by Emily Elgar
In the nurses’ room, I hear Mary chatting to the new junior nurse, Lizzie. Lizzie starts laughing at something Mary’s said. Both of them were working over Christmas. Mary can be an acquired taste, so I’m pleased it sounds like they got on.
I pick up the ward-notes folder from the reception table. Sharma likes to do rounds with the most senior nurse on duty instead of with each patient’s nurse; I suspect it’s to avoid talking to too many of us. As ward manager, I’ve been called up today. I turn towards Sharma.
‘Hello, Mr Sharma. How was your holiday?’
‘Bonum. Thank you. Shall we proceed?’ Sharma sprinkles his speech with Latin, which incenses Mary – ‘The pompous arse. Who does he think he is? Julius Caesar?’ – but it just makes me laugh.
There are only three patients on 9B at present. Just after Christmas, Caleb in bed two caught a nasty infection after his cancer-ridden spleen was cut away. He was ready to go, as they say; even though he was as weak as a lamb, he still found the strength to try and pull out the IV that pumped the antibiotics into his arm. His wife Hope wrote us a thank-you card after he died; it’s still pinned up behind reception. Winter is usually a busy time here, with pneumonia for the old and more accidents from slippery roads and revelry for the young; odds are Caleb’s bed will be filled by the end of the day.
Rounds start with bed 1: a cardio patient called George Peters, recovering from a recent bout of pneumonia. Sharma moves on to Ellen Hargreaves in bed four, an eighty-nine-year-old with multiple organ failure, dementia and cancer, before lastly coming to Frank Ashcroft. Sharma finds Frank the most vexing patient on the ward. Not because of his symptoms but because of his prolonged presence. Frank has been on 9B for too long in Sharma’s opinion; most other patients stay for a few weeks, maximum, Frank’s been here two months already. On our way to Frank’s bed, we pass Lizzie who waves, grins and blushes at me. She’s already making up Caleb’s old bed, bed two opposite Frank, sticking ‘I’m sterilised’ stickers onto everything that has been made ready by the healthcare assistant.
‘No tinsel for Mr Ashcroft, I see,’ Sharma says as we stand at the foot of Frank’s bed. His voice still contains some notes from Hyderabad. Accents can’t be bleached.
‘Oh, no, I already took it down actually.’
‘Can you see to it that all the other stuff is removed as well?’ he asks as he looks down at Frank’s notes.
I bite my bottom lip as he talks.
‘Righto, Frank Ashcroft, fifty, our brain stem stroke. Coma for a month and now probably PVS since some involuntary eye movement was observed. EEG showed extensive damage with some upper and lower pon activity. He’s been on a ventilator since he arrived, is that correct?’
Sharma knows about Frank’s medical care, of course, but he still likes to go through the motions. I nod.
‘It was thought we’d try and encourage him to breathe independently, check his diaphragm function, so we tried a reduction but he suffered another minor stroke.’
‘Yes, that’s right.’
Sharma likes pliant nurses. He decided Frank was in a Permanent Vegetative State after a few minutes of looking at his scan results and less than two minutes of being with Frank. The protocol for diagnosed PVS requires approval from two other consultants. Sharma only has approval from one. If Sharma gets his diagnosis that would be the end for Frank; he’d be moved to a facility, a morgue waiting room, kept alive until he got an infection and the antibiotics stopped working. I have to hope for something better for him; otherwise, what’s the point?
‘I recall he doesn’t have any family to speak of. None that are involved in his care anyway?’
I wish I could shush him up; Frank is just a couple of feet away.
‘He has a daughter.’ I speak quietly. ‘Her visits are infrequent. He’s estranged from his wife; a couple of his friends and his mum visited once or twice but she’s now moved abroad. She wanted to come over for Christmas, but I think it was too expensive. But, no, apart from them, I don’t know about anyone else.’
Sharma looks down at Frank and then back at his notes, his forehead creasing. ‘Well, as you know, he’s been here a long time. It’s a huge drain on resources. I’m afraid it’s the times we live in; we have to find somewhere for him to move on to. I heard a care home in Reading is looking to invest in new equipment. I’ll make some enquiries.’ Out comes the blue pen and, with that, rounds are over until this afternoon. I imagine Sharma, retreating to his office, doing sums with his red pen, working out how much money Frank’s life is costing.
