All She Wants for Christmas

by Annie Claydon

  Beth grinned at him, her grey eyes dancing, and he felt his chest tighten. ‘What will they come up with next? Are you going to see an angina case?’

  ‘As it happens. Do you know something I don’t or was that just a lucky guess?’

  She rounded the corner and made for the doors to the A and E department. ‘Your patient’s name is Doug Grant and he’s there with his wife, Jean. They’re both deaf.’

  ‘You know them?’ The name rang a bell but Matt couldn’t quite place it. Well, surely there were many Doug Grants…

  ‘Yeah. Jean asked the A and E staff to contact me.’

  ‘That’s a good start, then. Do they use speech or signing for preference?’

  ‘Jean uses mainly signing. Doug has more hearing than her and can usually get by with hearing aids, but if he’s not in good shape and needs to be lying down then he probably won’t be wearing them. He’ll be relying pretty heavily on Jean.’

  ‘In that case, I’ll be relying on you.’ Matt wondered briefly why no one had thought to mention this when they had called him down and was glad that Beth was there. Moving quickly, he reached the swing doors before her, holding one open and letting her lead the way.

  A brief exchange of wordless signals between her and the A and E receptionist were enough for her to locate the correct treatment booth, and Matt followed her inside. A middle-aged couple was alone in there, the man lying on a bed and the woman sitting beside him, holding his hand. The man was hooked up to an ECG machine, and Matt noticed a dressing on his arm, which indicated that blood had already been taken.

  The woman brightened visibly when she saw Beth. A rapid succession of signs passed between them, and Matt waited for them to finish. Jean obviously had something to say, and it was important that someone take notice of that. Beth was nodding, and Matt positioned himself beside her, so that the woman could see his face.

  Beth flashed him a look of approval. ‘This is Jean and her husband Doug.’ She was both signing and speaking, so that everyone in the booth could follow her. ‘Doug had a bad angina attack this evening and the paramedics brought them in here. The doctor has taken blood, but beyond that they don’t know what’s going on and they’re both very worried.’ She gestured towards Matt. ‘Jean, this is Dr Matt Sutherland. He is a cardiac specialist.’

  Matt held his hand out to Jean, and she took it, smiling at him through the stress lines that were etched into her face. ‘Tell them…’ Matt thought better of his words and turned to Jean, speaking slowly and as clearly as he could. ‘I’m going to assess your husband’s ECG results.’ He paused and indicated the machine that was monitoring Doug’s heartbeat. ‘And speak to the doctor who has already seen you. Then I will examine Doug and I may recommend that he stays in the hospital for tonight.’

  A quick nod told him that Jean understood, and she signed to her husband. Matt waited for her to finish and turn her attention back to him. It was not usual practice to use a relative as an interpreter, but Matt also knew the value of communicating directly with patients and their families. Beth was there, keeping a close eye on him, and would make sure that nothing was missed.

  ‘Has Doug had any aspirin? Any other medication? Either here or at home?’

  Jean signed and then shrugged tearfully. Reaching into her handbag, she withdrew two bottles of tablets and pressed them into Matt’s hand.

  He looked quickly at the labels. Standard prescriptions for angina. ‘Good. That’s helpful, Jean, thank you.’ He turned to Beth. ‘What did she sign?’

  ‘He’s just had his regular medication.’ Beth pointed to the tablets in his hand. ‘She doesn’t think they gave him anything else here but she’s not absolutely sure. Do you want me to go and find the doctor who saw them?’

  Matt nodded. She was here to interpret, not run errands, but at this point clinical issues came first and she knew that as well as he did. ‘Please. It’s Dr Martin. I need confirmation about the medication.’ He might have added that she should ask why the couple had been left alone like this, but he let that pass for the time being.

  Following Beth’s example, he touched Jean’s arm lightly to get her attention. ‘Beth is going to find out what’s happening. In the meantime, can we make do with a pad and pencil?’ Matt had noticed a ruled pad poking out of Beth’s handbag.

