and you’re on take for emergencies.’
‘Fine. What are the day cases?’
‘Two endoscopies for investigation of query gastric or duodenal ulcers, and an ERCP for query cholecystitis.’
He chuckled. ‘The miracles of modern technology. Thank God for abbreviations—endoscopic retrograde cholangiopancreatography is a hell of a mouthful!’
‘But probably quicker than saying sticking a tube with a camera on down someone’s throat and into the duodenum and injecting radio-opaque medium into the bile duct to see what happens! Oh, and there’s a sigmoidoscopy—middle-aged man with fresh blood in his stools—Ross is querying colitis or carcinoma; his wife reckons he’s got piles.’
Tom looked thoughtful. ‘Well, I hope to God she’s the one that’s right.’ He glanced at his watch. ‘Is it OK if I wait here? Hamilton said he’d meet me here at eight-thirty.’
Just then the door opened and Ross came in.
‘Tom—good to see you again,’ he said, extending his hand, and after a brief exchange of pleasantries he turned to Helen.
‘Got the day cases in yet?’
‘Yes—Gavin’s clerked them and they’ve been prepped—they’re all ready for you.’
‘Good girl. Right, Tom, let’s go and see you in action.’
‘I can hardly wait,’ he said drily under his breath, and winked at Helen, drawing his finger across his throat.
‘Coward,’ she muttered at his departing back, and he chuckled.
‘Too damn right. Save me some coffee—I’ll need it.’
And the door closed behind him, leaving her alone with her chaotic emotions.
They reappeared two hours later, deep in conversation and clearly troubled. Helen, back with her paperwork again, looked up, smiled and carried on.
‘So what do you think we should tell him?’ Ross asked, reaching for the coffee-pot.
‘Hmm.’ Tom propped himself against Helen’s desk and shrugged. ‘I don’t know. What do you think the prognosis is?’
‘I should say he doesn’t have one,’ Ross said candidly, passing Tom a cup of coffee. ‘Helen?’
‘No, thanks. Who are you talking about?’
‘Ron Church—we’ve just done a sigmoidoscopy and he’s got very widespread CA colon and rectum—God knows how he’s been so symptom-free for so long.’
‘Perhaps he hasn’t,’ Tom said quietly. ‘Perhaps he just didn’t realise it was anything to worry about till he started passing blood.’
‘Yes, it’s the fresh blood that frightens people. A higher bleed will usually go unnoticed. Oh, hell. So, what would you tell him?’
Tom frowned thoughtfully. ‘That we found something that needs further investigation and removal? That he will have a colostomy, and that depending on what else we find he will need further surgery and possibly other treatment to alleviate symptoms. That it’s possible that relieving pain and preventing further distress is all we will be able to do.’
Ross regarded him steadily. ‘What if he says no?’
‘Then he’ll suffer unnecessarily, possibly intolerably. I’d do my best to talk him into it, even if I know that we can’t save him.’
‘Would you mention the word cancer at this stage?’
‘Maybe. I’d let him lead me on that.’
Ross nodded. ‘Fine. Would you like to go and talk to him now?’
Tom looked resigned. ‘If you think so, but I don’t know him—wouldn’t it be better if you gave him the news?’
Ross’s mouth lifted in a wry smile. ‘Now how did I know you’d say that?’ he murmured, and, putting his cup down, he left the room.
‘Poor chap.’
Tom looked at Helen quizzically. ‘Who, Ross?’
Helen laughed. ‘No, Mr Church. He seemed a nice man—he’s only in his forties, isn’t he?’
‘Yes—forty-six. God, Helen, it was unbelievable considering his lack of symptoms. He’s within a few days of perforating, I should say—if that.’
‘His wife’ll be shocked—she said this morning as she was leaving, “Oh, well, at least once they’ve done this you’ll know there’s nothing wrong and you’ll be able to stop being such a worrywart.” She’ll feel dreadful, I should think.’
‘I wonder,’ Tom said slowly, ‘if that’s why he hasn’t done anything until now? Although the bowel is notorious for not giving signals.’
‘Yes.’ Helen sighed. ‘How about the others?’
‘The endoscopies? Two duodenal ulcers and one narrow bile duct, probably due to scarring following an infection. No sign of any stones now, but Ross is going to operate and enlarge the duct if he can, and have a closer look. He might even link the gall bladder to the duodenum and bypass the bile duct—it looked pretty tight. We’ll have another look at the plates before we operate, I guess, but I doubt we’ll see anything new.’
‘Are they staying?’
‘Ron Church will be, I imagine, but the others will go out and come back in a few days or weeks—Mrs Tranter and her bile duct sooner, I suspect.’
Helen smiled teasingly at Tom. ‘Funny how it’s usually the men who get ulcers. It’s because you all bury your emotions and won’t talk to each other—everything piles up and becomes intolerable.’
A fleeting shadow crossed Tom’s face, and he straightened up and set the cup down on her desk.
‘Yes, very likely. Mind if I have a look at the post-ops?’
The sudden change in atmosphere was puzzling. What had she said? Had he taken her remarks as criticism? She hoped he wasn’t going to be all tetchy and theatrical—it would drive her mad.
‘Feel free,’ she offered.
Then his bleep squawked and with a muttered, ‘May I?’ he reached for the phone.
She listened as he talked to the A and E department, and then he cradled the receiver and straightened up. ‘Acute abdo in A and E—probably surgical.’
‘Who did you speak to?’
‘Chap called Jack Lawrence?’
‘The consultant—if he says it’s surgical, it’s surgical. I’ll get a bed ready. Once you’ve seen him, can you let me know if it’s an ITU job?’
He grinned. ‘Sure—and it’s a she. Will you tell the
