The Dilemma

by Abbie Taylor

The stock room next door was dazzling, too bright. She had to wait for her vision to adjust so that she could see. The morphine, of course, was locked away and Mandy had the keys. But all the other drugs and medicines were in the big cupboard at the back where anybody could walk in and take them.

  Hurry. Hurry. She stood before the shelves, looking along the rows of familiar bottles. She had never thought of any of them in this context before; but that wasn’t a problem. It was just a matter of looking at things in a different way.

  Two things were important.

  First, it had to be quick. The Beeches staff might be here at any minute to collect her.

  And second, it had to be painless. Mrs Walker had been through enough.

  On the middle shelf sat a box of plastic vials. Around each vial was a scarlet label, a vivid splash of warning in the white.

  Potassium Chloride.

  In small doses, one of the most commonly used drugs on the ward. But a large dose, given quickly through a vein, would stop the heart within seconds. The only problem was, the injection could be painful. But she could add some local anaesthetic to the syringe.

  Easy. Easy. When you knew what you were doing.

  Dawn took two vials of potassium and drew them into a syringe. She added a couple of mls of local anaesthetic. Then she threw the empty vials into the sharps bin. She put the syringe in the pocket of her dress and stepped out of the room.

  The ward was peaceful. Morning visiting hour was over. From here Dawn could see the rows of patients in their beds, dozing, reading, listening to headphones. At bed fourteen, Elspeth was showing Trudy the new student how to set up a nasogastric feed. Across the floor, in the Day Ward, Mandy was covering the steady stream of admissions and discharges. Clive had left. His shift had ended at twelve thirty. Dawn had seen him with his backpack on his shoulder, slamming through the doors to the hall. It had been a relief to see him go. Apart from the nurses on duty, no other staff were about. All the pharmacists, dieticians and physiotherapists were at the research conference. The ward was the quietest Dawn had ever seen it.

  If she was a person who believed in signs, surely this would count as one?

  The side room was dim, filled with the patter of rain and the blip blip blip of the ECG. Mrs Walker lay on her pillows with her eyes closed, her fists clenched on the sheets. Her breaths came out in a hiss: Swishh, swishh, like car tyres on a wet road. At the sound of the door she moved her head.

  ‘It’s all right,’ Dawn said softly. ‘It’s only me.’

  She closed the door. Then she went to pull the blinds down over the glass. She tugged at the cord but nothing happened.

  Oh yes. Broken. Clive had said.

  Dawn paused. It was a nuisance. Through the window, she could see Mandy in the Day Ward, busy with a patient. Her back was to Dawn. The Day Ward was quite a distance away, thirty feet at least. To the right, the main ward and Elspeth and Trudy were not visible from here. To the left, the double doors to the hall were tightly closed. There was no one to look in, no one to see her. And if there was, so what? She was the Matron. She had every right to be in here.

  But the broken blind must have unsettled her, because as she approached the bed she tripped on the ECG cable. The lead was yanked from the monitor. Instantly the alarm shrieked: BLEEE-BLEEEBLEEE-BLEEEE.

  The high-pitched screech drove straight through Dawn’s head. She shot her finger out and stabbed the Alarm Silence button. The shrieking stopped. Hands shaking, she shoved the cable back into its socket. The ECG, silently now, resumed its green spiky progress across the screen. Dawn glanced again at the window. Mandy’s back was still to her. No one had come running. No one seemed to have heard. But now, as though roused by the blast of sound, a cloud of doubts had risen to flap and wheel about inside her mind.

  Was she really, seriously, thinking of doing this?

  Of course she knew why this sort of thing was illegal. Where would it end? Mandy had asked, and she was right. You couldn’t have just anyone allowed to go about killing patients. Most people simply did not have the ability – or the character – to be trusted to make that kind of decision. Imagine, heaven forbid, someone like Clive having that sort of power over people’s lives!

  But it was different for her.