  Jean nodded and her lips formed ‘Thank you’, her hands signing at the same time. Beth grinned in response.

  ‘You’ll do. You have good lip patterns. Here you go.’ She slapped the pad into his hand and disappeared out of the door, leaving Matt to share a laughing shrug with Jean.

  Beth was gone for a while, and Matt spent the time questioning Jean about her husband’s medical history and his current symptoms. Her answers, written on Beth’s pad, were clear and concise, giving him the information he needed.

  It wasn’t that he had never seen a deaf patient before. But in the rarefied atmosphere of the fast track, he had never had to speak alone with someone who signed. And of recent years he had spent much of his time in the operating theatre, where it didn’t much matter whether your patient could hear or not.

  Matt had come there to learn, though, and this kind of skill was as important as his well-proven clinical ones.

  Beth still wasn’t back when he got to the point where he wanted to examine Doug, but he managed well enough, even prompting a couple of encouraging smiles when he resorted to makeshift signs to indicate when he wanted Doug to breathe in and out. Finally Beth reappeared, the brief look that she shot at Matt intimating that she’d had some trouble finding Dr Martin. Matt drew the young doctor to one side and checked on the observations he had made, comparing them with his own.

  He heard Beth laugh behind him. She was making a good job of seeming relaxed in front of Doug and Jean, but there was something forced in her tone that told him she was under stress. He dragged his attention back to the matter in hand and looked for a phone to arrange for a place on one of the general wards. He could have left it to someone else, but in his experience this kind of thing always happened slightly faster if someone senior made the call.

  He returned to Doug’s bedside and with Beth’s help it took only a few minutes to recap on what he had already told them and explain that Doug’s symptoms were severe enough to mean that he would be admitted to hospital. He would be in a general ward and a doctor would assess Doug’s condition again in the morning.

  Matt laid his hand on Beth’s arm and she fell silent. She had been speaking as she signed, so that he could understand what she was saying.

  He caught Jean’s attention and spoke directly to her. This was a personal assurance and he wanted to make it himself. ‘I will follow up on Doug in the morning and make sure that everything is explained to both of you properly. If you have any unanswered questions, I want you to contact me directly. We have to take every precaution, but Doug’s condition is stable and you should try not to worry too much.’ He pulled his card out of the inside pocket of his jacket and handed it to Jean.

  Jean nodded to show she understood and her hand found his and squeezed it. A nurse appeared at the doorway, with a porter in tow, and he said his goodbyes to Jean and Doug and accompanied Beth out of the crowded booth.

  ‘Are you or Marcie available tomorrow morning?’

  ‘I’m not usually here on Fridays, but Marcie is. She’ll be here whenever you need her.’ Now that Doug and Jean were out of range, her tone was clipped and she was obviously angry about something. Matt wondered if she was angry with him.

  ‘About eleven? Shall I call her in the morning?’

  ‘No, that’s okay, I’ll speak to her. Thanks.’ She had given him a half-smile, but it was clear that she was dismissing him, as if he wasn’t wanted here any more. The tiny hairs on the back of Matt’s neck started to prickle. No. She wasn’t just going to send him away like this.

  ‘How long are you going to be?’

  She bristled visibly. ‘I’ll pop up to the ward in half an hour to make sure that Doug’
s settled in okay.’

  Matt caught her elbow, exerting a fraction more pressure for a second longer than he needed, to indicate that he didn’t want to hear any arguments. ‘With me. Now.’

  It wasn’t fair. Beth knew that she had been snappy with Matt when it wasn’t really him she was angry with at all, but if anything that only made her more agitated. He put the two paper cups from the canteen down onto his desk, closing his office door and motioning to her to sit. Beth watched him doggedly as he stirred his coffee with the little wooden paddle that passed for a spoon. He was the one that wanted to talk about this, not her.

  He took his time about it, but finally he broke the silence. ‘I learned something tonight that I didn’t expect.’

  ‘What was that?’ His conciliatory tone was antagonising her even more.

  ‘I felt that I was the one at a disadvantage, not you or Doug or Jean.’

