by Nina Raine
BRIAN. And you couldn’t wait to cross it off.
VASHTI. In case you hadn’t noticed, if you’re a woman, children’s what you do when your career hasn’t worked out. Cos it’ll finish it off for you. Joke.
BRIAN. You’re full of jokes today.
VASHTI. I am. Put in a penny, I’ll tell you a joke.
BRIAN. I don’t want you to screw things up for yourself because people think you come across as arrogant.
VASHTI. You know, I’m fed up with being told I ‘come across’ as arrogant. I ‘come across’ as arrogant because I am arrogant.
Why can’t I just be me?
BRIAN. Because you can’t jackboot around your juniors, and then go running for back-up to your seniors. Either you’re the boss or you’re not. You can’t be both.
VASHTI. But I am both, Brian! I’ve got the worst of both worlds! I’ve got crap coming at me from the consultants, and crap coming at me from the juniors, and crap coming at me from the nurses, who resent the fact that I’m not a nurse, so they strop, if you don’t say ‘please’ and ‘thank you’, they wait for the moment they can undermine you in front of a patient, and boy will they undermine you if they get a chance. And it’s these fat, old, vacuous black nurses – Pardon me for saying so, but it’s true –
Just as she says this a NURSE passes and she is forced to lower her voice, which gradually rises again throughout the following.
– But, you’re a woman, and so are they, and you’re not white, and neither are they, so why do you think you can boss them around? This job is about being liked, by blokes, but men don’t like women who act like blokes, and to be taken seriously as a surgeon you have to act like a bloke, so you’re fucked. Or else it’s some wanker in orthopaedics saying so how come you didn’t have an arranged marriage, then, Vashti, isn’t that what ‘you lot’ do?
BRIAN. Don’t complain about Mark.
Not if you want that consultancy.
VASHTI. Why not?
BRIAN. Because… It’ll make you look weak. Not Mark.
Beat.
VASHTI. This job is not about saying please and thank you and being nice.
BRIAN. Sometimes, it is.
VASHTI. It’s about having standards.
BRIAN. You can’t be a perfectionist in a hospital.
A&E
MARK and REBECCA. MARK is busily filling in a form.
MARK. A bullying form.
REBECCA. What?
MARK. I’m filling out a bullying form. I’ve only got two questions left.
REBECCA. You are joking.
Beat.
MARK. No, I’m not.
He carries on writing.
It’s amazing how many of these boxes I’m ticking.
‘Have they taken aversion to your physical appearance?’ I’m going to have to say, ‘Yes.’
Don’t you remember? Vashti said to me ‘If you want to be a surgeon, you’d better get rid of the goatee, for a start.’
REBECCA. Well, she had a point.
– Oh, for fuck’s sake, Mark, don’t be a / twat.
MARK. Why should I be patronised by someone who isn’t even that good?
EMILY comes up, silently, and starts collecting up some notes.
She can’t cut. She hasn’t got the balls for it.
REBECCA. What have balls got to do with anything?
MARK. She’s a crap surgeon, with a crap manner.
REBECCA. Name me one surgeon that doesn’t have a crap manner. You / included.
MARK. Listen.
He turns to EMILY.
What do you want to be, surgeon or medic?
EMILY.…Surgeon.
MARK. And why do you want to be a surgeon?
EMILY. Cos… you actually do something. (Gestures with her hands miming her next few phrases.) Bone’s snapped, you fix it. You see something bad – you cut the badness out. Rather than trying some drugs… standing back… seeing what happens… trying different drugs… That’s why I want to be a surgeon, not a medic.
MARK is looking at her.
MARK. You know what surgery’s really about?
Slabs of meat. Not people.
You saw this morning. You’ve got a slab of meat on a table rendered helpless by the anaesthetic. You’ve got supreme power. They can’t fight you.
REBECCA (to EMILY, apologetically). This is his way of trying to impress –
MARK (ignoring her). And you have to be able to live with what you do to that slab of meat. When you make a hole in the wrong place. Because once you open the skin you’re on your own.
(To REBECCA.) I’ve watched Vashti. She’s scared when she cuts.
