehead, and pulled off her gloves, mask and theatre cap. This, then, was her
life as a doctor, she thought, her personal satisfaction at a time of personal sadness. She and her mother had grown much closer over the past week, and Bridget had said for the first time that she was proud of her daughter, for which Shelagh gave thanks that it had been said before it was too late, and would always be remembered.

Leigh McDowall touched her shoulder. ‘Your mum’s doing well, Shelagh.’

‘What? Oh, er, yes, much as would be expected,’ she said. ‘I’m hoping that a sister of hers will be able to come over from Ireland to look after her when she’s discharged.’

‘Ah, that’d be ideal. She’s quite a character, is your mum.’

A sudden thought struck her. ‘Was it
you
who went to see her on Monday afternoon? I thought it must have been the anaesthetist, but obviously not Dr Okoje. Whoever he was, he talked a lot of nonsense, she said.’

‘Is that what she said? And there was I, thinking she’d taken a fancy to me. Cruel world!’

It was impossible not to smile through her irritation. ‘I see what my mother meant about the nonsense – but you certainly made her laugh.’

‘It’s the way they sing the refrain to “Patapan”,’ Jeremy North told Derek Bolt. ‘The choir sings the verses, representing the children playing, and at the
end of each verse old Mr Wetherby quavers up on a rising scale, “
Too-ra-loo-ra-LOO!
” followed by Cyril with a face like a hanging judge singing, or rather whistling on another rising scale, “
Pat-a-pat-a-PAN!
” It’s hilarious, and sooner or later we’re all going to collapse with laughter at the poor old chaps.’

It was time for rehearsal again, and Jeremy greeted his enlarged choir, noticing that poor soul Beryl Johnson, looking anxious as usual; perhaps she’ll be as entertained as the rest of us are by the duo, he thought. He looked at Iris and gave her a broad wink, at which she held a finger to her lips;
don’t laugh
. It was a silent exchange between them.

At the end of the rehearsal he glanced at Iris and tentatively offered a lift to any ladies going home. It was answered by a grateful ‘yes, please!’ from Rebecca Coulter who pushed herself forward with Phyllis Maynard and Mary Whittaker.

‘Between us we’ll fill his car,’ she said, and it was only too true. The quiet drink with Iris would have to wait until next week.

‘I’m not too happy about that poor Pendle kid,’ said Leigh McDowall in the antenatal ward office.

‘Trish Pendle with the toxaemia? Yes, she hasn’t got much going for her, has she?’ Shelagh replied. ‘Only seventeen, illegitimate herself, deserted by her boyfriend, the usual story. It’s hardly surprising that she gave in to the first boy who showed her any attention.’

Sister Dickenson interrupted sharply. ‘That girl would do better to stay in bed instead of always hopping off to the day room for an illicit smoke. She’s such a
silly
girl, says she can’t eat the food here, and gets a girlfriend to bring her in a bag of soggy chips every evening. It’s no wonder she’s so overweight!’

‘I’ll try having a talk with her,’ said Shelagh. ‘And we’ll get the dietician up to see her and discuss her likes and dislikes. Meanwhile I’ll write her up for multivitamins and iron.’

Tanya sniffed, and continued speaking to McDowall. ‘Her blood pressure’s creeping up, Leigh, one hundred and forty-five over ninety-five, and one plus of protein in her urine. What she needs is a twice daily dose of methyldopa to slow her down, keep her in bed and control her blood pressure.’

‘I’ll speak to Mr Kydd tomorrow,’ said Shelagh briefly, irritated by the sister’s self-assumed role of diagnostician and prescriber of medicine.

‘And let’s get an intravenous pyelogram done before the old man’s ward round on Thursday,’ added McDowall. ‘Can you book one for tomorrow morning, Tanya?’

‘An IVP? – when we try to avoid X-raying pregnant women?’ Shelagh queried.

‘Do you want me to try to get one done tomorrow, Leigh?’ asked Tanya, ignoring her. ‘If we say it’s urgent, they’ll probably fit her in.’

