by Mairi Chong
Fraser wished that the man would disappear. If only he would return to wherever he had come from. He imagined Jackson having a car accident and needing to go back home to recuperate. And then, despite his better nature, he imagined Jackson dying in the accident. Fraser wasn’t a bad person but with so much to lose, it might clear many of his worries. If Jackson survived an accident, he might return to Glainkirk and take up again where he left off, but death would free Fraser from this torment forever.
Horrified by this idea, Fraser fleetingly thought that perhaps the only answer was his own death. If only he had the courage to commit suicide. As he considered the possible methods, Fraser doubted that he had it in him.
No, suicide wasn’t the answer, but whichever way he turned, Fraser saw that Jackson’s existence would only lead to his own ruin. When he realised what he was really contemplating, Fraser felt physically sick. He, Fraser Edwards, a murderer? But no, it was a shocking and horrifying thought. He must banish it from his mind immediately.
But for the remainder of the evening, as Fraser sat alone in his front room brooding, the idea would not leave him. The shadows around him grew gradually longer until the place was quite dark.
14
Dr Suzalinna Bhat cursed under her breath. Turning to the rest of her team, she smiled sadly. Their faces were expectant. Presumably hoping for some guidance on how best to proceed. But she had no more answers to give them. It was over.
‘Well done everyone,’ she said. ‘I think we’ll call it there. Time of death: 13.45.’
The anaesthetist next to her snapped off his gloves before the others. He’d seen it all before but it didn’t make it any more palatable. The monitor above them continued to wail plaintively. Dr Bhat reached up and flicked the switch.
‘Thanks, folks. We’ll talk later.’
It had been going like a bloody circus all morning in A&E. Resus hadn’t stopped. Suzalinna, the consultant in charge of the department that day, tried, as all the experienced doctors did, to shield her juniors from the more traumatic cases. This time, however, she had not managed. They had even had three of the anaesthetists down. This was far from routine, but when the crew bringing him in had radioed ahead, she had called the crash team immediately. They pulled out all the stops that day, knowing that he was one of their own. But it had all been in vain. Losing a doctor was about as bad as it got, Suzalinna thought.
Slowly, she walked to the wash-hand basin and peeling off her own gloves, tossed them into the bin. Suzalinna turned the tap and welcomed the icy shock of cold water on her fingers. Pumping the hand-sanitiser three times, she scrubbed. She inhaled the sharp scent of antiseptic and it caught at the back of her throat. Here she stood for a full minute, working the lather between her fingers and watching the pink foam circle at the plug and then disappear. It was as if by washing her hands, she might also wash away the failure she felt.
It was a side to the job she hated. She had, of course, seen countless traumatic cases. At the start of her career, she had been thrilled by the excitement of an arrest or trauma. These days, however, having seen so many families wrecked, and having had to break the news to them that their husband, father, sister, or worse still, child, hadn’t made it, her enthusiasm had ebbed. And of course, when it was one of your own, another doctor, well, that only amplified the feeling of defeat.
Suzalinna hadn’t failed to notice the effect the death had had on the rest of the team. That too was now part of her job; to ensure the safety and wellbeing of her staff. Two of her juniors had left the resuscitation room in tears that afternoon. She would have to speak with them and de-brief when she had sorted out the paperwork and tied up all of the loose ends. Anne, a staff-nurse she favoured above all others for her straight-talking, no-nonsense approach, was fortunately on that day. Suzalinna knew that she would steer the team back on track admirably, until she was able to go through and take charge. And anyway, she had seen that the waiting room was full when she passed earlier. Her junior staff would have no choice but to get on with the job, and perhaps that wasn’t such a bad thing.
The telephone on the wall sounded, interrupting her thoughts. Reaching up to the receiver without raising her eyes from the notes she was recording, she waited for the voice. ‘Doctor Bhat? I have a GP on the line, can you take the call?’
‘Sure,’ Suzalinna said and waited for the telephone to splinter and crack as it always did when they connected an outside line. Within moments she heard a voice she knew only too well.