I peer through the square window leading to the little nurses’ room at the end of the ward. Carol – a middle-aged matron with short, permed hair, a quick laugh and big boobs that give her back ache – is sitting behind her desk, which overflows with policy and procedure manuals, lists and memos. On the far wall of the small, windowless room Carol has framed a photo of all the permanent ward staff on the ‘Nines’. Everyone on the ward hates the photo, our tired faces ghoulish and aged by the strip lighting, but we all like Carol too much to take it down.
With five years under my belt, I’m the second-longest-serving nurse on 9B. My friend Mary – who is, this morning, sitting opposite Carol, eating a half-price mince pie and drinking a cup of tea – brings home the medal with twenty years’ service on 9B.
Nearing retirement, Mary is small and, in her words, ‘shrinking fast’; she’s thin but always eating. She has short, grey, cropped hair and huge, goggly eyes, which she says grow the more she sees. Even the consultants revere Mary, who’s been known to diagnose patients faster and more accurately than the most senior practitioners. In the safety of the nurses’ room, Mary treats them with a mixture of pity and disdain, calling them the ‘Ist’s’, her catchment term for the Intensivists, Neurologists, Chemists, Oncologists, Cardiologists and so on who visit the ward daily, most of them like nervous insects, hovering by a patients’ bed before scurrying back to the safety of their desk and their books.
Carol and Mary both give me a hug. We ask about each other’s Christmases, and then Mary gets back to the rant I interrupted.
‘The Ist’s don’t get it. They don’t get it at all.’
She’s angry; she’d been nursing Caleb with her usual painstaking care and attention when he died over Christmas. Caleb’s wealthy family sent the consultants tickets to an England rugby game as a thank you for looking after Caleb. The nurses got a dozen crispy cremes.
Mary, as usual, keeps talking. ‘They think everything they could possibly need to know must be in a book. Most of them don’t even bother looking properly at the patient, let alone speaking to them. But here we are, day in, day out with our patients, their families; we see it all. Nurses are like hospital furniture. Everyone else constantly moves, the Ists get promoted, patients go home or die but we stay, steadfast, waiting to be sat on, leant on, perhaps kicked about a bit.’
Carol chuckles at Mary and Mary rolls her round eyes at me. I turn to the rota board so neither of them see me smiling; I know how irritated Mary gets with Carol’s perpetual jolliness. She comes round to stand next to me and squeezes my shoulder with her thin, strong hand that has lifted, wiped, squeezed and caressed so many sick and dying over the last two decades.
‘Here we go again, eh? Happy New Year.’ With that Mary walks back out on the ward and starts calling to the ward technician, ‘Sue, hey, Sue!’, before the door shuts behind her.
I take the seat opposite Carol, where Mary had been. Carol’s shaking her head at the door and beams at me as she says, ‘Something about old dogs and new tricks, huh?’
Carol, who is already wearing one pair of glasses, starts fishing in her permed hair for her reading glasses, which are, as usual, roosting somewhere in her thick hair.
‘I know,’ I say. ‘She keeps talking about retiring, you know. I can’t tell if she’s doing it for attention or if she’s serious. Either way, I can’t imagine this place without her.’
Carol nods at me as she swaps her glasses and,
opening a file, she says, ‘So, what’s happening today?’
As ward manager I’m part matron, part nurse. At Kate’s the matrons are managers who perform hundreds of administrative duties on the three critical care wards of the hospital. 9B has a core nursing staff supplemented by roaming ‘bank’ nurses. It is a reflection of the strange hospital hierarchy that the amount of patient contact within a role dictates that role’s position in the hospital food chain. Many hours of patient contact – healthcare assistants, porters, cleaners and nurses – are the plankton and krill, yet positions with very few or no direct hours with patients – most of the ‘Ist’s’ – are the sharks and whales of this peculiar ocean. Despite my increased administrative duties, I’d never give up the patient contact. I studied medicine at UCL but failed the first round of doctors’ exams. I was devastated at the time, of course, hated the way my parents quietly hinted I was more suited to nursing. As it turns out, they were right; I am more suited to the human part of medicine. I administer drugs, change sheets, comfort families and hold the hands of dying patients until their last breath. I’m with them. I’m happy to be plankton.
