Dirty Work

by Gabriel Weston

  And then doctors and nurses arrive in groups and the hospital begins to put on its face for the world, and I know that, however much I wish I could keep my vigil up all day, I can’t afford to be discovered here loitering. I go out through a different exit so I can see more of this place that is my home. I walk past the canteen where I always have my bacon butty after a night on call, and past Endoscopy. And near the room with the flower sign, which is not actually a florist’s but a place where you go if you are going to have a stoma and want a nurse to talk to you about it and comfort you. And past the long, wide corridor which leads to the gynae wards, my very own quarters. I pause there and look down the corridor, wishing that doing this would tell me something, before leaving the hospital to collect my bike and return to where I live.

  WEEK TWO

  Day breaks on a Saturday at my sister’s. I can’t remember the last time I even noticed the weekend. The house is still, the sky and sea are one darkness outside the window. Straight away I scan myself, my night-mind, and am relieved that I have had no bad dreams. No foetus dreams, baby dreams, Lady-Macbeth-style dreams.

  I sit up in bed and gather the pillows behind me, push others under my knees. Outside, the wild world is not declaring more than its simplest layers. Garden, wall and stones form a slab, and everything above this is sea and sky, though all I have to tell me which is which is the occasional stripe of wave brightness cutting across my sightline where I had imagined the horizon belonged. The morning is so thick that even Nab Tower, with its usual rounding blink, is invisible in the distance.

  When I wake in London, I look at wall. Here, every ten seconds, there is change. I close my eyes and count. I open them and see the discs of groyne posts peeping out from the sea. The next ten seconds bring a man with three dogs to the top of the beach. He bends to release them from their leads and all four take off, running down over the crest of the pebbles, out of view.

  Morning arrives with each second. The house creaks above me and I hear through the walls Julia and Mark talking as they move about their room. And I wish I had this. I come out from my cocoon and shuffle over to the window. Then I hear my sister rebuking her son. ‘Leave Nancy alone. Let her, at least, get some sleep.’

  When I push the window open minutely against the weight of the wind, the wet hits my face, and the blare of the sea, one solid sound, overwhelms all else; drowns out domesticity so that I am back out there at large, with everything that has gone awry, and a young woman whom I might have killed, who may in fact be dead by now. May have stopped breathing in any of these instants. Go tell Aunt Nancy, go tell Aunt Nancy, go tell Aunt Nancy the old grey goose is dead.

  I pull the window rubber-shut and, just like that, I am back in this home, a part of it. I know this because my sister, with a softer voice now, is saying, ‘Well all right then, I’ll make you a cup of tea to take in to her.’

  When the weekend is over, Julia drives me to the station. We don’t talk much. I look out of the window and consider whether it’s worth getting cross with her. I imagine a possible, righteous script. I thought I was coming to stay with you so I could rest. And then you send me scurrying around for two days doing all your errands. I listen to my sister whistling softly, and try to identify her tune, which wraps itself around me. I unwind the car window a fraction so that I can smell the air off the sea. I think of the loose clasp of weeds in my fingers as I pulled them from the vegetable beds. Picture the small pile of flints I cleared from the soil. Recall the gentle toil of reading bedtime stories to my sister’s children.

  By the time we reach the car park, I have forgotten my irritation. I am even happy to indulge my sister, to listen to what passes for her homily. Don’t squander the interview. Be confident, not tricksy. It’s going to be fine. That sort of thing. Her words don’t amount to much but I want to stay with her nevertheless, to keep in the orbit of her smell, to try and locate my mother in her eyes. My dear, sweet sister. And then, just like that, we’re not together any more. I don’t immediately find a seat on the train, but keep looking out of the window. I imagine Julia driving away, but only for as long as I can see her car on the wet road as my train cuts across it. This is the limit of my imagination; then I am back in my own thoughts again.

