The idea of him performing any of the stunts he describes strikes me as ridiculous. ‘No, I didn’t have that feeling.’ I uncross my legs. I try to change the fix of my facial muscles. Perhaps relaxing my body will make me feel less combative.
‘But you’ve had that sense before? You know what I’m talking about? If you had felt somewhere deep down that you were making the wrong decision, embarking on this career, you would have recognised it?’
‘Why do you say that – “this career”? Seriously, why don’t you say what you mean?’
He picks his pen up, spins it round once in his hand. ‘Is there something you think I’m leaving out?’ He puts the pen down on the arm of his chair.
‘Well, yes. My abortion work, obviously. That’s what you’re skirting around, isn’t it? That’s the thing you don’t want to say out loud. A-bor-tion. Abortion.’ I am surprised at how strange and shocking the word sounds, even in my own mouth. I am not sure if I’ve ever said it before.
‘And how do you feel, saying it out loud?’
‘Oh, for goodness’ sake! What is this? What are these questions? “How does it feel to say it?” Was I scared like a baby at medical school? That’s what you were asking me before, isn’t it? About my instincts. It’s ridiculous. I mean, doctors’ lives are full of disgusting things, full of events one’s instinct, as you call it, rises up against. Dealing with the sick and dying. Performing horrible procedures on people. You know, spending two years cutting up dead people before tea isn’t exactly genteel, is it? But we all do it. Even you must have done?’
He makes as if to talk, but I stop him. I lift up my hand.
‘No. Let me tell you, the first time I touched our cadaver I was so spooked that I went home afterwards, put all my clothes in the wash, and scrubbed myself clean in the shower like bloody Meryl Streep in that movie. But, within a couple of weeks, I wasn’t even bothering to wipe my hands after dissection. And you want to ask me about my instincts?’
My question hangs in the air. My aggression comes to nothing because Dr Gilchrist doesn’t retaliate. He’s not interested in having a fight. He wants more from me than that. It would be easy to go quite limp in the circumstances, but I need to keep my wits about me. I feel deflated. After a minute, in which he writes, the psychiatrist looks up at me again. He smiles.
‘I can see you’re a plain-talker, Nancy. So. Why don’t you tell me this. What kind of person becomes an abortionist, do you think? What—’
‘Abortion provider. Not an abortionist, an abortion provider.’
‘Ah. A provider, is it? Okay. Fair enough. Is there a type, though? Do you think there might be a type? Are you that type?’
I haven’t come close to answering this question in my own mind yet, but I relax. I know what I can say. There’s a rhetoric that goes with the job I do, and I’m familiar with it. I’m well versed enough in the matter to be able to provide an explanation. What other truth do I have? I put my hands in my lap and look at Dr Gilchrist. I notice the arcus senilis in his eyes, which gives them a very slightly milky appearance.
‘I think it does take a certain kind of person, yes. I mean, any surgery does. And I know we gynaecologists aren’t thought of as surgeons proper because operating isn’t all we do. But we need the same qualities. To be determined, competitive, I suppose. Hard of stomach. Unsentimental. Yes. Because, however neutral you feel about the work – and there really is no reason not to feel neutral, is there? I mean, this is a legal procedure and women are entitled to it – however neutral you may feel, there are the sensibilities of others to be contended with. You know, people at work who may disagree with what you do. Doctors, nurses. And everyone outside work too – family, and so on. You have to be able to deal with all the baggage that everyone else brings to the table …’
I stare at Dr Gilchrist’s head as he writes his notes, remembering the first time I ever saw Frederick addressing my class of medical students, nearly a decade ago. ‘It is safer to have an abortion in this country than it is to see a pregnancy to term’ had been the first sentence of his lecture, dropped like a bomb. He must have witnessed the same herd reaction every time he delivered his lecture. First, a whole row of girls had moved, like one bashful invertebrate, along the bench and out of the lecture-room door. A few boys had joined them, grabbing the opportunity for a bunk. Quiet expectation had fallen upon those of us who remained. Frederick had opened a window and smiled, before beginning to teach us.
