The Dilemma

by Abbie Taylor

  The thing was, she never did that. She never put syringes into her pocket after use. She always put them in the sharps bin. Every single time; the action was as automatic to her as turning off the water when she’d had a shower or locking her door when she left the house. And she had used a 10ml syringe to give Lewis his morphine. She always used a 10ml syringe to administer morphine. There was less chance of accidentally giving an overdose.

  This 5ml syringe with its blue morphine sticker lay shining on the lawn. The same syringe that had lain in the darkness under Milly all night.

  Another few seconds of disorientation before the message clicked home.

  It’ll be nothing to what’ll happen if you cross me.

  Dawn had made herself go to bed for a while. She had been up all night and she still had to work again that evening. She did not sleep, however, but lay and watched the light move higher and higher on her bedroom wall. At 5 p.m., she got up again. She sat at the kitchen table in her dressing gown, with Milly in her usual spot in the basket near her feet.

  ‘I need to go, Mill.’ Dawn swirled her mug of cooling coffee. ‘I’ve got to get back to work.’

  The kitchen was warm from having had the sun in it all day. The sun was shining through the glass back door directly over Milly’s basket. Milly could not spend another full day here in this heat. Tomorrow, Dawn would have to do something about her. For now, all she could do was wrap her back up in her paw blanket and leave her for the night.

  She knelt by the basket. Where had Clive injected the morphine? Had he used a vein or just stuck the needle in a muscle, anywhere he could reach? It wouldn’t have been easy. Milly would have wriggled and moved about, displacing the needle before he could inject. How had Clive managed it, with his bloodshot eyes, his shaking hands? It was odd. Last night he had begged so hard for Dawn to give him the morphine. If he’d had a spare syringe of it lying about, why would he have wasted it on a dog?

  It was when Dawn began to tuck the blanket back around Milly that she saw it.

  A dark, clotted stain in the blue. The mark was new, Dawn was sure of it; she had washed that blanket only recently. She took the blanket back and examined the stain more closely. Maroon. No – dark red. She looked at Milly but could see nothing in the coal-black coat. She put the blanket to one side and ran her hands down Milly’s sides, not even sure what it was she was looking for. There! There, on Milly’s chest. A matted clump in the fur. Dawn lifted her hand and looked at her fingertips. More specks of red. She returned to the matted area of Milly’s coat, exploring it with both hands, separating the thick fur until she found them.

  Two wounds – two stab wounds – each about an inch long. One in Milly’s side, just between her ribs. One further down in her abdomen. In both places, Dawn’s finger went right through the skin and muscle and into the space beneath.

  She lifted her head, gazing into the smooth blankness of the side of the washing-machine. No, Clive had not wasted a syringe of morphine on a dog. There had been no quick, friendly injection for Milly. Her end had been a lot more painful and brutal than that. The empty blue-labelled syringe placed beneath her afterwards as a symbol only. A message. To make sure that Dawn understood.

  It’ll be nothing to what’ll happen if you cross me.

  The anger rose in her then. It sat in her like a thistle. When it was time to go, she wrapped Milly up again in her blanket.

  ‘Goodbye, Milly.’ She rested her hand on the dog’s still head. ‘I’ll see you soon.’

  She checked that there was a full bowl of water within reach, right beside the basket. A little pile of dog biscuits on the lino, the same as there had always been. It wouldn’t have seemed right to leave her there with nothing.

  With every step on her way in to work, Dawn felt larger and bulkier and more violent. Walking along the corridor to Forest Ward, her shoes seemed to punch holes in the floor. If Clive was here! If he had come in tonight! If she went on to the ward and saw his horrible bristly face and red, insect eyes twitching at her over the desk … She could hardly think. Her ears were ringing. Just as she had arrived at the bottom of the hill outside the hospital, a train had hurtled at full speed over the bridge. The deafening blast of it had smashed the circuit of her thoughts, driving them in twenty different directions. The noise was so loud that for a moment she was convinced the bridge was about to collapse. Surely it shouldn’t be shaking like that? The air was so cloudy; it was like trying to see through a thick pall of smoke. Then the train had passed on, sucking with it the noise and the smoke and the shaking, leaving behind it only the relatively peaceful hoots and rumbles of the traffic below.

