by Abbie Taylor
‘Mrs Walker’s tumour is pressing on her nerves,’ Dawn explained to Trudy. ‘That’s why she’s in so much pain. Have you seen morphine administered before?’
‘No, Sister.’
‘I’ll show you.’ Dawn was unlocking a metal cupboard beside the sink. ‘Morphine is a controlled drug so there are strict rules about how it’s kept. Each day a named nurse holds these keys. Two members of staff must be present every time the safe is opened and any morphine removed must be witnessed and signed for so we can keep track of where it’s going.’
‘Yes, Sister.’
Dawn held up a glass ampoule about the size of her thumb, filled with a clear liquid, like water.
‘Notice anything?’ Dawn asked.
Trudy frowned at the ampoule. ‘There’s no lid. It’s made completely of glass. How do you open it?’
‘You break the glass.’ Dawn showed her where. ‘It’s to prevent anyone tampering with the contents. Go on, have a try. Just snap it in two.’
‘Y-yes, Sister.’
Trudy fumbled with the ampoule, her fingers slithering over the sides. She really was the most nervous student Dawn had seen in quite a while. Had she been that terrified when she’d first started? She thought back to her first morning at St Iberius, to the eager girl of eighteen, so in awe of Sister Cranmer who had seemed so grim and old. Though the frightening thing was, she couldn’t have been all that much older than Dawn was now. Seventeen years! Where on earth had they gone?
‘Well done,’ she said when Trudy finally managed to get the ampoule open. She drew the morphine up into a syringe and stuck a blue Opiate identification sticker on the side. Then she took the syringe back to Mrs Walker’s room. Clive had finished and gone. Mrs Walker was dressed again in her printed hospital nightgown, the stiff cotton floating like a giant square on her thin frame. Perspiration shone on her forehead. Her wispy, see-through hair was plastered to her scalp. The green ECG spikes on the monitor above her bed raced along: blip-blip-blip. It was clear that she was in pain. She muttered something as Dawn approached the bed.
‘What, sweetheart?’ Dawn leaned in closer. ‘What did you say?’
‘I want to go!’
‘Go where?’
‘I want to go to Dagenham.’
‘Dagenham, eh?’ Dawn couldn’t help a smile. ‘Not quite as nice as the South Pacific, is it?’
Mrs Walker mumbled something as if in defeat. Dawn felt guilty at having made fun of her, however gently. Mrs Walker’s gaze flitted constantly about the room, her eyes puzzled and unhappy, as if searching for someone. How terrible to be so alone, to find yourself in a strange place, unable to understand what was going on, surrounded by strangers, deserted by all your family and friends.
‘I’m going to give you something for the pain,’ Dawn told her. ‘It should help in a few minutes.’
She beckoned Trudy over to watch her inject the morphine into Mrs Walker’s drip.
‘It’s very important to make sure you give the right dose,’ she explained. ‘One third of all hospital complications are due to staff errors. If ever you are in doubt about something you are about to do to a patient, just remember the most basic rule of nursing: first do no harm.’
‘First do no harm. No, Sister.’
While waiting for the morphine to work, Dawn held Mrs Walker’s hand. It was like holding the cold, fragile wing of a bird. The hand was so wasted that Dawn could almost see the bones through her skin. The grey light from the window emphasized the bareness of the room. There was just the single plastic chair pushed into the corner, the bag of saline hanging from its stand, the ECG monitor mounted on its bracket over the bed. On the locker was a box of tissues and a glass of water with a set of dentures at the bottom. That was it. No books, no sweets, no homemade cards with Get well soon, Grandma printed on them. The world outside, it seemed, had forgotten that anyone was in here. Mrs Walker seemed to respond to the contact. Her frail body turned towards Dawn. The frantic blip-blip-blip on the monitor began to slow. Dawn felt the quiet, familiar satisfaction. She loved every part of her job: the technical side, the teaching, the managerial aspects. But this – just being with the patients – this was what it was really about.
‘You’ll probably want to give up your ward commitments now you’ve been promoted to Matron,’ Claudia Lynch, the Nursing Director, had told her. ‘You’ll have enough on your plate with all the admin and meetings. Leave the hands-on work to someone else. You’re above all that now.’
