Clinical Judgements Read online

  Four times. Four times he’d been promised this operation, four times he’d had a date and now to stop him again, this close! Another ten minutes and he’d have been out of the house, locking up, walking down the road to get the bus to take him along the Highway, and into the hospital. He’d been really looking forward to it. Not that any man ever wants to be put to the knife and made ill; he’d had enough of being ill in the war when he’d got the frostbite on Salisbury Plain and been on the sick for five months, but when you got a problem like this, what are you supposed to do? Seven times he’d been up to pee last night, seven times. No wonder he got so tired and couldn’t think out of his cotton-wool brains. He needed this operation, needed it real bad. He’d be able to hold his water properly afterwards, that Mr Le Queux had promised him faithful, and now this. The bed gone, taken by an emergency, they’d let him know as soon as they could when he could come in. Soon as they could.

  And he stands and stares down at the phone and the tears begin to slide down his carefully shaven cheeks, making tracks in the film of talcum powder he’d put on so carefully, so as to look his best when he went up to Old East to have his operation.

  Nine-forty-five a.m.

  They stand in a little huddle, very aware of their shining new uniforms, very uneasy, rustling with anxiety, smelling of it. Alice Abingdon looks all right though, bouncing and full of herself, and some of them look at that round beaming face and ache to share her self-confidence. ‘She looks as though she knows it all already,’ Clemency says to Suba who looks at her with a scared sort of sideways glance and whispers, ‘Yes —’ but doesn’t really care whether Alice feels that way or not. She’s too scared herself to care tuppence about anyone else and she wishes she was at home, with Mum and Daddy.

  Alice looks at Peter Burnett and David Engell, both very neat in their tunics and white trousers and feels her chest get even tighter. She looks awful in her own uniform. They haven’t done anything to find one that really fits her, and she can feel it straining across her bottom and flapping at the back and knows she looks silly. Big people don’t ever look their best in pink nylon, she tells herself, and smooths her face even more. Never let them think they’re getting at you, her mum had said. Keep it all inside and bring it home. Never let them know they’re getting at you. And Alice stares at the two boys who look back at her and one of them blushes and looks away and for the first time Alice begins to feel it will be all right after all. She can do it. And again she puts on her bouncing sort of face.

  There is a rustle of chatter at the door and she comes in, Miss Chessman, the senior tutor, and with her Miss Hyte and the tall man with the red hair who always sneers so much, the clinical tutor. Alice can’t remember his name at all. All she knows is she doesn’t like him much and he doesn’t like her.

  ‘Good morning,’ Miss Chessman says briskly. ‘I dare say you don’t feel it is much of a one, but it is, all the same. This is a difficult day for you and we all know it and will make it as easy as we can. Now, do remember once you are on your wards all we told you in your lectures in the Introductory course. No one expects you to know all there is. All we ask of you is to be calm and sensible and to ask when you need to. You will be comfortable I am sure, as long as you don’t try to go beyond your own abilities too soon. Now, Miss Hyte will tell you your allocations, and then you will collect your timetables from Mr Muncey. Make sure you keep them with you at all times, in case they are required for alteration, and if you have any problems you can always talk to one of us, or to Mr Kellogg, who’s off sick today but should be back tomorrow. We’ll be around the wards from time to time anyway. Now —’

  ‘Miss Chessman, may I just ask —’ The tall girl with the very short hair — a crew cut really — and the small gold earrings speaks loudly and Suba looks at her and wonders how she can do it, in front of all these people. She has been at the lectures and so forth for three months now and still is frightened to speak, and this one is never frightened, not even this morning. ‘Miss Chessman, I wanted to ask you about that business of talking to people —’

  ‘If this is the matter of first names and surnames again, I really don’t think —’ Miss Chessman begins.

  ‘But I still don’t see why,’ the tall girl says loudly. ‘Why should the sisters and the staff nurses be allowed to call me by my first name and me have to call them Miss this and that? If they can say Sian to me, why can’t I say Jane or whatever to them? Why can’t I say Edna to you?’

