Death Before Time

by Andrew Puckett

  “Better than I was, thankee, doctor,” she said in ripe Wiltshire. “Still hurts here, though.” She indicated the infected site. Her face was round and wrinkled, haloed with fluffy white hair, her eyes like a pair of blackcurrants.

  Armitage examined the wound site. “You’re feeling better because the antibiotic’s working,” he said. He felt her forehead. “Your temperature’s coming down – “ He knew this already from the chart, of course – “And so’s your pulse rate. The discomfort may last a little while, but you’re on the mend, Mrs Hobbs. Tell Sister if the pain goes on bothering you and she’ll give you something for it.”

  He patted her hand and they left the single room – most of the rooms in the hospital held six beds, but MRSA patients were nursed in isolation.

  They stopped outside. There were eight of them: Armitage, Singh, Edwina and Fraser; Helen St John, who was the senior sister, another sister and a couple of house officers. Fraser had to make an effort not to stare at Sister St John, for she was the woman he’d glimpsed crying in Ranjid Singh’s room.

  “That antibiotic’s taking its time,” said Tim Oakley, one of the housemen. “Should we add another?”

  “I don’t think so,” Edwina said. “The lab said the organism’s sensitive to Vancomycin and I think we - ”

  “Excuse me,” a soft voice behind them said – they were blocking the corridor and a young HCA with a loaded tea trolley was trying to get past.

  Armitage smiled at her and backed against the wall. When she’d rattled by, he turned to the houseman -

  “It may seem to be taking its time, Tim, but it’s clearing the infection.”

  Next was Edith Underwood, 83, and suffering from Multi Stroke Disease. Armitage spoke gently to her, but she was deeply unconscious. He briefly examined her, then ushered them out.

  “You’ve spoken to her family?” he asked Edwina.

  “Yes. They know she’s on diamorphine and Fluids Only, and they’re fully in agreement.” She hesitated. “She hasn’t spoken for a month and they know she’s not going to.”

  Fraser had no trouble in believing it; there had been a blankness about her face, a sense of something missing …

  Armitage nodded and they moved on. In another side room lay Stanley Oglevy, 79, with Lewy Body Dementia, a disease similar to Alzheimer’s, but more aggressive. He’d been admitted with a broken hip after falling out of bed. He’d been made comfortable and his daughter had agreed that it would not be in his best interest to treat any further condition that might arise.

  “I think he has pneumonia,” Edwina said quietly.

  Armitage sat by the bed. “Mr Oglevy?”

  There was no answer, so he carefully undid his pyjama jacket and listened to his chest, painfully thin, as it slowly rose and fell, rose and fell ...

  “I think you’re right,” he said, rebuttoning his pyjamas and replacing the bedclothes. He stood up and turned to the staff nurse. “Continue intravenous fluids and keep him comfortable.”

  “Do we treat the pneumonia?” Tim asked.

  “I don’t think so,” Edwina said.

  “I agree,” Armitage said.

  After the ward round was finished, Fraser went with Edwina back to her office. It was almost as spartan as Armitage’s.

  “We’ve got ten minutes before Referrals Clinic,” she said. “Perhaps you’d like to give me your thoughts on what you’ve seen so far.”

  “Well, I’m impressed.” Realising that more was required, he went on, “I like the way you all act as a team, I like the way Philip leads from the middle, and I especially like the way every patient is treated with respect – Mr and Mrs rather than false chumminess.”

  She smiled, then, “What about the decisions we made not to treat?”

  “I think in those two cases they were right.”

  “Good,” she said. “After all the bad publicity we’ve been having, I know some places have started treating cases like Mr Oglevy again. In his case, I think it would be cruel.”

  “I’m glad you have the courage of your convictions,” Fraser said.

  She smiled again and nodded as if to say: You’ll do.

  In the Referrals Clinic, as with the Out Patients’ Clinic later in the day, he thought she handled the patients briskly and competently. Her policy seemed to be to keep them out of hospital for as long as possible.

