Clinical Judgements

by Claire Rayner

  ‘Well, Mr Saffron,’ she said, peaceably enough. ‘I’ll do what I can. But I hope you have some clearer understanding now of what life is like for so many of our more ill patients and their families. No one is trying to make things hard for you, but —’

  ‘Some success is being enjoyed all the same,’ Saffron said and rested his head back on his pillow. ‘I’ve assured Mrs — what was her name? — I’ve assured her that I will see to it efforts are made on her behalf. I can’t do more.’

  ‘You’d better rest, now,’ Vera said and turned to go. ‘I’m afraid there may be some disturbance later this afternoon because we have a special case that will need to go down to the operating theatre, but we’ll try not to cause too much upheaval —’

  ‘Thank you, Sister,’ the private nurse said icily and Vera flicked a glance at her and then went away, guiltily aware of the way Saffron was looking. Far from well. The sooner Byford finished what he had to do for him and let him go home to get over it all the better. And for a moment she felt a pang of real pity. He was not a pleasant man, Saffron, being pompous in the most ridiculous way and to a degree that had amazed Vera. Could the stereotyped notions of politicians be in fact accurate? He was also selfish and arrogant. But his life was clearly a difficult one, for even while he was here dealing with a potentially life-threatening illness the work did not stop. The steady traffic of secretarial and security people drove her nearly to distraction. What must it be like for the man at the hub of it all? She shook her head at the images that conjured up as she reached the end of the ward where Mr Holliday was sitting in a wheelchair waiting for a porter.

  ‘Well, Mr Holliday!’ she said cheerfully, at last pushing Saffron out of her thoughts. ‘Do you feel as good as you look?’

  ‘Better,’ the man said after a moment, and she smiled even more widely for the change in his speech was marked. Without the rigidity of muscles which had locked his mouth and throat and tongue in a harsh grip his words, though slurred, were much more comprehensible now.

  ‘And your physio — how does she say you’re getting on?’

  ‘Marvellous,’ the man said and slowly smiled. It was a difficult grimace, and could have looked like a leer, but since for many years even that much had been impossible for a face locked in a Parkinsonian blankness, it was a major achievement and Vera felt her spirits lift as she looked at him.

  ‘I know Mr Bulpitt’s delighted with you,’ she said and leaned over to wrap his rug more firmly round his knees. ‘And I do hope the improvement is maintained or even increased. Keep in touch if you can — even after you get home. Let me know how things are —’

  ‘Can you spare a minute, Sister?’ Mr Holliday’s eyes flickered as he shifted his gaze over his shoulder. ‘Wife’ll be back in a minute — need to ask you —’

  Vera crouched beside him to hear him better. His voice was improved perhaps, but still difficult to follow.

  ‘I don’t mind waiting for her if you want her to explain,’ she said kindly. ‘Don’t exhaust yourself —’

  ‘No — can’t talk to her. She gets annoyed. Listen, Sister.’ He stopped and swallowed and automatically she leaned forwards to wipe his mouth with the towel kept tied to the side of the chair, and then stopped herself. It really was remarkable; before his operation he had salivated all the time. Now it was clear he could get rid of it all for himself. Remarkable.

  ‘So tell me,’ she said. ‘What is it?’

  ‘I’m worried about the woman,’ Mr Holliday said and she peered more closely at him. He must have been good-looking once, she thought; a thin bony man with a well-shaped head, and good thick hair still, even though rather grey, and large dark eyes which lit up the wreckage of an interesting face. The patch of bald skin on his scalp where he had been shaved to make his operation possible gave him a rather endearing infantile air, and she wanted to hug him, to rid his face of the pathetic look that seemed to hang over its smoothness.

  ‘What woman, Mr Holliday?’ His wife perhaps? It wouldn’t be surprising if he were frightened of her, come to think of it, Vera told herself. A small and very birdlike lady who looked at first sight to be a fragile creature, she was in fact a whirlwind of activity, much given to streams of chatter and sharp little actions that pushed her helpless husband about his bed as easily as if he were a bag of laundry. Vera had to be very firm with her to prevent her taking over half the ward. ‘Who worries you?’

