The Dilemma

by Abbie Taylor

  ‘All right, is it?’ Dawn asked.

  Will made a face. ‘Funny taste, isn’t it? Sort of bitter.’

  ‘It’s the brand.’ Dawn’s heart was pounding. ‘It takes a bit of getting used to.’

  He shrugged. ‘If you’re thirsty enough, I suppose you’ll drink anything.’ He took another mouthful. Then a larger one, gulping it back. ‘Actually,’ he said to Eileen, ‘it’s not that bad. Sure you won’t have a cup?’

  Footsteps clacked in the street outside.

  Dawn leaped forward. She shouted to Eileen, ‘Come on. I’ll walk you home.’

  ‘What?’

  ‘Come along.’ The words came out almost as a shriek. The people passing the gate turned to look. Tim and Sue Rutledge, from number 46. Dawn hustled Eileen out of the porch. She caught a glimpse of Will’s startled face, his open mouth above the rim of the mug, but there was nothing he could do.

  ‘Evening, Dawn,’ Sue Rutledge said as Dawn and Eileen hurtled past.

  Dawn didn’t look back. She kept going, almost shoving Eileen ahead of her. She didn’t stop until they were across the road and inside Eileen’s house.

  She slammed the door behind them.

  ‘Dawn?’ Eileen’s voice was trembly. ‘Dawn, what’s happening?’

  Dawn was listening at the door. She was trembling herself. Will. Milly. The hedgehog in the playground. Again and again and again.

  ‘Dawn?’ Eileen was twisting at the buttons of her cardigan. ‘Dawn? Is everything all right?’

  Dawn was still listening, her ear pressed to the letterbox, her breaths coming in half sobs, her arms spread wide, almost hugging the door.

  ‘I think so,’ she said. ‘I think now it might be.’

  She gave it half an hour, to be sure.

  She made a cup of tea for Eileen and herself. ‘It’s all right,’ she told Eileen. ‘Will’s a distant cousin of mine. We’ve never got on. He won’t be calling around again.’ By next week, she knew, Eileen would barely remember what he had looked like. ‘Look,’ Dawn said, ‘let’s see if that crash you mentioned is on the TV.’

  She turned on Eileen’s black-and-white kitchen portable. On the screen appeared a familiar L-shaped tower block, high on a hill. In the foreground, a woman in a red jacket was shouting into a microphone, her hair blowing over her face.

  ‘… latest reports … train derailed … hundreds injured. St Iberius Hospital overwhelmed …’

  Dawn and Eileen watched in silence. Behind the woman were smoke and flames, glimpses of twisted carriages, the railway bridge partially collapsed, rubble all over the road. The camera moved back from the woman, panned over the people swarming everywhere: police with radios, men in orange vests and hard hats, hurrying with equipment.

  When the news was over, Dawn returned home. The Rutledges had long since disappeared; the street was deserted. Warily, Dawn pushed open her gate. Almost on her toes, she walked up the maroon and black tiled path. The front door was ajar. No movement showed behind the glass. Dawn stopped to listen, almost feeling the bulge in her eardrums, her hearing so hyper-acute and attuned that she knew she would hear any breath, any creak. But there was nothing.

  In the kitchen, she paused by the open drawer, dazed all over again at what had happened. But there wasn’t time now to think about it. She had other things to do. She could still stop, still turn back. It wasn’t too late to change her mind. But she could not let Will go. Clive had died because of him. Now that she knew who the blackmailer really was, why should he be allowed to get away with it when Clive had not? As long as Will was out there, she would never be safe. And nor would Mr Farnley, and nor would whatever other elderly victims Will might decide to target in the future.

  Calmly, efficiently, she did what had to be done. It did not take as long as she had expected. Afterwards, she spent some time cleaning up the kitchen. She cleared away the coffee pot and filters, wiped up the spills in the drawer and on the floor. She washed Will’s mug thoroughly, making sure to remove every last mark and stain. She didn’t want any trace of him left in her house.

  When everything was spotless, she went upstairs to change. Before leaving the bedroom, she paused to check herself in the mirror on her wardrobe door. She smoothed down her navy dress, straightened her tights, fixed her ID badge on her pocket. She refastened her belt, positioning it so that the buckle sat dead in the centre. Only when she was satisfied that everything was exactly as it should be did she gather up her bag and jacket and leave the house.

