Читать книгу The Perfect Treatment - Rebecca Lang - Страница 8

WHEN the consultation was over and the two doctors were out in the wide corridor again, divested of their protective clothing, Blake Contini drew Abby to one side, out of the way of the pedestrian traffic, and queried her about aspects of the disease.

‘How would you make the final diagnosis here, Dr Gibson?’ he asked, fixing her with an astute glance from those rather unnerving blue eyes.

Abby cleared her throat, feeling a little like a student taking an exam. At the same time, she was grateful to have this opportunity for learning—even if her feelings towards her teacher were a little mixed. There was no time now to dwell on that.

‘Well,’ she began, ‘there are abnormal cells in the blood and in the bone marrow—tests for those would be decisive. The cells in the bone marrow never mature beyond the myeloblast level.’ Abby met his glance squarely, warming to her subject. ‘And, of course, the proliferating leukemia cells accumulate in the bone marrow, eventually suppressing the production of normal blood cells and the normal bone-marrow elements.’

‘Yes.’

‘He would have evidence of abnormal blood-clotting function—an elevated prothrombin time and low fibrinogen levels, as well as the clinical findings,’ she added decisively.

‘Right.’

Mr Simmons had manifested two common clinical signs. Abby had felt those distinctly when she had examined him as well—an enlarged spleen and an enlarged liver. They were signs indicative of a blood disease. ‘He has hepatomegaly and splenomegaly,’ she said, ‘two other diagnostic signs.’

He nodded. ‘Quite right. After the transfusions that we’re going to give him, how would you proceed with treatment, Dr Gibson?’

‘Well…’ Abby took a deep breath. ‘I would give him the remission induction chemotherapy that you mentioned—provided we think he’s a good candidate. We hope to induce a complete remission. We would need to really build him up first, including, probably, the giving of broad spectrum antibiotics to try to get rid of residual infection, particularly if he has some gastrointestinal involvement.’

‘Yes…good. I can see that you know your stuff Dr Gibson,’ Blake Contini conceded, raising his dark eyebrows at her and giving her a small smile, a gesture that transformed his lean face.

They had moved well away from the door of room six to discuss their patient, yet Abby glanced at it, feeling a familiar sense of pity. ‘I expect he was generally a very fit man before this,’ she said. ‘He doesn’t smoke, has always exercised regularly.’

‘Yes,’ he agreed. ‘We’ll see what the packed cells and the plasma do for him over the next day or two. I try to be as hopeful as I can with these patients. After all, what’s the point of trying to play God when each case is somewhat different from the next. We can only talk in probabilities. Do you agree?’

‘Yes.’

‘There’s nothing to stop him from getting hold of a medical book, of course, and reading about probabilities for himself,’ he commented dryly.

‘No, he’s obviously done some reading.’

‘Do you think he’s a candidate for a bone marrow transplant?’ he asked, looking at her quizzically again.

Abby shrugged, indicating her uncertainty. ‘Statistically speaking…I’m not sure,’ she said slowly. ‘His age is not on his side.’ She considered how well Mr Simmons would stand up to the effects of the toxic drugs that would be required prior to a transplant of bone marrow. ‘But I…I wouldn’t want to rule it out.’

‘Quite right, on both counts,’ he said crisply, ‘so I don’t think that’s an undisputed option. We’ll see. Before we start chemo, we need to do another liver function test and make sure his kidneys are in good working order.’

A small silence ensued, while other staff moved busily past them in both directions.

‘Well…’ Abby said, thinking of her outpatient clinic yet oddly reluctant to bring this teaching session to an end, ‘thank you for the time you’ve taken to go over this case with me, Dr Contini. I guess I ought to be getting back…’

Dr Contini looked at his wrist watch. ‘That’s the least I could do since you missed the presentation because of Will Ryles. A quick cup of coffee is in order, I think, don’t you?’

‘Definitely,’ she agreed.

‘Come to my office,’ he said lightly, ‘then I can quiz you about your attitudes and biases, Dr Gibson.’ The smile he gave her surprised her once again, as did his almost playful propensity to goad her in a gentle way, just out of the blue. Although he would not suffer fools gladly, she suspected, he would also be quick to burst any bubble of pomposity wherever he found it…and there was certainly plenty of pomposity in a hospital setting. For this reason, she found herself warming to him even more.