  I reach London with three hours to spare before the start of my second panel session. I know what I need to do. I get home as fast as I can and don’t even bother to unpack. I pull out the stepladder, then rummage around in the top cupboard where I keep all my medical books, and finally manage to locate my old psychiatry folder. I make tea and toast and set up camp on the floor. I search through tons of files and books. I had forgotten just how complicated taking a psychiatric history is, all the different sections of it, all the areas of enquiry necessary to make an assessment of the vulnerable mind. I reacquaint myself with the rubric so that I will know my way around the diagnostic template that is about to be applied to me. I lick butter from my fingers and read about the mental state examination, take note of the fact that the doctor assessing me will be performing one of these as he goes, looking for signs of agitation, too much or too little eye contact, a pathological posture, an abnormally flattened or elevated mood. It’s a minefield, but I hope it won’t be such a daunting one if only I can work out where to find the explosives.

  The problem is that all of this only helps me up to a certain point. The point at which I pack my books up and leave my flat behind. Because it is one thing to sit alone and make sense of what is about to happen, and quite another to hurtle towards this fate in the great outdoors. I don’t have long to wait, but by the time my bus comes I have already had a couple of layers of confidence jostled away from me. And it doesn’t matter that I find a seat right at the front so that I can enjoy the feeling of disappearing into trees as the bus pushes past low branches. After half an hour has gone by, I have been harried by the cacophony of so many others’ conversations, by such a multitude of smells, such a swarm of coats and elbows, that half my composure has abandoned me.

  When I step off the bus, near the hospital, and head towards the building in which the psychiatrist must already be waiting by now, I already feel I am under interrogation, under the cosh of my own neurotic mental enquiry, as if the official one I am about to face were not quite enough to contend with.

  How has it come to this? How could you have ended up in this state, Nancy? Questions beleaguer me. What kind of human being performs abortions for a living? What sort of woman are you? Why did you end up doing this job? Can such a thing happen by accident? What female, in her reproductive prime, would actually agree to do this? A ruthless one, surely. A brutal one, no doubt. Quite out of the blue I think of the girl at school whom no one wanted to be friends with any more. I remember her crying in the loo next to mine and how I crept away from her lest I became infected by her lack of popularity. I remember pushing my sister over in the mud in our backyard in America. I also remember the sound of a patient’s tears.

  Michael Hanforth was the golden boy of general surgery. We all knew him. There wasn’t a single one of us who didn’t, from medical student to top-dog consultant. And we all wanted a piece of him. This young buck walked so fast along the corridors that his bosses had to break into a trot to keep up with him on a ward round. Everyone wanted to sleep with him. All the nurses and physios and medical students. All of us. I wish I could say that I was different but I was mad about him just like everyone else, desperate to be in his tutorial group, to have the benefit of his study-notes, to own even a shadowy piece of the Hanforth magic.

  I never was one of his students, though. Which was why I felt as if all my ships had come in when, one day, I was suddenly asked if I could go down to help out in a particularly busy general surgery clinic, a clinic being presided over by Mr Hanforth.

  I had no foolish ambitions. I was thrilled just to be helping on the sidelines and didn’t imagine there would be any occasion to talk to or impress my surgical hero face to face. I worked hard all afternoon, taking blood, remo
ving stitches, looking for X-rays. Then, towards the end of the afternoon, one of the nurses asked me to see a lady who was waiting in the treatment room to have her sutures taken out following an operation she’d had the week before.

  I don’t remember what surgery this middle-aged lady had undergone. She was lying behind a green curtain and as soon as I came into the room she hitched up her sweatshirt to reveal her abdomen. I guessed it might have been emergency surgery for an infection of some kind because what held this woman together was not the neat row of metal staples I was used to seeing, but something that looked like a plastic shoelace, criss-crossing her middle.

  This green binding, the calibre of a drinking straw, had been fed through the open edges of the wound running from her chest to pubis about as many times as a shoelace would pass through the eyelets of a Converse baseball boot. But the thick stitch didn’t sit loosely there. The skin of the patient’s abdomen had healed enough to clasp each part of the tether in place, growing snugly around the plastic and hugging it. And the whole area was red with the effort of healing, with the hectic activity of inflammatory mediators rushing to the site of recent injury.

