Clinical Judgements

by Claire Rayner

  She nodded and stood looking at him as he stared down at his newspaper clipping. She had recognised it; an item that had appeared in one of the Sunday heavies about the row at the BMA between consultants and GPs, and she had been irritated by it then and still was. As far as she was concerned no one had any right or need to force a blood test for HIV on anyone. Even as a surgeon she wasn’t concerned; there had been enough discussion of the fragility of the virus and the protection conferred against it by use of normal and necessary barrier methods of surgery in operating on these patients to reassure her. She had long ago decided that should the problem arise in any of her list all she’d do was put the patient on last, so that the theatre could be carefully cleaned and sterilised afterwards, and would herself operate with a no-touch technique. She’d done her first surgical house job as an orthop under a man who was so obsessed with infection control that no one was ever allowed to set a finger inside any wound he dealt with. All instruments and nothing but instruments was the rule. Even the finest needles were threaded with forceps to hold them and their thread. A difficult technique, but it could be done and could be learned. She could operate on most things she now dealt with in the same way, of that she was certain. So she had turned the page of the newspaper and given the matter no further thought. Till now, watching Gerald Slattery carefully folding his cutting and tucking it away.

  ‘The day you were admitted the surgeon in charge was Mr Goodman Lemon,’ she said abruptly.

  He grinned at that. ‘Sounds like a recipe for a farmhouse cake. I adore baking — you must give it to me.’

  ‘If you knew him you wouldn’t be so flippant,’ she said sharply. ‘He has — strong views on a number of issues.’

  ‘And gays are one of them? Thinks we’re the scum of the earth and so forth?’ Slattery said and for the first time sounded bitter. ‘Nice to be some people.’

  ‘Yes, he’s like that. And refuses to operate on people he thinks are — gay — unless they’re HIV tested first. So we had to find a way to get you transferred to another surgeon since you refused testing. That’s why the cystoscopy. I’m sorry you had to go through such a thing —’

  ‘No harm done,’ he said. He was staring at her now very fixedly. ‘Nice to know I’m clear in there, I dare say. So you’re not scared of plague rats like me?’

  She reddened. ‘I don’t see you that way.’

  ‘Nice of you. Tell me, does this cake recipe man refuse to operate on smokers and boozers? Or doesn’t he worry about that sort of morality?’

  She raised her brows. ‘I’m not sure that —’

  ‘It’s the same sort of thing, really, isn’t it? Self-induced disease and all that, hmm? We’re treated like bloody dogs when we’re ill because they think we’ve brought it on ourselves, but not the cancers of the lung and the hobnailed livers — oh, no. They’ve got nice normal weaknesses, not like us, who find ourselves loving the wrong sort of people. Or what the cake man thinks are the wrong sort of people.’

  ‘I really can’t discuss that,’ Kate said. ‘I want only to reassure you that under my care you won’t have to have any test to which you object and I’ll do your operation tomorrow morning. Are you happy to let me?’

  ‘If you’re happy to do it, I’m grateful. I don’t want to feel worse than this. It won’t get better on its own, will it?’

  ‘It seems unlikely,’ she said. ‘We haven’t been able to reduce it — to push it back.’

  He grimaced. ‘And don’t I know it. Felt like a lump of dough I did, the way everyone kept kneading away at me. No fun at all, even though you’d think it would be. So you’re not scared of me — that’s interesting —’

  She shook her head. ‘No,’ she said. ‘I’m not scared. There’s no need to be.’

  ‘Why? Because you think you’re cleverer than the cake man at dodging the bugs or because you think I’m not infectious?’

  He looked at her very directly and his eyes seemed to glitter a little and she thought — He’s terrified. All this show and under it he’s scared silly.

  ‘Both,’ she said lightly. ‘But most of all I don’t think you’re a risk to anyone. Not after seventeen years with the same partner. This is one of your new infections, isn’t it?’

  ‘I always said I liked women,’ Gerald Slattery said and smiled at her widely, his teeth glinting in the sunlight. ‘I always say to the others when they go on about women, and some of them do, I’m afraid, some of them do, you don’t know what you’re missing. Thanks, Doctor. See you with the knife then —’

  ‘Yes,’ she said. ‘See you with the knife. Good morning.’