  “You’ve probably noticed yourself,” she said when they’d finished, “How some people seem to give up the moment they’re in hospital, especially older patients. It’s as though it’s a signal to them that their time’s up.”

  At six he walked back to his flat, which was in an uninspiring grey block about a hundred yards away. Even to call it a flat was euphemistic, he thought as he let himself in – it consisted of a single room with en suite loo and bath.

  He showered, then went back to the canteen for a meal – he didn’t feel up to taking on the shared kitchen yet. Then, back to his room, where he immersed himself in the book Armitage had lent him, studying especially Multi Stroke Disease and Lewy Body Dementia. Edwina was right, he thought – the prognosis was grim in both cases.

  By ten, he’d had enough and decided to visit the Doctors’ Bar. He had a bottle of whisky in his case, but thought the walk and fresh air might do him good.

  The east wind had teeth and he was glad of his coat – spring was late and the site was on a hill on the outskirts of the town. The Doctors’ Bar was in the main hospital and very quiet by the time he found it, just a couple of small groups of people talking in low voices. He had a pint by himself at the bar, then the deadness of the place got to him and he left.

  His flat was beside a playing field and across it, he could see a brightly lit entrance and caught a gust of laughter on the wind – the Social Club Bar.

  On a whim, he followed the dimly lit path that led round the perimeter of the playing field. A copse ran along the far side with a high wall behind it.

  There were perhaps a score of people in the bar, some playing darts, some chatting, two or three sitting on their own. Tobacco smoke layered the air. He bought a beer and joined the loners – by not joining them. He’d had a solitary nature since his youth, even more so since Frances had died.

  So why did he feel more comfortable in this smoky, grubby, noisy den than in the Doctors’ Bar, he asked himself? Were they more his kind of people? Maybe … or maybe it was because for all its vulgarity and soon to be banned smoke, it was somehow more authentic …

  He finished his pint and bought another. His mind went back to Frances. He’d been thinking about her after his talk with Edwina, how precious those last few months had been – in fact, he thought now, some of those days and evenings before she died had even held a kind of happiness … watching TV with her, reading, playing chess, just being with her …

  Life is precious, he thought - and yet only that day he’d agreed about allowing the two vegetative patients to die… But those decisions had been made with respect, a love of humanity …

  Maudlin. Time to go. He drained his glass and left. No one paid him any attention. This time, he walked slowly across the playing field, needing the aloneness and anonymity the black hole in the middle gave him.

  The sheer mass of the main hospital block reared in front of him, the non-pattern of the lighted windows making it look like a giant computer. Tears stung his cheeks before being whipped away by the wind. What the hell am I doing here, he wondered?

  *

  Time passed as he absorbed the unit’s routines. In the evenings he read in his room, sometimes went over to the Social Club. Weekends, he went back to Bristol.

  By and large, he got on well enough with Edwina, with only one blip.

  Patients with dementia were usually moved on to a nursing home as soon as their acute condition had been treated, but there were some borderline cases – like Mrs Chambers.

  Her dementia was partial, caused by cerebral atherosclerosis, but she’d clearly never be able to look after herself again
.

  Sometimes she could speak quite lucidly, more often not. Her only visitors were her care worker and a welfare officer. She had to wear a nappy and had no modesty about it whatsoever, lying on her bed with flaccid white legs and nappy on full display.

  She was always pressing her bell for attention and when the harassed HCA put it out of her reach, she would pester the other patients and their visitors in her reedy, penetrating voice until she got it back. Then she’d press it again.

  She was terminally pathetic, Fraser thought, helpless but unlovable.

  She got a chest infection and Edwina put her on ampicillin. The next day, Fraser was called by the staff nurse to look at her. He thought she had pneumonia and his inclination was to add another antibiotic, but perhaps he ought to check with Edwina first.

  She’d always told him she had an open door policy, so he tapped on her door and went in. She had company, a large, slightly florid man in a baggy tweed suit and a smartly dressed woman with short blonde hair.

  “What is it, Fraser?” she said abruptly.

