A Quiet Death

by Cari Hunter

  “Hi, Dr. Fielding.” He pushed a set of notes toward her. “Vera Aster, eighty-nine. She’s in bay two with her daughter. Came in via ambulance from Pennine View.”

  Meg arched an eyebrow. The facility was one of several notorious nursing homes in the area. “How long had she been ill before they realised?”

  “Half an hour, or so they claimed.” Asif set the blood results on top of the chart. “Her lactate was four point six. She was hypothermic and hypotensive, and her urine output was nonexistent.”

  “Christ. I’m guessing there’s not been much improvement.”

  “No. She has advanced dementia, and ITU won’t touch her. We’re waiting for a call from Medical Assessment, but they’re at capacity.”

  “She’ll die in here, then, the poor sod.” Meg glanced at the cubicle where Vera lay unmoving, swaddled in blankets, with her daughter holding her hand. She shuffled the notes, searching for the familiar lilac pro forma. The last thing she wanted to do was start jumping on the brittle chest of an eighty-nine-year-old. The “Do Not Attempt Resuscitation” was already signed and dated, however. “Thanks for getting this sorted.”

  “The daughter is very sensible,” Asif said. “She just wants her mum to be comfortable.”

  Meg nodded, intimately familiar with the sentiment. Early onset Alzheimer’s had kept her own mum in nursing care for the past two and a half years. “I’ll go and introduce myself. Is everyone else okay for the time being?”

  “Yep, all stable and rather boring, really.”

  “Lovely.”

  Monitors flashed at her as she approached the second bay, all of their numbers in the red. Every breath Vera snatched rattled through her chest, but her kidneys had succumbed to the sepsis first, and the catheter bag hanging from the side rail was empty. Vera’s daughter dried her eyes before shaking the hand Meg offered.

  “I’m Dr. Fielding. I’ll be looking after your mum tonight.”

  “She keeps asking for her dad.” The woman’s voice cracked. “I don’t know what to do for the best.”

  “Tell her that he loves her and that he’s on his way here,” Meg said without hesitation.

  The assurance seemed to allay the woman’s uncertainty. The fear eased from her expression, and she stroked a hand through her mum’s thin hair.

  “Will it be long now?”

  Meg looked again at the monitors, ignoring the shrill peel of the bat phone. “I don’t think so. Is there anyone you’d like me to call?”

  “No, there’s only me left. Thank you, though.”

  Vera stirred, her voice rising in distress and then falling away when her daughter spoke to her. Meg drew the curtains as she left, affording them a modicum of privacy in a department ill-suited for end-of-life care.

  Liz had answered the standby phone in Meg’s absence. She handed over the details of a red pre-alert for Meg to read. Male, fifty-eight, haematemesis, GCS nine.

  “Great, that’s just what we need.” Meg yanked fresh gloves and an apron from the wall holder. “ETA?”

  “Ten. There’s nowhere to ship anyone out to. We’ll have to stick him in the shock room.” Liz reached for the phone again. “Anaesthetics?”

  “Yeah, might as well. Fluids, O-neg, and another candidate fast-tracked onto the tranexamic trial.”

  Liz gave a thumbs-up. “Bonus.”

  Once Meg was satisfied with her preparations, she went to wait by the ambulance doors. The sound of sirens lured her outside, and she hugged her arms across her chest to fend off the bitter cold. Timed to perfection, the blue lights she’d seen approaching were extinguished just before the ambulance hurtled beneath the canopy. She recognised the EMT driving, and opened the vehicle’s back door to greet his regular mate.

  “Hey, Kath—” She stopped dead as a woman in the passenger chair turned at the sound of her voice. “Oh shit. Teresa?” She looked at the man on the stretcher, his gaunt face half-hidden by an oxygen mask. What little she could see of him was soaked in crimson. Teresa sobbed and covered her mouth with bloodstained hands.

  “Shock room. Now,” Meg told Kathy. She unclipped Teresa’s seat belt and guided her down the steps. “Are you hurt anywhere?” she asked, aware of John’s propensity for lashing out.

  Teresa shook her head. “It’s all his.” Her eyes widened as she watched the crew rush by. “I need to tell Sanne,” she whispered.

