‘He’s got oesophageal varices,’ said Beth. ‘Like varicose veins, but in the oesophagus.’
Victoria looked none the wiser. ‘His wife has gone to the bathroom and will be back in a minute,’ she said. ‘Shall I make out a name card for the wall?’
‘No, it’s all right, I’ll do it.’
‘How does oesophageal varices happen, then?’ Victoria was almost irritated that Beth seemed to know what it was without having to dash to the office and ask Sister Crawford, as she would have done. And it was also annoying that Beth seemed to look upon her as someone who was there to assist, not as her equal.
‘It’s most common in alcoholics.’ Beth whispered so that Mr O’Leary couldn’t hear her.
‘He doesn’t look like an alcoholic,’ said Victoria. ‘They’re usually screaming for a drink. Mr O’Leary looks too pale and sick to scream for anything.’ His complexion was deathly white and when she’d touched his arm, it had felt unnaturally cold.
Beth put down the notes on the locker. ‘I think he’s already had a skinful today. He’s very merry for a man who’s been vomiting blood and has just been hospitalized. I’ll do his obs and his charts. Could you fetch a urine bottle, please?’
Victoria felt another flash of irritation. ‘Beth...’ she began.
But Beth cut her off. ‘Well, would you look at that. Here comes Nurse Moran.’
They both turned as she came into view, pushing a perfectly normal drip stand. The stands were heavy; their ornate, cast-iron bases were moulded with filigree leaf patterns travelling down the four legs, and though they were on castors, it took two hands to push them. The cream paint was chipped in places, revealing rusting iron beneath.
Victoria breathed slowly and deeply. She was about to say to Beth that, actually, she would do the observations and Beth could fetch the urine bottle.
‘God, you would not believe it. The porter made me wait for ever for this stand,’ Bridget Moran said as she approached the bed.
‘Did he now?’ said Victoria. ‘Made you “take-a-long-stand”, did he?’ She pronounced the words very slowly and carefully and both she and Beth watched as the penny dropped.
‘Was that another joke?’ Nurse Moran demanded.
‘It really was, I’m afraid, you poor love. I wouldn’t worry, though. You can’t expect to complete your probationary months without being totally done over at least half a dozen times,’ said Victoria. ‘Now, can you fetch Mr O’Leary a urine bottle, please?’
Nurse Moran abandoned her stand with a scowl and headed for the kitchen in the nearest thing to a strop she could manage. As she passed the dayroom doors, she let out a scream.
Seconds later, Beth and Victoria were at her side. They were met by the sight of Mr Trimble laid out flat on the dayroom floor. His face was blue and a horrible gurgling sound came from his mouth and then suddenly stopped. His cigarette lay burning into the wooden floor at his side and his wife stood nearby, frozen in shock.
Beth dropped to her knees and took his pulse. She shook her head. ‘Nothing there. Mr Trimble! Mr Trimble!’ she yelled as she rolled him over on to his front and turned his head to the side.
‘Here, let me help,’ said Victoria. ‘Go and fetch Sister,’ she said sharply to Nurse Moran, ‘and take Mrs Trimble out of here to the visitors’ seats outside.’
She led the stupefied Mrs Trimble to the door and placed the probationer’s arm around her. ‘Just give us five minutes with him, please, Mrs Trimble,’ she said.
Turning her attention back to Beth and Mr Trimble, she fell to her knees on the floor as she pulled one of Mr Trimble’s arms up and tried to tuck it under his chest. ‘His lips are cyanosed,’ she said. ‘His whole face is becoming cyanosed.’
They both tried again and managed to slide Mr Trimble’s hands underneath to elevate him slightly. Beth began to push down on his back, as they’d been taught by Sister Ryan in the school.
Victoria’s heart was beating wildly. They had all been taught how to deal with a patient who collapsed, but being taught in the school was one thing, having to deal with the situation in real life was quite another. Whenever something like that happened to one of the nurses at Lovely Lane, they would all sit around at supper wanting to know every little detail, glad it hadn’t been on their shift. But now Victoria was in the middle of it. She swallowed hard. Pull yourself together, she thought as she secured Mr Trimble’s hands. Her heart continued to beat like a runaway train, pounding against her chest wall.
They both heard the sound of rapid footsteps as Sister Crawford appeared at their sides.
