Clinical Judgements

by Claire Rayner

  But now, sitting in the corner table at the back of the restaurant, well away from the area of greatest traffic and waiting for the bottle of house white they were allowing themselves, he found his determination slipping ever further away. Chickening out, he thought again as he watched Kate study the menu; it was one of the newer terms that he liked, and it certainly described the way he felt at present. Small and scrawny and feathery, that was Oliver Merrall tonight, he told himself, and reddened a little as he realised that Kate was staring at him with her brows raised in interrogation, apparently waiting for an answer of some kind.

  ‘I’m sorry,’ he said. ‘Did you say something?’

  ‘I asked you whether you were going to be adventurous tonight and have something different, or was it to be potato skins and barbecued ribs as usual?’

  ‘I don’t know,’ he said and bent his head to look at his own menu. ‘What is there?’

  ‘Most of the usual and a couple of new things — look, Oliver, what is it? You’ve been anywhere but with me tonight. Would you rather abandon ship and just go home now?’

  ‘Of course not. I’ll have the skins but I’ll try the — oh, dammit, no I won’t. The ribs’ll do fine.’

  ‘The way they always do,’ she said and pushed the menu away. ‘And I’ll have the gravadlax and the spinach salad and what else is new? Nice to be creatures of habit, I dare say. Makes you feel secure.’

  ‘Yes,’ he said and then leaned back gratefully as the wine arrived and there was an agreeable flurry of opening and pouring to occupy them. He gave their order then and, as the waiter went away, managed to smile at her.

  ‘It’s been far too long since we did this,’ he said. ‘Behaved like normal people.’

  ‘Far too long,’ she agreed. ‘So now try and do it.’

  ‘I am!’ he protested. ‘Aren’t I? Put on a sweater instead of a suit — very normal casual person, that’s me.’

  She looked dispassionately at the sweater. ‘Well, yes. E for effort at least. But it’s hardly the sort of sweater that would make most people think of normalcy.’

  He looked at the pattern of tumbling white squares that covered the black front of the sweater. ‘It was a Christmas present —’ he began and then stopped, suddenly aware of the pit he had dug for his own feet. But it was too late.

  ‘Oh,’ was all she said, but it was enough. Sonia had come into their evening as surely as if she had walked in and sat down at the table with them. Oliver could have bitten his tongue off at his own stupidity. She had given him this sweater two Christmases ago, the last they had spent together, and now he couldn’t imagine why he had put it on tonight. He hadn’t actually thought about it at the time; just been aware that the weather had changed and it was chilly after dark and so had taken the top garment in the drawer. He hadn’t, for once, thought at all about Sonia; he was far more anxious about his dilemma regarding Kate. But she didn’t know that and wouldn’t believe him if he said it; as far as she was concerned he’d done it again. But he didn’t say anything; instead he tried to pretend nothing had happened.

  Their food arrived and they began to eat, both of them clearly grateful for the distraction, and as he chewed his way through his barbecued ribs and made superficial small talk about the other people around them and the items they had read in the papers that day, Oliver let the thoughts scurry around beneath the surface of his attention, trying to work out what to say to her and precisely how to say it.

  And she, apparently as relaxed and conversational as he was, felt exactly the same. She knew he was abstracted and paying her only half his attention, and she knew with all the certainty she had in her that it was his ex-wife who had supplanted her. Again. And as she swallowed her food, tasting none of it, she thought over and over again — It’s not worth it. I love him, but it’s not worth it. We’ll have to stop all this. It isn’t me he wants; it’s her, and I can’t take it any more. I’ll have to tell him so, find the words to explain it —

  ‘Kate,’ he said as at last the waiter went away with their plates, and at the same moment she leaned forwards and said, ‘Oliver —’ and then they both laughed, and for one glorious moment there was accord between them as fragile as a soap bubble.

  And like a soap bubble it burst as soon as it had formed and she leaned back and said coolly, ‘Yes?’

  ‘No.’ He sounded almost eager. ‘You first.’

  ‘It wasn’t important.’

  ‘I’m sure it was.’

  ‘No.’

  Again there was a little silence and then he took a deep breath and began. And because he was so anxious to get it right, to explain it all to her clearly and simply so there could be no confusion, he forgot the need to explain fully, and went in head-first. And knew at once he’d got it all wrong.

  ‘Kate, you’ve got a patient in your ward — a sex-change operation. And you’ll have to hand him — or her, or whatever — over to someone else. It’s really the only way.’

  She stared at him, her face smooth with amazement. ‘What did you say?’

  ‘Believe me, Kate, I’m not trying to interfere,’ he said earnestly and leaned forwards, reaching for her hands. But she kept them firmly in her lap below the level of the tablecloth. ‘It’s just that I have information that you don’t and that’s why I had to say that —’

  ‘Then suppose you give me the information, whatever it is? And as for not interfering — you’re giving a pretty damned good imitation of it.’

