Clinical Judgements Read online

  ‘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 into the St Andrew’s Wing? He’s 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.’

  ‘Oh,’ Sister said and then lifted her brow at him. ‘And how are my nurses to cope with the extra fuss there’s sure to be?’ And the emphasis she put on the ‘my’ was unmistakable. ‘I’m short-handed as it is, with a new nurse straight out of Introductory and —’

  He waved his hand airily. ‘Oh, no need to worry about that. He’ll have his own nurses coming in. And he’ll need extra telephones — two — and a desk in there. For his secretary, you know. And you’ll need a spare corner somewhere for the security people. He’s a considerable security risk you see — he was Northern Ireland in the Cabinet before he was Health, or have you forgotten? So the security will be considerable.’ He looked almost dreamy-eyed for a moment. ‘I’m afraid the publicity will be considerable, Sister,’ he said. ‘Really considerable —’

  Chapter Five

  Prue Roberts sat in the corner seat and waited for Jerry to fetch the drinks from the bar. The place was full of smoke already, and noisy too, but the doors to the street were wide open and that helped a little. It was getting cooler, at last; it had been another pig of a day, hot as hell and just as sickening, and as the word came into her mind she felt her gorge rise and she closed her eyes to concentrate on preventing the feeling. And blessedly it settled as Jerry came and set her fruit juice in front of her and then sat down with his own beer.

  ‘When I said have a drink I meant a drink,’ he said, sounding aggrieved. ‘What’s this orange juice kick, for Pete’s sake? You’re not driving or anything, after all.’

  ‘I like it,’ she said shortly, and sipped the stuff. It was warm and sticky but it seemed to help a little and she felt a bit better.

  There was a long silence between them as they sat and drank until he could bear it no longer. ‘So all right, ducks, tell me what it is,’ he said at length when he’d swallowed half his beer and she still hadn’t spoken. ‘Don’t hang about.’

  ‘What do you mean?’ She looked at him and then let her eyes slide away.

  ‘Here,’ he said, and pulled on her shoulder. ‘Look at me. See? Pink and lovely, that’s me. Nothing green is there, anywhere? Not even my eyes. They’re as pink as the rest of me. So, come on, Prue. After all this time, you can’t pretend you said you wanted to have a drink with me just to sit shtoom. Or to cuddle up. You made that bloody clear the last time. So it’s got to be you want something.’

  She took a sharp little breath in through her nose. ‘Well, all right. Money.’

  He lifted his brows at that, and pushed his tankard away. ‘Who doesn’t? I thought you were all right, you and your bloody Gary. Coining it, isn’t he, working for the bleedin’ A-rabs? Why ask me for money? I offered you the lot once and you didn’t want to know. Why ask me now?’

  ‘Because I don’t know no one else who’d help me out, that’s why,’ she said with some desperation and reached for her glass and then pushed it away as another wave of nausea lifted in her at the sight of the bright orange stickiness that clung to the rim of the glass; and he peered at her more closely and said with a sharper note in his voice, ‘Hey, what’s this? You look like a bloody sheet, you do. You all right? Come on, I’ll get you out of here before you show us both up —’ and he tried to lift her to her feet.

  She managed to shake her head and then took a deep breath and leaned back. ‘I’ll be all right,’ she said after a moment. ‘Just give me a minute —’ and he watched her as she sat with her head back and her eyes closed as around them the pub roared into even noisier life as a group of young people, some in hospital uniforms, came pushing in through the wide-open doors, chattering and shouting at the tops of their voices.

  ‘I’m all right now,’ she managed. ‘Sorry, Jerry. It’s just that —’ She made a face. ‘In the bloody club again, aren’t I?’

  ‘Christ,’ he said after a moment. ‘Don’t mess about, do you, you two? How old’s the baby?’

  ‘Five months,’ she said drearily. ‘I know. It’s awful. But what can you do? These things happen.’

  ‘Aren’t you on the Pill?’

