‘I’m on a split shift today, but I don’t mind not going back to Lovely Lane for my split, and I will come in on my day off, to help with the decorations. I know Sister Haycock is keen too – she loves children’s – and she and Biddy will be over in a flash. And my mam could come up from the WVS.’
Matron smiled. ‘Well, that seems like a jolly good idea. Nurse Tanner, the decorations have just become your sole responsibility. You can inform Sister Haycock. I do love a good competition, so make sure we win, won’t you.’
*
As the nurses bustled out on to the ward, with the staff nurse and a year-three student as their guides and mentors, Sister Paige said goodbye to Matron and then stood in the doorway to the office with a pale and tired-looking Night Sister, who had remained in the cubicle of baby Louis for report, at her side.
‘Matron’s been here all night, you know,’ said Night Sister, who Aileen noted now spoke to her as though she were her equal, following her promotion. ‘She came down from her flat to do the ten o’clock medicine round with me. We were just passing through casualty as the call came through that the baby was on his way.’
‘I bet she’ll just carry on all day too,’ said Aileen. ‘She’s too old to be going without her sleep. She will make herself ill.’
‘Ah, well, you know Matron. She would say that of others, but as far as she’s concerned, she’s invincible. Listen, about Louis – we’ve done what we could. I washed him as best as I could manage, but to be honest, his dehydration was the main concern. I can’t see him still being here tonight when I come back on duty. I’ve never seen a baby so neglected. He’s a desperate sight. Can’t think I will sleep much today for worrying about him.’
‘You must sleep,’ said Aileen. ‘We are looking after him now, just remember that, and I promise you, he will still be here tonight. You go and have a good sleep.’ She sounded more confident than she felt as she turned on her heel into the clean utility room.
*
Pammy and Beth were sent together to collect the clean linen basket from the linen room at the end of the ward.
‘I can’t believe my luck,’ said Beth. ‘I thought I’d be spending Christmas with Sister Tappsy on ward four.’
Pammy grabbed the trolley standing outside the linen room and pulled it inside behind them ready to receive the clean sheets and pillow cases. ‘My mam loves Tappsy,’ she said. ‘She says she’s the best ward sister in the hospital by a mile.’ She climbed the step resting her feet on the bottom shelf of the cupboard, holding on to a slat on the middle shelf with one hand for balance and began to lift down sheets to Beth, who placed them in the trolley.
‘Really, does she?’ Beth had a lot of time for Maisie Tanner and trusted her opinion. ‘Why?’
‘Can you see the pillow cases?’ asked Pammy as she looked around the shelves. ‘Every ward sister has a different way of laying out their linen room. Why can’t they just all be the same?’ Spotting the pillow cases, she began to shuffle along her perch towards the shorter shelves at the end. ‘Mam says that she doesn’t just nurse her patients’ sickness, she looks after their hearts too. You know what my mam’s like, Beth. She’s just a big softie.’
Beth took the pile of pillow cases from Pammy. ‘She’s such a stickler though, you know. They say she even forgets to send the nurses for breaks. I’m the last person to object to hard work, and I am a stickler too—’
‘Don’t we all know it,’ said Pammy, laughing.
‘It’s just that it is Christmas and, besides, I wanted to be with you.’
‘And now you are!’ said Pammy as she climbed back down off the step. She turned to Beth. ‘All I would say though is this – and I only know this because I’m from around here and grew up on these streets – everyone loves Tappsy. She has a reputation to equal that of a saint. The one question I am asked more than any other by me mam’s mates and our neighbours is, “Have you worked with Sister Tapps yet?” I swear to God, she will be canonized one day. Right, just the cot draw sheets to go and we can get this trolley back down the ward.’
*
Aileen laid up her trolley in the clean utility room and mentally ticked off the items as she went. She had prepared so many nasogastric trolleys, she no longer had need of a piece of paper in her top pocket listing her requirements. She filled and switched on the Little Sister sterilization steamer and then one by one took down what she needed from the scrubbed wooden shelves. Orange rubber nasogastric tubing, neo-natal gauge. Syringe, litmus paper, kidney dishes, Vaseline, aspiration sample pot. She lifted the lid of the Little Sister and popped in the glass syringe.