‘Well done, Nurse, that is the correct position. Continue depressing his back at five depressions per minute. And you, you stupid girl,’ she said, addressing Nurse Moran, ‘you have tried my patience to the end today.’
Nurse Moran was standing behind Sister Crawford with her mouth open and her eyes fixed on Beth and Victoria.
‘I have already called for the doctors and the oxygen,’ said Sister. ‘Keep on doing what you are doing and stay calm. You, girl,’ she said to the terrified Nurse Moran, ‘help Mrs Hutch to make up a tea trolley and take it around the ward. Don’t let any of the patients into the dayroom, close the ward doors and fob them off with a story. Say it’s being cleaned. Is there any way you can manage that without getting something wrong? Tell Mr O’Leary and his wife that we will be with him in two minutes.’
The probationer looked as though she was about to burst into tears. ‘Yes, Sister,’ she whispered and made her way to the kitchen.
The thought crossed Victoria’s mind that Nurse Moran would simply not be able to remember so many instructions at once.
Within seconds they could hear the rattle of cups and saucers being laid on the drinks trolley and the murmur of voices as Betty Hutch asked Nurse Moran what was going on.
The sound of boots pounding up the stairs at speed intensified the atmosphere and the dayroom doors burst open to reveal the casualty doctors with Jake running behind them and wheeling a cylinder of oxygen into the room.
‘God, can you not manage without me? I only left five minutes ago,’ said Jake as he swung the oxygen bottle round on its wheels and connected the rubber tubing to the outlet valve.
The fact that the doctors were running brought home to Victoria and Beth the seriousness of the situation. Sister Crawford would as good as shoot any nurse if she caught them running anywhere, even in an emergency. Mr Trimble’s face was purple. His body was a dead weight. It felt to Victoria as though all hell had broken loose. She jumped to her feet as Dr Mackintosh took her place at Mr Trimble’s side.
‘Good work, Nurse,’ he said to Beth as he took out his stethoscope. ‘Keep depressing.’
Again, Victoria was irritated by this. They had both been attending to Mr Trimble and yet no one thought to say ‘Good work’ to her. Just because Beth always assumed responsibility didn’t mean that Victoria, or anyone else for that matter, was less capable.
The second doctor had brought up a brown canvas bag from casualty. It looked similar to the ones used in field hospitals during the war. He crouched on the floor, undid the leather straps and took out a large wooden box. ‘Does he have a blood pressure?’ he asked as he unwound the rubber cuff.
‘I doubt if he does any more,’ said Dr Mackintosh. ‘But here, I’m going to try something.’
To everyone’s amazement, he grabbed Mr Trimble’s hands and pulled them out from under his chest.
Beth slipped to the side and everyone stared at Dr Mackintosh in amazement.
‘There’s this fellow in America, he’s been trying this new method and I’m going to give it a go. We have nothing to lose here.’
There was a sharp intake of breath from Sister and the nurses as, with little ceremony or dignity, Dr Mackintosh flipped Mr Trimble over on to his back. Lifting his fist high in the air, he let it come down with a bang on Mr Trimble’s sternum and then, lifting the patient’s chin, he opened the airway and breathed hard into his lungs.
/> ‘Gosh, his chest rose,’ said the junior doctor.
‘Aye,’ said Dr Mackintosh. ‘It’s supposed to. Do you think you could push down from the front, Nurse Harper, just like you were doing from the back, while I respirate him? While I do that, Doctor, could you please quickly draw up some Coramine. With a bit of luck, if we keep depressing and respirating, we might get some flow through and the Coramine may have half a chance.’
Beth’s eyes were wide with alarm.
‘You too, Nurse Baker,’ he said to Victoria. ‘It is extremely hard work.’
Beth didn’t respond. She just stared at Dr Mackintosh. It was as though she was in shock.
In a flash, Victoria rushed round to the side of Mr Trimble and fell to her knees. ‘Like this?’ she asked as she pushed down on his sternum.
‘Exactly, Nurse. Sister Crawford, can you hold the oxygen mask here, please.’ He indicated Mr Trimble’s mouth. ‘Doctor, can you keep trying for a pulse or a blood pressure once you have the Coramine ready to inject.’
It felt to Victoria like she had been pressing up and down on Mr Trimble’s sternum for ever. Her arms were weakening, the force of her depressions lessening each time, and she could see that Dr Mackintosh had gone puce in the face.
