A and E was obviously even more hectic than her own ward. She hovered in the doorway for a moment, staring round, all her confidence draining away through her feet, and felt that hateful feeling in her belly come back; it was awful to get so scared when all she was doing was the work she so much wanted to, ever since she had been so very young, and she drew a deep breath and walked in, pretending she had every right to be there. Which of course she had, though it didn’t feel that way.
She managed to stop one of the second years she knew by sight from the dining room and whispered, ‘I’ve been sent down from Annie Zunz to collect a patient — can you tell me where —’
‘Oh, lumme, don’t ask me, ducks,’ the second year said and rubbed her face with one hand leaving a streak of bright yellow skin lotion there. Her hands were covered it and it smelled powerful and Suba managed not to wrinkle her nose in disgust. ‘I only work here don’t I? It’s been like Paddy’s market all morning. Look, try Sister — it’s all right — she won’t bit. Not hard anyway.’ And she hurried away, leaving Suba to weave her way through the crowded waiting benches to the cubicle at the far side where Sister was standing talking with one of the doctors. He was tall and burly and very black and wore his stethoscope hanging round his neck sideways instead of the usual collar fashion. Suba thought that he looked very dashing and thinking about that gave her the courage to walk right up to them.
‘Of course he has to be admitted, Sister,’ the black doctor was saying. Suba liked his voice too; very deep and rich and with the sort of accent you only ever heard on the BBC news. ‘It’s undoubtedly strangulating. We might be able to get it down without surgery but there are no guarantees. I can’t think what the problem is. If a strangulated inguinal isn’t a surgical emergency, what is?’
‘It’s Mr Goodman Lemon’s take-in day, that’s the trouble,’ Sister said with an air of distraction. ‘If you can just hold him till tomorrow, when it’s Alan Kippen, I doubt we’ll have any problems. But Lemon’ll raise the roof if I just admit him. He made it very clear to me that he’ll insist on blood tests, and if they’re positive — well, let’s just say he said I should arrange for them to be done before I sent up any doubtful patients. I told him that has to be someone else’s responsibility. I can’t do it, not off my own bat. But he was adamant. So there it is. If I admit one of them for surgery through this department I have to let him know personally and once I do there’ll be all hell let loose, which is rough on the patient. Do me a favour, Mr Monsarrat, and hold him for twenty-four hours on outpatient observation. If you still want him in tomorrow then I can take him —’
‘I want him in now, Sister,’ the doctor said. ‘I’m not being responsible for sending home a man with a lump like that in his groin that I can’t reduce. I’m sorry about the fuss Mr Lemon might make but there it is. The man’s a —’ For the first time he seemed to be aware of Suba standing near to them and his voice dropped. ‘I wonder what Lemon’d do if he were working in Cameroon or Zaïre where I was? The incidence there is much higher — and it’s both sexes, everyone, everyone. None of this nonsense there. Well, anyway, Sister, I’ll arrange the admission and the wretched test. You send him up. And I’ll tell him —’ And he went into the cubicle alongside with a swish of the curtain, leaving Sister standing staring anxiously after him.
‘Please, Sister,’ Suba ventured. ‘I’ve come for the patient for Annie Zunz. Sister said that I was to —’
‘Hmm? Oh yes —’ Sister looked as though she hadn’t heard a word Suba had said, but that was misleading, because she turned then and took her to the corner cubicle. ‘In here. Her name’s Roberts — Prue Roberts,’ she said. ‘As soon as I can find one, I’ll send one of the porters. Thank Sister Morgan for sending you, will you? I haven’t a single nurse to spare —’ And she went away, her heels thudding on the terrazzo floor, leaving Suba to look down at her patient, asleep, or so it seemed, on the cubicle couch.
Her first thought was that she had never seen anyone quite so pale. The woman’s face looked more than white; it seemed deeply bleached as though even inside the darkest places of her body she was pallid. Her eyes were partly closed with a line of the white showing beneath each puckered lid, and she was breathing rapidly and shallowly. Suba stared down at her and then at the bag of blood which dangled beside her, dripping quickly into the connection to the tube which snaked down to the back of her hand. The cubicle couch was tipped so that the woman’s head was lower than her heels and that had the effect of crumpling her face as the pull of gravity dragged her cheeks up to the level of her lower lids. Clearly she was very dehydrated for her skin looked pouched and saggy, even though she was quite young. How young Suba couldn’t be sure but there was no question in her mind that the woman was far from as old as she appeared at first glance.