  Clive was not on Forest Ward. When Dawn came through the doors there was just Pam, peacefully filing her nails at the desk, and Mandy buttoning up her cardigan, all ready to leave.

  ‘Looks like it’s going to be just the two of you tonight,’ Mandy announced as Dawn appeared. ‘Clive hasn’t shown his face yet.’

  ‘Must still be sick,’ Pam said, holding her fingers out to inspect her nails.

  Mandy sniffed. ‘Well, he should have phoned to say.’

  Dawn stood with the strap of her bag digging into her hand. Clive’s presence had been so vivid in her mind that even now she could see him, hovering in the air beside Mandy like a dark, malignant cut-out.

  ‘We’ll manage.’ She made herself sound calm. ‘We managed last night with just Pam and me.’

  Forest Ward was going through a peaceful phase. Danielle and Lewis were settled on their proper painkillers and well on the road to recovery. All the other patients were established on management plans that seemed to be working well. But long after Pam had finished seeing her half of the ward and gone to the staff room for her break, Dawn still went on prowling up and down between the rows of beds, tweaking a curtain here, an infusion pump there, letting the familiar routines and patterns ease the drumming of her heart, the sickening, acid hatred she felt for Clive. Had he sneaked up on Milly in the porch while she was asleep and simply rammed the knife into her side? Or had Milly heard him at the gate and come to greet him, wagging her tail, delighted to have a visitor in the middle of the night? Either way, her last moments: gasping in pain and shock, her eyes popping, her poor stiff hips wrenching and twisting as she struggled.

  The phone rang. Dawn picked up the receiver.

  ‘Forest Ward.’

  ‘Dawn!’ It was Francine. ‘Thought I’d find you there. I’m on tonight too.’

  ‘Right—’

  Francine interrupted her. ‘Have you heard?’

  ‘Heard what?’

  ‘Clive. Your nurse.’

  A cold little clutch at Dawn’s heart.

  ‘What about him?’

  ‘He’s in A&E,’ Francine said. ‘Been brought in as an emergency.’

  Further down the ward, an empty infusion pump began to beep a warning.

  ‘He’s taken an overdose of some kind,’ Francine said. ‘He was found a few hours ago, unconscious down an alley in Stockwell. The police reckon he was beaten up and robbed. He had no ID on him but the A&E staff recognized him. Apparently he’s a user. Track marks all over his arms and groin. Did you know?’

  ‘No.’ It was the simplest thing to say.

  ‘Well, you’d think he’d have more sense,’ Francine said. ‘Buying God knows what from some sleazy street dealer. He was seizing when he came in. A&E had to intubate him. He’s stabilizing now, apparently, but I thought you’d want to know. Thought you’d want to go down and see him.’

  ‘Yes, of course. Thanks Francine.’

  Dawn put the phone down. The infusion pump was still beeping. It was several seconds before she could gather herself enough to go and look for Pam.

  ‘Will you change that pump for me?’ she asked. ‘I’ve got to go down to A&E for a few minutes.’

  ‘Will do, Dawn.’

  Clive was in Resus Room Two, lying on a trolley under a powerful white theatre lamp. His T-shirt was slit down the front, hanging in ra
gs at his sides. Giant, circular ECG stickers covered his chest like potholes. An endotracheal tube stuck out of his mouth, connected by a hose to a nearby ventilator. The bellows of the ventilator moved up and down phht, phht, in time with the rise and fall of his lungs. The A&E SHO was with him, young and nervous, a little arrogant to hide the fact that she wasn’t quite sure what she was doing.

  ‘Clive,’ she was shouting. ‘Clive, wake up.’

  Clive’s eyes remained closed but his jaw moved in a chewing motion around the ET tube.

  ‘Coming round,’ the SHO said with satisfaction. ‘Hello, Matron,’ Graham, one of the A&E nurses said. ‘Come to see your favourite colleague?’ He winked towards Clive.

  ‘Yes, I have.’

  Clive must have heard her because his eyes opened. His gaze slid to the side. His eyes met Dawn’s and held them.

  Graham said, ‘Well, would you look at that! You’ve only been here two minutes and already you’ve got him awake. Go ahead, Matron – talk to him if you want to. I’ve got a couple of things to fetch so you can have a minute’s privacy.’

