Dirty Work

by Gabriel Weston

  WEEK THREE

  It doesn’t take me long to remember how I know David. I am reading fairy tales to my niece. The children are being led deep into the forest by their father and wicked stepmother, but Hansel is a clever boy and drops white pebbles from his pocket, making a path along which he and his sister can wend their way home again in the moonlight. Lying there on the top bunk, I am put in mind of David’s boots, the crescents of mud they shed. And suddenly I think of his feet on a different floor. He is getting up from a chair in a faraway hospital and walking with purpose into one of the side rooms.

  The woman in that room was a respiratory patient and should have been in a different part of the hospital, but there was no space for her so she’d been placed on our ward. The problem was that she was often forgotten. I was a house officer then, and I passed her many times a day as I went about my work. And as long mornings arrived at their destination of lunchtime, while afternoons dimmed into evening, no relatives came and often no ward rounds. She didn’t forget herself, though. Whenever a shadow passed her threshold, she’d call out, ‘Come in, please’ or say, ‘I’m here. In here.’

  The smell of her also reminded us of her presence. She left lunches uneaten because she probably had no appetite. And the stink of these lunches and her disease filled the corridor of our ward, and her disease filled her small room where the window was never open. It misted and showed strange scuffs from earlier times, when greasy backs may have leaned against it, or brushed against it as nurses or doctors gave care to someone lying in the bed.

  She made me feel terrible, this woman, but what could I do? I was a junior doctor and had my own responsibilities. But this didn’t stop one of the other doctors. It didn’t stand in the way of David. One day, he walked on to the ward when I was sitting at the nurses’ station. He went straight for the notes trolley, pulled out that woman’s file and put it on the counter. He didn’t notice me sitting there. He bit his nails and flipped through the notes and he looked angry, which struck me, as it seemed very daring that a house officer should think it their place to exhibit any personal feelings at all.

  Then he shut the folder, put it back in the trolley and did something even more brazen. He headed directly towards her, that woman who wasn’t even his charge. When he strode straight into her room she looked over from the window to his face and smiled and, for a moment, I wondered if they knew each other. She held out a hand to him and he took it immediately and stood next to her like her best boy. I moved from the nurses’ station to right outside the patient’s door. From my watchpoint, I could see how her eyelashes were separate and fanned out with glee because her eyes had a reason to be wide open for the first time in ages, because someone required her attention.

  ‘What do you need?’ he asked her.

  ‘For someone to tell me when I am going to die.’ She smiled and her voice was strong. She pumped his hand as she said the strong words, encouraging him: do not lose heart, my boy.

  He took her hand in both of his, as I stood outside the door, watching, listening. He spoke slowly, as if by measuring out the medicine of his words in the tiniest doses he might know exactly when to stop, at precisely which point his charge might fail in her courage. I should have remembered his gentle accent from this sentence alone. Oh so slowly the words came out, in syllables.

  ‘Your life is coming to an end.’

  That was all he said. And she exhaled. The more air she let out, the more her smile re-formed. She shut her eyes to allow herself this, then opened them again. Her face was full of gladness. Her voice was steady. She thanked him. It was the fullest thank-you I have ever heard: a blessing.

  Might there be a way, after all, for me to tell my own difficult truth? To say everything that has happened without sinking myself in the process? Does the whole story have to be dark, just because that’s how it ends?

  I take the train back to London. I look through the window for answers. I study the distinct sections of land, the way the fields darken into the distance, mark where deep green meets the vast arc of orange-and-blue sky, note the tiny pylons stretching over the hill, looped together with black threads. Then I change my view and stare down at the blurring of grass right next to me and the bending and weaving of the sidings. I feel the train rock this way and that and, for a few moments, I think I have it. The truth weaves and bends along the tracks, and the colours of this evening are the shades of my American childhood, and all may still be well, because the events of recent times are lining up for me and promising to make sense.

  In a summer full of rain, I summoned the courage to apply for a job as a registrar. My peers laughed at me and told me I was jumping the gun, I didn’t have anything like enough experience, but they were wrong because one day I got the response I’d been dreaming of. I was called to compete for one of the two available training positions in my region. Standing by the window in my flat, I gripped the letter of invitation until my fingers made dents in it, and looked out at the courtyard where the wet weather had brought out the brightness in everything so that the paving stones shone like gunmetal and the bench stood conker-bright and the plants appeared as shiny as new limes.

  What a grand new start. I would leave behind the rest of my underling class, the phalanx of unnoticed junior doctors, the scut-workers. I imagined myself, briefcase in hand, smartly dressed, greeting senior colleagues on the ward round. I envisaged how it would be to do my on call from home, bleep on my bedside table, taking messages over the phone and electing, on occasion, to drive through the brilliant empty night to my hospital where I would sweep sick patients for surgery, ease tricky babies out of their mothers, rescue women from ectopic pregnancies. I thought of the operating theatre, that green heaven in which I would clear and console and sort. Where I would no longer be a bystander, but a person worthy enough to be trained to the point of absolute surgical freedom.

