rustier than an old garden fork.’
‘I’m just aware that it’s probably a long time since you did a consultation that wasn’t staged. The way our surgeries run at the moment, there’s not a lot of time to look in a textbook between cases. And you only get the one take.’ Anna sucked in a breath. ‘I was trying to be helpful. Next time I won’t bother.’
‘Good idea. You worry about your own patients. I’ll worry about mine.’ Without giving her time to respond, Sam strode down the corridor towards his father’s consulting room.
‘I’m going to kill him.’ For the first time since she was five years old, Anna found herself wanting to stamp her foot. With an enormous effort of will she managed to restrict herself to an inward growl of frustration. ‘Well, at least we don’t need to change the name on his door,’ she muttered, and then turned to Glenda who was watching open-mouthed. ‘Don’t look like that.’
Glenda found her voice. ‘Nice to see that neither of you have changed,’ she said faintly, and Anna sighed.
‘Oh, don’t make me feel guilty. Maybe I shouldn’t have spoken to him like that, but the guy drives me crazy. And whatever he says to the contrary, he hasn’t seen a real patient for ages. Diseases that they stage for the camera aren’t the same thing at all.’
Glenda frowned. ‘Anna, I thought he’d—’
‘He won’t admit it, of course, because he’s a man, and a man with a big ego,’ Anna said, reaching forward to pick up a pile of results, ‘but you’d better keep an eye on him, Glenda. If you think he’s got a problem with someone, let me know because his pride won’t let him do it himself and he certainly won’t ask me.’
Glenda looked confused. ‘But, Anna, I thought that Dr McKenna—’
‘Oh, let’s drop the subject for now,’ Anna muttered, deciding that she’d had enough of talking about Sam McKenna. ‘Just buzz me if you think there’s a problem.’
With that, she walked through to her own surgery and settled herself behind her desk. Instantly she felt calmer and more in control. This was her space, a place that she loved, and even having Sam next door couldn’t spoil it.
She switched on her computer and pressed the buzzer for her first patient. Seconds later there was a tap on the door and a young mother entered, struggling with a wriggling toddler.
‘Hello, Heather, how are things?’ Anna had been in the year above Heather at school and the two of them were still friends.
That was the wonderful thing about general practice, she mused as she stood up and walked around her desk to admire the baby. You knew the patients. Not like Accident and Emergency where she’d spent six months during her GP rotational training. There the patients were little more than cases and numbers. In general practice the patients had lives. They were real. And the family doctor was part of all that. It was a job worth doing.
‘It isn’t me, Anna,’ Heather murmured, settling herself in the chair and trying to persuade the whining toddler to sit still with her. ‘It’s Grace. She’s had a personality change lately and, frankly, I’m ready to scream.’
Anna reached for her favourite puppet and slipped her hand inside. ‘Hi, Grace,’ she said cheerfully, waggling the furry fox at the toddler. ‘Nice of you to visit me.’
The little girl stopped grizzling at once and stared at the puppet, transfixed. Then she held out a hand to stroke its nose. ‘Fox.’
‘That’s right.’ Anna waggled the puppet. ‘Fox.’ While the little girl’s attention was caught she questioned the mother. ‘So what’s been happening, Heather?’
‘It’s Grace. She just doesn’t seem to listen to me any more,’ the young mother said helplessly. ‘She takes absolutely no notice of anything I say and she’s so loud all of a sudden. She shouts all the time.’
Anna frowned. ‘How long has it been going on for?’
‘I don’t know.’ Heather shrugged. ‘A couple of months, I suppose. We had a terrible winter with her as you know. We virtually lived in your surgery with colds.’
Anna tickled Grace’s ear with the puppet and reached across her desk for some equipment. ‘How’s her speech?’
‘Well, she was doing really well but if anything she’s slipped back.’ Heather gave a rueful smile and cuddled the little girl closer. ‘Whoever said being a mother was easy? Do you think it’s just her age? That she’s just being naughty?’
‘No, I don’t. I suspect that she might have glue ear,’ Anna said calmly, judging whether it was a good moment to abandon the fox in favour of a clinical examination. ‘Heather, hold out your hand. I need you to take over acting duties while I take a look at her ears.’
Heather dutifully slipped her hand inside the puppet, leaving Anna to concentrate on the little girl.
‘Grace, I’m just going to look inside the fox’s ears,’ she said cheerfully, ‘and then I’m going to look inside yours.’
Grace watched with round eyes as Anna pretended to look inside the puppet’s ears, then she sat still while Anna gently used the auriscope to examine her.
‘I’m just checking that there’s no wax or foreign bodies,’ she murmured as she examined the eardrum. ‘Oh, yes, there’s the problem. I see it. The eardrum is very dull and looks indrawn. She definitely has glue ear.’
‘Glue ear?’ Heather frowned. ‘What exactly is that?’
‘It’s a condition where the child has fluid deep in the ear,’ Anna explained, ‘but without signs of infection. It’s called glue ear because the fluid tends to be like runny glue—thick, clear and sticky.’
Heather pulled a face. ‘Sounds awful. But why does that make her shout?’
‘Because I suspect it is affecting her hearing.’ Anna reached for a pad and scribbled a simple diagram. ‘People can hear because sound waves are transmitted via their eardrums and tiny bones inside the middle ear. The eardrum and bones vibrate.’
Heather stared at the diagram and pulled a face. ‘I was always bottom in biology.’
Anna smiled and put the pencil down. ‘Doesn’t matter. All you need to know is that in glue ear the middle ear, which is usually full of air, becomes filled with a sticky fluid and that damps down the vibrations.’
‘And stops the child from hearing?’
‘It can do.’ Anna stood up. ‘It’s very common in children so don’t think Grace is the only one. Speech is affected because she isn’t hearing well.’
‘So what do we do about it?’
‘Fortunately glue ear almost always settles down of its own accord but if Grace’s hearing gets worse then we may need to look at referring her to an ENT specialist. But at the moment I don’t think we should do that. I’m going to refer her to the audiology department for an assessment of her hearing and we’ll take it from there.’
‘So she doesn’t need antibiotics or anything now?’
Anna