A nurse put her head through the curtains and said, ‘You all right? Keep an eye on that drip — make sure it doesn’t slow down. She needs all the blood she can get, as fast as possible. Check her pulse every five minutes too, will you? We’ll get you on your way to the ward as soon as we can. Sister said to hold on — she’ll send a porter in a minute, but the only one on duty’s holding down a drunk over the other side. Call me if you need me —’ And the nurse disappeared before Suba could say anything.
And the thick frightened feeling inside her got thicker and spread further as she looked again at the pale woman on the couch and the dripping blood bag. All round her she could hear the roar and clatter of the busy department: voices shouting as well as talking, the rattle of trolley wheels and instruments and the occasional hiss of oxygen cylinders. And yet she had never felt so alone in all her life. There was just herself and this pale woman for whom she was responsible. It was dreadful.
Tentatively she reached for the woman’s wrist to find her pulse, and then the fear grew even more for she couldn’t find it at all, and in a sudden panic she scrabbled at her, trying to find it, and the woman’s arm flopped to the side of the couch and Suba wanted to scream. Was she dead? Had she been standing here watching a woman die and done nothing about it? Not that she could do anything to stop people dying; how could she, a first year with only a handful of lectures behind her and a few classroom demonstrations to back up her few days of work on Annie Zunz Ward? There’d been no dying patients in the classroom to save, so how could she have learned how to do it? And she felt tears begin to choke her as once again she reached for the dangling wrist to try desperately to find that pulse before running to fetch Sister. And this time she felt it, thin and swift beneath her middle fingertip and relief swept over her so lavishly that she felt dizzy with it and could have hugged the silent figure on the couch. She held on to the pulse for a long time before managing to take her watch from her breast pocket to start counting, and even then counted for far longer than she usually did: a full minute. She bit her lip anxiously because it was so fast. A hundred and eighty, whispering away against her fingertip at such a rate and so feebly that it was hard to count individual beats.
But at least she was alive and it was possible for Suba to stand there and let the fear ebb away a little, and as she waited for the porter, her eyes on the dripping blood and her right-hand middle finger still held over the woman’s pulse, as though holding it there like that would prevent it from stopping its headlong rush of beating, she could hear other things around her.
Mostly the voices coming from the adjoining cubicle separated from her and her patient by just a curtain. There was the nice voice of Mr Monsarrat and another voice, higher and more fluting and as she listened she thought — He sounds like someone I’ve heard before, and puzzled about it for a moment, and then even managed to smile a little as she realised who it was. He sounded like Larry Grayson, the comedian who always made her laugh a lot — though Daddy didn’t like him much — even though he didn’t have the same sort of accent at all. It was more the way he made his voice swoop and seemed to put some of his words into big capital letters with fat exclamation marks after them.