‘Yeah, speak to them in your most seductive tones, Tanya,’ he grinned.

‘Whatever for? There aren’t any signs of renal failure,’ objected Shelagh.

‘I think there may be more to Trish’s problems than meets the eye,’ he said thoughtfully. ‘Just a hunch. Put her on four-hourly temperature as well as blood pressure, and a fluid balance chart. We’ll see if anything comes up. All right by you, Dr Hammond?’

She nodded assent, hardly able to contradict a medical registrar, and she knew that Mr Kydd respected his opinions. But the smile exchanged between him and Tanya infuriated her.

‘Good. Then I’ll go over to Gynae,’ she said, and as she walked away she could hear them conversing in low, intimate tones. Such damned lovebirds were no asset on the team!

On Gynaecology her mother had wonderful news. ‘Shelagh – oh, Shelagh me girl, wait till I tell ye! I’ve had a letter sent here from me sister Maura, and what d’ye think she says? She’s comin’ over to stay for a bit – isn’t that grand? Just till I get back on me feet, like. It’ll save ye a lot o’ worry, Shelagh, bein’ as busy as ye are!’

Shelagh was moved to see how her mother’s pale cheeks flushed with pleasure at the prospect of seeing her sister again and being reunited after so long. At least
some
good had come out of this sad situation.

‘I’ve just got to show you this cutting from the
Daily Mail
, Phyllis,’ said Mary Whittaker over coffee. She took from her handbag a full-page story headed
Our Little Princess
, which showed a fortyish couple looking fondly upon a little girl of about four, holding a pet rabbit.

‘This couple suffered disappointment year after year, Phyllis, and then they saw a documentary on TV about the number of children in care due to neglect – alcoholic parents, fathers in prison, all kinds of social deprivation – and there was a social worker looking for couples wanting to adopt or foster with a view to adoption. This middle-aged couple agreed to enquire further, and look, they’ve got this little girl, they’ve called her Sally, and they’re
so
happy – look at the picture, isn’t she a little sweetie? Phyllis, call me an interfering old busybody, but my dear, this is what your Jenny and Tim should do, give a good home to a child who needs one.’

‘I’d never call you an interfering busybody, Mary, but – Tim’s parents are dead against adoption. They say you don’t know what you’re getting, and they don’t think they could ever love a child that wasn’t Tim’s actual son or daughter,’ said Phyllis sadly.

‘Listen, I’m sorry about Tim’s parents, but they have no right whatsoever to inflict their opinions on a young couple like your Jenny and Tim,’ said Mary Whittaker firmly. ‘As for not knowing what you’re getting, do
any
of us know how our children are
going to turn out? Look at poor Jeremy North and
their
three – the elder girl has presented them with a fatherless child, the boy – or rather man – has been thrown out by his wife for drinking, so he doesn’t see his child at all, and I hear the younger girl has become so out of control that Jeremy’s sent her to stay with his sister and brother-in-law, just to get her out of Everham for a bit. No, Phyllis, you show this to Jenny, make her read it, and talk it over with Tim.’

Phyllis read the article through twice, and gazed at the photo of the little girl with her pet rabbit. Tears came to her eyes at the thought of unloved, neglected children when Jenny had so much love to give. The continuing disappointments of the Giffords was becoming a threat to their marriage, as Jenny no longer wanted to have sex because she said ‘it didn’t work’.

Phyllis Maynard’s mouth set in a determined line. The ‘little princess’ was like a message of hope at a time of despair, and she resolved to do everything in her power to persuade Jenny and Tim that this was the answer to hitherto unanswered prayers.

Trish Pendle’s IVP report came back with a red star, indicating that urgent action was needed. Shelagh stood in the antenatal ward office and read it with consternation.

Left kidney small, poorly outlined, appears to be non-functioning, suggestive of congenital abnormality or chronic pyelonephritis. Right kidney shows moderate hydro-nephrosis due to reflux.