  Esther stopped her as she reached the end of the ward, her head down as she went on, thinking about Slattery. Should she warn the theatres now that she wanted to use a no-touch technique for the man’s operation or deal with it in a more casual sort of way tomorrow when she got there? Would Theatre Sister fuss if she told her now? Would — the thoughts were sliding around in her head and hard to control, and being interrupted by Esther was to be welcomed.

  ‘Prior,’ Esther said as Kate stopped and looked at her. ‘Have you been able to do anything about him?’

  ‘Mm?’ Kate did her best not to look stupid as she tried to remember what it was she was supposed to have done about William Prior.

  Esther sighed a little theatrically. ‘I knew you’d forget. You just hate having to transfer anyone, don’t you? You said you’d call St Kitts, see if they could take him off our hands. You know old Davies likes you and does what you want when he can. Prior really is more of a social problem than a medical one — and medically he’s bad enough.’

  Kate sighed too, remembering. ‘What’s he done now?’

  Esther giggled then, somewhat spoiling her image as a sensible ward sister. ‘I wish you’d seen it. You know that chap who was admitted last night, query renal colic? He was fairly smashed — the pethidine you wrote him up for the pain knocked him for six — and couldn’t really do anything much when it happened. But Prior was disconnected from his machine for a while — I thought he could go a night without and we’d see how stable he was — and though I’d set one of the nurses on to special him, she had to go off for a moment or two because there was a panic in the next bay, and old Prior got out of bed and decided that Mr Buries, the renal colic, was his wife. Or whatever. Anyway he climbed into the poor chap’s bed next to him and got a good deal friendlier than Buries might have expected from a total stranger, and a bearded smelly old man at that, He’s a banker or some such, apparently — very proper type. The nurse came back, thank God, and saw what was happening and got Prior out and managed to get him back to his own bed and then, clever girl, was able to persuade poor old Buries that he’d dreamed it all because of his pethidine —’ Again she giggled and Kate felt her own face crease.

  ‘But it was a close run thing. He was all set to sue the hospital, the Area Health Authority and the entire damned DHSS come to that. It’d have been as interesting a case of rape to come to court as most, wouldn’t it? Really, Kate, you’ll have to do something about him. Prior, I mean. Buries is fine — seems to have passed his stone and after he has his pyelogram done this afternoon it’s my guess we can send him on his way rejoicing. If a little ashamed of the quality of his dreams. But Prior! Will you call St Kitts, see if they’ll take him into their unit?’

  Kate shook her head. ‘Sorry, Esther — I already did. As soon as we discussed it ages ago. They’re chock-a-block, and anyway, they won’t take any of ours because I never agree to take any of theirs. I mean, you won’t, will you? So there you are. You’ll have to manage the old man as best you can. Poor devil —’

  ‘Poor devil he may be, but I’m worse off than he is,’ Esther retorted. ‘He’s a bugger to deal with. Oh, well, I thought I’d have another bash. I’ll nag the nursing office to see if I can get some extra nurses to help me out, seeing I can’t get any joy out of you.’ And she made a face and went bustling off to bawl at one of the hapless juniors down the w
ard who was standing chattering instead of working, leaving Kate to go on to her outpatient clinic still undecided about how to handle the theatre sister over Slattery’s operation.

  Oh well, she told herself as philosophically as she could as the rattling old lift took her down to the echoing basement where the outpatients waited in untidy noisy rows for her, whatever happens the man will be rid of his hernia. And that’s what matters.

  ‘And what the hell are you doing here?’ Oliver said after one stupefied moment. ‘You’re the last person I’d expected to see.’

  ‘You weren’t supposed to see me,’ Jimmy said. ‘Damn you. Why can’t you go someplace else for your morning coffee?’

  ‘Why can’t you?’ Oliver hauled his Uher on to the table and sat down facing him. ‘You’re a sneaky sod, Rhoda, you really are. I ask you for a bit of information and you come straight round here sniffing round —’

  ‘I bloody didn’t!’ Jimmy protested. ‘Here, I’ll get you some coffee. It tastes like puke, believe me, but it’s hot and wet. Hold on.’ And he went over to the counter at the end of the visitors’ canteen and began to chatter at the large woman in the flowered apron standing behind the big urn as Oliver relaxed and stretched at the table.