  ‘Can’t take it. We used — you know. Anyway, what’s the odds? It’s happened. And I’ve got to get rid of it. I can’t have another — I can’t —’ and her voice rose a little and he looked back over his shoulder, embarrassed; but the young people at the bar were making such a din that no one had heard.

  ‘Well, tell the quack, then. Or go up to Old East, get them to fix you up —’

  ‘I’ve been,’ she said savagely. ‘Been, haven’t I? First thing I thought of. And they just sends me off, like some sort of bloody tart or something, they’re full up in their wards, they can’t take me no more, go to the GP, see what he can do, no good coming to them. So I goes to the GP and my regular one’s retired and this new one sends me packing. He doesn’t believe in it, he says, it’s all wrong he says, and gives me a bloody lecture about it. Some bloody Paki telling me what’s right and wrong, what does he know? So I told him to piss off and he could do what he liked with his fucking lectures and —’ A tear appeared in one eye and began to track down her cheek. ‘I didn’t know what to do. I’m in dead trouble now. I can’t go back to the doctor, not after the things I said to him and what if the kids get ill? I got to get a new one and I can’t just walk in and say hey, gissa’n abortion, can I? That’ll do a lot of good, that will. So now what?’

  ‘There’s people,’ Jerry said uneasily, watching her. ‘I’ve seen the ads down the underground.’

  ‘Life!’ Prue said bitterly. ‘I called ’em. They don’t do abortions, for Christ’s sake. They talk you out of them.’ She shut her eyes again, but it didn’t stop the tears which kept on streaking her face. ‘And then I tried the other ones, but they said I’ll need some money. And anyway —’ She opened her eyes and stared at him. ‘Anyway, I’ve cocked up everything. Gary sends me money but I’m always getting in a mess over it and now there’s the new welfare rules I can’t even go to the Social and — please, Jerry. I didn’t know who else to ask.’

  He sat in silence for a while and then laughed softly. ‘What my old dad used to call a right turn up for the book, ’n’t it? You give me the push so you can marry that bugger Gary but when he goes off and leaves you in the club and on your uppers who do you come to? A right turn up —’

  She began to get her things together then, her thin blue cardigan and the old white handbag, keeping her head down. ‘Sorry I bothered you,’ she said in a high voice. ‘I’d better get back. Left the kids on their own and they might wake up. The baby’s due a feed anyway — I’d better get back.’

  ‘Oh, don’t be in such a bloody rush,’ he said and pulled on her arm to make her sit down again. ‘Who said I wouldn’t help? I just said, what a turn up for the book, that’s all. Christ, bloody nurses. The row they make! Listen, let’s go back to your place, all right? You can see to the kids and I’ll pick up a Chinky and we can talk, all right? We’ll sort something out — come on —’

  David and Peter saw the two seats fall vacant and made for them like a shot as the others went on shouting and chattering at each other at the bar. ‘My feet are killing me, I swear to you,’ Pet
er said, almost groaning, and eased himself into the corner seat gingerly as the thin pale girl and the big bearded man who had been there pushed their way out past the crowd to the street. ‘Ooh, thank God to sit down! I could cry with it, I really could.’

  ‘Listen, you didn’t really pass out, did you?’ David slid in beside him and settled himself for a long gossip. ‘It’s not as though you were on a surgical ward or anything — I mean, what can there be on a psychiatric unit? All those mad people, but no blood or anything. Why faint, for God’s sake?’

  ‘You don’t want to believe everything that cow says,’ Peter said, throwing a malevolent glare at Clemency Strange who was holding court in the middle of the crowd, throwing her long curls around with great abandon and a good deal of eye-flashing to back it up. ‘She wasn’t there, so how does she know? She only heard about it afterwards —’

  ‘Well, what did happen? If you don’t tell me, I’ll believe Clemency and you’ll never live it down. Peter Burnett fainted on his first day on the wards, did you hear. Peter Burnett fainted —’