So McDowall’s hunch had been right. The girl had a chronic kidney condition, possibly from before birth, and the ‘good’ kidney had to do the work of two. So far it had managed, but the additional strain of pregnancy, aggravated by a poor diet, was proving to be too great a burden, and it was beginning to show signs of pressure,
and a backward flow of urine. The warning signs of rising blood-pressure, swollen legs and protein in the urine had been diagnosed as toxaemia of pregnancy, a fairly common condition, and not to be ruled out as additional to the kidney dysfunction. The newly begun fluid chart corresponded with the finding of the IVP, and Shelagh went straight to find Trish and ask her to get into bed for an examination.

‘Just sit up for me, Trish,’ she said, pressing the palm of her hand over the girl’s left loin, in the region of the faulty kidney. ‘Now, does it hurt here, my dear?’

‘Yeah, a bit. I been tellin’ ’em it aches round there, but they don’t take no notice, they just say it’s ’cos o’ the baby.’

‘And here, Trish?’ Shelagh placed her hand over the right kidney, and Trish shouted, ‘Yeah, that’s sore –
ouch!
– Bloody hell!’

Shelagh was concerned. Tenderness over the right loin indicated that the back-pressure was causing some inflammation of the ‘good’ kidney, already overloaded with work.

‘’Ere, ’ave yer ’eard anything about that whatsit I ’ad yesterday?’ Trish demanded.

‘Yes, dear, and it does look as if you might have some kidney trouble,’ Shelagh answered with the calm, matter-of-fact manner she used when imparting unwelcome news.

‘What are they goin’ to do about it, then? Any chance o’ Dr Kydd startin’ me off early?’

‘I really couldn’t say right now, Trish. We’ll have to wait and see what Mr Kydd says on his ward round tomorrow,’ Shelagh temporised. ‘Meanwhile we’ll get some blood tests done. Don’t worry about it, dear, you’re in the best place – though I believe you’re having some problems with the food in here, so Sister says.’

‘Yeah, it’s muck – makes me feel sick.’

By the time Shelagh had finished trying to advise Trish about the importance of a healthy diet, it was visiting time, and Trish’s scruffy girlfriend’s arrival cut her short, though it was interesting to overhear the girls’ comments to each other.

‘Who’s she, then Trish? Is she any better than the others?’

‘She’s not bad, at least she listens to yer, ’stead o’ dronin’ on about toxaemia an’ stuff, so’s yer can’t make out what they’re on about.’

Over in the doctors’ mess, Shelagh found Paul Sykes drinking a solitary cup of coffee, so took a small cheese salad and went to join him.

‘You look whacked out, darling,’ he told her. ‘What we both need is a night in that cosy little place at Eastbourne. How soon d’you think you’ll be free?’

‘Mother’s being discharged on Thursday, and my Aunt Maura will be arriving tomorrow to stay with us – so perhaps next time we’re both off at a
weekend … we’ll enjoy it all the more because of the wait, Paul!’

‘Seems like years,’ he said dolefully. ‘How long is Auntie staying?’

‘As long as she’s needed, and that means – until my – you know,’ she said bleakly, and he was immediately apologetic.

‘Oh, darling, what a stupid question, I’m so sorry.’ He put his hand over hers on the table. ‘That’ll mean over Christmas, I suppose.’

‘How do I know? How do any of us know, Paul?’

As usual there was a pile of post on the hall table, and Derek Bolt’s quick glance went straight to the backward sloping handwriting on the blue envelope. He picked it up at once and put it in his pocket. Daphne was in the living room watching television, and heard him come in.

‘Derek, who
is
the person who keeps sending you these letters on posh paper? It looks like a female hand. Is it something to do with that Christmas choir of Jeremy North’s?’

‘No, just a poor soul I’ve been visiting, grieving for her mother and going through a phase of doubt. Let’s get this stuff out of the way,’ he said, sweeping up the rest of the post and taking it to his study, so that she would not notice the absence of the blue envelope. He went through to the kitchen and plugged in the kettle. ‘I’m ready for a cuppa, aren’t you?’

‘Doubt? What sort of doubt? Has she lost her faith, d’you mean?’