  He left the room, accompanied by the SHO. Now the only two people present were Dawn and Clive. Clive lay spotlit under the theatre lamp, like the principal actor on a stage, Dawn was in the wings, outside the circle of light. But she knew he could see her face.

  ‘You bastard.’ She spoke in a low voice. ‘You bastard. You didn’t have to kill her.’

  A column of little wrinkles appeared in Clive’s forehead. His eyes moved from side to side, as if he was searching for someone.

  ‘Looking after him, Matron?’ Graham was back. ‘See, Clive. You’re in good hands tonight.’

  Clive seemed to be trying to say something but the tube was still blocking his vocal cords. His straggly hair lay like weeds on the pillow. More hair straggled on his chest, sprouting up between the ECG stickers. The SHO appeared, fiddling with something in her hand.

  ‘Sorry, Matron,’ she said. ‘I just need to give him his antibiotic.’

  She held up a large syringe filled with a yellowish liquid. The sticker on the side of the barrel read: Augmentin. At the sight of it, Clive’s eyes grew round. He began to buck and heave on the trolley.

  ‘All right, Clive,’ the SHO said. ‘Just let us take care of this.’

  Clive began to claw at his chest. ECG stickers flew off all over the place.

  ‘What’s he doing?’ The SHO stared at him.

  The answer came suddenly to Dawn: Clive was searching for his silver chain and medallion. The one with the Penicillin Allergy warning on it. But the medallion was gone. Whoever had stolen his money and ID must have taken that as well.

  ‘It’s all right, Clive,’ the SHO soothed him. ‘This won’t take a second.’ She attached the syringe of yellow liquid to his drip. Clive stopped clawing for the medallion and reached up to his face, trying to rip the ET tube from his mouth. ‘Don’t do that,’ the SHO shouted, grabbing his hand. ‘Someone – quick. A little help here.’

  Two porters came racing into the room. They seized Clive’s arms and legs and pinned him to the trolley.

  ‘He’s very confused,’ the SHO explained. To Clive, she shouted, ‘We’re trying to HELP YOU, do you HEAR me? But you’ve got to COOPERATE.’

  ‘Annoying when they put up a fight like that, isn’t it?’ one of the porters said. ‘If they don’t know what’s happening, they should just cooperate and let you get on with your job.’

  The muscles in Clive’s throat were working. A clicky ack-ack sound came from around the ET tube. He was lying on his back, his arms immobilized. The other porter was leaning on his legs. Clive’s eyes went to Dawn’s and held them. Please, his eyes said. For God’s sake. At his sides, his hands twitched. The sight of them gave Dawn a revolted feeling, of something crawling down her spine. Those were the same hands that had written those vile e-mails. That had yanked Mrs Walker up so violently that her head banged off an iron bedstead. That had driven a knife, twice, deep into Milly’s side.

  The SHO pressed the plunger of the syringe. The movement snapped Dawn out of her mini-trance. She stepped forward. ‘No—’

  But before she could get the words out, there was a further commotion around the trolley.

  ‘What’s happening?’

  ‘He’s seizing again.’

  ‘Where’s the Lorazepam?’

  The alarms on the ventilator were buzzing and shrieking. More people came crowding into the room.

  ‘His BP’s dropping. That shouldn’t happen with a seizure.’

  ‘It’s not a seizure,’ someone else said. ‘It’s the antibiotic. Look at him. He’s having an anaphylaxis.’

  A third voice shouted, ‘No pulse. No pulse. V. Fib on the ECG.’

  There were so many people around the trolley now that Dawn couldn’t see Clive any more. There was a high-pitched whine as the defibrillator charged.

  ‘Stand back.’

  The crowd parted. As the current flowed through Clive’s chest, Dawn saw him arching upwards, his body flipping into the air like a seal’s. There was a crash as he landed back on the trolley.

  ‘Adrenaline. Quickly.’

  The A&E nurses were racing around, opening cupboards, emptying drawers. Dawn could do nothing to help them. This was their territory; they knew the routine here, where everything was, how the protocols should proceed. In this cluttered space, she was the one who was in the way. She went out to the hall to give them room. She waited by the door, listening to the terse instructions, the ripping open of packages, the further crashes as Clive’s body landed on the trolley.

