She needn’t have worried. He lifted one finger and pointed to the film. ‘Pleural effusion without any parenchymal lesion.’ He didn’t finish there. ‘I know there’s some mixed feelings, but because of how this little girl has presented, I would be inclined to drain the effusion rather than leaving it.’
She took a few minutes to recheck things. This was the first time he’d seen a child with tuberculosis, never mind the added complications, and he’d picked it up straight away. She couldn’t help but be impressed.
She turned to face him. ‘I think you’re right. Let’s put our public health heads on and try to persuade the rest of the family to comply with their medications. We can use a sample of the effusion to diagnose the tuberculosis. A pleural biopsy would likely be too traumatic right now.’
He nodded in agreement. She paused for a moment, wondering whether she should question his skill set any further.
‘Any experience of doing a pleural effusion in a five-year-old?’
He nodded. ‘I specialised in paediatrics before training as a GP.’ He gave her a steady look. ‘I’ve got this. But I’m happy for you to stay if you’d like.’
He didn’t seem defensive or annoyed, but it felt like a bit of a line in the sand. He already knew she’d questioned his diagnosis. Now she’d asked about his experience. Lots of other clinicians that she knew might have been annoyed by this, but Joe just seemed to have accepted her actions without any discomfort. Still, the tone in his voice had changed a little, as if he was getting a bit tired of her.
She pressed her lips together. If he’d expressed any anxiety about the situation she would have been happy to take over. But he hadn’t, and she knew it was time to step back. She had enough patients of her own to see still in the waiting room.
She glanced at the nurse and interpreter. She had confidence in both of them. Either of them would come and find her if they were worried. She tried her best to look casual. ‘I’ll leave it with you. Shout if you need anything.’
Joe watched her retreat, knowing exactly how hard it was for her. Was his counterpart a bit of a control freak? Or maybe she just second-guessed everyone she worked with?
He tried to understand, even though he couldn’t help but feel a little insulted by her lack of faith in him. It’s not like he hadn’t experienced this himself. He’d worked with plenty of other doctors, in a variety of settings over the years, and it always took a bit of time to reassure himself about a colleague’s skills and competencies.
It was clear she loved this place. She’d more or less told him that already. There was also the added responsibility of her employers not being here right now, so the well-being of May Mắn hospital was really in her hands.
He gave some instructions to the nurse, who seemed to understand his English, then knelt down beside the little girl and her mother with Mai Ahn, the interpreter, to explain what would happen next.
Thirty minutes later the procedure was complete, with some hazy yellow fluid in a specimen bottle for the lab. The little girl’s cheeks and lips had lost their duskiness, the oxygen saturation monitor showed improvement, and when he listened to her chest he could hear the improved inflation of her lung. He gave instructions to the nurse for another X-ray, and to further monitor for the next few hours.
‘I’ll come back and have a follow-up chat about the medicines,’ he said. Something came into his head. ‘Do doctors make home visits here?’
The nurse frowned for a second as if she didn’t quite understand what he’d said, then shook her head. ‘No. Never.’
Joe sat back in his chair for a moment. He didn’t want to send this child home with just a prescription in her hand. The rest of the family were important too. The mother had already told him that both her husband and father-in-law kept forgetting to take their tuberculosis meds. Only her own mother remembered. If he could just see them, and persuade them how important it was, it might stop other family members being infected. He glanced out to the waiting room. He still had a whole host of patients to see, some of whom would need vaccinations, and some might need tuberculosis testing. He went to the waiting room with Mai Ahn to call the next patient, while his idea continued to grow in his head.
‘He went where?’
Ping, one of the nurses, shrugged. ‘He talked kind of strange. Something about a home visit. Apparently they do them in Scotland a lot. He persuaded Mai Ahn to go with him.’
Lien walked over and looked at the notes, checking the address on the file, then grabbed her jacket. She’d nearly made it to the front door, when her brain started to become a bit more logical. All she was feeling right now was rage. She went back and scanned the rest of the notes, checking to see what other family members were affected. ‘Did he take prescriptions, or did he take the actual medicines?’ she asked Ping.
Ping gave her a smile as she carried on with her work and brought a single finger to her lips. ‘I couldn’t possibly say.’
Lien nearly exploded. It was obvious that the Scottish charm was already working on her staff. What on earth was he thinking? They had to account for every dose they used. They weren’t a dispensary. On a few occasions they gave out enough medicines to see a patient through the night, but they didn’t give out medicines on a regular basis.
She snatched up her bag and made her way out into the streets. It was around six now, and the pavements were filled with people making their way home from work, the streets filled with traffic. She did her best to dodge her way through the crowds and cross the few streets. The home address wasn’t too far away, but the walk did nothing to quell her temper.
By the time she’d reached the address her heart was thudding in her chest. This wasn’t exactly the best part of town. She had no idea how he’d managed to persuade Mai Ahn to bring him here, but she would make sure it wouldn’t happen again.
The house was on the second floor of an older block of flats, where each storey looked as if it squished the flats beneath it even more. She climbed the small stairwell and walked swiftly along, checking the number before she knocked on the door.
‘It’s Dr Lien, from the hospital,’ she said.
She held her breath for a few moments, and then frowned. Was that laughter she heard inside? The door creaked open and the elderly grandmother of the household gave a little bow as she ushered Lien into the house.
Lien walked through to the main room, where the majority of the family was sitting on bamboo mats on the floor, Joe amongst them.
Mai Ahn was by his side, translating rapidly as he spoke. He had laid the complicated drugs for tuberculosis out in front of the elderly grandfather, instructing Mai Ahn to draw a paper chart with dates and times.
Lien stopped the angry words that were forming in her mouth. Back when she’d worked in the US, dispensary boxes had been commonplace for patients who were on several drugs. But they weren’t widely used here at all. That was what he was doing. He was making a do-it-yourself chart and placing the individual tablets on it.
He looked up and caught her eye. ‘Lien, oh, you’re here.’ His eyes shot protectively to Mai Ahn, whose face revealed she thought she was in trouble. The little girl from earlier was sitting curled into her mother’s lap. She’d done well, had been sent home with a prescription for her own meds, and if they were administered to her, she should do well.
Joe stood up. ‘I was just explaining to the family the problems with drug resistance and how important it is to keep taking their medicines.’
There was a shout behind Lien and she turned to see another two children playing in another room. She swallowed and took a deep breath.