  The bus trundled on its familiar journey to the hospital. Will had been right about the traffic. The packed lines of cars moved barely an inch at a time. The few hundred yards from Tooting Bec to Trinity Road took twenty minutes to cover. At the corner of Trinity Road and Wandsworth Common, the bus was forced to stop. The road ahead was strung with blue and white police tape: Do Not Cross.

  ‘Journey terminates here,’ the driver shouted. ‘Everybody off.’

  In front of the blue and white tape, police in fluorescent yellow jackets stood directing cars and pedestrians down alternative routes. Dawn spoke to one of them.

  ‘Is this because of the crash at Clapham Junction?’

  ‘Yes, Madam. Roads need to be kept clear for emergency services.’

  ‘I’m the Matron at St Iberius.’ She lifted her badge from her uniform to show him. ‘I think they’re going to need me there tonight.’

  The policeman examined the badge. He glanced at Dawn’s uniform under her jacket. Then he lifted the blue and white tape. ‘Go ahead, Matron. All right to walk the rest?’

  ‘Of course.’

  The common was empty of people, filled instead with shadows and deep hollows. On her soft-soled shoes, Dawn hurried between the trees, flitting through the violet glow. The brightness of the glow filled up her eyes, made her feel that something was about to happen. All her lethargy and confusion flew away. The nearer she came to the hospital, the more alert she became, the straighter she walked and the faster her heart beat in her chest.

  Chapter Twenty-one

  Before she had even reached the end of Northcote Road, she saw the rows of police bikes, ambulances, blue flashing lights. Falcon Road, below the hospital, was a mass of rubble and crushed cars. From the semi-collapsed railway bridge, a train carriage hung down, dangling above the road like a sheet from a washing-line. On the bridge itself, two carriages appeared to have met head-on and driven each other into the air. The shapes formed a triangle, like a smoking wigwam against the purple sky. The smell of smoke and diesel was everywhere. The most unexpected thing was the silence. No screams, no cries of panic or pain. Just some distant clanging and the occasional faint shout from a man in orange.

  Dawn made her way around the rubble and began to climb the hill to the hospital. A group of men marched past, carrying a stretcher. One of the men held a fluid bag high in the air. Several of the injured came trudging up under their own steam, grey and ghostly in the dusk, their clothes ripped, their faces streaked with black or blood.

  At the A&E entrance, Dawn had to show her badge again. A line of police was keeping out everyone who wasn’t either staff or injured. Inside, the strange balloon of silence that had enveloped the bridge was abruptly punctured. The scene before her was like something from a Hieronymus Bosch painting. People lay everywhere, filthy and bleeding, some groaning on trolleys, many more sitting or lying on the floor. The tiles were littered with torn packaging, empty fluid bags, bloodstained dressings. Curtains whisked back and forth, revealing cubicles crammed with yet more bloodied and wounded. Alarms shrieked. Nurses rushed about, white-faced and frantic.

  ‘Where’s that O-negative?’

  ‘We need more cannulas.’

  The A&E doors crashed open. Another stretcher came barrelling through.

  ‘Crush injury,’ someone shouted. ‘We’ve had to take off his leg.’

  Maria, the small, round A&E sister, rushed at them, making slicing motions in the air with her hands. ‘We’ve got no room. Take hi
m somewhere else.’

  ‘No time, love,’ one of the stretcher-bearers said. ‘He won’t make it.’

  Dawn spoke to him. ‘Why are you still bringing people here? You can see we’re overwhelmed. There must be three hundred patients in this area at least.’

  ‘There’s nowhere else to go,’ the man in orange said. ‘The roads are impassable. We’re doing our best to clear them, but for now you’re all we’ve got.’

  Maria’s short, dark hair stood up in spikes, like a threatened hedgehog. ‘We’re almost out of dressings,’ she pleaded to Dawn. ‘And syringes. And staff. I don’t know how they think we can take any more.’

  Dawn eyed the carpet of blackened, bleeding bodies. ‘Can’t we move some patients to other parts of the hospital? Spread the load a bit?’

  ‘We’re trying to. But we’ve had so little warning. All the wards and theatres are full. There’s nowhere for them to go.’

  The doors crashed open again. Another casualty was helped through, his face streaming with blood.

  Dawn said to Maria, ‘Give me an hour or so. I’ll see what I can do.’