  “I’ll call her,” Meg said. She co-opted a passing nurse to escort Teresa to the Relatives’ Room, and kissed Teresa’s cheek. “Sit tight, and I’ll come and see you as soon as I can.”

  She sprinted across to the shock room and grabbed hold of the sheet either side of John’s feet to help slide him onto the bed. The abrupt motion made him vomit, and he coughed, splattering the bedding with frank blood.

  “Get him on his side!” She tipped the sheet with Liz, flipping him over and arranging him into a rough recovery position. The anaesthetist, appearing with impeccable timing, started suction to clean up the mess.

  “Thanks, Sahil.” Meg listened to Kathy’s handover with half an ear, trying to order her priorities, number one of which kept coming back to phoning Sanne, even though she couldn’t, not right now.

  “IV access?” she asked.

  “Left ACF,” Kathy said. “He’s had a litre of saline.”

  The fluid hadn’t done much to improve matters. John’s blood pressure was unrecordable, his heart rate fast and irregular. He barely reacted when Meg stuck a large-bore cannula in his other arm. It was unnerving to see him so compliant, when he’d spent his adult life being a complete tosser.

  “Liz, get his details up on the computer. I ran some bloods for him last night. He’ll be typed and crossed, so order six units.” She hooked up a bag of O-neg, setting it running as Liz gaped at her. “It’s Sanne’s dad,” she said in an undertone.

  “Right.” Liz’s only outward reaction was a slight double-take before she collected the ambulance paperwork and ran to the desk.

  Meg finished John’s baseline obs and began to inject drugs that would—on a good day—help him to clot and then stabilise any clots he managed to form.

  “Shall I fast-bleep GI and see if they have an endoscopist on call?” Liz shouted, anticipating the worst-case scenario and reminding Meg that this really wasn’t a good day.

  “Yes, please. Sahil, can you manage his airway until then?”

  “Just about.”

  “Let me know if that changes.” Meg watched the suction tubing fill with another stream of bright red gore. The duodenal ulcer that John had ignored had probably chewed a hole in a neighbouring artery. “How long on the blood?”

  “Ten minutes max, and GI are on their way.” Liz began to help her prep for an arterial line, their heads close together as they worked. “Is he a drinker?”

  “At the last count it was five litres of crap cider a day.” Meg shrugged and wheeled the trolley to the bedside. “There was no telling him.”

  “Let’s get this done,” Liz said. “I’m guessing you have a phone call to make.”

  *

  Sanne dug a tissue into the corners of her eyes, trying to stop them from watering. She’d spent nine hours trapped within this surreal EDSOP binge watch: endless silent footage of cars driving aimlessly, rendered in grainy black and white. The desks around her were empty, her colleagues having given up one by one to stagger home and remind their families they still existed. She had set herself a target of two more files, and her latest was three-quarters through when her mobile rang. Eager for distraction, she prepared to listen to an automated sales pitch and was delighted to see Meg’s name instead.

  “Hiya.” She clicked “pause,” feeling brighter than she had all day. “Did you manage to sleep all ri—”

  “San, your dad’s been brought in,” Meg said, cutting her off. “He’s lost a lot of blood, and he’s really unstable.”

  Holding the phone between her ear and shoulder, Sanne closed the video and marked it as incomplete. “Is my mum okay?” s
he asked.

  “Yes, she’s sitting with him. A specialist stopped the bleeding, but he’s still waiting for an ITU bed.”

  Sanne logged off and collected her belongings, her movements stiff and automatic. “Tell her I’m on my way.”

  “Sanne.” Meg used her schoolteacher voice, guaranteeing Sanne’s undivided attention. “Drive carefully.”

  “I will, love.”

  The weather, as indecisive and moody as a teenager, chose to favour Sanne with clear skies this time, and warning signs on the bypass informed her that gritting was in progress. Mindful of her promise, she concentrated on the roads, keeping well away from the boy racers and speeding taxis. Waiting at a red light, she tried to remember the last time she’d seen her dad and what he’d said to her, but she couldn’t. She couldn’t remember him ever saying anything she’d want to keep hold of.

