There were four patients booked in for two o’clock. Andrew took Mrs Green and Mrs Stanley, cubicles three and four, and she took Mrs Yates and Miss Nicholson. Andrew went into cubicle three with barely a look in Mrs Green’s folder, but she stood outside cubicle two reading Mrs Yates’s notes for a long time. She always read notes carefully before going to examine a patient, needing to concentrate without their presence, whereas Andrew chatted and read at the same time, in front of them. It was important to her that all the details should have been memorised before she was ready, and even then she needed a minute or two to gather her energies to banish the anxiety she still often felt. Mr Wallis told her repeatedly that she worried too much. Let the patients do the worrying, he said, it’s your job to be reassuring and you can’t reassure if you’re allowing yourself to worry on their behalf. All true, she knew that, but what she didn’t know was how to detach herself from the patients, to stop herself absorbing and empathising with their worries, for which, in this clinic, there were nearly always valid reasons.
She closed the folder, straightened her shoulders, pulled the curtain back gently – Andrew yanked curtains, it set her teeth on edge – and smiled. ‘Good afternoon, Mrs Yates,’ she said. ‘I’m Dr Harrison. How are you?’ Some day she imagined a patient would shout back, How do you think I am, lying here waiting to be told the state of my cancer, eh? But Mrs Yates loved the inquiry. ‘Awful,’ she said, loudly, closing her eyes and screwing her face up. ‘Awful, I feel terrible, I don’t know what you’ve done to me. I feel worse than I ever did before you lot got your hands on me. I do, really.’ Chrissie made a sympathetic noise. She’d read the notes. She knew about Mrs Yates. She’d understood the neat little initials peppering reports about her case. It was important not to get bogged down in all her complaints but, instead, to concentrate on examining her. ‘Let me have a look at you, then,’ she said, and she helped Mrs Yates sit up (groaning) and remove her wrap which barely covered her enormous breasts.
A body was a body, but this one was memorable. It wasn’t just the size of Mrs Yates’s breasts which made them extraordinary but the shape of them – they stretched wide across her chest, as full at the sides as underneath so that there was this temptation to adjust them, to push them back towards the centre. And then there were the veins in them, which stood out more like the veins in a leg. Mr Wallis, during Mrs Yates’s lumpectomy, had given them all a little lecture on the unique appearance of her mammary glands while he was operating. She thought he’d rather enjoyed digging through the blubber to find and extract the tumour, which was in one of the milk ducts. Good news for Mrs Yates. Three years on and no recurrence. Carefully, Chrissie felt round the scar. It was still very visible on the dull, pale flesh, but it had mended beautifully. There was a patch of reddened skin left from the radiotherapy but no irritation present. About a quarter of the breast had been removed, all the tissue around the tumour, which Mrs Yates had complained ruined her appearance and upset her husband. Chrissie palpated the reduced breast gently, then moved on to the other. She could feel lump after lump, the whole breast was a mass of lumps, but the notes had told her these were common in this patient’s case and that they were benign cysts. She went on feeling them, searching for any with a bullet-like centre, like a ball-bearing, but found none. All the time she did this she scrutinised the nipples. Mrs Yates’s nipples were dark brown, with black hairs sprouting from the areola. Chrissie had a sudden image of a cowpat, crusted on the top, and said hastily that everything seemed fine and would Mrs Yates raise her arms slightly, but was told this was impossible, her shoulders were too sore, she could hardly move her arms at all. Chrissie said just the slightest movement would do, and this was grudgingly managed.
She wished she were wearing gloves. Mrs Yates’s armpits were hot, sweaty caverns, thick with strong hairs. Her fingers slipped about and she felt as though they were being sucked in and trapped, never to be released. Mrs Yates, apart from not removing underarm hair, didn’t use deodorant, and she was perspiring freely. Surreptitiously, Chrissie wiped her fingers on her own sleeve before putting her hands on Mrs Yates’s neck. All the lymph glands seemed normal. Only the ovaries to check, in so far as they could be checked, but probably she’d be unable to feel much in this case. She tried, all the same, thinking as she pressed Mrs Yates’s stomach that though the image was unoriginal it reminded her of kneading dough. The colour of the skin, never mind the texture, was like the bread dough they used to play with in cookery lessons at school, punching and pulling it and fooling around until it was grey in colour and revolting to touch. She was aware suddenly that Mrs Yates, who had been talking throughout the entire examination, though Chrissie had taken little in, had stopped. She was staring at Chrissie with a strange expression on her face. ‘Is Mr Wallis away?’ she asked. Chrissie said yes, he was on holiday. ‘Who’s in charge, then?’ Mrs Yates said. ‘Well,’ said Chrissie, hesitating, ‘I suppose I am.’ Mrs Yates snorted. ‘You are? How old are you?’