  ‘I didn’t! I just came over — well, anyone would have. You too. I was with this man, you see, who gets violent, they said, if he’s upset, but he was all right; and then when they took him down to X-ray for something they said to go to fetch clean sheets from the linen cupboard to make up the bed, and I suppose I was a bit uptight with having been worrying about whether this bloke’d suddenly go berserk or something, and I dare say that was what did it. Anyway, I went into the linen cupboard and it’s not very light in there — just one low bulb, you know how it is — and I almost tripped over something and when I bent down to look there sticking out from under the bottom shelf was this leg, wasn’t there? A bloody leg. Brown shoe, striped green and red sock, pin-striped trousers — I tell you, I can still see it just while I’m telling you! And I thought, Christ, that bloody man must’ve killed someone and no one knows but me and I just turned and ran out of the cupboard and right into this staff nurse and — well it had been hot in the cupboard anyway and what with that and being so taken aback I can’t pretend I didn’t feel a bit off. So this staff nurse — she’s got tits the size of bloody water melons, gorgeous she is, a right cracker — she picks me up and holds me against her and I’m not stupid, am I? So I kept my eyes closed and just stayed there all cuddled up and made the most of my chances. Well, I mean, who wouldn’t? Well, maybe you wouldn’t, not for a pair of water melons, but I did, believe me! And they all made a lot of a fuss, but it wasn’t anything, really — I didn’t actually faint you see —’

  ‘Peter, for Christ’s sake!’ David was staring at him aghast. ‘The leg — what about the leg?’

  Peter laughed. ‘Oh, that, that wasn’t anything. I mean it was, but it wasn’t to worry about. Bloody artificial leg, wasn’t it? We’ve got this manic depressive, lost his leg in the war. Just hops around on crutches, so they shove it in the linen cupboard for him. You’d think I’d have realised there wasn’t room under the shelf for a whole body, wouldn’t you? But I was being stupid. Worth it though.’ He grinned reminiscently. ‘Those tits — I’m going to like that ward. Got time to talk to each other, people have, you know?’

  ‘You’re a randy devil,’ David said. ‘One of these days it’ll catch up with you, just you see if it doesn’t.’

  ‘So are you in your own way,’ Peter said, and grinned. ‘Though the ward they’ve shoved you on — Male Medical, isn’t it? All those old buggers — not much talent there.’

  ‘I wouldn’t dream of getting involved with a patient,’ David said and ducked his head, but too late; Peter had seen the flush and let out an uproarious laugh.

  ‘Hey, get you! What’s happened to you, then? Seen love’s young dream, have you?’

  ‘Shut up!’ David said furiously and got to his feet. ‘That’s not funny. We’re not all like you, you know, the original three-legged man, nothing in our heads but our bloody pricks.’

  ‘Oh, shut up yourself,’ Peter said equably. ‘And get in another. And give us a fag —’

  ‘I haven’t got any,’ David said, as he went off to get the drinks. They’d had spats like this before, but they never really amounted to much. And as the only two men in the intake they had to stick together, after all. ‘I’ve given up. As of today.’

  ‘They’re not really going to, are they?’ Barbara Darwood, one of the juniors from Outpatients, said, and her eyes were as round as saucers. ‘Not all of it, I mean — are they? How will he — you know?’

  ‘How will he what?’ Sian said and teetered back on her bar stool. She was having a marvellous time, all of them standing there and staring and listening. ‘If you’re going to be any good at this job you’ve got to learn to be honest. Not so mealy-mouthed.’

  ‘Well, how will he pee for a start?’ Barbara said and slid her eyes sideways to look at Frances, her friend from Female Geriatrics, and the black girl, Fatima, both of whom were as round-eyed over Sian’s revelations as she was, and then giggled, and the others did too.

  ‘Nothing very complicated about that, I imagine,’ Sian said, with all the lofty certainty of total ignorance. ‘They’ll leave the urethra patent, of course. Put in catheters I dare say or something of the sort. Anyway, they’re taking the lot, I promise you.’

  ‘It’s wicked,’ Fatima said suddenly. ‘I mean, poor man — how can they do it to him?’

  ‘Because he wants to have it done,’ Sian said with exaggerated patience. ‘He said to me when I helped him get undressed, he said this was the best day of his life knowing they were going to do it for him.’

