‘Sims’, Cusco’s, Ferguson’s, a uterine sound, rubber gloves, three enamel kidney dishes, sterilized rubber gloves and a towel. Yes, that’s it,’ she whispered and popped into the sluice room for a warm bedpan from the hot pipes. She slipped it into the paper cover and on to the bottom layer of the examination trolley and filled a large metal jug with the chlorhexidine solution.
As Pammy pushed her trolley back towards the cubicle, she bumped into Branna leaving the domestics’ room. ‘Branna. Where have you been? Staff Nurse is looking for you and she’s in a right strop. On the war path for you she is.’
‘Well now, you wouldn’t believe it if I told you. Looking for me in a strop, is she now. I knew her when she first started here. Wouldn’t say boo to a goose, she wouldn’t, terrified of her own shadow she was and now she orders everyone about, those who let her get away with it. Where are you rushing to with that trolley? Sure, you will slip on me wet floor if you don’t slow down.’
‘We have a mystery patient in the cubicle. Just waiting for a doctor and some notes to arrive, so we know what to do next. Hasn’t spoken a word she hasn’t. Poor thing is terrified.’
‘Aye, well, sure, ’tis a mystery to some maybe,’ said Branna. ‘I’m off to the school to see me mate Biddy. If Staff Nurse asks again, tell her I’m on me break.’
‘But you’ve just had a break,’ said Pammy.
‘Yes, well, I’m having a second one now. I don’t save lives like you lot so I don’t, and while the cat’s away I’ll make the most of it. Besides, I have important business to see Biddy about and it cannot wait. Mysteries and secrets everywhere they are.’
Pammy looked at Branna suspiciously. She was hiding something. But there was no time to wonder what.
Staff Nurse Bates walked out of the cubicle. ‘Don’t leave her. I think it will be best if we make sure that there’s always one of us with her. I’m not happy about this case. I wouldn’t trust this one not to run away. She looks like a scared cat.’
‘I’ll get her a cuppa and some toast from the kitchen,’ said Pammy.
‘Yes, well, it will give her some strength,’ said Staff Nurse Bates. ‘The poor thing is going to need it, in more ways than one.’
Pammy tried again to get the mystery girl to talk to her, after she had gratefully eaten the tea and toast. ‘So, are you from around here then, love? Or have you travelled far?’ She talked about everything other than why the young woman was actually lying in the bed in an attempt to encourage her to provide them with some information.
Some of the other nurses were bristling with disapproval. They could barely conceal their moral indignation. ‘I would refuse to nurse a case like that,’ one of them said to Pammy as she passed her on the ward. ‘Tell them you are a Catholic and it’s against your religion. You’ll have to go to confession, you know.’
‘I’m here as a nurse, not a nun,’ Pammy snapped. ‘We aren’t here to judge, that’s not our job. I don’t know about you, but I’m here to look after people who are sick, whatever the reason.’
Staff Nurse Bates had overheard the exchange, and smiled so sympathetically at Pammy that Pammy’s indignation boiled over.
‘Never let me behave like some of those pious madams,’ she said in a fierce whisper as they disposed of the towels they had used to wash their patient in the laundry trolley outside the cubicle. ‘We are supposed to be nurses. I can hardly believe them. That poor girl, she’s no more than a child herself. A waif and stray and she’s in agony. I’ve never seen anything so sad. Do they not have hearts, that lot?’
‘God, I know. They make me sick. There was a reason why Staff Nurse asked us two to nurse her, you know. She may be a bit big for her boots today, but she’s not stupid, or unkind. There but for the grace of God go all of us,’ Staff Nurse Bates replied.
Pammy thought that wasn’t strictly true. She had never done more than hold a boy’s hand. A situation she hoped to rectify at the doctor’s dance. ‘Do you think she’s married? That wedding ring, it’s not real, is it?’
‘I have no idea, but look at her. How old do you think she is?’
Pammy peeped through the door at the girl who was now lying back against the pillow with her eyes closed. ‘I don’t know. The same age as me? Eighteen, nineteen maybe?’
Both nurses fell silent as Mr Scriven walked in through the ward doors. He recognized Pammy instantly, and frowned.
‘I will examine the patient now, please, Staff Nurse Bates.’
