The Doctor's Proposal (7 page)

‘And became people,' she said gently.

He looked surprised, as if he hadn't expected such understanding. ‘I fell for them,' he conceded. ‘My girls. But the reality of life with twins appalled Laurel. She hated everything about our new life, and she hated what the twins were doing to me. She issued an ultimatum—that we get a live-in nanny or she'd leave. That I return to the life we had pre-kids. So I was forced to choose. Laurel or the twins. But, of course, she knew my response even before she ever issued the ultimatum. The girls are just…too important to abandon to someone else's full-time care. So that was the end of our marriage. Laurel took off overseas with a neurosurgeon when the twins were six months old and she hasn't been back. So much for marriage.'

Ouch. That almost deserved being up there with other life lessons, Kirsty thought. All the reasons why it was dumb to get involved.

‘So what did you do?' she probed gently.

‘I moved to the country,' he said, almost defiantly. ‘My career in Sydney was high-powered. I knew I'd see little of the twins if I stayed there and I had some romantic notion that life as a country doctor would leave me heaps of time with the kids. Pull a few hayseeds from ears, admire the cows, play with my babies…'

‘It hasn't worked out quite like that, huh?'

‘Well, no. But the problem is that I love it. The people are great. Alice and Penelope are loved by the whole community. They might not have as much of me as I'd hoped, but they have huge compensations.'

‘And you? Do you have compensations?'

‘Now we're getting too personal,' he said, stiffening as if she'd suddenly propositioned him. ‘I don't do personal. The only reason I'm telling you this is because of Margie Boyce. As I said, Margie's a housekeeper-cum-nurse. She also acts as my babysitter. She's married to Ben, who was a gardener here before his arthritis got bad. Ben and Angus are old friends. What I've suggested to Angus in the past is that he has Margie and Ben stay with him, but of course he won't agree. He knows Margie looks after my girls so I'd need to find someone else, and the thought of Margie fussing over him when he wants to die is unbearable. But now…' Jake looked thoughtfully over to the two heads discussing pumpkins. ‘If we tell Angus that a condition of Susie staying here is that Margie comes out to care for her during the day…bringing the girls with him… He may well agree.'

She thought that through. It sounded OK. ‘That'd leave me doing nothing,' she said slowly.

‘That'd leave you working with me,' he said bluntly, and gave her a sheepish smile. ‘I've nobly worked it all out to stop you being bored.'

She tried to look indignant—and failed. She needed to be honest, she decided. She'd been kicking her heels in Sydney for the last month, waiting to see whether Susie went into premature labour, and by the end of that time she'd been climbing walls. Dolphin Bay was a tiny coastal village, and exploration would here be limited. She'd be bored to snores here, too.

‘I don't think I can work here,' she said cautiously. ‘Don't I need registration and medical insurance and stuff?'

‘This is classified as a remote community. Really remote. That means the government is grateful for whoever it can get.' He glanced at his watch. ‘It's still late afternoon yesterday in the States. If you give me a list of your qualifications and a contact number for the hospital you've been working in, I can get you accreditation to work right now. As in
right now
!'

‘You really want me,' she said, awed, and he grinned.

‘I really want you.' Then he hesitated. ‘As a doctor.'

‘Of course,' she said demurely. ‘What else would you mean? But…to bring everyone here… What will Angus say to that?'

‘I'll give it to Angus as a fait accompli,' Jake told her. ‘You intend to work with me. He wants Susie to stay here, but Susie can't stay unless Margie stays here with her. Margie can't stay here unless the twins come, too, and Ben as well.

‘This place has been like a tomb,' Jake went on, his smile disappearing as he tried to make her see how seriously he'd really thought this through. ‘Since Deirdre died, Angus has locked himself away and waited to die as well. But he has so much to live for, if only he can see it. If I can throw open the doors, bring in his old friend, Ben, Margie to care for him, the twins to fill the castle with giggles and play-dough—and Susie and a new little baby to give him family again… Don't you think that might equal any anti-depressant, Dr McMahon? For Susie as well as Angus? What do you think?'

He was anxious, she thought incredulously. He was watching her and there was much more than a trace of anxiety behind the smile. He was waiting for her approval.