  ‘He’s mad then,’ Fatima said. ‘And that makes it even worse, doing things to mad people who don’t know any better.’

  ‘He’s as sane as you are, ducky. More than most, in fact. I like him a lot. He’s funny and nice. It’s just he says that he’s suffered a terrible mistake of nature all his life. He’s known since he was a baby, he said, that he was trapped in the wrong body. All his life. But he’s done the best he can and he’s been really incredible. He’s a designer, you know. Did the training, got all the exams, went to night school, the lot. He works for this firm of dress manufacturers now, and he says they’re a good lot, they understand, and let him stay on when he started to change.’

  Barbara leaned forwards, a little breathlessly. ‘How? I mean, what happened?’ she said in a low voice. ‘How did he change?’

  Sian wriggled into a more comfortable position on her seat, even more pleased with herself as one or two of the others standing at the bar came and joined in, as interested in her information as her existing audience of three.

  ‘Well!’ she said, in a low voice. ‘He went on hormones, for a start. Mind you, Dr Rosen — she’s the psychiatrist in the Gender Identity Clinic — she said he had to pass as a woman for two years before she’d do anything, so before the hormones he had masses of electrolysis — can you imagine? Having all those hairs taken away with electric needles. He had to go twice a week for months. Not that he had a lot of beard, he said, and none on his chest which was just as well. He says that was one of the ways he knew he was supposed to be a woman. Like the size of his hands and feet — quite small really. Anyway, he had all that, and then the hormones, and that made his breasts grow.’

  She made a face then and looked down at her own narrow chest. ‘He’s got better boobs than I bloody have,’ she said and a great laugh came up from the listeners, and a few more came and collected around Sian.

  ‘Anyway, that went on a long time, almost two years I think he said, and then they started talking about the surgery. He’d had some plastic surgery already at a private clinic, nearly bankrupted him that did, he said. They’ve built up his breasts a bit as well as what the hormones have done. He’s a B cup, thirty-eight, would you believe? And now he’s going to have this operation —’

  ‘What’ll they do exactly?’ someone from the back of the group said.

  Sian’s voice became even more confidential. ‘They’ll remove his w
hatsit, and take away the testicles as well. He says they’ll save as much as they can of the skin of his — you know — the scrotum so they can use it to help make a false vagina later on. He says it’s a technique that Miss Sayers’ not used before but it’s been done in America —’

  Frances drew in a little hissing breath. ‘Oh, it’s sickening, it really is. They shouldn’t do such awful things to people! It’s not what we’re for, is it? I mean, I never thought they’d do operations like that. I thought it’d be things like appendixes and hernias and things like that —’

  ‘Where have you been all these years?’ Sian said scathingly. ‘They do those on day patients these days — have it in the morning, home at night, pop back to have the stitches out. All part of saving on the NHS, that is. The things we keep them in for are much bigger. Important things —’

  ‘You can’t tell me cutting of a chap’s whatsit’s a big thing!’ Frances said hotly and went red as several people around her hooted with laughter. ‘I mean it is, but it isn’t what ought to be in hospitals, is it?’ And she appealed to Fatima.

  ‘I don’t know — don’t ask me,’ Fatima said and turned away. ‘I said it was wicked and I still think so, but don’t ask me —’

  ‘Well, I’m going to ask about it,’ Frances said. ‘I’m going to ask at the next Branch meeting, that’s what I’m going to do. Isn’t that a good idea, Sian? You said if we joined for you we could talk about all the things that bothered us, and I tell you, this bothers me —’

  ‘Oh, don’t be daft,’ Sian said, and now she sounded even more scathing. ‘The Union’s for things like pay and conditions and equality. It’s got nothing to do with who has what operations, has it? Anyway, it’s none of your business. I only told you because it was interesting, that was all.’

  ‘Well, I’m going to ask someone about it,’ Frances said stubbornly. ‘Because I think it’s awful. I’ll ask Mr Kellogg or the Pawn or someone.’