  ‘Oh dammit — I knew this’d cause trouble. Look, Kate, this patient of yours — he took another man’s bed. A man who’s been on the waiting list for ages. He’s had five false calls for admission and each time he’s been told at the last minute that his operation has been cancelled. The poor devil’s nearly out of his mind with it all. That’s why there was that letter — he wrote to me, you see —’

  ‘What letter? Who wrote to you? And what has it got to do with —’ She was looking totally bewildered now and he shook his head in impatience at his own crass stupidity at explaining so badly. And to her it looked very like an expression of irritation directed at her inability to understand what his garbled account was all about. And her mouth hardened as she stared at him.

  ‘This man, Scribner, wrote me a letter,’ he said with careful patience; and again it sounded to Kate like an almost studied attack on her capacity to understand. ‘Well, not to me precisely. To anyone in the press who would take up his case. Only it was me he happened to give it to. It was — it was the night we went to dinner at Esther and Richard’s —’

  ‘Oh,’ she said noncommittally. The night he went to Sonia’s, a little voice murmured in her deeper mind. The night he went to see Sonia, even though he didn’t say he had. But I knew, I knew —

  ‘I went back to the studio to get some stuff, you remember? And he was there hanging about and he gave me this letter. I didn’t look at it for a while, though — you know how it is. Shoved it in a pocket and forgot it. So when I did read it I felt so bad about the delay I suppose I put more effort into it than I might have done — anyway, I took it up rather.’

  ‘Oh?’ she said again, still noncommittal. ‘You took it up. How?’

  ‘Went to see him. Found out what it was all about — and —’ He stopped then, awkwardly. ‘I didn’t realise at first it had anything to do with you, Kate. If I had known, I’d have talked to you right away. As it was, I wanted to keep you out of it. So I said nothing. But I set the story up with Radlett, and we’re doing a series. Four half-hour programmes —’

  ‘About this man who wrote you — didn’t write you — a letter which you put in your pocket.’

  ‘I know I’m not explaining well. It’s because I was so anxious for you to understand properly.’

  ‘I’m not precisely stupid,’ she said, and now her voice was distinctly frosty. ‘I usually manage to pick up most things I’m told.’

  ‘Of course you’re not stupid,’ he cried and then lowered his voice as the people at the adj
oining table glanced at him. ‘That was why I wanted to keep you out of it. As I said, I set up these programmes and now there’s no going back. Because now another chap’s got hold of the story — someone from the Globe — and it’d take the last trump to stop him from following up. I tried to persuade him, but it’s too good a story. Anyway the chap himself wants to sell his story — needs money I gather because he’s lost his job —’

  ‘Who?’ Kate almost wailed it. ‘The man who didn’t write you a letter?’

  ‘I’m sorry. No, Hynes. Your patient Hynes.’

  Now she stiffened. ‘You know this patient of mine?’

  ‘Not yet. I mean, we haven’t met. But I know all about him. Her, now I suppose I should say.’ He stopped then and made a face. ‘It’s a nasty business, Kate, isn’t it? Why on earth are you doing cases like that? You’ll be better off without him, surely?’

  She raised her brows at him. ‘Really? You find Kim distasteful in some way?’

  ‘Anyone would. There’s something unremittingly sleazy, isn’t there, about sex changes? Real News of the Screws stuff — cheap and tawdry —’

  ‘You of course have a great deal of experience in such matters.’ Her voice dripped ice now and he stared back at her miserably.

  ‘Oh, shit, Kate — I’ve really cocked this up, haven’t I?’

  ‘Have you? Isn’t that what you intended to do? First you point out that you’re wearing one of Sonia’s presents, just to rub my nose in the fact that what we have isn’t of course important enough to you to make a commitment of it, and then you remind me, oh so delicately, of the night you went and — let’s say spent time with her instead of coming back to bed with me, and then you have the brass neck to tell me how to run my job. Isn’t a cock-up precisely what you intended? Because it sure as hell is what you’ve done.’

  ‘Of course it isn’t what I intended,’ he said and now anger began to bubble in him. She can’t really think, can she, that I’d deliberately try to upset her? How could she think that? ‘All I wanted to do was tell you, in the best way I could, that there’s trouble brewing. The Globe have got this story as well as me, so even if I try to hush it up — and frankly I don’t see how I can, seeing I’ve gone so far down the road and Radlett knows about it; he’ll only send someone else on it if I hand in my chips — as I say, even if I tried I couldn’t stop the row happening. This case is going to be all over the place. There’s going to be all hell let loose when people find out that not only are NHS services being cut to the bone even more than they know, but that cases like Kim Hynes are being given preference over cases like poor old Ted Scribner, ex-soldier, lonely pensioner — it’s real hearts and flowers stuff. Jimmy Rhoda’ll give it all he’s got and that’s considerable. And I don’t want you to be caught up in it. Can’t you get someone else to take the case over?’