Chrissie knew she didn’t have to answer that. She didn’t have to answer any personal questions. All she needed to do now was tell Mrs Yates that all seemed well, see you in a year, must get on to the next patient, and whisk out, Andrew-style. But she answered. She said she was 30. ‘Married?’ asked Mrs Yates. Chrissie smiled and shook her head. (The smile had never left her face, just faded slightly now and again.) Mrs Yates, if she had been harbouring any contemptuous thoughts, seemed to relent. She sighed. She said she felt sick, and couldn’t she be given something for this nausea, which was constant, and that her back ached, and she was tired and would like a tonic. Chrissie said she should visit her GP, that that would be the best thing, and backed out of the cubicle. She felt exhausted. She leaned against the shelf along the back wall, holding the next patient’s notes and closed her eyes for a minute. She heard Andrew coming out of cubicle four – he’d finished two patients in the time it had taken her to do one – and coming along the passage. He patted her on the shoulder as he passed. ‘In a trance, Chrissie?’ he said. She didn’t reply. Yes, she was in a trance. Had to be. Andrew was whistling as he went in to the next patient. Nothing got him down. If he was tired, it was always just physical, the result of being on his feet all day, or some other simple cause. He was never tired to his soul, thought Chrissie. I am tired to my very soul. Tired of bodies, tired of their workings, tired of their malfunctions. Sometimes, in spite of all her training – and oh, how brilliant she had been at exams! – she didn’t understand the body at all. Mr Wallis, to whom she had confessed this in an outburst she’d then been horribly embarrassed by, had said that this was nothing to be ashamed of. He said it was a good thing to feel humble (though humble was not precisely what Chrissie had indeed felt). ‘Don’t get too clever,’ he said, ‘it doesn’t do in our work. We’re not God, though the patients would like us to be, they’d like miracles.’
Chrissie sighed, and got on with Miss Nicholson’s notes. She was young. Only 35, unmarried, childless. Chrissie read her notes twice, though she could not afford the time. Wallis had seen Sarah Nicholson last month and sent her for a mammogram and a blood test. The results of both were in the folder. Wallis had written that the lump Miss . . . no, Ms – she wanted to be Ms – Nicholson had found was in his opinion a benign cyst, but that the patient was extremely anxious, so he was ordering the tests. The tests were clear. Relieved, Chrissie drew back the curtain, thinking this one would be over quickly and cheerfully. She was taken aback to see not only a young woman on the bed, but a man standing beside her, holding her hand. It was against the rules. These rules were not actually written down but they were always obeyed: only the patient in the examining cubicle, unless special permission had been requested and granted. No one had asked her if Ms Nicholson could have a man – friend? relative? – with her. How had Sister Butler allowed this? Hesitantly, Chrissie stood at the foot of the bed, hand still on the curtain. She should say something. There wasn’t room for anyone but doctor and patient. She would need to get r
ound the side occupied by the man, she would have to ask him to move. It was going to be awkward.
But all she said was ‘Hello, I’m Dr Harrison.’ Ms Nicholson didn’t reply. Tears ran down her face and she gave a hiccuping sob. The man squeezed her hand. Chrissie could see his knuckles whitening as he tightened his grip, and thought how this must be hurting the woman if the pressure was so great. She would have to address him. ‘And you are?’ she said. ‘Her friend,’ he said. ‘I’m Sarah’s partner, her friend.’ His voice was deep and hoarse, a smoker’s voice. ‘She can’t talk,’ he said. ‘She’s too scared, she won’t be able to answer any questions, you’ll have to ask me. I’ve seen the nurse and she said it would be OK.’ Well, Chrissie thought, did she indeed, and flushed with irritation. She’d been going to start by saying she had good news, the tests were clear, but instead she said she’d like to examine Ms Nicholson, so would she slip her robe off. The woman went on weeping and the man who, Chrissie suddenly realized, had neither given his name nor been asked for it, helped her remove her robe. ‘Just try and relax,’ Chrissie said, but now Ms Nicholson was shaking as well as sobbing. ‘There’s no need to be frightened,’ Chrissie said, ‘the tests were clear, I’m just having a last look and then you can go.’ ‘It’s no good telling her that,’ the man said, ‘she’s got herself into such a state.’ Chrissie didn’t reply. Instead, she indicated with a nod that he should move, but he misunderstood the gesture and thought she was trying to send him out. ‘I’m not leaving her,’ he said loudly. ‘I wasn’t asking you to,’ Chrissie said. ‘I only want you to move to the end of the bed.’ Reluctantly, he let go of Ms Nicholson’s hand, saying, ‘I’m still here, darling.’ It was ridiculous. Of course he was still very obviously there. Then he blew her a kiss.
