Tiger Country

by Nina Raine

  Pause.

  No, you talk to him.

  I don’t know because I wasn’t there. So it’s pointless asking me –

  Beat.

  There’s nothing ‘wrong’ with me.

  Mum, I’m standing here getting a brain tumour. I’ll speak to you tomorrow when I can think straight. Mum –

  She listens for a beat, then puts the phone down, obviously in the middle of the other person’s sentence. It immediately rings again. She throws herself flat on the bed, lets it ring, doesn’t pick up.

  There is a knock at the door. EMILY goes to it, opens it. JAMES comes in.

  Shit!… Shit! What are you doing here?

  They hug. EMILY is delighted.

  I thought you were on call.

  JAMES. I am. A&E is dead. I’m going to catch some kip. With you. Because you’re not in Brighton any more, you’re not a two-hour drive away, you’re right here where I can get you, so they can bloody well bleep me if they need me.

  God, it’s good to see you.

  They kiss. He looks around the room.

  That fucking bed.

  EMILY. I know.

  JAMES. Three months here and you still haven’t done anything about it. Screwed my back. (Throws himself on to her bed, prods around behind him.) It isn’t a bed. It’s a fucking portcullis. (Lies back, gingerly.)

  Still, better than nothing.

  Come here.

  He squints at her.

  You look gorgeous.

  She is wiping her make-up off with a small rag.

  Is that a swab?!

  EMILY. They’re perfect for taking make-up off.

  JAMES. Ingenious use of hospital resources.

  She walks over, looks down at him, but doesn’t get on the bed.

  You’re upside down.

  Please don’t spit on me.

  Pause.

  So tell me.

  EMILY. What?

  JAMES. Everything. Tell me about your day.

  EMILY. My mum’s been bending my ear again… family. And – caught a meningococcal septicaemia.

  JAMES. Good call. What happened?

  EMILY (moves away from him). Girl complaining of flu-like symptoms. The reg wasn’t having any of it because she’d been in two days before with a sore throat, he thought she was a Munch’s. He said what she needed was a ‘leather suppository’.

  JAMES. Oh, a boot up the arse.

  EMILY. Exactly. Well it wasn’t barn-door, she just had a headache, not photophobic, but then I had a look at her ankle and she’d got a little red spot that didn’t blanch when I pressed it… And the lab called back six hours later and said… they’d grown gram-negative diplococci from her blood cultures.

  JAMES. Fucking hell. You tell the reg?

  EMILY. Yeah.

  JAMES. And?

  EMILY.…I feel like shit.

  JAMES. Why? That’s great. Shows you’ve got great hunches.

  EMILY. No, I just see the worst all the time. (Comes slowly over to him.) I wish I hadn’t been right about that girl.

  JAMES. Why?

  EMILY. Because then I wouldn’t mind that I’d nearly sent her home without double-checking.

  JAMES. But you did double-check.

  EMILY. Because I’m an obsessive-compulsive. Did I check the notes. Did I check the bloods. It feels like there’s no space left in my head.

  It doesn’t help when I get proved right.

  JAMES. The best docs are OCD, you know that.

  EMILY (this is hard for her to say).…And I fucking missed something.

  JAMES. What?

  EMILY. This old guy. Handed on to me at the end of the afternoon, twenty minutes away from breaching, bed manager was whipping my arse to get him onto the ward, I kept getting bleeps telling me to hurry up, everyone was hassling me to hand him over. And just as I did, I saw his ECGs upside down in his notes, I thought ‘hang on’ but it was too late, they’d gone.

  They showed that he’d had a heart attack. He’d broken his hip and while he’d been stuck on the floor he’d had a heart attack.

  JAMES. Doesn’t make any difference. He’d already had the heart attack.

  EMILY. I’ve made my first mistake.

  JAMES. Look. You’re in A&E, you make the first, basic decision – take them in or send them away. Anything else and you’re wasting time. Say you get an aneurysm – they can pop off any minute to the great Sainsbury’s in the sky. Or say you have to lead an arrest –

  EMILY. Thanks for these merry little tales, but I haven’t had to yet.

  JAMES. But it’s only a matter of time. And when it happens, you’ll be the most inexperienced person there, but they’ll all be looking at you to tell them what to do, and everyone’ll see, straightaway, whether you’re any good or not. Then you’ll have to make quick decisions.