  “Ah … Sorry to interrupt you Edwina – it’s Mrs Chambers in room three, I think her chest infection’s developed into full blown pneumonia.”

  “I’ll come and see her when I’ve finished here.”

  As he turned to go, the blonde woman said, “Aren’t you going to introduce us, Edwina?”

  Edwina did so – reluctantly, it seemed to Fraser.

  “This is our local MP, Patricia Matlock – “ She was thirty-five going on fifty, attractive with vivid blue eyes.

  “And this is George Woodvine, Chairman of the Trust – “ He was around sixty, with thick white hair, a tanned face and military moustache.

  “You’re a long way from home, Dr Callan,” the MP observed, appraising him as she did.

  “And also a very busy man,” Edwina said firmly before he could reply.

  She came looking for him fifteen minutes later and together they examined Mrs Chambers.

  “Should we add another antibiotic?” Fraser asked.

  “All right,” Edwina agreed, “Erythromycin. Oh, and Fraser,” she said as they walked away, “For future reference, if you find my door open, come in. If you don’t, don’t.”

  Mrs Chambers died that night.

  *

  He hadn’t made much effort to get to know any of his colleagues socially, so when a few days later, he saw Ranjid Singh sitting at a table in the canteen on his own, he went over to him.

  “Mind if I join you, Ranjid?”

  Ranjid looked up. “Sorry, but I’m expecting company,” he said. It was a small table, too small for three.

  “Sure,” said Fraser. He was moving away when Helen St John arrived.

  “Were you going to join us, Dr Callan?”

  “It’s all right, there isn’t really room.”

  “For goodness sake, we can move.”

  She took her tray to an adjacent table. Fraser followed. Ranjid joined them with evident ill grace.

  They began eating. She said, “How are you settling in, Dr Callan?”

  “It’s Fraser,” he said. “Well enough, I think – although maybe you ought to direct the question to Edwina.”

  “I’d have thought the confidence she’s displaying in you answered that.”

  “Thank you,” Fraser said with a cheesy grin.

  There was a silence while they ate. Aware of the awkwardness, he said, “Have you worked here long – er – Helen, isn’t it?”

  “Helen,” she agreed, a smile dimpling her cheeks. “Since the hospital was opened, about eighteen months ago. Before that, I was in London.”

  “D’you prefer it here?”

  She made a mouth. “In some ways. I don’t have a problem with London. You, I take it, are from Glasgow?”

  He grinned, genuinely this time. “Is it that obvious?”

  “It’s… distinctive,” she said. Her own accent was pure Home Counties and hockey.

  He glanced at Ranjid, who seemed to be concentrating his attention on his food. “How about you, Ranjid?” he asked.

  Ranjid looked up. “How about me – what?”

  “Have you worked here long?”

  “Since the hospital opened,” he replied, staring back without expression. “Before that, I worked at St James, which was formerly the hospital in Wansborough for older patients. Does that answer your question?”

  “It does, thank you.” And sod you too, Ranjid – or do I mean Rancid ?

  “Good,” said rancid Ranjid. “And you, Dr Callan, did you work for long in Glasgow, or did you perhaps have a problem with it?” He put down his knife and fork although his meal was barely half-finished. “Forgive me, I have work to do.” He got up and took his tray over to the stacker.

  Helen watched him with compressed lips; her eyes glittered and her face flushed as it had that time he’d seen her in his room. “Excuse me,” she said abruptly, getting up. She caught up with him, spoke to him angrily as she followed him out.

  “Weird,” Fraser muttered to himself… but none of his business.

  Chapter 3

  He got in the next morning to find that Frederick Allsop had died during the night. He’d been admitted the week before with a broken arm after a fall – he was 76 and had Parkinson’s Disease. He’d been made comfortable, but had got a chest infection and been put on ampicillin. What surprised Fraser was that the infection hadn’t responded to the antibiotic and had developed so quickly into pneumonia.

  *

  “Mind if I join you?”

  He looked up to see Helen St John.

  “No, of course not.”