She felt him scrutinising her all the time she was carrying out her examination. Every time she uttered a reassuring ‘good’ or ‘fine’, he echoed her, repeating the words with great emphasis, and adding, ‘There you are, darling, everything’s fine.’ The tears did not entirely dry up but they were less plentiful. Chrissie was palpating Ms Nicholson’s breasts and looking at the nipples. They were quite unlike Mrs Yates’s. They were tiny, pale pink, very pretty, like the furled buds of wild roses, the sort entangled in hedgerows in June. There was nothing wrong with them, no sign of any discharge or crustiness. She felt the cyst Wallis had noted, but then, higher up the breast she thought she felt something else. She let her fingers circle the whole breast again before returning to it. It was small, much smaller than the cyst. She asked Ms Nicholson where she was in her menstrual cycle. The man replied that her period was due in a couple of days. If Wallis had been in the clinic she would have gone to get him, but he wasn’t and the decision was hers. ‘Look,’ she said, speaking directly to her patient and ignoring her male mouthpiece, ‘it’s probably nothing again, but I’d like you to come back . . .’ But before she could explain why, Ms Nicholson started to scream and the man rushed back to her side and flung his arms round her, pushing Chrissie out of the way so that she banged into the thin partition with the next cubicle. She was furious. ‘There’s no need for this,’ she said, but the couple were locked in each other’s arms. Chrissie took a deep breath. She wasn’t going to order another mammogram or a blood test. The way to resolve this was with a needle biopsy. It was maybe an extreme measure, but the patient was neurotic and hysterical, and the new lump did seem suspicious, much more so than the cyst. She must become brisk and sound confident and efficient. ‘If you’ll get dressed,’ she said, ‘the nurse will give you an appointment for a needle biopsy. It’s a simple process and . . .’ But at the word ‘needle’ Ms Nicholson said she was going to be sick, and Chrissie grabbed a dish and offered it to her. She wasn’t sick. Chrissie carried on with her explanation and the man asked if the biopsy couldn’t be done now. ‘She can’t stand the waiting,’ he said. But it couldn’t be, not today. Chrissie said so, and the two of them shuffled back into the changing part of the cubicle, the man holding Ms Nicholson as though she had just had a major operation.
Chrissie stood in the passageway, leaning on the shelf, her head in her hands. She’d mismanaged the whole business. Everyone would’ve heard the commotion, and there would be questions to answer from Sister Butler and Andrew, but what appalled her wasn’t the shame she felt but the antagonism towards Ms Nicholson and her partner. It was bad, it was unprofessional. What was happening to her, that she couldn’t deal with such situations? But the next patient was waiting. She needed to study her notes and carry on. She must not be agitated. Most patients were not like Ms Nicholson. They were stoics, the majority of them, they put up with things, they were humble and deferred to her knowledge and training, and most of them never queried what was said to them. She had marvelled often at the acceptance with which her words, whatever they were, were greeted. Fear made patients timid, usually. Mrs Morgan was very timid. Chrissie remembered her. She’d seen her six months ago. Nice woman, mid-fifties, doing well. No need to fear Mrs Morgan. She smoothed her hair down, dabbed her face with a tissue, wiped her hands on another, and went into cubicle one again, smiling.
*
Smiling, always smiling. Didn’t fool anyone. Rita wondered if Chrissie Harrison ever looked in a mirror and saw how strained her smile appeared, how much the smiling mouth was contradicted by the worried eyes. She was nice, well liked, but she was pitied too. Something pathetic about her. She was always so anxious, always checking and rechecking things. Rita got tired of it. She felt she wasn’t trusted to do her own job properly.
