Do Me No Harm

by Julie Corbin

  ‘I don’t agree with you.’ Her eyes were treacle pots of gloom. ‘And I don’t want to see you making a mistake.’

  I waited as she wrestled with her better nature. With three older brothers and already eight nieces and nephews, she had been brought up in an atmosphere where every child was a gift. I felt bad making her complicit in my decision, but I knew I couldn’t do this alone and neither could I tell Phil. I couldn’t risk him disagreeing with me, and without his support I couldn’t go ahead with the abortion. And then where would I be?

  I spent the next couple of days keeping the secret. I carried it off because I was utterly determined that this was my decision and I was not about to change my mind. I saw my GP and was booked into the hospital on the other side of town where nobody knew me, and anyway, I told myself, I’d be in and out in no time; there was no way that what I was doing could get back to Phil.

  I arrived at the ward for eight in the morning – Phil presumed I was off to work as usual – and Leila was taking the afternoon off to collect me. While I waited my turn, I watched a batch of first-year student doctors walk on to the ward, fold lines creasing down the front of their pristine white coats. That had been me several years ago, lit up with enthusiasm and an eagerness to learn. I’d got myself away from my mother and out of Ireland and was ready to follow in the footsteps of great men and women before me. I believed medicine was a noble profession, one that wasn’t entered into lightly, one that dealt with the sacred treaty that existed between health and sickness, life and death. Although I was no longer religious, I had a strong sense of the holy ghost’s presence in each one of us.

  And then it hit me. When I graduated as a doctor, I took an oath – First, do no harm. I promised that my actions would be directed towards healing rather than hurt. Was I only a doctor when I was on duty? These were ideals that I subscribed to – that, in fact, I felt defined me – and yet here I was, set to very deliberately put myself in the way of life. The more I thought about it, the more the idea permeated my resolve and stole away my clarity. I was setting out to kill a living creature, and not just any living creature – my own baby, Phil’s baby.

  But I’m not even ten weeks, I told myself. The heart isn’t beating. It’s less than two centimetres in size. It’s not viable, for God’s sake!

  No, it isn’t, another voice in my head said, but it will be.

  I wrestled like this for ten minutes and then, as the resident doctor approached, I grabbed for my clothes, fully prepared to make a run for it. ‘I can’t go through with the abortion,’ I said, afraid she’d tell me it was too late and bundle me on to the trolley anyway. ‘I’m so sorry for wasting your time.’

  Far from being irritated by my last-minute change of mind, the doctor smiled equably. ‘Good for you,’ she said.

  I took a taxi back to my own hospital and hunted Leila down. She was in the canteen, looking thoughtful, spooning yoghurt slowly into her mouth. When I told her I’d changed my mind she was overjoyed and jumped up and down, clapping her hands together. ‘I’ll get pregnant too and then we can go through everything together! Sore boobs, weepy moments, childcare. We can share all of it. Then it won’t be so scary!’ She put her arm through mine. ‘Our children will grow up to be friends. How good will that be?’

  I wasn’t happy with my decision. I still didn’t want a baby but I knew that unless fate lent a hand and I miscarried, I’d just have to accept it, and adapt my dreams accordingly. I knew I’d made the right decision for the baby inside me, but I felt miserable, sure that my life was no longer my own.

  As I expected, Phil was at first speechless and then delighted by the news. He thought I should try for surgery anyway, but in my heart of hearts I knew it wasn’t an option and all my surgical ambitions were abandoned.

  More than two months went by and I was starting to show. When I lay on my back and palpated my lower abdomen, I could feel the crest of my womb rising up out of my symphysis pubis. It felt solid, like the edge of a grapefruit. I was a doctor and I knew exactly what was happening inside me, from the anatomical to the biochemical, but still I couldn’t seem to visualise an actual baby. Worse still, I had a horror of being genetically incapable of loving a small baby; that I would hold it and feel nothing except the heavy weight of responsibility around my neck. I was afraid that I would end up like my mother, someone who expected too much from her children and who never listened, too obsessed with her own misery, her own lost dreams.

