by Carl Shuker
‘Yes, please,’ Elizabeth said.
‘They—were talking about a dog, a pet,’ Matthews said.
‘Uh huh. A dog?’
‘And travel to the UK.’
‘Uh huh.’
‘In the next few hours Lisa said she had some head and neck pain that was eased temporarily by changing her position.’
‘We changed her pillow, moved her around,’ the senior nurse said beside her.
‘Uh huh.’
‘Her respiratory rate had increased. You tell it Jan.’
Jan looked Elizabeth in the eye. ‘I sat with her from about midnight. She was pretty high maintenance at this point.’
‘What do you mean. I’d like details please.’
‘I talked with her. About the UK and a trip she was going on. Because she didn’t like the mask and she couldn’t get comfortable.’
‘Uh huh.’
‘I had to keep explaining the importance of the mask. She was complaining that she was having to work harder and harder to breathe. The family had gone home at this point. The wee hours.’
‘Uh huh.’
‘At this juncture she was given midazolam for anxiety,’ Matthews said. ‘Sorry, Jan.’
‘Um, so at about 3 a.m. she refused the CPAP mask and she had to be talked into it. She was clawing it off. We came up with a deal where we would keep the mask on for five minutes and she’d earn a sip of water.’
‘Uh huh,’ said Elizabeth. ‘Go on.’
‘By then,’ said Matthews, ‘she was deteriorating. The sepsis was advanced.’
‘Uh huh.’
‘She called out,’ said the nurse.
‘She was pale, anxious, agitated.’
‘Uh huh.’
‘She was dropping her sats. A breath about every two seconds. She was complaining of being tired and cold and the catheter was bothering her.’
‘And the mask. She hated the mask.’
‘Uh huh.’
‘She was still speaking, just one to four word sentences and her breathing was very rapid and we called the registrar to see if she needed intubating. What time was that?’
‘About three or four,’ said Jan.
‘So you were with her from midnight till four?’ said Elizabeth to the nurse. ‘Jan, is it?’
‘Yes.’
‘Okay.’
‘I told her the doctor was coming and she was holding out for that.’ The nurse’s eyes were bright and wet. ‘I wasn’t there for the rest until the resuscitation.’
‘The parents arrived about four,’ Matthews said. ‘We’d called them when we’d seen what was happening. We asked them to step outside as we were going to intubate her then put in a central line.’
‘Uh huh.’
‘We put her off to sleep. Ketamine and roc. Rocuronium. I can get Dr O’Connor in here if you’d like?’
‘No, that’s all right. What happened after that please?’
‘I remember from Jim’s notes he believes she arrested some time during induction and we began resuscitation at that point.’
‘Uh huh.’
‘We tried for about half an hour. I remember. She was just 24. Young, strong woman. Pronounced dead at four or five or something like that. The wee hours.’
‘Thank you both,’ said Elizabeth.
Matthews was watching her and the other nurse came up to stand beside Jan.
‘I’m sorry about your colleague,’ Matthews said.
‘Thank you,’ Elizabeth said.
‘Is that . . . is that what you needed to know?’
‘I think that’s some of it,’ she said. ‘Very helpful, thank you.’
‘Do you want more? Notes?’
‘No, not from you. That’s very helpful. Thank you. Thank you for . . . caring for my patient.’
He looked at her.
After a while Elizabeth said, ‘The anaesthesia had not kicked in before the cardiac arrest, you think?’
‘Jim didn’t think so. No. I don’t think so.’
‘Was it at all lonely for her, at the end?’ Elizabeth said.
Matthews looked at the nurse.
She blinked and looked at Elizabeth. ‘We were all here,’ she said. ‘Her family were here right up until intubation. I was with her during the night.’
‘You sat with her.’
‘Yes.’
‘About four hours, you said. Until the death at four. Or five.’
‘Yes, I was here.’
‘And your shift finished at midnight didn’t it.’
The nurse shrugged.
‘Okay,’ said Elizabeth, and nodded at the linoleum. ‘Thank you.’
‘Okay?’ said Matthews.