  ‘The injection,’ he said and stared at her very hard. His voice seemed less capable now as he became tired. ‘The woman what gave it me. Is she all right?’

  Vera frowned. ‘But it was Mr Bulpitt who did the operation —’ she began but Mr Holliday closed his eyes in clear exasperation and then snapped them open to stare at her again.

  ‘No — the stuff I had. The woman whose baby — is she all right?’

  ‘Ah.’ Slowly Vera straightened up and her knees cracked as she flexed her strained muscles surreptitiously. ‘Well, she’s fine,’ she said after a moment, speaking heartily. Too heartily perhaps. ‘You needn’t worry about her —’

  ‘I do,’ Mr Holliday said. ‘I worry all the time. Did she — does she know?’

  ‘Know what?’ Vera was hedging for time and knew it. She could see through the big double doors to the lift gates from which Mrs Holliday had just emerged and was standing talking with great vivacity to one of the nurses. Come on, woman, she thought. Come and get me out of this —

  ‘Does she know about my operation?’ Mr Holliday managed the words in a little rush, as though the only way to get them out was to push them out. ‘Did she say it was all right?’

  ‘But no one has to say it was all right for you to have an operation, Mr Holliday. Only you —’

  Mr Holliday looked at her with such intensity that Vera felt her face redden. There was animosity in that glare now.

  ‘You know what I mean,’ he said and his failing voice made the words seem almost menacing. ‘That woman and her baby —’

  ‘The pregnancy had to end, Mr Holliday,’ she said. ‘I can’t go into details, it wouldn’t be right. But I can tell you that if the doctors hadn’t operated she’d have died. They told me that, because I wanted to know too. Could have died before the baby was due to be born. It had to be done.’

  He tried to nod but managed only a tremor. ‘I know that, Mr Bulpitt said. But did they tell her what they were doing? Did she get asked?’

  The big double doors at the end of the ward opened and Mrs Holliday came bursting through them with her usual headlong rush, titupping along on her high-heeled shoes like an anxious sparrow, talking all the time.

  ‘— so when I said, she changed it, so there’s no need to worry, Reg. We’ve got the transport all fixed up and the home help and the laundry and Miss Allen’s ever so good in the Social Services department, very kind and helpful, and says she’ll see to it Mr Bulpitt knows all that is happening, now are you ready, dear? That’s right then, all set to go and maybe we can get Sister to send her porter to see us on our way. Thank you, Sister, you’ve all been wonderful, really wonderful —’

  Mr and Mrs Holliday disappeared in a backwash of chatter as she harried the porter along with Mr Holliday’s chair and Vera watched her go with mixed feelings. If only the man hadn’t waited so long to talk about it, she would have been able to sort it out, get Laurence Bulpitt to come and talk to him perhaps; but as it was — and she straightened her back and turned away as she saw Neville Carr getting out of the lift into which the Hollidays had disappeared.

  He would want to spend some considerable time over Joe this afternoon, now that he’d had his last chemo, and there was the matter of his bed to discuss. Had Saffron really managed to arrange matters so that she was given the extra beds she needed, and could Joe stay a little longer? Maybe he had managed to get Byford to agree to get rid of some of his long-term patients; they really ought to be in a geriatric ward, and she’d been telling him that for heaven knows how long. If he at last had seen the light, she woul
d have good cause to be grateful to Saffron after all … So, despite a rough morning, things might be looking up on Male Medical, after all, she thought, and went to meet Neville Carr.

  Chapter Seventeen

  ‘I’d rather not let him in,’ Herne said and pulled his chair closer to Professor Levy’s desk, trying not to notice that the Dean’s office looked even shabbier than usual, if that was possible. ‘But if I refuse it looks as though we’ve got something to hide. And they’ll make more of that than they’ve any right to do. On the other hand if I do let him in, God only knows what some idiot of a porter mightn’t come out with, and you can’t trust these media people to know the difference between what porters say and what we say —’

  ‘What porters say has been known to be more direct and to the point than anything that ever comes out of your offices,’ Professor Levy murmured. ‘Are you asking if —’

  Herne scowled. ‘Of course I’m asking,’ he said, even though of course he had been doing nothing of the kind. ‘The last thing I want to do is waste your time, let alone my own. I have a job to do here as well, you know.’

