Clinical Judgements Page 5

  ‘The doctors do,’ Joe said mildly and then began to cough, and full of compunction Audrey said even more sharply, ‘Now just you be quiet, Joe Slater! Let me have those trousers — that’s it —’ And she bustled about him, taking his clothes, putting on the nice clean pyjamas she’d ironed so carefully last night and helping him on to the high bed. It wasn’t difficult: he’d never been a big man, her Joe; ever since young Mary had been born, she’d outweighed him by a good two stone or more; but he’d always been sturdy. Compact she’d called him in her mind, her Joe. He’d been compact. But not now. Lifting him now he felt like a bird, a bag of bones that moved uneasily inside the tired stretched skin, and she felt the traitorous tears fill her eyes as she pulled him into place against the piled-up pillows so that he could lean back and recover from his coughing bout. His face was reddish-blue with the effort but the skin around his mouth looked white and his eyes seemed glazed with the struggle just to breathe; but then, slowly, it eased and he looked a bit better. But only a bit.

  She had turned her back on him to fuss over his clothes, folding them neatly to repack them in her little suitcase. There was no room in the ward, the admissions office clerk had told her firmly, to store patients’ day clothes. Audrey must take them home and bring them back when he was to be discharged; and she had said a heartfelt thank you to the woman for that, as though her talking about Joe’s discharge and saying his clothes would have to be brought back actually meant it would be that way, even though Audrey had known it wouldn’t. She’d never bring these clothes back, not again, not ever … and she folded and refolded, smoothed and resmoothed, to give the tears a chance to reabsorb inside her eyes and run back down the back of her nose to be swallowed so that she could present him with a calm face when she turned round.

  ‘Now, I’ll put your Lucozade here, on your locker, and there’s your paper hankies and the magazine Mary sent for you — and here’s your soap and flannel and razor and all like that — you make sure those nurses keep it all nice and tidy for you, now. I think that’s all you’ll be needing.’

  ‘Packet of fags,’ Joe said and grinned at her, a wide-mouthed grin that showed his teeth, dull little yellowish teeth that showed no gleam of reflected light at all.

  ‘Well, I suppose you think that’s funny!’ Audrey said but she managed a smile all the same and he stopped grinning and closed his eyes and said, ‘Funny, really. It was the first thing they gave you when you got back out of the fighting. A cigarette they’d give you, and then fill your pockets with ’em while you lay on your stretcher. Funny, when you think of it.’

  ‘Yes,’ Audrey said. ‘Very funny. I’ll go and get you some chocolate now, Joe, from the shop down in the courtyard. Like I said, even if you don’t want it yourself, you can always give some to the nurses. They like a bit of chocolate, nurses do —’ And she smoothed the counterpane over his thinness and then bent and kissed his cheek. ‘I’ll send that there nancy nurse, then, and I’ll be back soon. Just you behave now and have a little rest. You must be tired —’

  And he nodded on his pillow, not opening his eyes. He was indeed very tired.

  The new patient in the corner bed had slept all afternoon, once his wife had gone, and David was disappointed at that. Sister Sheward had said he could take a special interest in him, make observations to discuss with Mr Kellogg, the clinical tutor, when he came round, and he’d cheered up no end at that. After a whole morning doing nothing but dirty work, it felt like a bit of real nursing. But Mr Slater had gone to sleep, and there wasn’t much you could observe about a man asleep.

  But things improved once the teas were served. David woke Mr Slater up for his tea, though he said he didn’t want any, thanks all the same, and David was just trying to persuade him to try a bit of bread and butter and jam when Sister arrived at the foot of the bed together with a doctor. David was too busy with Mr Slater, trying to lift him up without spilling the tea on the counterpane to pay much attention at first, but then Sister leaned over and whisked away the tea tray and put it on the bed table — where really it should have been all along — with a sharpish look at David when she did it, he noticed with a little knock of fear against his ribs, and came and stood beside the head of the bed. David stood there too, not knowing what else to do, and looked over to the other side of the bed where the doctor had gone to stand, and this time the knocking feeling against his ribs was quite different.