She’d known there would be chaos this afternoon. Inevitable. Full clinic, no Mr Wallis, no Dr Cohen. The moment she’d arrived and unlocked the door to her little area she’d anticipated trouble. A woman was already there. It annoyed Rita. There was being early and there was being absurdly early. The woman knew the routine. She let Rita get settled before walking up to the reception desk – well, it wasn’t a desk, it was a counter – and handing in her card, then she returned quietly to her seat. Rita got organised. She sat facing the clinic on a chair that had wheels so that she could swivel backwards and forwards as she needed to. Her computer was to her right, the telephone to the left. She always let it ring seven times before answering. It was her system. Even when she wasn’t doing anything she never answered it instantly – it only encouraged people to imagine she had nothing better to do than answer their calls. Sometimes, patients would stare at the ringing telephone and Rita could sense them willing her to answer it at once, but she rarely obliged. If a patient came to hand in her card, or to ask something, Rita always put the patient first. A receptionist in such a clinic had to have standards, and Rita had them. Small things mattered, she knew that. Some of the doctors didn’t, they didn’t realise how being offhand could hurt. Chrissie Harrison knew, but even she had her faults. Weak, she was weak, could let certain patients dominate her. Rita never let that happen. Sometimes patients, or more often their companions, would stride up to the counter and complain loudly about how long they had waited. They could be abusive, but Rita remained polite and calm at all times. She explained, she apologised, she reassured. That’s all it took to defuse most situations, a bit of kindness, a bit of understanding. Allowances for bad temper had constantly to be made, and she made them. Compassion, she liked to think, was her middle name.
It was put to the test on days like this one. By 2.30 p.m., half an hour after the first person was supposed to have been seen, every seat in the clinic had been taken, and two people (men, so not patients) were standing. Rita surveyed the scene before her with an experienced eye and calculated where trouble would come from. The truly terrified patient had a way of sitting which she had learned to recognise. It wasn’t the one in the buttoned-up raincoat, the woman whose back was rigidly straight, and knees pressed together, who might faint or have hysterics, but the overly casual one, trying to look as though she hadn’t a care in the world, the one sprawled in her seat whose fingers endlessly plucked at each other. In a minute
she would get up – she promptly did – putting her bag on the seat, and walk to the notice board where she would read the posters about Art Therapy and the Befriending Service and the details of the Cancer Bacup freephone. She’d read them twice already and, Rita was prepared to bet, hadn’t taken a word in. She might be the one who in another half-hour, if she wasn’t called, would come and burst into tears in front of Rita. Or it might be the man accompanying the woman with the neck bandage who would come. He would be angry. He would harangue her in a fierce whisper about how scandalous it was to keep patients in his wife’s condition waiting. Others would follow him but not be so much angry as worried. There were buses to be caught, work to be returned to, children to be collected. People came from so far away to this hospital, it wasn’t easy for the majority to come and go. Rita bore that in mind. She came a considerable distance herself.
Today, though, she hadn’t had to bother with two buses. She’d got off the first to catch the second, which went from the same stop, and Mrs Hibbert had offered her a lift. Rita hadn’t thought the car was stopping for her, and had looked around to see who was going to be lucky. But Mrs Hibbert (whose name she didn’t at the time know, though she knew her by sight) lowered her window and said, ‘I know you’re going to work at St Mary’s, would you like a lift?’ She’d been delighted to accept. They’d had a nice chat on the way in. Mrs Hibbert introduced herself and said how long she’d been a Friend, and Rita responded with similar information about herself. She said she admired what the Friends did, and Mrs Hibbert said it was nothing, she just wanted to help. Rita confided that her husband was always trying to persuade her to be a receptionist somewhere that paid better, in a hotel or a health club, but she loved the hospital and wouldn’t think of it. Mrs Hibbert was glad to hear this. She said it restored her faith in human nature. Rita felt a little uncomfortable, wondering if maybe she had boasted about her own virtue. They moved on to discussing the state of the hospital, agreeing that the fabric of it was in a deplorable state, and that the building of the new one couldn’t happen soon enough. They were in perfect accord about Rita’s clinic, how shabby it was, how inadequate in every way to deal with its particular patients. Mrs Hibbert said that if she won the lottery she would spend some of the money on the clinic, and for the last few miles they vied with each other in suggesting improvements: sofas, new carpet, soft lighting, pretty pictures, fresh flowers, a fish tank maybe, glossy magazines – oh, they had such fun.
Is There Anything You Want? Page 3
