She spoke only to her reflection in the bathroom mirror. What are you waiting for, Claire? For Barclay to commit some act so he can at last be locked up? She shrugged She didn’t have the answer, only a statement of fact. Well, he isn’t here now and Grant is not coming back. Not ever.
Well …
She slammed each bedroom door hard, hearing only the hollow sound echo round and around the house. She needed to fill the silence with something. Luckily she had a radio in her bedroom. She switched it on, tuned it to Radio 4 and listened to the bedtime story.
You can get through this, Claire, she whispered to herself, climbing into a bed which felt cold, too big and too full of memories, inside which she tossed and turned, one of her hands clutching at the other.
The weekend loomed ahead.
Empty.
But in the end the weekend was fine. She got up early on the Saturday, went into Hanley and bought herself some books and a DVD. That was her entertainment seen to. The weather was bright and pretty, so she went home, changed into her running gear and trainers and jogged along the canal towpath for a couple of miles. This was something she loved about the Potteries, the industrial heritage mingling with the fanciful. Etruria, for goodness’ sake. About as far from the middle of Italy as was possible – unless you have a potter’s dream. This Etruria was a rundown area peppered with bottle kilns, two derelict factories and a boarded-up pub. She ran on, along the towpath, passing some old factory wharfs. She overtook a decorated narrow boat sliding through the water. Holiday-makers waving at her rather than past workers loaded up with coal, china clay, finished wares. She stopped to catch her breath, hands on knees, and was passed by dog walkers and a couple with a baby in a sling. The baby’s head was lolling. Practically asleep. One thing she was sure of as she straightened up; Barclay’s baby would never pass the time in one of those, walked by Daddy. But what could she do about it? Really? The thought stopped her and she stood, breathing in the cool October air and came up with … nothing. She could not prevent a crime before it had happened. She hadn’t exactly been successful alerting the authorities after he had committed a felony, so what hope?
None, and the knowledge that she was powerless depressed her.
Time to move on.
Back home she showered, cooked a meal of pasta, bacon, onion, tomato and cheese and sat through the film which had been a mistake from the first, We Need to Talk about Kevin.
It did nothing to lighten her mood.
On Sunday she had a late lunch with Julia and Gina at the house they were restoring. She left just after ten to ready herself for the week ahead.
Monday, 27 October, 10 a.m.
Khaled Farouk was good enough to ring her himself with the result of Stan’s brain scan. ‘Not good news, Claire,’ he said. ‘Poor old Stan. He has a frontal lobe tumour. A large one.’
‘Primary or secondary?’
‘We’ll have to do a biopsy to see, but I think it’s a primary, fast growing, as big as a walnut and unlikely to be amenable to either treatment or surgery. Particularly in the difficult circumstances of Stan’s mental state and probable lack of cooperation and compliance with any treatment plan.’
Claire was silent for a moment. Stan Moudel was thirty-two years old. Unlike Hayley, his life had not begun terribly. He had had a chance. Once. Now it had gone.
This was the final insult to the person who had once been Stan Moudel, husband, father, working man.
‘Dr Farouk,’ she said, ‘how long will he live without intervention?’
‘Months,’ he said. ‘Possibly weeks.’
‘Do you propose to do a biopsy?’
‘I want,’ he said seriously, ‘to have a case conference before any surgical or radiological intervention.’ There was a pause. ‘Without any intervention he will certainly die.’
‘So the sooner we have this case conference, the better.’
‘Exactly.’
They made an appointment to meet up. He would organize the neurosurgical team and the radiologists and Claire tracked down the necessary colleagues who’d had most to do with Stan’s case: Edward Reakin, Teresa and Astrid. She still didn’t trust the girl, even if Barclay had denied knowing her. But Astrid had been subdued since the confrontation and Claire did not want to antagonize her, so she kept her suspicions to herself.
The wheels for a case conference were swiftly put in motion. They arranged to drive over to the RSUH on the following morning.