  I thought morning sickness was supposed to stop at around fourteen weeks, but I wasn’t that lucky and seemed to be stuck on a four-hourly cycle of vomiting. And I felt fatigued, deep into the very marrow of my bones. I wasn’t managing more than five hours’ sleep a night and fantasised about lying in my bed and never having to get up. My brain felt muddled, my back ached and the hours I spent on my feet made my ankles swell. I would have described myself as a zombie if it weren’t for the fact that I was experiencing so much discomfort. I looked back down the centuries, at women who worked in the fields until they gave birth and women today in developing countries who did the same, and I wondered whether I was just a wimp and a weakling, a whiner who wanted what she couldn’t have and was too self-absorbed to appreciate the blessing she’d been given.

  And then one day came my wake-up call. It was Sunday evening, and we were approaching the end of a long and gruelling week. Two patients in their thirties had died, both from cerebral aneurysms. Being witness to their declines and to their families’ grief took its toll on the morale of both nursing and medical staff, and there was a heavy feeling in the air. The other patients, although unaware of the details, picked up on the grave mood and several of the post-op survivors sat in their chairs, heads bandaged, drip stands like sentinels beside them as they stared out at the relentless rain.

  Around teatime, I took a phone call concerning a patient who was being transferred from another hospital. The doctor couldn’t tell me much, except that the woman was named Sandy Stewart, that she had raised intracranial pressure, some of her motor responses were compromised and she had extreme headaches and vomiting. ‘Oh, and I almost forgot, she’s pregnant,’ the doctor told me. ‘Thirty-two weeks.’

  I phoned my registrar who was also on call that weekend but had gone home because he was coming down with the flu. ‘Book her in,’ he told me, through a thick, phlegmy throat. ‘She’ll be seen on the round tomorrow.’

  So it was me who was waiting to greet her, the most junior doctor representing the team. I stood by the lift doors as it clanked and rumbled its way up to our floor. Sandy Stewart was lying on the trolley, an ambulance man on one side, her husband on the other. She was tiny, her body almost pre-pubescent, apart from the small baby bump just visible through the sheet that covered her. The skin under her eyes was black from lack of sleep. Her hair was a dirty blond colour and had long outgrown any styling it might have had. It was clear that, in recent weeks, she hadn’t had the time or energy to care for herself but, in spite of all this, she was smiling.

  ‘I’m Dr Naughton.’ I held out my hand and she gripped it with both of hers. ‘You must be Sandy.’

  The staff nurse and I settled her in a bed in one of the single rooms. ‘I’m glad to be getting a diagnosis at last,’ she said. ‘I’ve been throwing up nonstop and everyone kept on telling me it was morning sickness, but I knew my baby couldn’t be doing this.’ She stroked her stomach. ‘And the headaches have been awful.’

  I felt ashamed of all my complaining. I was only pregnant. Sandy Stewart, on the other hand, was housing a tumour the size of a tennis ball inside her skull, encroaching on her brain, altering its structure and affecting its function. Prognosis wasn’t good. The tumour was fast growing and the space it was occupying had reached critical point. On the Monday, after Professor Figgis read the scans, he told her she had two options: leave the tumour alone or operate. Either way she wasn’t set to live very long, but reducing the size of the tumour might just give her six months or a year.

&nbs
p; ‘I want to see my baby. That’s all I want.’ She smiled up at us. ‘The miracle of life; it’s so marvellous isn’t it?’

  Professor Figgis explained to her that the obstetrician was willing to induce her at thirty-four weeks and so a compromise was reached. Sandy would stay on the ward for two weeks, being supported with fluid balance and anti-emetics, and then her baby would be delivered. She would be able to hold the baby and spend a few days with him or her before the surgery was performed.

  The next morning was Tuesday and we were chronically short-staffed. The registrar was still absent with flu and Professor Figgis was lecturing in Glasgow. That was bad enough, but the resident doctor on the neighbouring ward was also off sick, so I was down to cover his duties as well. I knew I’d have to race around the ward, and still never catch up, but when I visited Sandy’s room to take blood, she was in the mood for a chat.

  ‘I don’t want to be nosy but . . . you’re also pregnant, aren’t you?’

  ‘Yes. I’m five months now.’ I attached a tourniquet round her upper arm. ‘Not quite as far along as you.’