He didn't have to wait, she thought, throwing any remaining caution to the wind.

She was going into country practice.

He had her approval in spades.

A
T TWO
that afternoon Kirsty was sitting beside Jake on her way to her first house-call, feeling bulldozed.

Back at the castle were Susie, Angus, Ben and Margie Boyce, Alice, Penelope and Boris. Maybe they were feeling equally bulldozed, but they certainly seemed happy. Susie and Angus had gone reluctantly to have an afternoon nap. Margie Boyce was baking. Jake's freckled and pigtailed four-year-olds were waiting to lick bowls, Boris was under the kitchen table, waiting for things to drop, and Ben was having a quiet dig in Angus's parsnip patch.

‘How long did it take to work all that out?' Kirsty demanded, and Jake gave a self-satisfied smile and turned his car onto a dirt track leading away from the town.

‘I work fast when I see rewards in front of me. Pretty good, huh?'

‘Pretty fantastic,' she whispered. From the dark and gloomy castle of last night, there was now life and laughter and the chaos of a family. Even if it lasted only a day, this was worth it. Susie had been so bemused this morning she'd laughed at least half a dozen times, and that was six times more than she'd laughed since Rory had been killed. She thought the twins were great. They'd all sat at the kitchen table and eaten cold meat and salad for lunch, and Susie had hardly seemed to notice that she was eating.

The twins, two chirpy imps with their daddy's gorgeous
brown curls and eyes that were wide with innocence and mischief, hadn't permitted a moment's silence, and who could be desolate when they were around?

‘It's excellent,' Jake said, and she grinned her agreement. But…

‘There's no need to get too smug. If we come home and Boris has dug up the pumpkin patch…'

‘Boris is a dog of intelligence,' Jake said solidly. ‘Besides, it's a pumpkin patch. Now, if it was lamb shanks or even strawberries, I'd worry.'

There was a long contented silence. It wasn't just Susie and Angus who were benefiting from this, Kirsty thought. Her own mood had lightened about a thousand per cent.

And maybe some of that was to do with sitting beside Jake Cameron?

‘Tell me about the patient you're taking me to see,' she said hurriedly, in an attempt to distract herself from thoughts she had no right to think. But she was thinking anyway.

For a moment she didn't think he'd answer. Maybe he was distracted too, she thought hopefully. Maybe he was thinking…

Cut it out!

‘Mavis Hipton is a sweetheart,' he said softly, and she knew she'd been misjudging him. His face said all his attention was on his patient, and he was worried. ‘She's eighty and has terminal cancer. Uterine cancer with bone metastases. Like Angus, she refuses to go into hospital. She's better off than Angus, though, in that she has her daughter caring for her. Barbara is looking after her mother really well.'

‘So why do you need me to see her?'

‘She has breakthrough pain. I can't keep it under control without making her so drowsy she can't read to her grandchildren. I saw her when I left you last night. I upped her morphine, but I was hoping you might be able to give me a more imaginative solution to the problem. I can ring a physician in Sydney to get advice, but without seeing her he's not much use. And…' He hesitated.

‘And?'

‘And he seems to think sleeping into death is the way to go,' Jake said bleakly. ‘I'm hoping you disagree. Mavis may have a few months left, and if I can give her some quality time with her family…well, I'm damned if I'll deprive her of it unless I have to.'

Their destination was as far from Kirsty's Manhattan hospice as she could imagine. It was a tiny weatherboard shack, ramshackle around the edges but with bright gingham curtains in the window, hens clucking around what was obviously a well-tended garden and a toddler making mud pies on the front step. The lady who greeted them was wearing jeans, an oversized shirt and big workman's boots. She was wiping her hands on a dishcloth as she opened the door, and she tossed the cloth aside to seize Jake's hands in welcome.

‘Jake. I didn't think you'd make it back today.'

‘I told you I would, Barbara.'

‘Yeah, but you squeezed us in last night and we know how busy you are.'

‘How did she sleep?'

‘Like a baby,' Barbara told him. ‘It was great that you did come. She was in so much pain.'

‘And today?'

Barbara's eyes clouded. ‘It's probably worse than it ought to be. She won't take any more of the morphine. She'll take it tonight, she says, but not now. It makes her drowsy and she says if she's going to sleep all the time then she may as well die right now.'

