Clinical Judgements

by Claire Rayner

  ‘Come back here and sit down again for a moment. You can sort out the ward later. I want to ask you — dammit, I don’t like having to do this, but I can’t help myself. Your private life is of course your own, but when it impinges on the hospital, then I have to get involved. The thing is, I’m a little concerned about your friend, Mr Merrall.’

  She felt herself stiffen. She had come to sit down again as he had bade her and now she sat on the very edge of the chair staring at him with a stony face. It was so shaming to have been found out in deviousness; clearly he had known all along that Oliver had warned her, she thought, and now he was going to tell her he knew. And she was mortified.

  ‘He came to see me some time ago about a programme he was making. All about NHS cuts. He hadn’t realised then that the area in which he was more interested happened also to be the area in which you work. I pointed this out to him — actually warned him that Kim Hynes was your patient. Now, I don’t know if the programme he is preparing will in any way deal with the same areas as this rag here’ — and again he flicked his finger at the Globe — ‘but if it does — well, you’ll need to be aware of the problems, won’t you? As I say I don’t like to meddle but I thought I should just mention it —’

  She was so grateful that he had not realised her own duplicity that she smiled at him widely, which took him aback rather.

  ‘Oh, don’t worry about that, Professor,’ she said and got to her feet. ‘I can deal with that problem. But —’ and she sobered then. ‘Look, I don’t have to — I mean I have the right to choose my friends where I will with no reference to the hospital, but I do want to tell you I’m — er, sorry that a friend of mine should be — well —’

  ‘There’s no need for that!’ Levy said strongly. ‘None at all. Never think I have any objection to the fact that your Mr Merrall is a journalist. Not only would I have no right to object — I actually admire him. I’ve listened to his programme sometimes when I’ve had to drive at that time of the morning. An interesting man with a very — um — definite style. No waffle and a good deal of plain and very refreshing horse sense. No need for you to apologise at all!’ His own face split into a grin. ‘Just be careful, that’s all.’

  ‘I will,’ she said and got to her feet and went, feeling surprisingly better than she had. Nothing was different of course: Oliver had still behaved badly and she had behaved worse; there was still the problem of what to do about Kim and how Goodman Lemon would react when he heard what had happened over Slattery; but all the same, she felt better. It was comforting to have Professor Levy’s approval, that was the thing, and she felt a moment of embarrassment as she realised how much she needed someone like him to lean on. She was supposed to be a grown-up person, a professional person. Did she really need a daddy to protect her and to give her the balm of his respect? Yes, murmured her secret policeman, yes you do. But embarrassing though it was, it made her feel better to have him there.

  She hurried across the courtyard towards the main ward block, making a wide circle to avoid the demonstrators. There was some sort of fuss going on in the street outside: she could hear shouts and a good deal of confused noise coming from behind the archway and many of the demonstrators had broken the curve of their determined circular march and had crowded into the archway to see what was happening.

  For a very brief moment she felt herself drawn towards the centre of the excitement; her curiosity was as well developed as anyone else’s, and it was irritating not to know what was happening here in her own hospital. But she pushed the impulse away. She had work to do and the fact that the demonstrators’ attention was distracted meant she could get away and across the courtyard without impediment and that was no bad thing. So, she widened the circle of her pathway even more and went purposefully into the main building, her white coat flapping behind her with the speed of her movements.

  The ward when she got there was in its usual state of barely controlled chaos. All the dialysis beds were full, and there were two people waiting in the day room until they could take their places at the machines, as well as the usual gaggle of waiting relations who were there to be taught how to use the machines, ready for the day when their patients could be given machines of their own at home. The Friends of Old East had been running their Jumble Sales and Bring-and-Buys to considerable point this year and there was every hope that soon some of the pressure could be eased on the inpatient dialysis unit by the provision of a home machine for a lucky few. Teaching them and their families how to make use of such a windfall took a lot of nursing time, but it was well worth the investment in the long run. But today was one of the days, clearly, when the pressure was screwed down tightly and everyone was showing its effects in their behaviour, becoming edgy and sometimes snappy.

