Night Mares

by Manda Scott

  Eric still had his arm round my shoulder. ‘We’ll get the records,’ he said.

  The registrar was looking in her eyes with a ’scope. Looking past the walnut of the iris, through the wide, round window of her pupil to the scattered brightness of her retina and her optic disc. He didn’t like what he saw. He called Eric and Eric looked too, for longer. He didn’t like what he saw, either. He called a neurologist and, in time, the neurologist came. A wiry, hook-nosed Aberdonian with lasers for eyes and no small talk. They both looked at her retinas with the ’scope. They tested reflexes on her hands and on her feet. Then they shaved her head. Little bits of it, carefully, where it wouldn’t show. They ran an EEG and printed it out. Put their heads together over the squiggles and lines. Eric came back to me, running tight-corded fingers through the red waves of his hair. I have seen him hang his full weight off those fingers, halfway up a hundred-foot cliff. And then, the next day, slide an arterial line into a pre-term infant and get it in first time.

  ‘Was she breathing, Kellen, when you found her?’ There are tight lines round his eyes. Tighter than his fingers. This is not a casual question.

  ‘No.’

  Laser-eyes joined him. ‘How long was the period of apnoea?’

  I was a student, once, of men like this.

  ‘I have no idea. She was blue. That is, she was severely cyanotic with a marked bradycardia. I initiated artificial respiration and then intubated and ventilated with a hundred per cent oxygen.’

  ‘Did you indeed?’ The lasers flashed. ‘How long between finding her and ventilating? How long before she got oxygen?’

  ‘I don’t know.’ Time goes very fluid in a crisis. ‘Mouth-to-mouth straight away. Not more than five minutes till the oxygen.’

  ‘Good lass.’ He patted me on the arm. ‘Very good.’

  They went back to study her eyes. The neurologist wrote in the notes and left. Eric gave orders. More drugs went into the lines.

  Eric came back to me. Crouched down again. Put his hand on my knee.

  ‘Eric … I don’t want to know.’ My voice is far away. Very faint. Like a child, in the morning, halfway in the dream.

  ‘It’s better than evens,’ he said. ‘You need to know that much.’

  ‘How much better?’

  ‘I don’t know. She was lucky. Pentobarb’s neuroprotective. It gives us more time. We’ll blast her with Lasix. Mannitol if we have to. Run the trace again in the morning. Alec’s hopeful.’

  Hopeful. Hopeful. The man with no small talk is hopeful that Nina Crawford might still have a mind. That she might be able to walk. To talk. To laugh. To hear. To see. To remember.

  To know who she is.

  ‘She was a surgeon,’ I said. Because I had to say something.

  His fingers curled tight round my knee. ‘She might still be again,’ he said, and it was the compassion in his voice that made me weep. ‘We’ll do what we can.’

  Later, he came back and sat with me by the end of her bed. Brought sandwiches and coffee to share. It was quiet then. Beyond the rush of visitors in the other wards. Beyond the late evening flush of cisterns and the gush of water in ward-end sinks and the rattle of plumbing laid two hundred years ago and still in use. We sat in our oasis of electronic rhythms, hypnotised into silence by the twelve-second hiss of the ventilator and the intermittent whine of the indirect pressure cuffs on her arm and the minute-on-minute tick of the fluid pumps.

  ‘You’d think they’d have invented something quieter by now.’ He stared forward, focused on nothing. As if there were only two of us in the room.

  ‘They think there’s no need. Patients on this much technology can’t hear it anyway.’

  ‘Maybe.’ He nodded. ‘They hear more than you think.’

  I’d like to think so.

  He pulled a piece of paper from his pocket. ‘I just got her blood results from toxicology,’ he said. ‘You were right.’

  ‘What about?’

  ‘Ketamine.’ He passed me the sheet. ‘There was ketamine in there with the pentobarbitone.’

  ‘Shit.’ I looked at the report. Three sections were ringed in red: Pentobarbitone: 0.15 mg/ml. Opiates: 00.00 mg/ml. Ketamine 0.98 g/ml.

  ‘How much is 0.98 g in real money?’ It’s a long time since I did pharmacology.

  ‘I don’t know. Enough to bring the big green monsters crawling out of the walls, big time, but I don’t think it would have been enough to knock her out.’