Jake grimaced. ‘Maybe we can do better than that. Barbara, this is Dr McMahon. Kirsty's a pain specialist from the US. I wondered if your mum would mind seeing her.'

‘Mum's delighted to see anyone,' Barbara said. She motioned to a bigger house along the track. ‘That's where my hubby and I live,' she told Kirsty. ‘But Mum gets lonely and her oven's better than mine. I've got scones in the oven right now. You go in and see her and by the time you finish I'll have the scones ready.'

‘Who needs payment when we have scones?' Jake said lightly, bending down to admire the toddler's mud pies.

Kirsty's astonishment grew. Jake Cameron was a doctor with heart, she decided. Real heart. Most of the doctors she knew cared about their patients, but they'd not spare the time to stoop to admire a small child's mud pie—or to give their patient's daughter a swift hug, as Jake did as he passed Barbara to enter the house. Barbara sounded cheerful but her eyes were strained and bleak. Kirsty knew from experience that there was often little sleep for the primary caregiver. Not much sleep and too much heartache.

Mavis's bedroom was lovely. It was simply furnished, with an old double bed on a plain wooden floor, a worn rug and a vast patchwork eiderdown that was the centrepiece of the room. But it was the window that made it. From where the diminutive old lady lay, Mavis could see out over the veranda. She could see her granddaughter making her mud pies. She could see the hens scratching among the rose bushes, and in the distance she'd see the cows ambling lazily up toward the dairy from the clifftops further away.

Who would choose to be ill in hospital when you could be ill here? Kirsty thought, stunned. No one.

But the lady herself was in trouble. The look in Mavis's eyes suggested fear and pain. Relentless pain, Kirsty thought. She'd seen that look so many times. Acceptance that pain would be with her until the end.

A bottle of morphine mixture stood on the bedside table. Any time she wanted she could use this, Kirsty thought, appreciating that Jake had ensured Mavis could ease her pain whenever she wanted and drift into painless sleep. But she was obviously choosing not to.

Sleeping into oblivion had a distinct downside when there was so much life just through this window.

‘So you're a pain specialist,' Mavis said as she walked in, and Kirsty realised she must be tuned in to everything that was said in the outer rooms. She'd be aching to be a part of the world again.

‘Hello, Mrs Hipton,' she said, taking the lady's proffered hand. It was dry to touch—was she dehydrated? ‘I'm Dr McMahon.' She hesitated, then added, ‘Call me Kirsty.' That was something she'd never do back home. The use of first names in her Manhattan hospice was frowned on by the powers that be, but here it felt right.

‘Where do you fit in?' Mavis whispered, and Kirsty saw it was an effort to talk. ‘Don't tell me you flew in all the way from the States just to give me a consultation.'

‘Kirsty's sister was married to Rory Douglas,' Jake told her, and the lady's eyes lit up with interest.

‘Married to Rory. Angus's Rory?'

‘My sister's visiting Angus,' Kirsty told her. ‘So I thought I'd make myself useful while they get to know each other.'

‘So Angus has family again,' Mavis breathed. ‘Well, well. Isn't that lovely?' She managed a tight, pain-filled smile. ‘Everyone should have family,' she whispered. Her sharp, intelligent eyes moved from Kirsty to Jake and back again. Questioning without words. ‘Even Dr Cameron.'

‘I think twins are enough family for anyone,' Kirsty said lightly, ignoring the innuendo. ‘Mrs Hipton—'

‘Call me Mavis.'

‘Mavis, then.' Kirsty smiled. ‘Could you bear it if you and Dr—if you and Jake gave me a complete history of your pain?'

 

Kirsty listened. For a while she didn't comment. She waited while Jake completed his normal examination. She sat while Jake talked, while he checked a pressure sore on Mavis's back, while he listened while Mavis told him about her granddaughter's attempt to conquer a tricycle. Jake was deliberately giving her space to think.

So she thought.

‘I think I may be able to help a little,' she said at last, tentatively. ‘That is, if you trust me.'

‘I've checked Dr McMahon's credentials,' Jake told Mavis before the old lady could respond. ‘She's the best.'

She shot him a surprised but gratified look. That was a compliment that must have come via her boss back home, but hearing it from Jake felt good.

