The Dilemma

by Abbie Taylor

  Geoffrey Kneebone was still eyeing her. She bent her head to write in the Rounds book. That was all she needed! To draw even more attention to herself than she had already. She forced herself to concentrate on the rest of the round.

  Afterwards, however, she was glad to return to her office and shut the door on the lot of them. She sat in her chair, facing the blank screen of her computer. This was ridiculous. Here she was again, scuttling off to hide in here like a beetle in a crack. How long was this going to go on? Angrily, she pulled the computer towards her and switched it on. For possibly the hundredth time since she had posted the money, she logged on to check her e-mails. But still there was no reply.

  Her desk phone purred. She picked up the receiver. ‘Good morning. Matron’s office.’

  ‘Dawn!’ A deep, penetrating voice in her ear. ‘Claudia here!’

  Claudia Lynch! Dawn had the distinct sensation of being in a lift whose cable had just snapped. The Director of Nursing. What did she want?

  ‘Got a minute for a quick word?’

  ‘Well—’

  ‘Excellent! I’ll be right there.’ The line went dead.

  Dawn sat holding the receiver for a further couple of seconds before slowly putting it down. Claudia never just dropped in for a ‘quick word’. She was far too busy to pay unscheduled visits to people’s offices. Claudia sent memos, communicated by post, pencilled in meetings months in advance. That was it then. She knew! Dawn had no idea how, but she did. Her desk grew fuzzy at the edges. It was strewn with pens, folders, crumpled sheets of paper. She hadn’t bothered to clear it before she left on Friday. She might as well do it now, while she was waiting. While she still had the right to be here. Her fingers felt like pieces of carpet as she dropped stray pens back into their jar, threw used Post-its into the bin, filed away documents it looked as if she wasn’t going to be needing any more.

  ‘Good morning!’ Claudia came barrelling through the door, bringing a breeze with her from somewhere even though they were not outdoors. ‘How are you today?’

  Her voice could have been heard two floors away. Even when she was just having a normal conversation with someone, Claudia always sounded as if she was shouting from a boat at sea. Probably this had been no barrier to her having risen so high in management. It was years since she had laid a hand on an actual patient, but she was well used to defending them at meetings, fighting their corner, steamrollering over everyone else’s arguments to make sure her point was heard. Her tight maroon skirt suit was more or less exactly the same colour as her cheeks.

  From the wide, stretched feeling around her eyes, Dawn guessed she must look pleading and desperate but she rose from her chair and said in as normal a voice as she could manage, ‘Good morning, Claudia.’

  ‘I’ll make this quick,’ Claudia said. ‘I know you’re busy. I just wanted a word about these burglaries.’

  ‘Burglaries?’

  ‘Yes. The ones we’ve been having lately. Jim Evans tells me your locker was broken into recently.’

  Dawn had to think back. The burglary in the locker room, when her coat had been ripped. It might have happened months ago rather than a couple of weeks. ‘Yes,’ she said. ‘Yes, that’s right.’

  ‘Well, now we’ve had a further run,’ Claudia said. ‘Three of the A&E staff have had money taken. There’ve been complaints from several of the patients. Jim Evans wants CCTV cameras installed on every floor. I agree with him, and I think the time has come to push the issue at the next budget meeting. The problem is, I’ve got a seminar in Birmingham that week. That’s what I wanted to ask you, Dawn. Will you stand in for me at the meeting? You’ll be the ideal person, since you’ve been personally affected by the issue.’

  Dawn’s brain was struggling to adjust to the swerve in proceedings. This was what Claudia had wanted?

  ‘Of course,’ she said. ‘Of course I will.’

  ‘Excellent. They’ll have to listen to you. The Matron being a victim is bound to have an impact.’ Claudia frowned. ‘You know, Dawn, I’m surprised you never mentioned it to me. I would have taken something like that very seriously.’

  ‘I know, I know.’ Dawn was still floating, high with relief. ‘I just never seemed to get around to it.’

  ‘You work too hard,’ Claudia said. ‘You should come sailing some time. Only worry on a boat is which way the wind’s blowing.’ She looked at her watch. ‘Right. I’d best be on my way. I’ve got three meetings this morning and I’m already late.’

