The Dilemma

by Abbie Taylor

  ‘It’s a pneumothorax.’ Dawn pulled the stethoscope from her ears. ‘Do you know how to set up a chest drain?’ When Trudy hesitated, she said, ‘Just get the surgical set and a trolley. I’ll show you the rest.’

  While Trudy ran to the stock room, Dawn went to the desk and paged the surgical SHO.

  ‘Grove.’ It was the harried SHO from earlier.

  ‘This is Sister Torridge on Forest Ward. We’ve got a seventy-nine-year-old lady with difficulty breathing and decreased air entry on the left. I think she needs a chest drain.’

  ‘I’m sorry,’ Dr Grove said, ‘but I can’t possibly come up right now.’

  ‘Her BP’s right down. If she’s not treated, she’ll arrest soon.’

  ‘I’ve got my hands full here.’ Dr Grove sounded even more stressed than he had earlier. ‘I’ve got seven urgent patients still waiting to be seen.’

  ‘More urgent than Mrs Rycroft?’ Dawn asked. ‘They’re younger.’

  ‘Younger?’

  ‘Yes. On a night like this, we have to prioritize. I’m sorry, Sister. I’ll be up when I can.’

  The line went dead. Dawn was left standing with the receiver in her hand. She looked over at Mrs Rycroft. The old lady breathed jerkily into her oxygen mask. Her clothes were stained and ripped but you could see how they had looked when she had first put them on. Neat brown skirt, pale lavender top, matching cardigan. There were traces of lipstick around her mouth. Mrs Rycroft might not be as young as the other patients Dr Grove had to see, but she was a woman who cared about herself and what she looked like. She had been going somewhere this evening, with plans to do something or meet someone. She had been in a major train crash and had survived it. She did not deserve to die now for the sake of a simple chest drain.

  Dawn put the receiver down, then lifted it again. She paged the senior surgeon on call.

  ‘Coulton here.’

  Dawn sighed to herself. Could their luck possibly get any worse? She repeated the story anyway. ‘I know how busy it is tonight,’ she said at the end, ‘but it’s a simple chest drain. We’ll have everything ready by the time you come. It will only take you a couple of minutes, but it could save her life—’

  Dr Coulton interrupted her. ‘Who is this, please?’

  ‘It’s Sister Torridge. On Forest Ward.’

  ‘I’m on my way.’

  To her surprise, he was there within minutes. Dawn and Trudy had the chest drain set up already. Dr Coulton listened to Mrs Rycroft’s chest. Then he pulled on a pair of sterile gloves.

  ‘Scratch coming up,’ he warned the patient.

  He took a scalpel and made an incision in Mrs Rycroft’s chest, just under the armpit. At that, she flinched and gave a loud groan.

  ‘OK. It’s OK.’ Dawn touched her arm. The groan was encouraging. It meant that despite the low BP, there was still plenty of blood flowing to Mrs Rycroft’s brain.

  Dr Coulton stretched and deepened the wound with his fingers. Then he took the chest drain and slid it in. His movements were quick, yet deft and confident; it was plain that he had done this many times before. He attached the drain to a length of tubing, the other end of which was sitting in a container of water on the floor. The water in the container frothed and bubbled as the trapped air came whooshing out of Mrs Rycroft’s chest.

  ‘BP’s coming back up,’ Trudy said, listening with the stethoscope.

  Mrs Rycroft opened her eyes. Then she started up from her pillows. ‘What’s happening? What am I doing here? Am I dead?’

  ‘You’re not dead,’ Trudy assured her. ‘You were in a train crash. But you’re going to be fine.’

  ‘My daughter.’ Mrs Rycroft was struggling to sit. ‘I was supposed to meet her. She’ll be wondering where I am.’

  ‘We’ll call her,’ Trudy soothed. ‘Just as soon as we’ve sutured your chest drain. Try to lie as still as you can until it’s done.’

  While Trudy settled Mrs Rycroft, Dr Coulton got on with stitching the drain in place. Dawn handed him the bits and pieces he needed. She said quietly, ‘Thank you for coming so quickly. I know how chaotic it’s been tonight.’

  Dr Coulton snapped off the end of the suture.

  ‘It’s thanks to you,’ he said abruptly, ‘that we’ve been able to treat half the people we have. You’ve made an enormous difference to the A&E.’