  ‘I think we’ve spent quite enough time on this issue, Miss Bevan,’ says Miss Chessman frostily and turns to Miss Hyte. ‘Now, if you will, please?’ and she, after a sharp glance at the now sulky Sian Bevan, begins to read her list.

  And one by one, the new nurses make their way to the wards where they will spend the next twelve weeks. Alice Abingdon is sent to Paediatric Outpatients, which comforts her greatly, for children, surely, can’t cause her any problems; and Suba Mahmoudi takes a deep breath of happy relief as she is told she is to go to Gynaecology. To be with women patients: wonderful! That should stop Daddy nagging for a little while anyway. She walks through the big double doors into Annie Zunz Ward and, as the sign closes behind her, feels much better about being one of the new nurses’ intake at the Old East.

  But Sian Bevan marches into her ward, Genito-Urinary, in a very different frame of mind. This place, she tells herself firmly, needs stirring up, and I’m the one who’s going to do it.

  Ten a.m.

  ‘I rather think I preferred the Elephant House,’ murmurs Professor Levy as they make their way through the shining new splendours of the DHSS offices in Whitehall. ‘I find dirty paint and the smell of dust much more comforting than this magnificence. How many intensive care beds could I have got for the money they spent here, do you think?’

  ‘My dear Professor, talk that way and they’ll never listen to you,’ Matthew Herne says anxiously, every inch the hospital administrator trying to soothe an intransigent hospital Dean. ‘Not noted for their warm responses to that sort of shroud-waving here, you know, you really mustn’t try to —’

  ‘Pooh,’ says Professor Levy loudly and likes the sound of it so well he says it again. ‘Pooh. It’s because no one ever tells these jacks-in-office the truth that they get away with what they do. You can’t tell me that they can’t see how stupid they’re being over this issue? To close us down just because they can sell the land —’

  ‘It isn’t just the value of the site, Professor,’ Herne says patiently. Too patiently, but he’s been through this argument so often and got so little further forward that perhaps he is entitled to show some of his irritation. ‘The area’s overbedded and that’s the truth of it. There’s St Kitts, and there’s the whole Bart’s setup and Guy’s and Thomas’s just over the river and —’

  ‘You know as well as I do that that has nothing whatsoever to do with anything,’ Professor Levy snaps as the large lift wafts them silently upwards. ‘We’ve all been cheek by jowl for centuries, literally centuries. And we’ve always had more work to do than we could handle. Do we have empty beds or waiting lists? Do we have short outpatient clinics or massive ones? Are we trawling for patients or sending ’em out half treated to let their poor bloody GPs cope as best they can? You tell me, and try not to insult me with such stuff as overbedding. You tell Le Queux he’s overbedded in his renal unit. You tell Gynae they’re overbedded — they’ve got the longest bloody waiting lists of them all and —’

  ‘If they didn’t do so many abortions and stopped that very expensive IVF programme they might find it easier to shorten their lists,’ Herne says waspishly. ‘And it’s no use getting angry with me, Professor, because I tell you what the thinking is here. If you don’t like the message it’s no use shooting the messenger. They say the area’s overbedded and —’

  ‘And I say they want to sell our site to put up more million-pound flats for city whizzers. None of whom use the NHS of course, so they don’t give a damn for the poor devils who do. The people
on our overbedded hospital’s waiting lists.’

  They are still bickering as they reach the big conference room where they are to hear the current views of the mandarins dealing with Old East and St Kitts, and they will go on bickering for some considerable time. They always do and they always will. And the mandarins, as usual, will pay them no attention at all.

  Another day at Old East is on its usual creaking way.

  Chapter Two

  ‘I think,’ Esther Pelham said loudly, ‘indeed, I’m sure that if I have to put up with yet another round on this ward this morning I shall go bonkers. Not noisily you understand, nothing spectacular. Just quietly bonkers. I shall probably dance naked in the day room. Then everyone will know for sure that Sister in charge of Genito-Urinary is a certifiable lunatic.’

  Kate snorted with laughter. ‘It can’t be that bad. Just Keith Le Queux and me, and I promise I won’t take that long.’