  EMILY. I know! But it’s… these bloody decisions all the time.

  I can feel them all still.

  JAMES. Feel them?

  Beat.

  EMILY. On my back…

  Do you think the job… makes us sick?

  Beat.

  JAMES. This bit’s the worst, Em. I drank a lot in my first A&E job. You last this, you’ll be okay.

  EMILY. One day, I really will fuck up.

  JAMES. No. Every day, you will fuck up. And if you don’t, the next person’ll fuck up for you. (Ironically.) ‘Teamwork.’ That’s what it’s all about.

  Beat.

  EMILY. Someone is going to die…

  JAMES. Everyone’s going to die…

  They kiss. Beat.

  EMILY. Is there someone else?

  Beat.

  JAMES. Where did that come from?

  Beat.

  EMILY. We’re all right?

  JAMES. Yes, we’re all right. Why?

  Why are you looking at me like that?

  EMILY. Why are you looking at me like that?

  JAMES. Like what?

  EMILY. Talk to me.

  JAMES (tenderly). I am talking to you… Now shut up. Jesus.

  He kisses her. Beat. JAMES sits up, starts to take her top off. Quietly, as if he is telling her a story:

  When you want to find out what’s going on… there are lots of things you can do…

  He illustrates as he undresses her.

  First of all you look at what’s in front of you…

  And then you listen… to what they say to you…

  And then you feel… the bit they say is hurting…

  He puts his hand to her shoulders.

  And see if you can feel anything…

  And you might listen to their chest… or to their heart… drum and bass…

  And if they’re a little kid… you ask them lots of questions.

  EMILY. Like what?

  JAMES. Like what their favourite food is… the name of their art teacher… because sometimes the answers to the questions are not important… it’s what they do while they’re thinking about them… They forget when they’re meant to say ouch… (Touches her.) and you find out where it really hurts…

  And there are lots and lots and lots of tests you can do…

  But never forget… to listen to your gut.

  He puts his hand on her stomach.

  EMILY (playing along). My stomach?

  JAMES. Yes. Because the gut’s all covered by these nerves… that are like… the wiring… left over from the old, primitive nervous system… from a long time ago, from before we had a brain… like in earthworms, and flies…

  …and it’s where you feel happy and where you feel sad.

  EMILY (drily). And what about listening to your brain?

  JAMES. Well, your brain can control a lot… like it can make my finger wiggle… (Wiggles one finger.) but it can’t control what you feel down here… Because there’s a different sort of brain down there… and all those primitive things you can’t control… like breathing… or feeling angry… or just feeling… it’s the gut brain that’s controlling them. And that’s why
you should listen to it. Because you can’t control it.

  They kiss.

  The Mess

  Night. JOHN sits in the mess, staring into space. He has a dressing on his neck. The lights are off. The room is lit only by the television, which is on mute. JOHN ignores it. He slowly starts to collect his belongings. He sits, rifling through his bag. BRIAN comes in, sees JOHN. Stops. Watches him but doesn’t say anything. JOHN, sensing something, turns around, sees BRIAN.

  JOHN. Hey.

  BRIAN. Hey. What are you sitting in the dark for?

  JOHN. Dunno. Well, bit of a day.

  He heaves a sigh. Hums for a second.

  Can’t get rid of it. (Hums again.) Had it on the brain all day.

  Beat.

  BRIAN. I chased your biopsy for you. It’s come back.

  JOHN. Already? My biopsy? No way!

  BRIAN. Yeah.

  JOHN (getting up). Shit, man! Thanks. How come –

  BRIAN. I knew you wouldn’t, so I did.

  JOHN. – Hope they didn’t give you a hard time, the lab?

  BRIAN. No no. They owe me, anyway. I just gave them a friendly prod. Spoke to Bob at the end of the MDT. Turned out Prof Kroll was dealing with it.

  JOHN. Well, no wonder. You know what he’s like. Fills you with a perfectly healthy, natural desire –

  BRIAN. – to kill him.

  They laugh. Beat. JOHN rubs his neck, involuntarily.

  JOHN. What’s the story?

  BRIAN. Well, really you need to talk to Prof Kroll. Not me.