Once it was at boiling point, she stood and waited for the large black dial on the front to tick away. As she did so, her thoughts wandered unbidden to Freddie: to the concerned and tender smile he had given her when Matron had taken her into Louis’s cubicle; to his paternal protectiveness towards Louis and his tenderness as he had helped her lift the tiny boy into a slightly raised position in order to encourage his left lung to drain. And then her thoughts wandered to Freddie’s dark brown eyelashes and the way they curled upwards almost to his eyebrows, framing his unusual blue and brown eyes and giving him a startled, wide-eyed expression. Without her even being aware it was happening, a smile hovered on her lips, her face softened and a warm glow spread through her. He was nice, she thought. There was something about the way he had looked at both Louis and herself. His unashamed and obvious attachment to the little boy he had rescued from near death, the way his smile had made her heart somersault. Her smile broke through and it felt so good to have something of her own, something deeply personal that no one else, least of all her mother, could possibly guess.
The black dial buzzed as it hit zero and Aileen was so lost in her thoughts, she almost jumped. She quickly picked up the forceps that were sticking out from under the lid, the end still in the boiling water, being sterilized along with the tubing and the glass syringe. Passing a nasogastric tube was not a sterile procedure, but Aileen still liked to take every precaution.
As she began to lay her trolley, all thoughts of Freddie vanished and the smile slipped from her face. She was Sister Aileen Paige and her only focus was on baby Louis and the task ahead. Despite this, she felt lighter and hopeful. She would keep the memory of Freddie’s smile locked away in her heart. There was nothing she could do about it. Her mother had to be her priority. But it was a gift Freddie had left her and when she was next alone with her thoughts, she would bring it back out and remember the way he had looked and made her feel.
*
Back in his lodgings, Freddie pulled across the blackout curtains, which had remained in place since the end of the war. ‘They come in handy for night workers,’ his landlady had said. Freddie had to admit she was right. When they were closed it was as if it was night in the room and he could sleep soundly, though he couldn’t imagine that there was a single lodging in all of Liverpool as depressing as his own. He slipped between the sheets and pulled the eiderdown over his shoulders, and as the exhaustion he had fought off began to wash over him, he fell through the folds of his own consciousness into a deep sleep. His last waking thoughts were of Aileen Paige and the tears that had rushed into her eyes as she looked down into the cot and saw baby Louis. He’d been so relieved, instinctively knowing that he had no need to worry about feeling ashamed, she would understand the tears that were filling his own eyes too.
*
Sister Paige wheeled the trolley into the cubicle and the first nurse she saw was Pammy Tanner, walking down from the bay with a trolley full of half-sized china bedpans. The ward’s tiled walls had murals painted on to them depicting well-known nursery rhymes and Pammy was standing directly beneath Humpty Dumpty. Aileen had always thought it sad that the nursery rhymes were painted in dark greens, mustards and murky browns rather than the bright colours the children seemed to prefer.
‘Can you see what the others are doing,’ she said to Pammy, ‘and whether anyone wants to watch or assist
? I’m about to pass the nasogastric tube on little Louis.’
Minutes later, Beth and Pammy crowded into the cubicle and stood around the empty cot. There was a hint of tension as they looked towards the staff nurse who was specialling Louis and was sitting on a chair holding him in her arms. Pammy gasped and clamped her hand over her mouth in horror, which prompted a look of disapproval from the staff nurse. Beth held her breath, determined to maintain an inscrutable and professional expression. There would be no dramatic reaction from her.
Sister Paige was more sympathetic towards Pammy than the staff nurse had been. She placed her hand lightly on Pammy’s arm. ‘I know it will take you a moment to adjust,’ she said softly. ‘I felt the same myself when I first saw him.’
Beth now gave Sister Paige a sharp look, annoyed that her efforts to remain absolutely professional had gone unnoticed.