  ‘Oh you two are the least of it. And I don’t mind you — I mean, you’ve got a right. It’s your unit. But first I had Professor Levy with a bunch of Japanese and Americans doing some sort of study tour and then I had that boring old fart from the Manager’s office — you know the one I mean — Puncheon, isn’t that his name? Goes around looking like he knows it all and as far as I’m concerned wouldn’t know a spigot from a catheter and I could cheerfully shove either one into him. A long way up too. He had a crowd of DHSS characters with him and architects and Gawd knows who else —’

  Kate looked up from her pile of notes sharply. ‘What did they want? I’ve heard the rumours. Is there something in them, then?’

  Esther made a face. ‘Mm — more coffee? Shove your cup over. Not rumours any more. Looks like the real thing. They were talking nineteen to the dozen about the Admin block and one of them said something about was the building listed, being Georgian, and another one said it wasn’t, being in such poor condition. And then someone else said something about the Victorian ward blocks as compared with the later ones and then I had to leave ’em to go and sort out Sally Charterhouse, who’d blocked her cannula again. But it sounds bad, doesn’t it?’

  ‘I can’t see they’ll do anything as silly as close us,’ Kate said and drank some more coffee. ‘There’s no way they can, not with the pressure we’re under for our beds. Don’t worry, Esther — no need to man the barricades just yet. May I have Sally’s notes, then? I think I might be able to get her stabilised at home on the League’s new dialysis machine. They’re more than halfway to another one, they say, bless ’em, so I can put a bit of pressure on, I think, and try to get another patient into the programme —’

  ‘You should be so lucky,’ Esther said. ‘Mr Le Queux’s got his eye on the League’s equipment and you know he’ll pull rank on you.’

  ‘Damn him,’ Kate said, but didn’t sound too put out. ‘But I suppose I expected as much. Then we’ll have to get someone else on to a bit of fundraising and then get another machine. How about talking to some of the relatives who come here? Won’t they —’

  Esther shook her head. ‘They’re already busy with the League, and there are all the other funds going too. There’s some damned jumble sale or bazaar every other week, it seems to me. What with the new computer the Special Care Baby Unit wants — they’ve only got one for their seventeen prem baby cots — and the Gynae unit pushing for a laser for the colposcopy clinic and the fund for a breast cancer scanner that Alan Kippen’s got going, we’re well down the list. Anyway, most of the groups seem to be making posters and banners for a Hands Off Old East campaign. They’re really worried — I think I’ll go into private, you know. It’s getting more and more like a market place here every day.’

  ‘I can just see it,’ Kate said, a little abstracted now as she returned to her notes. ‘You’d just love poncing around at the Wellington or some such carrying flowers and looking delectable. All for the benefit of fat old Arabs and Greek millionaires.’

  ‘I could do with a nice millionaire,’ Esther said. ‘Someone to take me away from all this and to hell with Women’s Lib. How’s Oliver then?’

  Kate laughed. ‘How you can think of him in the same breath as Greek millionaires, my love, I can’t imagine. There isn’t exactly big money in radio, you know, and he won’t do ads, though they ask him often enough.’ She looked a little irritated for a moment. ‘I understand what he says about the ethics of it, but I do wonder sometimes — what with Sonia and the children. It’d take a load off his back if he did do the occasional discreet little something.’

  ‘Sonia making trouble again, is she?’ Esther pushed her own paperwork to one side and leaned her elbows on the desk and propped her chin on her fists. ‘Do tell.’

  ‘You’re a nosy old bag,’ Kate said without rancour, but pushed her own notes to one side too. They had ten minutes now to call their own, after all; the patients were eating lunch and the nurses busy tidying the ward for the afternoon, and it would help to clear her head about it all. And who better to talk to than Esther, who’d been her friend for so long? And she looked across at the round cheerful face and untidy curly hair and saw again the student nurse who had stood behind that terrifying old physician whose clinics she had used to take at St Kitts and mouthed the answers to his questions to the worried medical student Kate had then been. And grinned.