But first Claire felt she must speak to Stan herself. She needed to involve him in the decision – well, inform him at the very least.
As she walked along the corridor towards his room, she felt nothing but sympathy and sorrow. Sometimes, she felt that her job was just too difficult.
She pressed the buzzer of the locked ward where Stan had had to be moved since he had become unpredictable, and was let in.
The rule was: no lighters, no mobile phones, no sharp objects or anything that might either be used as a weapon or might disturb the patient. As a member of staff she still paused underneath the notice. It looked so commanding. She put her phone on the desk.
Astrid was in charge of the ward. Uniforms upset patients, so the staff generally wore jeans and a baggy top. It seemed the most neutral of non-uniforms.
‘I need to speak to Stan,’ she said, tempted to add, ‘the doomed homeless man,’ just to bait her and watch for her reaction, but she resisted.
Astrid must have caught something of her tone. ‘What is it, Claire?’
‘The scan did pick up on something.’
Astrid was no fool. ‘So they’re going to do what exactly?’
‘He needs a biopsy. We’re having a case conference tomorrow morning to decide.’ Claire glanced along the corridor. ‘I should speak to him,’ she said.
Astrid looked concerned. ‘Alone?’
Claire nodded. ‘You can switch on the CCTV,’ she said, with a watery smile. ‘Keep an eye on me.’
‘OK. He’s been very quiet today.’ She too gave an anxious look that skittered along the corridor, skipping along with guilt. ‘Hope it’s not the calm before the storm.’
Claire touched her arm. ‘Let’s hope it’s not the storm before the calm,’ she responded.
TWENTY-EIGHT
At first it seemed that Astrid was right. Stan was sitting quietly, looking out of the window. He could have been any of their patients, lost in thought. Or simply lost.
‘Stan.’ She spoke softly from the doorway. Since his condition had worsened (developed), loud noises or sudden approaches made him nervous, likely to lash out.
He turned his head.
Why is it that even the most unbalanced patients rarely look frightening? There is usually no clue in their demeanour to hint of the turmoil filling their heads.
Stan was a lanky man with prominent cheekbones and hollow eyes. He was dressed in jogging pants and a T-shirt, plain white except for the food that had been spilled down the front. Heinz tomato ketchup, by the looks of things.
She sat down opposite him and spoke gently, slowly, quietly, her words containing a lullaby rhythm.
‘Stan, you know you haven’t been well lately.’
He shook his head jerkily, as though impatient with himself.
‘And you’ve had some headaches.’
He nodded. Head bowed, ashamed now, as though somehow he was to blame.
‘And you probably don’t remember it, but about a month ago you had a fit. You lost consciousness.’
He nodded abstractedly, still looking out of the window.
‘Initially …’ She corrected herself. ‘At first we thought it was due to the alcohol or the drugs that you’ve taken.’
He dropped his head. Then lifted his eyes with a question.
‘Claire,’ he said, ‘is something wrong with me? They put me to sleep to look in my brain, didn’t they?’
She nodded, keeping her gaze on him, more sorry for him than she could bear. They hadn’t dared use the word brain sca
n. Stan’s behaviour was unpredictable at best; any member of staff who had been involved in his care would have known these particular words would have conjured up terrifying images in his damaged mind. A scan would imply an alien being drilling inside his brain ready to burst out at any opportunity, or some scientist watching him.
His eyes regarded her, expressionless. Not even asking the obvious question: what did they find?
‘Stan,’ she said, ‘we think something’s wrong inside your head.’
And with the combination of both unpredictability and insight, he gave a lopsided grin. ‘You’re telling me,’ he said. ‘That’s what I’m here for.’
Claire smothered a smile. Sometimes her patients could be unintentionally insightful, accidentally funny. This wasn’t the first time one of them had made her smile with a comment.
‘Stan,’ she said, ‘how would you feel about going back to the hospital?’
He looked at her blankly.
Capacity. It was the buzzword. If your patient has capacity, he or she must make their own decisions. The question was: did Stan really have the capacity to make this decision?