‘OK, let’s see here,’ Carol says, reading from the schedule. ‘Well, you’ll continue with Frank, Brighton have requested bed two for a thirty-year-old head trauma, GCS 4 coma patient, but she won’t be arriving until this evening or maybe even tomorrow. Lizzie is getting the bed ready now. If you could take on Ellen Hargreaves, she’s got all sorts of appointments today; Paula said she’s been bad, especially at night, getting very agitated. She keeps calling out like she’s back in the Blitz, poor love. Oh, and the notes mention something about mouth ulcers and her g-tube needing to be checked. We have a meeting with her children at two o’clock. Then if you could do afternoon rounds, check in with George Peters’ family – he was with a bank nurse over Christmas so I think they need some attention – and then get going with the Nursing rota that would be great. I was also wondering, Ali … you wouldn’t mind keeping an eye on Lizzie for the next few weeks as well, would you? Just make sure she’s finding her feet, that sort of thing.’ She lobs a grin at me again and I smile back, before walking onto the bustling ward to meet the long day ahead.
I pull in to our drive at 22 Blackcombe Avenue just before 7.30 p.m. David and I have lived here since we got married, seven years ago. It’s one of those houses that’s shrouded in evergreen bushes, giving the impression that it’s much smaller than it is. Like something from a children’s book, the dark front door seems to peep out of the shrubbery like a kindly eye. Built in the fifties, it was considered indescribably ugly when we first bought the red-brick two-storey house – perhaps that’s why the previous owners planted the shrubs – but now it’s called ‘retro’. David tells me that – as he knew it would – mid-century’s become cool again, so we’re bang on trend apparently. David describes the house as ‘Old Hollywood’, a phrase I’m sure he picked up in one of his architecture magazines, which he now uses to make me laugh and give me an excuse to call him an ‘Archi-wanker’. I have to admit, though, it’s a fairly good description. The house has a balcony around the back, with glass sliding doors that overlook the sloping garden. David loved the generous proportions and the opportunity for building an extension; I loved the three bedrooms and the opportunity for building a family. Of course, now we just have two spare rooms.
It’s dark in the house so David must be out. David works for the Planning Permission Trust, and for the last six months he’s been working from home, which suits his budget-minded boss and also suits David who I know carves out extra hours to work on his private architecture projects. David said this year will be the year he reduces his hours at the Trust to finally practise full-time as an architect. His job at the Trust, where he pursues and debates controversial planning applications for local government, was always supposed to be just a stop-gap, a year tops, while we settled into our new semi-rural Sussex life. But as the financial crisis hit, people stopped planning expensive home conversions while Tesco’s still needed their car parks, so David dug his heels in and clung onto his desk and we talked at night about how it’d just be for another year or so, until the economy improved.
David’s out now though; he’s taken Bob, our black Labrador, with him. I fondle the wall for the light switch and shrug my coat off, dropping my bag with a thud on the stone floor in the hallway. Claire once described our house as ‘adult tidy’. No muddy trainers or wooden toys dot the floor. There are no safety locks on the cupboards or potties behind the toilet.
Our kitchen is a miniature farmhouse kitchen with a little larder and big windows out to the garden. David, I know, would prefer something modern but I’ve always been a sucker for anything rustic. I step over Bob’s chewed sleeping rug and stare into the fridge. I quite fancy a glass of wine but we always try and do a month off booze for Dry January, so I pour myself a large glass of fizzy water instead and lean against the trough-style sink to text Jess.
Can you guys come for dinner next Thursday? David wants to catch up about the extension. I’ll get him to cook and we could make a night of it? X
As I press send the outside light flashes on and through the kitchen window, I see David. He looks like he’s recently been on fire; white clouds of sweaty heat billow around him like smoke, puffing up from his Lycra running top. He’s breathing hard and puts one hand flat against the driveway wall as he uses the other to grab his ankle and stretch out his long thigh, the muscles in his standing calf tense with his weight. He only holds the pose for a couple of seconds, before he does the other side. Stretching’s never been his thing; he’ll be sore tomorrow.