  Warmth crept from her fingers, stealing slowly up her arms. She often felt that hearing people who could not sign were missing out in some way, but few would agree with her. ‘Perhaps…’ She left the thought unfinished. She really didn’t want to talk about this.

  ‘Look, Beth, I know there were mistakes made here. Doug and Jean should never have been left alone in that booth, not knowing what was going on. No patient should. But it happens. A and E staff work under pressure and with a constant set of conflicting claims on their time. They can’t always stop to explain exactly what they’re doing, they don’t have that luxury.’

  ‘So you’re defending them!’ Beth was shaking with an emotion that she couldn’t quite define. She didn’t want to hear Matt, of all people, telling her that it was okay to be confused and out of control of the situation just because you were deaf.

  ‘No. I’m trying to find out what happened in there.’

  ‘What happened is that the A and E doctor could have done more. You did. It didn’t take much to explain what was happening to them.’ Beth felt herself flush. He’d been great in there, caring and professional at the same time, and he deserved more than a grudging acknowledgement that sounded more like a criticism than a compliment.

  The almost imperceptible twitch of his lips indicated that he didn’t need marks out of ten for how he handled his patients. Not from her, anyway. ‘I’m not saying that there isn’t room for improvement.’ He paused, running his finger speculatively around the rim of his cup. ‘You’re not just mad about this one incident. It’s all the other times you’ve seen this happen that’s got you mad.’

  ‘Okay, then, yes, I’m angry.’ She was sick of this. Every time the world reared up and smacked her in the face, there he was, ready to pick her back up again. She was tired of feeling his liquid blue eyes on her while she was struggling to cope with one sticky situation or another.

  ‘So what are you going to do about it?’ His question was quiet, measured.

  ‘There isn’t much I can do. As you just pointed out, it isn’t necessarily anyone’s fault. It’s just the way things are.’ If pretending that were true was going to end this conversation any sooner then she was willing to give it a try.

  He laughed in her face. ‘You don’t believe that! No one with the kind of passion that you have truly believes they can’t change things.’

  ‘So what’s wrong with a bit of passion?’

  ‘Nothing. Do you think I don’t feel it, too?’ The sudden flare in his eyes, the way his lips curved slightly told her that he did. He might keep it firmly under control, but Matt Sutherland was no stranger to passion. She almost choked on the thought.

  She could keep her mouth shut, but her hands betrayed her. Okay, I feel it.

  He seemed to get the gist of her gestures. ‘Then let me put my cards on the table. And perhaps you’ll show me yours.’

  ‘Let’s see yours for starters.’

  His fingers pinched the bridge of his nose in a brief expression of frustration and then he cleared a space on his desk, placing a thick document in the middle of it. ‘This is the list of areas that I want to review in the cardiology department.’

  ‘You’ll be busy for a while, then.’

  ‘That’s the idea. There are a lot of items on here that are all about organisation and communication. If we can get that right, then I believe that it’ll have real clinical benefits for our patients as well as improving their experience of our service.’ He gestured towards a pile of files to one side of him. ‘No-shows, for instance, which cause us a great deal of trouble and put the patient at risk.’

  He stopped suddenly and flipped through the files. ‘I thought Doug’s name rang a bell. It so happens that he missed an appointment with me last Friday.’

  Beth’s heart thudded against her ribcage. This was awkward. ‘I know.’

  ‘You what?’ He shot her a startled look.

  ‘I know. Jean told me.’

  ‘And you thought…what? That this wasn’t a relevant piece of information that needed to be passed on?’ Matt’s eyes flashed dangerously.

  ‘Jean asked me not to. As an interpreter I have a duty of confidentiality.’

  ‘Not when the health of a patient could be compromised. The sole responsibility for clinical decisions is mine and I can’t make them without all the information.’ His control slipped slightly and he shot her a thunderous look.