That’s why she’ll always be a crap surgeon.
EMILY. Well, the surgical reg told me that on the rotation here –
MARK. Hold on a second. You’re going to apply for the surgical rotation here?
EMILY. I haven’t decided yet. My boyfriend’s already on it and –
MARK. Your boyfriend?
EMILY. James Ransom. Wants to be in Orthopaedics.
MARK (sing-song). Oooohhh… I didn’t know ‘Handsome Ransom’ had a girlfriend.
REBECCA (seeing MARK’s expression, under her breath). Give it a rest, Mark.
EMILY. What do you mean, ‘Handsome Ransom’?
MARK. Nothing, nothing. (Drawling.) ‘Orthopaedics…’ So, he wants to be a bone monkey. Does he like playing with Lego? (Looks at her, with ironic wonderment.) God, you don’t like me being rude about your boyfriend, do you? Very haughty. Carry on, you were saying?
EMILY (changing her mind). – Look, I’ve got to go. I’m meant to be taking these ECGs to Cardiology –
MARK (interrupting her). How much operating did you do in your last job?
EMILY. Well, I just observed. Three months. Breast.
MARK. Mm. Brrreast… Well, give it a little more time. Try doing a few operations that go wrong. Do you know what it’s like to be the person who’s actually sticking the knife in here? Or here? (Gestures to two arterial points – in the groin, and near the armpit.) You stick a knife in close to an artery, boy do you know it.
Then you’re in tiger country.
He looks at her.
You’re a medic. Not a surgeon. You’ll end up in GP-land. I give you six months.
He goes.
Cardiology
JOHN and MRS BRACKEN in a small room together. MRS BRACKEN (Essex accent)is in her early sixties and looks pale and sweaty. JOHN is taking her pulse.
JOHN. Are you nervous?…
MRS BRACKEN. Why?
JOHN. No, just cos your pulse is bounding a bit.
EMILY comes in with some pieces of A4 pink graph paper with a series of jagged graph lines across them: MRS BRACKEN’s ECG printouts.
EMILY. The ECGs.
JOHN (his face is expressionless as he scans the graphs. Under his breath). Mhm, mhm… fair enough, fair enough…
EMILY (looking over his shoulder, in an undertone). Quite… um… is it, saggy inferiorly, isn’t it?
JOHN. Mmh.
(Louder, to MRS BRACKEN.) So, Mrs Bracken… Mary… first it was just the burning in the throat –
MRS BRACKEN. Yes but put it this way, I’m feeling none too good altogether now.
JOHN. Mmhm. What I want to do, right now, is have another quick listen, and then I’m going to look at your heart myself, my love. If you could unbutton your top…
She does so. She is facing out towards the audience. JOHN takes his stethoscope, puts it to the lady’s chest, and listens. He does not look at her but his face is cocked out to the audience too. His expression is inscrutable.
Silence. Everyone is still. Finally.
Right.
He gestures to a stretcher couch.
If you could just lie down there for me, Mary…
She does so.
MRS BRACKEN. What are you going to do?
EMILY hovers uncertainly.
JOHN (to EMILY). You should stay and watch.
He pulls on some
gloves, takes a tube of clear jelly-like substance.
This might feel a bit cold. What we’re doing is called an echocardiogram and on that screen – (Gestures to a computer screen at the bedside.) we should be able to get a look at your heart.
He puts some jelly on her chest.
(To himself.)…And see what this is all about.
MRS BRACKEN. Ooh that is cold.
JOHN. Sorry about that.
(To EMILY.) Could you switch off the lights for me?
She does so. The computer screen glows in the dark room.
JOHN moves a plastic rod over MRS BRACKEN’s chest. On the screen a black-and-white, very grainy fuzzy image of the heart and the sound of its beats. The beats do not sound like the typical clichéd sound effect. Amplified, they sound like footsteps far away, echoing down a corridor.
There we go… we…
The heart bulges in and out of view, shifting and pulsing.
…We have to make use of what views we can get. See there’s your lungs getting in the way.
MRS BRACKEN. Sorry about that. Shall I move them?