There’s a light scratch at the front door. I open it and Bob’s slick black head pushes forward, pink tongue lolling out, urgent for affection. I give him a pat on his cold, muscular shoulder. He’s breathing hard but still manages to raise his eyebrows in pleasure as I look in his loving eyes and reassure him he’s a good boy.
David walks through the door, kicking off his ancient running trainers. His greying hair clings to his forehead in sweaty curls as he leans towards me for a salty kiss. His eyes rest on mine, taut just for a second, scanning to check I’m OK.
To reassure him that I am, I look down at his sweaty running kit and say, ‘I’m impressed. New Year’s resolution number one.’
He laughs. ‘I know, big bloody tick for Bob and me. I have to say though, Bob didn’t do much for morale, did you, Bobby?’ Bob, at the sound of his name, only has the energy now to thump his tail a couple of slow, heavy times against the floor where he’s already collapsed in his basket on his side of the kitchen, his black flank moving wearily up and down.
David refills Bob’s water bowl before pouring himself a glass from the tap. He drinks it in three gulps and says, ‘He was doing that stopping thing he does, you know, where he just sits down, refuses to budge and then starts trotting home. I had to drag him along.’
I laugh. Bob can be as stubborn – and heavy – as a mule.
David strokes my bottom as he passes me to get to the tap for a refill. ‘How was your day?’ he asks.
I drop the post I was flicking through onto the counter and bend down to take my trainers off. After the break my feet hurt more than usual.
‘Busy,’ I say, ‘but fine. You know, Mary’s been at Kate’s for twenty years now? Seriously, that woman’s got stamina. I don’t know how she’s done it. That’s another resolution actually: I need to make a plan, think about what I’m going to do next.’ I’m pleased I keep my voice breezy. Our first few years together in our tiny Hackney basement flat – me as a newly qualified, overwhelmed nurse, David finishing his architecture training – we’d talk over pints in our damp local about the future; Hackney at that time was more associated with ‘Murder Mile’ than flat whites and pop-up restaurants. In my plan, we’d have kids in our late twenties and early thirties, I’d stop nursing while they were tiny and maybe do something completely different when they went to school, like working in an art gallery o
r designing jewellery, something creative that would allow me to always be there for any sick days and holidays, by which point, David would have his own flourishing practice. We’d live in a rambling farmhouse near the sea and our kids would grow up with dogs, chickens and goats and they’d be the boisterous, ruddy-cheeked type, unafraid of adults and the future. I had it all figured out.
David turns to hug me; he probably knows what I’m thinking. I fit perfectly under his shoulders and instinctually he bends to kiss me somewhere on my face. His lips land near my eyebrow.
‘How was your day?’ I ask, my voice muffled against his chest. He kisses me briefly on the lips this time before we let each other go.
‘Oh, fine, you know. I did some more drawings for Jess and Tim’s extension; it’s starting to come together pretty nicely.’ David’s charging our friends a mates’ rate but it’s worth it to get his name more visible locally.
‘That’s exciting!’ I say, opening a mobile phone bill and immediately putting it back on the counter top without looking at it. ‘I just texted Jess actually. I invited them over on Thursday next week. I thought you and Tim can geek out on the drawings and Jess and I can have a proper catch-up.’
David rinses out his glass. ‘Sounds good, I’ll make one of my famous lasagnes.’ He winces into the fridge. ‘What shall we have for dinner? God, it’s a jungle in here.’ He’s talking about the bushels of spinach and kale I bought. Resolution number five: actually use the juicer I bought David for Christmas. David pulls all the green stuff out of the fridge until he finds an old block of cheddar, which he starts chopping directly on the counter top and eating in chunky pieces. Through a mouthful of cheese he puffs his cheeks out and nods. ‘Looks like it’s going to be good old kale with lettuce on the side and spinach for pudding tonight. God, I miss Christmas.’