  He started on the next stitch. Dawn watched his fingers fly around the tiny knots. Did he feel any curiosity about what she had said to him the other evening? Did he wonder whether she had gone to the police about the blackmail? Or did he even remember the conversation? If he did, he gave no sign. All of his concentration was on the drain. They worked in silence, both of them so familiar with what they were doing that they knew without having to speak what came next, what was needed. When Dr Coulton had finished the last suture he glanced up for the dressing. The lamp over the bed shone full on his face. His eyelids were reddened with fatigue. Deep lines puckered the skin around his eyes, lay in grooves all down his high forehead.

  ‘What time did you start?’ Dawn asked.

  He considered. ‘Thirty-seven hours ago.’

  A pager squealed. ‘Surgical reg to A&E,’ squawked a tinny voice from Dr Coulton’s pocket. ‘Surgical reg to A&E.’

  Dr Coulton stood up, pulling off his gloves. ‘I’d better go.’ He nodded at Mrs Rycroft. ‘She should be OK now, but any worries, give me a call.’

  ‘I’ll do that. And thanks again.’

  He went off up the ward. Dawn watched his white coat disappear beyond the curtains. Beside her, Trudy was clearing up the discarded gloves and packaging.

  ‘When you’ve had your coffee,’ Dawn said to her, ‘I want you to take charge of Mrs Rycroft for the rest of the night.’

  Trudy looked uncertain. ‘But she’s a red patient—’

  ‘She’s your patient. You were the one who found her. If it weren’t for you, things could have been a lot worse.’

  Trudy flushed. She went back to settling Mrs Rycroft. Dawn watched her as she fixed the pillow, re-checked the BP, adjusted the oxygen mask, every action accompanied by a reassuring word or a gentle gesture. Where had the nervy, vapid young girl gone who had started on the ward only a few weeks ago? There was no sign of her tonight, that was for sure. That frightened child had vanished, leaving in her place this strong, competent nurse, this capable future ward manager in whose hands any patient could be sure of protection and safety.

  ‘You’ve done extremely well tonight.’ Dawn touched Trudy’s arm. ‘None of us will forget it. You should be very proud.’

  Trudy turned an even deeper shade of tomato. Dawn left her to it and returned to the staff room for her cup of tea. On the way past bed sixteen she spotted old Mr Otway, grimacing as he tried to reach a glass of water on his locker. He was one of their less sick patients so Dawn hadn’t seen much of him during the night.

  She stopped by his bed. ‘Thirsty, Mr Otway?’

  ‘Oh, Nurse, I am. My throat feels like the Sahara desert.’

  Dawn thought of her own drink, rapidly cooling in the staff room.

  ‘Come on, then,’ she said.

  She sat beside his bed and held the glass to his mouth.

  ‘Ahh.’ Mr Otway gulped down the water. ‘Lovely. Just what I needed. But I’m holding you up, Nurse. I’m sure you’ve got your job to be getting on with.’

  Dawn tilted the glass again. She settled herself more deeply into her chair.

  ‘This is my job,’ she said.

  Chapter Twenty-two

  And then, at half past seven, when she was doing the morning handover round with Mandy and Elspeth, the heavy double doors to the ward opened and two men in dark jackets walked towards the nurses’ desk.

  Very calmly, Dawn took off her gloves and her plastic apron. She said to Mandy and Elspeth, ‘I’ve got to go now. I’ll leave you to finish up here.’

  Claudia Lynch was with the two men. Most unusually for her she was not taking charge of the situation, bossing the m
en around and issuing orders in her sea-captain tones. In fact, she appeared bewildered, wringing her hands, looking much smaller and less intimidating than normal despite her violent royal blue skirt suit. As Dawn approached, one of the men stepped to meet her, holding up a badge.

  ‘Matron Dawn Torridge?’

  ‘Yes.’

  ‘Detective Sergeant James Patterson.’ His sideburns were long and pointed, like horns growing down his head the wrong way. ‘And my colleague, Detective Constable Rowland. Is there somewhere we could have a word?’

  ‘It’s extremely busy here this morning as you can see.’ Dawn looked about her. ‘Perhaps out in the hall would be best.’