  I just wanted to let you know that the results were back.

  JOHN. Why?

  Suddenly JOHN turns, switches on the lights. They flicker on. Both men blink in the sudden neon light. A pause.

  You’re doing it. You’re giving me that look.

  BRIAN. What look?

  JOHN. The look.

  Beat.

  My cells are ugly.

  BRIAN. John… I don’t want to be the one to talk you through it now. I just wanted to tell you that I chased the results and they’re back. You need to talk to them. Plus, you know that there are limits to what you can deduce from the biopsy. It’s difficult to say exactly… what it shows.

  JOHN. Oh, please, don’t talk to me like that.

  BRIAN. Like what.

  JOHN. Like I’m one of them.

  Beat.

  I dreamt about my cells. There were too many of them, purples and blues.

  Tell me what they looked like.

  BRIAN. I can’t tell you because I didn’t look at them.

  Beat.

  The histologists said that the cells didn’t look entirely… normal. No.

  Beat.

  JOHN. Okay… okay.

  Beat.

  BRIAN. Grade Two.

  JOHN. Thanks.

  Beat. He sits down.

  BRIAN. You don’t know –

  JOHN. So this thing in my neck, that’s been sitting there for three months, is a lymphoma. Yes. I do know that.

  What do you think I should do.

  BRIAN. Oh, Christ, John… You’re a doctor. You know you shouldn’t be asking me –

  JOHN. Yes; because this shouldn’t be happening to me!

  I spend my life watching other people get sick and die. And it’s a shit life.

  I’ve paid my dues, haven’t I?

  Beat.

  BRIAN. You know that this could be nothing.

  JOHN. But that’s not what I’m getting from you.

  Beat.

  I need you to tell me what to do. You’re the doctor now.

  Beat.

  BRIAN. Get it all cut out.

  JOHN. Get it all cut out.

  BRIAN. Yes.

  JOHN. And hope for the best.

  JOHN is still, staring ahead of him. Softly, he starts to hum – the same tune – again.

  Interval.

  ACT THREE

  A&E

  EMILY stands, on her own. She is reading, aloud, from the Oxford Medical Handbook.

  EMILY. ‘Is your pain sharp or dull? Sharp like a knife, or dull and crushing?’ Patients often avoid using the word “pain”… “wind”, “tightening”, “burning”, or “a lump in the throat” may be used… Symptoms are often half-formed, and it is our role to give them a local habitation and a name. Be as vague in your questioning as your patient is in his answers… A patient came to one of us saying “last night I dreamt I had a pain in my chest”…’

  She puts her hand on her chest.

  ‘…“ Now I’ve woken up, and I’m not so sure. Have I got a chest pain, doctor?”’

  Then, she goes to sit with an old lady, GILLIAN, who is sitting up on a bed. There is a tight, bloodstained bandage on her head. Her HUSBAND stands next to her.

  I’m sorry you had such a long wait… She’s definitely going to need stitches from what you’ve told me – it’s a long gash, is it?

  HUSBAND. Oh yes. Very long. (Gestures vaguely.) I couldn’t look at it. Flapping away from the… you can actually see her… the skull underneath…

  EMILY. Well… you have been in the wars…

  HUSBAND.…If she’s hurt, I’m hurt. It’s as simple as that.

  EMILY makes a note.

  EMILY. And she can usually verbalise normally… (Pats her arm.)Sorry to talk about you… I know you can…

  GILLIAN. – Yes, yes! –

  EMILY. I just have to ask.

  HUSBAND. Oh yes. Yes, absolutely.

  EMILY. But at the moment she can only say yes and no.

  GILLIAN. Yes.

  EMILY. Right. Well… I think I’m going to test your reflexes, Gillian, before we do anything else…

  She does so, knocking on her knees, shining a torch into her eyes. She scratches the soles of the old lady’s feet with a stick. GILLIAN, not expecting this, is slightly distressed.

  Sorry, we’re being mean to you, aren’t we.

  EMILY stops, carefully replaces, again, one of her slippers which has fallen off her foot.

  Okay. (Talking directly to GILLIAN.) Let’s just stick with yeses and nos for the moment, otherwise I think it’s going to be a bit traumatic for you.

