by Nina Raine
MARK. Large.
VASHTI (coldly). Small.
MARK (takes it). Cool!
VASHTI (struggling). I can’t… quite… get at the… Lakshmi. I think I’m going to have to open this up a bit more. Mark, you can stop arsing around and make yourself useful. Get ready to swab.
MARK stands next to her with a swab in his hand. LAKSHMI passes VASHTI the diathermy probe. VASHTI lengthens the incision. She quickly starts to cauterise the wound.
Swab.
Swab.
Lakshmi, I need more retraction. I can’t see… what I’m doing…
MARK swabs in the wound.
Okay. Get another.
Quick.
I said get another!
LAKSHMI. Is everything all right?
Beat.
VASHTI. I’ve lost it… I’ve lost the bleeding point.
Suddenly everyone is tense. MARK scurries round, gets another swab, LAKSHMI also comes forward and hovers with a swab. EMILY hovers impotently – she is not sterile. A brief, tense silence as they work.
EMILY. Can I do anything?
MARK. Shit, he’s really bleeding.
VASHTI (to MARK). Get out of the way! How can I cauterise if you’re in my way?
MARK. But you told me to swab!
VASHTI (a note of real panic in her voice). Brian, he’s bleeding.
BRIAN immediately emerges from the side room where he was tinkering at his computer.
BRIAN. Okay. Let me just –
VASHTI. I just can’t find what’s bleeding –
He doesn’t bother scrubbing up properly, just pulls on sterile gloves, extremely swiftly and as he does so instructs –
BRIAN. Just try and get rid of the blood so we can see –
VASHTI’s bleep goes off. Everyone ignores it. LAKSHMI is swabbing. So is VASHTI. MARK passes swabs.
A scratchy voice comes over the intercom.
INTERCOM. Patient’s here.
LAKSHMI (in direction of intercom). All right, thank you.
BRIAN comes hastily up, takes over from VASHTI who hovers at his elbow, nervously. The bleep bleeps again, louder, since no one has intercepted the page. They are all intent over the patient. MARK continues to swab, so does VASHTI.
BRIAN. Don’t worry –
I’ll see if we can… find what’s bleeding…
INTERCOM. Could someone answer the Urologist’s bleep please.
LAKSHMI (in direction of intercom). She’s scrubbed and busy in theatre.
INTERCOM. Thank you.
BRIAN. Ah.
Can I have a mosquito please…
…and load me a Dunlop, please…
LAKSHMI (to ROSIE). Two-oh Vicryl.
ROSIE empties the sterile needle pack out of its packaging onto the trolley. LAKSHMI passes BRIAN a threaded needle. BRIAN starts to put in a stitch.
VASHTI. He…
BRIAN. There we go…
Another pause, everyone still intent.
That should… should do the trick…
There.
VASHTI walks away and stands by herself, looking at BRIAN and the patient from a little distance. Looks away.
Vashti.
VASHTI. Yes.
BRIAN. It’s okay now. You can take it from here.
VASHTI. Thanks.
But she doesn’t move.
Cardiology
JOHN and OLGA in a private room. There is a man sitting on the bed – MR MERCER – thin, naked from the waist up. His jaw is sagging strangely, in fact his whole body looks strange and sagging. He is very sick.
JOHN (carefully drawing up the plunger of the syringe, he injects it into a bag and connects a Venflon). You know how much this stuff costs?
MR MERCER. How much?
JOHN. Eight hundred quid a pop. You’ve got all the pharmacists on our backs, know that, Mr Mercer?
MR MERCER. Ahh… but I’m ‘worth it’, aren’t I?
They laugh, which turns into a rattling cough in his case.
JOHN. You know you’ve got a crazy fan in here? Olga wants to get your autograph.
OLGA. John! I didn’t mean now.
MR MERCER. Not a problem.
Beat while JOHN works.
OLGA. I do watch it every week.
…Is Dr Patel going to come back? I liked him.
MR MERCER. There’s a vague rumour.
JOHN. So, you know the drill, Geoffrey. I’ve given a bit of local and now we’re going to find our way in with a wire and drain you off a bit.
MR MERCER. Last week it was yellow.