  ‘And is it your first baby?’

  ‘Yes.’

  ‘Have you been getting the room ready?’

  ‘Not yet, but my sister-in-law is busy knitting for me,’ I told her, feeling for a vein. ‘I’ll have enough layettes to kit out sextuplets.’

  She started telling me about the preparations she’d made. The room had been ready for months: painted apple blossom white, decorated with mobiles in primary colours and pictures to interest a new baby, plus nappies and a changing mat and all the other paraphernalia that goes along with caring for a newborn. ‘We’ve been trying to get pregnant for almost ten years and finally it happened,’ she told me, exuding a joie de vivre that coloured the air sunshine yellow.

  ‘Do you know the baby’s sex?’ I asked her, the four bottles on my tray now filled with blood.

  ‘No. We want it to be a surprise. But still I spend a lot of time imagining what he or she will look like.’ She gave an apologetic laugh. ‘I think my baby will have laughing eyes, a small nose and smiley cheeks with dimples.’ She laughed again. ‘Trevor says the baby might not be attractive at all. It might be wrinkly and birth-marked and cry all the time but, really, I don’t mind, because I know that this baby will be the best thing that’s ever happened to me.’ She leant back on the pillow and gazed up at the ceiling. ‘If it’s a boy we’ll call him Michael and if it’s a girl we’ll call her Kirsty.’ She gave a dreamy, contented sigh. ‘I mean a baby? Can you imagine?’

  I smiled. ‘Actually, I can’t. I’ve been trying but I just can’t.’

  She talked some more, and her absence of trepidation about her health during the weeks ahead made me wonder whether she understood what the professor had told her. Her husband Trevor, on the other hand, was tense and worried, and I knew that he was under no illusions about what the future held.

  Later the same day, and desperate for an afternoon nap, I stood in the treatment room and made up the intravenous drugs, taking vials of steroids or antibiotics from the fridge and injecting them into one of the fifteen 100-ml bags of saline that I’d lined up in front of me. I stuck a drug and patient name label on the front of each bag, specific to the patient for whom the drug was prescribed. While I was doing this, I was interrupted three times to deal with issues on the ward. Half of the nursing staff, including the ward sister, were off sick, and a junior staff nurse, as yet unsure of herself, was in charge.

  In retrospect, it was so obviously a recipe for disaster, but I didn’t see it at the time. I was simply moving from one task to the next, rushing to get everything done.

  During the two o’clock drug round, Sandy was due to be given one of the bags of saline with added steroids that I had prepared earlier. It was put up by one of the nurses, exactly as written on the drug chart. Within five minutes I was called to Sandy’s room because she was experiencing severe itching and urticaria. Her skin was bumping up and reddening before my eyes. But worse than that was her compromised breathing. Her lips were blue and a wheeze sounded in her chest. I could see that she wasn’t getting enough oxygen into her lungs and it was growing worse by the second. She was experiencing all the classic signs of an acute allergic reaction, most likely caused by the fact that she had been given an IV dose of a substance she was allergic to. I checked the IV bag and the label and the name of the steroid. Nothing wrong there. She couldn’t be allergic to this; she’d had it several times already with no ill effect. My mind spooled through other options and then realisation hit me hard. All the interruptions, my tiredness and lack of concentration – I must have labelled the bags wrongly. I was the doctor who booked Sandy Stewart in so I knew about her penicillin allergy, and two of the bags I made up had penicillin in them.

  Shock cracked through me like an earthquake and the baby dropped down in my womb, the head pressing on my bladder. I’d made a serious error and I needed to reverse it – now and quickly – before Sandy grew any worse. Hands trembling, I stopped the IV and asked the nurse to call the crash team while I gave Sandy an injection of adrenaline. Within seconds she was breathing more easily but I saw something in her eyes that I hadn’t seen before – an accelerating sense of the inevitable.

  ‘Sandy!’ I held her hand. ‘Doctors are on their way. We’re going to get you better.’

  I could see she didn’t believe me and I had no idea what to do next. I had never felt less like a doctor. My limited understanding of neurology had shrunk to nothing and my mind was a blank page when I tried to calculate how this allergic reaction was affecting her already damaged brain.

