Tiger Country

by Nina Raine

  VASHTI. And?

  NURSE. And it seems as though – the doctors think that she may be morphine sensitive, which is why she’s –

  VASHTI. No. This is not the picture of someone who is ‘morphine sensitive’.

  She goes to the bedside, picks up the drain which is snaking out from underneath the covers.

  Has she been seen today?

  NURSE. My shift has only just started so –

  VASHTI. Has she been seen today?

  NURSE. Yes. But I don’t know exactly when because –

  VASHTI. What was she like this morning? Was she like this? How long has this been going on for? Since the operation? Has she deteriorated?

  NURSE. I’m afraid I can’t tell you any of that. Not without looking at the notes.

  VASHTI. Why not?

  NURSE (her tone hardening). Because, as I said, my shift’s only just started. And I’ve had two days off.

  Beat.

  VASHTI. So is there someone who can tell me? (Before she has time to answer, referring to the drain.) Has anyone sent this off for bile?

  The NURSE looks blank.

  (As if to a five-year-old.) If the surgeons have made a hole in the wrong place then bile will be leaking out into her abdomen.

  Which would not be a good thing.

  Beat.

  NURSE. Would you like to speak to a doctor?

  VASHTI. Yes. I would.

  JAMES comes up. He is jovial.

  JAMES. Hey, Vashti! What are you doing here? You don’t have any patients on this ward.

  The NURSE takes the opportunity of this distraction to make her escape.

  VASHTI. I came to see my aunt.

  JAMES. Your aunt? I didn’t know you had a relly in.

  VASHTI. I know, not many people did. Mrs Mehta. (Gestures down at the bed, right next to them.)

  JAMES (digesting this, sobering up). Oh. Right.

  Beat.

  They just bleeped me and asked me to come up from A&E –

  VASHTI. Yes. It was me who asked them to bleep you.

  JAMES. Right.

  Beat.

  VASHTI. What’s going on? She looks like shit.

  Beat. A realisation.

  I can’t believe this is happening.

  JAMES. Yeah. Um, they think it might be that she’s morphine sensitive.

  VASHTI. Oh, for God’s sake, James. What is all this ‘morphine sensitive’ crap? – (Flicks through the chart on the end of the bed.) My aunt’s febrile, her blood pressure’s in her boots – this is not someone who’s sensitive to morphine. This is someone who is septic.

  JAMES. You don’t know that.

  VASHTI. What happened when Milward operated on her?

  Beat.

  Oh Jesus.

  JAMES. I don’t know, I wasn’t there.

  VASHTI. He’s made a hole, hasn’t he.

  JAMES. I don’t know. I started a week of shifts in A&E the day of her operation.

  Beat.

  VASHTI. James, please –

  JAMES. Vashti –

  VASHTI. I want to see the operating notes.

  JAMES.…Vashti, I can’t.

  VASHTI. Yes, you can. I work here, I’m your senior, I’m asking you to get me the notes.

  Beat.

  JAMES. I can’t get you the notes.

  VASHTI. Why not.

  JAMES. Because at this moment in time, you’re not a doctor.

  VASHTI. What am I then?

  JAMES. A relative.

  A&E: Doctors’ Station

  EMILY and MARK, mid-argument.

  MARK. Because it’s not a case for the surgeons. That’s why. She needs to be seen by the medics.

  EMILY. Mark, it’s seven o’clock, she came in at three-thirty, she’s got a massive laceration, at the very least she needs to be stitched up –

  MARK. So why don’t you stitch her then?

  EMILY. Because this is too big for me to stitch! It’s from here to here, it’s like she’s been scalped. I’ve never stitched anything that big before, I don’t know what stitches to use, and I’m nervous of taking the compression bandage off –

  MARK. You mean you haven’t even examined the lac yet, and you want me to stitch it up for you? (Laughs.) I don’t believe this.

  EMILY. I didn’t want her to start hosing blood everywhere.

  MARK. You saying you’re scared of blood?

  EMILY. I can’t do it, it’s too big for me to manage on my own, and she’s about to breach! This is your job! – Why have you got such a problem with me?

  MARK. Why do you think everything’s about you?

  EMILY. Let me get this straight. Are you or are you not going to help?