But Dawn had insisted on keeping her ward. Yes, it would mean a great deal of extra work. She’d have to do a lot of the admin and paperwork in her own time. But she didn’t want to end up sitting in an office filling in forms, her time taken up with endless meetings, losing touch with what was happening at the bedside. She wanted to be out there on the front line, to … well, to keep her finger on the pulse, as it were. And surely the whole point of becoming a nurse in the first place was that you enjoyed working with the patients?
And if she had a favourite type of patient, it was the elderly. Younger patients tended to be confident and informed; they had the back-up and support of family and friends. The elderly, on the other hand, were so often vulnerable and alone, yet so stoic and unwilling to complain, determined not to be a bother or a nuisance to anyone.
Mrs Walker was gripping her hand, the way Dora had gripped at the end. Dora who had refused to come in to hospital where she could have been helped. But Mrs Walker had come in. She could help her. Gently, Dawn smoothed a strand of hair from the damp forehead.
‘I’ll make you comfortable,’ she said. ‘Don’t worry. You’re in safe hands here.’
Over the next few days, however, despite regular doses of morphine, Mrs Walker’s pain seemed, if anything, to get worse. She was seized by attacks where she lay rigid and trembling in her bed, her eyes wide and staring, tiny shudders rolling all the way from her head to her toes. Dawn was increasingly drawn to her and troubled.
‘There must be something we can do,’ she said firmly one evening, collaring Professor Kneebone after the ward round.
Professor Kneebone’s plump, ski-tanned face took on a hunted look. ‘Like what? We’re all in agreement here. Her cancer isn’t for treatment.’
‘But for the pain,’ Dawn insisted. ‘What about surgery? Would something like that help?’
‘She’s too frail for surgery,’ Professor Kneebone said. ‘She’d never survive it.’
They were interrupted by Dr Coulton who had been standing to one side, flicking through Mrs Walker’s notes.
‘It says here,’ he announced, ‘that she’s on an extremely large dose of morphine. More than twice what she was on in the nursing home. I find it very strange that it’s not working. Are you sure your nurses are actually giving it to her?’
Dawn counted to five in her head. What the hell did he think they were doing with it? Squirting it under the bed? Dr Coulton was relatively new here, she reminded herself. Give him a chance. He probably didn’t realize that she was the matron.
‘I have given the morphine to her myself,’ she said pleasantly. ‘It does seem strange, I agree, but it definitely is not helping.’
‘Maybe she’s not in pain at all then,’ Dr Coulton said. ‘You do know she’s …’ He twirled his finger in the air beside his temple.
Dawn looked at him coldly. ‘I am well aware of Mrs Walker’s disability. It doesn’t mean that she can’t feel pain.’
He really was appalling. Francine, who normally got on well with all her colleagues, had no time for him either.
‘Pompous git,’ she had commented only the day before. ‘Treats the patients like lab experiments and the nurses like servants. No bedside manner whatsoever. The junior staff call him Rude Ed.’
Dawn turned back to Kneebone. ‘So what should we do?’ she asked. ‘If her cancer isn’t for treatment?’
‘Well, I don’t know.’ Professor Kneebone scratched the back of his head. ‘The only reason we admitted her in the
first place was to treat her pressure sore. Strictly speaking, the cancer is a side issue. Once the sore has improved, she’ll be going back to her nursing home.’
‘But we can’t send her back like this. Look at her. She’s in agony.’
‘I’m sorry, Sister, but I don’t see what else we can do. She can have her morphine at the home just as easily as here. No point her blocking a hospital bed that could be better used by someone else.’
Professor Kneebone was edging away, his eyes flicking towards the doors. Dawn knew perfectly well what was going through his mind. This sort of conversation was not why Geoffrey Kneebone had put himself through fourteen years of surgical training. To be fair, he was an excellent surgeon, but what he liked best was snipping away in a nice, sterile environment with Radio 4 playing in the background and the patient out cold. Actually having to deal with awake, messy people was a lot more tricky. He left that side of things to Dawn, which was why the two of them normally worked together very well. Now here she was, breaking the agreement, expecting him to deal with her half of the problem. He exited the ward as quickly as he could, a long line of white-coated doctors and students trailing behind him like spume from a motor boat. Dawn drummed her fingers on the desk. Of course she knew the pressure there was on beds. But still. Once a patient was actually in one, the least they could do was treat them properly. She had promised Mrs Walker that she would help her. There must be something she could do.
