Clinical Judgements

by Claire Rayner

  ‘Sister, don’t go!’ Kim reached out and held on to her and Esther looked down at her more sharply, for the hand was moist and a little shaky. She reached for the pulse and stood there with it thudding under her fingertips and then reached for the thermometer in its little cup on the wall at the head of the bed.

  ‘And what have you been up to to get yourself so overheated?’ she said as she slid the glass tube under Kim’s tongue. ‘Your wound’s nice and clean and your output seems all right. Are you drinking enough?’

  Kim nodded, still staring up at Esther with imploring eyes, and then as Esther took the thermometer from her mouth and twisted it to read it, she burst out, ‘I’m so worried, Sister! Tell me what to do!’

  ‘Worried about what?’ Esther put the thermometer back in its cup. Only half a degree up; not enough to get really bothered about. It was excitement that had caused the fast pulse and the hot hand, not a fever. Something to be grateful for; the last thing they wanted was another bout of theatre infections. She remembered all too well what hell it had been the last time that had happened.

  ‘I — it’s so hard to explain. But — well, money, I suppose.’

  Esther cocked an eyebrow. ‘My dear Kim, aren’t we all worried about money? I wish I had enough. I doubt you’re that much worse off than the rest of us. You’ve got a good job, haven’t you? And no one to depend on you? Or have you been spending too much on fripperies?’ And she took one of the frills of Kim’s pink silk bedjacket and slid it between her fingers. ‘This must have cost a bomb.’

  ‘It did,’ Kim said mournfully. ‘I thought when I bought it I’d have no problems — but the thing is, I got this awful letter. The day before yesterday.’ Her eyes filled with tears again and she looked more woebegone than ever as she held the letter out to Esther. ‘I mean, right after my huge operation a letter like this! What am I to do, Sister? What on earth am I to do? I’m desperate! I’ve got the mortgage to think of and the insurances and all that, and I’m behind as it is, and I’d meant to have a lovely convalescent week before I went back to work — oh, Sister, what shall I do?’

  Esther had been reading the letter, and now she folded it and gave it back. ‘Oh, Kim, I am sorry. Who is this Morris?’

  ‘He’s a shit, that’s what he is!’ Kim said hotly. ‘He’s always been after me, but I thought — I had old Mr Morris on my side, you see. This one’s uncle. As sweet an old man as you ever met. Live and let live, that was his motto. He always said I was good at my job, he liked my stuff, so he said it made no odds to him what else I did and let me stay on when I started my change. But now this! That bastard Ian, he’s always been after me. Not like Mr Lew —’

  ‘Well, maybe it is as he says, Kim. If they’re changing the sort of merchandise they’re making and your designs just don’t fit in — I mean, you’re a very — well, you have a decided taste of your own, haven’t you?’ She tried not to look disapprovingly at the pink silk and its lavish lace trimmings. ‘But surely you can go somewhere else? It might be better at that —’

  ‘Somewhere they don’t know about me, you mean? I should cocoa! Listen, Sister, the rag trade’s like a village. A bloody village. Everyone knows everyone else’s business, take it from me. There won’t be a firm anywhere from Great Titchfield Street to Margaret Street and back who won’t know all about me. And what’s worse, more than there is to know. They’ll tell such lies about me no one’ll dare to take me on. I needed this job — oh, Christ how I needed it! I won’t get another that easy —’

  ‘Well, I’m not sure what I can suggest —’

  ‘Do you know anyone that’d lend me money?’

  Esther lifted her brows. ‘Me? Where do I know people with money?’ She made a face. ‘My husband’s a businessman, Kim, so I know how tough it is to get money even to run a business. Let alone for your own personal use —’

  ‘I meant for my own business. I thought maybe —’ Kim stared up at her again, once more producing her pathetic look. ‘I’m ever such a good designer, honestly I am. I understand what it is people like me need and there are ever such a lot of us. I thought, if I could borrow enough, I could start my own business, sell the stuff mail order maybe, to start with, and then get a shop of my own somewhere. I could pay it back in a year or two, I’m sure I could —’

  ‘Listen Kim, if I had enough money to start a business, I might start my own,’ Esther said and shook her head. ‘I wish I could help, but truly —’

  ‘Then I’ll have to do it,’ Kim murmured, and Esther said, ‘Do what?’