‘Yes, Mr Scriven, but you do know, sir, we have no information about her. All we have are the notes taken by Dr Mackintosh in Casualty. We don’t even know her name, because she won’t speak to us.’
‘Hardly a priority given the circumstances, Staff Nurse Bates. I am more interested in what is happening from a gynaecological perspective.’
They both saw the expression on the girl’s face when she heard Mr Scriven’s voice before he had even entered the cubicle. She looked terrified.
‘Her contractions are erratic,’ Staff Nurse Bates continued after a short pause. ‘No regularity whatsoever, but all the same, she’s in a great deal of pain.’
Pammy had just taken her pulse and blood pressure. Both were high. Pammy wondered if she dared to say anything to the godlike Mr Scriven. First-year nurses never spoke to consultants, unless it was one who was friendly and encouraged it. Taking what felt like her life in her hands, she said, ‘Mr Scriven, her pulse is now 120 and her blood pressure is 170 over 100. It has risen since she arrived with us thirty minutes ago.’
Mr Scriven ignored Pammy. It was as though she hadn’t spoken. He picked up the fluids chart to check the input.
‘Is she still bleeding?’ he barked at Staff Nurse Bates. ‘What’s her PV loss like?’
‘Very little to speak of, sir.’ She shot a quick glance at Pammy, and the two girls frowned at each other. Something wasn’t quite right, but it was not their place to question the consultant. What Mr Scriven said was law.
‘I will give her an injection to speed things along. The foetus will be delivered dead. Call the porters and have it sent down to the incinerator immediately, and I mean without delay. She will suffer some sickness and diarrhoea as a result of what I am about to administer, but that will help with the delivery. She may develop a temperature, but it won’t be anything to worry about. My registrar will check the expulsion is complete and that there are no retained products from the pregnancy and then she can be discharged and sent home. Wherever that may be.’
Staff Nurse Bates was so stunned she could barely speak. It was unheard of to send someone home so quickly after such a traumatic procedure. Mr Scriven was known as a bed blocker. He kept his patients in far longer than Mr Gaskell.
Mr Scriven turned to the young girl, who had kept her eyes closed and her head turned away. She was terrified. Pammy saw that her fists were clenched tight. Mr Scriven looked as though he was about to say something directly to her and then decided not to bother. Instinct took over and Pammy moved to the side of the bed to take one of the girl’s hands in her own.
Mr Scriven raised his eyebrows. It didn’t take a clairvoyant to tell anyone that Mr Scriven didn’t like the new nurse.
‘I have seen her in clinic before today. Her name is Jane Smith,’ he barked, in a tone which left Pammy and Staff Nurse Bates in no doubt he was in a foul temper. They were also amazed. Both nurses wanted to ask How did you remember that? Mr Scriven had needed to be reminded of Mrs Toft’s name almost every time he came on to the ward and she had been an in-patient for over a year. He knew his patients by their condition, not their name.
‘Well, at least we have a name to put on the charts,’ said Staff Nurse Bates in a sceptical voice as she filled out the blue TPR forms. And to stop people from asking her what her real name is, thought Pammy. She felt a shiver run down her spine. Pammy was streetwise and sharp. Mr Scriven was lying about the girl’s name, and the question now banging in her head was Why? Why was Mr Scriven lying?
‘P
lease prepare a trolley for induction, nurse,’ he said to Staff Nurse Bates. ‘I will put some of the drug into the drip first and get it running. In the meantime, I will perform an examination.’
‘Yes, Mr Scriven.’
Pammy positioned the examination trolley she had laid up earlier against the side of the bed. Both she and Staff Nurse Bates were shocked by Mr Scriven’s roughness. In less than a minute he had pulled the girl’s legs up without any explanation and inserted a Sims speculum.
‘She’s burnt,’ he announced, removing the speculum and pulling the covers over her knees. ‘The solution they used was too caustic. Probably carbolic and water. I’ve seen worse, but we had better get her delivered. Let’s set up and get on with the induction, nurse.’
Before she left the cubicle for the clean utility room, Staff Nurse Bates found the courage to ask one question. ‘Mr Scriven, I hope you don’t mind my asking, but as we have no notes and I shall be nursing this young lady, do you remember how old she is?’
‘She’s twenty.’
Staff Nurse Bates gasped. ‘Twenty?’ Her voice was incredulous. The girl kept her head turned away and her mouth shut tight.