  Not a bad morning, he thought. An interview with Herne at last, and though the man had been unbelievably cagey, at least he’d said something; Oliver would be able to get enough of his damned pap out of the tangle of tape he’d provided to put in the finished programme and so stop anyone saying he hadn’t given the management of Old East a fair crack of the whip. That and the stuff he’d at last got out of the Professor and the demo leader — interesting woman, that — and he was well on the way to having his first half-hour show and a certain amount of the second. Not bad after only a few days on the job. And still not a word of what he was doing to Kate. That was quite an achievement.

  But he felt bad about it. They’d been together now at the Finchley Road flat for almost fifteen months and though there had been no-go areas, God knew — with Sonia in the background how could it be otherwise? — they’d never had to keep big secrets from each other. Not that this was exactly a secret, he told himself now as he watched Jimmy getting even more expansive with the flowered apron. This was work, and they’d never exchanged every detail of each other’s working day with each other, so this could hardly be called secretiveness.

  No? jeered a little part of his mind. Then why are you sneaking round so carefully watching out for her so that you can dodge her if you spot her? How can you say this job isn’t involved with hers? That damned sex-change operation is hers; when are you going to interview her about it? And he grimaced as at last Jimmy Rhoda turned away from the counter to bring the two plastic cups of coffee over to him.

  ‘I didn’t bring anything to eat. All they’ve got are those roof-tile things they call chocolate chip cookies. Disgusting. Sugar?’

  ‘No thanks. What are you doing here, Jimmy? Treated my call as a tip-off, did you?’

  ‘In a way,’ Jimmy dropped three spoonfuls of sugar into the plastic cup and stirred vigorously. ‘Not on its own, you understand. I had another tip-off as well —’

  ‘Another —’ Oliver stared at him over the rim of the cup. ‘What sort?’

  ‘Why should I tell you? You’ll scoop me and then where am I?’

  ‘Oh, shut up, idiot! I’m radio and you’re a bloody rag. You know there’s no competition involved. Different markets entirely. What tip-off?’

  Jimmy looked at him for a long moment and then sniffed hard. ‘Got to think about this. I need some more information before — Look, if I cut you in on this, will you cut me in on yours?’

  ‘How?’

  ‘Well, what’s your angle? What story are you doing? Let’s see if there isn’t meat enough on this bone for both of us and no wires crossed.’

  ‘You’re so bloody literate you amaze me,’ Oliver said. ‘If you mix your metaphors much harder you’ll come out with alphabet soup. You tell me what you’ve got, I’ll tell you if it cuts across me.’

  ‘Like hell,’ Jimmy said. ‘Do I look as though I was born yesterday? You tell me yours first —’

  Oliver sighed. ‘It’ll have to be the usual trick then. Here —’ and he pulled his notebook from his pocket and tore off a sheet. ‘Are you enough of a journalist to have a pen with you? Oh, miracle of miracles — OK, I’ll write down my angle, you write down yours and we’ll swop at the same time. Fair enough?’

  ‘What else can I do?’ Jimmy grumbled. ‘Give me a pen that’ll write, for Christ’s sake, this one’s dried up. Ta.’

  There was a little silence as they both scribbled and then when both had finished and folded their sheets of paper in half, there was a short pause as they drank coffee. And then Jimmy said, ‘OK, fish face. Hand it over.’

  ‘Simultaneously,’ Oliver said and held out his sheet of paper invitingly. After a moment, Jimmy laughed and did the same, and with a solemn nod of each head they swopped papers.

  The silence that followed was a short one, and it was Jimmy who broke it first.

  ‘Ah, shit,’ he said disgustedly. ‘I might have know it. You’ve done a bloody sight better out of this than I have. Are we at the fucking crossroads? Christ, can’t you do better than that? They used to use that one on the People back in the fifties, as I recall.’

  ‘Long memory you’ve got,’ Oliver said. ‘Considering your age —’ But the badinage was mechanical. He was staring down with a frown at the piece of paper Jimmy had scribbled on.