JOHN. Yep, on the shelf over there…
They chuckle. Then, silence, filled with the noise of the heartbeats.
JOHN manipulates the rod, to get a different view.
EMILY moves closer, studying the image on the screen.
How did you get here today, Mrs Bracken?
MRS BRACKEN. My husband drove me. We live a little bit out, over Dulwich Way, do you know it?
JOHN. I do. Very pretty. I was thinking of buying there.
Beat.
(Casually.) Where is your husband now?
MRS BRACKEN. In the corridor, poor thing.
Beat.
Where do you live?
JOHN. Islington.
A pause while he carries on manipulating the image. EMILY sees something in the image and cranes in to look. JOHN has seen it too.
(Abstractedly.) But I want to move…
MRS BRACKEN. Why’s that then?
JOHN. Just… not very convenient for work… Bit hectic. Be nice to get away from it all a bit.
Beat.
EMILY (in an undertone). The right atrium.
JOHN (shortly). Yup.
Pause.
MRS BRACKEN. Your job must tire you out.
JOHN. Sometimes.
Pause.
MRS BRACKEN. Because you’re not well at the moment, are you?
Beat. JOHN looks at MRS BRACKEN directly for the first time
JOHN. What?
MRS BRACKEN. You’re not well.
Beat.
I know you’re only young, but you look tired to death.
JOHN. That’s just being a doctor I’m afraid.
There is silence again as JOHN continues to probe with the ultrasound.
Okay, I think we’d better… Let’s just try… (To MRS BRACKEN.) See the heart is dependent on itself for its own blood supply. It pumps blood into itself. This’ll show us whether that’s… this’ll show us the direction of flow.
Beat.
(To himself.) It’ll show us if there’s… turbulent flow.
He changes the image on the screen. Now the heart is strikingly rainbow-coloured, like a heat-sensitive photograph. Red blending to blue, yellow and green, fanning and flowing.
Right.
(To EMILY.) Tamponade.
EMILY (shocked). Really?
JOHN. Mrs Bracken, there’s nothing to panic about, but what’s happened is, you’ve got some… fluid round the heart… see there? (Indicates on the screen.)
MRS BRACKEN. Fluid round the heart?
JOHN. Yes… just there – (Indicates again.) and that’s what’s causing your problems. And… we need to treat this.
He starts to pack up the probe, strip off his gloves. Switches on the lights.
MRS BRACKEN. Right away?
JOHN. Well… the sooner the better really.
He is ready to go.
So, I’m going to leave Dr Logan with you while I go and tell the relevant people, and we’ll get this sorted out for you in no time.
He starts to leave the room.
MRS BRACKEN. And I just wait here?
JOHN. You just wait here. And take it easy, Mrs Bracken. (To EMILY.) You can get started on the notes.
MRS BRACKEN. Well, this is what I call service!
He exits, EMILY follows, joins JOHN outside the room. He is busily dialling a number into a phone.
JOHN. Fluid’s built up around the heart in the pericardial cavity. You saw how the right atrium was almost completely collapsed in diastole.
EMILY. Shit, so –
JOHN. So the pressure build-up could stop it beating if we don’t get a move-on. Yep.
EMILY. Oh my God.
JOHN. No, well done. You went on a hunch and you were right. Now all we have to do – (Gestures to phone.) is wait for ‘our man’ to answer the bleep.
He nods, looks at her.
You’re good. You listen and you look. And you ask them the right questions.
And that’s what it’s about.
EMILY. Is it?
JOHN. Yeah. Asking the right questions, but sometimes, just listening…
EMILY. To what?
Beat.
JOHN. You had a feeling about her, didn’t you?
Sometimes your body gets there first and tells you. ‘There’s something wrong here.’
Something you saw out of the corner of your eye and you never knew what it was because your body told you before your brain got there.
When you’re walking down a dark street and something tells you to turn around.
He looks at her.
EMILY. What do we do now?
JOHN. We stick a needle in and we let off the fluid before her heart stops beating entirely and she dies. (Grins.)
Or rather, we bleep our consultant Dr West who will stick in the needle for us when we’ve told him what’s happened. Who should be calling us back right about –
The phone rings.
