Second Opinion

by Claire Rayner

  All right, she thought, what about their backgrounds? This was even less help than the facts about the babies, for they were so widely disparate that there could be no connection between them. The first infant had been born to a mother who abused both alcohol and, the midwives had suspected, drugs; she had lived a hand-to-mouth existence partly on the streets and had had no antenatal care at all. Her baby had in fact been a prime candidate for a death in the neonatal period.

  The other two, however, couldn’t have been more different The Chowdary baby had been the result of long months spent under the care of the Fertility Department at Old East and had therefore been particularly precious, while the Popodopoulos baby had been the third child of a healthy happy mother who had had excellent antenatal care on the district and who had no history of any illness or problem that might contribute to her baby’s death.

  ‘I could go and talk to them in Fertility, I suppose,’ she murmured to herself aloud, ‘see if they can add anything to the Chowdary history,’ and then as Bridget stirred in her armchair, decided to pack up her work. The two old ladies needed to be woken, provided with their malted milk nightcaps and despatched to bed, and she set about doing that feeling rather like one of the nurses on the wards back at the hospital. She’d never before realized just how agreeable it was to live alone and do just what she wanted when she wanted, without any responsibility for anyone else. Oh, the joys of selfishness, she thought, and went and crouched in front of her mother to coax her awake. I’ll never moan about being on my own again …

  In the event she couldn’t find time to visit the Fertility Clinic until Thursday morning, and then she went directly to the clinic before going to her own department. Once she got herself bogged down in the day’s work she would, she knew, once again find it impossible to get away, and she did want to follow this through. The more she thought about it, the more peculiar the whole affair was, and anyway, there was another value in having a case like this to think about. If she got absorbed in this, it made it harder for her to think about her mother and her health and the implications that carried for her own future.

  The Fertility Clinic was housed in a small set of rooms on the far side of the Maternity Department; not a very tactful placing, George thought as she pushed open the main door. Patients attending the clinic had to make their way through a corridor that it shared with Maternity, so the sounds of crying babies and even, sometimes, yelling labouring mothers could be heard clearly. She could imagine the distress that might cause to people who were yearning to be parents and failing abysmally.

  She said as much to Dr Julia Arundel, the consultant in charge, when she found her in her office. Julia grimaced.

  ‘I know that perfectly well, George! I’ve been nagging them till I’m blue for a separate unit, but there isn’t a hope in hell at present, if ever. They’ve cut two of my staff as it is, and when I do ask for more help all I get is a lecture about the budget deficit and GP fund-holders not sending the patients here in large enough numbers, and threats to close me down altogether. I’ve even thought about talking to those people out there on those demonstrations — by the main entrance, and at A & E, you know? — to see if they realize what they might lose here. I might have to eventually, unless I can get my hands on some more money outside the NHS. I’ve been chasing supporters and sponsors till I’m blue but there’s damn all cash around these days and people are so uncaring anyway. Not enough are willing to even think about how desperately important a unit like this is.’

  George bit her lip, holding back the thought that had immediately come to her, which was that though she sympathized deeply with the misery of people who couldn’t have babies, in a world as crowded as this one and a hospital as poverty-stricken as Old East, perhaps it was understandable that not everyone shared Julia’s view. But it wouldn’t be politic to say that, so she just contented herself with murmuring vaguely about the generosity of those who had supported the building of the new Children’s Unit, Barrie Ward, at which Julia at once snorted and shook her head.

  ‘And where will their future patients come from if my department vanishes for want of a few pounds?’ she demanded.

  George blinked at that. ‘Well, the birth rate’s still pretty good with people who don’t have fertility problems — Maternity seems to be run off its feet these days.’

  Again Julia displayed her disgust. ‘Maternity? They could double their throughput if they made the effort and streamlined their service so that I could have a couple more rooms, which I definitely need, but will they put themselves out? Not they! No, I have to go around with my begging bowl to keep a decent service going here. I’m speaking to the Operational Board about it at their next meeting. I need all the help I can get — I hope you’ll support me there.’