As she gave him a quick sideways glance, Abby reconfirmed her convictions about the false veracity of first impressions; she didn’t know what to think about Dr Contini. Two things were certain—he was an unusually attractive man, and knowing him was going to be a challenge, both personally and professionally.

‘You said you were good at other things, as well as taking histories,’ he said. It seemed that he was determined to shake off the slightly sombre mood that had been engendered by Mr Simmons’s condition. ‘Tell me what some of those other things are.’ His hand lightly under her elbow indicated that they should walk and talk at the same time.

‘Well…’ Enjoying his touch, she walked slowly. ‘I’m pretty good in a crisis.’ Looking at him sideways again, she challenged him to contradict her, her full lips curving up at the corners in an involuntary smile.

‘I expect you are,’ he conceded thoughtfully, his voice husky.

‘Even though you think I’m a bit klutzy?’ Her smile broadened.

‘You said that—I didn’t,’ he reminded her. ‘I would have come up with a word that was more complimentary.’

‘I’m not sure I believe that,’ she said.

As he led the way to a quiet side corridor off the main second-floor corridor, where the department of internal medicine offices were situated, Abby considered, a little nervously, what he might query her about, and she began to think that maybe she should have declined the offer of coffee.

‘Dr Wharton will be wondering what’s taking me so long,’ she ventured, as he led the way into his cosy office.

‘I spoke to Dr Wharton. It’s all right,’ her colleague informed her. ‘This is a teaching hospital after all. You haven’t told me what else you’re good at…outside work. I like to know who—and what—I’m dealing with in my new colleagues.’

‘Well…’ Abby racked her brains. ‘I’m good at gardening, and I make a pretty mean rum baba when I’m in the mood for it.’

Although she had not intended to make him laugh, his uninhibited amusement at her response was very gratifying.

‘Perhaps you’ll let me experience that some time,’ he said, still grinning. ‘I shall look forward to it. Coffee?’

‘Please. I’m desperate for coffee and was beginning to think you weren’t going to give me any after all.’ Trying to cover up overt signs of her growing attraction to him, she pushed her unruly hair away from her forehead and fussed around with her attachè case which she placed on his desk.

‘A coffee now in exchange for a rum baba at a date yet to be decided. Right?’ The tone was light.

‘Right,’ she said unthinkingly, aware only that her heart was beating faster than normal and that she wanted more than anything to be able to meet him outside a work setting—not thinking beyond that.

‘Back to serious things. Tell me about your personal ethics, Dr Gibson,’ he said, as he handed her a cup of coffee. ‘Would you like to sit—get more comfortable?’

‘I…I prefer to stand,’ she said.

‘So I’ve noticed,’ he said.

As her face flushed, he shook his head in a self-deprecating way. ‘I’ve done it again, haven’t I? As I said before, I don’t mean to be unkind. I’ve got into a habit of…insensitivity with women.’

‘It’s all right,’ she insisted. Then, like a litany, she mentally went over the many rules for good medicine which she had made for herself, trying to answer his question. While he poured himself coffee, his back to her, Abby took a swallow of hers and collected her thoughts.

‘As for my ethics…well, do not force or coerce a patient into having a treatment he or she does not really want, even if the prognosis without it would be poor,’ she stated. ‘Sometimes “treatments” can kill—many are not without risk. If a patient wants a second, or a third, opinion, before agreeing to a course of treatment or an operation, make sure he or she gets it.’

‘Hmm. Go on.’ He sipped coffee, eyeing her thoughtfully. Abby had no idea what he was thinking. This was a snatched interlude that must soon be over.

‘Know your biases. Even the very best doctors have them,’ she said, hoping that he would not press her further. What, she wondered, were Dr Contini’s biases and weaknesses? Maybe finding out would be interesting. ‘Try to know your strengths and weaknesses.’

‘What do you think of euthanasia?’ he asked unexpectedly.

For a few seconds Abby looked at him, sensing something other than curiosity about her opinions in his question, yet she could not have analyzed why she thought that.

