*
The morning was unusually quiet. No ward admissions, lots of discharges and hardly anyone in through the doors of Casualty.
‘Come on, you, coffee. We have half an hour,’ said Doreen, as she burst through the cubby hole door. She had red tinsel wrapped around her alice band and had been smiling all morning.
‘Look at how excited you are,’ Tilly laughed.
‘Oh God, a day with hardly any patients would make anyone around here cry with relief. What’s the last week been like? It was chaos. What a week for you to start. Come on, let’s go through the main entrance on the way back. They’ve only got two clinics on this morning and Maisie is giving out mince pies and tea in the waiting room. I said we would meet her in the greasy spoon and then walk back with her.’
‘Coming now,’ said Tilly, grabbing her coat.
Morning coffee had become one of the highlights of the day. The greasy spoon stood alone, a large hall with enough tables and chairs for almost every member of staff. At the bottom of the hall tables were loaded with cups and saucers and big urns of almost boiling hot milky coffee. Over at the counter, they served streaky bacon on white barm cakes, which were soft baps of white, floury bread and it was all free. Doreen and Tilly grabbed their bacon barm and coffee and looked around the hall for a table to sit on.
‘There you go, Maisie’s over there with Pammy and Elsie, go on, you first, Tilly.’
They weaved their way through the tables until they arrived at Maisie’s.
‘Oh, there you are Doreen, come on sit down, we’ve got news and Tilly, are you sure you can’t spare a few minutes tonight? Some of the nurses are in sick bay and Matron is short on numbers. Our Pammy says she’s heard you singing in the cubby hole when you’ve been working and she said that if Patsy Cline walked into Casualty and heard you, she’d be worried sick.’
Tilly was speechless. Her old habit of singing when she was busy had crept up on her after a long absence, but she hadn’t realised anyone could hear her. Some of the carol concerts she had organised sprang to mind, the children she had loved to teach, the characters she had taught to sing and she felt a wave of sadness wash over her. She would never be able to teach again.
‘I can hold a note,’ she stammered.
Her mind was searching for reasons why she couldn’t stay. She knew that Sam would be fine with Arthur; he loved looking after him.
‘Oh God, you can hold a note. Isn’t that fabulous,’ said Maisie to Doreen and then, added in an aside to Elsie, ‘What does that mean?’
Elsie shook her head, ‘Haven’t got a clue.’
‘Well, I could stay for half an hour, I suppose,’ Tilly said.
Maisie clapped her hands, ‘Isn’t that marvellous! I’ll tell you what, Matron will be made up with you.’
*
At five o’clock, it was already dark and Sister Pokey led the procession of day staff from Casualty over to the main entrance, along with other groups of staff heading in the same direction. Dr Cohen materialised at Tilly’s elbow, as they were walking. She pulled her coat around her, as everyone hurried through the cold.
‘I thought you had to catch a train?’ she plucked up the courage to say.
The snow had stopped falling, as darkness fell and it had covered the dirty red bricks in a glistening ice frosting. The air was sharp and cold and fresh and Tilly filled her lungs.
‘I have, at nine. I’ve plenty of time,’ he said. ‘What about you, don’t you have someone waiting at home?’
He could have bitten off his tongue. Kicked himself, extracted his own toenails, anything. He didn’t want to hear her tell him about her husband. He knew, as soon as he asked, he couldn’t bear it. At that moment, Pammy Turner interrupted, ‘Tilly, me mam’s told Sister Haycock you can sing?’ Tilly almost groaned aloud. She could guess what was coming.
‘Only, they’d love someone to open “Once in Royal David’s City” with a solo. Last year, Jake did it. Well, honest to God, you could hear the mice running out and through the door. Everyone in the room was praying for him to reach the end. Could you do it tonight? She’d be saving the lot of us, wouldn’t she, Dr Cohen?’
Tilly spluttered, ‘I know the carol, but I can’t do that in front of all these people.’
Dana had pushed in beside Pammy and grinned. ‘Oh yes you can,’ she said, ‘and here comes Sister Haycock, once we tell her, there will be no backing out for you.’
As they stepped through the doors of the main entrance, Tilly gasped. It looked beautiful.