  ‘I’m not on the Board,’ George said hastily. ‘I have to run my own budget, of course, but as I’m a single-handed consultant they agreed to let the head of the Investigative Directorate be from Radiology. So Dora Hebden’s the Board member for me — you’ll have to ask her for help.’

  ‘A fat lot of good she is,’ Julia said with a fine scorn. ‘Got three children and had them like shelling peas, as far as I can gather. Certainly she can’t — or won’t — see that Fertility matters. You see what I mean? It’s hell trying to get this department properly funded.’

  The only way to head her off, George decided, was to go straight to the point. ‘I wanted to talk to you about a baby you produced — sad case. It died soon after birth, in Maternity. A cot death.’

  Julia looked blank for a moment and then said, ‘You must mean the Chowdary child. Yes, terribly sad, that. I had the mother here for — let’s see …’ She reached into her desk drawer for a notebook and then stopped and looked sharply at George. ‘Why do you ask?’

  ‘There’ve been a couple of these neonatal deaths recently,’ George said. ‘I just wondered if there could be any connection.’

  Julia looked surprised. ‘Connection? Why should there be?’

  ‘I’ve no idea,’ George said candidly. ‘If it hadn’t been for a note attached to the request form for the PM on the most recent of them, I might never have given it a thought.’

  ‘Note?’

  George explained and Julia listened and then nodded in comprehension. ‘Oh, well, yes. Under the circumstances you better had investigate. Now …’ She began to riffle through her notebook. ‘Here it is. The Chowdarys. She’s thirty-nine. He’s forty-two. Sperm motility a problem as well as the actual count, but she had an oocyte shortage into the bargain. Or so it seemed. We managed to cause a super ovulation, harvested five ova, used a concentrated specimen of his sperm, did a straightforward in vitro job with two of them — she absorbed one foetus early on but managed to retain the second. A very speedy and satisfactory result. And then it went and died even though it had gone to term.’ She snapped the notebook closed and sighed. ‘All very sad, as I say. I never even saw the infant, you know.’ She sounded a touch aggrieved.

  ‘Oh?’

  ‘No. And that matters to me. I photograph them all, add them to the gallery.’ She waved a hand at the wall over her desk where pictures of babies, many of them in twinned pairs and a few in triples, were posted. George had noticed it of course. It was unmissable. ‘But I was away the day this one was born. At a meeting in Wolverhampton — the Society, you know. We need to keep in touch with all the newest techniques and it does mean a lot of meetings. So there it was. Couldn’t see the child the day it was born. But they had no reason to think there were any problems, I gather, so no one here was alerted to get a picture.’ She seemed to brood over that for a while and then went on: ‘When I got back next day and heard it had died I was most put out, I must say. It was very upsetting. But what could we do? Not a thing.’

  She threw George an almost shy glance from beneath the thick straight fringe of dark hair streaked with grey which hung over her deeply set brown eyes. It was a look that made her seem a little like a mournful dog of the bloodhoun
d sort. ‘Though I have written and told her we could try again. Usually after they’ve had one successful pregnancy and birth they have to be turned away or into the fully paid private sector. I can’t afford to tackle them again, even though they do pay something for their care. We’re not entirely NHS, you see. We can’t be, dammit, the way things are at present. But in this case — well, I told her we’d try again.’

  ‘Will she?’

  ‘Will she what?’

  ‘Want to try again? I mean, I can imagine her never wanting even to think about pregnancy and childbirth ever again. I think I’d feel that way.’