The nurses did not – could not – speak. Before them, on the staff nurse’s knee, lay a scrap of life with a head that looked abnormally large for his body. His eyes were open but unseeing, the eyeballs rolled back and looking like huge white saucers sunk into his face. His skin was so dry and flaky, it resembled elephant hide. He had no hair on the back or one side of his head and only tufts around the other side and at the front. A wooden splint, twice the size of his arm but still the smallest in the hospital, was bandaged to him and the rubber tube of a now collapsed drip disappeared within. Baby Louis was unconscious.
‘The drip has tissued again,’ said the staff nurse, looking up towards Aileen. ‘His veins kept collapsing on the night staff – it’s desperate. If only he could have a cut-down and a leg splint.’
Sister Paige acknowledged this with a grimace. She retrieved Louis’s notes from the bottom of the trolley and handed them to the staff nurse. ‘You should all know what is going on here. You may want to pass those notes around to the others,’ she said, ‘so that you fully understand what we’re doing and what’s at stake. There is a reason there’s been no cut-down and that we have been desperately trying to manage with the drip in his arm…’ She looked over at Pammy and Beth. ‘I expect you’re familiar with the venous cut-down procedure? When the cannula is inserted directly into a larger and much deeper vein, sometimes under surgery?’
Beth and Pammy both nodded but didn’t say a word. Staff Nurse also made no comment as she read the front page of the notes, but as soon as she handed them to Pammy, she bent her neck and kissed the top of Louis’s head. ‘Bless him,’ she whispered. ‘The poor thing.’
Pammy picked up the notes and gasped at the letters scrawled across the front. ‘Who wrote that?’ she asked.
‘The consultant. Dr Walker,’ said Aileen. ‘Because the police were involved, Dr Mackintosh called him in from home. Dr Walker is away on a course in Manchester this week, so, as you can see, every little thing we’re doing to help Louis is being done against his explicit orders and in secret. Matron has really stuck her neck out here. This is his ward. He is responsible for clinical decisions and we work to his orders. Liverpool children’s services run this ward, albeit in Matron’s hospital. You are all familiar with the Florence Nightingale code. Our duty is to serve the physician and not to question his instructions or challenge him. That was one of the reasons why Matron swore you to absolute confidentiality. To be fair, it was the main reason. It isn’t just because of the police and the newspapers, it is because for the first time in her entire career, Matron has lost a battle with a consultant and is expressly defying his orders.’
Pammy handed the notes to Beth. The blood drained from Beth’s face and her eyes opened wide. Across the top in a bold hand with a black pen was scrawled three words: No further treatment.
‘Does that mean…?’ Beth’s voice trailed off.
Sister Paige finished her sentence for her. ‘It means “leave to die”. We sometimes receive babies up here who have been delivered downstairs and have serious disabilities, heart or lung problems, or maybe they were delivered too early and the doctors are worried there may be brain damage as a result. You might see that written on notes during your time here, when a cot is wheeled up from maternity. You will only see it on paediatrics, never on an adult ward and always only on the notes of a newborn, always a newborn. However, Louis is not a newborn. I am with Matron on this one: I think Louis has a fighting chance. He is about six months old. That was why Matron was so cross. But we have less than a week to turn him around and save his life – otherwise there could be the most almighty row. Dr Gaskell would be involved and if Dr Walker was being bloody minded, now that we are part of the NHS and under the auspices of children’s services, it could go further. In short, Matron is taking a very big risk.’
Pammy, forever outspoken, said exactly what she was thinking. ‘I don’t get it. The poor child’s parents abandon him to the elements, for goodness knows how long, and Freddie brings him in here, all for Dr Walker to just give up on him? Why? It doesn’t make sense. Is that why the CID are here?’
Sister Paige looked out through the cubicle window at the plainclothes officers arriving through the ward doors and then down at Louis. ‘Yes. Dr Walker assured them last night that this would be a murder case within forty-eight hours. He said that baby Louis couldn’t possible survive. Matron begs to differ. Dr Mackintosh, of his own accord and without Matron’s intervention, appears to agree with us. He is also defying orders and has prescribed Louis antibiotics – streptomycin. But, despite Dr Mackintosh’s best efforts, we are struggling to get it into Louis. The drip keeps letting us down because his veins are collapsing. Hence our own nursing intervention and the nasogastric tube.’
