The Dilemma

by Abbie Taylor

  ‘Not too comfy, eh?’ Dawn said. ‘How did the surgery go?’

  ‘All right.’ Lewis shifted again. ‘But I’m getting a lot of pain now.’

  ‘The painkiller Mandy gave you hasn’t helped?’

  ‘Nothing’s helped. I’ve been saying it all day but I don’t think anyone believes me. But I’m not making it up, Sister. The last time was nothing like as bad as this. It’s like I’ve had the op with no anaesthetic at all.’

  ‘That last dose might just be taking a while to kick in,’ Dawn reassured him. ‘Just give it a chance and try to get some rest. I’ll come back and check on you in a little while, OK?’

  ‘OK.’

  Dawn finished the rest of her round. Many of the patients were delighted to see her.

  ‘On call this evening, Matron?’ they said. ‘Poor you. Stuck with us lot on a Friday.’ One elderly lady gripped her hand and said, ‘It’s nice to see your lovely face. I’ll know we’re in good hands tonight.’

  Afterwards, Dawn sat writing her report at the nurses’ desk. The overhead lights had been turned off, the ward lit only by the glow from the nurses’ lamp and from the individual reading lamps over the beds. Several of the patients had pulled their curtains round, transforming their cubicles into glowing blue squares.

  From the side room, Lewis called out, ‘Sister! Sister!’

  Dawn got up again and went in to him. Lewis was sweating, still moving about in the bed.

  ‘Can’t I have something?’ he pleaded. ‘I’m in agony here.’ His hair was stuck down flat to his forehead. His cheeks and eyes were scrunched up as if he was about to cry.

  ‘Still no result from the morphine?’ Dawn asked.

  ‘No. It just seems to be getting worse and worse.’

  He was actually shaking. His whole leg trembled in its bulky plaster. Dawn felt a stirring of unease. Even this soon after an operation, it was unusual to see someone in so much distress. Mandy was right: Lewis was not normally a complainer. Something was very wrong here.

  She examined Lewis’s leg. As far as she could tell through the heavy plaster, there didn’t appear to be any bleeding. She touched the tips of his toes with her finger.

  ‘Can you feel this?’

  ‘Yes.’

  ‘And this?’

  ‘Yes.’

  No nerve damage then. And his toes were warm. She reached her fingers up under the plaster to feel his pulse. The rate was up. She checked his BP: high as well, which pointed to the fast pulse being due to pain rather than to anything more sinister. Still, she didn’t like the look of him. Inside her head, a red warning light had begun to blink. Dawn had a strong suspicion that she knew what she was looking at here. Lewis had Compartment Syndrome. She hadn’t seen a case in years but it was the one complication every orthopaedic surgeon dreaded. If she was right, then Lewis was in serious danger of losing his leg.

  She didn’t let any of this show in her voice. ‘I’ll tell you what,’ she said. ‘Why don’t I ask the surgical registrar to come up and take a quick look? Just to see. And in the meantime, I’ll fetch some more painkiller for you.’

  ‘OK. But please hurry.’

  At the desk, Dawn paged the registrar. The surgeon on call was a girl called Katherine, pleasant and unflappable, easy to work with. Succinctly, Dawn outlined Lewis’s symptoms.

  ‘Shit,’ Katherine said. ‘Doesn’t sound good. I’ll come up when I can.’

  Next, Dawn went to look for Clive to get the morphine keys. She couldn’t see him at any of the beds. She checked the staff room. Normally Clive could be found there at every opportunity, watching Sky TV with his feet on the table, complaining about his ridiculous workload. But tonight his usual seat in front of the telly was empty. She tried the sluice room, the kitchen, the stock room. No sign.

  ‘Seen Clive anywhere?’ she asked Pam, busy emptying a urinary catheter bag.

  Pam clambered to her feet, balancing her brimming plastic jug. ‘I thought I saw him go out the main doors a while ago. Maybe he’s gone to the toilet?’

  ‘I’ll give him a few minutes.’

  Dawn returned to the nurses’ desk and tried to continue writing her reports. But within minutes, Lewis was calling out again.

  ‘Sister, please. You’ve got to do something. I can’t stand this.’

  ‘All right, Lewis. Coming now.’