JOHN. Yellow is good.
MR MERCER. So what’s bad?
JOHN. Anything else. Blood.
Lego. White picket fence…
They laugh.
Right, ready to go, I think.
MR MERCER. You’re the boss.
He looks off at an angle, to distract himself. JOHN carries on, busily. Because he is working from his back we can’t really see what he’s doing.
OLGA. So can you tell us the storylines coming up for Bernie?
MR MERCER. More than my job’s worth… Nah, you create it yourself to a certain extent. The writers lead you and then they follow your lead.
OLGA. Do you ad-lib or is it all in the script?
MR MERCER. Oh no, there’s a script and you stick to it.
OLGA. I think they should give you a bit of romance. A nurse or something.
MR MERCER. So do I, darling.
MR MERCER’s breathing is laboured. It is obvious his lungs are swimming with fluid.
I’m going to cough now, is that all right?
JOHN. Help yourself.
He coughs. JOHN winces.
Ooh, got a lot of fluid there, haven’t you.
OLGA. I cried. When Josie died.
MR MERCER. I know. I still get letters.
OLGA. Did it affect you? I mean, in an emotional way?
MR MERCER. Sort of. Sometimes, do a very upsetting scene, it gets in your bones.
OLGA forces the plastic packaging from the sterile syringes and paraphernalia they are using away into her overflowing bin.
OLGA. This bin needs emptying.
MR MERCER. Like me.
JOHN (to OLGA). Bit more local please.
She passes him another syringe. A short silence.
MR MERCER. Think I’ve got pain now. Up here.
JOHN. Yeah that’s because… when I touch your diaphragm, you feel the pain up there in your shoulder… Weird, but that’s how we’re wired…
He carries on manipulating the wire, then feeds a tube up it.
There we go.
Another short silence.
MR MERCER. I feel sick.
JOHN (to OLGA). Get him a bowl.
OLGA goes to the sink and brings back a grey cardboard dish. She puts it on MR MERCER’s lap.
That’s because the wire is… stimulating certain nerves. The pain response is to feel sick. (To OLGA.) Give him something for the sickness.
OLGA. Cyclizine?
JOHN. Fifty milligrams.
Another short silence, during which OLGA flushes the Venflon with saline and then injects Cyclizine.
MR MERCER (weakly). Got something for everything, haven’t you.
JOHN. We do.
OLGA. We’ll have you back on telly in no time.
JOHN. You should feel better in a moment.
– Don’t blame you actually, I’d feel sick if I was having that done.
MR MERCER (to OLGA). My turn next week, you hold him down.
They laugh.
JOHN reaches behind MR MERCER and we see the beaker, behind MR MERCER’s back, filled with fluids from his chest. There is blood in it. JOHN and OLGA meet each other’s eyes as OLGA takes it from him.
Is there blood?
Operating Theatre
BRIAN is still at the side of the patient. He is just completing the first stitch to close the last layer of the wound in the patient’s skin. VASHTI is nowhere to be seen. EMILY watches si
lently.
BRIAN. Kids!
BRIAN and MARK laugh.
All surgeons want to be plastic surgeons when they grow up… all medics want to be neurologists… and all kids want to be lions.
Can I have a suture and forceps please.
LAKSHMI passes him a threaded needle.
Arhhh… can someone scratch my nose please…
EMILY hesitantly does so.
That’s right… that’s it… just there. Right, what are we waiting for. Close.
Mark. Do you want to have a go at doing him up?
MARK, who has been eagerly hovering, moves forward with alacrity.
MARK. Great.
BRIAN. Just make sure your stitches are the same size, you’ll be okay.
Meanwhile LAKSHMI is counting the bloody swabs out in fives, muttering under her breath as she counts. ROSIE holds out a yellow plastic bag for the swabs to go into. There is a catchy tune playing on the iPod: ‘We No Speak Americano’. Imperceptibly, everyone starts to bob in time to the music.
BRIAN holds up the plastic kidney bowl with the forlorn, bloody testicle in it.
Anyone want his testicle?
MARK. Vashti. She collects them.
LAKSHMI (firmly, taking the kidney bowl). One for the theatre dog, I think.