  There was no point in being modest. Dawn knew that she was an exceptional nurse. All through her training she had come top in her exams, had won the gold medal at her graduation. She was the youngest Matron ever to be appointed at St Iberius; she had won the post even over Francine who, in fact, had more experience. Over the years she had come to learn that in a crisis she could trust herself. She’d been faced with some difficult decisions, decisions that many other nurses might have hesitated to make. Jack Benson, for example, only a few days ago. He might so easily have died, but thanks to what Dawn had done his life had been saved. In all her years of nursing, her instincts had never let her down.

  Mrs Walker’s clenched fist lay on the blanket. Dawn touched the back of it.

  ‘Ivy?’

  Then she jumped back. Mrs Walker had answered with a sharp intake of breath. Her shoulders drove upwards until they were right under her ears. A deep line appeared between her eyes. She held the breath for a moment, then released it with a long sound, somewhere between a sob and a sigh: ‘Aaaaah.’ Dawn let her own breath out, and felt all her doubts fly with it. It was enough. Mrs Walker was dying anyway. Dying in great pain, and it would only get worse. She was her patient, her responsibility. She would not stand here and watch her suffer and do nothing.

  She attached the syringe to the drip in Mrs Walker’s arm. Then she pressed the plunger. The local anaesthetic had done its work. Mrs Walker did not flinch. Dawn pressed the plunger the rest of the way. Going in … going in … and now it was gone, it was in, it was done; it was over. Seconds left. If that.

  At the last minute, as if for reassurance, even though she knew that none was needed, she put her hand on Mrs Walker’s.

  She had never known Ivy Walker. Never would now. But she had nursed her enough to guess a few things about her. That delicate face, now drawn and taut, had known its share of laughter. You could see the tiny lines at the corners of her eyes. She had no one in the world now, but once she had been loved. Her husband had asked her to marry him. And pressed her to him with dizzy relief when she said, ‘Yes.’ She’d had a child once, who for a little while had been the whole world to her and she to him.

  Mrs Walker’s shoulders were relaxing. The ECG spikes on the monitor were flattening and slowing. The gaps between them came longer. Dawn should leave. She should leave now, while no one was around.

  When she was thirty, Ivy Walker had stood on the gangplank of a ship, her suitcase at her feet, and gazed about her in the balmy, unfamiliar breeze. When she was twenty, men had turned to stare at her as she passed, and she had tossed her hair back and laughed and walked on. Because she had all the time in the world. And when she was two, she had sat on a kerb and played in the mud, and everyone who had seen her there with the sun in her hair and the world at her feet had felt a sharp wrench of hope and longing that they could hardly understand.

  Dawn should leave. She really should leave now.

  One final green spike on the monitor. A pause. Then the spiking ceased. All that was left were random, crazy loops trailing across the screen, like a thread fluttering in a breeze. Mrs Walker’s shoulders sank from her chin. The deep lines of suffering faded from her face.

  And still Dawn stayed, and still she held her hand. Because no one should die alone.

  Chapter Four

  It was still raining when the bus dropped her at Silham Vale. The sky was like a dark, dripping bowl upturned over London. Halfway down Crocus Road, the streetlights blinked on. The roofs of the 1930s houses, shining through the mist, appeared otherworldly, not quite real.

  In the porch of number 59, Milly yawned and pushed herself up from her rug.

  ‘Hey, girl. Hey, girl.’ Dawn crouched beside her. Milly’s chunky body
was so warm and solid and safe. Still sleepy, Milly pushed the top of her head into Dawn’s knees. They stayed like that for a while, Dawn pulling over and over at the floppy ears, Milly enjoying the unexpected massage. The tip was missing from her left ear where another dog in the home had chewed it off years ago before Dora had rescued her. After a couple of minutes, Dawn released her and stood up.

  ‘Let’s get you some dinner,’ she said.

  In the kitchen, however, the gleam of the fluorescent light on the white fridge and washing-machine made her pause. All of a sudden she was right back in the cold, clean stock room on Forest Ward.

  No one had seen her leave Mrs Walker’s side room. She had slipped into the stock room and thrown the empty potassium syringe into the sharps bin, making sure to push it right to the bottom. Then she had gone to her office and concentrated on her Disaster Plan.

  The knock came an hour later: Mandy in her pale blue tunic and trousers, her frizzy blonde hair framing her face like a halo.

  ‘Just to let you know, Dawn. Mrs Walker has passed away.’