  Except, to Kate’s huge relief, Esther. She was wrapped in a large plastic apron and was working over one of the machines to which William Prior was attached and, as Kate came into the ward, she looked up at her and lifted her brows cheerfully.

  ‘Hello! Haven’t seen you today! What a lot of drama going on, hmm? What do you think of that Hynes madam? I’ve told her what I think of her and no mistake — you’ll no doubt find her in floods because I was so nasty. But honestly — letting that damned man photograph her here! I’ve had the whole bloody Admin office on my back over it. You’d think I’d taken the wretched picture myself, they fussed so. But what the hell. Look at our Bill here!’

  And she looked down at the man in the bed with an affectionate grin and cocked her head sideways as she stared at the face against the pillows.

  The man lying there looked very different from the way he had since his admission. He was conscious now, his eyes open and showing a degree of alert awareness that was totally new in him. He was shaven and washed and looked remarkably presentable.

  ‘Isn’t this something, hmm?’ Esther said and looked again at Kate, grinning. ‘All this time on the machine and I thought we were getting nowhere. And now look at him. Very bobbish, aren’t we, hmm, Billy? Oh, you really are the best —’ And she leaned forward and pinched his cheek gently and the man grinned back at her, revealing regrettably broken teeth; but his eyes were smiling and he looked pleased with himself.

  ‘I ought to bring Richard in to see this,’ Esther said then, as she finished disconnecting the machine. ‘Then maybe he’d see why I’d rather be here than making bloody sandwiches in Gants Hill or wherever. Nurse! You can move Mr Prior’s bed into the far cubicle on the other side. Then get this machine cleaned up, will you, and we can start Mary Josephson on her stint. With a bit of luck, we can get her out by suppertime and young Gary in before the end of the day. Now, Kate — your man Slattery —’

  ‘Mm?’ Kate said and slid one hand into Esther’s elbow as they made their way up the ward towards the end where Slattery and Kim were. ‘Listen, Esther, sorry I was so ratty last time I was in and —’

  ‘Forget it,’ Esther said sunnily. ‘I have. Oh, and I’m sorry I was a bit off too. We all get days like that. I’ve decided life’s too short to spend it in a rage — told Richard that this morning —’

  Kate stopped and then peered at her. ‘You two quarrelling again?’

  Esther laughed. ‘In spades, ducky! Or at least he is. I’ve told you. I’ve decided I’m not going to let any of it get to me any more. It’s not worth the ulcers.’

  ‘That’s this week,’ Kate said shrewdly. ‘How long can you keep it up?’

  Esther looked at her and now Kate could see that behind the cheerful insouciance there was a hint of panic. ‘I’ll worry about next week when it comes,’ she said. ‘Honestly, there’s a limit to how much one person can take. I reached it this morning with Richard going on about — well, anyway, I got here and there was old Prior, bright as a button and demanding breakfast. And I thought — sod the lot of ’em, Richard included. When I’ve got people like old Bill to deal with, who am I to get my knickers into the proverbial twist, hmm? Listen, Kate, your man Slattery —’

  The
bleep in Kate’s pocket began its intermittent yelling and Kate made a face.

  ‘Hang on, I’d better see what that is — though I can’t imagine — I mean I’ve got no one in ICU and I’m here. Has one of the nurses from here sent a message?’

  ‘I’ll check,’ Esther said and went bustling over to the desk to talk to her staff nurse there. But she shook her head and Kate made a face, and picked up the phone.

  Switchboard took an age to answer, but she didn’t mind, whistling softly between her teeth. Esther was right; she’d have to take a leaf out of her book, as her old English teacher used to say with a bob of her tightly marcelled head, and Kate remembered her so vividly suddenly it was as though she were a child again. But she’d been right, and Esther was right. It just wasn’t worth getting into a state over anything. Getting upset only tightened the pressure, and made you less able to cope with it. Accepting things as they happened and dealing with them logically, that was the way to keep your sanity. And your health.