  She didn’t flinch as I approached her, gloves on. I was pleased I looked so authentic. But as soon as I gave one end of the plastic suture a tug with a pair of surgical clips her hands fell reflexively on to mine to stop my efforts, which she clearly found uncomfortable. Gingerly, I tried another twitch before excusing myself to find whichever registrar was in clinic that day. I regretted having to disturb whoever this might be. The usual unfair pile of notes was stacked up outside their room, representing all the patients they still had to see, their own quota plus any extras the consultant could justify palming off as beneficial to their training.

  When I knocked on the door a man answered, ‘Come in,’ and I recognised Mr Hanforth’s voice. I put my head round the door, and he beckoned me in, saying, ‘Have a seat. I’m just finishing my dictation.’ His manner was level, and I admired this, the democracy of his approach. I had already become so used, as a medical student, to being treated like the scum of the earth.

  The letter he spoke into his Dictaphone came in clean short phrases. He did not need to flick the machine on and off or rewind. And then Mr Hanforth placed the machine lightly on his desk and put the patient notes he had been looking at in a trolley beside him. He allowed himself one backward stretch, arms behind his head, sunbathing style, before settling forward again and asking, ‘What can I do for you?’

  I told him who I was and what I was struggling with. He got up, ushering me out of the room before him as I finished my explanation, which I tried to make as practical and short as I could, wanting to please him, not unaffected by his straight-backed masculinity.

  On entering the cubicle where I had left my patient, Mr Hanforth asked the lady, who was lying just as I had left her, for some details about her operation. She seemed more nervous than before, responding perhaps to his palpable seniority. Yet although she spoke to him she looked at me, seeking encouragement from my comparatively more familiar face. I knew it was mean of me, but I slightly resented this. I was nearly a doctor now, and wanted her to see me as his ally rather than hers.

  Without waiting for her to finish speaking, Mr Hanforth picked up the metal clips from the steel table where I had discarded them. He rolled backwards and forwards on his heels. He inspected the clips minutely and this surprised me because it struck me as rude, the scrutiny of his eyes combined with the nonchalance of his heels. I think his attitude made our patient apprehensive, for she fixed her gaze on me, causing me to look at my feet.

  But then I did look up because abruptly the lady stopped talking and I heard her gasp. The sound made me feel bad before I even knew what had happened. Then I saw that my senior colleague had roughly pulled the first loop of the stitch from the patient’s abdomen, transforming her face from placid to tearful in an instant. I wondered at how active the nasolacrimal gland could be to produce tears so briskly. I had always witnessed this process as being preceded by a slow welling.

  I looked back and forth between Mr Hanforth and the supine woman, the only way, without insubordination, that I could draw his attention to the distress he must surely have noticed he was causing. I saw the clips, bloodied at their jaws, moving straight to the second coil of suture. But on he went. And on.

  With every length of stitch that he pulled out I caught my breath, and with each of his emphatic arm movements, a new personal feature of my patient leapt out at me. Tug: pink lipstick, applied for the doctor’s eyes. Yank: necklace and matching bracelet, both in fine gold braid. Pull: the heels of practical shoes, worn down on one side. I dared not look at the face of the man beside me, knowing I would find it as smooth as ever, sure now that he was ignoring the woman lying beneath him, her eyes turned to him in supplication. She was sobbing and her abdomen joined in the protest with a good show of blood. My cowardly toes were curling inside my shoes, although the rest of me did nothing.

  Removing the whole thick line of plastic did not take long. When he was finished, Mr Hanforth grabbed some swabs and blotted them over the bleeding, sob-trembling woman and nodded to me as if to say, you can take it from here, at least? Surely? And he was off.