  She got up again. Where was Clive? Surely he couldn’t still be on the loo? Dawn remembered his appearance when he had turned up earlier, his porridge-coloured face and bloodshot eyes. Even for him, he had looked appalling. Was there something more going on here than lack of hygiene? Could Clive actually be ill?

  She went to the main doors and pushed them open. This night shift was beginning to fall apart at the seams. She went down the corridor to the male locker-room and knocked on the door.

  ‘Clive?’

  No answer. She knocked again.

  ‘Clive, it’s Sister Torridge. Are you all right?’

  Still nothing. He must have gone elsewhere; maybe down to the main hall, to the vending machines. It wasn’t illegal, but he should have told her or Pam where he was going. Wards shouldn’t be left under-staffed at night without the ward manager being made aware. She was just turning away from the locker-room when she heard something: a high, humming sound, emanating from behind the door. Or not a humming exactly – more a buzzing whine, like the drone of some tiny electrical instrument.

  ‘Clive?’ No response. The code for the male locker-room was the same as for the female. Dawn keyed the numbers into the pad and opened the door, tapping all the while as she entered.

  ‘Hello? Hello?’

  The buzzing whine grew louder. The light from the hall shone over the rows of metal lockers and slatted wooden benches. There was a strong smell of socks. The room was empty but still the buzzing noise continued. There was something familiar about the sound, but for the moment Dawn couldn’t place what it was. She moved forward, turning her head from side to side, trying to gauge where the noise was coming from. It seemed to be loudest at the back of the room, just outside the door marked ‘Toilet’. The door was closed but a narrow strip of light showed from underneath. Next moment, Dawn had tripped over something lying on the floor: a wooden theatre clog. The clog flipped into the air, ricocheting off the metal leg of a bench with a ringing clang. Instantly, the buzzing noise ceased.

  ‘Clive? Is that you?’

  Silence. But in the strip of light underneath the door, a shadow moved. Someone was definitely there. Dawn went to the door and rapped on it, hard.

  ‘Clive!’

  She pushed the door open. Inside was a tiny, square room with a sink and a single flimsy toilet cubicle. Clive was at the sink, his face ghastly white behind his stubble. As Dawn entered, he turned, quickly stuffing something underneath his tunic. His elbow brushed against something on the edge of the sink. It fell to the tiles with a tinkling sound.

  ‘I’m sorry.’ Dawn’s gaze had followed the object to the floor. ‘I did knock but there was no answer. Are you all right?’

  ‘I’m fine.’

  ‘When you didn’t answer, I was worried. I thought you might be—’ Dawn broke off. ‘What is that?’ she asked. ‘That thing you’ve just dropped.’

  Clive made a lunge for the object but Dawn was nearer. Before he could bend down she had stooped and brought it up, holding it between her finger and thumb. It was a small glass ampoule. Familiar in size and shape.

  ‘What’s this?’ Puzzled, she turned it in her hands. The side of the ampoule was printed with red writing: Morphine Sulphate 10mg. The glass was unbroken. Yet, peculiarly, something was protruding from the bottom of it. A needle, sticking right through the glass, so that half of it was inside the ampoule and half out.

  Clive stuck his hand out. ‘Give that back to me. It’s mine.’

  ‘But isn’t this a morphine ampoule? From the ward?’ Dawn was still staring at the needle. Was she seeing things? How had a steel needle got through solid gl
ass?

  ‘It’s not from the ward,’ Clive said. ‘It’s my property, my business.’

  The violence of his tone made Dawn look up at him. There was something strange about his eyes. The pupils were so dilated that the irises had almost vanished. His eyes were two giant, black discs, floating on a bloodshot base.

  Irritability, alternating with lethargy … Pupils that are enlarged and then pinpoint.

  Dawn had dismissed Dr Coulton’s words as lies. Or the deluded ramblings of an arrogant know-all convinced he knew what he was talking about despite being completely on the wrong track. She knew that Clive had not broken into that safe the other night. Now, however, as she watched Clive’s peculiar, jittery performance, suddenly an awful lot of what Dr Coulton had said began to make a lot of sense.

  She said slowly, ‘You’ve been taking it, haven’t you?’

  ‘Taking what?’

  ‘Morphine. From the ward.’

  Clive gave a scornful laugh. ‘If you’re talking about that burglary, I wasn’t anywhere near here at the time.’

