‘When Bill was in Sydney I had a physician look at him,’ Quinn continued. ‘He suggested Bill’s only problem was mycoplasma pneumonia and I hadn’t left him on antibiotics long enough the last time he’d had it. He’s been on antibiotics almost continually since then, though, and here he is crook again. I guess…I guess I should send him back to Sydney. Trouble is, I reckon the next we’ll hear of Bill will be of his death. The Sydney physicians don’t seem to have any more of a clue than I have.’
And his death would hurt, Fern knew, looking up at Quinn’s defeated face. This man might be a cheat to the women in his life but there was no doubting that he was a caring doctor.
He was worried sick now.
‘What’s causing the haemoptysis?’ she asked slowly. The plugs of bloody phlegm Bill was coughing were not normal for straight pneumonia.
‘The coughing might be causing it-or the continued infection.’ Quinn shrugged. ‘His cough’s so dry and consistent that he could be breaking small blood vessels. There hasn’t been much haemoptysis till now.’
‘There was a fair bit tonight.’ Fern frowned. ‘You’ve excluded things like AIDS?’
‘Of course.’ Quinn wasn’t offended. He seemed almost grateful to go through the options with another doctor and Fern knew how he was feeling. There was nothing worse than not knowing what was wrong when you were the only one qualified to do anything about it.
Quinn lifted a hand and wearily counted on his fingers. ‘It’s not HIV, or Q fever, or legionella or psittacosis. A CT scan of the thorax and abdomen were normal. Mycoplasma and Brucella serology were normal. He’s been on Aminophylline twice a day and bronchodilator and steroid inhalers for his asthma, and until six months ago his asthma was well controlled. It certainly isn’t now. He’s lost over four stone and is still losing. His sputum grows only a light growth of beta haemolytic Strep Group D and at last count his white cells were 7.38.’
Fern stared. For a country GP without specialist internal medicine training, Quinn’s search for a diagnosis was impressive.
But not conclusive.
There had to be something else.
‘Have you excluded TB?’ asked Fern thoughtfully. TB was rare in this country now-but not unheard-of. Mostly it occurred in migrants coming from more heavily infested areas, in AIDS sufferers or in elderly derelicts whose general poor health made then susceptible. Bill was certainly none of these.
‘His Mantoux test showed a positive response,’ Quinn told her. ‘But we’ve sent off pleural aspirate for cytology with negative results. Pleural biopsy, bronchoscopy and bronchial washings have all shown nothing. If I send him to Sydney now, the hospital’s going to waste time repeating all those tests and meanwhile…’
‘Meanwhile he’ll be dead,’ Fern said brutally. ‘We’ve run out of time for tests.’
‘Bill’s run out of time for living, then.’
‘Maybe.’
Fern scuffed her toe on the polished wood of the corridor, a habit she’d started as a child when she was thinking hard.
Silence.
‘He’s running a fair temperature,’ she said at last.
‘He has all along. Even when we cleared the pneumonia he’s been spiking nocturnal temperatures of thirty nine plus,’ Quinn told her. ‘I saw him the day after your…after your attempt at a wedding…because I was concerned he might have eaten some of those damned oysters.
‘In fact, he hadn’t eaten any because he was feeling off colour, anyway. He hadn’t tried to go to your wedding. I thought his temp was up then-but he wouldn’t come in for a check. Said he was as well as he’d been for a month and he was sick to death of being prodded and poked. I can’t say I blame him.’
‘But his Mantoux test showed positive…’
‘Half the population of the known world shows a positive Mantoux test,’ Quinn said brutally. ‘That doesn’t mean he’s consumptive.’
‘It means TB hasn’t been excluded, though…’
‘The tests were negative…’
‘They often come back with false negatives.’ Fern’s sandal scraped forward and back again. Her personal friction with Quinn was forgotten for the moment. Her mind was all on long-ago lectures.
‘Sometimes asthma treatments can stir up TB,’ she said thoughtfully. ‘It’s been documented.’
‘Yeah?’ Quinn was watching Fern’s face, trying to follow her thought processes. There was no denigration of a junior doctor here. If Fern had an idea that might help, Quinn Gallagher wanted to hear it.
‘It’s true. And somewhere…I remember one of my professors saying over and over, “Never let a patient die with an undiagnosed fever without at least considering TB and a trial of triple therapy”. He was an elderly professor who’d seen a lot of TB-but his advice is still sound. He didn’t trust tests. He trusted what his gut feeling was telling him.’
‘So…’ Quinn was still noncommittal, still watching.
‘So we either give up on Bill and send him to Sydney,’ Fern said. ‘And hope he survives the trip. Or we treat the pneumonia aggressively and at the same time we start him on treatment for TB. My gut feeling’s saying TB and I think we should go with that. We send more pleural fluid for culture but even if that comes back negative we keep him on the regime for a while-just to see.’
‘But if we’re not sure…’
‘Are we sure it’s anything else?’
‘No. But…’
‘Then what’s our choice here, Dr Gallagher?’
Quinn stared at the girl in front of him as if he was seeing her for the first time. Fern’s voice was steady. This was a considered choice and she was ready to accept the consequences if it failed.
‘What on earth’s your training?’ he asked. ‘I asked your aunt if you’d done anaesthetics and she said you’d done a resident rotation-but you don’t talk like any intern I’ve ever met.’
Fern smiled faintly and shook her head. ‘I’m a specialist medical registrar,’ she admitted. ‘I’ve done my first part of internal medicine. In twelve months I’ll be a qualified physician.’
‘A physician…’ Quinn’s eyes widened. ‘For heaven’s sake…’ He shook his head as if in disbelief. ‘You realise-once you’re fully trained-what we could offer here…?’
‘“We”?’
‘“We”,’ Quinn said, his voice firming as the ramifications hit home. ‘Fern, I’m a surgeon and I’m trained for accident and emergencies. You have enough anaesthetic training to support me-and you’re a physician, for heaven’s sake…’
‘Not yet.’
‘No. But if we found a locum to take over here…Dr Rycroft, all we lack is an obstetrician. With the hospital already operating and if the job was advertised only for twelve months we’d find a locum to take over from us. There are medicos who’d see twelve months here as a welcome break, as long as they weren’t pressured to stay at the end of it.
‘If we were to spend twelve months in Sydney-you finishing your physician training while I deliver every baby I can get my hands on and getting myself some paediatric training in the process-think of the service we could offer.’
‘And Jessie would come back to Sydney with us while we did it, I suppose?’ Fern said slowly, watching his face.
Quinn shook his head. ‘She’d stay here.’
‘Without her husband?’
The word hit Quinn almost as a physical slap. He took a step back and stared down at Fern.
His burst of enthusiasm faded and fatigue crept back.
‘Jessie wouldn’t mind,’ he said flatly.
‘Well, I’d mind for Jess.’ Somehow Fern made her voice brisk and businesslike but it wasn’t how she was feeling. ‘Do you want help writing up a drug list for Bill?’ she asked harshly. ‘If so, let’s do it and then ask someone to take me home. I really have other things to do than stand in hospital corridors and discuss plans by you to abandon someone who clearly loves you.’