  ‘I see.’

  The flowery thank-you cards, pinned to the board in front of her. Dear Matron, You knew what I wanted, even when I was too ill to say it …

  ‘It was the new student who found her,’ Mandy said. ‘I sent her in to see if Mrs Walker needed anything and there she was just lying there, cold. The student’s in hysterics. She came running out in a right state. She’s gone to have a bawl in the toilets. Honestly,’ Mandy rolled her eyes, ‘you’d think no one ever died in a hospital.’

  She added, ‘I didn’t call the crash team, is that all right? The notes said: Do Not Resuscitate.’

  ‘No, that’s fine.’ Dawn’s voice sounded much more casual than she had expected. In fact, all of this was happening so normally it was beginning to seem as if it was just one more natural death. Mandy, busy fixing her hair by the door, seemed so unperturbed. To her, Mrs Walker’s death was nothing more than the natural end to a life that had run its course. Which, if you thought about it, was exactly what it was.

  ‘Thanks, Mandy,’ she said. ‘I’ll let Professor Kneebone know.’

  The one tricky moment had come during the phone call.

  Professor Kneebone said, ‘Well, it’s for the best. Not going anywhere, was she? You’ll let the family know, Sister?’

  ‘Of course.’

  Dawn was about to put down the phone when Professor Kneebone added, ‘Oh, and Sister, will you inform them about the PM?’

  A sharp rattle of rain on the window.

  ‘The PM?’

  ‘Yes. Quite a sudden departure, wasn’t it? Interesting to pinpoint the cause.’

  Dawn’s hand had stiffened around the receiver. A post-mortem! The idea had never occurred to her. And why should it? Why on earth would anyone order a post-mortem on an elderly, terminally ill inpatient who must have been seen by a dozen hospital staff in the weeks before she had died?

  But of course Professor Kneebone would want a post-mortem! Of course he would want to know what had happened. It didn’t look good that Mrs Walker had died on the very day he had said she was fit to leave the hospital.

  As if from nowhere, Dawn heard her own voice, calmly addressing the receiver: ‘Yes,’ she said, ‘yes, it would be interesting to know. Of course, if you think about it, there are several reasons why she might have died.’

  ‘Well—’

  ‘What with her being so elderly,’ Dawn went on firmly, ‘and with that cancer diagnosis.’ She wasn’t even thinking about what she was saying; her brain seemed to have gone on to autopilot, the way it often did in an emergency when there wasn’t a second to be wasted. ‘And she’s been through so much already. All those tests and investigations she’d had before you came along and worked out what was going on.’

  ‘Well, you know,’ Professor Kneebone sounded pleased, ‘ovarian cancer can be tricky.’

  ‘And then, of course, the family …’

  ‘Distressing for them, you’re saying?’ She could tell by Kneebone’s tone that he was starting to lose interest. ‘It’s a good point, Sister. Well, we’ve got enough to go on, I suppose. End-stage metastatic cancer and advanced Alzheimer’s Disease. That’ll be plenty to put on the death cert.’

  ‘Of course, Professor. Whatever you think.’

  The air in the room seemed to glitter when she had hung up. She felt the way she had the time she’d gone up in the gondola on her very first skiing holiday with Kevin, and only realized when she had looked out half-way that they were suspended above a vertiginous drop down the valley. Although, now she thought about it, she remembered something: even if there had been a post-mortem, the potassium wouldn’t have shown up anyway. Or no, wait. Wasn’t it that it would have shown, but that a high potassium was so common in dying people that no one would think twice about it?

  She couldn’t remember now. It made no difference. There wasn’t going to be one anyway.

  She went to bed early that night. Usually she read for a little while before going to sleep but tonight she switched her lamp off as soon as she was under the duvet and lay gazing upwards into the dark.

  She often did this after a difficult case: spent time going over the incident, picturing the events that had led up to it, wondering if there was anything she could have done differently. Tonight, though, it was odd, but when she tried to recall the events of the afternoon there were strange gaps in her memory, like a DVD that kept skipping. She could see what had happened, see herself moving about in her navy uniform, drawing the potassium into the syringe. But she couldn’t seem to get inside herself, to remember how she had felt, what had impelled her to move on to each next step. It was as if the woman she was remembering was a completely different person altogether.

