by Manda Scott
Lee found a clean set of gloves in her pocket. ‘I’ve got a practical class with this lot all afternoon, so I can’t go today. I could probably do Friday. I’m supposed to be on call but I can work on Murdoch and see if I can get her to cover for me. Otherwise we’ll have to make it Saturday.’
‘See what you can do. I’ll be in the Unit for the rest of the week.’
‘OK. I’ll let you know.’
‘It’s early in the morning, maybe around six, half six. That space between the birds waking and the sun rising. The sky’s clear and cold. You can see the clouds banking up on the horizon but they’ve not pulled across yet. It’s the best part of the day. Always. The birds are making a hell of a racket, mind. You know the noise. You hate it when it wakes you up and you love it once you’re out and walking. You don’t hear it in here. Too many buildings. Not enough trees … Anyway, we’re out for the morning and the dogs are working the field. Guinness—that’s the Labrador, cracking little dog—she’s out quartering the plough. It’s autumn. We ploughed yesterday. We’ll be putting the winter wheat in any day now. So, she’s there, working across and across without me ever telling her where to go. If there’s a pheasant there, she’ll find it. It’s October now, so she’s legal at least. Rastus is away on his own doing terrier things: hammering into the hedges, diving down rabbit holes. Scruffy little tyke. We bred him for Sally and then she went off to college, so he comes out with me all the time now. Wouldn’t be without him. God knows what he’ll do when—’
‘What can you smell? Tell me what you can smell, Jack.’
‘Smell? That’s difficult. If I’m honest … you want me to be honest? I can smell the incense the lass lit when she came in. And the wound, I can smell the bloody wound. Smells like something the dogs have rolled in. Too long dead. And melted … I don’t want to melt, Kellen.’
‘I know. I know.’ Who would want to melt? ‘We can leave this if you want. Just go with more morphine and let it be at that.’
‘No. No. This is better. Bit of a daydream never hurt anyone. Not now, anyhow … Take me back in.’
‘You’re in the fields, early morning in October. With the dogs. I’d guess it would be frosty but you’d still smell the plough underneath. And you might catch your arm on a bramble on the way past …’
‘What? Oh, aye … a bramble … There and I was thinking it was a needle … Frosty? Aye, it’s frosty. A grand, rare frosty morning. Beautiful, you know? White, like crystal all over the plough. And cold: that lovely sharp, clear cold that makes you feel warm as you’re walking. And I can smell it. You’re right. You can always smell the plough … There’s nothing in the world smells like the earth, just turned over …’
We waited for the half-dose of morphine to take, me and a nurse called Jo McCauley. In another world, Jack Souter took his dogs for a walk across the fields and through the woods, past hawthorns in late berry and oak trees that shed leaves down in front of him as he walked. He turned down a side path and nearly walked into a marsh, but the terrier grabbed his arm, in the way terriers do, and worried at it to get him to turn round. In the world of the ward, Jo began to unwrap his bandage. The dog bit deeper into his arm. He made it a game, pulling and cursing, swinging the dog up in the air, growling at it as it was growling at him. His arm lay still on the bed. Jo teased the last layer of melolin from the great, melting ulcer that ate into the tissues of his forearm. A wash of decay and putrefaction flowed out, more than you could drag out with the air conditioning or cover with incense. With care, Jo washed the puckered edges of the lesion and eventually the dog let go. She started the first layer of the dressing, and out in the wood, Jack Souter peeled back the sleeve of his shirt to find that the dog had broken the skin. Nothing serious. ‘Just a flesh wound …
‘… and then we’re on the way home. I have my scarf wrapped round my arm where the dog got it. Daft bloody thing. She didn’t mean to, mind. Just playing. And I can walk up the stairs now, wooden ones at the bottom and then they’re covered in lino and the room’s all done in yellow, pale yellow, like old beeswax, and I can smell the incense and the grass outside and … heather, I can smell heather. The smell of the bandage isn’t as bad as it was … Are you done?’
‘We’re done.’ Jo backed out through the door, the foul mess of the old dressing sealed in a clinical waste bag, on its way to the incinerator.
The man opened his eyes. She turned at the door and smiled. Red-blonde hair and freckles and wide grey-green eyes. He smiled back and gave her a nod. His gaze wandered the room, searching the walls, the drip stands, the rack of tablets, the bedside table. Anywhere but on the bed.