They exchange a look. VASHTI comes in from the sinks, pulling on a pair of gloves.
VASHTI. Hi.
Beat. MARK sings softly under his breath – ‘Hitler has only got one ball’.
Where are we at?
She comes over to MARK busy working on the patient. Watches him.
You shouldn’t be holding the needle in your fingers, Mark. You should get used to holding it with an instrument.
MARK. Yeah, but… it makes it more difficult.
VASHTI. That’s why you should get used to it.
LAKSHMI passes him the relevant instrument, silently. This hampers MARK’s progress considerably. A pause while VASHTI watches MARK labour, in silence.
It’s easier if you stand on the side you’re stitching.
BRIAN. He’s halfway through now.
VASHTI watches, with contained impatience, as MARK sews. Suddenly –
VASHTI. Oh God let me do it.
She takes the needle and starts to work, very quickly.
BRIAN. I said Mark could do it.
VASHTI. Brian, look at this. (Indicates.) Mark. You’re meant to try and make the skin meet the skin again. (Gestures.) If I left it like that he’d end up with one hell of a scar.
She busies herself.
MARK. How am I going to learn if you won’t let me practise?!
BRIAN. Mark, calm down.
VASHTI. Listen, Mark. The only thing the patient sees is the scar. He won’t see what a great job we’ve done inside. Just the scar. So the scar had better be good. And this scar is going to be crap.
She continues to work. MARK storms out of theatre, tearing off his theatre gown as he goes. EMILY watches him go.
A&E
JAMES is with EMILY. She is talking to him conspiratorially. She is exhilarated.
EMILY. Shitting myself! I’ve already discharged five people and it’s not even twelve o’clock.
JAMES. Perfect. Get ’em out of here. Then see if you can sneak out and watch me operate.
EMILY. I’ve already seen one. The guy who walked me in was a twat. Are you all like that?
JAMES. Yeah, probably.
EMILY. But A&E’s bloody terrifying. I love it. I’m making it up as I go along. Everyone’s got chest pain –
JAMES. Got your Bible?
She looks at her hand, which is gripping a green and yellow book – an Oxford Medical Handbook.
EMILY. Oh yeah. Yeah! I haven’t let go of the cheese and onion all morning. (Brandishes it.) It’s fantastic. It’s the only thing that’s keeping me together.
– But then this dick of a radiographer – refusing to give me a second X-ray – you should have seen the one I got, it was blurry, it was crap – I felt like saying, look, mate, this is why you’re a radiographer, not a doctor, because you’re a lazy shit –
JAMES. Babe, listen to me. (Puts his hands on her waist.) There’s absolutely no point –
EMILY. – I know but –
JAMES. – In getting angry with them –
EMILY. – I didn’t –
JAMES. Especially not if you’re a young-ladeee doctor. I know this place.
Beat.
It just means they take you less seriously, not more.
EMILY. I didn’t say it. I just felt like saying it.
JAMES. Don’t bother even feeling it.
MR LEFFE and BRIAN walk in, mid-conversation. MR LEFFE is older – a consultant. He is imposing, authoritative.
MR LEFFE.…It’s been dragging on for weeks, upshot is, she doesn’t want surgery on her gall bladder – because she’s been told she’ll get diarrhoea.
They laugh.
We’re never going to get rid of her!
BRIAN. Tell you what, let’s swap. Swap her with one of mine.
MR LEFFE. Done.
BRIAN. Shake on it.
They shake hands, and laugh again.
MR LEFFE. Oh God, am I going to regret this? What am I getting?
BRIAN (with an ironic expansiveness). No, mine’s wonderful. Eighty-seven-year-old, been here two months, she’s stopped eating and drinking and wants to die.
They both burst out laughing.
MR LEFFE (ruefully). You bastard. Fair enough. Fair enough.
As MR LEFFE strides past EMILY and JAMES, they both visibly straighten.
JAMES. Good morning, Mr Leffe.
MR LEFFE. Ah. Gather we’ll be seeing you skiing this weekend, James.
JAMES. Absolutely.
MR LEFFE. Good, good. Very much looking forward.
MR LEFFE is about to walk on.
EMILY. Mr Leffe, can I introduce myself? I’m your new FY2.