  With visiting hours long since finished, the car park in front of the Royal was almost empty. She chose a bay close to A&E and flung enough money into the ticket machine to cover her till morning. Meg met her at the main reception, guiding her through the clamour of Minors before stopping in the deserted ambulance corridor to pull her into a hug.

  “You all right?”

  Sanne closed her eyes for a moment, reluctant to move, though she drew away almost at once. “I’m fine. What happened?”

  “Arterial bleed from a stomach ulcer. Your mum found him, but he’d lost about half his volume by then.”

  Sanne nodded, wondering vaguely whether half would be enough. “Will he wake up?”

  “I don’t know. He’s so battered by the drink that it’s hard to say. If he has a rebleed, then no, he probably won’t.”

  “Is he on a ventilator?” she asked, hesitating at the shock room. She knew from past experience that a vent would mean anaesthetising drugs and no chance of her dad regaining consciousness without prior warning.

  “Yes, he’s vented.” Meg touched Sanne’s cheek, encouraging Sanne to look at her. “He won’t know you’re there, San.”

  Emboldened, Sanne opened the door. Her mum was alone at the bedside, both hands clasped in her lap as she stared at the bed. Evidently used to medics coming and going, she didn’t react until Sanne spoke.

  “Hey, Mum.”

  “Sanne.” She rose then, meeting Sanne halfway and brushing her fingers through Sanne’s windblown fringe. Her hands were red-raw where she had scoured them, but flakes of blood remained beneath her nails. “Were you at work?”

  “Yes, I’ve come straight from the office.”

  “Oh, love, you must be tired out.”

  They sat together in the hard wooden chairs.

  “Have you had any tea?” Sanne’s mum asked.

  Sanne huffed a small laugh. “No, but I’m not hungry. Honest.”

  From her position, she could see her dad’s thin face in profile, with its dirty growth of whiskers and the spiderweb bursts of veins on his cheeks. His teeth were slack against the tube from the vent, as if he would be gnawing on it were the drugs not keeping him placid.

  “Have you called Michael?” she asked.

  “I tried, but there was no answer on the last number he gave me. He could be anywhere.” Though her mum managed to keep the disappointment from her voice, her furrowed brow betrayed her pain. Her only son had declared himself born again some five years ago. The last Sanne had heard, he was trying to spread the word in Tower Hamlets.

  “Keeley knows,” her mum continued. “But I don’t think she’ll be able to come.”

  Sanne listened to the vent forcing oxygen into her dad’s lungs and watched his chest move with each artificial breath. A pile of crumpled antiseptic wipes sat on the overbed table, but although her mum had done her best to clean his face, she could do little to alleviate the foul smell coming from the rest of him.

  “I was watching Strictly in the back room.” She shook her head in apparent despair at her frivolous behaviour. “I only had it on low, because he hates the music, but I didn’t hear him shout or anything. I took him a couple of crumpets when it finished, and he was on the floor. There was blood everywhere.”

  Sanne gripped her mum’s hand. The last time they had been here, she remembered being steered into the A&E shower and then shivering in oversized scrubs as doctors rushed about and used words she couldn’t understand. She had found her dad collapsed in the bathroom and slipped on the clots when she’d tried to help him.

  “I knew he wouldn’t touch the crumpets,” her mum whispered. “But you have to keep trying, don’t you?”

  Sanne didn’t know how to answer that, so she said nothing. With a fortuitous sense of timing, a nurse bustled in to check monitors and adjust fluids. She closed the door again as she left, shutting out the tumult of Saturday night in Resus, and restoring the room’s strange, confidential atmosphere. Sanne rarely had a chance to see her mum alone. Sunday lunches meant Keeley talking about Keeley, and kids running riot, while Sanne’s shifts left few opportunities for long phone calls.

  She stood and took the two steps to the bedrail, wrapping her hands around the metal so that she wouldn’t act on her instincts to shake her dad and convince herself he really was oblivious. As a child she’d been terrified of his unpredictable rages and his tendency to lead with his fists or his belt. He didn’t scare her now; he just reminded her of the pathetic gutter-dwelling scrotes she dealt with on a daily basis.

  “Did you ever love him?” she asked, turning back to her mum.

  There was no answer for a moment, and the flicker of her mum’s eyes toward the bed implied she shared Sanne’s apprehension.