  ‘Would it be enough to make a difference to the odds?’

  ‘No.’

  ‘Thanks.’ I sat for a while, in the warm and the dark, staring at the numbers until they blurred on the page. ‘Why, Eric?’ I said it into the darkness. Not expecting an answer. Just trying to make sense of the senseless.

  ‘I don’t know. Maybe it makes the going easier. It would be painless, anyway. You wouldn’t feel much on ketamine.’

  ‘She wasn’t running from pain, Eric, not physical pain. She was running from what she saw in her head. The big green monsters. Except hers were horses with teeth like mink and cats with maggots crawling out of their eyes. It took her years to recover after last time. She’s had nightmares and flashbacks that would make your skin crawl on and off for the last seven years. It was the ketamine that did it. She knew that. She hated the stuff. Why would she call it all in again?’

  ‘Some of us climb when we’re terrified of heights. It’s something about facing the thing that scares us most. To prove that we can.’

  ‘But, when you climb, you’re not trying to die.’

  ‘I don’t dream of patients with teeth like mink.’

  ‘No.’

  I gave him back his sheet of paper and watched him slide it to the back of her notes and I sat there thinking of ketamine and of pain and of what it takes for anyone to want to die that badly.

  Eric stood up after a while. Crushed the paper mug in his hand and threw it in the clinical waste bag. ‘Are you staying?’ he asked. ‘Are you in for the night?’

  ‘If you don’t mind.’

  ‘Whatever.’ He thumbed a button on the wall by the oxygen inlet. Somewhere in the staff room at the far end, a buzzer sounded. ‘I’ll get them to bring you an airbed.’

  ‘I wasn’t planning to sleep.’

  ‘No.’ He smiled, all red hair and dark, sparking eyes and the shoulders of a bear. ‘But you’ll need an osteopath in the morning if you spend the night in that chair.’

  He stopped at the end of the ward. Turned round. Pitched his voice to carry down the ward. ‘Better than evens, Kellen. You should sleep on that. It’s the best we’ve got.’

  I didn’t sleep on it. I didn’t sleep much at all. But the thought was there.

  Steff came to visit with the dawn. They shouldn’t have let her in any more than they should have let me stay. But she wore theatre greens, with her hat poking out of her pocket and the blood-stained mask round her neck and there’s no night sister in the world that would argue with a surgeon, even if she wasn’t six foot two with blonde spikes and a nose stud.

  She stood over the bed for a while, inhaling the ward-smells of night-sweats, unwashed skin and stale urine, taking in the monitors, the drips, the urine bag filling slowly on the floor. She put out a hand and touched the unmoved, unmoving skin, seemed surprised that there was no response. She ran her fingers up a cheek and lifted an eyelid. Looked in at nothing. Nobody. Laid a hand on her chest and felt the steady, rise and fall of the ventilated lungs. She shook her head, slowly and then came to stand by the edge of the bed; a still, sober, giant with the patchwork of half-held feeling still running fresh beneath the surface. She smelled of straw and horseshit and artificial milk replacer and if she had any news at all she would have told me. I didn’t ask.

  ‘She looks just like your mare,’ she said. ‘Except the mare knows who I am.’ Which was what I needed to know. ‘How is she?’

  ‘She’s alive. She’s ticking. She has cerebral oedema. They’ve pumped her with IV Lasix and mannito
l and they’ll re-evaluate at morning rounds.’ I have been in hospital too long. I can say this now almost as if it is yet another clinical read-out.

  ‘Shit.’ She sat carefully on the edge of the bed. Pressed her fingers lightly to her forehead, running circles above her brows and across to the temples. The kind of thing that might keep the headaches at bay if you were running low on coffee. Or trying not to think.

  We said nothing for a while. She sat on the end of the bed with her chin on her hands and she watched me. I would have done a lot, then, to avoid the wide, grey stare of her eyes.

  ‘Did you talk?’ she asked eventually. ‘After Saturday?’

  And I was the one who wanted to be judged.

  ‘No.’ I shook my head. ‘We didn’t talk.’

  ‘Mmm.’ She nodded slowly. Took her eyes and directed them somewhere less painful. ‘That’s too bad.’

  I said nothing. Because there was nothing left I could say.