  Switchboard responded at last and when she had identified herself put her through to Accident and Emergency who had been bleeping her. And when they too at last answered Kate stood with her brows lifted in puzzlement.

  ‘Miss Sayers?’ the little voice clacked tinnily at her in the earpiece. ‘There’s someone down here who says he knows you. Got some nasty contusions, he has, and may be concussed and very anxious to speak to you. Could you come down, do you think? Right away, Sister says —’

  ‘Someone who says he knows me?’ Kate said, deeply puzzled. ‘Who?’

  ‘His name — er — hold on a moment — oh, here it is. Merrall. He’s Oliver Merrall. You know, the chap from the radio. And he’s really not feeling at all well.’

  Chapter Twenty-Six

  Suba couldn’t remember when she had last felt so dreadful. She had thought it was hard enough going to the meeting on her own, without Shirley, but she’d managed to do that and to tell them what they asked her to. She’d thought she’d be miserable when Shirley was moved at the last routine changeover for second years from Gynae to go on night duty in the Orthopaedic ward, so that she no longer had a friend to talk to on duty and discuss things with, but she’d got used to that. This was something worse. Much worse.

  It had started when they had begun making beds, she and the second year who had been sent to the ward to replace Shirley. She was Michelle Lomax, a small black girl with a cheerful grin and a stream of chatter that seemed never-ending; and she chose to talk all the time, not as everyone else was, of the story about that patient on Genito-Urinary who’d had that awful operation and who was all over the newspapers, but about Miss Buckland. And Suba had tried to change the subject but simply couldn’t.

  ‘I wish I’d been there to see it all,’ Michelle said as she flipped the corner of the sheet and tucked it in with an experienced twist of her wrist. ‘I mean, she must have been gobsmacked! Someone told me, she’s got a friend who’s working on theatres, she said it was all about abortions she’d been doing. But someone else said it was different, just about a car or something, but you can’t tell me they’d come all the way into theatres to go on at someone about a car! And she a consultant too! It’s not what they’d do, is it? Give us that pillow — ta — have you heard anything about it?’

  ‘No,’ Suba said wretchedly. ‘Er — did you read all about that patient on GU who had the sex change? There are bits in the paper all about it — and —’

  ‘I knew all about that,’ Michelle said and shook her head in disgust. ‘I said all along that was wrong. I heard about it even before it was in the paper — we all did. We were talking about it in our last block, because we’d heard, someone was over the road in the pub and there was someone from the ward in there and she was saying — no, that’s just disgusting really. But Miss Buckland! I mean — will she get her name in the papers, do you suppose?’

  Suba began to feel dizzy. ‘Why should she? I mean, I really don’t know. Listen, do you have a lecture or anything that —’

  The other rode over her as though she hadn’t spoken. ‘It’s sure to be, isn’t it, about abortions? Like that doctor over at — where was it? — I read about it somewhere, how he was doing abortions in private clinics and getting big money for it and then how he did some of his private patients in his NHS beds and still made them pay and the hospital found out and there was all sorts of trouble, do you remember?’

  ‘No,’ Suba said. ‘I wanted to ask you — I’ve lost my medical textbook, you know, that one with the green cover and I was wondering —’

  Michelle marched cheerfully to the next bed and began to strip it, flashing a smile at the occupant but still addressing all her words to Suba.

  ‘I mean, what with all the cuts it’s awful someone doing that but I don’t think Miss Buckland’s the sort, do you? She was ever so nice when we had our gynae lectures. I liked her a lot but I was telling my mum about it and she says you can never go by what people look like or even behave like. When it comes to money they’re all devils and she could be right; but still, Miss Buckland —’

  With a massive effort, Suba managed to stop listening. The words ran on at a great rate as they went from bed to bed, shaking pillows, smoothing counterpanes, pulling drawsheets through and still Michelle chattered on and still Suba tried not to think about what she’d done.

