Clinical Judgements Read online

  ‘Point taken,’ Esther said and reached out and squeezed Kate’s arm. ‘Sorry, ducks. Listen, any chance of coming to dinner one night soon? With Oliver or on your own — either way.’

  ‘I’ll talk to Oliver,’ Kate said. ‘He likes coming to you — he says Richard makes him feel so inadequate and boring. It’s good for his immortal soul and doesn’t do a bad job on his sense of proportion either. What’s Richard’s latest?’

  Esther sighed. ‘He’s thinking of a sandwich service. Make ’em at home, deliver direct to people’s offices. As if it wasn’t bad enough he’s got the restaurant and that bloody wine bar — I can hardly get into my own fridge for the leftovers. Not that I ought to complain, I suppose. It beats cooking for myself, and the children do well out of it. So do half the school, mind you. They bring the world and his girlfriend home most afternoons. I can tell you, it’s a relief to be here at the Old East in among the peepots most of the day. Family life!’ And she snorted softly as she led the way out of her office into the ward. ‘It’s not all it’s cracked up to be and don’t you forget that before you go getting yourself in the club. Let me know when you can make it. Try Sunday. It’s the only day I can count on Richard not having to rush off to an emergency like a collapsed soufflé or a corked bottle of Beaujolais. Now, here’s Sally, Miss Sayers, wanting to talk to you about her plans for a holiday with her boyfriend —’ and she slid smoothly into her professional mode as the nurses in the ward straightened up instinctively as Sister appeared at a bedside with the consultant beside her.

  By the time Kate had finished her round and discussed the various social and emotional problems of her dialysis patients as well as the medical ones, she had got over her irritation with Esther. They were old friends, God knew, but that surely didn’t give her the right to be quite so bossy, she had thought as Esther had scolded her about wanting a baby; but now as she left the ward to make her way to the Outpatient department and her discussion with Barbara about her new patient, she had to admit she had been right. It would complicate an already very tangled set of problems quite disastrously if she became pregnant. She knew that perfectly well; but it didn’t stop her aching with the desire sometimes. Last night she had wished with all the fervour that was in her that she could somehow persuade Oliver to forget his responsibility, and had been even more abandoned in her caressing and kissing than she usually was, almost as though she were trying to push him so hard and fast that he wouldn’t be able to prevent himself; but it hadn’t worked. He had timed it perfectly, as always, reaching for his damned condom and putting it into her hand so smoothly that she had it unwrapped and on to him before the idea of deliberately snagging it had come into her mind. But that had been a wicked thought, a selfish and plain wrong thought, and she had been able to banish it completely; till Esther had started her off again —

  It was just as well, she told herself now as she reached the courtyard that lay between the high old Victorian ward block which housed the Renal Unit and the rest of the hospital, just as well I’m not a suitable candidate for the Pill. If it was up to me, there’s every risk I’d really muck things up, accidentally on purpose. And I’m supposed to be an intelligent, capable woman; and she shook her head at herself in renewed irritation and shoved her hands deep into the pockets of her white coat, and began the long hike across the courtyard to Outpatients.

  Around her the sprawl that was Old East glittered still in the blazing late August sunshine and she felt the sweat break out across her forehead and begin to trickle between her breasts. The tar was soft beneath her shoes, filling the air with a faintly antiseptic reek, and she took a deep breath, relishing the smell of it, and all the other scents that joined with it to make up the familiar atmosphere of the place. Exhausted parched grass and sour drains and the dustbins from behind the kitchen block; diesel fumes from the highway that flanked the hospital grounds and, further away from the south, the smell of Thames water; all mixed up with the heavy pine fluid the cleaners used to scrub the long corridors; and the general carbolicy scent the whole place had, even though it had been decades since anyone had used the stuff. This was the very essence of the hospital, and in many ways, of her life.