  ‘There’s nothing really new, I suppose,’ she said. ‘Sonia rings every other day to change the access arrangements, and she seems always to know the precise times Oliver will be working, and always picks on the days when he can’t take them. So then she says he’s not interested and when he tried to arrange different days she accuses him of using the children as a weapon between them, when of course she’s the one who’s doing precisely that. Oliver thinks there’s someone at City who’s got it in for him who tells her what his diary’s like so that she can work out how to make things as difficult as possible for him.’

  ‘The secretary? What’s her name — Bridget?’ Esther hazarded.

  ‘Bridget? Hardly — she’s been with Oliver for years. Thinks the sun shines out of his ears. She’d never —’

  ‘Oh, don’t be daft, Kate. Of course she does, and of course that’s just why she would. You’re very clever, my love, but you can be awfully dumb sometimes. She’s got a crush as big as a bloody house on your Oliver — well, I mean, who hasn’t? He’s very pretty, after all — and if the best way to get rid of you is to make life easy for the repellent Sonia, she will.’

  Kate shook her head, dismissing that. ‘No, Esther, it’s not her. And even if it were it wouldn’t make any difference. It’s Sonia who’s the real problem. She’s doing all she can to make life hell for Oliver and doesn’t care who gets hurt, especially the children. Her own children, I ask you!’

  ‘Do you get on with them any better?’ Esther asked bluntly, and looked at Kate shrewdly, who reddened.

  ‘Frankly, not at all,’ Kate said after a moment. ‘I still find them odious. Barnaby is really the most disgusting creature — spits all the time, at everyone. And Melissa does nothing but whine and grizzle — I get really screwed up because I’m so glad when Sonia ruins the access and Oliver can’t have ’em, but that makes him miserable so then I feel awful. I just can’t imagine what we’re going to do — I have this sort of daydream, you know, that Sonia will just go potty one day and take off to America or somewhere and take them with her, and then Oliver will just have to get used to the fact that he can’t have them when he wants to and we’ll be able to concentrate on each other.’ And she looked at Esther through lowered lids, like a child ashamed of the sin she has been caught committing.

  ‘Better out than in,’ Esther said lightly. ‘Pretending to like people you don’t has to be hell. But even so, if Sonia did do that, would it help? He’d miss them so much, surely? I know you think they’re repellent but they’re his kids and he loves them.’

  ‘I have to admit they’re not nearly as ghastly when he’s with them. It’s only when I’m around. They must hate me a great d
eal.’ And Kate bent her head and stared down at her hands clasped on the desk in front of her. It seemed a long time since this morning when she had felt so good, driving into the hospital, even longer since last night when Oliver had made her feel so sure, so very sure, that all in their life was wonderful.

  She lifted her chin then and looked defiantly at Esther. ‘Which is probably reasonable enough, seeing how much I dislike them. They’d be happier without being pulled every which way, surely? I wish she’d take ’em away, I really do. As for Oliver missing them — well’ — she tried to speak lightly — ‘I could always have a baby, I suppose, take his mind off them with a new family.’

  ‘You want to watch it, my duck,’ Esther said, and got to her feet. ‘You’re getting broody. That’d be a hell of a joker to throw into a game already as messed up as this one. Whenever you talk about Oliver, it sounds more and more like a soap opera than real life. Have a baby yourself? You’ve got to be potty.’

  ‘Why potty?’ Kate collected her own pile of notes and followed her to the office door. ‘It’s what women are for, would you believe. I seem to remember you thought it a good enough idea a couple of times.’

  ‘I wasn’t a shiny new consultant in a shiny new post, was I?’ Esther said. ‘And let’s be brutal, ducks — I wasn’t involved with a much-married man who doesn’t know how to control a bitch of a wife who’s doing all she can to screw up their divorce and their kids equally.’

  ‘No. And you weren’t thirty-five and running out of time, either.’ Kate followed her out into the corridor. ‘It’s all very well lecturing me, Esther, but you’ve got your family. How old’s Emma? Fourteen? And Davy’s a year older. It’s easy for you to talk —’