She took Mrs Walker’s enormous chart from its pigeonhole and sat down to go through it in detail. For the past few years, Mrs Walker had been resident in a nursing home called The Beeches. Dawn knew the name. She had often heard Dora talk about it with her friends.
‘Ethel Hickey had to go there after her operation,’ one of them had said. ‘They seemed to have different staff working there every week. They gave her the wrong pills, and when she tried to tell them they said it was all in her head.’
‘Janice Whitfield’s husband – you know, the one who used to be in the Army? He was sent there after his stroke. He had to go to the bathroom but they didn’t have anyone to help him, and when he had an accident he had to sit in it for five hours.’
‘The trouble is,’ Dora said, ‘I don’t think they pay their staff very well. It can’t be very pleasant, a young person like that having to clean us old ones up, can it?’
‘No. No.’
They had shaken their heads and sat in silence, their cups of tea balanced on their knees, perched like thin brown birds around Dora’s gold three-piece suite.
Dawn tightened her lips. They couldn’t send Mrs Walker back there. By the sound of things, if The Beeches had only been giving her half the morphine she was on here, they hadn’t even noticed she was in pain. What if they could find her a nicer home? The difficulty with that was, her family would have to be involved. No one had come to visit Mrs Walker on Forest Ward, and according to the letter from the Beeches she never got any visitors there either. But it was worth a try.
From the notes, she discovered that Mrs Walker’s next of kin was her niece, a Mrs Heather Warmington, of Kent. Dawn rang the number. A woman answered.
‘Mrs Warmington?’
‘Yes?’
‘This is Sister Dawn Torridge, calling from St Iberius Hospital. It’s about your aunt, Ivy Walker—’
‘Dead, is she?’
‘Well – no.’ Dawn was taken aback. ‘But she is in quite a lot of pain.’
‘Oh dear. But what can I do about it? You’re the nurse, aren’t you?’
Dawn said gently, ‘Would you like to come in and see her?’
Heather Warmington gave a curt-sounding laugh. ‘Sister, you’ve seen her. What would be the point? She wouldn’t know me from the bin man.’
Then, as if realizing how that sounded, she changed her tone. ‘Look. It’s not as if I ever even knew her that well. The only reason the social workers put me down as next of kin was because there wasn’t anyone else.’
‘She doesn’t have any other family? No children?’
‘My mum said she’d had one child but it died as a baby. And her husband’s not been around for as long as I can remember. Like I said – I hardly knew her. She lived abroad for years, didn’t keep in touch much with my mum or any of the family. And I live miles away now and I’ve got my own kids to think of, so …’ She tailed off.
‘I thought,’ Dawn said, ‘that if we changed her to another nursing home?’
‘But that’s the one the council said she had to go to,’ Heather Warmington said. ‘And if she doesn’t know where she is, then what’s the difference?’
Dawn said nothing.
Heather Warmington sighed. ‘Look,’ she said. ‘I do know Ivy was a very independent woman in her day. She travelled the world when she was young – on her own, which not many women did back then. She’d have hated to see herself the way she is now. Lying in that bed all day, not able to feed herself, not knowing who anyone is. Where’s the dignity in it? She’s eighty-four years old, for God’s sake. And now she’s got cancer. What’s the use in prolonging things? Can’t you just … you know … give her something?’
‘Mrs Warmington—’
‘I know, Sister, I know. The sanctity of life, and all that. Look, I’m sorry but I can’t stop to chat. I’ve got the kids to pick up at three.’
The line went dead.
‘The old finish-them-off routine, eh?’ Mandy, one of the other nurses was at the desk, refilling a stapler. ‘Probably wants to get her hands on the money.’
‘I doubt if there is any,’ Dawn said.
