The Dilemma

by Abbie Taylor

  ‘But he’s a senior grade.’ Dawn was crouched by the fridge, hunting for the milk. ‘And it wasn’t just Mr Benson. Other patients were neglected as well, left all morning with nothing to drink. I don’t know, Fran.’ She found the milk and stood up, closing the fridge door with her hip. ‘Clive’s been here for over two months now, but he doesn’t seem to have any interest at all.’

  It was a relief after all the drama to be able to let off steam. Dawn and Francine went back a long way. They were both sisters on the same floor, Francine on the ITU, Dawn on the surgical ward. Francine, a slim blonde, was as silvery and delicate as the porcelain dolls you saw in toy shops, wrapped in tissue paper. Her dainty appearance, however – all willowy slenderness and glamorous chignon – masked the fact that she was a shrewd ward manager who was perfectly capable of getting her own way when required. The time last year that she and Dawn had both gone for the Surgical Matron position, there’d been very little to choose between them. Dawn often wondered if the reason she had been successful was because Francine had come across in the interview as just too fragile for the post.

  ‘Some of the junior staff these days, you’ve really got to wonder,’ Francine was saying. ‘We had one recently who absolutely refused to wash her hands between patients. No matter how many times I reminded her, she’d just widen her eyes and go, “Ooh, sorry, Sister, I forgot.” Then one day she was eating her sandwich in here and kept saying there was a funny taste, and it was only when the last bite had gone in that she realized she’d got poo on her fingers.’

  ‘Blimey.’ Dawn almost choked on her mouthful of coffee.

  ‘Yes, well. Standards these days aren’t the same as yours or mine – especially yours, Dawn. The trouble is, the patients keep coming faster than ever and we’re so short-staffed. You’ve got to bite your lip sometimes, don’t you? Give this Clive person a chance. You don’t want to have to do everything yourself.’

  ‘No. That’s true.’

  Dawn finished her coffee and got up to wash her cup. Francine watched her from the small round table in the corner.

  ‘Dawn – are you all right?’

  ‘Of course. Why?’

  ‘You look tired. You’ve not been yourself for a while. Doing a full day’s work here, then going home to care for your gran on your own all night too. It can’t have been easy.’

  ‘It wasn’t so bad.’ Dawn squirted washing-up liquid into the mug. ‘Anyway, Dora refused point blank to come in to hospital. She said it was no place for the old.’

  ‘Well, she was lucky to have you, then,’ Francine said. ‘But you were back at work the day after the funeral. The day after! That’s not right, Dawn. Not healthy. Why don’t you take a break now it’s all over? Give yourself a chance to recover?’

  ‘I will do, Fran. It’s just, the ward’s quite busy at the moment. Now’s not the best time—’

  A frightened-looking face appeared around the door.

  ‘Sister Hartnett, can you come? Bed nine’s just pulled out his breathing tube.’

  ‘I’ll be right with you, Seema.’ When the nurse had gone, Francine said, ‘Look. I know where you’re coming from. I’m exactly the same. We’re both a bit … obsessive, I suppose. You have to be, or you’d never keep on top of this job. But you need something outside, too. You need to keep your perspective. Don’t give your life up for the hospital. All right, Seema.’ She was standing up from the table. ‘All right. On my way now.’

  On the bus home, looking out over the swaying trees on Wandsworth Common, Dawn thought again about what Francine had said. She had meant well, but now really wasn’t a good time to take a break. The hospital was going through a busy patch and only a couple of months ago Priya, one of her best staff, had gone on maternity leave. Clive had been hired from an agency to replace her but Dawn had never been entirely happy with him and today hadn’t helped. There was no way she could go off on holiday and leave him in charge.

  Anyway, she wasn’t tired. Far from it. In fact, she hadn’t mentioned it yet to Francine, but only recently the idea had come to her for a huge new project. One of the biggest and most complex she had ever taken on, but one which, when completed, she was convinced would be of unprecedented importance to the hospital.

  At number 59 Crocus Road, Milly came panting to the gate to greet her.

  ‘Hey, girl.’ Dawn bent to pat her. ‘How are things? How was your day?’