  She was off, sweeping out of the office before Dawn even had time to register that the conversation was over. Claudia didn’t know! She knew nothing about Mrs Walker, she didn’t have a clue about anything that had happened. Light-headed, Dawn lowered herself back on to her chair. Her cheeks ached as the fake rictus grin she hadn’t even realized was there faded from her face.

  For the first time, the fuzzy ball of fear inside her hardened into a tight knot of anger. This was her office. Her ward. She should not have to be like this. Forcing a smile at every Tom, Dick and Harry who barged in on top of her. Creeping around like a scared little mouse, keeping to the corners, while all the time the blackmailer strutted about outside, thinking they were in control. Well, she’d had enough. Whether Well-wisher liked it or not, she was still the Matron here. There were some things she could do.

  She sat up, yanked open the drawer of her desk and hauled out the off-duty ledger. If this person, whoever they were, was getting some sort of sick enjoyment out of watching her squirm, they weren’t going to get it for much longer. She would go on leave. Next week, if possible. She could communicate with the blackmailer from home just as easily as she could from here, and it would be a lot easier to get through all of this away from the sensation of being constantly watched by sly, gloating eyes. She’d been going to wait until Priya was back before taking her holiday but it couldn’t be helped. Mandy could act up as ward sister, and she would ask Francine to cover for any Matron-related emergencies. Francine had prepared for the Matron interview at the same time as Dawn had so she knew the ropes.

  Dawn printed her initials into the Leave column for next week. There. That just left the rest of this week to get through. But now she had an idea for that, too. She flipped further through the ledger until she came to the section marked Night Shifts.

  Normally, ward managers and Matrons did not do night shifts. But Dawn had stayed in the habit of doing them every now and again, just to keep in touch with what went on in the hospital after hours. And she was glad now that she had, because no one would think twice about her swapping into one. There were fewer staff about at night; fewer people to have to face. She studied the rota. Two night shifts still to be covered this week; one on Friday, one on Saturday. The hospital had been going to book an agency nurse to fill them but now Dawn would do them herself. Let the agency nurse cover her day shifts instead. Perfect! She wrote in her initials. As a bonus, she noted that the other nurse covering the Friday and Saturday night shifts was Clive. Normally the last person she would want to work with, but now, ironically, out of all of her staff, probably the one person with whom she would feel at ease.

  She closed the ledger and sank back in her chair, feeling as weary as if she had single-handedly lifted every patient on the ward. But it felt good to have done something, however small, to claw back some degree of control. From outside, sixty feet below, came the familiar clanking howl as a train roared over the railway bridge. One of the more than two thousand trains a day to pass through Clapham Junction. The howling was as much a part of the background here as the hum of the patients’ voices, the rattle of the meal trolleys, the steady blip-blip-blips of the monitors and infusion pumps.

  This is my ward, Dawn thought, banging shut the drawer of her desk. My hospital. I am in charge here.

  Well-wisher’s e-mail came the next day.

  It arrived just before lunch. When Dawn switched on her computer and found the words, Attention. Matron Torridge, Forest Ward, in her inbox, she almost l
ay across her keyboard with relief. The long wait was over. No matter what was in the e-mail, she could get on now and deal with it.

  She was about to open the message when the screen blinked up a warning: This is a public network. All e-mails may be read. Dawn’s finger froze over the keyboard. Did the IT department really bother trawling through other people’s work e-mails? But she couldn’t take the chance. It would be risky, beyond reckless, to open the message here. She took her hand away from the keyboard and placed it with her other hand between her knees, squeezing the knuckles together. How was she going to last until the evening? Her pager buzzed at her belt. She looked down. Mrs Ford in bed four was waiting for her tracheostomy change. There was nothing for it now anyway but to shut down the computer and go out.

  At bed four, Elspeth was waiting with the tracheostomy trolley all set up. Trudy stood beside her, her gloved hands held in front of her in the correct, sterile, above-the-waist position. She was there as an observer only, never having seen the procedure before. Dawn couldn’t look at either of them. She went straight to the patient.

