Joanna Neil - New Surgeon at Ashvale A&E

All was not well, though, she discovered. When she walked into the emergency unit later that morning, after spending some time reviewing patients’ progress in the observation ward, she found that there was a general air of discontent about the place.

‘Okay, so what’s the matter with everyone?’ Ruby asked, taking a quick look around the resuscitation area and then inspecting the assembled crowd in the waiting room. ‘There are far too many long faces around here.’

‘I think you’ve just seen for yourself,’ James murmured. He drew a chart from the pile on the desk and cast a quick glance over the notes. ‘It’s still relatively early in the day, and we’re already stretched tight at the seams.’

‘We’ve had five people brought in by ambulance from rush-hour traffic accidents,’ Olivia added, going over to the whiteboard and writing up more names. ‘And the waiting room is heaving with an assortment of fractures, sprains, nasty infections and people with chest pains.’

‘Sounds like everything’s perfectly normal, then,’ Ruby said with a laugh. ‘It’s a case of heads down and let’s get on with it, to my way of thinking.’

‘Hah! You’d think so, wouldn’t you?’ James’s mouth made a downward turn. ‘Except that two of the nurses are off sick, one of the doctors has gone home to deal with a domestic crisis, and we have no one to replace them.’

Ruby raised her brows. ‘No agency nurses or a locum doctor?’

‘None,’ he answered. ‘Not a one.’

‘Hmm. That certainly is going to make life difficult.’

‘Apparently we’re banned from bringing them in on account of it being too costly, and all overtime beyond a certain level has been stopped.’ James’s tone was edged with annoyance.

‘I almost paged you at one stage, but Dr Boyd said you were dealing with an emergency in the observation ward and we’d cope.’ Olivia pulled a face. ‘I suppose he was right, and we did manage, but we’re run off our feet, and patients are already complaining about waiting times.’

‘I guess Dr Boyd is behind the restriction on agency staff,’ Ruby mused. So he had kept tabs on her while she was working in the observation ward, had he? He obviously had his finger on the pulse of how the department ran, but she could certainly see why the two doctors were feeling under pressure. ‘He didn’t waste any time putting his plans into action, did he? He must be very keen to pull the department into shape.’

‘That’s right. I’m the one who put a stop to the extra staff. It costs way too much to bring in staff from outside.’ A now familiar voice came from behind her, and she swivelled around to see the man himself standing just a couple of feet away. Ruby studied him briefly. He was immaculately dressed, as before, in a dark grey suit and crisply laundered shirt, with a silk tie that was perfect in its understated elegance. ‘What do we have here,’ he asked, ‘a union meeting?’

‘Dr Boyd,’ Ruby acknowledged him. ‘It’s good to see you again…albeit in difficult circumstances.’

‘Call me Sam,’ he said in a brisk tone. ‘No need to stand on ceremony.’ He frowned. ‘As to the circumstances, you should all know from the outset that I don’t believe in letting the grass grow under my feet. It’s important to start as we mean to go on if we’re to have any chance at all of saving the A&E unit. We’re not playing at this. It isn’t a game. It’s for real.’

‘I know. I’m sure we’re all aware of that.’ Ruby made a muted response to his bracing tone. Perhaps he was annoyed because they had been talking about him, and they needed to make allowances for that. She added softly, ‘And I expect the problems that follow will be for real, too. I’ll leave you to deal with the complaints from the patients, shall I, and from the management when we fail to meet targets?’

He acknowledged that with a rueful twist of his mouth. ‘I imagine those will be the least of my worries.’ He gave her an assessing glance, his gaze shimmering downwards over her curves outlined by the soft cotton blouse that clung where it touched and then draped itself loosely over the waistband of her calf-length skirt. ‘Besides, I’m sure I can rely on you to help smooth things over during these difficult times. I hear you’re good at dealing with most problems that come your way. You appear to have a knack for calming troubled waters. Perhaps that’s why the department operated so efficiently while Dr Stanford was winding down for his retirement.’

Ruby’s eyes widened a fraction. Where would he have gleaned that wedge of information? Was it possible that he had been talking to his predecessor? Or maybe one or two of the board members had filled him in on her way of working. They might not have given her the job, but it didn’t necessarily mean they were unaware of her capabilities. Her lips made a wry shape. Perhaps her calm attitude was what had lost her the position. They wanted a lion that would roar and show its teeth.

Sam glanced at James and Olivia. ‘I know this is difficult for all of you, but there’s no point in moping about the situation. What we have to do is prioritise, knuckle down and get on with the job and concentrate on providing the best service we can under the circumstances.’

He turned to James and held out a patient’s file to him, his manner totally businesslike. ‘You examined a man who came in earlier with a broken wrist and suspected head injury after a fall…is that right?’

James nodded. ‘Tony Barton…a young man in his late twenties. I treated him for the wrist fracture and assessed him for brain injury, but his neurological responses were fine. I was getting ready to discharge him.’ He glanced at the file. ‘Are you ready to sign off his notes for me?’

Sam shook his head. ‘His condition has changed, according to the nurse who was following up on him. I’d like you to come with me and take another look at him, please.’

‘Oh…of course.’ James’s colour faded, and Ruby could see that he was wondering if he was in trouble of some sort. He was usually thorough and conscientious in everything that he did, but Sam, being a newcomer, clearly didn’t know that.

Sam nodded towards Ruby and Olivia and then strode off with James in the direction of the treatment room.

Ruby’s gaze met Olivia’s, and the senior house officer rolled her eyes. ‘Does that man ever stop to engage in the niceties of getting to know his colleagues?’ Olivia asked. ‘He’s brisk and businesslike, and his whole attitude is “stop fussing and let’s get on with it”, though I must say he seems half inclined to pass the time of day with you…but as to the rest of us…’ Olivia sucked in a deep breath. ‘He’s only been here five minutes, and I’m already beginning to wish Dr Stanford had delayed his retirement.’

Ruby grinned. ‘I dare say we’ll get used to him, given time. He has a huge task ahead of him, and he’s probably still working on his strategies. I expect he has a heart of gold underneath it all.’

‘We’ll have to dig deep to find it,’ Olivia murmured, moving away in search of her next patient. ‘I have the feeling it’s buried under a ton of steel.’

She could be right in that. Ruby frowned as she riffled through the files in the wire tray. Their new boss didn’t appear to be making any concessions to the fact that he was a stranger in their midst, and that they might have difficulty getting used to this different way of working. It was all or nothing with him.

She glanced through the list of patients waiting to be seen. Her first job was to check on the patients from the traffic accident, and in doing that her time was taken up with a host of complications that had arisen from an assortment of broken bones and punctured blood vessels. Worryingly, one man went into cardiac arrest, and she had to use the defibrillator to shock his heart back into a safe rhythm.