Suddenly, the junior doctor shouted out, ‘We have a pulse, by Jove! We have a pulse.’
‘Sister, turn up that oxygen to the maximum the outlet valve will allow, please,’ said Dr Mackintosh. His face was flushed, his eyes alight. He had just tried something no one at St Angelus had ever done before. And it had worked.
The sudden hiss of the oxygen as it moved from a gentle flow to a loud rush filled the room as all eyes fixed on Mr Trimble. Much to Victoria’s amazement, he took a large and loud breath.
‘We have a blood pressure,’ said the junior doctor, who was almost lying on the floor, having managed to secure his cuff round Mr Trimble’s arm and pump up his sphygmomanometer.
‘Well done, everyone,’ said Dr Mackintosh. ‘If Jake is still here, perhaps he could help us get Mr Trimble back into a bed? He will need specialling, Sister. A drip, the usual. He’ll need more Coramine.’
Sister Crawford, who was holding the oxygen mask over Mr Trimble’s face, said, ‘Nurse Baker, you wouldn’t mind moving that burning cigarette from the floor, would you? I fear we may all be about to get blown up.’
A visitor had slipped past Betty Hutch and Nurse Moran on the ward. Opening the dayroom door and appearing not to notice Mr Trimble, she said, ‘Nurse, could my old man have a bottle, please? He’s desperate, he is.’
As Victoria got to her feet to remove the cigarette, the office phone began ringing and the porter’s lads arrived outside with the linen delivery.
Within minutes, a very sick-looking Mr Trimble was back in his bed with a drip in place.
*
Dr Mackintosh sat in front of the fireplace in Sister Crawford’s office and wrote up his notes. ‘I’ve put some morphine in Mr Trimble’s drip, Sister. I am going to prescribe him a sleeping sedative too. Six weeks’ full bed rest. Keep his bowels regular. No stress, and small, frequent meals rather than three large ones. Oxygen every time he looks as though his lips are cyanosed or he is having trouble breathing. All this will be confirmed in the morning by the cardiac team, I’m sure.’
‘Very well, Doctor. It looks as though Mr Trimble is never going to go home at this rate. He has gone from being a TB patient to a cardiac patient with no effort whatsoever.’
‘Well, Sister, that’s not so unusual. However, I am delighted with our results. As soon as I’ve finished these notes, I’m going back to my room to write a letter to my friend at the Johns Hopkins University in America telling him about our results in using cardiac compression combined with artificial resuscitation. He is leading the field in this research.’ He paused and smiled. ‘Today was a great day. Not only has Mr Trimble benefited from my friend’s research, but this experience will help to inform the whole programme. They are way ahead on this in America.’
He sounded so enthused that even Sister Crawford managed a smile. Dr Mackintosh was such an earnest young man. ‘We are lucky to have doctors like you here in Liverpool,’ she said. ‘So many of the bright ones want to go to London and yet all the experience in the world is here in Liverpool. We have it all: poverty, smog and every disease known to man.’
‘Well, Glasgow would see you there, Sister, but you are right, it is a very exciting city.’
Mrs Hutch, without being asked, shuffled into the office and placed a cup of tea in front of Dr Mackintosh. ‘Tea, three sugars, Doctor. Good job,’ she said, and shuffled back out.
For a moment, as they watched her retreating back, laughter threatened to fill the office.
Sister Crawford took the notes from Dr Mackintosh. ‘Drink your tea, specially made by your secret admirer. Still no sign of a Mrs Mackintosh on the horizon then?’
Dr Mackintosh blushed. ‘Not at all, Sister. What is the point? What woman would understand my job or my hours? And besides, we doctors have a terrible reputation for playing fast and loose with the hearts of young ladies, you know, even though I am not of that nature myself. What self-respecting young woman would trust any doctor?’
‘Nonsense, you aren’t all Casanovas. Some might say that you work the hours you do precisely because there is no Mrs Mackintosh to stop you,’ said Sister, probing in her motherly way.
She waited for a reply. There was none. A moment’s silence fell when she and Dr Mackintosh locked eyes. Both looked out towards the ward. Both sensed that something was wrong. Both moved as if in slow motion towards the door as the air was pierced by a chilling scream, which Sister recognized as coming from Nurse Moran.