  Sandy held my hands tight and stared into my eyes, grabbing for my full attention. ‘Make sure they do everything they can for my baby,’ she said, her nails digging into my skin. She was struggling to breathe again and I tried to pull away to draw up some more adrenaline but she held on tight. ‘And Trevor. Tell him I love him.’

  By the time the crash team arrived Sandy had lost consciousness and I was ready with a second syringe of adrenaline. The doctor in charge was from another neurosurgical ward and he tried one treatment after another, but with everything else her body was going through, the chances of saving her were reduced. An emergency Caesarean section was performed and the baby, only three pounds in weight, went straight into an incubator. When the doctor recorded Sandy’s time of death, there was a hush in the room and one of the junior nurses started to sob.

  I took refuge in the toilet. It was as good a place as any to examine the enormity of my incompetence. I sat on the toilet seat in a locked cubicle, unable to come to grips with what I’d just done, my thoughts revolving in a tight circle of horror and disbelief.

  Eventually I had to come out and by now the ward was trying to get back to some sort of normality. Patients were having their evening meal and Professor Figgis had returned from Glasgow and was telling Trevor Stewart that his wife was dead. She had passed away in a flurry of medical intervention, none of which worked. And the baby wasn’t doing too great either. Unable to breathe for itself, it was immediately whisked off to Special Care. I hadn’t even had the chance to see whether it was a boy or a girl, mired as I was in trying to keep Sandy alive.

  I wasn’t brave enough to meet Mr Stewart, so when he was finished talking to the professor and he came on to the ward, I hid in the treatment room, my head close to the doorframe, and squinted through the crack. His skin was white, his eyes stared straight ahead, unseeing and unresponsive. The nurses had packed Sandy’s belongings into several bags that he lifted wearily from her bed, already stripped of all evidence that she was ever there. I watched his back as he walked towards the lift, stooped like an old man. Suffering had aged him.

  Professor Figgis called me into his study, directing me towards an upright chair before he sat down behind his desk, leaning forwards on his elbows, his hands clasped together. A late afternoon sun warmed the room with a bright light that had me shielding my eyes. I told Professor Figgis th
e story from start to finish, holding nothing back and fully expecting to be fired on the spot. He listened, his expression serious, as he agreed that I’d made a terrible mistake.

  ‘I’ll write a letter of resignation,’ I said, the words cutting me in two.

  ‘What good would that do?’ His tone was firm. ‘You’re a young doctor with a promising career ahead of you. Doctors sometimes have to learn the hard way and you have been both foolish and unlucky.’

  ‘But what about Mr Stewart?’ I moved my head over to one side to try to escape the sun, my hand still shielding my eyes. ‘Does he know what happened?’

  ‘Mr Stewart knew his wife was terminally ill and nothing you or I could do was going to change that.’

  ‘Yes, but—’

  ‘Your mistake was in not recognising your own limitations.’

  ‘I should have asked for help.’

  ‘You should have,’ he agreed. ‘But we have been uncommonly short-staffed so it’s no wonder that you didn’t.’

  ‘I understand that I can’t make it right but—’

  ‘We’re not gods, Dr Naughton. We can’t fix the unfixable.’

  ‘I know, but surely if I was honest then at least—’

  ‘At least what? She’ll rise again like Jesus? And it will all be better?’ He shook his head at me, his expression resigned. ‘She had a Grade IV astrocytoma. She shouldn’t have died today but she was most definitely going to die at some point over the next couple of months.’

  ‘But I accelerated her death,’ I said, still squinting against the light, my eyes filling with tears. ‘I killed her.’

  ‘You’re a human being, Dr Naughton, and there isn’t a doctor out there who hasn’t made a mistake. I was mentored by Professor Lewis Markham. You’ll have heard of him?’

  I nodded.

  ‘He told me once that a doctor was never really a doctor until he had killed a patient. A dramatic statement, maybe, but unfortunately, there’s often truth in it.’ He turned behind him and adjusted the blinds, shutting them almost completely until the light could only filter through in centimetre strips, drawing lines across everything in the room. ‘Today you’ve learnt that you are fallible.’