  ‘Oh, well do I know it,’ Professor Levy said and smiled sweetly. ‘You’ve made it into a very important job.’ At which Herne first bridled with pleasure and then frowned; it was impossible to know when this bloody man was being serious and when he was sending you up. ‘Well, since you ask, I’d say let him in. He’ll make his programme anyway. You can’t stop him. This way you can at least put in your own sixpenn’orth.’

  ‘Hmph,’ Herne said. ‘Well, I’ve got better things to do than talk to the wretched man. All he wants to go on about is cuts, cuts, cuts. As though Old East was the only place to be suffering.’

  ‘As far as I’m concerned it’s the only place whose suffering matters,’ Levy said with a sudden flash of energy. ‘And if you felt the same sort of partisanship it mightn’t be a bad idea. Maybe you’d fight a bit harder for us. As it is you give the impression sometimes of acting more as an apologist for the DHSS than a person responsible for management here.’

  ‘That’s nonsense,’ Herne said huffily. ‘I simply have the sense to take a global view and don’t pretend that the sun rises and sets in just one hospital. But that doesn’t mean I don’t care about this place. Of course I do. It’s my job to care —’

  ‘But it’s inside the DHSS that your own career will grow, isn’t it? Not here,’ Levy said. ‘Oh, forget it, Herne. I’m tired of digging over this old ground. Is that all? This chap and his programme. Was there anything else?’

  Herne sniffed and bent his head over the sheaf of papers in front of him. This weekly meeting with the Dean of the Medical School was supposed to facilitate the smooth running of the hospital; as far as Herne was concerned it just gave the bloody man another chance to stir up trouble. The way he went on you’d never think there was a Region to worry about let alone an Area Health Authority —

  ‘I’d be glad if you would stop encouraging those demonstrators to go on about things they don’t understand. What do they know of NHS finance?’ he said loudly then, and lifted his chin to stare at Levy. ‘They have no right to be here and you should call the police and get them evicted from the hospital premises. Your section of the hospital premises, as you’ve pointed out to me often enough —’

  ‘Why don’t you tell them? You’ve as much right to do so as I have.’

  Herne flushed. ‘And have you call out all the medical students to join in and turn it into a complete circus? I’m not as green as that, you know.’

  ‘I wouldn’t dream of calling out the medical students, even if they’d listen, which is highly unlikely,’ Levy said and then laughed. ‘Anyway, they need no calls, believe me. I’m surprised they haven’t joined in already.’

  ‘They might as well have done.’ Herne sounded savage now. ‘The way they feed them with tea and buns — probably hospital property at that. Look, Professor, you know perfectly well that if you talk to these demonstrators they’ll go away and the students won’t come out unless they know you’re in agreement with their being there. You’ve got the whole school eating out of your hand and —’

  ‘How agreeable for a Dean,’ Levy said. ‘And rather rare. But I doubt if it’s quite so clear cut, you know.’

  ‘Do you? Well, I don’t. And please believe me, these demonstrators are doing no one any good. The DHSS people see their presence here while Saffron’s on the premises as a clear indication that we lack control over the place and —’

  ‘Ah!’ Levy said. ‘I see now! They’re after you, are they, because of it? That’s why you want them out.’

  Herne reddened. ‘Well, of course they blame me! It’s what I’m for, dammit, being blamed for everything. The patients and the unions blame me for the cuts, you and the rest of the medical staff blame me for the state of the budgets, with all of you wanting to spend like lunatics and to hell with every other department, and the DHSS says all of it’s my fault no matter what happens. It’d serve you all right if I just walked out on the lot of you. I could go into the City, I swear, and earn a great deal more for half the effort.’