‘Well, honestly Doctor, what would you have done?’ he was saying. ‘There I was minding my own affairs — well, you know what I mean, I’m sure — and there’s this huge extra one! Well, I’ll swear to you that’s what I thought! Who wouldn’t? And I said to my friend, will you just look at this, and well, he was in stitches, rotten devil. But then he could see it was serious and there you are, and here I am! Came here at once, of course. And I won’t pretend I’m not stirred up about it because I am. Here I am with a new shop opening in a matter of days, so help me, and more work to do than you could shake a stick at, and an extra bollock! What am I to do? Is it serious? Do tell me — I can take it, you know! Even if it really is an extra bollock, which I doubt a good deal —’
‘You have a right inguinal hernia, Mr Slattery,’ Monsarrat’s voice rumbled reassuringly and Suba lifted her chin, suddenly pleased with herself because she understood what he was talking about. A loop of intestine sliding down into —
‘That means that a loop of intestine has slipped into the gap down which your right testicle came from your belly, originally. They develop inside the belly about here, do you see, and then at or around birth migrate down into the scrotal pouch, here. But the gap that is left behind in some men is rather larger than it might be and if a loop of intestine slips in, that’s a hernia. Generally the hernia can be reduced — that is, the loop can be gently pushed back into the place it should be —’
‘Ooh, don’t I know it!’ Slattery’s voice came a little breathily. ‘Been dealing with that for years — but it’s never been that bad. I mean, no pain or anything, just a little bulge sometimes to be pushed back. But nothing like this! Dreadful, this is. And this does hurt — and getting worse —’ His voice sounded less cheerful than it had, Suba thought. I dare say he is hurting a bit now —
‘I’m sure,’ Monsarrat said. ‘Yes, I’m sure it is. I suspect we’ll have to reduce this surgically to make sure the loop of gut doesn’t get so pinched that it’s permanently damaged. Don’t want that to happen. So we’ll take you to the ward and keep an eye on you and if necessary sort out with the surgeons what’s to be done —’
‘Ooh, me under the knife!’ Slattery said and managed a fluting little laugh, but it was not very convincing to Suba on the other side of the partition. He’s scared, she thought. Well, of course he is. I’d be scared if I had to have an operation. And she looked down at her own patient and wondered if she would need an operation. At least she wouldn’t be scared. So deeply asleep — unconscious — as she was she couldn’t be feeling anything.
‘You’ll feel a lot better when it’s all sorted out, Mr Slattery,’ Monsarrat said. ‘Now, just a few things to see to first. I need some blood for tests —’
‘Tests?’ Now the patient’s voice sounded rather different. Sharper, and even more apprehensive, and Suba lifted her chin and wanted to say — It’s all right. I used to be scared of injections, but you get used to it. They made us practise on each other and you do get used to it — but the man’s voice came again, sharper than ever.
‘Just what tests are you planning to do, Doctor?’
‘Oh, blood tests you know,’ Mr Monsarrat said and Suba could imagine his face, shining black and expressionless, for his voice had seemed like that too.
‘Yes, but what for? Don’t I have to sign a form or something to give permission?’
‘Not usually for blood tests, Mr Slattery. Only for surgical procedures.’
There was a little silence and then Slattery said more loudly, so that it almost seemed to Suba he was in her own cubicle with her, ‘Well, I think that’s all wrong, frankly. I mean I think patients ought to know what tests are being done. And why. Will you tell me?’
‘Ah — haemoglobin in case you need transfusion,’ the doctor said. ‘To see if you’re anaemic, you see. And blood group so that we can match blood if necessary. Why? Are you a what-is-it — one of those who refuse blood transfusions?’
‘Me, Jehovah’s Witness? Not me! I ask you, Doctor, do I look the type? Hardly! No, I don’t mind blood transfusions. I just don’t want any other tests. Not unless I know what they are and why they’re being done. I’ve the right to say that, haven’t I?’
‘Er — well, I’m not sure.’ Mr Monsarrat for the first time sounded a little flustered. ‘We don’t usually discuss the details of tests with patients. It’s rarely necessary.’
‘I think it is.’ The jokiness had gone out of Mr Slattery’s voice entirely now. He sounded very determined. ‘I’ve heard of this sort of situation with one or two of my friends, to tell you the truth, Doctor, and I’ve made up my mind to it that I won’t be bullied the way some of them have been. If I need an operation, well and good, I’m prepared to have one. I’ll give all the necessary signatures for that and no messing about. But blood tests are something else.’
‘Why, Mr Slattery?’ Mr Monsarrat said softly.
‘Oh, come on, Doctor! You weren’t born yesterday! You must know the fuss some people make about — about some people!’
‘You’re homosexual, Mr Slattery?’
‘Is the Pope a Catholic?’ Slattery said. ‘Come on, Doctor, I’m hardly one of your all-time male hunks, am I? Everyone else I meet spots me the moment I open my mouth and I don’t give a damn. I am what I am and if they don’t like it they can get stuffed. But I’m not about to be bullied, and that’s the end of it. So no blood tests I haven’t agreed to. All right?’