  As they all trooped through the doors, Claudia caught her arm.

  ‘I found your letter,’ she hissed. ‘In my office an hour ago. But it wasn’t me who called the police, Dawn, honestly it wasn’t. I would have come and talked to you first, you know I—’

  ‘I do know, Claudia. It’s all right.’

  ‘But, Dawn.’ Claudia’s grip tightened on her arm. She hauled Dawn closer so that her mouth was almost brushing her ear. ‘Dawn, why on earth would you write that? Killing a patient! And Clive! You know you couldn’t possibly … You know you’d never …’ She swung to the two detectives. ‘There’s been a mistake,’ she said loudly. ‘Sister Torridge has been under a lot of strain recently. I’ve known this woman for years. I know how utterly incapable she is of doing anything like … like whatever she might have said.’

  ‘Claudia.’ Dawn tugged gently at her arm to free it. ‘It’s all right. Just let me deal with this.’

  ‘Sister Torridge.’ Detective Sergeant Patterson cleared his throat. ‘Just to clarify the situation. Did you write two letters, one addressed to the CEO and one to the Director of Nursing of this hospital, and at some point during the past twelve hours, post those letters through the doors of their offices?’

  ‘Yes, I did.’

  ‘Letters stating that you are responsible for the deaths of Mrs Ivy Walker and Mr Clive Geen?’

  ‘Yes.’

  ‘And the contents of these letters? Are they true?’

  ‘Yes, they are. Every word.’

  Claudia’s eyes were almost bulging out of her head. She had dropped Dawn’s arm and was holding her hands to her mouth.

  Detective Sergeant Patterson said, ‘I’m sure you realize, Matron, that we will need to discuss this further. Is there any chance you could come with us now?’

  Dawn looked back through the doors of the ward. At the nurses’ desk, Mandy was standing, clipboard in hand, directing the staff to the various patients. Her blonde hair was in a cloud around her head; she looked pink-cheeked, cheerful and in control. A nearby patient said something and Mandy turned at once and sat down on the bed. She touched the patient’s shoulder. Whatever she said to the woman, it made her sink back against her pillows and smile.

  Dawn turned back to the two detectives.

  ‘Yes,’ she said. ‘Yes, I can come.’

  They waited for her to collect her bag and jacket. Then they accompanied her down the hall. Claudia followed them, every so often uttering gaspy little intakes of breath as if she was about to say something, but nothing came out. When they entered the lift, Detective Sergeant Patterson somehow managed to take up so much space inside the doors that Claudia dropped back and didn’t attempt to join them.

  When the doors closed, Detective Sergeant Patterson said to Dawn, ‘Where is Will Coombs now?’

  ‘Bearing in mind that’s almost certainly not his real name,’ Dawn said. ‘He left my house shortly after nine o’clock last night. I don’t know where he went after that.’

  ‘We’ll need to find him and talk to him.’

  ‘Of course.’

  Dawn leaned her head against the wall of the lift. She was tired now. Very tired. But things had worked out very well. Really, she couldn’t have asked for better. She had worried when she had written the letters the previous evening that the police might come for her before the night was over, while she was still needed here. But as it happened, their timing was perfect.

  Writing the letters to Claudia and the CEO was the task that had kept her so busy last night after she had returned from Eileen’s to find the house empty and Will gone. His disappearance was no more than she had expected. By now he was probably miles away. Funny – that crazy impulse she’d had to drug him with Dora’s sleeping pills and inject him with potassium chloride. It never would have worked, of course. But it was the fact that she’d had the impulse in the first place that had made her sit down at her kitchen table yesterday evening, pick up her pen and write those two letters.

  Will, holding her head in his hands that night, the night they had gone for dinner in London. Why had he done that? Why had he bothered to pretend? Why did she think! To gain her confidence, to keep an eye on her. To get to know her and to influence whatever she might decide to do. No wonder what they’d had between them had never seemed quite real. She had been a fool, plain and simple.

  The lift doors opened. Dawn had never seen the main hall so empty at this time of the morning. The glass entrance doors were locked. Outside, on the steps, a huge crowd had gathered – relatives, journalists, reporters – all craning their necks, desperate for some sort of update. Harry Rowe, the CEO, was due at any moment to deliver a statement. Dawn and the two detectives avoided the main entrance, veering instead down the narrow side corridor past the HR and payroll offices.