  He was, David decided, the most marvellous-looking man he’d ever seen. Not big — David never felt really safe with big men — but nicely made, very nicely made, sort of solid without being fat. He had close-cut curly hair, a bit white at the edges, and big round glasses which he kept pushing up his nose with a long forefinger as though they were slipping, and behind the glasses his eyes were dark and friendly. Even when he was looking at the patient, David could see that. The eyes were so wide and dark you could see into them even if they weren’t looking right at you.

  ‘Hello, Joe,’ the doctor said and the patient blinked and peered up at him and then gave a big smile, the biggest he’d given anyone since he’d got on the ward.

  ‘Hello, Dr Carr! Well, it’s nice seeing you! I thought I wouldn’t, seeing they sent me to this ward. I said to them in Admissions I always go on to Andrew Green Ward, Dr Carr’s ward, not Mr Byford’s, I said, but they said not this time, so I thought, maybe I won’t be looked after by Dr Carr no more —’ He began to cough, after the effort of saying so much, and Dr Carr sat down on the bed and set one hand lightly on Mr Slater’s chest.

  ‘Oh, you’ve got me, all right, Joe. I wouldn’t let anyone else look after you! Remember what I showed you, Joe?’ he said and David thought — It’s a smashing voice. Nice and friendly like his eyes and not a bit stuck up like most of them are. ‘Breathe easily and pace yourself. You need to take your time with what you have to say, not run at it like a bull at a gate.’

  The old man in the bed, still coughing, tried to do as he was told, but that made him splutter and for a moment there was a bustle of activity as Sister Sheward and Dr Carr together eased him forward with concerted and skilful movements that had the old man upright and breathing more easily, so quickly that David had hardly been aware of how they had done it, and he thought — One day I’ll be as quick as that. I’ll be the one that’ll stand on the other side and help him instead of Sister. I’ll be the one he smiles at and says ‘Thanks’ to like that —

  ‘That’s better, Joe,’ Dr Carr said as the coughing at last stopped and the two of them eased him gently back so that once again he was leaning against his propped-up pillows. ‘Slow and easy, that’s the ticket. Now, let me tell you what’s to happen. I explained to your wife — I saw her downstairs before she went home. She’ll be back later this evening, I dare say, but I promised her I’d explain it all to you. We’ll try the chemo again, Joe —’

  The face against the pillow seemed to go yellow with anxiety. ‘You said I didn’t have to have no more of that, Dr Carr,’ he said fretfully. ‘After the last time you said it wasn’t right to make a man feel so ill —’

  ‘I know I did, Joe,’ Dr Carr said and pushed his glasses up his nose yet again. ‘I had great hopes it wouldn’t be necessary. But the thing is that it did help. Not as much as we’d hoped, I can’t deny, but it helped. It stopped the tumour growing and pressing on your windpipe. You remember how that felt, now, don’t you? Of course you do. Well, it could happen again, going by last week’s X-rays. That’s why I’ve brought you in again. To try again. A short course, and that should give you some considerable relief to your breathing. Do you see, Joe?’

  ‘It’s like drowning, sometimes,’ Joe said and his voice was lower now, and he stared up at Dr Carr with unblinking intensity. ‘Just like drowning.’

  ‘I know, Joe. It’s no fun. That’s why I want to try another short course of the chemo. It’s worth it, even if it does make you feel a bit off colour for a while.’

  ‘Off colour!’ Joe said. ‘For a while!’ And began to
cough again.

  ‘It’ll stop the coughing too,’ Dr Carr said.

  ‘I’d rather have cough medicine,’ Joe said. ‘That linctus I had last year — it helped a lot, that did.’

  ‘It won’t help now, I’m afraid. Not where there is a pressure, you see. That’s what’s causing the coughing. Pressure on the windpipe. We’ll sort this out, just a short course. Sister here will look after you just like the nurses on the other ward did, if that’s what’s worrying you. She used to be one of my staff nurses, eh, Sister, before these cardiologists got hold of her —’ And he looked over his shoulder at Sister and smiled and David felt a stab of pain as real as if a knife had slid between his ribs.