  She took the lift up to Forest Ward. After the chaos in A&E, the fifth-floor corridor was peaceful, more deserted even than on a normal evening. Every staff member was occupied elsewhere. The turmoil resumed as soon as Dawn entered the ward. Midway down, Elspeth, Trudy and Pam were huddled around a patient. The floor around them was spattered with blood. Frightened faces peeped around curtains as Dawn walked along the rows of beds. The whispers followed her down the ward. ‘She’s here … The Matron’s here … Everything will be all right now.’

  The patient, a young man in a filthy shirt, lay wincing on the mattress. His trousers had been slashed so that they only covered one leg. The surgical SHO, skinny and harried-looking with a pronounced Adam’s apple, was leaning his full weight on the other leg, pressing a wad of tissue paper to his groin. Blood welled through the tissue, soaking into the sheets. Trudy, looking terrified, was rummaging through the drawers of the crash trolley.

  ‘Gauze,’ the SHO snapped. ‘I need gauze, for Christ’s sake.’

  ‘What’s going on here?’ Dawn asked.

  ‘Sister.’ Elspeth swung to her, ‘A&E sent this patient up a half an hour ago … They said he was stable but he’d only been here ten minutes when his wound burst open. We can’t … the bleeding won’t stop, and I can’t find the type of dressing Dr Grove wants—’

  ‘Bottom drawer,’ Dawn said to Trudy. ‘Big cupboard in the stock room. Wide gauze and Haemostat. Hurry.’

  Trudy flew down the ward. Seconds later she was back, ripping open a package. The SHO took the gauze, folded it into a thick square and pressed it hard on to the patient’s thigh.

  ‘Bleeding’s slowing,’ he said with relief.

  ‘Keep the pressure on it,’ Dawn said. ‘I’ll call theatre and see when they can take him.’

  She phoned theatre and got the bleeding young man placed on the emergency list. ‘I don’t know yet what time it’ll be,’ Dilly, the theatre manager, said. ‘We’ll get to him when we can but we’re up to our eyes at the moment.’

  Dawn led Elspeth to her office. ‘OK. What’s been happening here?’

  ‘It’s too much, Sister.’ Elspeth was nearly crying. ‘A&E sent up three patients all at the same time; we haven’t had a chance to assess any of them properly. And then this happened. And they still keep on phoning us, insisting we take more, but we can’t do it, we can’t, we don’t have the staff or the beds, we can’t possibly—’

  ‘We can do it,’ Dawn said. ‘We just need to prioritize.’

  ‘But how—’

  ‘The first thing is to free up as many beds as we can. Get the most stable patients dressed and taken to the relatives’ room with their charts. The doctors can discharge them from there. As for the rest, essentials only for tonight. We don’t wash anyone, we don’t do any routine dressings. Here.’ She was pulling her large red Disaster Plan folder out of her drawer. ‘Put one of these stickers over every bed. Red for the sickest patients, green for the ones who’ll manage with less care. Yellow for the people we can send home. Come on. I’ll go through them with you.’

  Around the walls of her office were the Disaster Plan guidelines she had drawn up a couple of weeks ago, stating in clear steps how to triage a ward in an emergency. Dawn unpinned them and took them with her. Between them, she and Elspeth quickly triaged every patient.

  ‘You take the reds,’ Dawn told Elspeth. ‘Pam can take the greens and Trudy the yellows. At least that way you can each plan what you need to do. I’ll be back soon to help. I just need to have a quick word with the other ward managers.’

  She did a tour of all the surgical wards, handing out sheets of triage stickers and copies of her guidelines.

  ‘Essential procedures only,’ she told the staff. ‘Vitals, meds, fluids. If you need more hands, call in your off-duty staff but remember it may take them a while to get here. In the meantime, use your students. Use the patients themselves. The alert ones can help to keep an eye on their neighbours.’

  She pulled more pages from her red folder. ‘Here’s a list of what you’re most likely to run out of: syringes, needles, fluids, dressings. Stick the list up on your stock-room door and put an X beside each item as you run low. I’ll arrange for runners from Pharmacy and Central Supplies to carry stock around in bulk and check your lists regularly so you won’t have to keep phoning to re-order.’

  The ward managers almost fell on Dawn’s pages of guidelines. Some had been handling the situation better than others but those who had been struggling were utterly relieved to find that they weren’t on their own. On her way back to Forest Ward, Dawn stopped in to the ITU. Francine was grim but coping.