  ‘Hello, Mrs Ford. How are you feeling?’

  Mrs Ford, a thin, tough-looking woman in her fifties, wiggled her hand in the air in an apprehensive way. She couldn’t speak because of the plastic tube in her throat.

  ‘This shouldn’t take long,’ Dawn promised. ‘That tube you’ve got in at the moment keeps blocking but the new one should feel a lot more comfortable. The change might make you cough but you can squeeze my hand whenever you need to.’

  She was casting an eye over the trolley Elspeth had prepared. Sterile drapes, a fresh tracheostomy set, clean ties.

  ‘What about the suction?’ she asked.

  ‘Oops, sorry.’ Elspeth unrolled a length of tubing and attached it to the sterile, plastic suction catheter on the trolley.

  ‘OK,’ Dawn said. ‘Let’s start.’

  She still found it hard to look directly at Elspeth or Trudy. Instead, she addressed all her conversation to Mrs Ford.

  ‘Now we’re going to open the ties on your old tracheostomy. Then, just before we take the tube out, we’ll give your airway a good clean with the suction.’

  In this way, she was able to lead Elspeth through the procedure while concentrating all her attention on the patient. She watched Sheila Ford’s face, alert for any grimace or narrowing of the eyes which might indicate discomfort.

  ‘Tube’s coming out now,’ she said. ‘This might make you cough a bit.’

  It did. As the tube slid from the hole in her neck, trailing a slick of yellow mucus, Mrs Ford coughed with such violence that the force of it propelled her head right off her pillow. Her face turned purple; a tear spilled from her left eye. The harsh, hacking sounds came from two places at once: her mouth and the hole in the front of her throat. The cough was a natural, healthy reflex but it was uncomfortable for the patient and distressing to watch. Dawn glanced towards Trudy. Judging from past performances, she expected to see her turning every shade of green, perhaps even starting to sway. To her surprise, however, Trudy appeared perfectly relaxed. She stood by the trolley, still with her hands clasped, watching everything with calm interest.

  Dawn said to Mrs Ford, ‘Now the new tube is going in. You might feel some pressure. A slight pop as it goes into place – there! That’s it.’

  Mrs Ford was coughing again. Her eyes were squeezed shut. Tears rolled from under the lids. Dawn touched her hand. ‘Just tying the new tube in place. When you’ve recovered, I think you deserve a cup of tea.’

  Mrs Ford, still purple, managed to stick her thumb in the air.

  Dawn said in a professional way to Elspeth, ‘That was very smooth. Well done.’

  Elspeth said nothing but she looked pleased. She peeled off her sterile gown and gloves and began to clear the trolley. Trudy helped her, gathering up the used ties and packaging and popping them into the yellow plastic bin. She was still very composed; Mrs Ford’s coughing and discomfort appeared to have had no effect on her whatsoever. Dawn watched her as she wheeled the trolley down the ward but already her mind was beginning to wander. Now that the worst was over for Mrs Ford, all her anxiety was back. She couldn’t wait until this evening to find out what was in that e-mail. She had to read it now.

  Dawn went to the locker room and pulled her jacket on over her uniform. Down in the main hall, the queues for the WRVS shop almost reached the door. People in dressing gowns sat on the benches around the fountain, chatting to relatives or reading the papers. On the steps outside the entrance, a cluster of patients sucked frantically on cigarettes, clutching their drip poles. Dawn continued past them down the hill. Somewhere near the bus stop on St John’s Road was an internet café. She had often noticed it as she passed, though never paid it too much attention. Now that she was trying to find it, of course, she couldn’t see it anywhere. She walked up and down the pavement, studying the shop signs over the doors. Finally she found it, further from the bus stop than she had thought. The café was down a set of steps, in a windowless basement lined with computer terminals. Half of them were in use, mostly by tourists with backpacks or teenage boys busy blowing up tanks.

  ‘Number five,’ said the listless-looking youth at the counter.