  Around us, the wards began to wake. Cisterns flushed again with increasing regularity. Somewhere, a television blared early-morning breakfast TV until an earphone plug in the socket silenced it midsentence. In our room, the staff changed shifts. Junior clinicians began to filter in, swinging their hands in the pockets of their white coats, brandishing stethoscopes like badges of office. Reading the case notes, looking at the monitors, looking at me. And at Steff. Working their way up to asking difficult questions.

  Steff stood up. She tore the mask from round her neck and threw it in a waste bucket beside the bed. Then she pulled something small and weighty from her pocket and passed it to me. A mobile phone.

  ‘It’s hers,’ she said. ‘She left it on the table in the Lodge. I don’t know who we should tell but we have to start telling folk soon, before the shit hits the fan. All the numbers you need will be in there.’

  ‘That I need?’

  ‘I’ll tell the Dean,’ she said. ‘I figured you could do the rest.’

  Thank you so much.

  ‘I could call her mother, at least.’ I opened the directory and found the number. Under ‘M’ for Marjorie. Just above four separate entries for Matt.

  Strangely, through the night, I managed not to remember that man. The thought of calling him did nothing to improve the morning.

  I turned the phone so that Steff could see it. ‘I suppose we should call?’ I suggested. We. One of us. Not necessarily me.

  Steff brought her eyes back to mine, level and clear. ‘Matt’s on holiday,’ she said. ‘You won’t get him now.’

  ‘We can try.’

  ‘The only person who knows where he’s gone is Nina,’ she said. ‘We aren’t going to find him before she wakes up.’

  ‘He went to his parents,’ I said. ‘She told me.’ I tabbed through the listings. Two numbers with Glasgow dialling codes, a third called his mobile. The fourth read ‘MH (A)’

  ‘Arisaig.’ Somewhere, a long time back, she’d told me. ‘His parents live in Arisaig.’ On the west coast, half an hour’s drive from Mallaig, on the mainland opposite Skye.

  Steff had her car keys in her hand, ready to leave. She stood over my chair with her hand on my shoulder, the way surgeons do with the grieving relatives.

  A balding man in a white coat changed his mind and turned away. Found it necessary to fiddle with the ECG settings instead.

  I stood up and walked with her to the door. She leant against the wall of the corridor, taking two inches off her height. ‘I’ll call Matt if you want,’ she said. ‘He’ll hear from the Dean soon enough but I think it would be better coming from one of us.’

  ‘I think it would be better coming from me.’

  ‘If you say so.’ Halfway down the corridor, she turned. ‘I’ll be in the clinic if you change your mind,’ she said.

  14

  At seven o’clock, I called her mother. At five past, I called the machine at work and cancelled my appointments for the day. Shortly before ward round, I pulled myself together and called Matt on his parents’ number. A machine answered, its older Morningside accent blurred by age and technology. I left a message for Matt to call me back on my mobile. On the spur of the moment, I called MacDonald, who wasn’t in. The clerk at the station said that he was on the night shift, that they were expecting him in at lunchtime and that if it was personal, I could leave a message. It’s the first time I’ve ever called the man at his work. I didn’t leave my name.

  The ward began to fill. Professionals in clinical coats filtered in, in ones and twos, responding to the bush telegraph of the hospital. Eric arrived, hot and damp from a morning run, and he brought with him a miniature travel toothbrush, a thumb-sized tube of toothpaste and a white NHS-issue towel.

  ‘Showers are on the third floor at the far end of the corridor,’ he said. ‘Ward round starts in ten minutes. She’s today’s star case. They’ll have everyone in here from the porters to the Prof. You might want to stay.’

  And I might want to be clean if I do. This man thinks of everything.