  Milly barked and twisted in circles, trying to present every part of her stubby body to Dawn at once. Her dark muzzle was smudged with grey but the bright, triangular Labrador eyes were still shiny and alert.

  ‘Poor old girl.’ Dawn scratched the furry chest. ‘On your own here all day. You miss Dora, don’t you?’

  She missed Dora herself. It was still so strange, to open the door into the narrow, Regency-striped hall and see no Dora bustling from the kitchen to greet her with some joke or piece of gossip: ‘Dawn, you’ll never believe what the new young man at the chemist’s said to Mrs Morton …’ Because when she pictured her grandmother now, that was how she saw her, the way she had always been, plump and cheerful and active, not the withered, pain-racked skeleton she had become. The sitting-room was back to normal now, the bed and commode and sleeping pills cleared away, the tasselled lamps and gold-coloured three-piece suite restored. Just the way they had been the day Dawn had first come to live here when she was ten years old. No more Dora lying there, faded and wasted amidst the cushions, her thin face twisted with distress. Dawn closed the door and continued on her way to the kitchen.

  After dinner, she spread the notes for her new project out over the kitchen table. The project was still in the very early stages. Still an enormous amount of work and research to do, but if it worked out as she hoped, the whole future of St Iberius could depend on it.

  The idea had come to her a couple of months ago. It had been shortly after Dora’s death. Priya had just gone on her maternity leave and Clive hadn’t yet started his contract at St Iberius. The ward had been so short-staffed that Dawn had ended up working two shifts back to back. She had come home around midnight and collapsed into bed. Towards morning she’d had the dream.

  St Iberius was on fire. Dense black smoke swirled in the corridor. The piercing shriek of the fire alarm echoed around the walls of the fire escape.

  ‘This way. This way.’ The fire officer ushered the panicking crowd towards the stairs. The patients shuffled along, leaning on the arms of the nurses, clutching their drips and oxygen masks to their chests. Behind them came the faint cries of those patients still on the ward: ‘Help! Don’t leave us!’

  ‘They can’t walk,’ Dawn said urgently. ‘How are we going to get them out?’

  ‘We can’t,’ the fire officer said. ‘We’re five flights up. We’re going to have to leave them.’

  Dawn pictured the patients struggling to escape from their beds: Mr Cantwell with his fractured spine, Mrs Murray with her emphysema, Mr Ugabe with his amputated leg. Tangled up in their blankets, unable to climb out, left with no choice but to lie there and watch in terror as the flames approached.

  She had to go back. They were her responsibility; she could not leave them. She retreated from the stairwell and turned to grope her way back towards the ward.

  ‘Sister,’ the voices cried. ‘Help us.’

  ‘I’m coming. Hold on.’ But the smoke was thicker now, charring her throat, stinging her eyes. She had to squeeze them shut and put her hands out to feel in front of her. Every time she touched something she thought she had reached the doors of the ward, but each time it turned out to be just another wall. Then the cries turned to screams as the flames reached the beds and Dawn cried out too.

  She had been very agitated when she woke. The dream had seemed so real: the hot, stinging smoke, the feelings of panic and helplessness. But once she was up and sipping a cup of tea in the kitchen in her dressing gown with the sun pouring through the frosted-glass back door, her normal, practical self returned and she could see why she
’d had the dream. The newspapers recently had been full of stories about pandemic flu. Questions had been raised in parliament: Can Our Hospitals Cope?

  Dawn had been wondering that herself. Since being promoted to Matron, she was responsible not only for the day-to-day running of her ward but also the development of future services at St Iberius. The A&E was bursting at the seams as it was, the patients stacked in rows like tins of beans at a supermarket, operations being cancelled daily for lack of beds. If something happened and the numbers of patients suddenly mushroomed, how on earth would they cope?

  St Iberius did have a Disaster Plan in place. Dawn took a copy of it home to study. But despite 200 pages of dense text, the main points it seemed to boil down to were: (1) call in extra staff and (2) divert excess patients to other hospitals. The whole approach stank of an ostrich burying its head in the sand. What if the entire city was affected and there were no other hospitals? Dawn pictured St Iberius overrun, the floors lined with groaning and bleeding patients and still more crushing through the doors. Ever since she’d had the dream, the strongest feeling had been with her. These things came in cycles. Something terrible was going to happen; it was only a matter of time. And when it did, it would be vital to be prepared.