  He was lunching alone in the canteen. She put down her tray and sat opposite him. She said awkwardly, “I wanted to apologise for yesterday.”

  “You don’t have anything to apologise for.” He carefully avoided putting any stress on the “you”.

  “Mm.” After a pause, she said, “I take it Philip hasn’t said anything to you about Ranjid?”

  He shook his head.

  “Then I suppose I’d better.” She paused, picked up her fork and picked at the food on her plate.

  She said, “Ranjid hasn’t had much luck in life recently. His wife left him and he was involved in a long, drawn out custody battle for the children. She won and took them back to India.”

  “I’m sorry,” Fraser said without expression.

  “It would help if you’d try and be patient with him.”

  Fraser nodded as he put down his knife and fork. “I’ll do that. Thanks for telling me.”

  She gave the slightest of shrugs. “Someone had to.”

  After a moment he said, “Can I get you a tea or coffee?”

  “That would be nice, but if you’ll wait till I’ve finished, we’ll go to the coffee lounge. More comfortable.”

  “OK.”

  He glanced covertly at her. She really was beautiful, he realised, not just attractive … it was the combination of her high cheekbones, widely spaced grey eyes and full, almost bee-stung lips. How old would she be? Mid thirties? A bit older than him, he thought, and at the pitch of her beauty – she looked up suddenly, smiling as she put her fork down, the smile instantly banishing the slight look of petulance to her mouth.

  They took their trays to the stacker. “Where is he now?” he asked as they went out.

  “Ranjid? At a meeting somewhere.” She led him to the lounge and found an armchair while he bought the coffee.

  “Thanks,” she said as he handed it to her.

  He sat beside her. “I couldn’t help noticing,” he said, fishing, “That he seemed a wee bit sensitive when I asked him how long he’d been here.”

  “Mm. It’s not-so-ancient history, part of the baggage we carry around.”

  “I’m listening.”

  “You don’t remember hearing anything about St James’ hospital a couple of years ago? It was a national scandal.”

  He shook his head.

  “It was the old workhouse – appro
priately. I say was, it’s still in existence – some imbecile’s trying to have it Grade II listed. Anyway, it was the worst type of Geriatric Hospital – ‘Out of Sight, Out of Conscience’ so far as the public were concerned. Then the aged parent of some TV celebrity died there – she’d gone in with a urinary tract infection and ended up more or less starving to death. The TV celeb, who probably hadn’t given dear old mum a thought in years, made a cause célèbre out of it.”

  “Exaggerated?”

  “Not entirely, no …”

  It really had been a terrible place, she told him, standards of hygiene non-existent, nursing not much better and food that had to be seen to be believed because the catering staff stole all the decent stuff …

  “Not that it made much difference, nobody bothered to feed them properly, so they all suffered from malnutrition.”

  Not knowing what to say, he grimaced.

  “They probably didn’t suffer as much as you’d think,” she said, “Since they were all dosed to the gills with diamorphine.”

  He said slowly, “I don’t know whether that makes it better or worse.”

  “To tell you the truth, neither do I.” She sighed. “Anyway, our TV celeb managed to blow it into a major scandal. I’m surprised you didn’t hear about it.”

  “I’d have still been in Scotland at the time.”

  She looked at him curiously. “You Scots aren’t kidding about being separate, are you?”

  He grinned at her as it occurred to him that he was in no great rush to get back. “What do you mean by major scandal?”

  “Oh, it was all over the national press and TV. There were demands for heads to roll – our local MP, Patricia Matlock, was a junior minister in the DOH, an ambitious junior minister. She’d been banging on about health standards, so it really was embarrassing for her.”

  “I’ve met her,” Fraser said.

  “Really?” She looked genuinely surprised and he explained how he’d seen her in Edwina’s room.

  “Well,” she continued. “She managed to retrieve the situation by forming a committee with some of the Trust managers to sort it out. Philip was headhunted and redesigned the new hospital. While it was being finished, he got a team together of people he knew or had worked with before – including me and Edwina – then the staff at St James were mostly sacked or moved away.”