  ‘I don’t mean the burglary.’ One by one, the pieces were dropping into place. Clive’s attitude and behaviour. The way he seemed to hate the patients so much, yet still persisted in working there. ‘I mean you’ve been taking it bit by bit. On the days you’ve been holding the safe keys, you’ve just walked in there and helped yourself.’

  ‘That’s crap. How could I have? Check the counts. No ampoules have gone missing.’

  No, no ampoules had. Or none that she knew of. But he had been taking the morphine. And all of a sudden she knew how. She’d read about something like this happening elsewhere. There’d been a hospital in America …

  ‘You’ve been draining the morphine out of the ampoules,’ she said. ‘Replacing it with something else so no one will know, then putting the ampoules back in the safe.’

  ‘You’re off your fucking head.’

  In the American hospital, the thief had heated up a needle until it was red hot, then slid it through the glass. Afterwards, when the needle was removed, the hole had sealed up again and no one could tell that the ampoule had been tampered with. But how had Clive done it? How had he made his little hole? The air in the bathroom was cold. He couldn’t have been using any kind of heater. Dawn spun around, taking everything in, the cubicle, the sink, the bunch of morphine keys sitting between the taps. Then she looked at Clive again, still cradling the bulky object under his uniform, and she knew why the buzzing noise she’d heard had sounded so familiar.

  ‘You’ve got a drill,’ she said.

  ‘What the fuck are you talking about?’

  ‘Like a dentist’s. To drill through the glass. A tiny one obviously, but it’s there, isn’t it? That’s what you’ve been clinging on to, trying to hide it under your tunic.’

  ‘This is bollocks. Bollocks! I don’t have to explain to you what I—’

  ‘If I hadn’t interrupted you just now, you’d have taken the morphine out of this ampoule and replaced it with – what? Water? Saline? Then you’d have sealed up the hole … I don’t know how, exactly, but we haven’t noticed any leaks so you must have some way. Then you’d have put the ampoule back in the safe and no one would have been any the wiser. Except, of course—’

  Dawn stopped.

  ‘Lewis. Bloody hell! That’s why his leg’s been so painful. He’s been getting doses of morphine all day but none of them have worked and no one would believe him. And he’s not the only one, is he? Danielle, too, the girl who’s had the surgery for her Crohn’s.’ Clive tried to speak but she talked over him, her voice rising with her anger. ‘Lying there on the ward with that massive wound all down the middle of her abdomen. And she’s been getting bloody water for it! How many other—’

  She stopped again. A prickly feeling had risen in her face, hot, itchy dots spreading over the skin. Her ears tingled, filling with a rushing hiss, like the white noise from a TV, growing louder, drowning out the horror underneath.

  Mrs Walker.

  Mrs Walker, writhing in agony with a swollen, malignant tumour compressing her spine. Mrs Walker, shuddering and exhausted, getting all of that morphine, the maximum possible dose, yet all the while, hour by hour, her pain worsening and none of them able to work out why.

  Dawn gripped the edge of the door.

  ‘You bastard,’ she said in a low voice. ‘You bastard.’

  ‘Hang on—’

  ‘No. I will not hang on. I’ve let you get away with a lot of things. But by God, there’s no way you’re getting away with this.’ The morphine keys were sitting on the sink. ‘Give me those.’ She snatched them up. As she did so, Clive made a grab for the ampoule in her hand.

  ‘You give that to me, then.’

  ‘You must be joking. Let me past, please.’

  ‘You don’t understand.’ Clive’s voice was hoarse. ‘I’ve got to have it. Take the keys if you want to. Do whatever else you like. But I’ve got to have that ampoule.’

  He did look unwell. His face was the colour of cement. The skin was sludgy and damp, like that of a patient having a heart attack. But all Dawn could see was Mrs Walker, her frail body contorted with distress, her cheeks drawn, her eyes stretched with misery and despair. Clive had known – all that time, he had known. A woman, dying in torment, had been getting nothing but water to ease her pain and Clive had stood back and watched and said nothing.

  ‘I don’t want to see you on my ward again tonight.’ It was an effort even to spit the words at him. ‘You can leave now, or I can call security and have you thrown off the premises. It’s up to you.’