‘So help me God, I am going to string that girl up by her boot straps,’ snapped Sister as she flung open the office door and strode out towards the sound of the scream with Dr Mackintosh at her heels.
They stopped dead in their tracks. The sight that greeted them would have made anyone scream, and besides, it hadn’t actually been the probationer nurse who’d screamed but the newly widowed Mrs O’Leary. While all the commotion had been going on with Mr Trimble, Mrs O’Leary had slipped across to the bedside of her husband, removed the bottle of gin from her handbag and given Mr O’Leary a sip or two, or probably much more. They were each one as big an alcoholic as the other, but only one of them suffered from oesophageal varices. And only one of them had just died as a result.
While Dr Mackintosh had been talking to Sister, Beth and Victoria were in the linen room. They were loading the shelves with the clean sheets the porter’s lads had delivered in the middle of Mr Trimble’s collapse.
‘What happened to you, why didn’t you want to do the chest depressions?’ asked Victoria.
Beth frowned as she clutched the clean sheets to her own chest, as though to protect herself from Victoria’s questions. ‘I know it sounds odd, but it was because it wasn’t what we’d been taught. I didn’t think it was proper. I didn’t know how to do the chest depressions, but well done to you, Victoria, because you just got on with it. I am cross with myself. I panicked. Froze.’
At the sound of the scream, they both left the linen room and risked being told off for running.
Beth placed her hand across her mouth at the sight that greeted them. It was truly horrifying. Blood ran down the wall, dripped from the bedside locker and puddled on the floor. It dripped from Mrs O’Leary’s hat, and her hair and hands and arms were covered. Her dress was soaked and was slowly turning from bright red to brown.
Mr O’Leary was as white as the pillow he lay against. Blood pooled in the dip of his chest and his counterpane was a now a blanket of blood.
It had all happened so quickly. The patient in the next bed had been talking to his visitors. They were reading the newspaper and had failed to notice. The visitors’ chatter and general cacophony that usually filled the ward between seven and eight in the evening had ceased as suddenly as if they had been halted with a conductor’s bato
n.
No one spoke as the ward staff took in the sight before them.
‘Jesus wept,’ whispered Dr Mackintosh.
The scream came again, followed by pitiful sobbing from Mr O’Leary’s wife. ‘I only gave him a little sip,’ she cried.
The footsteps of the junior doctor returning up the stairs in response to Beth having chased after him filled the ward. The clock ticked. A visitor coughed. The more delicate ladies sniffed into their handkerchiefs.
‘His varices must have ruptured,’ said Dr Mackintosh as he walked over to the bed and took Mr O’Leary’s pulse.
‘Clear the ward of all visitors,’ snapped Sister Crawford to Nurse Moran, adding, ‘There’s a good girl,’ in a gentler tone.
‘It would have been over in ten seconds.’ Dr Mackintosh turned to Mrs O’Leary and spoke to her gently. His Edinburgh burr, soft, reassuring and authoritative, worked its own magic at moments like this. ‘He would have thought he was having a bit of a cough, that’s all. Instead, it was a fatal haemorrhage as the varices ruptured. He wouldn’t have known a thing. I am so sorry, Mrs O’Leary.’
Beth led a sobbing Mrs O’Leary away as Victoria, paddling in rapidly congealing blood, drew the screens around the bed. Nurse Moran rang the brass hand-bell instructing the visitors to leave. There was not a single murmur of protest.
*
An hour later, Beth and Victoria met in the ward kitchen. The death had happened on their watch and so it was their responsibility to carry out last offices. Victoria had volunteered to do it while Beth special-nursed Mr Trimble. Matron had sent two additional nurses from other wards to plough on with backs, beds and obs.
‘Sister said Nurse Moran helped you with last offices,’ said Beth.
‘She did, poor kid. She almost fainted twice. For once, I actually felt sorry for her. If anything was going to make her grow up a bit, tonight should have done it.’
‘It was the suddenness of it,’ said Beth. ‘One minute he was chatting away, the next, gone. Over in a flash. Dr Mackintosh said some people just ignore the fact that they are coughing up blood and die at home. It’s always the heavy drinkers, he said. Apparently, the post-mortems always show extensive cirrhosis of the liver as a pre-disposing factor.’
The Children of Lovely Lane Page 32