Pammy was aware that an oppressive and slightly alarming atmosphere had slipped into the cubicle. Something was deeply untoward, but she had no idea what.
‘Where is Sister Antrobus?’ barked Mr Scriven. He was now clearly irritated. Neither nurse had spoken, but they hadn’t needed to. He took a clean handkerchief from the pocket of his white coat and wiped his brow. ‘It’s hot in here. I hate these cubicles. Open the bloody window,’ he snapped.
Pammy obliged. She had decided during her first spell on ward two that the dislike was mutual. She far preferred Mr Gaskell and wished he were here instead of Mr Scriven, but Mr Gaskell was not at the hospital today. They knew that much at least from Dr Mackintosh.
Staff Nurse Bates mumbled something about Sister Antrobus being ill and, aware she had overstepped the mark, scuttled out to fetch the trolley so that she could set up for the induction. Pammy did not bother to offer to find the senior staff nurse. She had seen her heading off with the other nurses for their coffee break, Staff striding out ahead with the juniors trotting along in her wake like obedient pink little ducklings. If Staff Nurse had had any inkling whatsoever that Mr Scriven would be calling into the ward himself, she would never have left for coffee. Securing the position of sister on ward two would involve Mr Scriven’s approval one day, and even Pammy, inexperienced as she was and unused to the ways and politics of St Angelus, knew Staff would never miss an opportunity to ingratiate herself. She would have hung around all day waiting for Mr Scriven, and would be blisteringly mad to have missed him when she returned.
Pammy had also noticed on her first spell on ward two that whenever Mr Scriven was present, Sister Antrobus became quite giggly. She flushed and preened when he was due on the ward for his round. She held him in higher regard, almost, than he held himself. She would often disappear to the cloakroom before his mid-morning round began and return smelling of hairspray, lipstick and eau de cologne.
Once the round was over, she would order Branna to leave a tray of tea in her office, to be drunk as they devoured a tin of Huntley and Palmers while she wrote his instructions in the case notes.
‘She’ll try any way she can to get into a man’s trousers, that one,’ Branna used to say, to the shock and horror of any prim and proper young nurses who happened to be around to hear her. ‘Someone needs to tell her it takes more than a custard cream.’
Staff Nurse Bates returned to the cubicle, pushing a trolley with one hand and a heavy drip stand with a fresh glass bottle on with the other. She struggled as they rattled along, each intent on going its own way. Pammy rushed to the door to help her through, and taking the drip stand from her wheeled the heavy contraption to the head of the bed. Staff Nurse Bates smiled her thanks.
‘Would you please hold, er, Miss Smith’s hand, Nurse Tanner, while I assist Mr Scriven,’ she said.
Pammy took the girl’s hand and squatted down beside the bed. ‘Mr Scriven is going to give you an injection, love, to help the baby on its way,’ she whispered. ‘But you can hold on to my hand and you just squeeze away as hard as you want.’ Her face was only inches from the side of the bed. She could feel the patient’s warm breath on her cheek. Mr Scriven had not explained what he was about to do.
She looked towards Mr Scriven, who had snapped off the top of half a dozen or so glass vials containing a clear solution with a faint straw-coloured tinge. The syringe was a large one and the needle about eight inches in length. Pammy felt her skin tighten as with little finesse and not even a glance at the patient’s face, or a word of encouragement, he pulled back the sheets to reveal her swollen belly. Pammy saw the girl’s abdomen jerk to the side and then ripple back again, as though the baby within objected to the sudden cold and exposure. She had seen Lorraine and her brothers move in much the same way when they had been in her own mother’s belly. ‘Doesn’t like lying on me spine. Too bumpy,’ Maisie had laughed as she had laid her own hands protectively on her abdomen. This baby was kicking away in protest. Just like Maisie, the girl placed her free hand protectively over the area where what appeared to be a tiny heel, or a fist, pushed outwards, distending the smooth and stretched skin.
Mr Scriven had not noticed. He was drawing up the solution into the syringe from the last remaining vial.
‘Swab the area with iodine, nurse,’ he snapped at Staff Nurse Bates, who, with an unreadable expression, responded to his instructions.