‘So, it’s more a question of dealing with other people’s difficult feelings about your work than having to wrangle with your own?’ Dr Gilchrist is speaking again.
‘Yes. Look, here’s the thing. I consider it to be a life-saving procedure that I do, that we do. It’s saving the life of a woman, it’s something that saves a woman’s freedom. And what is her life without this? It’s painted in this bad light, but terminating a potential life is not the worst thing that can happen. What about finishing a woman’s life before it’s even started?’
My words sound thin to me. My thoughts feel full but not when I speak them aloud. They bleed out. Dr Gilchrist clears his throat. He says, ‘I see.’ He attempts to clear his throat again. ‘Yes, that’s a good, complete explanation.’ And I’m distracted. It reminds me of my dad, that noise. His eyes are red with the effort of getting his voice back. I’m not sure what I should do to help him. After a moment, Dr Gilchrist, still struggling, excuses himself to get some water. He gestures his intention to me with his hands as he rises from his chair. I feel the air shift as he walks past me.
When he has gone, I listen to the traffic outside the window. I separate it into strands. A low-frequency sound posits itself as a van. I hear the noise, I know what it is. And there’s another. A car, this time, surely? Why am I incapable of doing this with my own thoughts? Why can’t I name them, bring them out, paint them truly? In my mind’s eye I see myself standing next to Mr Hanforth. Is that memory enough to make me bad? And now here I am extolling the virtues of toughness while at the same time a different scene entirely, that of a poor man lying in front of me in a hospital bed, reveals itself to me for the first time in years. Unravels into what I have been saying aloud, belies it. Experiences rise up to defend as well as accuse me. It is as if my patients stand in the wings, each of them leaning on one or the other side of the argument. How on earth am I to begin to understand what has happened, let alone how much I have been to blame, when it seems that everything that can be said about me is both true and also not true? I am a brute and I have the evidence. But I am compassionate too.
It must have been someone’s birthday. That’s what I thought when I walked in that morning because there was a joyful hubbub, a humorous sound lightening the everyday train-station noises of the ward. A few nurses were gathered together near the central station, the one made from the long desk and the couple of computers and the trolley of patient notes. And the nurses weren’t huddled over something so much as leaning on each others’ shoulders to support themselves. They were catching their breath between bouts of laughter.
I drew closer and I saw my colleague, Matt, a house officer just like me and a real hit with the nurses. He had the right body. He looked as if he’d sailed on well-built boats in clement bays. His jaw was square, his eyes bovine. He was good-natured too. He was standing there, anyway, in his clean white coat, arms crossed over his handsome chest, looking benignly at the nurses, indulging their joke, whatever it was. I saw how his tolerant stance encouraged this gaggle to new levels of mirth and how each of these women felt the possibility that the handsome young doctor’s regard might fall on them. I watched them find singular ways to look amused and pretty for him.
There was a West Indian nurse leading the fun, keeping the joke alive. Every time she straightened up and wiped tears from her eyes to offer another jest, the others paused with her, readying themselves for another short lease of laughter to do their best with, to shape to their own sexy advantage. I marvelled at this nurse, at the ease with
which she could create such a festive scene.
‘Now when you finish here, Matt, you just come along with me to my house. I find plenty for you to do about the place with that there apron on!’ she said, enjoying the lengthened drama of her own Caribbean vowels, which prompted new peals of laughter all around.
Matt came forward to me. The thin plastic apron tied around his slim waist shone along the length of him. He touched me and it was as if this made me visible: for a second or two, I felt the great bounty of being drawn into the group on whose periphery I had been standing, invisible. But it was short-lived, this pleasure. It stopped ever so quickly. The nurses, having spotted me, started to collect themselves. They were still smiling and murmuring but they did not exactly bother to hide the fact that my appearance on the scene had soured their game.