  “I’m not sure,” she said slowly, as if she’d never dared to give the matter any thought. “I was fond of him at first, when we were courting. Believe it or not, he was funny and quite handsome, and he had a steady job at Bradshaws, so your grandma approved.”

  “Bloody hell, the battleaxe actually liked him?” Sanne laughed in disbelief, and her mum smiled with her.

  “Aye, as much as she liked anyone. I never told her about the drink, though, and she died before he really hit his stride.”

  “Did you know about that before you married him?” It was something that had always bothered her: why her mum—usually so astute and sensible—would commit to a man on the verge of alcoholism.

  “Yes, I did.” Her mum toyed with the wedding band on her finger. “But it was…it was complicated, Sanne.”

  It wasn’t much of a clue, but Sanne’s career relied on her ability to read people, to gauge their expressions and tease the meaning from their evasive replies. In the end it was such a simple deduction that she wondered why she’d never worked it out before. Perhaps she had, but had never wanted to acknowledge it.

  “You were pregnant,” she said. “With me, before you married him.”

  A nod from her mum confirmed it. “He wanted me to get rid, but I couldn’t, and my mum would’ve washed her hands of me either way; all her side were staunch Catholics. I was only six weeks gone, so we pretended I’d caught on the honeymoon, and no one batted an eyelid.”

  Sanne felt as if a load of rocks had been dumped onto her chest. It hurt when she breathed, and tears began to cloud her eyes. Her mum held out a hanky and then dabbed Sanne’s cheeks for her when she blinked and stared at it.

  “You were a tiny, perfect baby,” her mum said. “And beautiful, and I wouldn’t change a thing. Please don’t cry.”

  There had been countless days during her childhood when Sanne had railed against her lot: the toys she’d wanted for Christmas and never received; the gang of girls who’d smacked her around the playground; coming home to Keeley screeching and her dad full of beer. But there had also been long, lazy summers mucking about on the back field with Meg, and stealing kisses behind the bike shed, and reading beneath the covers by torchlight. And propping up all of that was a mum who had always loved her unconditionally. Sanne leaned over and kissed her mum’s cheek.

  “Thank you for not getting rid of me,” she said
.

  CHAPTER THIRTEEN

  Nelson didn’t say a word as Sanne draped her coat over her chair and set her notepad beside her computer. He merely rested his chin on his steepled fingers and watched her every move like a hawk.

  “Nelson…” The glare she attempted made her a bit squiffy. “Pack it in. I’m okay. I slept at my mum’s.”

  She didn’t mention that they’d only got home at four thirty, or that she’d spent the next three hours tossing and turning in the bunk bed that she and Keeley had once shared. Having just glimpsed her reflection in the locker room mirror, she was sure he would read between the lines.

  He didn’t labour the point. “How’s your dad?” he asked.

  “The nurse I spoke to this morning said he’s poorly but relatively stable. I left plenty of taxi fare for my mum so she can visit him, and I’ll go and see her when we finish here.” She logged on to the case directory. “Any developments overnight?”

  “Yes, actually. Hang on a tick.” He lifted a file to check beneath it, setting it down when he failed to find whatever he was looking for. His desk drawer banged shut, and Sanne lost sight of him as he chased something he’d dropped. “Aha! Here we go.” He reappeared, brandishing a blurry image of a Toyota Previa. “Our mission for the morning, courtesy of an eagle-eyed officer at GMP.”

  “Ooh, nice.” She nodded her approval. “Do we have a registered keeper to go with it?”

  “I’m glad you asked that.” He held up a typed report. “Put a bit of spit and polish on yer boots, San. We’re off to leafy Thirlow.”

  The early morning cloud cover had split and thinned, allowing fingers of sunlight to break through and dazzle the Sunday drivers, none of whom seemed to be in any hurry whatsoever.

  “You’re taking a right onto Thirlow Court Road, once this dozy bugger finds second bloody gear.” Sanne rapped her knuckles against the passenger door of their pool car. Lack of sleep and the constant parade of bimbling idiots clogging up the roads were setting her teeth on edge.

  “Shall I find us something soothing to listen to?” Nelson reached for the radio.