  ‘Oh nothing. It’s just that — well I thought if I could get some money quietly I would. But there’s another way I might be able to do it. It won’t be nice, but there —’

  Esther had reached the end of the bed, on her way back to her piled-up paperwork, but now she stopped. ‘What do you mean?’

  Kim wouldn’t look at her now, just sitting there in bed with her head bent. ‘It’s nothing, Sister. Thanks for letting me sound off. I just thought — well, it’s not important. Do you want me to get up now? I’ll have a try if you do.’ And now she did look up and smiled bravely at Esther, who stood for a moment longer and then said briskly, ‘I’ll send the little first year, Sian. She’ll help you. And make sure you don’t make too much fuss and disturb Jenny. She’s resting.’

  ‘I won’t, Sister,’ Kim said and smiled at her and she went away thinking — I must have a word with the social worker about her. See if she can sort things out. But before she got back to her desk she was waylaid by Mr Le Queux, complaining bitterly about the way his patient, Jenny Caversham, had been seen by Miss Sayers this morning after her dialysis had run into trouble. Why had she been sent for, and why had Sister not notified him and —

  Esther sighed and readied herself for a long fifteen minutes trying to soothe him. It was the only answer she had found over the years of dealing with him; most of the time he was harmless enough, as long as everyone fussed round him, but every so often he found it necessary to jump on his highest horse and then it paid to coax him down with the most honeyed words she could find. Today it wasn’t easy, because she was irritable anyway, but she had the wit and foresight to know that if she didn’t make the effort she’d pay for it heavily in the future. So, she sent for coffee and biscuits for him and led him into her small office to explain.

  Kate by this time had left the ward to do her outpatient clinic and Esther was glad of that, though she would have liked a chance to talk to her before she went, just to make sure they were friends again. It was miserable when they were snappy with each other; life was complicated enough without that. And Esther badly needed the chance to talk to her about Richard, and what she should do about his nagging. It would be so much easier to give in and become what he wanted her to be, a restaurateur with him. But she’d miss Old East abominably. Or would she? She really needed to talk to Kate.

  But first, Le Queux, and she settled now to explain to him how she had told her night staff only to call him out if it was really essential to disturb him.

  ‘I always say, sir, that it’s a waste of time to make you come if we can deal with it without bothering you. Even for your patients. I mean, you have a list this afternoon and it would never do to lose your sleep before you operate, would it? You’ve told me that yourself. Well, clearly the staff nurse on last night understood that much but instead of checking with me about how to deal with the matter of Jenny’s thrombosed fistula she called Miss Sayers. I think she gets mixed up, actually.’ Now she played her trump card. ‘I’m not sure she realises that Miss Sayers isn’t — er — your registrar.’

  As she had known he would, Le Queux bridled and then preened a little. He had fought tooth and nail, Esther knew, to block Kate’s appointment to the junior consultancy. He’d wanted an older man, and one of his own kidney, a bad joke that had gone round the hospital like wildfire at the time. When Kate had got the post he’d been furious. Now to hear her described as little more than his registrar helped a lot and
Esther watched him go marching self-importantly down the ward to start his round with a slight tinge of guilt. I really must call Kate and tell her what I did. She’ll laugh, I know. I mean, I hope she will. Oh, damn. This is turning out to be a pig of a day.

  But it still wasn’t over. At half past twelve, just as they were up to their eyes serving the lunches with two orderlies short because of the loss of the stupid one this morning and the refusal of any of the others in the hospital to take her place, and a threat to turn the whole episode of the misplaced bacon and eggs into a Union issue, a patient arrived in a wheelchair from Psych accompanied by an anxious-looking young first-year boy.

  ‘Please, Sister,’ he said. ‘Staff Nurse said I was to bring Mr Lloyd for his cystoscopy, and that I couldn’t stay with him because we’re too short-staffed and please when he’s ready to come back could you call a porter and then —’

  ‘What?’ Esther roared. ‘You’re short-staffed? On Psych? And I’m supposed to — not on your nelly, young man. You phone your staff nurse and tell her from me that if she wants this patient to be seen here on this ward then he has to be accompanied by one of her nurses. I’ve no one to spare. Anyway, why isn’t he being done in Outpatients?’