Jake was handing out the candles in lanterns to the nurses. Jam jars, suspended on wire on the end of whittled sticks, made in the porter’s lodge. ‘Take your candles, please, nurses. Be careful now, especially you, Nurse Tanner. We don’t want any accidents on Christmas Eve.’
It was a tradition that the nurses carried them around the wards and sang, when the service was over. The tree was decorated with brightly coloured tinsel and baubles and fairy lights were strung across the large windows that fanned out on each side of the revolving door. The room smelt of cinnamon and cloves and the nurses had pinned tinsel to their caps and their capes. There were crêpe streamers strung across the ceiling and wrapped around the banisters leading to Matron’s office. Pammy suddenly shouted out, ‘Sister Haycock, here she is. She sings like an angel. We know, we’ve heard her and she’s said she’ll do it. She will open with “Once in Royal David’s City”.’
‘Welcome to St Angelus, Tilly,’ said Sister Emily Haycock, reaching out and taking Tilly’s hands in her own. ‘It’s like pulling teeth trying to get any of this lot to sing a solo. Even to sing in tune, to be honest. Have you sung in a choir?’
Tilly’s face froze, she almost turned around and ran. How did she know? She didn’t. She couldn’t. And then her thoughts calmed.
‘I did at school, Sister.’ That wasn’t a lie.
‘Fabulous. What a relief to have you here.’ She laughed, as Pammy playfully punched her on the arm.
‘Oi, you don’t say that when you are looking for volunteers, do you? You tell us we all sing like nightingales.’
Matron now appeared with Sister Theresa. ‘Miss Townsend is going to open with the solo, Matron,’ said Sister Haycock.
‘Well, now, that wasn’t in your job description,’ said Matron. ‘Are you telling me we won’t even need the usual ball and chain to stop her running off, Sister Haycock? What a lovely Christmas this is turning out to be.’
‘Oh, I’ve heard Tilly sing in church. She does indeed sing like an angel,’ said Sister Theresa.
Tilly ignored her and turned her head away to address Matron. She didn’t see the look of pain on Sister Theresa’s face. Tilly was still smarting about the fact that she had interfered in her caring of Sam. Hadn’t she told her that she had to prove she could manage all by herself?
‘Thank you, Matron. I will try my best,’ said Tilly.
As she spoke, she saw the clock on the wall. It was almost a quarter to six. She had wanted to be home for six and had already stayed fifteen minutes longer than she had agreed. There was no chance of her getting away now that Matron knew she was singing.
Maisie came along with a tray filled with glasses of sherry and mince pies. ‘Come on, girls. Get one of these down you, before you start singing on the wards. It’ll open the pipes and lubricate the voicebox just nicely.’
‘Down the gullet,’ said Doreen, tipping her head back.
‘Dor, you’ll be tipsy,’ said Dana.
‘I don’t care,’ said Doreen. ‘It’s Christmas Eve, I’m allowed to be.
‘Are we ready, everyone?’ said Matron from the light switch by the door. ‘Sister Haycock, and our new Miss Townsend, are you ready?’
‘Oh, go on, that’s you, Tilly,’ said Pammy, pushing her forward gently. Tilly’s face burned as she walked across the hall to stand next to the piano.
Sister Haycock smiled up at her. ‘On three,’ she said. ‘After the main lights go out. Ready, Matron.’
Matron switched the overhead lights off from the wall and Tilly gasped at the beauty, as what had been a hospital main entrance only hours before, glistened and sparkled with reflected fairy lights and the candles from the tall windows. Snow fell softly against the tall dark windows and sparkled in the candlelight. Tears filled Tilly’s eyes. She might never be able to teach again, but she had found something special here. The nurses had been right, this was a family and they had accepted her with no questions asked.
‘Ready,’ Sister Haycock whispered.
‘Yes,’ said Tilly, swallowing hard, holding the printed hymn sheet in front of her in case, through nerves, she forgot the words she had sung at a dozen school carol concerts.
‘One, two, three,’ Emily Haycock whispered, her hands resting on her lap, ready to come in at the beginning of the second verse.
Tilly breathed in and then sang the first line which soared through the vast space. ‘Once in Royal David’s City, stood a lowly cattle shed.’
She saw the faces lit by flickering candlelight and heard a faint intake of breath.
‘Where a mother laid her baby, in a manger for his bed.’