Matt didn’t pick up on this slight change of mood, and his continuing jocularity kept a couple of nurses close by as he said to me, rather loudly in fact, ‘I’ve been asked to learn a new skill, Nancy, and perform manual evacuation of faeces on a patient.’ There was a single squeal from one of the more dogged sisters. ‘Apparently, none of our nursing colleagues has been on the course that teaches this skill. I, of course, pointed out that neither you nor I have, or ever will go on that course. But Mary informs me that, since we’re doctors, it’s fine for us to just hop in and give it a go. She’s not going to do it herself, but she’s kindly offered to stand by and supervise.’
‘And now that Nancy has turned up, you can do it together.’ All the others dispersed, leaving the pert young sister in charge of the situation. I was afraid of her. She had short bleached hair and her attitude was poised between the affection she was sending out to Matt and the hostility she wanted to make quite plain to me. ‘Better get an apron and some gloves. Your man’s right there,’ she said, pointing her chin to the cubicle next to us, not bothering to unfold her arms from under the ledge of her pretty bust. ‘Bed three.’
I went into the stocks room to get the things we would need, and when I came back I saw, from the empty space beside the nurses’ table and the drawn curtain around bed three, that Mary and Matt had gone ahead of me. I felt a pulse of shame on seeing how near the patient was all along to where the nurses had been laughing just a few minutes before, although it was also from the feeling of being left out. It seemed as if Mary could read my mind, for when I joined my colleagues behind the curtain she said to me, ‘Don’t worry yourself, Nancy, he’s not really with it, this one.’
I looked down at the bed. It was easier to look at a sick patient than at Matt and Mary. It was easier to look at a back curved with pain. I tried to ascertain what was wrong with the man lying in the bed, as this gave me a good, public reason to be resting my eyes on him. What illness might he have which would require the performance of an act I had never heard of before then? His sheets had been pulled back. He was positioned on one side, facing the window, his back exposed to the three of us. His pyjamas had been pulled down, his knees hitched up. Mary must have done this too. I noticed how flat and wasted the muscles on his bottom were and, just as Matt began to speak, I observed the suction dressing stuck to a large area of his sacrum.
‘He’s got some neuro condition. Mother tries to look after him at home, but he’s got shocking sores so he’s here for what the tissue viability nurse can do. Then probably on to a care home.’
I wondered about our patient’s level of awareness. As an ignorant junior doctor, I knew it wouldn’t help me to hear the name of the neurological condition this man was suffering from but, with nothing more than eyes in my head, I could see that the man curled up and half naked on the bed in front of us was conscious. I didn’t understand why no one was talking to him, explaining what we were doing, something I’d seen nurses make a point of, even with babies in their care. I couldn’t understand why no one else was concerned about how it might seem to him, to hear a group of nurses and a doctor laughing right outside his cubicle over the sheer comedy of who was going to have the horrible job of looking after his needs.
Matt squirted a transparent worm of KY Jelly on to his gloved hand, found the patient’s anus and inserted two fingers. Seconds later, he dropped a few small, dark pellets into the kidney dish Mary was holding next to our patient’s buttocks on the bed, and she said, ‘Bingo!’
On his second try, Matt came back with nothing. I noticed how close Mary’s face moved to his when he leaned in, because of how she was holding the bowl in place and, on his third attempt, she smiled directly at him and challenged him, ‘Go on, Matt, go a bit deeper.’ I heard the patient groan but this time Matt pulled his hand straight out and, surprising Mary and myself, said to me, ‘Mate, I can’t do this. I just can’t. I swear I’m gonna bloody puke if I carry on.’ And so Mary, miffed that he had chosen me and not her to address in this moment of crisis, took her gloves off and said, ‘You’d better see what you can do then, Nancy.’
Matt stood up next to me in the small cubicle. Because of his height, his hands came nearer my face than I would have liked. ‘I’m really sorry, Nancy. Do you mind?’ he asked. ‘I owe you one.’ I could smell the faeces on his gloves. All I wanted was for him to leave, for I knew Mary would leave then too. By myself, I would be able to try my hardest to rise to the occasion. So, I said, ‘Really, it’s no problem. I’ll bleep you when I’m finished and we’ll go through the other jobs.’