  ‘We’ll take perfect care of you, Mr Slater,’ Sister said in her bright cheerful voice. ‘You’ll see. We’ll take you to have the first injection tomorrow, and it’ll be over in no time at all. Don’t you worry —’

  ‘It’s not the injection I worry over,’ Joe said, and then closed his eyes, as though the lids were too heavy to stay up any longer. ‘It’s not the injection —’

  There was a little silence and then Dr Carr said softly, ‘That’s right, Joe. A little nap’ll do you a world of good.’ And he got to his feet and walked to the foot of the bed. Sister followed him; and after a moment David did too. No one had told him not to, after all.

  ‘Are you specialling him, Sister?’ Dr Carr said as they reached the nurses’ station at the end of the ward, and he looked over his shoulder at David who felt his face turn brick red.

  ‘Hmm? Oh,’ Sister too turned to look at him. ‘No, this is a new student today, first year. He’s writing notes on Mr Slater for his clinical tutor. I’d use a more senior nurse if he needed a special, but I don’t think he does. And there’s his wife, of course. She wants to be here most of the time, I gather, so we can press her into service. Just as well. We’re very pushed, you know. I’ve got three of Mr Byford’s cardiac catheterisations in at the present. He’s keeping the theatres very busy.’

  Dr Carr lifted his brows at which David felt his chest get even tighter, it looked so marvellous. ‘Then he’s off again? Looking for a suitable transplant candidate? I’d heard a few whispers —’

  Sister positively snorted. ‘They’re no rumours. If he can get a donor he’s off again all right. Any one of the three’ll do, I gather. I don’t like it, I must say. Place overrun with people — but at least they won’t be on my ward. I just have to have them for the catheterisations. Then they go to Surgical Cardiology or Intensive Care as the case may be —’

  ‘Will Byford fuss over my having one of his beds? If I leave Slater much longer he’ll suffocate, you realise that. This treatment’s only palliative, of course, I don’t know how often I can do it, but we’ll have to hope he’ll get toxic and dies comfortably that way before he reaches occlusion. You realise, young man, what this patient’s problem is?’ And he looked at David directly, who went redder than ever.

  ‘Er, yes, sir. I mean no, sir, I mean I think I do, a bit,’ he said and knew his voice sounded silly.

  ‘Well, tell me then.’ He sounded friendly enough; it was Sister who was staring at him accusingly as though daring him to make the sort of fool of himself he knew he was going to.

  ‘Er — well, sir, I think he’s got cancer.’

  ‘Well done, that boy. Where?’

  ‘Er, trachea, sir?’ He did tell the man it was his windpipe, didn’t he? David thought feverishly. Didn’t he?

  ‘Not quite. He has pressure on the trachea. That’s causing the breathing difficulties Mr Slater is most aware of, of course, and the coughing attacks. It’s quite a high lesion. No, it’s not tracheal. He has bilateral upper lobe carcinoma of the lungs. Used to smoke thirty cigarettes a day. Do you smoke?’

  ‘Er, no sir,’ David lied.

  ‘Just as well. You see what happens to people who do. Right, Sister, I’ll see Mr Slater in Andrew Green in the morning and send him straight back to you. I’m sorry we’re so full we can’t take him and very grateful to you for making a space for him. If Mr Byford is worried —’

  ‘He won’t be,’ Sister said with a certain grim relish. ‘What he doesn’t know won’t hurt him. And we’ll see to it that Mr Slater’s bed is curtained and we’re busy with him when he does his rounds. I’ll get Dr Azzopardi to write up the night drugs and the pre-med, shall I?’

  ‘If you would, Sister. And talk to Mrs Slater will you? She’s finding it more difficult to cope than she shows, I rather suspect. Needs a woman’s touch, and so forth. Good afternoon, Sister.’ And he went, his square back disappearing through the double doors as another doctor came towards them from the corridor. But David didn’t pay any attention to the newcomer. How could he, when the other one was so much more interesting?

  ‘Ah, Neville,’ Agnew Byford said and stopped in the doorway. ‘How are you? I haven’t seen you for a long time. Been on holiday, have you?’

  ‘No,’ Carr said, and managed a thin-lipped smile. Bastard, he thought, smooth bastard. ‘I’ve been extra busy, in fact. My wards are chock-a-block.’