‘Oh, it’s quite understandable when somebody loses the person closest to them – they feel that either God has deserted them, or doesn’t exist at all. I try to give such reassurance as I can, but the words can sound a little hollow, even to me, when dealing with bereavement.’

Hollow indeed, you lying cleric
, he told himself, and changed the subject to the date of the boys’ homecoming. ‘Will they be here by the Sunday before Christmas? Or are they staying on for the usual dinners and parties and pantomimes at Uni, and dashing home on Christmas Eve?’

‘How should I know? I’ve written to say we’re expecting them by the twentieth at least.’

Derek fervently hoped she would not be disappointed; her enjoyment of Christmas depended very much on the presence of Philip and Mark. Later, reading the unwelcome letter in the privacy of his study, heated by a one-bar electric fire, he experienced again the familiar mix of pity and exasperation.

He could read no more. What in God’s name should he
do
? He had tried praying for guidance, but there had been no definite answer. Of course he could not possibly arrange to meet her anywhere – should he send a firm letter, suggesting that
she
should pray about it? Of course he pitied her as one of the flock entrusted to him by God, but he could not help her.

‘
Blessed Lord Jesus, show me what thou wouldst have me do for this unhappy woman
.’ He frequently found himself using the English of the Book of Common Prayer when dealing with a problem, and the words in themselves were consoling.

‘You were right about Trish Pendle,’ Shelagh admitted to Leigh McDowall when she met him in the corridor that connected the antenatal and post-natal wards.

He shook his head gravely. ‘The poor kid will need to be thoroughly investigated after delivery, but we can do a full blood profile now for electrolytes, creatinine clearance and so on – and watch out for bugs in the urine.’

She nodded. ‘I’ve sent the requests to the lab.’

‘Good. D’you think the old man will go for an early delivery?’

‘An early Caesarean section, I’d guess, to save her pushing,’ she said. ‘Her condition’s only going to worsen as long as she’s pregnant, isn’t it?’

He sighed. ‘Oh, it just isn’t fair, Shelagh, that poor kid. Whatever kind of future has she got, if any? And the poor little beggar inside her, who’s going to take
him
on, or her? She hasn’t got a home for him, only a council flat with an alcoholic mother.’

‘It’ll be a case for the social workers to sort out,’ said Shelagh. ‘Foster care, most likely, while they wait to see how things go.’

‘Wish I could meet the father of that poor little bastard – he wouldn’t father any more!’

‘Then you’d be had up for grievous bodily harm! Nobody ever
does
find out who’s taken up one of these unlucky girls, get her drunk and then taken advantage of her. By the way, Dr McDowall, you’re on call tonight, aren’t you?’

‘Yes, but I can take a couple of hours off this afternoon – to keep an appointment with a very special lady!’ He gave a knowing wink, for they
both knew that Tanya Dickenson had a half day.

‘Enjoy yourselves,’ she said coolly, putting away Trish Pendle’s case notes in the file.

Miss Maura Carlin was scarcely able to hide her dismay when she saw her elder sister’s fragile appearance; the two of them clung together on their first meeting after nearly thirty years.

‘Sure, Bridie, none of us ever understood why ye upped and left us to marry that sailor feller, him that none of us ever saw,’ she said, smoothing back her sister’s white hair and looking reproachfully into the faded blue eyes. ‘Well, they’ll just have to manage widout me at home for a bit, so they will. I’m here to look after ye and little Shelagh until ye’re better!’

The bustling Irish spinster was as good as her word, and Shelagh was filled with relief and gratitude towards an aunt she had never met. On her part Maura was open-mouthed when she saw that her little niece had become an efficient, attractive doctor.

‘But why didn’t ye write to me before, Shelagh?’ she asked. ‘How could ye let your mother face such an operation widout lettin’ her family know?’

Bridget begged her not to blame Shelagh but herself, likewise for all the years without making contact.

‘But never mind, I’m here now, and here I’m goin’ to stay!’ declared Maura, before they were interrupted by the arrival of a visitor.

‘Bless yer, Dr Leigh!’ cried Bridget. ‘Meet me sister Maura!’