Sam. His perfect face as he slept in his drawer came to her mind. Her own precious son, her heart folded with the pain of missing him. For the first time ever, she knew how Mary must have felt all that time ago. ‘Mary was that mother mild, Jesus Christ her little child.’ Her sweet and crystal-clear voice rose above the assembled crowd as everyone watched, spellbound, enthralled in the moment.
The room fell still as the candles shimmered in their lanterns. Tears filled the eyes of some of the patients who were too poorly to return home, some knowing that this was their last Christmas and the final time they would ever hear that carol solo sung.
Maisie handed her handkerchief to the old man in the wheelchair next to her. ‘There you go, love,’ she whispered, folding it into his grateful hand and placed her arm across his shoulders, for comfort as well as warmth.
Tilly’s voice was exquisite. As Sister Haycock’s fingers touched the keys of the piano and voices rose in unison for the second verse, hardly anyone in the room heard the ambulance siren, as it came in through the gates. Dr Cohen had never celebrated Christmas, and now, he nodded to Matron, and slipped out of the door, back down to Casualty. The relief night doctor was enjoying the service. He would take this one for him and still be away to catch his train.
9
The night sister was carrying a baby in her arms and instructing the night nurse to set up an oxygen tent as Dr Cohen walked through the doors.
‘What do we have here?’ he asked as he noted the blue-tinged lips, the red face, the glazed eyes and a man, pacing up and down in the waiting area.
‘I’m not sure yet,’ Sister replied. ‘Ambulance drivers said father called from a pub, they have no idea where mother is. I’ve just taken his temperature. It’s 102 and he’s struggling to breathe.’
‘Lay him on the trolley, would you, Sister, so that I can examine him. Nurse, call Children’s Services and ask them to get a paediatrician over here, as soon as possible, please.’
Andrew specialised in chest conditions, but this baby was only around three months old. He was out of his depth and needed help. He placed his stethoscope on the baby’s chest.
‘I’m going to need a bronchodilator, he’s not good at all. I’ll go for stat dose of Aminophylline intravenously. I need to look up the dose for one so small. How old is he?’
‘Father said he thought he was around twelve weeks, but he didn’t really know.’
Andrew was bending over the flaccid body of the baby boy. ‘He didn’t know? That’s a bit strange, isn’t it? Let’s get a line up as quickly as possible and an open front Eliot tent, normal oxygen tensions at six litres a minute. I’m going to need some intravenous Erythromycin, but let’s get him breathing properly first.’
Andrew didn’t see the look Night Sister gave him. Didn’t he know that the baby was lying on the same trolley where his mother had been a year ago.
The night nurse appeared and pulled around a screen. ‘I’ve tried Children’s Services, Dr Cohen. They can’t get anyone over for at least an hour. The on-call paediatrician is stuck in the snow at Broad Green. Said he will be here as soon as he can.’
Andrew was trying to count the baby’s pulse; it was almost too rapid, thready, thin and he didn’t like the faraway look in his eyes. He was unresponsive, hot, floppy. His respiration was poor and he guessed his blood oxygen levels would be too.
‘Is there anyone in the path lab?’ he asked.
The night nurse shook her head. ‘There’s an on call over Christmas,’ she said apologetically, ‘we have to use the Northern if we need anything and get Jake to take or fetch.’
Sister was at his side with a trolley, a giving set and the ampules of Aminophylline ready.
‘Sister, I am going to set up a line and give the smallest dose of Aminophylline, and I will leave you in charge while I call Dr Gaskell. Nurse, I know Sister has asked you to tepid sponge him down, so you can do it right now. That temperature is dangerously high. Sister, if you could just depress the syringe very, very slowly and then we’ll give it five minutes and start with the erythromycin and a stat dose of cortosteroid. Let’s get the line up and then I can call Dr Gaskell.’
Andrew looked up at the clock. It was six thirty, he didn’t have long. The train would leave at nine on the dot. ‘Nurse, get that oxygen going, please.’ Slowly and carefully, he attempted to insert a cannula into the almost flat arm of the baby. ‘Damn and blast,’ he snapped. ‘I can’t get it in,’ he said. ‘He’s in peripheral shut down, or as good as. I need a paediatrician. I don’t think I can do it.’