‘I was right. It is heather.’ He reached out to touch it. ‘Was that you brought that?’
‘Yes. You said you liked it.’ I lifted it up for him to smell. He’s not old. Early fifties maybe. Old enough to have lived a full life. Still too young to die. Almost everyone in here is too young to die. They still do it, all the same. He looked down at last. Layers of white gauze wrapped fresh round his arm. A turn or two of micro-pore held it all in place. Neat and clean and innocent. Could be covering a dog bite. ‘Is it bad underneath?’
His eyes are back, holding mine. What can you say? ‘It’s not good.’
He closed his eyes. Now he looks old. His skin is the parched yellow of terminal hepatic failure; dry and crinkled like the oak leaves he was walking through. Two weeks ago, when we first walked the dogs, it was spring in his fields. Soon it will be winter. The mind follows these patterns.
‘How much longer?’ He still had his eyes shut. The blue veins stood out round his temples.
‘I don’t know. I can order an X-ray if you like. Or we can get some more blood tests. But we’re guessing at best. You know that.’
‘Aye. Never mind. I’ll go in my own good time.’ His breath came harder than it used to. ‘Not long now.’
‘No.’ His hand was firm in mine. There was nothing wrong with his mind. It’s just his body that was riddled through with the secondary spread from the melanoma on his arm. If he’s lucky, his liver will give out before anything else. It’s the most peaceful way.
‘How did your talk go?’ His voice was quiet. I leant over to hear.
‘Not bad.’ I’d almost forgotten about that. ‘They listened and they didn’t laugh and one or two of them asked intelligent questions. It was better than I expected.’
‘So they’re not about to turn the whole place into a palliative care unit?’ He was laughing, but only with his mouth.
‘Not this year, Jack. I need to get more facts before they take us seriously.’
‘Does this morning count?’
‘It will if you don’t mind us filling in the questionnaire. You had half the dose of morphine you were having on the ward. Do you think it hurt twice as much?’
‘Don’t be daft.’ He reached for the pen and the printed sheet that I gave him. ‘It’s nothing to do with the morphine, woman. You know that. It’s to do with the lass holding my hand like I was a real human being and you remembering about the heather and both of you knowing my name so I’m not just “the aberrant melanoma with multiple metastases in bed three” with a bunch of white coats standing round discussing sizes and growth rates like I was a steer at the sales.’
‘I know. But this is the age of science, Jack; you can’t write statistics about knowing someone’s name.’
‘Bollocks to that.’ He cleared his throat and peered down at the sheet. ‘You know, I never thought I’d end up a statistic.’
‘I know.’ No one ever does. ‘I’m sorry.’
‘Just make it count, all right?’
‘I’m doing my best.’
Dee was waiting for me in the office. She was white, shaken in ways I’ve never seen her shaken before.
‘What’s up?’
‘Room five. Can you give me a hand?’
‘Sure.’
Room five is back up on the first floor at the far end of the corridor from the one that Jack is i
n. I followed Dee up the stairs, reading the case notes as I went. Claire Hendon, twenty-three. Stage four cervical adenocarcinoma, picked up too late because no one expects cervical cancer in a lass of twenty-three. Rapid local and distant spread. Minimal response to radio- or chemotherapy. Urinary and faecal dysfunction. Permanent cystotomy placed two weeks ago to bypass urethral obstruction. Colostomy offered and refused. Referred to the Unit by her oncologist, the one who asked the intelligent questions after the talk on Monday. So maybe you can make changes without statistics. We reached room five. Dee was grey, the colour of wood-ash. ‘Do you know her?’ I asked.
‘No.’ She pushed both hands to her eyes. Her voice came out muffled past her wrists. ‘I was supposed to talk her in. I can’t do it.’ Her hands came away. Her eyes looked just like Jack Souter’s: without hope. ‘Have you the time?’
‘Sure. Will you be around afterwards?’
‘I guess.’
‘We’ll have lunch, huh?’
‘Sure.’