  ‘They’re having trouble with the examinees, Sister.’

  Her own staff nurse looked up from the food trolley where she was trying to sort out the individual diets. ‘I’m sorry — I should have told you. Miss Sayers called up to tell me. They’ve got the first-year medical students doing their vivas there, and they’ve sent over more than they expected from St Kitts, so Sister in OP said they’d have to do the cystoscopies up here instead of there. And she said —’

  ‘Did she, by God!’ roared Esther. ‘Sister OP said that, did she? And why did no one think to ask me whether I could accommodate ’em, hmm? Answer me that.’

  Staff Nurse went rather white. ‘Well, actually, Sister, I said — you were up to your ears with Mr Le Queux and I knew you wouldn’t want me to interrupt, so I said it’d be all right. We’ve got the treatment room free this afternoon. We did all the important jobs there this morning and I thought, by two o’clock when they want to start them, it’d be all right. I’m sorry, Sister. It’s all my fault.’

  There is nothing of course that makes anyone angrier than being offered an explanation and apology and having all reason to complain thereby removed, and Esther was no exception. For the next ten minutes she harangued her staff nurses, snapped at the young male first year from Psych and thoroughly indulged her own bad temper, and that seemed to get to the old man who had been sitting happily slumped in his wheelchair. Suddenly he began shouting in a loud strong voice and waving his arms about; what he was shouting no one was able to work out, though the nurse looking after him seemed to cope well enough, bending over the old man and muttering in his ear, but it added to the fluster that had attacked the ward since early morning and for two pins, as Esther told her staff nurse wrathfully, she’d go off sick right now, this very instant —

  At which point Kate arrived from OP and went straight up to Esther and said coolly, ‘I’m sorry not to have phoned you sooner, but I have to tell you I’ve agreed with Professor Levy to take a patient over here from Male Surgical. I hope that won’t make life too tricky, Esther, but I knew you’d manage somehow. He’ll be over here in a half-hour — I have to cystoscope him and then maybe operate. I’ll explain it all to you later — it’s a rather tricky situation.’

  But the damage was done. That was the point at which Esther really lost her temper.

  Chapter Sixteen

  David went off the ward to go to the special lecture for the first years with a sigh of relief. It was tiresome to have an extra lecture chucked at them like this instead of waiting for their usual study block, but the Pawn had said it was a vital one on Medical Ethics and this was the only time the professor could fit it in, so there it was. The first years had to be there or else. Of course, he’d muttered and moaned with the rest of them when it had first been posted on the board and their clinical tutors had warned them what would happen if they missed it, but now he was glad. Life on Male Med had been absolute hell all morning. Getting away had a lot going for it.

  ‘I’ve had the worst morning ever,’ Sian announced as she caught up with him in the yard on the way over to the nurses’ lecture theatre. ‘I thought Esther Pelham was all right, but this morning, Christ, what a bitch! Never stopped bawling at everyone long enough to catch her breath.’

  ‘Do you call her Esther to her face?’ David said, momentarily diverted. ‘You made such a fuss over the business of names before we started but I’ll bet you’re the same as the rest of us now and call her “Sister” —’

  ‘I never talk to her at all if I can help it,’ Sian said. ‘Bitch that she is. Some poor orderly on our ward, been there donkey’s years, she has, got such a lathering over accidentally giving a patient the wrong breakfast, you’d think the sky had fallen in. Chicken-Licken wasn’t in it with Esther-Lester, believe me. I told her, the orderly, go to the Union, I said. She can’t go on at you like that, not when no harm’s been done anyway. The fella never ate it — Sister saw and shrieked so loudly, poor bugger lost his appetite altogether —’

  ‘But maybe it would have been awful if she hadn’t noticed. Was he an operation case, then? If he had been and he’d eaten it and then had an anaesthetic and choked to death, the orderly could have killed him, couldn’t she?’