  ‘You should,’ Levy said. ‘And I don’t mean that unkindly. I think all you managers should get out of the NHS. We ran it all well enough in the past without any of you — a good matron and a few of her senior sisters and the medical staff and between us we kept the hospitals running like melted butter —’

  ‘Yes,’ Herne said and got to his feet. ‘Those were the days when you had to send nurses out into the street with trays of little flags to sell and had fund-raising committees constantly running jumble sales and begging for cash for essential equipment like thermometers. Not that we’re not getting damned close to having to be like that again. But your so-called good old days were cheaper, because they were before renal dialysis and Byford’s cardiac transplants and ICUs and SCBUs and all the rest of it. This is nearly the twenty-first century, Professor. A little more modern thinking’d do you no harm. Nor those demonstrators either. Modern medicine needs modern economic thinking, not bloody demonstrations, if you’ll pardon my language. I’ll tell that man Merrall you’ll talk to him, then. Good morning.’ And he turned and went, leaving the Professor looking after him with some compunction. Poor devil, he thought. I suppose it isn’t really his fault. And we do all go on at him —

  Merrall came to see him that afternoon at two o’clock. He’d been very punctilious, making an appointment for the interview and arriving dead on time, and Levy looked at him with a slightly beady-eyed stare as he sat down at the desk in front of him and started to fiddle with his tape recorder.

  ‘These Uhers are very good, sir, but they need to be handled with respect,’ Merrall said. ‘But that’s it, I think — yes, it’s fine — just a few words for level if you don’t mind, Professor, and then we can —’

  ‘But I know you,’ Levy said and stared even harder. And then his face cleared. ‘Of course! At the last hospital ball we had, Christmas. Didn’t you come with Kate Sayers?’

  ‘Er — yes —’ Oliver said a little hurriedly. ‘I think that will do for level, then. Now, if I could start by asking you —’

  ‘I understood you were — how shall I say, pretty close?’ Levy said and then smiled disarmingly. ‘I’m a wicked old gossip, you know. I like to know all I can about my people here. And some said that you and Kate —’

  ‘Well, yes,’ Oliver said. ‘But that has nothing to do with my being here. Doing this interview, that is. That is the result of a letter I was sent by a patient of Old East.’

  ‘Oh?’ Levy was satisfied now he’d placed Oliver accurately. ‘Well, that’s interesting. Which patient?’

  ‘Would you know if I told you the name?’

  ‘Very probably,’ Levy said with some complacency. ‘It’s one of the things I’m famous for. I get to know the patients well, and not just my own. And I make a point of remembering names.’

  ‘This one is called Ted Scribner and —’

  ‘Scribne
r … Scribner?’ Levy crumpled his face, thinking hard. ‘That says nothing to me, dammit. Hubris, you see. Shouldn’t have boasted of my memory’s prowess.’

  ‘You wouldn’t remember this one, Professor,’ Oliver said drily. ‘He hasn’t been in the hospital yet.’

  Levy’s face smoothed happily. ‘Ah, well now, I feel better then! But you say he’s a patient? An outpatient perhaps?’

  ‘A waiting-list patient,’ Oliver said pointedly and flicked a glance at the dial of the Uher. It had been recording all through and the needle was peaking exactly where it should. This would be a good clear recording. ‘He’s been waiting to come in here for a prostate operation for some time now. He’s very unhappy, it seems. Tells me that he’s exhausted because he wakes up six or seven times a night to go to the bathroom and that he has sundry other discomforts I needn’t elaborate here. And he’s been told five times that there’s a bed here for him to have this operation — and five times it’s been cancelled. So you’d hardly know him, would you?’

  ‘Oh dear.’ Levy shook his head. ‘It’s dreadful, isn’t it? It happens too much. I worry about it a great deal you know, and yet there is so little I can do. I’m just the Dean of the Medical School, one of the physicians here. I have to fight for my own patients as hard as any other consultant to get them in when they need to be to get all the care they should have. Over and over again I do domiciliaries — home visits, you know — to people I know ought to be in bed here at Old East. And what can any of us do? There simply aren’t the beds. Our nursing strength is down because before the improvement in their remuneration we couldn’t keep recruitment up, even here at Old East, which has a splendid reputation, and even now we’re very short on nursing strength. Mr Merrall, I can assure you that if you and your listeners can find ways to improve the bed situation in this hospital no one will be more grateful than those of us who work here.’ And he beamed at Oliver who looked a little nonplussed for a moment. But not for long.