  Determined to land that job, I did everything in my power to prepare. I cocooned myself from the sniping of my colleagues by working even harder than usual. During jobs on the wards, from under the canopy of patients’ legs, I studied the way the registrars behaved as a zoologist might a new species. I took note of the things they checked each time they visited a patient, the charts and drains and wounds. I studied their manners too, their gentle authority with the nurses, their new familiarity with registrars from other specialties, their ever so slightly attenuated deference to the consultants. I looked at what they wore.

  When others went to the canteen for lunch, I headed for the library and surreptitiously ate my sandwiches while reading a big book with a jazzy font called Gems of Clinical Governance from cover to cover. When I needed the loo, I took an extra minute there to study one of the index cards I carried in my pocket at all times, which outlined key steps for handling every emergency of my specialty. On my way home in the evening, I stopped at the municipal pool and mouthed my responses to classic interview questions, my lips billowing oddly against the chlorine, staring goggle-eyed at the steep slant of the pool’s base as if I were facing my interviewers, undeterred by the plasters and occasional panty-liner I saw dotted there. On a rare weekend away from the hospital, I bought a trouser suit.

  The interviews were held at a neighbouring hospital, in a modern glass building with a spacious foyer, unfurnished but for one long bench. As I approached I could see a line of candidates sitting there, the girls dressed hot like secretaries, the guys as tense as traders in their suits. I even recognised one or two. But I knew that if I joined them I would lose some of my nerve so, instead of heading for the bench, I ducked around the corner of the building where I wouldn’t be seen, and stood with my back to the wall to gain what shelter I could from the rain which fell relentlessly.

  It was minutes before I noticed that someone else had had the same idea, before I turned at some small noise to see Jay, another doctor from my own hospital, standing a few metres away, side on to the building, one narrow leg crossed over the other. He came towards me, stepping int
o the rain to pass by and, momentarily, he faced me head-on. Rain fell on him and he smiled.

  ‘You’re a better doctor than all those nitwits in there,’ he said. ‘I’ve seen you.’

  And then he sauntered off. I watched him until he disappeared around the corner, poof, just like that, leaving me with a sense of buoyancy and confidence I had not felt five minutes earlier.

  It’s no wonder, really, that Jay opens this story, the tale of Nancy-the-Brave, as my train chunters through the dusk towards London. No surprise that this young man – a force to be reckoned with, that’s what people are always saying about him – should come to mind as I gaze out at the elements of earth and sky. As my train begins to slow, and other passengers start to gather their coats and close their books and shift themselves, ready to alight, I stay quite still because I don’t want to disrupt memory and what it seems to promise. I want it to unravel itself, optimistically, all the way to its natural end. When we finally come to a halt, I don’t immediately get off the train, but think instead of coming out of that glass building, into whose interview room I had been called back and offered a registrar post. Stepping out into the evening which I had already marked as the first evening of the rest of my life, I saw an elegant man standing there, waiting patiently for me, as if the two jobs had been ours all along.

  Those first few months were as exciting as they were scary. My time was split more or less evenly between the two subspecialties, gynaecology and obstetrics, with on calls bridging the two. On an average day, I would turn up extra early to do a quick check of the really sick patients before my juniors arrived for the ward round. After ensuring they each had a list of things that needed to be done before the end of play, I would head off to clinic or theatre.

  Before my promotion, I had always scorned obstetrics as the lesser of the two disciplines. ‘Babies can get born by themselves,’ I would say. Or I would blithely join in with the institutional mockery of the ‘madwives’, that population of nurses we accused of taking pleasure in providing any obstruction they could to a woman getting proper pain relief in labour, who certainly had nothing to teach us. How I regretted my ignorance now. I soon saw that pregnancies could become disastrous at absolutely any stage. There were eclampsia and gestational diabetes and sickle-cell disease to look out for. Women contracted catastrophic infections and single-organ malfunctions and there was an entire compendium of complications associated with carrying twins. Then there were the really scary problems, placenta praevia, placental abruption, uterine rupture – bloody events that could result in the death of mother as well as child. And all this before a woman even went into labour.

  Realising how much I had to learn, I abandoned pride. I didn’t think twice about phoning the duty-consultant in the middle of the night if I was unsure what to do when I was on call, often summoning them to the hospital when distant advice didn’t seem enough and disregarding their impatient looks as they arrived in theatre dressed incongruously in civvies.

  I also started to make good the cavernous gaps in my knowledge. In the evenings, I read about every obstetric problem known to man, starting with the most worrying and working my way down the list. On days off, I went to the antenatal clinic and cast myself on the mercy of the midwives there who, over a period of months, supervised me while I honed skills I ought already to have been slick at. How to use a Pinard stethoscope, the best way to measure symphysial-fundal height, assessing foetal lie. In short, what a normal pregnancy looked like and how to monitor its development.