‘I know that some doctors advocate euthanasia,’ she said slowly, averting her gaze from his shrewd perception. This was something that she felt very strongly about. ‘I’m not one of them.’

‘Tell me why,’ he said softly.

‘I—I’m not particularly religious,’ she said, stammering a little, ‘but the admonition “thou shalt not kill” figures very large in my personal philosophy, I guess. I haven’t really analyzed it very thoroughly…In my experience, people do not want to have their life taken from them—they want to be relieved of their pain. We all love life, we cling to it.’

‘Hmm,’ he murmured, watching her.

‘To…er…to take a life is extreme arrogance,’ Abby went on. ‘I deplore arrogance of any kind.’

‘I agree with you absolutely. It is not in our mandate to take a life. Not actively.’ There was a bleakness in his voice, as though this were a question that he had been forced to consider many times. Abby knew that must have been the case.

Encouraged, she went on and felt her cheeks tinge with warm colour as she disclosed her thoughts, struggling to find the appropriate words. ‘To me, the trust that a sick person has in his or her doctor is a sacred trust, never in any circumstances to be breached. As you say, it is not our mandate…We are not in a position to have, or to take, that sort of power over the life of another. It’s abhorrent…obscene.’

He nodded, saying nothing. The silence that ensued seemed to be charged with a peculiar understanding between them, as though there had been other questions silently asked and just as silently answered. Yet Abby had no idea, no idea at all, what those questions might be…or what the answers were. She remembered the premonition that she had felt at the medical rounds.

Abby bit her lip indecisively, looking down at the cup that she held in her hand. She wanted to leave, but could not seem to summon up the energy to make the move. Then she felt his fingers touch her own as he grasped the cup.

‘Thank you for talking to me,’ he said quietly. ‘Let me get you more coffee—that must be cold. I’ve been asking you too many questions, haven’t I?’ The touch had the effect of deepening the inertia that had come over her. She could not understand herself. Neither did she know why he was thanking her for talking to him.

He handed her back a full cup. ‘Here, I won’t say another word while you drink that.’

Automatically she added cream and sugar to the hot liquid.

‘You ask a lot of questions, rather personal ones, Dr Contini,’ she said bravely, not looking at him. ‘I wonder if you answer them so freely yourself.’

‘Drink your coffee, Dr Gibson,’ he said. ‘You may not get another chance.’ They looked at each other, as they both drank the welcome coffee, sizing each other up. Abby was the first to look away.

‘I’d be pleased to answer any questions that you might have,’ he offered quietly. ‘Another time.’

There were footsteps of someone approaching the door outside, then a knock. ‘Ah, there you are, Dr Contini.’ A secretary had put her head round the door. ‘There’s an outside call for you from the Gresham General Hospital. They want to talk to you right away.’ She glanced at Abby. ‘Shall I put the call through to you here?’

‘Yes, please,’ he said, after a fraction of hesitation.

When he answered the telephone a moment later, it seemed to Abby that he switched instantly to a totally different mind-set—that he tuned out the present situation, including her, and projected his thoughts totally to whoever was speaking to him. When he looked at her his expression was blank, as though he scarcely saw her, when she made to leave.

‘Thank you for coming, Dr Gibson,’ he said formally. ‘I’ll doubtless be talking to you in a few days about Mr Simmons.’

‘Thank you, Dr Contini,’ she said.

As she walked away from his office, she considered that he might have a cross-appointment at one of the other teaching hospitals in Gresham, the Gresham General, although she was surprised at that. The position at University Hospital was a very demanding one, which, she had assumed, would take up all his time. Maybe he was just being called to a consultation. Gresham General was a hospital that she went to occasionally herself as part of her training program.

Abby felt sober and thoughtful as she left the floor to make her way to Outpatients on the ground level. Going over the case of Mr Simmons in her mind, it was clear that everything possible was going to be done for him to effect a cure. He was in very good hands. There would be unwanted side-effects for him, of course—in order for chemotherapy to be effective, the first dose had to be followed up not long after by a second dose. Such toxic drugs left a person’s body susceptible to opportunistic infections.

Abby had to admit that Dr Contini was very good at his job—very good indeed.

Lunch was almost over in the cafeteria when Abby got there late, in the early afternoon, having seen a few more patients.