‘Okay,’ she said. ‘Yes. Fine. Thank you all.’
Then she turned and left and they watched her go.
At 10 p.m. that night, 9 a.m. UK time, she called the Royal London Journal of Medicine.
‘Denise Cohen?’
‘Yes, hello Denise, this is Elizabeth Taylor.’
‘Yes?’
‘I’m an author of yours, working on the New Zealand editorial.’
‘Oh of course yes, I’m sorry. First coffee of the day still pending, ha ha. Public reporting of surgical outcomes in New Zealand, now I’m with you.’
She was posh, multilevelled, like the editor in chief of the Royal London too.
‘That’s the one. Look, Denise, there have been some developments that affect the piece.’
‘Oh?’
‘Is there any time left for revisions?’
She was silent.
‘Sorry,’ Cohen said. ‘I’m just at this moment staring across the desks of editorial towards where we keep our technical editors chained up like vicious dogs who are at present engaged in knocking your piece into shape. This goes to print tomorrow morning and will be live on the website tonight. Exactly what sort of revisions are we talking about?’
‘I don’t want to delay it. Here’s the thing.’
She explained it as briefly and quickly as was possible. That 24 hours ago her registrar committed suicide after publication of the data. That there was currently in effect a cover-up going on. That his body was being thrown under the bus and that he was young and should have been supported and it should have been her that did it.
There was a lot to leave out. The elusiveness of a public record to do justice to the thrill of the work. The speed and light of it, and the stakes; competence. What it feels like to be good, how somehow abashing. The versions of the truth. The long tail of shame. Jessica screaming on the phone at her. You killed my dog, you killed my dog. Elizabeth saying, I’m sorry, I’m so sorry. Jessica screaming before she hung up, You’re an evil bitch and fucking psychopath. Jessica calling her back later that night to say, I’m just really sad. That they sat on the phone together in silence for five minutes. Meeting Robin for a lunch at Maranui and being unable to make eye contact after all this, and the café too crowded and the ambient noise too loud, too many echoes. Walking on the beach afterwards together, no wind and the skies the same pale steel as the sea. Robin saying, I couldn’t lie to them for you. Elizabeth saying, That’s absolutely right. Missing the movement of their hands together over a patient, how they used to dance. Missing work. Service. A covenant. I will save you with my skills. How lucky, actually, Robin was to survive this with a job. Because in the time of scandals nurses eat their young, and the surgeons help them feed. Why don’t you find the family, Robin said gently. Meet with them. And not being able to answer that.
‘Well, it’s a faff, isn’t it,’ said Denise Cohen at last.
‘Yep, well,’ said Elizabeth.
‘I’m sorry about your colleague.’
‘Thank you.’
‘Look, speaking from the perspective of the Journal which I’m bound to do, I can buy you a couple of hours. This warrants telling, but I strongly suggest you restrict yourself to two paragraphs, fore and aft, and we’ll leave the edited body of the thing intact. The discussions about data
strength, the Lancet paper, all good stuff. Leave it alone. That’ll keep the tech eds reasonably happy. Tell us about Richard, the mistake, connect it with the data. You can make it personal, that’s good, but not too personal. Can you do it in two paragraphs?’
‘I can.’
‘It’s just an act of writing after all.’
‘Just an act of writing,’ Elizabeth said.
‘Ha ha, yep. I know how it is. Now while you’re here I can check some last minute things. Author affiliations. This is you and is it Andrew McGrath, capital M lower case c capital G, head of surgery, Wellington Hospital, etc etc. Have I got that right?’
‘No, this is all me now.’
‘All you?’
‘Yep.’
‘Right, fine, he’s deleted. Two hours or it goes ahead with or without your additions.’
The two Bunnings employees stood back from the roller doors as the silver Camry came in fast first thing in the morning, bumping over the judder bars into the timberyard. The tyres squealed on the slick concrete inside as the big car went round the stacks of treated and untreated two by four and pulled up by the plasterboard.
The woman got out. They watched as she went to the stack and crouched and read the labels. One of the employees sighed and pulled the tape from his tape measure and let it flick back inside, and looked down at his poncho. The other one looked at him and sighed too.