  ‘Oh balls,’ Sian said a little uncomfortably. ‘It wasn’t like that. He was just a kidney on a low-protein diet. It wouldn’t have —’

  ‘What did she give him?’

  ‘Bacon and eggs, and —’

  ‘And you told the woman to go to the Union?’ David jeered. ‘Honestly, Sian, you really are the pits. She ought to be chucked out, not protected. She’s dangerous —’

  ‘Why?’ Sian flared at him. ‘Just because she’s an orderly it doesn’t mean she can be walked all over. She’s got rights too, you know, and these bloody sisters who think they know it all —’

  ‘They know more than your stupid orderly, that’s for sure,’ David said. ‘Listen, if you’re looking for Union fights, you ought to be with me. We’ve had a much worse bloody morning than you have. What’s going on makes me so mad I could spit. I think the Unions are a waste of time, but even I’d complain over this Saffron business —’

  ‘We have,’ Sian said. ‘Much bloody good it’s done. He’s a real twister, that one. If we make any fuss about him being on an NHS ward, then they open their eyes wide and say do we want him to go to a private ward, and if we say it’s all wrong he’s got private nurses, they say it’s so that the other patients won’t be put out or suffer, and that anyway it’s because of security, on account he used to be the Northern Ireland Minister. Whatever we say they come up with a fancy answer. But don’t think we’re not trying. Look at that!’

  And she pointed at the demonstrators outside the Medical School who could now clearly be seen, still waving their home-made placards and banners as they marched dolorously from front to back of the building. ‘They’re there specially so Saffron can see them from his window. The best thing you can do is make sure he does —’

  ‘Oh, we don’t get anywhere near him,’ David said. ‘There he sits up at his end with everyone fussing over him but we never get near him. We’re not important enough.’ He laughed then. ‘Mind you, one of the visitors did and there’s been no end of a fuss ever since. She nagged Saffron because we can’t keep her husband in a bed any longer even though he’s dying, poor devil, and so Saffron nagged Sister and his consultant and the consultant’s been on at Sister for letting the woman get near him and she got mad at the consultant and they’ve been fighting and in the middle of it all we’ve got other patients on the ward who shouldn’t be there and he’s found out — oh, it was rich this morning. I wish you’d seen it all. You’d have loved it —’

  ‘Mr Saffron,’ Vera Sheward said firmly. ‘There is nothing I can do abou
t this. This is an open NHS ward and not a prison. If patients and their visitors wander about then there it is. They’ve every right to. I can’t lock them out of half the ward, can I?’

  ‘I don’t see why not.’ Saffron sat bolt upright against his pillows, staring at her with eyes mostly hidden by the reflection of the light on his thick glasses. That made Vera uneasy; it would have been easier to cope if he didn’t give back that blank cartoon character sort of glare. ‘And it is not half the ward, is it? Merely a segment of it. But let that pass. I am simply making the point that some privacy is not an unreasonable request. If you were doing something to a patient behind a curtain, you wouldn’t allow any other patients to come wandering in, would you?’

  ‘Of course not. That’s the purpose of curtains. Of course, if you’re saying you want your bed permanently curtained —’

  ‘Sister, you know I am not. I am asking you, simply, to please leave me in peace here. To tell your patients not to come into this section. A plain enough request, I would have thought.’

  ‘This section is part of my ward, and therefore available to all my patients,’ she said stubbornly. ‘And I can’t possibly ban people from it. If a physio tells patients they have to walk three lengths of the ward two or three times a day — which they often prescribe — then that is what they must do. To make them reduce their exercise simply to accommodate a special patient who is being given unusual status —’

  The colour in his cheeks seemed to increase and she felt a moment’s unease. He wasn’t her patient, of course; that had been made manifestly clear to her by the private nurses who had been brought in. She could feel the furious glare of the one now standing at the far side of Saffron’s bed, even without looking at her. But one of her own patients or not, the man was ill; he was in here for investigation and treatment of cardiac insufficiency and to harangue him as she had been was hardly fair. But dammit all, she’d had Byford on her back most of the morning, complaining at her. She had every right to give the man back some of the trouble he was causing — but she bit her tongue now.