  She worked until late in the evening, reading up on accounts of disasters in other countries, making notes about equipment shortage, power failure, infection spread. At eleven o’clock, she yawned and tidied the papers away. Milly was waiting at the back door to be let out for her run.

  The April night was damp and cool. The light from the kitchen window painted a bright yellow square on the lawn. From somewhere behind the houses, a dog barked, a lonesome sounding yip yip yip. Waiting on the step, Dawn thought again of Jack Benson, his terrified face under the oxygen mask, his harsh, desperate struggle for air, the split-second decision she’d had to make, which thankfully had turned out to be the right one. She hoped he would do OK.

  Right then, if someone had asked her, she would have said that of all the patients she’d seen that day, Jack Benson would be the one she would have most reason to remember.

  She would have been wrong.

  Chapter Two

  Dawn yawned, pressing the lift button for the fifth floor. These days it was getting harder and harder to climb out of bed. The cold, rainy weather did nothing to help; it was more like winter than the end of April. Glassy-eyed, as the lift doors closed, she took in the huge poster on the back wall: St Iberius International Research Conference. Sponsored lunch. All staff invited. For weeks, these posters had been up all over the hospital. St Iberius was extremely proud of its growing reputation as one of the top research centres of Europe. Dawn yawned again and looked at her watch: five past seven. Professor Kneebone would be just arriving for his round.

  The ward round began, as always, in the side room at the top of the ward. The professor and Dawn entered first, followed by the usual phalanx of junior doctors, nurses and students.

  ‘How are you today?’ Professor Kneebone called, very loudly and clearly, from the end of the bed.

  Mrs Ivy Walker, blinking out of her doze, stared in bewilderment at the crowd of people around her: Dawn, holding the large, red Rounds book; Professor Kneebone, short but immaculately dressed in his grey, fitted suit; Dr Coulton, the new registrar, in his pristine white coat, still with the supercilious expression on his face. Behind him was a cluster of medical students, some eager, some hiding yawns. Behind them again, the new nursing student, recognizable from her plain white tunic and trousers, stood almost flattened into the wall, plainly trying to make herself as invisible as possible.

  Professor Kneebone leaned further over the bed.

  ‘I said,’ he shouted, ‘HOW ARE YOU?’

  Mrs Walker shrank back into her pillows, clutching the sheets to her chin. Her mouth moved. A tiny, quavery voice emerged. ‘I want to go.’

  ‘Go where?’

  ‘To the South Pacific.’

  Professor Kneebone raised his eyebrows at Dawn. She touched the old lady’s thin shoulder.

  ‘She always says that. That she wants to go somewhere. She finds it hard to tell us what she really means.’

  ‘I see.’ Professor Kneebone glanced at his watch.

  ‘Well, Sister, we’ve had the results back from her scan. These pains she’s been having in her nursing home …’

  ‘Yes?’ Dawn beckoned him closer to the door, a little way away from the bed.

  ‘Bad news, I’m afraid. Ovarian cancer.’

  Dawn looked quickly at Mrs Walker, but she didn’t seem to have heard or understood. She was still gazing in confusion at the circle of faces.

  ‘Poor thing,’ Dawn said quietly. ‘How long has she got?’

  ‘A few months. At best.’

  ‘What about surgery?’ one of the medical students asked. ‘Wouldn’t that work?’

  ‘Highly unlikely,’ Professor Kneebone said. ‘And the hospital isn’t made of money. At her age … and with her Alzheimer’s Disease …’ He paused, glancing towards the bed. Then he crooked his finger for the medical student to step closer.

  ‘The thing to realize,’ he enunciated through barely moving lips, ‘is that this woman died years ago. The only problem is, her heart is still beating.’

  The students, still mostly young and idealistic, filled with dreams of saving the world, slid shocked glances at each other. But the callousness of the conversation was nothing new to Dawn. Geoffrey Kneebone was probably right about the prognosis, and whether anyone liked it or not, there was only so much money to go around. Today, however, for some reason, she found herself remembering a conversation she’d had with Dora. It was around the time her pain had begun to get worse.