‘No?’ Mandy snapped the stapler shut. ‘Well, then perhaps she’s got a point. Sometimes you’ve got to wonder, haven’t you, where we’re going with these very old ones. But where would it end, I suppose? Next thing we’d be bumping off the more annoying relatives. And then, who knows?’ She glared towards the spot where Dr Coulton had been standing earlier. ‘Maybe even the staff. Fancy that Rude Ed saying we weren’t giving the morphine properly! Arrogant twat.’
Before her shift ended, Dawn went back to check on Mrs Walker again. Her pain still hadn’t settled. A lot of the discomfort seemed to be in her back. Dawn tried everything she could think of: rolling her from one side to the other, placing pillows beneath the knobbly spine to take the weight off. Nothing helped. She was reluctant to leave her. The evening shift only had three staff on instead of the usual daytime four. Unless there was an emergency, everyone would be far too busy to spend time with Mrs Walker. Dawn decided to stay on for a while; check on Mrs Walker again in an hour. In the meantime, she could work in her office on the Disaster Plan.
Dawn’s office, at the end of the ward, was just large enough for a desk, a narrow filing cabinet and two chairs. On the wall above her desk was a cork notice-board, pinned with cards. ‘Dear Matron. Thank you for being so kind to my father during his illness …’ ‘Dear Sister Torridge, I was dreading my operation but you made it so easy …’ ‘Dear Matron, Thank you for always seeming to know just what I needed even when I was too ill to say it …’ Normally Dawn liked having the cards there, but this evening the grateful messages seemed to mock her. She sat at her desk and opened up the large red folder in which she kept all her Disaster Plan notes. At the top of the pile was the hospital’s current plan.
In the event of a major incident, read the first page, A&E patients should form an orderly queue.
Who on earth, Dawn wondered, had written this? Clearly not someone who had ever actually worked in an A&E. Dawn had no illusions about how a panicked urban population would behave in a crisis. Hobbesian principles would apply. The hospital would be overwhelmed. There was every chance they’d have to call in the Army. Dawn couldn’t say for certain, not being privy to top government policy, but she strongly suspected that in a genuinely serious catastrophe, with nationally depleted resources, the only people eligible for treatment would be healthy, skilled men and women who were of fertile age. Everyone else would be left to take their chances. The
thought gave her an odd feeling. Under those criteria, in another few years she herself would no longer be eligible for treatment.
She put the thought away and busied herself pinning blank A3 pages around the walls of the office. She would use these to write up clear guidelines, easy to read in an emergency. She was going to assume minimal supplies, loss of electrical power, a skeleton staff. Far from being able to call in extra workers, the hospital would likely find that even those people who were supposed to be on duty would stay at home to look after their families. But for those who would still come in and want to do what they could, Dawn’s plan would aim to guide them.
She was so preoccupied that she lost all track of the time. When she next looked at the clock over her desk, it was ten past seven. She leaped up, stuffing her notes back into the folder. Milly would be waiting for her evening walk.
Elspeth, on the late shift, was sitting at the nurse’s desk, reading a copy of Hello! magazine. She nearly dropped the magazine on the floor when Dawn came out of her office.
‘Oh, Sister.’ She shoved the Hello! under an X-ray. ‘You’re still here.’
‘Just leaving now.’ Dawn kept her tone mild. ‘Everything all right?’
‘Yes, fine. Actually, I was just about to do a quick round.’
‘All right then. Have a good night.’
Dawn continued to the side room, though not before she caught Elspeth looking at her watch, an incredulous and slightly scornful expression on her smooth, tanned face. Mrs Walker lay against her pillows with her eyes closed, her head dropping forward so that her chin almost touched her chest. Her breath went in, held for a few seconds, then pushed out again with a little slump of her shoulders. The sleep was probably more due to exhaustion than to anything else, but it was better than nothing.
Outside, the evening was dim and drizzly. Dawn put up her umbrella by the blue and white NHS sign at the entrance. A breeze lifted the edge of yet another enormous, glossy poster advertising the upcoming International Research Conference. Thursday, 27 April. Tomorrow, Dawn realized. At the bottom of the hill, the railway bridge over the road clanked and rattled as a train shrieked overhead. From underneath came the hollow roar of traffic: cars, taxis, green and yellow fluorescent ambulances. The bus to Silham Vale was just approaching the stop on St John’s Road. Dawn ran to meet it.