  I cross the road and make for one of the side doors into the hospital. My entrance is almost blocked by square metal bins on huge wheels. Litter tumbles on to the asphalt from their teeming summits. A greying man in a tabard spikes bits of rubbish and puts them back in the containers, pressing the bulk of the garbage down to make room for what he is adding. I walk past quickly.

  I am almost sorry to discover that the seminar-room door is open and that I am not going to be kept waiting this week. All the reading and preparation I did at home has come to nothing pitted against this one short trip to the hospital. I feel guilty and exhausted. I have to remind myself of Julia, whom I left only a few hours previously, of her love and her exhortation for me to keep calm. For me to be positive and not act as my own executioner.

  Taking a deep breath, I hold my head high and walk into the room. I attempt to comfort myself with the thought that I am about to be confronted with a bog-standard psychiatrist, not some mystical soothsayer, but this lame attempt at bravura doesn’t help. I resolve on calm but the truth is that there are all sorts of details which disconcert me. Not only that I didn’t have a chance to collect myself in the waiting room, but other things. The chair I sat on before has been removed from the middle of the room and put against one of the walls. My new judge has drawn two seats slightly aside from the table and angled them towards each other. The window is open on a sky amok with clouds, and even the sound of midday traffic, rising up from the street where I was walking just a few moments earlier, sounds like a racket to me now.

  Dr Gilchrist comes forward and shakes my hand. He is lanky and quite old, but there is such steadiness in him. For a moment, I think I could feel strong again too, simply by being near him. This happens just before he pulls the rug from under my feet with his news. There is no change in my patient’s condition: she is still unconscious and on assisted ventilation. By no means out of danger. I’m sure this was not meant as a weapon, this bald report, but I can hardly manage it. We are both standing, but he gestures to me to sit down, and I am glad to sink on to the chair. I can’t mask my disappointment. My fate feels so linked to that of my patient. I’m not sure what the point of my defending myself will be if she dies. And I know that the longer she spends in intensive care, the less likely she is ever to recover.

  Maybe it is because I am thinking so intently of the woman I have harmed that I get off on the wrong foot with Dr Gilchrist. I can’t really remember the first few minutes of our conversation. Perhaps he asks me about my last week, about how I’ve been feeling. That sounds more or less right. Whatever has passed, I can’t regain the lost ground. I would like to ask if we can begin again, but I know there’s no point.

  Everything I say to the psychiatrist, everything I fail to cope with i
n each second that elapses is more evidence against me. I’m sure he doesn’t miss a trick. I try and gird myself. I can’t afford to take my eye off the ball. I have to watch my manner at all times, give careful attention to the very modulation of my words, look my interrogator in the eye a reasonable amount: all of that. It’s not easy, though. There’s something about this man which provokes me, his sepia clothes, his wiry ankles, his bald determination to categorise me. The Diagnostic and Statistical Manual of Mental Disorders pokes from his hemp bag. I start listening intently and, suddenly, the psychiatrist’s voice seems very loud.

  ‘… if you had any doubts about whether you’d be able to handle it?’

  ‘Sorry?’

  ‘I’ll repeat. Were you worried you wouldn’t be able to handle it? I say, is my Scottish accent too much for you?’

  ‘No, of course not. Handle what?’

  ‘Medical school. Did you have any doubts—’

  ‘No.’

  Have I caught his meaning? The nerve of him, I think. If anyone has been too lame to rise to the challenges of hospital medicine, it isn’t me. His papers are square on the desk in front of him and I can see neat handwriting at the top of the uppermost page. I don’t remember him putting pen to paper. I wonder if he’ll add to this report right now, or wait for me to leave the room before letting officious thoughts flow from his nib.

  In place of the grey one in front of me, I imagine Julia’s face. I try to soften my tone. ‘Well, actually, I’m not sure what you mean.’

  ‘In my life,’ he pauses to clear his throat, ‘I sometimes have an instinct that I should avoid something. I don’t know, swimming in a rough sea, riding on the back of a motorbike, that kind of thing. When I ignore these instincts, it is usually at my peril.’