Clinical Judgements Read online

  ‘Well, why does he need a whole four-bedded unit to himself? Why do I have to crush up my beds so that —’

  ‘Because, Sister dear,’ Byford said triumphantly, ‘because this patient is only Mr Edward Saffron.’

  She stared at him and then said, ‘Who?’

  ‘Edward Saffron, Sister,’ Byford said, and then repeated slowly, breaking up the syllables insultingly, ‘Mis-ter-Ed-ward-Saf-fron, the Junior Minister for Health.’

  ‘I know who he is and what he does,’ she said tartly. ‘I just want to know why he’s coming here, and turning my ward upside down. Why don’t you take him to St Andrew’s Wing? He a private patient, surely? And that’s what we’ve got St Andrew’s Wing for, isn’t it? Private patients …’

  He raised his eyebrows at her, almost pityingly. ‘My dear Sister, how can he be a private patient? He is the Minister for Health. There’d be an uproar if he went into the Private Wing. No, he’s got to be here in an NHS ward. On my NHS ward.’

  Also by Claire Rayner

  MADDIE

  REPRISE

  JUBILEE: POPPY CHRONICLES VOL I

  FLANDERS: POPPY CHRONICLES VOL II

  FLAPPER: POPPY CHRONICLES VOL III

  CLAIRE

  RAYNER

  CLINICAL JUDGEMENTS

  ebook ISBN: 978-1-84982-043-1

  M P Publishing Limited

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  M P Publishing Limited Book

  Copyright © Claire Rayner 1989, 2010

  All characters in this publication are fictitious and any resemblance to real persons, living or dead, is purely coincidental.

  ALL RIGHTS RESERVED.

  No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means without the prior permission in writing of the publisher, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

  e-ISBN 978 1 84982 043 1

  The moral right of the author has been asserted

  For

  Basia and Hilary Howells,

  two very special doctors.

  With love.

  Chapter One

  Six a.m.

  Already the sunlight is so bright it hurts the eyes to look at the big windows in the operating-theatre block and the tall doors that lead to Outpatients, for they glitter ferociously, returning their heat to join the already burning brightness that is spilling over the cracked brown-grassed verges that line the pathways leading to the path lab and pharmacy. The hottest August, the gate porters tell each other as they sit and brew tea in their little cubby-hole and open the Sun to the racing pages, the very hottest since records were kept. And they nod companionably at each other as though they can take personal credit for so remarkable a circumstance, and light their cigarettes and build up an even thicker fug as they pore over the day’s selections at Doncaster and Kempton Park, and their kettle spews steam all over the grimy windows.

  Six-five a.m.

  The Accident and Emergency department cat wakes and stretches herself and jumps down from the low wall that curves round from the side entrance to the department as an ambulance comes into the yard. She stares at it, aggrieved at being disturbed so early, and then stalks off to find breakfast, lifting her paws fastidiously as she crosses the asphalt on her way to the kitchen block. Yesterday it had been so hot that one of the ambulance men found his rubber-soled shoe had actually stuck to the ground, an experience that led to a great deal of interested talk in the porters’ cubby-hole, and still the heat lingers, adding to the morning’s blazing sunshine. How can it be otherwise after so many days of temperatures up in the high eighties and nights that never drop below sixty or so? And the ambulance men jump down and open the back and one of them fetches an agony wagon from the department, complaining loudly at how hot he is already, and that bloody supervisor not letting ’em go into shirtsleeves till after eleven in the morning, he ought to come and try dealing with the sort of rubbish they have to carry about wearing heavy jackets and then he’d know better than to make such bleedin’ stupid rules. And the cat stops and stares into the ambulance for a moment as the man comes back with his trolley and then goes on her way, disgusted at humanity in general.

  Six-fifteen a.m.

  The staff nurse on A and E mutters irritably as the trolley comes in, the stench of the occupant leading the way in great waves, and stares down at the lumpy shape with the same look of disdain the cat had used before stalking away.