  Do you feel sick, Gillian?

  GILLIAN. No.

  HUSBAND. She was sick once, just a little bit. In the ambulance.

  EMILY. Any blood in the vomit?

  HUSBAND. I don’t know. I didn’t really look.

  GILLIAN. No.

  EMILY. Okay.

  (To GILLIAN.) Do you feel dizzy?

  GILLIAN. No.

  EMILY. Right.

  Beat.

  Gillian. Is the main thing that’s worrying you your speech?

  GILLIAN (straining to find words). Yes. Yes. Yes. (She is upset.)

  EMILY. Okay, Gillian. (Puts her hand on her arm.) Well, don’t worry, because generally in cases like this, the speech is recovered, it just takes a little time.

  HUSBAND. What’s happened? Is it her heart?

  EMILY. No, it’s not her heart, I’m… pretty sure what’s happened is that Gillian has actually had a little stroke and that’s why she fell.

  HUSBAND. How do you know?

  EMILY. I don’t know, I just… I’m making a guess here, but I think as a result of this particular little stroke she’s got what we call ‘expressive dysphasia’, which is when you know what to say but you can’t say it, you can’t…

  – Sorry, I’m not being very clear. It’s… a little breakdown in communication within your own brain. Like a short circuit. (To GILLIAN.) But, the brain is very good at adapting, so the chances are, with any luck, you will recover your speech.

  GILLIAN. Yes.

  REBECCA has come up and hears what EMILY says next.

  EMILY. Now, what I’m going to do first, is refer you to a team. And then the team will take a scan so we know better what’s going on. Any questions?

  HUSBAND. No. Thank you very much, doctor.

  GILLIAN. Yes.

  HUSBAND. Just make my beautiful wife well again
.

  Beat.

  EMILY. Yes.

  GILLIAN is wheeled off by a nurse. EMILY moves straight to a phone. REBECCA watches her.

  REBECCA. Aren’t you going to get her a scan before you refer her? You’re doing it in the wrong order.

  EMILY. No, she’s about to breach and the nurses are going mental at me, I’m going to get her on a team first. – (In response to her look.) What?

  REBECCA. No, just, if you think you can get her accepted by the medics without a scan, good luck to you.

  EMILY. But she’s about to breach.

  REBECCA. Yeah, you’re welcome to go and get shouted at. But if you think it’ll work you’re a brave woman, is all I can say.

  EMILY (an edge to her voice). So I’ll refer her to the surgeons.

  REBECCA (with some derision). The surgeons won’t take her!

  EMILY. Why not?

  REBECCA. Because she’s had a stroke. She automatically goes to the medics.

  EMILY. But she needs to be stitched. Look, the medics need to deal with the stroke. The surgeons need to stitch her. One of the teams will take her, they’ve both got reason to.

  REBECCA. And that’s exactly why they won’t.

  EMILY picks up a phone, starts dialling.

  Fine, go ahead. Try your luck.

  EMILY. Thanks, I will.

  The Ward

  VASHTI stands by BINDU’s bedside. BINDU looks terrible. Her eyes are shut, her face is sweaty. Every now and again she twitches from one side to the other. VASHTI looks at her, feels her forehead. Goes to the end of the bed, looks at the obs – the chart of BINDU’s temperature, blood pressure, etc. She doesn’t like the look of them. Looks at BINDU again. A NURSE drifts by and VASHTI moves away to intercept her.

  VASHTI. Hi.

  The NURSE looks like she’s going to carry on going.

  Hello, nurse –

  NURSE. Sorry. Can I help you?

  VASHTI. Yes. Can you fill me in on what’s been happening to my aunt?

  NURSE. Your aunt?

  VASHTI (pointing). My aunt. Over there. Mrs Mehta.

  Beat.

  NURSE. Oh right, Mrs Mehta. What would you like to know, exactly?

  VASHTI. She’s not conscious, she’s sweaty, and if you ask me, she looks peritonitic. So what I want to know is, what’s going on? And when was the last time she was seen by a doctor?

  Beat.

  NURSE. Well, she had an operation a couple of days ago –

  VASHTI. On her gall bladder, I know. And?

  NURSE. I know she was in some pain, afterwards, and she was prescribed morphine by the doctor to help alleviate it.