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 th
em 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 ‘… I 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 triumphantiy.
‘Richard, a word in my office before you leave if you please… and I’d like you there as well, Brian…’
* * *