  ‘Really? Sorry to hear that, indeed I am. Though you can’t be much worse off than we are here.’ He stopped then and looked over his shoulder at the ward which stretched away behind him. Sister and her attendant acolyte, he noticed, had disappeared from view behind one of the glass partitions which had been put up to break up the vista of the old Florence Nightingale racetrack arrangement, and he frowned. ‘Have you been seeing one of my patients, then? I can’t recall one with any need for an oncological opinion —’

  Carr, cursing silently inside his head at the mischance of the meeting, pushed his glasses up his nose and said cheerfully, ‘No, not one of yours, dear boy. One of mine. I’ve got an urgent chap for palliative chemotherapy and we’re bulging at the seams. I found out there was a spare bed here, and put in for it. I’m sure you won’t mind. I can’t send a dying man out, now can I? Not when there’s a bed available here on the medical side — just imagine the sort of fuss there’d be if I did that. Especially if you’re doing another of your transplants. Can’t damage the publicity for that, can we?’

  Agnew’s cheeks mottled suddenly. ‘Who told you that?’

  ‘Common knowledge, dear boy,’ Carr said airily and began to move away. ‘X-ray, was it? Or did I hear them discussing it in theatres? Anyway, it’s common knowledge. Must hurry. Got a chap waiting in OPD,’ and he went, leaving Byford to stump angrily into the ward.

  But the anger didn’t last. He had much too good a reason to feel pleased with himself and the way things were going for him to be annoyed by a character like Carr. He’d soon get him out of the place; no risk of anything different happening. But anyway it didn’t matter. Not now.

  ‘Sister!’ he called imperiously. ‘Sister Sheward!’

  She made him call twice more before she appeared and then came down the ward at a pace so calm that it verged on the impertinent and he wanted to snap at her, but had the wit to hold his tongue. This was not a time to antagonise the woman. But he’d have to talk to the Nursing Admin Office. This was getting intolerable. Thought she had the right to put anything she liked in front of him, and whose ward was it, damn it all? But now it would all be different, and he smiled widely, a happy smile that showed his teeth to very good advantage.

  ‘Ah, Sister, looking after Dr Carr’s patient, were you?’ he said a little spitefully, momentarily forgetting his good intentions. ‘You always had a soft spot for oncology, didn’t you? Surprised you came over to me and cardiology — but there it is! Unless your soft spot was more for the consultant, hmm?’ And he laughed fatly as Sister stared stonily back at him.

  ‘Your catheterisation patients are all ready to be seen, sir,’ she said with a faint and undoubtedly insulting emphasis on the ‘sir’. ‘They’ve all been prepped and I’ve had the forms signed. You can start as soon as you like —’

  ‘Well, they can wait for the moment,’ he said in high good humour. ‘Just for the moment. N
ow, Sister, we have some special arrangements to make — yes, special arrangements.’ And he actually rubbed his hands together like an eager cook about to set to work on a table full of rich ingredients. ‘Who have you in the far corner bay?’

  She looked startled. ‘Just one non-cardiac patient, sir. A Mr Slater.’

  He looked at her sharply and then grinned even more widely. ‘Dr Carr’s patient, no doubt. I don’t recall the name, so I imagine — yes. Well, he’ll have to be shifted. And who else is in there?’

  ‘The other three beds are your catheterisations, sir,’ she said. ‘As I think you know.’

  ‘Well, they’ll have to shift down to this end — I know it’s easier if they’re all in the same section, but needs must when the Devil drives, hmm? And the Devil is surely driving today. I want those four beds tucked in wherever you can get them, to release the whole of that unit at the end.’

  ‘Why?’ she said and frowned even more sharply. ‘I can’t pack the beds more closely than they are — not and leave a whole unit empty. If you need it for a transplant patient, well, I’ll have to tell you, sir, I don’t have the facilities here. It’s got to be the ICU, you know that. I can’t just —’

  He put up one hand and smiled again, clearly enjoying himself hugely. ‘Nothing of the sort, Sister. I wouldn’t dream of having my transplant patients anywhere but in my own ICU with nurses I know and feel sure of’ — at which Sister glinted with anger — ‘and this patient who is coming here is not for surgery. No, not for surgery. Yet.’ Again he rubbed his hands gleefully. ‘But he is a very important patient indeed. He’s coming in for close observation, possibly for catheterisation and if necessary a bypass, though I hope to avoid that. But first of all, I want him here for a few days to do a really exhaustive work-up on him.’

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