‘Suz? Is that you? Have you any news? They brought him into you. Did you deal with it? We’ve all been waiting to hear.’
‘Hang on, hang on. Cath, is that you?’
Suzalinna and Cathy Moreland had attended medical-school together and had formed a firm friendship since their first day of meeting, too many years ago to recall. They had been together on several placements as undergraduates and Cathy had looked up to her highly intelligent, if not mildly-arrogant comrade, whilst Suzalinna envied Cathy’s patience and gentle bedside manner. Somehow, they had negotiated the rigours of medical-school side-by-side, despite their differing personalities. Suzalinna had always been destined for A&E and Cathy was best suited to general practice. One particular attachment saw them travel together the four hours to a small district general hospital just north of Aberdeen. It had been a happy time and following the recent nervous breakdown of her friend, Suzalinna had urged Cathy to return for a holiday, promising to join her. Cathy had returned invigorated and ready to face her life once more with Suzalinna’s support and backing. Suzalinna was married, but poor brow-beaten Saj rarely got a look in when the two medics got together for an evening of drinks and conversation. It had been a number of weeks since they had last spoken and Suzalinna felt a pang of guilt at having forgotten to wish her friend well on returning to work. But Cathy was talking again.
Suzalinna moved the phone to her other ear. ‘What’s that you’re saying, Cath? Was a patient of yours sent into us?’
Suzalinna turned to look at the prostrate figure lying on bed three of Resus, now with a hospital sheet over his face. One of the nurses was still clearing the floor of debris; packets from needles and other medical paraphernalia that had been hurriedly discarded in the team’s urgent attempts to save the man’s life.
The nurse, feeling the consultant’s gaze upon her, turned and grimaced. Suzalinna smiled and nodded an understanding. The resuscitation was one thing, but it was the aftermath that was usually trickier.
‘He was brought in to you,’ Cathy said, her voice now becoming higher with impatience. ‘Didn’t the paramedics say? He was one of us.’
Only then realising, Suzalinna spoke. ‘Bloody hell, no. Oh God, Cathy, I really had no idea. They said he was a medic but it didn’t click. Was he from your practice then? I’m sorry, darling. I’m so sorry. We just called it five minutes ago. We were going to try pacing him, but it was hopeless.’
The phone was silent for a moment, and when Cathy spoke, her voice sounded distant. ‘I tried to intubate at the practice but I couldn’t see a thing and it's been years since I had to do one ...’
Suzalinna laughed grimly.
‘Cathy, don’t beat yourself up. Even I couldn't tube him and I do them every other week.’ Suzalinna turned again and looked across at the covered figure. ‘Darling, his mouth and larynx were a bloody mess. We did a trachy but we couldn't get cardiac output. We had Anaesthetics and ENT down but he was gubbed, Cathy.’ Suzalinna paused but her friend didn’t speak. ‘What happened anyway? Did he take something deliberately or was it accidental? I'm just writing up and then I’m about to phone the police.’
‘I don't know,’ Cathy answered. ‘We found him in the consulting room like that. I don't know what he took. I don't know what happened. It was in the middle of our morning surgeries with patients waiting. Listen, I'd better go and sort things out here and tell the rest of the practice. They’re all waiting to hear.’
‘Cathy? Give me a call at home later and
we’ll talk, OK?’ Suzalinna said.
As she replaced the receiver, she swore under her breath. She saw suicide attempts regularly. Joe Public weren't particularly imaginative in the ways they tried to kill themselves. Paracetamol or antidepressant overdoses were common and usually an ineffective cry-for-help. Then there were the attempted hangings. These were occasional and more common in middle-aged men. Sometimes to add variety, they had an attempted bridge-jumper, or in the farming community, a botched shooting. But medical colleagues were seen far less often. Suzalinna presumed that this was because they were usually more successful at killing themselves discreetly and without mistake. They never made it as far as A&E but headed straight to Police Surgeons for postmortem.