  ‘Ye gods, Davy,’ she says and makes a grimace at the ambulance man. ‘Not another — not at this time of the morning —’

  ‘I told the copper you wouldn’t be best pleased, that you’d ’ad a night and three-quarters of it, but all he said was take ’im to St Kitts then. And I ’ad to tell ’im that’d really set the cat among the shite’awks, that would. It’s Old East what’s on take-in tonight, I says to ’im, and I tell you they’ve ’ad a really bad time of it. Three BIDs I say and all ’e said was if you don’t put a move on this one’ll be brung in dead an’ all, so what could I do? Sorry and all that, Staff, honest —’

  ‘Not your fault,’ says the staff nurse and leads the way to the far cubicle, battering on the staffroom door as she passes. ‘I suppose it’s what we’re here for, though I sometimes wonder … What’s the story?’

  ‘Picked up over at the dump by Artichoke Hill — where the winos are, you know? Just the other side of the Highway — police was called because one of the yuppies in that new block o’ flats at the end of Pennington Street said ’e saw smoke and reckoned it was an ’azard. So the Fire was called out and it wasn’t a fire, only the blokes burning their stuff as usual, so the yuppie calls out the police, don’t ’e? And they goes and finds this one out for the count and can’t rouse ’im. So they reckon ’e’s your department and send the rest of ’em on their way.’

  He grunts as together with the staff nurse he pushes poles into the calico stretcher and lifts the bundle of stinking clothes and blankets on to the couch. ‘Not that it’ll make no difference, of course. They’ll be back tonight. It’s them yuppies — it’s a campaign they’ve got to get the ’ole area cleared, so as to make it nice and residential for ’em. I don’t see the ’arm it does ’em to let the poor buggers use that patch, been there for years, they ’ave —’

  ‘That’s as may be,’ the staff nurse says and leans over the man now lying on his back, breathing heavily and with his eyes half open. ‘My God, smell him, will you? Uraemia as well as the rest of it — David, get him cleaned up, will you?’ The young male student nurse who has come to hover at the entrance to the cubicle looks green and backs away and the staff nurse lifts an eyebrow at him, and he manages a nod and comes into the cubicle as the ambulance man takes his trolley away and the staff nurse follows him.

  ‘I don’t know what we can do,’ she says. ‘I’ll get Dr Harker up to see him once we’ve got him cleaned up and made a few obs, but it’s my guess he’s a renal. And they’re stuffed full and all the medical beds are tied up —’

  ‘Well, ’e’ll have to go somewhere,’ the ambulance man says cheerfully. ‘On account we can’t take ’im back where ’e come from, can we? I’ll book ’im in then, OK? Anything to ’elp, ducks. We got some info on ’im — ’ad some things in his pockets, surprise, surprise. Prior, ’is name is. William Prior. Forty-five, it says ’ere, got an old driving licence would you believe. Born 1943 — same as me, a
nd looks twice as old. Poor bugger —’ And he nods cheerfully again and goes off leaving the staff nurse to wake Peter Harker, the casualty doctor on call. Not too disagreeable a task, after all, she thinks as she makes for the phone. I’ve an evening off and I’m broke to the wide. Going for a drink with him could be a worse way to spend the time. And if I wake him now, maybe we can fix a date …

  Seven-fifteen a.m.

  In her flat on the seventeenth floor of Lansbury House on the Tarling Street Estate, Prue Roberts wakes as the baby starts to wail, and lies with her eyes closed as long as she can, praying he’ll stop. But he doesn’t, of course. He just wails louder and then she hears Danny start, and what can she do? She has to get up. But before she’s out of her bedroom door and halfway along the passage to the kids’ room she’s doing it, retching and heaving, and she knows she can’t pretend it’s not happening any more. Oh Christ, she thinks as she gets to the bathroom and manages to hang over the lavatory as the baby’s shrieks get louder and Danny starts to bawl at the top of his voice and the room goes round and the smell of the honeysuckle lavatory freshener comes up at her in thick cloying waves and makes the retching worse. Oh Christ, I can’t manage, not again. They’ll have to do something. I’ll go up Old East and see ’em, tell ’em they got to do something. The baby’s only five months, for Christ’s sake, and Danny won’t be two till bloody Christmas and how can I be expected to cope, with Gary not back till Christ knows when? All right for some goin’ off to bleedin’ Saudi Arabia, all right for some. And again she retches and then, slowly, manages to straighten up and stare at herself in the mirror over the washbasin. I look like death warmed up and gone cold again, she tells her reflection drearily. I’ll have to go up to Old East and tell ’em — make ’em do something —

  Eight a.m.