  The neurologist led the ward round. He gave a summary of her previous admission in slightly under three minutes and then a somewhat more detailed account of her current status, including the neurological findings, that had the students, the house officer, the SHO and the registrar taking notes. The professor accepted the loan of an ophthalmoscope and examined the patient’s retinas. He queried the doses of diuretics and had the house officer demonstrate a Babinski reflex, for whatever good that might do. She surprised everyone by performing it correctly, a feat which probably passed her through the entire medicine internship in one move. The students took more notes. Eric queried the presence of ketamine in the cocktail and the neurologist proposed an elaborate theory suggesting that the presence of ketamine would increase blood pressure and heart rate thus increasing the blood flow to the brain and enhancing cerebral uptake of other, concomitantly administered drugs. It was, he suggested, a particularly effective addition to a potentially lethal cocktail and would significantly speed the onset of cerebral and cardiac failure. We were given to understand that, should he ever be inclined to go, he might well try the same himself. There was a general murmur of admiration for the patient’s grasp of pharmacology. No one took notes. The registrar was required to give an estimate of the likely time for the patient to regain consciousness and was unable to do so. Neither Eric nor the neurologist was able to offer anything of any accuracy. The Professor demanded that the remains of her yellow cocktail be produced for his inspection and when it was, he held it up to the light, dipped his finger in, tasted it, did some rapid arithmetic on the back of the case notes, and pronounced that, in the light of his experience of pentobarbitone as a battlefield anaesthetic, she was unlikely to recover consciousness within the next twelve hours. At the very least. Possibly twice that. All further neurological and psychiatric examinations should be deferred until that time. The round moved on to the next ward.

  Eric stayed behind.

  ‘He’s not old enough to have battlefield experience,’ I said, as the dust cloud settled.

  ‘He was in Africa in his youth. As a volunteer. If you listen to him, the place was one big battlefield experience zone.’

  ‘And they still use pentobarbitone?’ Even on horses, they don’t use pentobarbitone any more. Except when they want them to die.

  ‘Apparently so.’

  ‘So he might be right?’ I asked.

  Twelve hours. Another whole day.

  ‘Hard to say.’ The bear-man shrugged. ‘Most of the time, he just asks difficult questions. He doesn’t usually commit to anything unless he knows he’s right. That’s why he’s the professor.’

  ‘Thanks.’

  Twelve hours. At the least.

  One of the fluid pumps sounded an alarm. A nurse ran to check it and between them, she and Eric decided it was faulty. The nurse was volunteered to go and find another one. We stood by the bed and waited while she ran through to the next ward. ‘You can stay if you want to,’ said Eric. ‘But I think you sh
ould go home and get some sleep. You heard the Prof. We can’t do anything except keep her ticking over until the pentobarb wears off.’

  ‘And then?’

  ‘And then we’ll know if Alec was being optimistic.’

  Then we’ll know if she still has a mind that works. Maybe. If she has any mind left at all.

  ‘I want to be here,’ I said.

  ‘I know.’

  The nurse returned. Replaced the pump. Rethreaded the fluid line and set a new rate. Warm, sweet, salt water ran, a drop at a time, through the giving set. Because that’s all that can be done until her liver chews through the yellow death and throws it out. And then we will know.

  I was never any good at waiting.

  ‘Come in at seven,’ Eric said, when the nurse had gone. ‘If she looks like she’s going to wake up before then, I’ll call your mobile.’

  The vet school is quite different during working hours. Even at eight o’clock in the morning, midway through the Easter break and with half of the clinical staff away at Congress, the place was teeming. Lights were on in places I had forgotten lights could go on. Nurses in green dresses wheeled dogs on stretcher trolleys across the yard. Academics in white coats and loud ties peered into their personal organisers and spoke into mobiles and bumped blindly into cars as they made their way to laboratories tucked away amongst the rhododendrons. Catering staff emptied Transit vans full of prepackaged food into handcarts and pushed them down a ramp into the bowels of the canteen. The car park was packed.

  For the first time in my life a man in dark green uniform stopped me as I tried to park my car and asked me to describe my business. He thought seriously about ringing the front desk for confirmation when I told him I was a client. He changed his mind when I told him that my horse and my foal were under the care of Dr Nina Crawford in the horse ward. It was the name that made the difference.

  The horse ward was a haven of quiet. Hard to remember it any other way. It was the smell that brought it to life. A mixed flavour of milk-replacer and calf-scour and late-night gnome flowed from the calf pens, the ones down at the bottom end of the ward, round the corner from the empty row of loose boxes. The place where Sandy Logan spent the night with his future stallion. A buoyant, optimistic kind of smell. Infinitely better than the aerosol violets of Nina’s room. Beneath it, the reek of rancid faeces wafting down from the ICU boxes said that Rain was alive, at least, if not necessarily well.