‘Fuck Tim, do a day’s work.’
‘Man, I’m just up.’
The boy walked over to the woman.
The Camry was classic period wagon, 2001 or 2 maybe, big 3-litre V6 and in good condition, not a single Wellington scratch. The back doors and the boot were open. There was a box in the back with two pails of Gib RediFilla and screws and tape and a pair of long ratchet straps.
‘Gidday, can I help you?’ the boy said.
‘Nope,’ she said to the stack, then, ‘actually yes, this is it. Give us a hand.’
She dragged out two long slabs of the 2.4-metre gib plasterboard halfway and looked at him. He grabbed the other end and they lifted the heavy slabs off the stack.
‘Dunno if you’ll get these in the Camry,’ the boy said, but she’d raised the boards head high and backed off and he had to follow her and then she circled round the back until they were holding the gib over the roof of the car between them.
‘Stop there,’ she said, ‘and just lay it down.’
He did, and she swung it round straight.
‘Um,’ he said, ‘look, sorry, we’re not actually allowed to let you leave like that.’
She’d bent down and disappeared behind the car. The ratchet strap fell out of the passenger side door at his feet. He smiled and bent down and picked it up.
‘Chuck it over,’ she said. ‘I won’t tell anyone.’
He threw it over the top and she ratcheted the strap tight, tight enough to twang but not so it would crush the edges of the boards. He noted it. Then she tied the second one and then she went round the car closing the doors and paid in cash and drove out the timberyard doors with two and a half metres of gib plasterboard strapped on top of the roof of her car, illegally, slower now.
Acknowledgements
Thank you to the people who have blown and broadened my mind the last few years. Richard Hamblin is a constant inspiration to me—thank you for the graphs and analysis, but mostly for all you teach me. Thank you to Catherine Gerard, Maria Poynter, Jenny Hill, Nikolai Minko, Ying Li, Vince Carroll, Alexis Wevers, Lisa Hunkin, Natalie Horspool, Emily Mountier, Karen Jones, Jade Cincotta, Shelley Hanifan, Owen Ashwell, Di Sarfati, Iwona Stolarek, Gillian Bohm, Janice Wilson and Alan F. Merry—all of whom have given me an education in health, data and friendship.
Thank you to Ryan Skelton, always, for your constancy, your hunger and your faith. Thank you to my agent Imogen Pelham for believing in me and the work. Thank you to Ashleigh Young, Kirsten McDougall and Fergus Barrowman at VUP. Thanks to Damien Wilkins and Emily Perkins at the IIML for their support. Thank you to early readers Patrick Evans and Katy Robinson who nudged me gently in the right ways. Thanks to Cameron Law and Jeremy Hansen for good-humoured support and advice. Thank you to Sarah Mary Chadwick whose song ‘Yunno What’ gave me the entire sound of the book. Thank you Pip Adam for your inspiration and attitude.
Thank you to the clinicians of Wellington Regional Hospital. A book needs a setting and the actions described in this narrative do not reflect real people, practice, policy or particular cases at the current Wellington Hospital. We are lucky enough to have a public service that is full of dedicated and gifted individuals who care deeply for their profession and their patients. Some of these clinicians are named above. One of whom, Alex Psirides, was kind enough to give me some tips on getting complicated things right. Thank you. All errors of fact and description in this short book are my own.
To my first and best reader in every way, without whom I am lost: Anna Elisabeth Smaill, mother to my beloved son Alexander. And lastly to my daughter Lotte, who asks me what my book is about and always revives in me the fire and strange and simple urgency of that question: what happens?
© Shane Reid
CARL SHUKER is the author of five novels, including Anti Lebanon, The Lazy Boys, Three Novellas for a Novel, and The Method Actors, which won the 2006 Prize in Modern Letters. He is a former editor for The British Medical Journal, one of the oldest medical journals in the world, and principal publications adviser to the Health Quality & Safety Commission. He has lived and worked in Tokyo and London for many years, and now lives in his home country, New Zealand, with his wife and their two children.