  MARK. I’m not going to take this as a referral.

  EMILY. Why not?

  MARK (getting up). Because I’ve got an appendicectomy to do and I want to do that instead. I don’t want to be stuck here stitching for hours and miss going to theatre. Do it and stop being such a baby. It’s just a flap of skin.

  EMILY. And real men go to theatre and do appendixes. Very impressive.

  MARK. You want to be a surgeon –stitch it.

  EMILY. Okay, I will. (Dials in a phone.) Thanks. Thanks, Mark, for being so delightful. Full marks, Mark. Sorry you’re on your period.

  MARK. Christ, you think everyone’s in love with you, don’t you?

  EMILY. What?

  MARK. Well, I’m not in love with you –

  EMILY. No, you’re in love with yourself, you wanker, I can’t believe you / just –

  MARK (going). Just because you’ve got a pair of tits, doesn’t mean you get whatever you want.

  Someone has picked up at the other end of EMILY’s phone so all she can do is glare at MARK as he goes.

  EMILY (containing herself with some effort). – Hi. Is that the medical CT2 on call?

  Yes, I’ve got a patient I’d like to refer to the medics. Seventy-five-year-old lady, suffered a bang to the head, large scalp laceration, severe expressive dysphasia, query haemorrhagic stroke.

  What?

  Sorry, but this is just stupid.

  REBECCA comes up, starts writing notes.

  (Presto.) Look. I’d love to get her a CT scan but by the time I’ve got her a CT scan she will have breached her wait time. Which is why I’m ringing you. If you won’t take her without a scan how on earth am I meant to – ?

  (Ironically.) Fine.

  No, thank you very much.

  No. I will talk to my consultant.

  She puts the phone down, turns on REBECCA.

  For fuck’s sake. The medics won’t take her, the surgeons won’t take her, we know what’s wrong with her, but the lady is sitting there, gradually losing blood and becoming unstable, while I go round in circles, all because one department won’t communicate with another.

  And all anyone will say is ‘no.’ Not ‘yes’: ‘No. No. No.’

  REBECCA. Expressive dysphasia. Welcome to A&E.

  The Ward

  LAKSHMI stands, looking at a file. VASHTI stands with her, keeping an eye out – this is illicit.

  LAKSHMI.…These notes are incomplete.

  VASHTI. Are you sure?

  LAKSHMI. Well, there’s nothing in here really.

  She peers at them again.

  VASHTI. I need to sit down.

  She puts her head in her hands.

  My hands… I’m tingling all over.

  LAKSHMI. Who wrote them? The reg would have written them, wouldn’t he?

  They both look at the notes again.

  Oh. That explains it.

  Yep.

  VASHTI. Milward.

  LAKSHMI. – Wrote them himself.

  Beat.

  Well, that’s pretty simple. You need to get hold of him.

  A&E

  EMILY and JAMES at the coffee point.

  JAMES. I bet you gave everyone exactly the same spiel. Didn’t you.

  EMILY. I can’t remember any more. My head hurts.

  JAMES.
Everyone spins. Buff, turf, bounce. It’s the first thing you learn in Casualty. How many different ways are there of telling the truth? Loads. Just know who you’re talking to, and sell them the case.

  EMILY. This job isn’t about giving a performance.

  JAMES. Yes, it is.

  EMILY. You could have stitched her.

  JAMES. I was busy.

  EMILY. Arsing about with Rebecca.

  JAMES. We weren’t arsing / about.

  EMILY. Bullshit, I heard her laugh down the phone.

  She’s got thick ankles, by the way. In case you hadn’t noticed. That’s why she always wears boots. (Flicks her hair.) ‘Oh, I’m Rebecca.’

  JAMES (his face is expressionless). That is not attractive.

  EMILY. I don’t care.

  It wouldn’t have made any difference what I said to Mark. He’s been a wanker to me ever since I said I was applying for surgical rotation here. And right now, you’re being a wanker too.

  JAMES. So you are going to apply?

  EMILY. Yes! I am going to apply!

  Beat.

  You don’t want me to either, do you. Because you don’t like us working in the same hospital.

  JAMES. Look, I haven’t got time for this. My shift finishes at nine. And your shift finishes at nine as well. Hand her over and get out of here.