  Kate Sayers closes the door softly behind her and runs down the stairs to the garage, feeling good, her muscles moving smoothly, feeling good. And then grins a little to herself, amused at how predictable she is. No matter how tired she is when she goes to bed, if Oliver is randy and takes his time she feels marvellous and no matter how long he manages to keep her going and how much sleep she loses, she feels super next morning. It must have been after three before they fell asleep and here she is, bouncing like a two-year-old. It’s always the same. Sex is the best remedy, no doubt about it. And she tries to see herself telling the patients that on her ward rounds and grins again as she unlocks the car and throws in her bag. Those poor devils; most of ’em have forgotten what sex is for, let alone trying it for therapy. I should have gone into orthopaedics, not genito-urinary, she tells herself as she starts the engine and pulls the car out into the street. I’m not fair to my patients, feeling like this.

  The traffic is building up already; the big BMWs with their sleek drivers shaving with expensive German battery shavers and the cheeky little Renaults with girls with long blonde hair at the wheel clutter up the roads and she shouts insults at them as they get in her way. Oliver finds this behaviour infuriating, pointing out that it’s useless since the other drivers can’t hear her, inelegant because she looks so silly when she sits there mouthing at people, and maddening to listen to. So she tries not to do it when he’s in the car with her, but indulges herself when she’s alone. And it does help to get rid of her rage at the halfwits who droop around in the middle of the road with nowhere to go and all day to get there, as she tells them loudly, while she has to get to the hospital early this morning. As on every morning.

  But then her sense of wellbeing comes back as the traffic eases and she can get out of the Finchley Road hubbub and into the side streets, heading steadily south. It should be a good day today. Interesting, certainly. And she thinks about Barbara’s patient, and wonders how the rest of the ward will cope with him, all the old bladder daddies and the kidney dialysis lot — not used to people as exotic as Kenneth Hynes, that was for sure. And for a moment her lips curve as she visualises Kenneth Hynes walking into the ward dressed as he had been when she had seen him in Barbara’s clinic last month. It would be hilarious, and though as a surgeon she shouldn’t find amusement in a patient’s dilemma, how could anyone fail to find some in Hynes? His own personality made sure you laughed as much as he did. It was his defence against his pain, of course, a veneer.

  Le Queux won’t laugh, she thinks then and again she smiles but this time a little sourly. If this doesn’t turn into a right royal showdown, nothing can ever be done. He’s got to see that I’m not his bloody houseman, there to be pushed around. I’m a consultant in my own right and he can get stuffed, however senior he is. If I want to take patients from Barbara Rosen’s clinic, take ’em I will. He can’t stop me and I won’t let him. I hope there is a row, I really do — and she lets her mind create an elaborate scenario, with Keith Le Queux shouting and ranting about Barbara’s bloody pansy clinic and truly showing himself up for the pompous ass he is and then retiring defeated, leaving herself the victor.

  And then she sighs as she manoeuvres her way through the King’s Cross traffic. It won’t happen that way, it never does, and she is going to be late this morning after all. And some of the good feeling evaporates, so to get it back she leans forward to switch on the radio, and snaps the buttons till she gets City Broadcasting and hears the trailer for Oliver’s morning show, inviting the first callers to stake an early claim to their Meeting with Merrall.

