‘Hey, Toni. Hello, Archie, you gorgeous boy.’ Julia, the nursing home manager, came over to them and scratched behind the dog’s ears. ‘Look, Ginny, it’s your favourite visitor.’
Ginny didn’t reply, but she smiled.
‘Catch me in my office on the way out, Toni?’ Julia asked quietly.
‘Sure.’ Toni knew it was Julia’s way of saying that she wanted to talk to her privately about a couple of potential health complications among the residents.
‘Thanks.’ Julia patted her shoulder.
Toni spent a few more minutes with Ginny, letting her stroke the dog and hopefully latch on to happy memories of dogs in her past, then said gently, ‘Ginny, Archie needs to go and visit Ella now. We’ll come back and see you next week. Say “bye”, Arch.’
The dog gave a quiet ‘woof’.
Toni did her usual round in the lounge, chatting with the residents in turn and letting them make a fuss of the dog. At the end of her allotted two hours—the maximum length of time for a therapy dog session—she made a fuss of Archie, said goodbye to the residents and headed for Julia’s office.
The nursing home manager nodded at her drawer, where Toni knew she kept a box of dog treats especially for Archie. ‘May I?’
‘Sure. He’s earned it—plus we’re going for a run on the beach when we leave here, so we’ll burn it off,’ she said with a smile.
Archie, knowing from long experience what was coming, sat beautifully and offered a paw.
Julia grinned, rubbed the top of his head and gave him a treat. ‘I love the fact you visit us on Mondays. It really sets our residents up for the week, not to mention the staff.’
‘He loves it, too,’ Toni said. ‘I assume you wanted to talk to me about a couple of residents?’
‘Yes.’ Julia took three files out of her drawer. ‘I think Liza is brewing a UTI. I did a dipstick test this morning, and although it wasn’t conclusive I’d like to nip any infection in the bud before it becomes full-blown.’
Toni knew that urinary tract infections could cause additional confusion in elderly patients, making dementia worse; and they were more frequent in elderly patients who sometimes refused to drink enough and weren’t that mobile. ‘OK. Do another dipstick test in the morning and let me know the results. I’ll flag it up at the team meeting tomorrow and see what everyone’s schedule looks like. Either I’ll come out tomorrow myself and see them, or I’ll get one of the doctors to come out; we won’t wait until our scheduled weekly visit on Thursday.’ Toni checked the notes. ‘This is potentially her fourth UTI in three months, so I’d like to look at giving her a lower dose of antibiotics long-term as prophylaxis.’ As a nurse practitioner, Toni was able to prescribe antibiotics rather than having to consult one of the GPs, which made life a lot easier.
‘Agreed.’ Julia, as the nursing home manager, was also a qualified geriatric nurse and Toni knew she was good at picking up early signs. ‘And I’m also a bit concerned about Renée. I’ve noticed she has a bit of a tremor when she holds a mug, and she’s been a little bit off with everyone for the last couple of days.’
‘You think her lithium levels might need rebalancing?’ Toni asked, knowing that Renée was bipolar; lithium levels in Renée’s blood needed to be checked regularly, to make sure they weren’t too high and the drug was doing its job properly. A tremor was often one of the first signs of a problem, along with a change in mood.
Julia nodded. ‘Again, I’d like to catch it early if we can.’
‘I’ll take a blood sample now and drop it in to the surgery on my way back,’ Toni said. ‘We’ve missed the bloods pick-up for today, but I’ll pop the sample in the fridge overnight and it’ll go in tomorrow’s batch. We’ll ring you as soon as the results are through.’
‘Thank you.’
She washed her hands, and went to see the charge nurse to pick up a syringe, a plaster, a phial and a label. Renée was a little more scattered than usual and kept wringing her hands. ‘They don’t like me in here, you know,’ she confided. ‘They’re going to tell me to leave.’
Toni knew from experience that when Renée was worried, she’d keep circling back to the same fears and no reassurance would work for longer than a couple of minutes; it just needed a couple of days for her lithium levels to get back in balance and her mood would change and her worries would disappear. So instead Toni gently asked if Renée would mind her taking a blood sample, then after her agreement changed the subject to the weather and how pretty the sunset had been last night.
Thankfully, the distraction worked and she was able to take the sample, then reassured Renée a little more before going to see Julia again to collect Archie.
‘Even before we get the test results, from her behaviour I’m pretty sure you’re right and her lithium levels are out of balance,’ she said. ‘But we need the numbers to fine-tune the dosage, and although I can prescribe a few things this is a medication I’ll have to talk to one of the GPs about.’
‘OK. Until we get the results back, we’ll keep reassuring her and changing the subject so she doesn’t get too anxious,’ Julia said. ‘Thanks, Toni. It’s appreciated.’
‘No problem. One of us will come out to see you tomorrow,’ Toni said, ‘and Archie and I will see you next Monday afternoon.’
* * *
‘She’s a smashing girl, Toni,’ Mr Fellowes said. ‘She used to work in a big London hospital. We’re lucky to have her.’
The nurse practitioner had come here from London, too? And it was unusual to move from a hospital to a general practice. Had she been burned out, in London? Ben wondered. Or had there been some other reason why she’d come here? Even though they’d clashed, Ben had been very aware of her—and, despite his intentions never to get involved with anyone again, he found that she intrigued him.
Mr Fellowes went on to answer the unspoken question. ‘She came home to help her sister look after their grandmother when she became ill. Lovely woman, Betty Butler. Her girls did her proud.’
Which sounded as if Toni and her sister had been brought up by their grandmother. Which was none of his business, Ben reminded himself. He wasn’t going to ask what had happened to her parents, or why her grandmother had needed looking after, or if her grandmother was still around. It was nothing to do with him.
‘She’d do anything to help anyone, our Toni.’
Which told him that the nurse practitioner was kind as well as being popular. He felt another twinge of guilt. Maybe he’d overreacted a bit about the dog. Or maybe he’d overreacted because he’d noticed the colour of her eyes and his awareness of her had spooked him slightly because he hadn’t noticed small details like that about anyone for the last two years.
‘That’s good to know,’ he said neutrally, and guided the conversation back to the ulcer on Mr Fellowes’ lower leg that refused to heal.
* * *
Toni dropped the blood sample into the surgery. She wasn’t sure if she was more relieved or disappointed not to see the new GP again, which unsettled her slightly. If he was a hotshot London doctor like Sean had been, he was the last person she wanted to spend time around. And yet there was something about him that drew her.
She shook herself, and drove to the car park by the beach. She changed into her running shoes, slung a bag over her shoulder with two bottles of water and a bowl for the dog, then clipped his lead on and took him to the dog-friendly