  ‘Shock again, please.’

  ‘And again.’

  ‘And again.’

  She lost track of the number of times they did it. Or of how long she stood in the hall with the A&E doors sliding open and shut behind her and the draught coming and going on her neck. Finally the crashing noises stopped. Dawn waited for someone to say, ‘That was a close one!’ or, ‘Well done, Clive. You’re back with us now.’ But no one did. She listened for a long time into the stretching silence, and no one said anything at all.

  Chapter Seventeen

  She walked in her uniform in a light summer rain.

  What would she do this afternoon? Where would she go? Not to the park; not without Milly, her faithful little shadow. She kept walking, away from the hospital, away from the stop where she normally caught her bus home. She walked northwards, over cobbled streets, under low, iron bridges, past the gold pagoda in Battersea Park. Then she was at the river, the chilly grey water reflecting the glass-walled tower blocks along the bank. She crossed the first bridge she came to, turned right, walked through a garden with leafy trees overhanging the river wall. It was only when she found herself up against a set of railings surrounding a high, yellowish building that she realized she had reached Westminster Abbey.

  A line of people was filing through the black gates. Between the pillars, a sign propped on an easel read, Evensong, 3 p.m. The rain was coming harder. When had Dawn last been to church? Now was hardly the time for her to defile the place by her presence. If it felt wrong, she wouldn’t stay. But the spacious, vaulted interior was more peaceful than she had expected. The other people had made their way to the top of the church, behind the ornate gold entrance to the choir stalls. Dawn was alone in the main part of the nave. The service had started. From behind the golden doors, a mournful male voice rose and fell. She stood, unsure. In the centre of the nave were several rows of straw-seated chairs which looked as if they had been placed there for latecomers. After a short hesitation, she sat down. A middle-aged couple came tiptoeing in, whispering to each other in some foreign language, and took their seats a few chairs along. Their disposable plastic raincoats dripped on the flagstones. Behind the choir stalls, the mournful chanting continued. The up-and-down cadence was soothing, slowing the ceaseless jumble and traffic in Dawn’s head.

  Clive was dead.

  Clive was dead and she had killed him.

&nb
sp; No! No, she hadn’t! She had tried to warn the SHO. Was it her fault that the girl had been in too much of a hurry to give the antibiotic to listen? Behind the stalls, the choir launched into a hymn. The high, childish voices rose, chased each other across the high, Gothic ceiling.

  She had killed him. Clive, lying there with his arms pinned, had sought her eyes and begged her for his life. She had been the Matron, the most senior nurse there. If Clive had been any other patient, it would not have happened.

  When Mrs Walker had died, Dawn had said to herself, ‘It’s OK. It’s OK.’ Because what she had done, she had done for Mrs Walker’s benefit and for no other reason. There was no way she could say the same about Clive. There was no getting around it. What had happened last night had benefited nobody but herself.

  The thin soprano voices echoed, eerie and discordant, like the cries of ghosts. Dawn put her fingers to her ears. She hadn’t just done it for herself. She hadn’t. What about all the people Clive had mistreated and abused? The vulnerable patients in his care whom he had made miserable? Almost certainly, Mrs Walker had not been the only one, nor would have been in the future. Clive had tried to make Dawn murder someone. He had savagely stabbed a harmless, elderly dog in her own garden. How would it help, for Dawn to lose her career and everything she loved because of a person like that? How would that benefit anyone in any way?

  The grey walls rose around her. The statues and memorials between the pillars, the slabbed tombs on the floors, all in memory of prime ministers, scientists, beloved daughters. And most of all, soldiers. Everywhere you looked: the Vice Admiral of a British fleet, killed in 1716; a Major General, commemorated for services to the forces of the East India Company; a James Bringfeild, who had died in battle in 1706. All of these people had run wars or fought in them or died in them. Many of them had killed other people. Probably none of them had thought they were doing anything wrong. In fact, as the monuments demonstrated, they were now seen as heroes. If they had killed, it had been for the greater good. What was so different about this? With Clive gone, Dawn was safe, James Franks was safe, any future patients Clive might have treated were safe. Dawn could return to St Iberius and continue her job as if nothing had happened. She could go back to enjoying her work as before. Really, she could. Everything would be just as it had been.