She sticks out her hand. MR LEFFE does not take it.
MR LEFFE. Sorry, your name is…?
EMILY. Emily Logan.
MR LEFFE. The new FY2?
EMILY. Yes.
MR LEFFE. Where were you this morning? At 8.30? When we went round last night’s take?
EMILY. I know, Mr Leffe. I’m sorry about that. It was a failure of communication between my last hospital and this one. I only finished there at midnight last night, they couldn’t change my shift.
Beat.
MR LEFFE. I see. A pleasure to have you with us. (Shakes her hand.) Good morning.
He goes.
JAMES. See, you got away with it.
EMILY. Got away with what? It was the truth. –Skiing? He’s not even your consultant, he’s mine, you operator!
JAMES. No, my consultant wangled a research freebie in Geneva. I couldn’t say no.
EMILY. I thought we were going to have this weekend together.
Beat.
JAMES. Babe, it’ll be different now.
EMILY. How?
JAMES. We’ll see each other all the time.
Beat.
We won’t be able to get away from each other.
Bladder Clinic
VASHTI sits at a desk. A small bare room. COMFORT, a West Indian nurse, stands by the door. By the end of VASHTI’s speech, JAMES has joined her.
VASHTI.…And I’m supposed to be completing on a house. How am I meant to do that when I look at people’s bladders and willies all day? (Gets up, starts striding around the room.) I don’t know how to buy a house. If it’s not a willy, I don’t know what to do with it. Comfort – you’re called Comfort, aren’t you?
COMFORT (heavily). Yes.
VASHTI. How about shutting the door properly in here?
Right, who’s our first patient. I don’t seem to have their notes here, Comfort.
COMFORT is still struggling with the door.
COMFORT. No?
VASHTI. I need the notes before I can see the patients. Comfort.
COMFORT.
I didn’t know…
VASHTI (goes to a weighty computer in the corner of the room). Would you be able to look up on the system –
COMFORT. No.
VASHTI. ‘No.’ She wouldn’t be able to look it up on the system. Okay. (Under her breath, but audible.) Not very ‘Comfort’–ing, is she?
(To COMFORT.) It delays the clinic if the notes aren’t there.
She starts to tap into the computer.
This isn’t really what I’m here for.
She scrolls down the screen.
Oh, for God’s bloody sake! We’ve got another one.
JAMES. Another one what?
VASHTI. ‘Wet woman.’ It’s the same boring story every time. (Scrolls through the notes.) Sixty-five, three children, suffering from urinary incontinence, bladi bladi bladi bladder. God, I hate them. What do they expect? It’s their own stupid fault. (As if to an imbecile.) ‘Stop having babies. Then you won’t get wet.’
JAMES. Bit of a drastic solution.
VASHTI. No. I’m going to get my tubes tied next year.
JAMES (genuinely taken aback). No way!
VASHTI. Yes way.
JAMES. Why?
VASHTI. Why do you think? Because I don’t want kids. That’s why.
Turning away from the computer, she picks up a single piece of paper on the desk.
What’s this? Something I’m meant to fill in?
COMFORT (leaving the door, coming over). Yes.
VASHTI (with barely suppressed irritation). Well how am I meant to know? Do I have to guess everything? I’m not psychic.
COMFORT. I thought it was a regular thing.
VASHTI (curtly). No.
She goes to a trolley.
KY?
COMFORT. I didn’t…
VASHTI. I’m going to need it, aren’t I, if I’m going to feel anyone’s prostate.
She waves some very large plastic gloves.
As well as some gloves in my size. (Holds her hand up, wiggles her fingers.) Small. Not gardening gloves.
Beat.
Can you get me the gloves and the lubrication and the notes please!
COMFORT exits, wordlessly. VASHTI turns to the desk, to start filling in the form. She mutters to herself.
How am I meant to run a clinic without the notes, without KY, without a nurse who knows her arse from her elbow. NHS again, innit. Great, innit.
Cardiology: Chest Clinic
JOHN. Sitting in clinic. He is on his mobile phone. Taking a chicken sandwich out of its packaging at the same time. Throughout the whole of the scene he is prevented from ever taking a bite of it.