‘When did you last have morphine?' she asked.

‘About four this morning.'

‘Why not since?'

‘I didn't need it.'

‘You're hurting now. A lot.'

‘I can bear it,' Mavis said. ‘I thought… You get used to it. You get addicted to that stuff so it's not effective. If it gets really bad…'

‘It's bad now,' Jake said gently, and Mavis flashed him a look of fear.

‘I'm not dying yet.'

That was always the unspoken terror, Kirsty thought. That the pain would get worse and worse, and then when you needed it most the drugs wouldn't work.

‘No,' Kirsty said softly, and she lifted Mavis's hand and held. ‘You're not dying yet. But you are in pain. You know, morphine is an odd drug. If you take it to forget your troubles, as many addicts do, then, yes, you'll become addicted. It'll lose effectiveness and you'll need increasing doses. But if you have real pain—as you have—then it never loses its effect. I promise you. Mavis, I'm thinking you're suffering a lot of unnecessary pain because you're frightened of becoming addicted and because it's making you drowsy. Because of your fears, you're not taking the morphine regularly, which means you're getting a lot of pain before you take the next dose. You reach the stage where the pain's unbearable and then you finally take it. That's right, isn't it?'

‘I… Yes,' she muttered, and Jake said nothing.

‘Mavis, I promise you that morphine is
not
addictive if we use it in the right dose for the pain you're having. I promise you also that it will stay being effective for as long as you need it. What we need to do is to find the right dose. The dose
is different for everybody, because everybody's pain is different. You need to start off by taking a prescribed dose of this mixture regularly every four hours. Slightly less than you're taking now—but regularly. I want you to promise me that you'll take this dose regardless. After a day or so the sleepiness will ease. The dose I'm prescribing will leave you free to enjoy life. It'll be regular and it'll keep the pain level tolerable. If, despite this, you have breakthrough pain, then I want you to take more, but I want the background dose to stay constant. I want you to call me every day, and we'll gradually increase the background dose until the pain is completely gone. Completely. And it will happen, Mavis. I promise. Then I'll change you over to a really convenient long-acting tablet that you can take just twice a day. That way we'll stay one step ahead of the pain, and you should rarely need to take the mixture. We're aiming to get rid of the pain completely—not just aim for good enough. We're aiming to get you out on the veranda, back into the kitchen when you're feeling well enough—not just watching life through a window.'

‘But the morphine makes me so drowsy,' Mavis whispered. ‘I don't want that. I have so little time. I can't just sleep….'

‘Drowsiness often happens if you take a little too much occasionally,' Kirsty told her. ‘You're waiting so long that you need a big dose to fight the pain and so you'll go to sleep. What we need to do is give you a little and often. Drowsiness is much less likely to happen then.' She smiled. ‘And this is only step one. If morphine still makes you sleepy, we'll ditch it and try another drug. No excuses, Mavis. We need to get rid of this pain completely. Will you work with me to do that?'

Mavis glanced at Jake. Jake was smiling.

She looked back at Kirsty.

‘You're staying for a while?'

‘My sister's expecting a baby in a month. I'm not going anywhere.'

‘So our Dr Jake has a partner for a month.'

‘I guess he does,' Kirsty said. ‘And you have a very bossy palliative-care physician. If you'll have me.'

‘Jake doesn't mind?'

‘Jake doesn't mind,' Jake said solidly from behind them. ‘Kirsty looks like being a gift horse, Mavis, and I'm not one for looking gift horses in the mouth.

‘Me either,' Mavis said soundly. ‘Welcome to Dolphin Bay, love. I'd very much appreciate it if you could make me more comfortable.'

‘Good,' Kirsty said cheerfully. ‘Great.' She beamed at her patient. This sort of case was the reason she'd decided on her specialty. She'd missed her work so much, and to be useful again was wonderful. ‘I'll have you bouncing in no time,' she told Mavis. ‘But meanwhile you need to answer the question that every palliative-care physician worth her salt asks every patient.'

‘Which is?'

‘What's happening with your bowels?'

 

‘That was fantastic.' Jake turned the car homewards and shot Kirsty a look of appraisal that was more than tinged with approval. ‘Really great.'