  ‘I’ve been told,’ Detective Sergeant Patterson looked at Dawn, ‘that this route will bring us out at the back of the car park?’

  ‘Yes, that’s right.’

  He was so polite. She wondered what he had thought of her letters. She had done her best not to leave anything out, to describe everything as it had happened, right from the very beginning. She had written a detailed description of Will and his red Honda; she’d even had a decent stab at remembering the registration number. She had added in all of Mr Farnley’s details; it was possible that he might have other information about Will that might be helpful. Finally, she had been unsparing in the description of her own involvement in the whole affair. She had given an unflinching account of exactly what she had done to Mrs Walker and to Clive. At the top of each page, in block capitals, she had written, Dawn Torridge. Full and Frank Confession.

  As it almost was. A full and frank confession. There was only one part of the story that she had left out. Because she could not bring herself to write it down.

  Behind them came the sound of running footsteps.

  ‘Stop!’ a voice shouted. ‘Stop! Where are you taking her?’

  Dr Coulton, white coat flapping, was beside them, red-faced and out of breath.

  ‘I saw you coming out of the lift,’ he said. ‘Are you … is this the police?’

  He looked the two detectives up and down in his aggressive, surgical manner. Dawn answered for them. ‘Yes, they are.’

  ‘Well, you don’t have to go anywhere with them.’ Dr Coulton turned to Detective Sergeant Patterson. ‘Excuse me, but have you actually arrested this woman?’

  Detective Sergeant Patterson said, ‘Sir, we’d prefer if—’

  ‘She is a wonderful nurse,’ Dr Coulton said. ‘A wonderful person. Whatever she thinks she might have done. If you knew what this hospital owes her … what she has achieved here last night …’

  ‘Sir—’

  ‘Let me speak to her, just for a moment.’

  They didn’t try to stop him from drawing Dawn a few feet away, out of their hearing. It was Dawn herself who lifted her hand to stop him from saying any more.

  ‘This is for the best,’ she told him. ‘There’s a reason I’m going with them. I did something terrible—’

  ‘You killed Mrs Walker.’

  She looked at him in silent astonishment.

  Dr Coulton moved between her and the detectives, deliberately blocking her from their view.

  ‘I knew,’ he said in a low voice. ‘I always
knew. When you got so upset about her that day, about the pain she was in. And then that row you had with Clive. Of course I heard about that. Everybody did. And then her death was so unexpected … I’d seen her myself only that morning and I knew there was no reason for her to … I always wanted to talk to you about it, but I didn’t feel I knew you well enough … I never knew how to bring it up …’

  He seemed too agitated to continue. His white coat was stained and crumpled. A row of greenish smears was blotched all down one lapel. Dawn had never seen him look anything less than test-tube sterile and perfect before. The stains made him look … they made him look human.

  ‘I should have talked to you,’ he said. ‘I shouldn’t have let it come to this.’

  His pager buzzed. He ignored it, still looking at Dawn. His eyes were grey, the deep grey of a snowy sky. Funny, that. She had often noticed how light his eyes were, but never before that they were grey. Northern eyes, like hers. Used to seeing in the dark.

  ‘Dawn,’ he said, ‘Dawn … I …’

  The pager in his pocket was still buzzing and flashing. Dawn pointed to it. ‘Look,’ she said gently. ‘You’d better go back. You’re still needed here.’

  They left him holding the pager and continued on down the corridor. Dawn didn’t look back. She knew by the silence, by the lack of footsteps, that he was still standing there, staring after them, right up until they turned the corner.

  Dawn sat in the back seat of the police car beside the silent DC Rowland. Northcote Road was deserted, all the shops and galleries closed, the tables empty on the pavements under the canopies. The street had an eerie, post-apocalyptic air, as if all of the citizens had somehow been spirited away in the night. The car radio crackled. Harry Rowe was live on the steps of St Iberius.

  ‘… outstanding response by our hospital team … Death toll this morning far lower than initially feared …’

  Dawn tuned out. She found that she was thinking again about her Full and Frank Confession. Or full and frank apart from the one thing she had left out. The one thing above all else that made her know, once and for all, that this had to come to an end.