  Sitting at the table, waiting for the screen to load, Dawn had the oppressive sensation that her abdominal organs were crushing right up against her diaphragm. It was hard to take a deep breath. Any second now. Any second … The possibilities flew again through her mind. The money had not arrived. The money had arrived, but the blackmailer wanted more. Well, at least she would know. At least the wait would be over and … Oh God! Oh God! Here it came. The e-mail was there on the screen. She gripped the edge of the table.

  Dear Matron,

  Thank you for your gift. I am glad we have come to an agreement.

  The money had arrived. Oh, thank God. Thank God. The letters swam about on the screen. Dawn blinked to still them, took a deep breath, read on.

  You mention in your letter that you don’t have any more money. I can understand that. However, this is such a delicate matter, I’m sure you would feel better if you thought my silence was properly guaranteed. So I have thought of something else you can do. I would like you to send me ten ampoules of Morphine Sulphate. The postal arrangement will be the same as before. The Morphine should arrive within one week. How you obtain it is up to you. It will be tricky but I know you will find a way. You are a powerful ward sister with lives in your hands.

  Sincerely,

  A well-wisher

  All right. All right. So it wasn’t over. She’d known it wouldn’t be. But her overwhelming sensation was one of relief. The money had arrived. Well-wisher was not going to report her. Not yet anyway.

  Walking back to the hospital she had a light, insubstantial feeling, as if her feet weren’t quite touching the cement. OK. So, not money. Morphine instead. To sell for money, presumably. She should be anxious; she was right back to where she’d started. Yet her head felt too flimsy and porous to grasp anything apart from the reprieve. Some idea, some notion, was hovering at the edge of her mind. There had been something odd about that e-mail. But just at the moment, Dawn was far too distracted to think what it was.

  Trudy greeted her at the doors of Forest Ward.

  ‘Sister! Oh, Sister, I’m so glad you’re back!’

  The insubstantial sensation in Dawn’s feet vanished abruptly. Now what?

  ‘What is it?’ she asked.

  ‘It’s the new girl in bed eight, Sister. She took her steroids at lunchtime but she’s just vomited them all up.’

  Dawn breathed again. Trust Trudy to make a drama out of something simple.

  ‘Not to worry,’ she said. ‘We can put in an IV.’ Her mind was back on the e-mail. In the lift on the way up she had realized what was odd about it. Ten ampoules of morphine. It was so little. A single ampoule cost the hospital, at most, about fifty pence. If the blackmailer was hoping to make money by selling it, they were in for a shock. C
learly whoever had written the message didn’t know very much about morphine. But if that was the case, why ask for it?

  Trudy was still there, trotting beside her.

  ‘I tried to tell her that, Sister. About the IV. But she’s very upset. Dr Coulton was here and said she had to have an operation tomorrow. And when she said she didn’t want one, he told her she was wasting his time—’

  Dawn paused. ‘He told her what?’

  ‘That she was wasting his time. He said if she didn’t want to listen to him, there were plenty of other patients who would love to have her bed.’

  ‘I see.’

  ‘She’s gone to the bathroom,’ Trudy said. ‘I tried to go after her but she shouted at me to go away. But I think she’s really sick, Sister. I didn’t know what to do … I …’

  Dawn said, ‘It’s all right. I’ll see her.’

  She put her jacket and bag away in her office. She knew the patient, twenty-six-year-old Danielle Jones, a lawyer who had very early on managed to acquire the label of Difficult Patient. Danielle was tall, slim and attractive with a posh, confident accent. A girl who was used to being in charge. Which was probably why, when her Crohn’s disease had started up last year, shredding the lining from her bowels and the control from her life, she had found it very difficult to cope. She had refused surgery, saying she couldn’t afford the time off work and she didn’t want a scar. But the steroids she’d been put on had made her look fat so she had stopped taking those as well. Now her condition was getting worse. This was her fourth hospital admission in six months and she was growing more and more angry. She was abusive to the staff, snapping at them that they were useless and a waste of her taxes. Most of them did their best to avoid her.

  Dawn tapped on the bathroom door.

  ‘Danielle?’

  No reply. She pushed the door open. The room was high-ceilinged and strip-lit, with four grey marble cubicles at one end and four discoloured china sinks along the other. The walls and floor were covered with tiny tiles, the grouting grimy from the years.