They all turned to look at baby Louis, lying flat in Staff Nurse’s arms. A cotton cover adorned with a print of Peter Rabbit was draped across his lower limbs. His breathing was shallow and in the silence that had descended on the cubicle sounded rasping and laboured. His belly was distended, his skin was raw and chafed and still ingrained with dirt, and his eyes, although not showing any signs of awareness of his surroundings, were now half open. Every nurse in the room, even Sister Paige, had tears in their eyes and one thought in their minds: the consultant might well have been right. None of them could imagine how such a poorly baby boy could ever regain full health.
Aileen took a deep breath. ‘The night sister specialling him said that he woke for a little while this morning, and he was semi-conscious on arrival, but he appears to have passed out again. He drifts in and out. So, let’s get this done, shall we? The registrar from children’s services is on his way, he is covering for Dr Walker and I want to get the tube in before he arrives and stops us. It’s the only chance we have. Matron said we have to replace the front cover of the notes before the registrar arrives and put this one in the desk drawer for a week – that is if we have a week.’ She handed the notes to Beth.
Staff Nurse stood up from the chair with Louis in her arms. ‘Would you like to hold him, Nurse Tanner, whilst I assist Sister?’
Beth was miffed that Pammy had been chosen and not her. Pammy, on the other hand, was terrified at the prospect.
The tension in the cubicle was now palpable. They were defying the explicit instructions of the consultant. Even if it was on Matron’s orders, to Pammy that still didn’t feel right. But the sight of the pathetic child in Staff Nurse’s arms made her heart tighten with pity. Her emotions were running wild and she didn’t trust herself to speak – which was highly unusual as she had something to say about almost everything. She sat on the chair Staff Nurse had vacated and Staff Nurse placed Louis on her lap, along the top of her thighs. She cupped his body in her hands.
‘Could you come and kneel down here, please, Nurse Harper, and place your hands very gently on each side of his head. Nurse Tanner, just in case, could you hold on to his hands. And don’t move, either of you. It is important there are no sudden movements from Louis – he may come to and try to push my hand away. If you could hold his palms on top of his legs, Nurse Tanner, while Nurse Harper keeps his head still.’
>
Pammy flinched as she placed her hands over Louis’s knees. They felt like fragile twigs beneath her fingers and she was afraid that if she applied any pressure, they would snap.
‘Right, here goes.’ Aileen smeared the end of the rubber tube with Vaseline. ‘I doubt he has the ability to absorb anything other than watered-down milk, but it will be something, for now.’
Pammy increased the pressure on her hands imperceptibly as her palms were now hot and perspiring. Her eyes locked on to Beth’s. Their heads were close together, Beth kneeling at Pammy’s side. They were both aware that Louis was on the edge. It felt as though the air had left the room as Sister Paige nudged the trolley closer to them with her foot.
‘Please stay asleep, little one, until this is over,’ she said as she reached over towards him. From one raised hand snaked the orange rubber tube, their one hope at keeping death away from the cubicle door, and as she bent, a shadow loomed over them all.
9
Aileen’s sister, Josie, ran up the steps to her mother’s house and rang the bell impatiently. ‘You took your time,’ she said as Gina flung the door back with one hand, holding a tea towel with the other.
‘Sorry,’ Gina replied. ‘I was washing up in the downstairs back kitchen. It’s hard to hear the bell from down there.’
Josie removed her gloves a finger at a time and, pushing them into her handbag, said, ‘Yes, well, I’m going up to Mother. Bring the tea and sandwiches up.’ She snapped the clasp shut and, receiving no reply from Gina, looked at her sharply.
Gina was standing with her hand still on the door knocker, and she met Josie’s gaze.
‘Please,’ said Josie.
As if by magic, Gina came back to life, closed the door and said, ‘Yes, Mrs Harrison, I will be up when the kettle has boiled. The sandwiches are already made.’
Josie didn’t knock on her mother’s door but let herself in and strode across the room to the chair. Her mother began laboriously making her way back from the window, where she’d been trying to see who was ringing the bell.
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