  Julia stared at her with real surprise. ‘Why should she react like that? We’ve always explained to all our patients the long odds. They know there can be no promises of success — and do remember she succeeded superbly once. She should be pleased with herself. I’m sure she is. I’ve only agreed to take her back right away because it seemed so unfortunate to have lost the child. But you really mustn’t underestimate my patients, you know. They truly are so sensible and strong and brave and uncomplaining…’

  George was startled. That some of her colleagues were obsessive about their chosen speciality, she knew, but she’d never realized that Julia Arundel was one of them. Julia didn’t involve herself much in hospital affairs outside her own department, it was true, but had always seemed easygoing enough when George met her in the staff canteen or at the occasional three-line-whip events set up by Professor Hunnisett; yet here she was now, looking like a different kind of animal to a bloodhound entirely. She was positively tigerish in her defence of her patients.

  George smiled peaceably. ‘Well, fair enough, Julia. Anyway, I was just wondering whether there was anything in her history that you thought might have contributed to this infant’s death.’

  Julia shook her head. ‘Once they get pregnant it’s Matty’s turn because usually they’re perfectly normal. I keep in touch, of course, out of general interest and to get my picture.’ She looked fondly up at her wall. ‘They nearly always drop in to see me when they come for the antenatal appointments anyway, and of course bring me their babies to say hello afterwards. But the actual maternity care isn’t my bag. I never heard there was anything wrong with the Chowdary child. Have you checked the Maternity Unit?’

  ‘Oh, yes. Of course.’

  Julia shrugged. ‘Then it’s just one of those things, I suppose. It happens, doesn’t it?’

  ‘Yes, it happens. If it hadn’t been for that strange little note pointing out that there’ve been three here — I hadn’t realized because I’d been off sick, of course — I might never have given it a second thought.’

  ‘Yes, the note … Well, I can see how you’re thinking, but I can’t help. As I’ve said, once they conceive, I’m out of it Let me know though what you do find out. I’ll be most concerned to hear. Poor Angela Chowdary, she was unlucky. But we know we worked the miracle for her once and there’s every reason to assume we can do it again. Do you want me to let you know when we do?’

  ‘Er — yes. Yes, please,’ George said, well aware of the fact that she wasn’t nearly as interested in Angela Chowdary’s next baby as she was in her last, and Julia got to her feet briskly and went to the door.

  ‘I will, then. Right now I have to go and check some of the ova we took yesterday. We might be using them for a surrogate mother, you know. We’ve got a most interesting case: a secretary prepared to donate ova for a boss she enjoys working with. Very generous. If you’re interested I could show you what we’re doing… ?’

  ‘Thanks,’ George said, ‘some other time,’ and escaped, wondering at the back of her mind whether she could ever have been the sort of clinician Julia was. To be that involved with your speciality, she thought a little wistfully, must be very nice. And then had the good sense to laugh at herself, for wasn’t she as absorbed in her own cases as Julia was in hers? Why else was she traipsing about the hospital trying to find out why a baby had died? She shook her head at herself and set out to return to her Pathology Department.

  She stopped as she reached the ground floor of Red Block and set her foot on the walkway that would take her to the far side of the courtyard and her own unit Behind her, an equal distance away, was the new Paediatric Unit, Barrie Ward, and on an impulse she turned and headed that way. What else there might be to find out about the baby called Oberlander (what a ridiculous choice for a pseudonym, she thought again) she wasn’t sure, but it might be useful to have another word with Prudence Jennings. All that faced her on her own desk was a pile of budget pages that had to be pored over to see where she could save a few more pennies out of her outgoings, and that was not a prospect that held out any temptations. The fact that she’d have Dora Hebden breathing down her neck for them at any moment now mattered not a whit She’d deal with that problem when it arose. Right now, she was busy. Busy doing Gus’s job, but who was to know that, after all?

  As she reached the Disney corridor she heard a sudden shout, followed by a great deal of confused noise coming from the ward at the far end and she quickened her step. Whatever was going on there was clearly not just the usual children’s play; there were adult voices raised in anger, and she frowned as someone came out of the big swing doors towards which she was heading, looking back over her shoulder as she came.