He bounced the question back to her. ‘What do you think, doc?’
She didn’t respond straight away but searched for the right words. It was another point that was drummed into them from the very first day at medical school:
Tailor your advice/suggestions to your patient. Don’t talk over their heads by using too much jargon and words they will not understand. Likewise, do not talk down to them. Remember they are not children.
‘I think it’s possible,’ she said tentatively, ‘that you might become even more ill if we do nothing. The headaches might become worse.’
Something perceptive passed across his face and he moved a little closer. His clothes smelt of a combination of fabric conditioner and tobacco. It was not unpleasant and sparked a vague memory. Of her father? The French frog?
She shook her head to erase the memory, and Stan continued, ‘But you can’t promise anything, can you, doc?’ His voice was raised now, his eyes bulging, his hands clenched into fists. She felt threatened, knew Astrid would be monitoring Stan’s behaviour with concern, finger on red-alert button. But she must stick to the truth. She owed him that.
‘No, Stan,’ she said gently. ‘We can’t promise anything.’
His eyes were starey scary now. ‘So what’s the fucking point? What’s the fucking point? What’s the fucking point?’ His body was rigid, movements stiff and jerky, his eyes staring at her in desperation. He stood up and moved quickly, his bony figure now between her and the door – her escape route.
She stayed sitting. And then the door was pushed open. Astrid and two orderlies stood there. ‘Come on, Stan,’ she said.
Claire stood up and Stan gave her a wicked grin. ‘I had you on the spot there, didn’t I, doc?’
She nodded and smiled. ‘You did that, Stan.’
As she left the room she knew that this unpredictability would cost him his life. Biopsies, scans, radiotherapy, chemotherapy, surgery. Compliance. Capacity. The chances weren’t great for anyone with this fat tumour inside his skull. And for Stan it was a hundred times more difficult.
She was not relishing the thought of the case conference.
TWENTY-NINE
Tuesday, 28 October, 10.00 a.m.
‘So,’ Dr Farouk said, ‘who’s going to kick off?’
During the car journey into the hospital they had discussed the difficulties of Stan’s case. Struggling to understand some of the concepts put before him – sickness, possible side effects from treatment, the risks of surgery – let alone the notion of a biopsy, of something growing inside his brain that needed to be looked at and identified under the microscope. He would, quite literally, be capable of tearing his hair out.
What is in the patient’s best interests?
It was another mantra they all abode by.
Khaled Farouk was courteous. He listened carefully to each point of view – Edward Reakin’s considered outcome (another buzzword):
Inability to cope with the follow-on treatment.
The possibility of violence towards staff.
Removing stitches and dressings through difficulties with comprehension.
General poor health – renal and hepatic compromise, long term, poor nutrition.
Both Astrid and Teresa were nodding their heads in agreement.
Finally Khaled turned his handsome head towards Claire. And though she was distressed at the thought of the outcome after yesterday’s encounter, she nodded in agreement. ‘All those.’
Dr Farouk brought the scan up on the computer, giving them an entire picture before enlarging. ‘You see,’ he said, pointing it out to Mary Elgin, neurosurgeon, a newcomer to the case. She was a natural blonde with a pale complexion unenhanced by make-up, and with an apparently permanently fixed frown.
Only Claire knew this was not quite so. She had seen her at one of the medical dinners she had attended a year or so ago with Grant, and Mary Elgin, wearing no frown and plenty of make-up, tanked up to the eyeballs, had been frankly flirting with him. But then, Claire reflected, Grant had had that easy-going, relaxed sort of demeanour that invariably did attract women. She felt the knife twist in her guts. And one of those women who was susceptible to that attraction was her. Current.
Admit it, Claire, you still fancy the pants off him.
Mary was studying the scan result, taking careful measurements using a ruler, studying the tumour’s proximity to the vital areas of the brain – in particular the Circle of Willis. In the end she would be the one to decide to operate or not to operate. To be or not to be. That was indeed the question. She turned to the roomful of people.