  ‘A&E’s just phoned,’ she said. ‘They want us to take three more. But we’ve only got two beds.’

  ‘Any possibilities for discharge?’

  ‘We’ve got one who could probably go. But I can’t see any of the wards agreeing to take him. He was only extubated this afternoon.’

  Despite the strain she was under, Francine’s manner was still gentle and unflustered, her porcelain face smooth and serene. Dawn looked at her, remembering the thoughts she had been having about this woman only a few hours before.

  ‘Send him to us,’ she said. ‘We’ll have a bed in an hour.’

  ‘Are you sure? What if he goes off again?’

  ‘If he does, he does. We’ll deal with it.’

  Francine touched her arm. ‘Bless you, Dawn.’

  She hurried away. Dawn returned to Forest Ward. Things seemed to be more under control. Elspeth, calmer again, was hanging a fluid bag for a red patient. Trudy had made up two beds already and was starting on a third. Pam was helping a green patient to the commode. Dawn’s phone rang constantly with queries from the wards and from Central Supplies. In between, she helped Elspeth with the red patients, monitoring obs, keeping fluids and feed and medications running. Francine’s ITU patient arrived, a very relaxed-looking middle-aged man who, he assured Dawn, had never felt better in his life. She put a red sticker over his bed anyway. An elderly lady with a fractured humerus came up from A&E. Dawn’s team processed her quickly and got her settled.

  At midnight, Mandy phoned.

  ‘I’ve just heard,’ she said. ‘I’ve been out all evening. How awful, Dawn. Should I come in?’

  ‘No. Thanks, Mandy, but the best thing for you to do is get a good night’s sleep. We’ll need fresh staff for tomorrow.’

  When the phone calls finally began to die down, Dawn paid another visit to A&E.

  ‘It’s getting easier.’ Maria put her hands on her hips and blew out her cheeks. ‘The wards are taking them now, so we’ve got more space. Oh, here comes another one.’ A grimy stretcher was being manhandled through the doors.

  ‘Resus room three.’ Maria led the way. She and her team converged around the patient, hanging drips, cutting off clothes. ‘Are there many more?’ she asked the team of firem
en who had carried the stretcher.

  ‘No,’ the lead fireman said. His eyes were streaming red slits in a soot-streaked face but he looked as if he hadn’t enjoyed himself so much in years. ‘We’ve been in and under every single carriage. This is the last one.’

  ‘Thank God.’

  The fireman looked at the two ward managers and tipped his hand to his forehead in a salute. ‘We’ve done our bit,’ he said. ‘Now it’s up to you.’

  It was almost four o’clock in the morning. Nine hours since the massive pile-up had occurred. But at least now they knew what they were dealing with. Now they could take a deep breath and get on with it. Back on Forest Ward, Trudy was on her knees, cleaning up the mess from around the bed of the man with the bleeding groin. He had finally gone to theatre to have his artery explored. Trudy’s thin face was white with exhaustion.

  ‘Leave that,’ Dawn said. ‘Go and have a coffee.’

  ‘But I’ve still got to—’

  ‘No, you don’t. You’ve been working flat out all night. Go and have a proper break.’

  ‘OK. Thank you, Sister.’

  Dawn felt her own fatigue in a mixture of exhilaration and nausea. Through her office window, a pale light was visible at the edges of the sky. On the bridge below, the pinprick lights of the searchers continued to bob and move. She went to the staff room and switched on the kettle to make a cup of tea. Just as she was pouring the water into her mug, an agitated voice called from outside: ‘Sister! Sister!’

  Dawn put the kettle down and hurried out again. Trudy was at the bed of the elderly lady with the fractured arm.

  ‘I just saw her as I was passing.’ She was ripping the Velcro ties from a BP cuff. ‘Her resps are forty. I can’t wake her up.’

  ‘Mrs Rycroft,’ Dawn called. Earlier the old lady had been alert, if traumatized. She had known where she was and what was happening. Now she was barely conscious, breathing in a deep, laboured way. Her eyelids flickered when Dawn called her name but that was her only response. Dawn pulled back the sheets. The first thing she noticed was that the right side of Mrs Rycroft’s chest was not moving. She took the stethoscope from the crash trolley and listened. No question about it. There was no air entry on the right.