  ‘Please,’ Dawn had begged her, ‘come into hospital. Just for a while. There’ll be much more we can do there to help.’

  Dora had shaken her head. ‘You’re best in your own home. No one wants you in a hospital when you’re my age.’

  ‘Of course they do.’ Dawn had sat beside her and stroked her hand. ‘Why would you think that? You’ve got as much right to be there as anyone.’

  But Dora had remained stubborn. ‘I know the way people think. I won’t go somewhere I’m seen as just a nuisance. I’d rather die here in my own house, where I belong.’

  The medical team trooped out of the side room, already shuttling Mrs Walker to the very backs of their minds. Dawn was the last to leave. She looked at the elderly woman, lying there shrunken and discarded on her pillows.

  ‘I’ll be back,’ she said softly. ‘Don’t worry. I’ll look after you.’

  After the round, Dawn took the new nursing student on a tour of the ward. Forest Ward, on the top floor of the old Victorian wing, had never been designed to be part of a hospital. St Iberius had originally been built in the 1800s as a workhouse for women and children. The long, high dormitory, with its iron-framed windows, was draughty and difficult to heat in the winter and the only privacy the thirty-odd patients had were the thin blue curtains around their beds. There was only one side room for infectious cases, well below the recommended number for a department of this size. Yet despite the inconveniences, Dawn had always loved working here. From the nurses’ desk at the top of the ward you could see every patient at a glance and know what was happening in every corner. In eighteen months’ time, the entire department was due to be relocated to the adjoining 1950s tower block as part of a multi-million-pound redevelopment programme. It would be better for the patients, of course – modern bathrooms, four people to a room instead of twenty. Still, Dawn thought, something would be lost: that feeling that you were a part of the hospital’s history, walking in the steps of all the nurses who had gone before you, helping to make St Iberius what it had become today.

  ‘This is the stock room.’ She opened the door to show the student. ‘Where we keep all our drugs and equipment. Over there is the Day Ward, where patients having minor surgery come in and go home again the same day.’

  ‘Yes, Sister.�
� The student’s voice was almost a whisper. She was a small, pale girl with brown hair cut in a feathery bob. Her thin, childlike face gave her a vapid, unfinished air. She seemed almost speechless with nerves at being shown around by the matron. Her name badge read, ‘Trudy Dawes.’

  Next to the stock room was the side room. The door had a pane of glass in the centre. Through it, Dawn saw Clive washing Mrs Walker with a sponge. The blankets were pulled all the way to the end of the bed. Mrs Walker lay shivering on the mattress, stark naked, for anyone passing to see.

  Dawn frowned. She tapped on the door and put her head around it. ‘Everything all right, Clive?’

  Clive dunked the sponge back into its basin of water, splashing droplets all over the bed. He didn’t look too happy to be interrupted. ‘She’s had an accident. I’m just cleaning her up.’

  ‘Shouldn’t you close the blinds? Mrs Walker might like some privacy.’

  ‘Blinds are broken,’ Clive said. ‘Won’t pull down all the way. Anyway, look at her.’ He jerked his head towards the bed. ‘Barmy as a fruitcake. Hasn’t got a clue where she is.’

  Dawn looked at Clive, at his sullen expression, his greasy hair straggling to his collar, the permanent three-day stubble like a dark rash around his mouth. It was people like Clive who had made Dora so afraid to come in to hospital. But it wasn’t Dawn’s policy to discipline staff in front of junior nurses or patients so all she said was, ‘Mrs Walker looks uncomfortable. Has she had her painkiller today?’

  ‘She had some morphine an hour ago.’

  ‘Well, it doesn’t seem to have worked. If you give me the morphine keys, we’ll fetch some more.’

  Dawn took the keys to the stock room next door. Trudy Dawes followed. Dawn pressed the light switch. The fluorescent ceiling bar buzzed and flickered, eventually casting a pallid gleam over the rows of spotless white surfaces, the drawers and cupboards filled with dressings, drugs, needles and syringes.