  ‘Useful though … Listen, there has to be more to your story than bloody cuts. That’s been done to death. Even the Guardians stopped beating that drum — in features at any rate.’

  ‘No, it was that. To start with.’ Oliver lifted his head. ‘I got a letter from a patient too. The chap I listed there as an interviewee had his operation cancelled for the fifth time, and he said this time it was to give his bed to a sex-change case. I wasn’t going to bother you with that —’

  ‘Bother me?’ Jimmy howled. ‘You bastard! Very tender-hearted you are, wanting to protect an old mate! That’s the only interesting part of the story and you bloody know it. You just didn’t want to let it go —’

  Oliver shook his head. ‘It wasn’t like that, Jimmy,’ he said and he looked up at the other with his face very straight, no hint of amusement anywhere. ‘I’m not like that and you know it. I make a deal and I keep it. We go back too far for me to pull a dirty one on you, anyway. It’s something personal —’

  ‘What, leaving out the plums from the plum pudding? That’s personal?’

  ‘Yes,’ Oliver shouted, and the woman at the urn looked across disapprovingly, and he lowered his voice. ‘Yes,’ he said again. ‘Strictly personal. But I have to tell you, since you’ve got it anyway.’

  ‘Have I ever got it,’ Jimmy said in high satisfaction. ‘Picked up one of the nurses, didn’t I? Took her out for a drink and blowout at the local Chinese — Christ, can’t these girls eat! — all the details about what was done, the lot. Verifies the patient’s word for it. She’ll be worth the money.’

  ‘You’re buying the story?’

  ‘She needs the cash,’ Jimmy said after a moment. ‘No, don’t look at me like that. It’s very easy to be high-minded when you’re in the sweet backwaters of radio. Not so easy when you’re paddling in the crappy sewers down what’s left of Fleet Street. So we’re buying —’

  ‘This nurse told you who the surgeon was?’

  ‘Did she ever — and there’s another lollipop. A woman, no less, and a doll. I saw her. Sian — the nurse — pointed her out to me in the car park. A lady surgeon with looks no woman’d be ashamed of —’

  ‘You don’t have to tell me that,’ Oliver said savagely. ‘I know that perfectly well —’

  ‘And you were holding that out on me too? Honestly, Merrall, I thought better of you. It was never your style to try to steal from under a mate’s nose. Not when you use him for cheap research when it suits
you.’

  ‘I wasn’t trying to cheat you,’ Oliver said wearily. ‘I was trying to protect myself. Listen, Jimmy, can I get you to lay off on this? It’s bad enough I’ve got to deal with it — if I’d known before I started I’d never have got so deep in. But — well, the fact of the matter is, the surgeon, Kate Sayers —’

  ‘Well?’ Jimmy squinted at him over the smoke of his cigarette, because Oliver had stopped. ‘Spit it out. If you ever want to get anything else from me, that is. Not another bloody word do I ever let you see from our morgue unless you blubber your bibful. Right now.’

  ‘I live with her,’ Oliver said. ‘She’s my — after my marriage died, I lived on my own a good while. And then I met Kate and about fifteen months ago I moved into her flat. You see what I mean? I’m in the crap up to my elbows and I’m doing all I can to try to keep my head above water. And now you’ve got hold of it —’

  ‘Oh, shit,’ Jimmy said softly. ‘Oh, shit! You poor old bugger.’

  Chapter Twenty

  Joe Allen’s was fairly quiet when they got there, pushing their way through the Covent Garden crowds, and Oliver was grateful for that. Usually they chose this particular restaurant for the fun of people-watching: the regular clientele of actors, singers and dancers were as good as a sideshow as they leapt from table to table with loud cries of welcome and much hugging; but tonight he needed time to talk and the sideshow would have been a distraction. He’d almost said as much to Kate when she had chosen the restaurant after he’d suggested dinner out on this, one of the rare evenings when she wasn’t on call; but had chickened out at the last minute. Bad enough he had to say what he would have to say; at least let her choose where they’d go. And anyway, saying nothing about his need to talk helped to put it all off for as long as possible.