  EMILY. Please. You’ve got half an hour left.

  JAMES. I’m meeting my consultant for a drink.

  Beat.

  EMILY. Your consultant? Tonight?

  JAMES. Yes. (Looking at her expression.) Oh for Christ’s sake, what is this?

  EMILY. I don’t know.

  How many different ways are there of telling the truth?

  JAMES. Oh, fuck this, Emily, I can’t believe you’re giving me grief when I haven’t seen you properly for weeks because you’re always staying late, sorting crap – well, this is me doing my job for a change, this is me doing my overtime, how does it feel? Do you think I want to go for a drink with him now? It’s what you have to do. That’s how the NHS is run. On – (Makes the inverted commas in the air.) ‘goodwill’.

  EMILY. Like our relationship.

  Beat.

  JAMES. Okay, why don’t you do this for me? Hand the woman on to the night team, and leave at nine o’clock, when you’re supposed to. With me.

  EMILY. I can’t.

  JAMES. You can, and I’m asking you to.

  Pause.

  EMILY. I can’t. I need to do this.

  JAMES. And when it comes down to you, that’s it. ‘No compromise.’

  EMILY. You’re not on my side any more.

  JAMES. And you’re not on mine.

  Beat.

  You don’t get it, do you?

  You can give and give and give. And this place will take and take and take. From the lazy shitty nurses to the administrative fuck-ups down to the contract cleaners that don’t clean. It’s a massive juggernaut riddled with vested interests and inertia and filth and it will fuck you in the arse. You don’t get paid more if you work more and you don’t get paid less if you work less so work less. Work less. Save yourself. You think you’re going to survive on the feel-good factor? This is the Soviet Union.There isn’t enough NHS. There isn’t enough me. I’ve missed weddings, parties, life events and so have you, I’ve given my pound of flesh without any regard for my own health and happiness, I’ve destroyed and suppressed what’s important to me, at least give me a career out of it. I won’t by staying late. I might by having a drink with my consultant.

  I’m out of here. I’m not doing any more unpaid work for the NHS than I have to already.

  He goes. She watches him go.

  The ORTHOPAEDIC REG walks hurriedly past.

  REG. Oh, you get to hate the noise of that printer. Means there’s another one coming.

  BRIAN (crossing in opposite direction). I’m clocking off. Night shift can deal with it.

  Gradually, EMILY is surrounded by the chaos of A&E as the night shift begins, some doctors packing up to leave, others arriving to start work.

  MARK (putting on his white coat). Don’t you hate it when it starts getting dark at four o’clock?

  REBECCA. Seen the one in seven? Yuck.

  REG. Should have seen his chest X-ray. It was like – (Blows raspberry.)

  BRIAN. What’s he got?

  JOHN. He’s got fat, that’s what he’s got. I needed three hands to do the ECG, two to get one boob out of the / way.

  BRIAN. You know someone’s just laid concrete down between resuss and theatre? It’s still wet. Quick, go and write your name in it and let’s hope we don’t get any emergencies in the next three hours.

  MARK (grimacing). Sister, there’s an awful smell in here. Is someone going to clean it up?

  JAMES (putting on coat, to leave). You do know him because you diagnosed him, mate.

  MARK (looking at notes). Oh! He’s not called Ernest at all. He’s called / Geoffrey.

  REBECCA (putting phone down with a crash). Our consultant does not think he’s perforated. From the other end of his telephone.

  MARK. So where do we put him? Clinical Decisions Unit?

  JAMES. Clinical Dumping Unit, yeah. I’m out of here.

  He leaves. The noise of the crash call rings out, drowning out everything else…

  And persists…

  A&E Resuss

  EMILY stands in A&E resuss. There are two empty A&E trolleys. She is nervous. MARK walks by, EMILY turns and walks into him. There is a moment of inadvertent embrace.

  MARK. Whoops! Hey! Sorry.

  Oh, it’s you.

  Then he looks at her properly, double-taking.

  Hey, are you okay? You look rough.

  EMILY. Thanks. Haven’t had much sleep.

  I’ve got a cardiac arrest coming. And I’ve got to lead it.

  MARK (looks at her a moment, gauging, then). – Oh, I see. First time.