– Now. Answering my bleep.
The phone rings.
You want to pick it up?
The phone rings.
And have the satisfaction of telling him it wasn’t acid reflux or candidiasis of the throat yourself?
The phone rings.
Go on. You deserve it. Enjoy it.
Have a chat with him. Man to man.
It won’t happen that often.
The phone rings. They stare at each other. They are still.
ACT TWO
The Ward
Some weeks later.
VASHTI is sitting next to a bed. In the bed is a middle-aged Indian lady, BINDU, who speaks a mixture of Hindi and English (in a strong Indian accent). After a brief pause:
BINDU. Vo tumse pyaar karta hai, aur vo tumhe bohot yaad karta hai. Von tumharaj intasaar karega. Tumhare seeva aur koyee nahee hoga. Manlo ooski baat, behta… [He loves you and he misses you – he’s going to wait until you see sense and he knows you will eventually – he says there’ll never be anyone else.]
VASHTI. Look, Jaspreed has obviously been bending your ear, but I’ve had a long time to think it over, and I’m not going to change my mind. We got married. We also got divorced. For a reason.
BINDU. Behta, darad maan mah hota hai – [You’re upset because – ]
VASHTI. No. I’m not upset about it any more. Mind over matter.
Can we talk about you now, please?
Beat.
Is everything all set for tomorrow?
BINDU. Yes. Mere khayalse jo mera ‘operation’ karega ooska naam ‘Mr Milward’ hai. [Apparently the doctor who’s going to do me is called… ‘Mr Milward’… at least I think that’s what they said – it was something like that.]
VASHTI. Oh right, Milward. Well, he’ll do a good job. Hopefully.
BINDU. They took some bits of blood… testing I think –
VASHTI. Look, just speak Hindi, will you? It’s fine.
Beat.<
br />
BINDU. Vashti, mai bohot pareshan hoon. [Vashti, I’m worried about this operation…] Things go wrong… you know they do –
VASHTI (interrupting). Oh God, Bindu. I’ve told you zillions of times. It’ll be very simple. Very straightforward. Very routine. It’ll be over before you can –
BINDU. Too samajti nahi hai. Ye log toomhara badaan nahi kaat ne vale. [You don’t understand, Vashti – you’re not the one going in there and being chopped open –]
VASHTI (interrupting). The only way to sort out the pain is to have it taken out. You’ve been dithering about this for – I know you’re scared of hospitals but honestly, you couldn’t have chosen a simpler operation. Look. I’ll explain it to you. You’ll be under a general anaesthetic. I know it sounds mad but pain is perception… ‘Darad maan me hota hai’… [‘Pain is perception.’] do you see what I’m saying?
BINDU makes to disagree but VASHTI is there first.
Also, Bindu, I got you bumped up the list… Aapke leeye maine bohot kaushish kee hai… [I pulled strings left, right and centre for you.] You went on and on about the pain, if you pull out now you won’t get done for months.
Beat.
BINDU. Aaccha, toom jaantee ho! [I suppose you’re the expert.]
VASHTI. Exactly. I am. I am the expert. So just lie back, and enjoy it. What time are they doing you?
BINDU. Eight thirty.
VASHTI. Good. You’re first on the list, everyone’ll be fresh, and you won’t be cancelled.
Beat.
Honestly, darling, take it from me. You’re doing the right thing.
BINDU. Vashti, too mooje milne aavogee na, operation ke baad? [Will you come and see me when it’s over?]
VASHTI. Of course I will, Massi. When you come round. Oh God, no, I can’t. I’m going to a conference. And preparing for my interview. It’ll have to be the day after, in the evening.
But you’re going to be fine, Massi.
BINDU. God willing.
VASHTI. Forget about him. I’ll be looking out for you.
She gets up.
That’s what I’m here for, darling.
Emily’s Room
This is a typical on-site hospital on-call room. Small, spartan. A narrow bed and not much else. EMILY is finishing a conversation on her mobile phone. There is something different about her, dispirited.
EMILY. Mum, I can’t talk. I can’t think about it. I’m too tired.
Pause.
Well, why don’t you tell him that?