‘In a healthy thirty-two-year-old,’ she said, weighing each word up carefully, ‘even in perfect health and with absolutely no previous medical history …’ She gave a rueful smile. ‘Even if it were someone who’d run the London Marathon last year, I’d say his chances would be slim.’ She looked at Claire, who wasn’t quite sure whether she had been recognized. ‘Ethics,’ she continued, ‘demand that we treat all our patients the same and that we involve our patients in our decisions. Obviously in this case …’ She let the sentence hang, unfinished, in the air, before jumping to the next point. ‘But even if he was perfectly healthy and fit, I wouldn’t be optimistic about the outcome of this.’ She peered closer, the rigid ruler measuring its size. ‘This is a very aggressive tumour.’ She addressed her question to Claire. ‘You say his symptoms have developed over the last few weeks?’
Claire nodded, feeling bad. Any change in Stan’s behaviour had initially been put down to his unpredictable lifestyle and mental state. That would have delayed diagnosis by a month or two.
‘And have you had any discussion with him about his diagnosis, possible prognosis and treatment options?’
Claire felt even worse. ‘Not really,’ she said. ‘Not a meaningful discussion.’
‘Then that’s it,’ Mary said decisively. ‘If we can’t guarantee his compliance with treatment, then I’m afraid surgery would be not only risky but a waste of time and resources.’
She stepped back.
The radiologist spoke next and put forward roughly the same argument.
So they were all agreed. No treatment. The result was documented, with their reasoning carefully compiled, and yet they would all leave the room with a sense that they had failed their patient. They hadn’t even given him a ghost of a chance.
They started to file out.
As Claire was almost out of the door, Mary Elgin asked her casually, ‘How’s that gorgeous boyfriend of yours, Claire?’
So she did remember. Considering how tanked up her colleague had been, Claire was surprised.
Even more so at her own swift, unthinking response ‘Oh, him? We’re not together any more.’
Mary’s eyes glittered. ‘Oh,’ she said. ‘Really?’
THIRTY
After the case conference s
he went to the general medical ward to see Hayley, whose prediction of having tubes coming out of all orifices was proving to be true. She was heavily sedated and so was compliant with her treatment rather than ripping everything out. Her eyes flickered when Claire entered her room and sat down beside her patient. ‘Maybe, Hayley,’ she said very softly, ‘we’ll have you back at Greatbach soon.’
Hayley returned a very watered-down smile. ‘Maybe,’ she echoed. ‘Maybe not.’
The hungry child.
It was such an apt description.
She was about to leave when her eye was caught by a card, four plump women dancing across the front, instantly recognizable as a Beryl Cook work. The women were having great fun in tight shorts and T-shirts, plump and jolly, a singularly inappropriate card to send to a young woman with anorexia nervosa. Claire reached for it, but even before she’d glanced at the inside she knew who had sent this and why. He would use Hayley’s deterioration to poke at her. Inside he’d written a message guaranteed to goad.
So – which one are you? To preserve the mystery he had not signed his name. He didn’t need to. Underneath he’d added advice:
You don’t need to eat. It just produces this.
So Barclay was still influencing her patients. He just couldn’t let go of his malicious little game. What worried Claire was what was he planning for the Triggs, his wife and unborn baby? She looked from the card back at her patient. Hayley’s eyes met hers then dropped away, ashamed. Claire read the evasion and knew she would not shake the truth out of her. Jerome was very good at persuading people to keep his secrets. And there was nothing Claire could say or do in this environment that would help matters. Even though Hayley was sedated, she could tell the girl had been affected by the card. Her eyes lingered over it, her face anguished. This was how she saw herself, whatever Claire might say or do. Barclay’s influence was always stronger – evil triumphing over good because his subject was so very susceptible. Claire wanted to know whether she had ever met Jerome, and if so where? How? She wanted to break the bond, stop the influence as putrid and polluting as the old London smog.
Dangerous Minds Page 16