  She had come here first as an eighteen-year-old medical student from St Kitts, to do a ward attachment during her pre-med years; a policy of the old Dean, Arnold Duce, who had said every student should know what it was like to mop up sick and empty bedpans as well as how to dissect a cadaver and take blood from a collapsed vein. She had been frightened then, terrified of it all, but she had fallen in love with it in spite of that, and still felt the same now. Seventeen years of her life had been spent in and around this huddle of buildings, one way and another. She had been away for short attachments elsewhere, but always she had been part of Old East, and she stopped now and looked round as though she had never seen it before, remembering what Esther had said about the round made by architects and planners. They couldn’t really be meaning to pull the place down, could they? It was unthinkable; and she stared at the big cream-coloured Georgian Admin building, once all the hospital there had been, when the place had been founded at the end of the eighteenth century, but now empty of patients and just a hive of noisy offices filled with a chatter of secretaries and a pomp of administrators; and she grinned at her own elaborate use of language, at the way she was consciously using words to release her impatience with the top-heavy management of the place who made life, it often seemed to her as to the rest of the medical staff, so much more difficult than it need be. Behind her rose the great red-brick blocks of the shabby old Victorian buildings; tall, a little ramshackle now, but still with a certain charm all their own. The high windows with the curtain rails clearly to be seen in the centre, even from this distance, and the clutter of plants and get-well cards on their sills which looked down on the web of glass-covered walkways that bisected the courtyard and which led to the various nineteen-forties and -fifties Nissen huts and pre-fabs, which clustered round the ward blocks like children attached to their mothers’ skirts. On all sides there was evidence of growth and spread; here a small hutlike building tucked between two others and clearly of recent origin, there a battered Portakabin brought in to fill a temporary need which had become very permanent; everywhere signs and noticeboards directing bewildered patients to the maze of departments and units that Old East now boasted. Haematology and Histology this way; Maternity and Colposcopy, Gynae, Antenatal and IVF Unit the other; Renal Unit, Outpatients, Cardio-Thoracic, Gastroenterology, Neurology, ENT, Physical Medicine, Rheumatology — the blue-and-white signs were everywhere, bearing mute evidence of the way medicine had spread and burgeoned over this past couple of decades. Even since her own student days it seemed that new specialities had exploded like popcorn until she was almost bewildered by their multiplicity; and if she felt like that, how on earth must the patients feel? For half of them it must seem as though they had newly invented diseases in newly fragmented bodies, and most certainly very newly invented treatments. And by no means all the treatments were less disagreeable than the diseases —

  But she had no time, she told herself firmly, as she started to walk again, no time to think of such matters now. There was a time to consider the ethics of her job, but this was not one of them. She had to see a patient with Barbara and she had no right to keep either of them waiting.

  ‘Thank you, Mr Hynes,’ Kate said at length. ‘Perhaps if you’d just get dressed, and then we can talk again.’ And she moved away from the couch and pulled the curtains behind her to leave him in decent privacy, taking with her his beaming smile and murmur of, ‘Kim, Miss Sayers, no need to be formal —’ as she went. She looked back through the curtains briefly before closing them, and he sat staring back at her, the blanket held bunched before his bare chest in tightly clasped hands and his eyes wide and dark with enlarged pupils. He had joked with her as she examined him, had made jolly little sallies and giggles, but she had not been deceived. He was sweating with terror, and his hands shook
damply. Under the cloud of perfume he was wearing she could smell the tension that was in him, thick and sour in her nostrils. It was a familiar situation, of course, but this patient’s fear was not like that of others. He had different apprehensions. And she closed the curtains with a last reassuring nod, and went back to the desk.

  She wrote her notes, and Barbara sat and waited, leaning back in her chair and watching her, the smoke from her cigar wreathing itself round her head defiantly. Her colleagues in the Medical Common Room had long ago given up asking her to stop smoking; they could not cope with her sharp grins and her raised brows nor her questions about their own bad habits, because who liked to expose themselves in such a way to a psychiatrist, anyway? Even as cheerful a psychiatrist as Barbara Rosen, with her sleek white hair tied in a cottage loaf sort of bun on the top of her head and her ridiculously red-cheeked face. There were actually some who thought her creepy; no one, they said, ought to be that cheerful and friendly when she had to spend all her working life dealing with such impossible patients. There must be something peculiar about her herself to choose such a field; and they kept their distance.