Suzalinna wondered what the man had taken. If a doctor wanted to kill themselves there were far better ways of doing it than the method this GP had chosen. Insulin overdose, diamorphine and diazepam were all reasonably easy to get hold of in general practice. But whatever this man had taken had been seriously caustic, blistering his mouth, and causing his larynx to become so oedematous, that his airway was almost completely occluded. Rather than it being a fast, efficient death, he must have suffered very much indeed.
Picking up the phone again she made the call through to the police station. The hospital, of course, did their own postmortems, but if there were any suspicious circumstances, as in this case, the body would have to go to the police mortuary for them to conduct their own.
‘Hi, can you put me through to the appropriate department? It's Dr Bhat, A&E. I need to report a suspicious death.’
15
Cathy replaced the receiver and getting up from her desk, she walked quickly to the sink in the corner of her consulting room and vomited. She then perched on the edge of her desk for a minute, staring blankly out of her window. A group of school children passed by, cutting across the playing fields that backed onto their staff carpark, crossing to the shops further down the road. Usually, she would have scoffed at their short skirts and laddish behaviour but today Cathy neither heard nor saw them. She wiped her hands on her trousers, back and forth, trying to compose herself. Instead, she found herself replaying the morning’s events. Over and over again she saw his gaping mouth, his oily complexion. She shut her eyes but it was still there.
It had been a normal morning up until then. She had been waiting for her next patient to arrive and had been so up to date, that she had managed to go through all her laboratory results.
After a quick coffee, she had returned to her room and was flicking through the next patient’s notes. It was a man she had seen many months before and it looked like he had been in regularly to see the other doctors since. All minor ailments. She had wondered if there was something more underlying his visits. As she scanned through the notes, she had become aware of a commotion outside her door, and then a woman had screamed. Cathy had jumped and slapped the surface of the table accidentally and banged her knee on the corner of it. She had opened her door to see Bert hurtling down the corridor at surprising speed for a man of his age.
Only when the old handyman, shuffled to the side did Cathy see the nurse. Tracy was standing holding onto the door-frame swaying, her beautifully made-up face, a grimace of horror. Bert was just in time to grab Tracy, easing her descent, as she crumpled onto the floor just outside Mark’s room.
Cathy had been glad of her training in accident and emergency that awful morning. As a junior doctor, her consultant trainer had allowed her to lead the arrests towards the end of her time there and although it was years ago, she felt the familiar adrenaline kick-in. She found herself thinking of her friend Suzalinna and imagining that this must be her life every day.
Doctors are often said to have a dark sense of humour and Cathy was no different. Back in her old A&E days, she and her colleagues made jokes that would have disgusted non-medics. Sometimes they’d laugh during a really messy resuscitation. But Cathy did not laugh today.
Marching down the corridor, she bypassed Bert and stepped over Tracy to find her practice partner Dr Mark Hope, lying sprawled on the floor, half under his table. From the doorway, she noted the staring eyes and mouth gaping wide. She saw hair plastered damp against his almost yellow face and the froth of pink foam which ran from his mouth ending in a congealed pool that seeped into the carpeted floor. She turned to James who now also stood in the corridor but was unable to see past Tracy and Bert.
‘James, get the girls to call nine nine nine, tell them it’s an adult male, cardiac arrest. Is Irene back from that meeting?’
Brenda, who had also arrived, clutching a ring-binder to her chest, had come to see what the problem was. She answered for him and said that yes, she was.
‘I need Irene in here.’ Cathy said. ‘Get her to bring the arrest trolley.’ Cathy had then turned to her senior partner. ‘James, get in here with me and someone move that stupid, bloody girl out of the way.’
Brenda and Bert half-carried, half-walked Tracy back to her own room.
‘Brenda?’ Cathy called after her. ‘Sort out the patients in the waiting room. James and I were consulting still. Get everyone who doesn’t need to be in the building, out now.’
In the distance, Cathy could hear Brenda addressing the patients still sitting waiting to be seen. Despite the grave situation, she was surprised and impressed by the woman’s presence of mind and resilience.
‘Oh, dear God. What’s happened?’ asked James, then coming into the room.