  EMILY. Yeah. And it’s a twenty-four-year-old girl.

  MARK. Shit. Where’s the A&E reg?

  EMILY. In CT.

  MARK. Oh, the doughnut of death.

  EMILY. Yeah, with a polytrauma who’s in VF arrest and they’ve got no kit. Why do these things always happen in threes? Why aren’t there more of us?

  MARK. Because that’s the way it is.

  Beat. The next thing is difficult for him to say.

  Listen, I’m sorry.

  EMILY. What?

  MARK (embarrassed). The… old lady. Scalp lac. Yesterday.

  I don’t know why I said all that stuff. It just came out.

  EMILY.…Oh that…

  Feels like ages ago. I haven’t really been to bed.

  MARK. I don’t know why… I was being a prick. I’m sorry.

  EMILY. That’s okay. My boyfriend was exactly the same. It’s fine.

  I’ve got an arrest to lead. How long did they say again? Over the bat phone?

  MARK. Don’t know, I didn’t hear yours, I was listening for mine. Got a trauma call coming in…

  Who took your old lady in the end?

  EMILY. The medics. Got my consultant to ring up and kick ass.

  MARK. So who stitched her?

  EMILY. I don’t know and I don’t care, right now.

  Beat.

  I’m kind of… losing patience… with the patients… do you know what I mean?

  MARK. Let me at least buy you a drink or something.

  But EMILY is looking at the trolley again, nervously.

  EMILY. Can you think of anything I might need that we don’t have?

  MARK.…Got enough adrenalin? That always takes ages to find if you run out.

  EMILY. I’ve got loads.

  MARK. You’ll be fine.

  EMILY. But where is everyone? I’ve got no team.

  MARK is putting on a green plastic apron. More of his team are now turning up, also putting on green plastic aprons.

  MARK. Do you want me to put out another crash call?

  EMILY is trying to leaf th
rough ‘the cheese and onion’.

  EMILY. Fucking hands are shaking.

  The intercom from inside the ambulance, that is relayed to resuss, goes off. EMILY jumps.

  INTERCOM (scratchily). Cardiac arrest twenty-four-year-old female.

  …down time fifteen minutes.

  …CPR last ten minutes.

  …ETA two minutes.

  MARK. There’s your girl. Two minutes.

  EMILY. So where the hell’s –

  MARK stops a passing nurse.

  MARK (authoritatively). Excuse me. Could you put out another crash call? Cardiac arrest’s going to be here in two minutes, she still hasn’t got an anaesthetist.

  NURSE (moving swiftly off). Okay.

  REBECCA arrives. The girls are noticeably cool but professional with each other.

  REBECCA. Hi. Not here yet?

  EMILY. No. Two minutes.

  REBECCA. Right. You leading it?

  EMILY. Yes.

  REBECCA. Have we got everything?

  EMILY. Everything apart from a team, yes.

  A tense pause. They are at a loss. There is nothing they can do.

  The bells of the crash call ring out. The intercom goes off again.

  INTERCOM. Trauma.

  …Thirty-five-year-old man.

  …fallen fifteen feet off a building site onto rubble and glass…suspected multiple fractures.

  …Estimated time of arrival two minutes, two minutes.

  MARK. That’s mine. Two minutes as well. Here we go. So we’ve got a double whammy, they’re going to hit us at exactly the same time. (Brightly.) That’s nice. Fifteen feet. Fuck. Wonder what sort of state he’ll be in.

  You’ll be fine.

  EMILY. Thanks.

  MARK goes over to the rest of his team, who have now all drifted in, and are assembling around the furthest empty bed. JAMES is there. They are all doing up their green plastic aprons. Their REG addresses them, confidently.

  SURGICAL REG. All right, guys… hey, Mark… Missed you last night, where were you?

  MARK. Turning over a new leaf.

  REG. Not like you. (To JAMES, next to her.) Got the grey Venflons?

  JAMES. Yep. Got messy, did it?

  REG. Just a bit. Ended up at Po Na Na’s.

  JAMES (laughing). Nuff said.

  REG. I don’t remember getting home. All right, guys… Mark, you’re primary survey, James, you’re access, bloods, fluids and gas. Is there o-neg in the fridge?

  JAMES. Yeah, I checked.