  Gynaecology came more easily to me and I was as happy sitting in clinic, taking histories from the women there as I had been anywhere in my life. It reminded me of when, as a child, I had been taught in music lessons how to separate strands of sound one from another, how to listen to a piece of piano-playing and be able to sing back to the teacher either line from the combined score, the treble or bass. In this altogether different setting I began to see that the words a patient uttered were not always what counted most; that there might be a more important meaning beyond what was being said, a contrary melody, if only I could train my ear to hear it.

  As for my surgical training, I was assigned for my first six months to a general gynaecologist called Mr Kapoor. During two lists a week, he started to teach me the bread-and-butter techniques of my field. I was grateful to have been placed with this consultant. He was a quiet, unassuming figure, the least macho man I’d ever met in a pair of scrubs. And, best of all, he was happy for me to get involved, evacuating vulval haematomas, cauterising cervical erosion, examining uteruses under anaesthetic, and plenty more besides. Cack-handed though I was at the outset, I sensed my boss was happy with me. I was punctual, hard-working and didn’t have a squeamish bone in my body.

  Jay, on the other hand, was already making a name for himself. All over the hospital, people were talking. The best pair of hands in a generation. A surgical prodigy. He had been seconded to a job where his time was split between the guy who did most of the department’s cancer work and the Assisted Conception Unit, an elegant glass building financed by donations from a millionaire and renowned for keeping the rest of the hospital financially afloat. On a ward round one morning, I overheard a junior saying Jay had been allowed to choose embryos for transfer the previous day, a task usually performed only by the consultant. I was eager to ask him all about it myself, though the truth was that we were both so busy now we didn’t see so much of each other.

  As it happened, I did bump into Jay that week. Early for my list one morning, I stopped by the surgical coffee room for a drink and found him sitting there. The only other person in the room was one of the orthopaedic surgeons, reading a magazine: legs splayed, dark scrubs tucked into white, calf-high boots adorned with the intricate tracery of blood-work.

  I took a cup from the cupboard and raised it to Jay in an offer of tea, which he declined. He put the journal he had been reading into his briefcase as I sat down opposite him.

  ‘So, what’s on?’ I asked.

  ‘Ovarian tumour. Big one,’ he said. ‘Hoping to get my hands dirty.’

  ‘Great.’ I picked up my mug of tea, which was still too hot even to sip. Steam collected in the hairs of my upper lip as I held it to my mouth. I waited for Jay to ask what my morning had in store. Across the room, the orthopod shook the magazine he was holding in one hand to make its pages stand to attention. I blew an eddy of steam across my cup. Eventually, I spoke again.

  ‘And the ACU. How’s that going? Are you magicking babies from thin air yet?’

  Jay frowned. But then he sat forward, and rested his forearms on his knees, his face keen again and as open as a little boy’s. His eyes shone, dark all over and glossy like nuts.

  ‘It’s incredible, Nancy. Really. You wouldn’t believe the things we’re doing up there. Truly ground-breaking things. It’s not just helping women with their fertility, you know. It’s like we’re giving them their freedom!’

  Of course I had learned something of this too, from my own side of the fence, this business of granting women control over their own bodies. But, after waiting a few moments, I realised Jay wasn’t going to ask me about my work. So I said, ‘I’d better get going’, rose and emptied my tea in the sink, untouched. As the door that I had pulled open began to swing back I thought suddenly that I had been harsh on my friend and turned round to say goodbye. But what I saw through the narrowing space left by the closing door made me change my mind. Jay’s back was to me now and the orthopod wasn’t reading his magazine. He had looked up and was facing Jay. And I could see clearly that a joke was already breaking between them.

  But this was an isolated incident. Mainly, we carried on as before, often sharing the on-call bleep, not because we couldn’t handle a whole night of work ourselves but because neither of us wanted to miss out on any of the action. They were happy days, whichever way I choose to cut it. After those on calls, we’d gather in the doctors’ mess, registrars from every hospital specialty. Sitting on the sofas with tea an
d toast, Jay still somehow managing to look as fresh as a daisy, everyone would tell stories about what they’d seen and done during the course of the night. As my companions talked, I would look out of the window beyond their heads and study the colours of dawn forming in the sky and the crenellation of buildings below, in the darkness. And I would feel complete, my appetite for conversation already sated by the events of the night. I concluded that if my life didn’t change one iota, it would be a happy one.

  At times, I can’t help thinking about how things would have panned out if Jay and I had started off in each other’s jobs. Whether our respective fates, my failure and his success, were sealed by a simple roll of the secretarial dice. But mostly I just wonder where he is now, my stellar friend. How much progress he has made in these past few weeks, while I have stood stock-still.

  Julia’s fond of saying I did my first abortion with my eyes half shut. That I never signed up for the events that dominate my life now. It makes her angry that no one ever sat me down and asked explicitly whether I wanted to learn how to perform a termination. And of course, I see her point. It is surprising, with all the namby-pamby talk in the medical world these days, the communication skills this, and cultural diversity that, that no such discussion ever took place.