Not bothering to answer, Cathy had made a quick appraisal of the situation. The area was safe for both of them to approach. Inwardly she recited her A, B, C. Airway, breathing, circulation. Well, if she started with his airway, it was a bloody mess. Cathy grabbed a pair of gloves and snapped them on, and then threw the box to James so he could do the same. She turned Mark over and with James’s help, pulled the figure clear of the table. He was heavy, like a dead weight, and as they manoeuvred him, his hair flopped out behind giving him a grotesque, casual look. His face was almost like wax, oily and cold to touch. She knelt by his head and tilted it back, lifted his jaw forward. She felt and listened for any signs of life. None. Scooping her first and middle fingers into his mouth she moved his flaccid tongue and produced a handful of bloodied foam.
‘What the hell’s happened to his mouth?’ James had asked in disbelief.
‘Not sure. James do you want to start doing chest compressions? He’s not breathing and he has no pulse.’
And then Irene was there to join them, looking shocked, but composed.
‘Irene, there you are,’ Cathy said. ‘’Don’t freak out, for God sake. Bring the Resus trolley right in here and give us a hand.’
Irene did exactly that.
‘Throw me a bag and mask and an oropharyngeal airway. I’ll deal with this end,’ Cathy said breathlessly.
Without needing to be told, Irene cut through her employer’s waistcoat and what remained of his shirt, which had been torn already, and steadily stuck on the chest leads to assess his cardiac rhythm. Cathy looked at the monitor.
‘He’s in asystole. Shit. Listen James, let Irene take over chest compressions. You need to get a venflon in so we have access. OK with that Irene?’
Irene had been fine with that, James perhaps less so. It was probably years since he had last put in a cannula and his hands wouldn’t stop shaking.
‘James, breathe. OK?’ Cathy said. ‘You’re no use like that.’
Cathy reached over James and pulled the airway kit from the trolley. God, how long was it since she had to do this? She remembered checking the trolley with the nurses and was glad to know where everything was. She removed the bag, mask and airway that she had been using intermittently to give breaths with, and inserted a laryngoscope, squinting to see if she could manage to intubate. Irene continued to compress his chest rhythmically, puffing a little with the exertion. James was still struggling to get venous access.
Fearing she was leaving him without oxygen for too long, Cathy replaced the
airway and mask and gave the bag two more squeezes. Then, she continued to try with the intubation.
‘I can’t quite see. Too much blood. There are blisters everywhere,’ she said, talking to herself.
‘Try a laryngeal mask,’ puffed Irene.
‘Yeah, I’ll have to,’ said Cathy, abandoning the tracheal tube.
The laryngeal mask slotted in easily just as the paramedics walked in the door. Irene and James looked up relieved that help had arrived and stepped back, allowing the experts to take over. Cathy continued to manage the resuscitation and gave the paramedics a verbal history of how they had found him and what they had done to try and help.
As the ambulance left the practice carpark, its lights flashing and siren starting up, Cathy had stood in her consultation room alone. Please God, let it be her friend Suzalinna meeting them at the other end. But in her heart, Cathy knew it was desperate.
Now, rousing herself from her thoughts, Cathy went to the door, knowing that she must break it to the rest of the team that they had lost their colleague. How would the practice go on?
16
Cathy finally got home at seven. It had been a long day. She kicked off her shoes as she entered the house, allowing them to lie haphazardly on the hallway carpet. She lived alone now so what did it matter? Walking through, she flicked the switch on the table lamp in the hall, which spread warmth up the walls and threw elongated shadows from the stair bannisters. She dropped her car keys on the kitchen unit with a clatter and went straight to the fridge and found the unopened bottle of white wine. She really must eat, but the alcohol had to come first. Oh God, what a day. She wanted to cry but felt too tired to do even that. Wine would help. It always did. She watched the yellow liquid slap the side of the glass, rearing like a wave, and settling at the bottom. The bottle glugged, the air taking up the space where alcohol had been. Cathy took a deep breath and leaning over the counter, sipped the top of the glass awkwardly, she had filled it so high that some splashed on the worktop. Her hand shook. She drank thirstily, without noticing the taste.