  And it could not be denied that her speciality was not greatly admired by the rest of the consultant staff. She had few allies among them for the work she was doing, few who felt that the many papers she had written for the journals and her two or three books actually brought any renown to Old East’s name. How could it be so, when she researched in so esoteric a subject?

  ‘Well?’ she said at length, as Kate finished her notes and pushed the folder towards her. ‘You are sure you’ll do it? No going back?’

  ‘With your endorsement of the patient’s determination and your certainty that he can and will cope well post-operatively, I can’t refuse,’ Kate said. ‘I can’t pretend I’ll feel as comfortable as I might. Mutilating surgery — it goes against the grain, obviously. But looking at him now and listening to him, as well as seeing what your preliminary therapy has done — well, I can operate next week. My lists aren’t too long and I can do him at the end —’

  ‘You’ll have to learn to change your pronouns, Miss Sayers, after that, won’t you?’ The curtain had been pulled aside and the patient stood there, smiling anxiously at her. His face was smooth and beautifully made-up with eye shadow that was just enough, and blusher set so expertly that his face seemed to be soft and rounded, even though in fact it was a firm and rather bony one. His lashes were so long and curly that they threatened to touch his upper lids in the middle, but he made sure he kept his chin up and his lids lowered so there was no real risk of that. His hair bounced softly against his shoulders in a profusion of red-gold curls, and the one hand he held casually to his cheek as he stood and gazed limpidly at Kate was long, very white and red-tipped with a perfect manicure. Kate wanted to hide her own rather square-tipped scrubbed hands out of sight as she looked at it.

  ‘Now, which side of the ward will you put me in?’ The voice was soft and husky and not a little provocative, and the wide heavily lashed eyes gleamed a little as they fixed their gaze on Kate, who blinked.

  ‘I hadn’t thought about that,’ she said, ‘how very silly of me —’ as Hynes came forward and sat down in the chair that stood on the other side of Barbara Rosen’s desk, and crossed one long very silken leg over the other, to show the long kid pumps with the very high stiletto heels more clearly. ‘I rather think we should let you have the side ward. To be on your own might be better for you —’

  ‘No need,’ Hynes said, a little more loudly. ‘I’m not ashamed. Why should I be ashamed? And anyway, why hide away when all that’s happening is that a mistake of nature is being put right? Eh, Dr Rosen? Isn’t that something surgeons do all the time? Babies with dislocated hips, and great ugly birthmarks — all that’s happening is a cure for an … an unfortunate mistake. I am right, aren’t I?’

  ‘Yes, Kim,’ Barbara said and took another deep drag on her small cigar, letting ash sprinkle itself around her already rather dusty cardigan as she looked sideways at Kate and raised her brows. ‘Well, Kate? Is Kim to be fully reassured you can help?’

  ‘Yes,’ Kate said after a moment. ‘Yes, I’ll remove both testes and the penis and make what sort of urethral arrangements seem best as I progress. You realise that I can’t fashion you any sort of vagina at this stage —’

  Kim gave her a radiant smile. ‘I fully understand, Miss Sayers. Dr Rosen has explained it all. I can think about that some time in the future. Right now, to know I’m going to get rid of those awful — that ghastly mess down there — well, I can’t tell you how happy you’ve made me. I was so scared, you can’t imagine how terrified, that you wouldn’t help me, wouldn’t operate. You’ve made me feel — I can’t tell you. You’re a dear soul, the best friend a girl could ever have. After Dr Rosen, of course —’

  And he leaned forwards and took Kate by the shoulders and kissed her on both cheeks, leaving a bright red smudge of lipstick on both of them, and when he leaned back tears were matting his lashes together into spikes above a face which seemed to have collapsed into a crumpled mask of distress. And after a startled moment Kate nodded in some embarrassment and then got up to go, leaving the unlikely pair, psychiatrist and patient, watching her solemnly.

  Oh God, she thought as she stood outside the closed door and heard the soft murmur of their voices as they began to talk. Oh God, what have I let myself in for with this one?

