At medical school she’d got along with most of her classmates. Reuben had come from a rich family in another city. He’d never asked her where she lived—he’d just made assumptions. Then, when he’d found out, after two years, she’d been dumped quicker than a hot brick.
Her family was proud of her, and she was of them. She’d hated the way it had made her feel. Not good enough. Not rich enough.
She came from one of the poorest areas in the city. Her family still lived there—no matter how much she’d tried to assist them since she’d qualified as a doctor. But even now they wouldn’t accept any financial help from her.
They liked where they lived. They still worked hard. They didn’t want change, in any form.
Lien lifted the pile of patient notes from the desk. They were all people who were due back at the clinic today to be reviewed.
One of the nurses gave her a smile as she walked into the waiting room. There were already ten people waiting. She gave a nod of her head and smiled, speaking in Vietnamese. ‘Okay, who is first?’
The only person having trouble concentrating today was her. She kept casting her eyes through to the other waiting room. She knew that Mai Ahn, the interpreter, would come and find her if he had any concerns. But she didn’t. Instead, she saw an occasional glance of Joe carrying babies and toddlers through to the examination room for assessment or vaccinations. Through Mai Ahn, he chatted to the mothers. Most of them seemed happy to talk to him and from the looks on their faces the Scottish doctor was proving a hit.
* * *
After a few hours he came through and knocked on her door.
‘Lien, can we have a chat about a child?’
She nodded, pleased that he’d come to talk to her.
‘I think I’ve got a little one with complications of tuberculosis. I can’t find any previous notes, and there’s no X-ray.’ His brow wrinkled. ‘Don’t most babies get immunised against tuberculosis shortly after birth?’
‘They should. Unfortunately, tuberculosis is common around here. If babies are born in hospital they are immunised if the parents consent. But not all babies are born in hospitals. What do you think are the complications?’
He ran his hands through his hair. ‘She’s losing weight, even though she’s feeding. Her colour is poor, she’s tachycardic, and I suspect her oxygen saturation isn’t what it should be. Her lungs don’t sound as if they are filling properly. She has a temperature and a cough. I suspect a pleural effusion. Do you have a paediatric monitor I could use while I order a chest X-ray?’
Lien stood quickly and gave him a serious kind of smile. ‘Let’s do this together.’
He raised one eyebrow. ‘Don’t you trust me?’ He didn’t seem annoyed by the fact she was effectively second-guessing him. He might even have looked a little amused.
‘You asked for a second opinion, Dr Lennox. I’m going to give you one.’
The amused look stayed on his face. ‘Absolutely. I haven’t seen many kids with tuberculosis in Scotland.’
She gave a nod as they walked through to the paediatric treatment room. As soon as they reached the door, Lien could almost verify his diagnosis. She switched to Vietnamese and introduced herself to the mother and her five-year-old daughter, who was clearly sick.
Joe’s notes were thorough. Three other members of the family had active tuberculosis. Only one complied with their treatment. It was no wonder the little girl was affected.
Five minutes later they were looking at a chest X-ray. Joe was right at her shoulder. She held her breath and caught a slight whiff of the aftershave he was wearing, even though it was overshadowed by his insect repellent. She wanted to know if he’d recognise what she needed him to on the X-ray.
She needn’t have worried. He lifted one finger and pointed to the film. ‘Pleural effusion without any parenchymal lesion.’ He didn’t finish there. ‘I know there’s some mixed feelings, but because of how this little girl has presented, I would be inclined to drain the effusion rather than leaving it.’
She took a few minutes to recheck things. This was the first time he’d seen a child with tuberculosis, never mind the added complications, and he’d picked it up straight away. She couldn’t help but be impressed.
She turned to face him. ‘I think you’re right. Let’s put our public health heads on and try to persuade the rest of the family to comply with their medications. We can use a sample of the effusion to diagnose the tuberculosis. A pleural biopsy would likely be too traumatic right now.’
He nodded in agreement. She paused for a moment, wondering whether she should question his skill set any further.
‘Any experience of doing a pleural effusion in a five-year-old?’
He nodded. ‘I specialised in paediatrics before training as a GP.’ He gave her a steady look. ‘I’ve got this. But I’m happy for you to stay if you’d like.’
He didn’t seem defensive or annoyed, but it felt like a bit of a line in the sand. He already knew she’d questioned his diagnosis. Now she’d asked about his experience. Lots of other clinicians that she knew might have been annoyed by this, but Joe just seemed to have accepted her actions without any discomfort. Still, the tone in his voice had changed a little, as if he was getting a bit tired of her.
She pressed her lips together. If he’d expressed any anxiety about the situation she would have been happy to take over. But he hadn’t, and she knew it was time to step back. She had enough patients of her own to see still in the waiting room.
She glanced at the nurse and interpreter. She had confidence in both of them. Either of them would come and find her if they were worried. She tried her best to look casual. ‘I’ll leave it with you. Shout if you need anything.’
* * *
Joe watched her retreat, knowing exactly how hard it was for her. Was his counterpart a bit of a control freak? Or maybe she just second-guessed everyone she worked with?
He tried to understand, even though he couldn’t help but feel a little insulted by her lack of faith in him. It’s not like he hadn’t experienced this himself. He’d worked with plenty of other doctors, in a variety of settings over the years, and it always took a bit of time to reassure himself about a colleague’s skills and competencies.
It was clear she loved this place. She’d more or less told him that already. There was also the added responsibility of her employers not being here right now, so the well-being of May M?n hospital was really in her hands.
He gave some instructions to the
nurse, who seemed to understand his English, then knelt down beside the little girl and her mother with Mai Ahn, the interpreter, to explain what would happen next.
Thirty minutes later the procedure was complete, with some hazy yellow fluid in a specimen bottle for the lab. The little girl’s cheeks and lips had lost their duskiness, the oxygen saturation monitor showed improvement, and when he listened to her chest he could hear the improved inflation of her lung. He gave instructions to the nurse for another X-ray, and to further monitor for the next few hours.
‘I’ll come back and have a follow-up chat about the medicines,’ he said. Something came into his head. ‘Do doctors make home visits here?’
The nurse frowned for a second as if she didn’t quite understand what he’d said, then shook her head. ‘No. Never.’
Joe sat back in his chair for a moment. He didn’t want to send this child home with just a prescription in her hand. The rest of the family were important too. The mother had already told him that both her husband and father-in-law kept forgetting to take their tuberculosis meds. Only her own mother remembered. If he could just see them, and persuade them how important it was, it might stop other family members being infected. He glanced out to the waiting room. He still had a whole host of patients to see, some of whom would need vaccinations, and some might need tuberculosis testing. He went to the waiting room with Mai Ahn to call the next patient, while his idea continued to grow in his head.
* * *
‘He went where?’
Ping, one of the nurses, shrugged. ‘He talked kind of strange. Something about a home visit. Apparently they do them in Scotland a lot. He persuaded Mai Ahn to go with him.’
Lien walked over and looked at the notes, checking the address on the file, then grabbed her jacket. She’d nearly made it to the front door, when her brain started to become a bit more logical. All she was feeling right now was rage. She went back and scanned the rest of the notes, checking to see what other family members were affected. ‘Did he take prescriptions, or did he take the actual medicines?’ she asked Ping.