  Because there could be no doubt in her mind. It was she who’d done it. How could it not be? They’d asked her to bring the details of Mrs Walton’s operation and she’d done that. It had been so easy, just photocopying the sheets from the notes which were waiting to go down to the office. The photocopier was just along the corridor, in the medical secretaries’ room, and she had known how to use it because Sister was often in need of extra sheets of special pages and kept running out of them. The day she’d photocopied Mrs Walton’s notes she’d been sent to make some extra temperature charts because Sister had run out again, so it hadn’t even been a matter of going where she shouldn’t at the wrong time. Sister had sent her —

  But no matter how she tried to wriggle around it inside her own head, Suba knew. It had been wrong to copy those notes and much more wrong to take them out of the hospital to someone else. People were always going on about confidentiality. They were so confidential, those notes, that even the patients they were all about weren’t allowed to see them. And Suba had given them to outsiders — and she closed her eyes at the thought and felt sick.

  ‘Are you all right?’ Michelle’s curious chattering voice broke through at last. ‘You look ever so seedy. Are you having a period or something? That always makes me feel lousy. Shall I fetch Sister? Or —’

  ‘I’m all right,’ Suba managed. ‘I’m fine. Look, you go and do the sluice jobs, will you? Or shall I? I don’t mind but someone’s got to fetch in all the flowers —’

  Michelle thought for a moment. ‘I’ll do the flowers,’ she decided. ‘I’ll senior to you, so you can do the sluice. And have a word with Sister and get some aspirin if your period’s playing up. You look ever so green —’

  It got no better as the day wore on. Wherever Suba turned, it seemed, people were talking about Miss Buckland and her brush with the police. What had she done? Why had she done it? What would happen to her? And when the first editions of the evening paper began to filter through to the wards, brought in by visitors as avid for gossip as everyone else, then the talk doubled and redoubled, for there was a report on an inside page that said Miss Buckland had been assisting police with their enquiries into an abortion performed on a patient at Old East and that she was one of the staff at the hospital already hit by unrest — and there were pictures of the demonstrators outside to illustrate the unrest, which indeed looked very lively — and also that the hospital was the crux of another scandal over the presence of a patient who had undergone a sex-change operation, when other patients were left on long waiting lists —

  Suba had tried very hard to pay no attention to it all, but she hadn’t been able to cut herself o
ff from it. When one of the patients actually pushed the newspaper into her hand she felt herself forced to read it. And stood there at the side of the bed, her head down over the dreadful words, praying she wouldn’t disgrace herself again the way she had that day in the operating theatre when she had fainted and Miss Buckland had been so nice to her and —

  And she lifted her head and looked miserably at the patient, who peered at her and said loudly, ‘Well, there you are, Alf! Didn’t I tell you that Miss Buckland was a really nice lady? Of course she is, because here’s Nurse all in tears over her and — oh, there, ducks, it’ll be all right, I dare say! Don’t you cry, dearie, now —’

  Suba fled down the ward and into the best haven she knew, the linen cupboard, and stood there in its musty warm dimness, her face pressed against a pile of sheets, weeping bitterly. She’d have to give up, that was what she’d have to do. She’d have to go back home and tell Daddy he was right, and she was wrong. She didn’t have what was needed to be a nurse. She couldn’t cope and there was an end of it. And she didn’t know what made her cry the most: the thought of Daddy’s face when she told him, or the thought of having to leave the hospital behind.

  Someone came in behind her and almost ran into her, and stood there blinking in the darkness.

  ‘What on earth?’ a voice said and Suba stood rigid, the tears drying in her throat.

  ‘It’s only me, Sister,’ she managed, her voice quavering dreadfully. ‘I was just looking for a — for a sheet —’

  ‘Well there are enough of them there, right in front of you,’ Sister said tartly. ‘What do you want it for? I thought you’d finished the beds, you and Nurse — whoever is it they’ve sent me — Lomax?’