‘Hello, Maura, pleased to meet you. I just bobbed in to ask how you’re doing, Bridget, but I needn’t have worried, you’re looking fine! Let me explain, Maura. Bridget’s my sweetheart, or at least I thought she was, but she won’t give me any encouragement, says I’m too old for her – what a cruel world!’

Amid the laughter, Maura brewed a pot of tea and found some biscuits in a tin.

Shelagh felt a little awkward at such familiarity. ‘Good heavens, Dr McDowall, what are you doing here?’

‘Why, don’t you remember, Dr Hammond, I told you I had a rendezvous with a very special lady? Thanks, Auntie Maura, I’ll have another. Cheers!’

Shelagh was both baffled and annoyed. What on earth was he up to, going behind her back to ingratiate himself with her mother?

‘I can’t stay long, Mother, I only wanted to see how you are, and Aunt Maura. It looks as if I needn’t have worried. Bye!’

Mr Kydd’s decision to perform an elective Caesarean section of Trish Pendle resulted in the arrival of a small but healthy boy whom his young mother called Donovan. He was taken to the Special Care Baby Unit for assessment of his prematurity, and from there transferred to the care of a foster mother by the social
worker under whose care Trish had been for several months. Trish herself was transferred two days later to Women’s Surgical for a battery of kidney tests, prior to possible removal of the non-functioning kidney.

‘My God, Shelagh, what a lump that Pendle girl is!’ groaned Paul Sykes over lunch in the doctors’ mess. ‘Overweight, unintelligent and adding to the housing problems by producing a kid that she can’t look after. I ask you, what can be done with creatures like that? There’s something to be said for compulsory sterilisation, and I know you won’t agree with that, but quite frankly it’s my gut reaction.’

Shelagh was a little chilled by his words, though she knew that there were many who would agree with his argument. She paused before replying.

‘In her case there might be no need for sterilisation anyway, Paul. With her serious kidney condition, she’s not likely to become pregnant again, in fact she might not even survive. Let’s just hope that little Donovan finds somebody to love him.’

‘God, Shelagh, you make me feel such an ogre,’ he protested. ‘I’m just as concerned as you are for the little chap’s future.’

The dark December days passed by, and Doctor Hammond was presiding at the last antenatal clinic before Christmas.

‘Morning, Iris. There’s quite a few here, so we’d better get started. Who’s first?’

‘A self referral. Her mother’s with her.’ Iris spoke a little breathlessly. ‘Denise North, the doctor will see you now.’

‘Good morning, Denise. I’m Dr Hammond. And – your mother?’

‘Yes, I’ve come to support her.’ Fiona waved a finger at the smiling little boy.

‘And this fine little fellow is your son?’

‘Yes, he’s my grandson. Come here, darling, don’t climb on the couch.’

‘And is there a daddy around, Denise?’ Shelagh asked quietly.

‘No, and we don’t need one. We’re all devoted to him,’ said Fiona North.

‘And have you been referred to a social worker?’

‘There’s no need, I’ll take care of my daughter, and see about maternity benefits.’

Shelagh turned to Iris. ‘Sister, will you take this little chap out for a few minutes, I need to examine his mother.’

‘There’s nothing to feel yet, it’s only been a month!’ objected Mrs North. ‘And
I’m
not going to be sent out of the room – my place is with my daughter.’

‘Just hop up on to the couch, Denise, and let me feel your tummy.’ Shelagh gently pressed her hand against the pubic bone.

‘I think you’re about ten or twelve weeks’ pregnant, my dear.’

‘But that’s impossible!’ cried Mrs North. ‘Her last
period was in November.’ Shelagh continued to speak to the daughter. ‘I think your last true period would have been around mid-October. Anyway, we’ll take a couple of blood samples today, and see you again after Christmas.’

‘What’s the blood test for?’ demanded Mrs North.

‘Oh, a whole raft of tests we do on our expectant mums, to check for anaemia and other conditions. A nurse will show you where to go, and make a further appointment. Good morning!’