Room five has an east-facing window that looks out towards the Art Gallery. If you stand at the right angle, you can see the sky reflecting off the surface of the Kelvin. The walls are green, spring green, to pick up the colour of the grass and draw it in. Someone had lit a candle. The flame flickered as I walked inside. Claire Hendon lay on the bed: a white half-ghost with the quarter-inch crew-cut of radiotherapy and the wasting translucency of chemo. With her hair longer and some colour to her face, she would have been stunning. Instead, her cheekbones poked out sharply beneath the dark pits of her eyes and she looked like the dead, newly risen from the grave. A syringe driver fixed to a stand by the bed fed morphine into the drip in her arm. A button by her hand gave her control of the flow. Patient-controlled analgesia, one step better than handing out a bottle of aspirin and leaving them to get on with it. She saw me standing in the doorway and reached out, her thumb twitching on the button. The driver whirred and then stopped. Already on maximum dose.
‘Hi, Claire. I’m Kellen Stewart. I’ve come to welcome you to the Unit.’
‘You’re a doctor?’
‘Kind of. A therapist, mostly.’
A short, derisive snort with more energy in it than I would have imagined. ‘So you’re going to therapise me out of here?’
‘No, I don’t think it works like that.’
‘Nothing fucking works.’ She threw the button from the bed. Plastic cracked on glass. A nurse hovered by the door, caught my eye and left. ‘All you need to do is get that fucking thing to work and I’ll be gone. Finito. Out of your hair. No more problem.’ Morphine overdose. It’s reasonable. It’s what I would do, given the choice. We are not often given the choice. ‘I’m sorry.’ I shook my head. ‘I can’t do that.’
She turned away to face the window. A kite swooped in the air above the gallery: a multi-coloured delta, carving the wind like a knife.
‘Does your head hurt?’
‘It always hurts.’ She has mets in her right hemisphere. The scan results came through this morning. That’s why they sent her up here.
‘Do you want me to help with that? There are things we can do, things that go beyond morphine.’
‘No.’ She closed her eyes. ‘I’ve had it with doctors. Get lost.’
‘OK.’ I sat down by the bed. Her free hand, the one without the drips, lay palm up on the bed. I laid mine beside it. Not touching, just close enough that she would know it was there. Time hung like the kite. Neither of us spoke. In a while, a long while, I felt her move. Her thumb lay across mine, curled round it, tightly. Her hand shifted sideways and hard-bitten nails dug deep into the skin of my palm. Somewhere in the quiet of the room her breathing changed and it was clear that she was weeping and that she was speaking and when the words came more clearly they were no different to Jack Souter’s, just said with less tact. ‘It’s not fair. It’s not fucking fair.’ I have no answer for that.
I stayed for a while. The syringe driver clicked round on the hour and released another dose of morphine. Her finger crushed the button, drained the machinery dry and, slowly, the desperate grip on my hand began to relax. She was asleep, I think, when I left.
Dee Fitzpatrick sat in one of the staff room’s armchairs, a great emerald cocoon of a chair placed with its back to the door and its face to the big bay windows that give out on to the lawns. It was a good place to hide. I stood behind it. From there, all I could see was the top of her head—the flat white-blonde hair cut level, like a lawn. She sat very still.
‘Hungry?’
‘No.’
I pushed a sandwich round the side into her line of view. Salmon and cream cheese on sun-dried tomato bread. The canteen’s finest. She reached out and took it. ‘Thanks.’
‘No problem. How are you?’
‘Crap. If I was on fags, I’d be on the second packet by now.’
‘Don’t start.’
‘I don’t intend to.’
I put my coffee on the window ledge and sat down slowly on the parquet flooring with my back to her chair. ‘What’s up?’
She peeled the plastic from the sandwich. ‘Everything. I’ve lost the plot, Kellen. I’ve just completely, totally lost it. I don’t think I’m cut out for this any more.’
A week ago, we were planning the next six months’ protocols and a submission to Pain. For all her wilful opacity, I wouldn’t have said Dee Fitzpatrick was one for sudden changes of heart.
All you can do is go with what you know. ‘Claire Hendon.’ I said the name with care. ‘Do you want to talk about her?’
Silence.
Outside on the lawn, a lass in her early twenties walked a black Labrador and a scruffed tyke of a terrier from the car park to the fire exit by room three. Behind us, the staff room filled with nurses, with orderlies, with the day’s rota of volunteers. Without the volunteers, we’d be dead. That is to say, the Unit would have closed before we ever got it off the ground.