He wiped his brow with the back of his hand and felt the pressure, the tension, the battle with death hovering nearby.
‘Try again,’ said Sister. ‘Look.’ She tapped the inner elbow of the baby who still failed to respond. His lips were still blue.
‘Hold the oxygen over his mouth,’ Andrew said to the nurse.
‘Look, again,’ said Sister and the palest blue of a vein rose and then disappeared again. ‘Try there,’ she said, ‘I’ll help.’
Once again, with the Night Sister tapping the vein with her fingers, he tried, and failed. His eyes met hers. They were alone with a dying baby and no one to help.
‘What do we do?’ he asked, picking up the boy’s arm. Laying it down gently, he turned the baby’s head to the side and examined his jugular veins, his groin and then his neck, again.
‘Well, one thing we never do, on here, is give up,’ said Night Sister and just at that moment, he saw the faintest line of blue on the back of the boy’s hand. ‘I’ll have to do a venous cut down, but I have never done it on one so young before.’
‘Try the back of his hand again,’ said the night nurse as she rubbed the back of the tiny hand with her fingers, coaxing a vein to rise and appear.
‘Here, quick,’ he said, holding out his own hand for a fresh cannula.
Sister rubbed the back of the hand with an alcohol-soaked swab.
‘Yes, here, it keeps disappearing, but when it does appear, it’s strong.’ The atmosphere between the three was tense, but calm, despite the consequences of Dr Cohen being unable to insert a line.
Andrew held the needle close to where Sister was rubbing and waited for the vein to surface, he would have seconds to pin it before it disappeared again. His eyesight blurred and he blinked and then, there it was. He moved the cannula swiftly and fearlessly into place.
‘Bingo!’ he shouted, as blood began to flow freely over the sheet of the trolley.
‘Thank the Lord,’ said Sister. ‘I told you, Doctor, we never give up on anyone here.’
Once the drops of Aminophylline were part way through, he handed the syringe to Sister. ‘Can you carry on? One milligram every minute. I’m just going to talk to father and call Dr Gaskell. Don’t go any faster, Sister, it will depress his blood pressure.’
Sister wanted to say she had been a Casualty Sister for over twenty years and knew that, but it was Christmas, so she would let it pass, just this once.
*
It was almost eight by the time Tilly arrived home and running up the stairs, called out to Arthur.
‘Oh. God, I am so sorry,’ she shouted, as she burst in through the door. ‘The bus went so slow in the snow. It took twice the normal time to get home.’
No one answered. There was no sign of anyone. She smelt something odd and realising that it was her dinner drying out, ran to the stove and turned off the gas. Arthur must be upstairs with Sam, putting him to bed for me, she thought, as she hungrily forked a piece of the delicious hot pie into her mouth.
‘Arthur, Sam,’ she called, as she ran up to her own flat. As she opened the door and saw no one was there, her heart turned cold. ‘Arthur!’ This time she screamed and ran down to his flat, ‘Sam, Arthur!’
She pushed open the door to an empty room. She thought she was going out of her mind, when suddenly the door to the ground-floor flat opened.
‘Oh, it is you,’ said a girl to whom Tilly had occasionally spoken. ‘He’s in the hospital. Arthur had to call an ambulance. The baby’s chest, it was, summat awful up with him. Arthur was out of his mind he was. Mrs Kelly, they used the phone in the Queen’s.’
Tilly wasted no time as she ran back out of the door. As she stood at the bus stop, she thought she was going to go out of her mind with anxiety. There were no taxis, the roads were quiet and frozen white. It was too far to walk. A bus was her only hope and yet she had no idea how long until the next one. The noise in the Queen’s Vaults reached her and she turned on her heels to run in and ask for help, when suddenly, a car pulled up alongside her and Andrew Cohen jumped out.
‘Come on, I’ll take you. He’s in good hands,’ he said. ‘Dr Gaskell is with him, while I came to get you. I’ve been with him since he was admitted.’
‘Oh, God, is he all right, what is the matter, tell me please?’ Tilly asked, as he opened the door. ‘Does anyone know? Please don’t tell the welfare, I beg you, don’t. They will take him off me if they know he got sick and I wasn’t there.’ She was grabbing at Andrew’s sleeve and tugging his cuff as he turned to face her.
An Angel Sings Page 6