  ‘What’s going on in there?’ George asked. The woman jumped at the sound of her voice and then shifted the big carrier bag she was holding to her other hand, clearly anxious.

  ‘Don’t ask me, doctor,’ she said, George’s white coat giving her an instant handle she could use. ‘I was just visitin’ my sister’s boy — ‘e broke his leg down the playground. I’m always on about that place, there’s never no supervision there like there should be, and then this man come in and started shouting at one of the doctors — that darkie one, you know? ‘Im with the teeth, very upset this bloke is, and calling ‘im every name ‘e can put his tongue to. For me, I speak as I find and I reckon ‘e’s all right, as Pakis go — nice fella, really. Our Wayne likes him, at any road’.

  Beyond the double doors the noise increased and behind George there was a thud of feet as one of the uniformed security men came running. George nodded swiftly at the woman with the shopping bag and pushed past her to go into the ward just as the security man arrived.

  Harry Rajabani was standing in the middle of the floor in a tangle of toys and picture books as a heavy-set man with a stubbled face and grubby clothes bawled at him at the top of his voice, while the young curly-headed male nurse George had talked to on her last visit to Barrie Ward (she reached into her memory for his name, Philip Goss) held on to him with a clearly iron grip. Harry’s face looked as though it had been carved out of polished wood; there was no sign that he was affected by the man’s shouting, George thought in some surprise, and then saw the muscles at the side of his face bunched and quivering and knew that he was controlling himself with enormous effort.

  ‘You lousy stinking black bastard, killing my boy, you and your nigger notions, get the fuck out of here and back into the trees you come down from, you bastard! If I’d have known you was putting your filthy black hands on my boy I’d have come down here and put a knife in you, do you hear me? A knife’s too good for you, you should be strung up and made to suffer like my boy suffered, you stinking nigger —’

  ‘That’s enough,’ yelled Philip Goss, shaking him by the shoulders. ‘We know how you feel, Mr Ritchard, but that doesn’t mean you can abuse Dr Rajabani like that No one’s to blame for Kevin dying. We’re all so sorry. Please come and let me —’

  But the man wasn’t to be reasoned with. He was dishevelled, and his eyes were bloodshot and bulging. He clearly hadn’t shaved for some time and he looked drawn and grey as well as stubbled. His mouth was open and still he shouted his obscenities into Harry’s rigid face. At the far side of the room a couple of the nurses, including Sister Collinson, stayed white faced and anxious behind the safe barrier of their desk while beyond the second set of glas
s-windowed double doors that led into the ward proper George could see other nurses peeping out and hear the voices of the children who were also shouting, some of them shrieking with fear.

  The security man pushed past George now with scant ceremony and grabbed the screaming man by his shoulders and whirled him around so that he lost his balance and fell against the stocky uniformed body. He was grabbed then by both arms which were held behind him just as two more security men came thudding along the corridor to get involved too.

  ‘Come along, sir,’ panted the first of the men, who held on as his colleagues came up and joined in. ‘We’ll sort this out, come with us …’ And they had him out of the ward and into the corridor with its absurdly simpering Mickey Mouses and Donald Ducks with smooth professionalism, leaving Philip Goss behind calling after them, ‘He can’t help it — his son just died,’ and Harry Rajabani standing rock still in the middle of the play area.

  A sort of silence descended, even the children beyond seeming to quieten as the nurses who were with them stopped staring and at last shepherded them away, leaving George and Philip Goss to hurry to Harry’s side. Sister Collinson came over too, now it was safe to come out from behind her barricade, and sent the other nurses into the ward to help calm the children. George reached Harry’s side first She took his arm and, when she felt the rigid muscles there, said without stopping to think, ‘You’ll feel better if you shout.’

  He shook his head, and slowly the muscles in his arm softened under George’s hand, his shoulders slumped, and Philip, moving with commendable speed, pushed a chair behind his knees so that he folded, half collapsing into it, as the power clearly left his legs, leaving them like a jelly.