  She turned to leave but Clive tried to block her way. ‘You give that morphine to me. Or else—’

  ‘Or else what?’ Dawn swung back. She was so angry, she felt that if Clive had laid a finger on her right now she could have flattened him across the floor. ‘Or else what?’

  Clive backed off. He stood swaying by the sink, his head down, like some scrawny, cornered animal, glaring up at Dawn through eyes that were slitted with hatred. The red rash on his forehead flared out like a traffic light.

  ‘I think you know,’ he said. ‘You’ve had a taste of it already. But it’ll be nothing to what’ll happen if you cross me.’

  ‘You don’t frighten me,’ Dawn said. She turned again to leave. She couldn’t stay another second here with Clive in this tiny toilet, this fetid, sock-smelling air. That he could have done something like this! To a sick, defenceless patient. She could almost feel in her own body the agony Mrs Walker must have felt, the jolts of electricity, like long spears pushed down her spine. No wonder her dose of morphine had been smaller at The Beeches. They had been giving her the correct dose all along; a small amount had been all that was needed to keep her comfortable. But then she had come to St Iberius and got nothing at all. Dawn was sick at herself. How could she have missed it? How could she not have known? Her hands trembled as she went to the safe. She unlocked it and removed every ampoule of morphine from the shelf. None of them could be used now. There was no way of telling which ones Clive had tampered with. And that was another thing! Not only had he caused a great deal of suffering, he had actually put the patients’ lives at risk. By tampering with the sterile seal of the glass he had risked introducing all sorts of contamination to the ampoules. For God’s sake – he’d been doing this in the toilets! Dawn took the ampoules to her office and locked them in a drawer. In the morning she would hand them over to Claudia Lynch along with a full account of what had happened.

  Lewis was still waiting for his painkiller. Calming herself, Dawn phoned ITU to ask if she could borrow some of their morphine.

  ‘Run out, have you?’ the ITU charge nurse asked chattily.

  ‘Just think we might have a faulty batch.’ No point going into details until the proper authorities had been informed. Dawn put down the phone and went to find Pam to ask her to nip down the hall for the morphine.

  ‘Did you find Clive?’ Pam asked.

  ‘Yes. He
’s not well. I’ve sent him home.’

  ‘Oh. Right,’ Pam said. ‘I thought he looked a bit peaky earlier.’

  ‘We should manage with just the two of us for the rest of the night,’ Dawn said. ‘The ward’s been pretty quiet.’

  And now that all of the problems had been solved so suddenly, it was quiet. When Pam had left to fetch the morphine, Dawn stood in her office and felt the soft, beeping hush at her ears. And it was then, in the lamp-lit dimness, that Clive came back to her. Not to the ward, but to her mind. Swaying by the sink in the toilet, his vivid red rash shining out a warning. You’ve had a taste already. But it’ll be nothing to what’ll happen if you cross me.

  Dawn plopped on to her chair, as limp as if all her strings had been cut.

  The blackmailer. The blackmailer was Clive.

  Chapter Sixteen

  He had told her. Right there in that dingy toilet he had told her. Only she had been too caught up in her own anger and revulsion to listen. Dawn sat with her mouth open. How had it taken her this long to see?

  Clive! He’d been the first person she had thought of, almost from the moment she had got the first e-mail. She had dismissed him because he had been gone from the ward that afternoon by the time she had killed Mrs Walker. But what was to have stopped him from returning? What was to have stopped him from coming back through those doors just as easily as anyone else.

  His glare of hatred as he had faced her at the sink. You’ve had a taste already. A taste! Dawn wrapped her arms around herself, squeezing the skin on the backs of them until it hurt. Yes, by God, she’d had a taste. A taste of fear and humiliation and despair. How long had it taken him to realize exactly what he was seeing that day? He must have been thrilled. It would have been like all his Christmases arriving at once. Blackmailing her would have been sheer pleasure for him, quite apart from any financial or other rewards he might have got out of it.

  Slow down, she told herself. Slow down. She was doing it again, leaping to preposterous conclusions at the drop of a hat. She had no proof it was Clive. Up until just a couple of seconds ago she’d been convinced the blackmailer was Dr Coulton. Why would Clive have come back to the ward that day? He had been so angry; if ever there was a time he would have wanted to get away from the hospital as quickly as possible, that would have been it. His threats just now might have been nothing more than bravado.