Both girls wanted to scream, What are you doing? This girl isn’t twenty, and surely she is too far gone? Just leave it a while and see if she settles, if the baby holds on. Doesn’t it deserve that chance? But both of them were only too well aware that if either of them did so, they would be sacked on the spot. Their role as nurses was to support the consultant, not to challenge him.
Staff Nurse Bates opened a brown ribbed bottle of iodine and poured a small amount into a white enamel kidney dish. She then clamped two swabs of lint into her Sinus forceps and dipped them into the cold solution before laying the forceps on the dish and moving the trolley closer to the bed.
‘This will feel a little bit chilly,’ whispered Pammy, ‘but I am afraid it is necessary to sterilize the skin.’
She was aware of the proximity of other patients in neighbouring beds on the other side of the thin plasterboard wall, and was by now well practised in keeping her voice low. There was not a flicker of acknowledgement. Pammy knew she would be in charge of the patient’s TPRs for the day and had been counting her respirations. At the beginning of the process they had been a steady twenty-two per minute, but they were now greatly increased. The girl was extremely distressed. Pammy’s heart was heavy as from her crouching position she watched Staff Nurse Bates swabbing away. Stark yellow rivulets of iodine ran down the side of the girl’s swollen white abdomen, soaking the fresh draw sheet on which she lay.
The solution was cold and the response from the life within became stronger as the baby kicked even more furiously. It seemed to Pammy as though the girl’s belly had a life of its own. The patient gave a tight sob as Pammy brushed the damp fringe away from her forehead. Her brow was now soaked in perspiration. Her eyes were squeezed tightly shut and her face was beaded with sweat that smelt of fear. The air in the cubicle was filled with the antiseptic smell of the iodine and Lysol from the newly washed floor.
Despite the fact that her eyes were tightly closed her tears would not be contained, and as the iodine solution ran down her belly, puddled in the valley of her groin and spilled over her exposed thighs, they flowed out from under her eyelids and ran down her face. Once again she moved her hand protectively, to cup her lower abdomen with her hand, and Mr Scriven barked roughly, ‘Don’t touch. That area has just been sterilized.’
Pammy reached up and took the patient’s free hand and held them both together in her own. She felt as if she was holding the girl prisoner
, and as she thought of Lorraine the tears prickled behind her own eyes. She knew that that gesture, the move to caress her baby, was instinctive: protective, loving, possessive. It was what all mothers did. The first touches, separated by a layer of muscle and skin, but each letting the other know hello, I am here. I am here.
‘Good work, nurse.’ For a moment, Pammy didn’t appreciate that Mr Scriven was talking to her, but far from being made to feel proud she felt ashamed to be praised for assisting in such an act. She was sure he had lied about the patient’s name and age, and she intuitively knew that this was not an induction, but an abortion, and it was not happening because the mother’s life was in danger. He was acting no better than a back-street abortionist. She felt utterly helpless. Everything that was occurring before her eyes screamed out to be challenged, but she was the lowest of the low in terms of medical rankings and felt unable to question or intervene.
Still holding both the girl’s hands in hers, she leant in yet again and whispered, ‘Don’t you worry, love. You aren’t alone. We are here with you and we won’t be leaving you.’ Her reward was an almost imperceptible squeeze of the fingers.
‘Right, all systems go. I am about to inject, so do not move a muscle. It will feel like a sharp scratch to begin with, but I’m injecting into a sac of fluid and you won’t feel anything after the first minute. It will be just like a bee sting.’
The mysterious Miss Smith still didn’t look at Mr Scriven, but kept her head turned away and her eyes tightly shut.
He lowered his tone to almost a whisper. ‘She needs to be kept calm.’ Ignoring Pammy again, he spoke directly to Staff Nurse Bates. ‘There will be some wriggling. The foetus always kicks up a fuss when the amniotic sac is penetrated, but she won’t feel much at this stage. All she has to do is keep perfectly still. You need to keep absolutely still,’ he said more loudly, as though the girl was deaf. He studied her, waited for a response. She gave a slight nod of her head to indicate that she understood. Now both Pammy and Staff Nurse Bates noticed that Mr Scriven was trembling. Staff Nurse Bates had never seen that before and it made her even more convinced that all was not as it should be. She had never seen any doctor carry out a procedure such as this before and even though she was yet to be placed on Maternity, she had also never heard of a pregnant woman being injected into the uterus through the abdominal wall.
The Angels of Lovely Lane Page 33