Dee put her sandwich back on the window ledge. ‘She’s Beth,’ she said. Her gaze roved back and forth across the upper branches of the sycamore at the far side of the lawn.
‘I’m sorry?’
‘Claire Hendon, she’s Beth. It’s been fifteen years and she’s come back. She looks like Beth. She sounds like Beth. She’s dying the same way Beth died. I can’t handle it.’
Oh. Christ.
I reached for her hand. ‘I’m sorry, Dee.’
‘So am I. You’d think that after fifteen years we wouldn’t still be fucking up the same old things.’
‘What have we fucked up?’
‘Claire. Her life. What it was, what it is now, what it could have been. Fucked up by a bunch of useless bloody medics who couldn’t make a diagnosis if it stood up and wrote its name on a board. Would they have blown it this badly if she was their daughter, their partner, their mother? I don’t think so.’
Maybe not. But you’d burn out in a month if you treated everyone who came through a standard medical ward as if they were a close blood relative. And, just at this moment, it is not Claire who matters most. Her arm lay tense on the arm of the chair. My hand lay on hers. ‘Was it like this for Beth?’ I asked.
‘More or less.’ She watched the dogs play chase-a-ball across the lawn. They were out of sight behind the rhododendrons before she decided what else to say. It takes courage, sometimes, simply to remember. She looked down at my coffee and nodded as I handed her the mug. ‘It wasn’t the secondaries that got her. She didn’t have any secondaries. It was the things rotting inside that they couldn’t keep together. She had the colostomy first. It didn’t work, but it gave us hope, for a while. It’s amazing how you can get used to the idea of living with an external bag when the alternative is not living at all. Then her bladder broke down and they took her in for cystotomy and we still believed them when they said that she was going to get better.’ She stopped, biting her lip, and then shook her head as if that way she could clear it of images. ‘I spent six weeks nursing a woman with no lower bowel and another
with only half a bladder.’ She stole a long drink from my coffee, smiled a strung-out, hard-edged, self-mocking smile. ‘We were four days from the last surgery when she died. Iatrogenic death. Real bad for the statistics. The consultant was furious.’
Christ.
I made hand signals to Jo and she brought me two more coffees, one white, no sugar, one black with two. Dee folded her hands round the warmth of the mug and stared out at the empty garden. Her face and her voice were balanced, almost bland. Her eyes burned. ‘We trusted them, you know? For weeks, we hung on every word they said. They were the doctors and so, of course, they knew what they were doing.’
‘You weren’t at med school when it happened?’ It doesn’t take long inside the system for the trust to wear off.
‘Nowhere close,’ She shook her head. ‘Beth was the one with the brains and the degrees. I had my “O” grade biology but that was about it. I was running a nursery school during the day and doing an art degree at college in the evenings. I was going to be a world-famous potter. And kids.’ Her teeth gripped hard at her lower lip. ‘We went for the smears because we were going to have kids.’
How often have I heard this? How often has she?
I found a clean tissue in my pocket and laid it on her knee. She wasn’t weeping. She wouldn’t weep, I don’t think, in front of me. But fifteen years is a long time to bury the pain. ‘So why are you not out there throwing pots for the great and the good of Glasgow, Dr Fitzpatrick?’
She shrugged and blew across the top of her mug. ‘I made a promise. The kind of thing you do when you’re sitting by a bed holding the hand of the person you were going to spend your life with, watching her die in front of your eyes. We thought, in our naïveté, that the white coats would listen to one of their own, that someone on the inside, if they had enough guts, could work on the people, on the system, that they could really make a difference. So I promised her that I’d do it, that I’d go back to college and get my own white coat, that I’d become one of them without ever becoming one of them. That I’d stop it and not be a part of it …’ Her lips compressed to a thin, hard line. ‘She was dead within forty-eight hours. I started at college that October, and got a place in med school three years after that. It was twelve years ago this year.’ The tissue crumpled under her hand. She flicked her wrist and it bounced off the edge of the bin in the corner. ‘Twelve years and I’ve made not the slightest fucking difference. I’m as much one of them as anyone else and I’ve stopped nothing. It’s all just exactly the same …’ Her fingers, wrapped round the mug, were white to the bone. She might have thrown it, I think, the same way as the tissue, but I was there. She sat instead with one knuckle gripped tight between her teeth. Her eyes were dry.