  Chapter Three

  Four of the new intake of nurses managed to get to first lunch, and even though they hadn’t been particularly close when they’d been on their Introductory course, still they made for each other like bees for the hive and coalesced into a tight little group as they collected their food from the bored women serving at the hotplate, and went and sat at a small table in the far corner of the great echoing dining hall.

  ‘Oh, my God,’ David Engell said, and peered down at his plate, his face creased with distate. ‘This looks even worse than we used to get over at the Annexe. What is it?’

  ‘It said on the board it was a chicken risotto,’ Sian said and stared at her own plate with equal gloom. ‘Looks more like sick to me. I think I’ll change it. I like the look of what you’ve got better, Suba.’

  ‘You’ll get bloody hungry if you try that,’ David said, looking over at the long queue that had formed at the hotplate. ‘You’ll really cop it if you try and cut in on that lot. It’ll take ages to get a new one. Anyway it doesn’t taste as bad as it looks. Quite nice really.’ He had started to eat hungrily, pushing the food into his mouth at great speed. ‘Though next time I’ll do the same as you, Suba. Looks like it pays to be one of you Muslims.’

  Suba went a dull red. ‘I’m not Muslim,’ she managed. ‘I just — I’m a vegetarian, that’s all. Lots of Catholics are. It’s not religion or anything,’ and she began to pick a little miserably at her macaroni cheese.

  ‘Scared of upsetting the dear little animals, are you?’ Alice said and laughed. ‘I’ll bet you’ve got leather shoes on, all the same.’ She had already finished her risotto and was now demolishing custard tart with equal dispatch, eating even faster than David, and her open-mouthed laughter was an unattractive sight in consequence. Suba looked away, redder than ever, hating herself for drawing attention by answering David. She should have said nothing, but how could she have done that? It was so stupid the way everyone always made the same mistake, always thinking all Asians were the same just because they were Asian, and it irritated her to hear it. That was why she had spoken, but oh, how she wished now she hadn’t; and she bent her head, wishing too that she hadn’t come to lunch at all, but had gone to sit in the garden for her half-hour instead.

  ‘Shut up you,’ Sian said unexpectedly. ‘Just because you’ve got no principles, it doesn’t mean other people don’t. Good for Suba. You eat what you like.’ And Suba glanced at her, scared but grateful and not a little surprised. That this odd-looking girl with her almost shaved head and angular face and spiky way of speaking to peo
ple should come to her defence was very strange, and for a brief second her spirits rose.

  ‘What’s it been like for you lot?’ David said. ‘I’ve had a great time and I don’t think. I’m on this male medical ward, full of awful old buggers with miserable faces. You never saw anything so dismal. I’ve done nothing but run around with bottles and bedpans. Oh, yes, and I helped change a wet bed. Big deal.’

  ‘Oh, I’ve been really busy,’ Alice said with great complacency and pushed away her empty plate and began on her coffee. ‘Playing with the kids and helping to undress them to be examined and taking them to be examined and taking them to X-ray and all that — no one to nag me at all. They just told me to look after the kids and that’s what I’m doing. I dare say it’s why I was sent there — they know I can manage on my own well enough.’

  The other three looked at her with cold eyes and David made a face at Sian who laughed aloud.

  ‘Yeah,’ she said, ‘I’ll just bet. They sat there in the office and they said to each other, all dead worried, they said which of these wards and departments we have here in this pathetic place is good enough for the towering talents of Alice Abingdon? I mean, we mustn’t waste her, must we? She’s the best thing that ever happened to Old East — as well as having the biggest arse.’

  ‘Jealousy,’ Alice said loudly. ‘I know all about you and jealousy, Sian Bevan. You’re too stupid to be anything else. It’ll be sunrise in the west before I take any notice of something like you. Can you smoke in this place?’ And she turned her head to peer around the big room. But there were No Smoking signs everywhere and she got up. ‘I’ll go and find some peace and a better atmosphere some place else,’ she said. ‘Make sure you keep an eye on the time, you lot, or you won’t be back in time to spend your afternoon shifting the bedpans, will you? I’ll think of you down in my nice clean clinics —’ And she went pushing her way through the tables with a deliberate swing of her haunches that made Sian laugh aloud.