  ‘Put London to rights!’ cries the announcer excitedly. ‘Let everyone know what you think and pit your wits against the sharpest of them all, Oliver Merrall. Eleven o’clock, this spot on the dial, don’t be late! The number you need to call is —’

  And she grins with pleasure even as she bawls ‘Halfwit!’ at the black-cab driver in front who has just cut her up. The hell with it. She feels good, she has an interesting day ahead of her, and what more can a woman ask for?

  Nine-fifteen a.m.

  Audrey settles herself in the seat beside Joe’s corner one and glares at the young man in the T-shirt and the earrings who had tried to beat her and failed. If he had any manners she wouldn’t have had to push him that way. Sickening it is, the way kids today behave, and she looks at Joe who winks at her, and at once she feels better. He only has to look at her with that droll gaze of his and it always has that effect. Takes all the rage away and the irritation, all of it. And she leans back and tucks her hand into his, trying not to notice how cold it is, even on this hot morning, and murmurs, ‘Not bad, eh? We’ll be there for half past easy, now. It was only the change at Barking I was worried about.’

  ‘As long as we can take our time walking at the other end,’ Joe murmurs as the train speeds up and the boy in the earrings deliberately leans heavily against Audrey’s knees with the movement. ‘I can’t be rushed, love, not on a hot morning —’

  ‘You won’t be rushed,’ Audrey says firmly and manages to move her foot accidentally as she crosses her legs, so that she kicks the boy in the shins and he can’t tell whether she knew she’d done it on purpose or not. ‘I’ll get a taxi —’

  ‘You won’t,’ says Joe, looking stern, but still droll like he always does. ‘Throw money around like there’s no tomorrow? There is, you know —’

  ‘Of course there is,’ Audrey says quickly, too quickly, really, and holds his hand tight. ‘Never mind, ducks, we’ll see when we get there.’ And they both sit and stare out of the window, and Audrey is glad when Earrings gets out at Plaistow and she can think quietly without wondering if he’s going to kick her or something.

  Not that she really wants to think. She and Joe, together thirty-seven years come November, never did have to talk a lot to be comfortable. They could always sit quiet and think together and be very easy that way. People used to talk about it a lot, saying how they was the perfect couple; and so we are, she thinks fiercely suddenly, so we are. But I can’t sit quiet and just think no more. Better to talk.

  So she talks, all the way, watching the stations go by. West Ham and Bromley-by-Bow, and Bow Road and Mile End and
chattering about everything and nothing. The roses in the gardens they go by and the dirt on people’s windows — wouldn’t you think they’d have more pride even if they do live by the railway? — and how it used to be in the old days of a Monday when there was always lines of washing, everywhere washing, only nowadays why put the washing out? It’s all dryers in the launderettes now any old day of the week, not like it was when we was first married and I did all that big wash in a copper on Mondays, do you remember, Joe? Stepney Green and Whitechapel and time to change to go to the last station, to Shadwell and Old East, and she would get a taxi for him, no matter what, because however hard he tries he can’t fool her. Exhausted he was, dead exhausted — very exhausted, she corrects herself swiftly, really very tired. And she holds his hand hard and lifts the case down from the rack and slowly they move through the hurrying morning crowds at Whitechapel station on their way to Joe’s deathbed. He knows it and she knows it and what can anyone say about that?

  Nine-thirty a.m.

  Ted Scribner puts down the phone and stands there staring at it, trying to think what to do. He’s been up so long getting everything ready, making sure his bag is properly packed with his special pyjamas and the sponge bag and the soap and the shaving things in their own special container inside, and giving Mrs Carroll next door the food for the cat, and turning off the water and the gas, and now he doesn’t know what to do. It’s like he’s trying to think with cotton wool instead of brains. It wasn’t his fault. It wasn’t being old or any such bloody rubbish as that. He wasn’t old for a start, not seventy yet, not quite, and anyway what was seventy nowadays? His old dad had gone on to be eighty-three and he’d been as sharp as a bloody tack till the day he died and then his mum had always said it had been the booze what had done it. He, Ted, had never been a boozer, not ever, and that was what made it so hard he had to have all this trouble now. Taken good care of himself he had, even after Enid had died, hadn’t been like some, letting everything go. And now this.