  He could rail at her all he liked, she wasn’t going to back down. ‘Yes, it is. But Jean was communicating directly with you and if she’d wanted to tell you there was nothing stopping her. She knew that you didn’t understand signing and she had every reason to expect that her signed conversation with me was private.’ Beth shook her head. There had been no obvious right answer to this and she’d had to make a judgement call. ‘I know what you’re thinking. If he’d turned up for his appointment then there’s a chance that what happened tonight might have been avoided….’

  He broke in, a note of exasperation in his voice. ‘I don’t think anything. I don’t know what to think, because I’ve no idea why Doug didn’t turn up for his appointment—for all I know he was being held hostage at gunpoint by the milkman. Don’t you think it might have been sensible to mention it so that I could at least make some attempt to deal with the issue?’

  ‘Yes, actually, I do. Which is exactly why I made Jean promise to discuss it with you tomorrow. She said I could tell you, but I wanted her to speak with you herself.’

  He opened his mouth and then closed it again. The tension in the room snapped and the suspicion of a smile quirked his lips. ‘Well, that’s good to know, anyway. And for what it’s worth, I think you made the right decision. I don’t like the fact that they felt they couldn’t trust me, but if the experience they had in A and E tonight is anything to go by, I can’t blame them for not having too much confidence in us.’ His eyebrows shot up as Beth’s face betrayed her thoughts. ‘What now?’

  ‘Oh. Nothing. I was just thinking that you might have a point.’

  He laughed. ‘Well, I suppose we could go another round over that, but I’m willing to call it a draw.’

  ‘Probably best.’ Arguing with Matt had set her pulse racing, and the look on his face told her that the feeling was not entirely one-sided.

  He scraped his hand over the back of his head. ‘Look, I don’t want to play games here. When you see Jean will you tell her that I remembered Doug had missed his appointment. That it’s okay, I’m not going to label them time-wasters or put them to the back of the queue, but I would really like to talk to her about it because I want to know if there are things that I can do better.’

  ‘Fair enough. Yes, that would be good. I’ll tell her. Thanks, there are some doctors who wouldn’t have taken that attitude.’

  It seemed that Jean and Doug needed no protection from Matt. ‘So, anyway, was that what you wanted to talk about?’

  He grinned, shaking his head. ‘No. That was a side-issue.’

  ‘So what’s really on your mind?’ Beth was feeling a bit more like listening to him now. She might even do a bit of t
alking of her own.

  ‘I want to talk to you about the study you’re doing. My deputy, Dr Allen, mentioned it to me and I found the proposal on the hospital intranet, along with some other papers that you’d written.’

  He’d been checking up on her. A sensation that was not altogether unpleasant shimmered up her spine. ‘Yes. I’m using computer modelling to isolate specific behaviours in doctor-patient interaction and relating them to the patient’s perception of satisfaction and clinical outcomes.’ She put an emphasis on her final words. ‘With particular reference to the deaf.’

  ‘I’d like to discuss the possibility of Cardiology participating in your study.’

  What on earth was he up to? ‘Why? Just because you have one deaf patient…’

  ‘Actually, it’s more than one, I got Phyllis to check. And it’s not just about my deaf patients. I think that better communication can improve both our patients’ confidence in us and our clinical outcomes. So it strikes me that I should be looking at whether the kind of techniques you’re using will help us to assess our current communication strategies.’

  He had to be under some misconception about what she was trying to do. ‘It’s only fair to tell you that your predecessor was resistant to the idea of me doing the study here in Cardiology.’

  ‘Yes, I know what my predecessor thought. Phyl dug the relevant emails out of the archive for me. I don’t agree with him. Both Sandra Allen and I think it’s a great learning opportunity for the department.’

  ‘But I don’t know much about other groups. Deafness is my speciality.’

  ‘Fine. All we want to do is to see how a study like this works. We’d like to be involved partners, rather than test subjects. But in return we’d give you an opportunity to try things out, see what works and what doesn’t. We’d do what we could to get other departments interested as well.’

  ‘How involved would you want to be?’ Beth had a sneaking suspicion that Matt’s idea of partnership meant that he would be in charge.

  ‘That’s up for discussion. But this is your study. You call the shots.’