‘Why not? Have you reason to suppose that —’
‘Oh, of course not! It isn’t that I think I’ve got it! Me and my friend — together seventeen years, we are, and fight like cats, but straight with each other, no matter what. I’ve no reason to fear. But I’m taking no chances. I’ve got to get a new mortgage on my shop and all sorts of money deals have to be set up — I’m taking no chances. So no test for this bloody AIDS, no matter what. Just get this extra bollock out of my way and let me get back to work, eh Doctor? Sounds reasonable enough, doesn’t it?’
‘I think so,’ Mr Monsarrat said after a long moment. ‘But I’m not the surgeon. Just the houseman admitting. Well, let’s get you into the ward, anyway. Who knows? It mayn’t come to surgery after all. Let’s just see how things go, shall we?’
And then the curtains of Suba’s cubicle parted and the porter was there with the trolley at last, so she had to go. But she wondered about Mr Slattery all the way back to Annie Zunz.
Chapter Eleven
‘I cannot of course be held responsible for any aspect of Mr Heme’s department and its work,’ Professor Levy said smoothly. ‘I’m just the Dean of the Medical School. My concern is with such matters as medical education and the provision of the doctors who will look after us all tomorrow. And as a physician, of course, I’m concerned about the welfare of my patients. But I have nothing to do with such things as closure of beds. Those major decisions are, I’m afraid, out of my hands.’
The big office showed every scratch of its yellowing paintwork, every film of dust on the shabby old furniture, as the sunshine picked out each and every detail with vivid cruelty, and he was glad of that. He didn’t keep his office looking like a sort of academic slum deliberately, of course he didn’t, but it helped when people coming to talk about money could see for themselves that there was certainly none wasted here. He could see from the way the people ranged in the half-dozen chairs in front of him had looked around when they came in that his message had reached them, for they looked alert but not hostile, and in a way pleased with themselves, as though they were thinking — Poor bugger — he’s no better off than we are.
They were the usual sort of mixed group demonstrations seemed to attract, a couple of blue-jeaned long-scarved students from the Poly up the road, a bunch of minor businessmen in well-brushed old shoes and seventies-styled suits, a gaggle of housewives in over-tight coats, and of course the woman sitting in the middle who was now leaning forward and looking at him very directly.
‘Out of your hands? But you’re
not just going to sit there and do nothing about it —’ A tall fair woman she was this spokesman for the group, raddled in a sexually interesting way, Professor Levy thought, looking at the way her long bony legs curled round each other as she sat on the edge of her chair as tense as the classic coiled spring, gazing at him with a fierce blue-eyed glare. ‘If you don’t take an interest, then who the hell’s going to —?’
‘I didn’t say I took no interest.’ Professor Levy was still as sleek as a cream pot. The whole meeting was working out exactly as he wanted it to. ‘Far from it. I just said that I can’t comment on Mr Heme’s threats to involve the police if you bring your picket line into the clinical areas of the hospital. However, there are certain sections of the premises that are under my jurisdiction. Mr Heme would be hard put to it to turn you out of the medical school area, you know. Hadn’t you thought of that?’
‘I don’t know the geography of this place as well as I might,’ the fair woman said brusquely. ‘I’ve been in and out of the wards, me and my kids, and the rest of the family, too, come to that, but —’
‘The Medical School, Mrs Blundell, is the building that runs along the other side of the courtyard from the Accident and Emergency department. It has its own alleyway leading out to Cornwall Street, you may have noticed, and anything happening in and around that area comes into my bailiwick. If you set your picket lines there, and indeed actually marched from the front to the back of the Medical School, you’d not only be seen by passers-by and — ah — be accessible to TV cameras and suchlike, you’d be clearly visible to the people in the wards. The main ward blocks look down on the other side of the courtyard, do you see?’ He smiled then and inclined his head towards his window through which the main ward block could be clearly seen over the way. ‘I’m sure the patients would be comforted to know how concerned you were for them. They could see you actually Fighting for their hospital and I’m sure that would encourage them immensely.’
Clinical Judgements Page 12