  First Do No Harm.

  Dawn shifted in the bed.

  You had no choice in this, she told herself. No choice! She had been over and over it in her mind. Everything she could think of to help Mrs Walker she had tried. She had given the maximum possible dose of morphine, discussed alternative treatments with the surgeons, tried to get the family on board. None of them had worked. Mrs Walker’s suffering had continued – and things would only have got worse for her. Dawn was not guessing; it was not speculation; she knew. She had watched Dora go through the very same thing until the pain had got so bad that Dora had said, ‘I want to die.’ Mrs Walker herself had wanted it to end. She had said to Dawn, ‘I want to go to heaven.’ How should Dawn have responded to that? Said, ‘Shh, shh, you don’t mean it,’ and walked away?

  Where would it end? Mandy had asked. Yes, the law was there for a reason. There had to be a taboo. The slope on the other side was much, much too slippery. Years of nursing had taught Dawn only too well how easy it was for hospital staff to get used to the deaths of other people, how appallingly quickly the justifications would arise as to why that sick, elderly person should not live too long, take up that hospital bed, sit on that inheritance.

  But where did the law leave someone like Mrs Walker?

  Dawn lay with her hands folded on her stomach, staring ahead of her at the bedroom window. Through the thin fabric of her curtains came the fuzzy orange glow from the streetlamp.

  Sometimes, when you were responsible for someone – when you knew for a fact that you could trust your own abilities – you had to make a decision. And what she had done, she had done in Mrs Walker’s best interests. Not for the family; not for the hospital; not for herself. But for the patient, and for the patient alone. In this one case, therefore, there was no slippery slope to apply.

  Her muscles relaxed. Her limbs grew heavy, sinking into the sheets. It had been the right thing to do. It had. Mrs Walker was safe now, free of all pain. Dawn’s eyelids drooped. The rain had started up again, a soft patter on the glass, soothing and pleasant, like the rushing of a stream.

  Something made her open her eyes again. A car, turning down Crocus Road, going somewhere, perhaps important, in the night. First came the ligh
t from the headlamps, arcing between the gap in the curtains, sweeping over the ceiling. Then the hiss of wet tyres, swishing on the tarmac.

  The stiff shoulders falling. The lines of suffering fading from her face. Swishh, swishh. It’s all right now. How peaceful her face had been.

  The St Iberius canteen was like a school gymnasium: vast, wooden-floored and slightly grubby, filled with rows of plastic chairs and melamine tables. A trellis and some ferns in china pots separated the staff seating areas from the main. At twelve thirty the noise was just building: cutlery rattling, chairs scraping, trays clashing. Staff poured through the doors in their tunics and trousers, the colours varying according to the speciality: ward nurses (pale blue), radiographers (purple), theatre staff (dark green). Giant steel vats gave off the smells of curry and goulash.

  Dawn placed a sandwich on her tray and joined the queue for the till. Behind her, a voice said, ‘Good afternoon, Sister.’

  Dawn turned. To her surprise, the speaker was Dr Coulton.

  ‘Hello,’ she said politely. What on earth did he want? This was the first time she had heard him speak to a nurse other than to be patronizing or to snap out an order.

  Everything about Dr Coulton was long and thin and pale: his bony limbs, his narrow, dolichocephalic head, his white coat, starched and pristine, despite the fact that hardly any of the other doctors wore them any more. Even his lips were little more than two white lines in his face. The light from the window gleamed on his forehead, making it seem even higher than it was. He looked like the stereotype of a mad scientist from a cartoon, plotting to blow up the world.

  ‘You know,’ he said. ‘You and I appear to have got off to a bad start the other day. Perhaps we should try again.’ He held his hand out. ‘Edward Coulton.’

  His smile showed too many teeth, as if his lips weren’t quite used to the movement. Dawn took his hand.

  ‘Dawn Torridge,’ she said.

  Dr Coulton’s teeth showed again. ‘I was very impressed,’ he said, ‘with what you did for Mr Benson the other day. It turns out you did exactly the right thing.’