Mary and Matt left and I remained there feeling lily-livered. I stood at the bedside of my patient and didn’t know how to rally. I berated myself for allowing sympathy to obstruct me, for letting emotion get in the way of the job that needed to be done. I resolved that I would not find myself wanting, as Matt had just done.
So, as I squirted jelly on to my own index and middle finger and smoothed it over the rest of my hand, I did not let myself look again at what I could see of my patient’s face, but fixed my eyes on the window in front of me. As I held one buttock out of the way, I noticed that this window gave on to a dark brick wall a few feet beyond the glass. Putting my fingers into the man on the bed, I concentrated on the pattern of these bricks, three laid horizontally next to three laid vertically, next to three laid horizontally. Feeling my hand curl around solid excrement, I actively ignored the sounds I heard from the bed and willed myself not to think about the body beneath me, moving away from my digital search, concluding instead that it must be a grey day outside from the lightless colour of the bricks on the wall.
But, as I brought out a mass of faeces into the bowl, my momentary trance failed me and I retched, tasting stomach acid in my mouth, only just managing not to vomit. And with this, I saw everything as it was. I could see distress in my patient’s profile, could hear that the noises he made were noises of pain and resistance, and I felt that old familiar feeling of shame, the strong emotion that had been my enemy in the general surgery clinic and now threatened to sabotage me again.
I knew my job was far from done, and was galvanising myself to try again, to detach myself, when my eyes happened upon my patient’s bedside table. On it was the hospital phone, the regulation hospital tissues, a maroon flannel in a blue dish. But just behind this I saw something that interested me more. It was an old-fashioned hairbrush, like my granny used to have. Silver-backed and with an ornate silver handle and pale, almost uselessly soft bristles. The ones that usually come in a set with a looking-glass and a comb. And on this hairbrush I could just make out three initials, barely visible in its worn and shiny surface.
Reflexively, because I had been reminded of my dead granny, my eyes cast about for something to confirm this memory, to stop it from fading as quickly as it had arisen before I had caught proper hold of it, and my eyes fell back on my patient. His hands were drawn up to his face. Perhaps, had I not been thinking about my granny, I might not have made the connection that my patient was about the same age as my dad. But I did, and I felt sad to see a man of that age with his hands at his face like a child. And the weight in my mind of the hairbrush and the hands and my
dead granny and dad was such that I rested my left hand on my patient’s back for relief. As I did this, I felt him relax. Then, without making a decision, but just naturally, I went about my work. With five or six passes I managed to clear my patient’s rectum. I felt I was gentle and efficient, and I was glad to do it because I knew my patient wasn’t scared any more and neither was I. And I looked at that damn wonderful hairbrush and thanked it in my head for making me realise something important that had been beyond me until that time. That it would never work for me to disengage from my patients. That I would only be able to do the horrible things my job would require by doing the exact opposite. Standing by that man’s bed, with shit on my hands and a bowl full of shit in front of me, I knew that I would never forget what I had learned. And that no patient of mine would ever again feel they had been treated like meat in my care.
I look up to find Dr Gilchrist sitting in front of me. The angle of the light in the room has changed, altering my interrogator’s appearance. He sits absolutely still, and all the folds and creases and cuffs of his clothes appear as different shades of green and brown and blue. Woodland hues, not grey at all. I wonder how long he’s been there, for how many minutes I’ve been daydreaming right in front of him. There are two glasses of water newly placed on the table in between us and I watch the meniscus on each tremble. When the psychiatrist speaks, his voice is different.
‘I didn’t set out to be a psychiatrist, you know, Nancy. Not at all. I went to medical school with the same grand visions of myself, of what I might amount to in the future, as anyone. But those grand visions didn’t last long in my case. They only got me as far as A & E. I was working in a hospital near Glasgow at the time, still living with my parents. I’d been in the job maybe a day or two, and I was doing just fine. And then a crash-call came in one evening. A knife fight. They were bringing in a whole bunch of lads who’d been at each other, ten or twelve of them. The boss-man said there’d be lots of sewing to do, anyone who could throw a knot should get ready. Just the ticket, I thought.
Dirty Work Page 6