  ‘Let’s give you the benefit of the doubt,’ she said after a long moment. ‘Let’s pretend, just for now, that you really mean what you say, and you want to protect me. Christ, Oliver, what sort of person do you take me for? What sort of doctor? Do you think I’d really dump a patient just because some cheap journalist wants to peddle garbage around and then chuck it at me? I’d be one hell of a surgeon if I did that! Kim Hynes is my patient. I operated on her and did what I did out of something that I thought once mattered to you, but now wonder about: compassion. And care for individuals’ needs. And human dignity. And old-fashioned medical ethics. Not that you’d know anything about that, would you? Anyway, that was what I did, and there is no way I would ever dream of dumping her on someone else. Why the hell should I? I’m not ashamed of caring for Kim Hynes! To run away from her now would suggest I was. And anyway, what possible good would it do your other man — what do you say his name is — Scribner? Is he a patient of mine?’

  Oliver shook his head. ‘Mr Le Queux’s.’

  ‘I see,’ she said, and her voice dripped sarcasm. ‘I have to dump Kim Hynes, my patient, for another patient who has nothing to do with me, who isn’t on my waiting list, and who has nothing whatever to do with Kim. Is that it? Why should I?’

  ‘Because Scribner lost his bed to Hynes, of course,’ Oliver said. ‘Can’t you see that?’

  ‘You’re a fool, Oliver,’ she said shortly. ‘A complete fool. You don’t even know what you don’t know. Scribner’s bed or lack of it has nothing whatsoever to do with me or my patient. If he’s on Le Queux’s list of patients, then he’d have to be admitted to one of his beds. I have mine, he has his. In fact —’ She squinted then, staring inside her memory for the way the beds on GU were currently occupied. ‘In fact, I can tell you who’s to blame for your Scribner’s situation. His name, as I recall, is Prior. He’s a wino. Admitted from the wasteground in uraemic shock, been on dialysis ever since, and they’re still trying to get him stabilised. So there you are. Start a campaign against a sick sad dropout, why don’t you? There he lies, a piece of human garbage suffering from self-inflicted disease — after all, he’s been on meths for God knows how long — and using up a bed that ought by rights to go to your old soldier. Try that one on your friend at the Globe. Tell him to scream and shout to have treatment refused to characters like that, and see where it gets you. Even the Great British Public — or the segment of it that reads the sort of filth that paper peddles — with a mind as wide as a streak of slime is likely to rise up against that —’

  ‘No one’s saying that people should be refused treatment —’ Oliver began, but she gave him no chance.

  ‘Aren’t you? Of course you are! Dump Kim Hynes, you were saying, to clear the way so that your friend on the Globe, and you too, I imagine, can start thumping your great big drums about how wicked it is to waste NHS resources on people like that, people with different sexual needs. They’re not important to people like you, are they? The fact that Kim has been to hell and back with the problem she has, the fact that she’s suffered more misery than you could ever imagine in your smug life doesn’t matter, does it? She’s a sexual weirdo so anything goes. Well, the man who took that emergency bed is a weirdo too — he’s a booze weirdo. Have a go at him instead —’

  ‘You’re being deliberately obstructive,’ Oliver said. There was a thin white line round his mouth now as he tried to control his temper. ‘Of course I’m not going to start a campaign like that. I wasn’t even going to have a go at your damned Kim Hynes, either. I just wanted you to realise that no matter what I do or don’t do, this story is out. And other people will be hateful about the sort of work you’re doing. I love you Kate, you know I do. And because I care about you, I care about your reputation as well. I just don’t want you pilloried as the sort of surgeon who —’

  ‘Who what?’ she flared as he stopped. ‘Who looks after sexual weirdos, right? Isn’t that what you mean? Oh, Oliver, listen to yourself! The great compassionate campaigner, the man who loves the underdog, the man London listens to to find its heart: how shallow does it go? Tell me how you’ve managed to keep it all going for so long with no one noticing it’s all a sham!’

  How he still sat at the table he didn’t know. His mouth was dry and his face felt as stiff as if it had been chilled in iced water for hours. ‘That is cruel and totally unjust,’ he said in a low voice. ‘You have to know that.’

  There was a long silence and then she took a deep and shuddering breath. ‘All right,’ she said. ‘I’m sorry. It was a bit over the top, I suppose. A lot, in fact. But you must see you asked for it — saying you were trying to protect me, and all the time all I could hear were judgements about Kim Hynes and her right to be cared for. Why should I be ashamed of looking after her? Can’t you see what it was you were saying?’

  ‘I suppose so,’ he said. ‘It wasn’t meant that way, but I suppose so. But what else could I do? You live with me, for heaven’s sake! How can I carry out a proper job on this story while you’re so deeply enmeshed in it? If I’d realised at the start that this was going to involve you I’d never have started on it. But now I have — I ha
ve my job to do too, you know. Just as you can’t pass your Kim on to someone else, neither can I stop investigating this story. You understand that?’

  ‘I’m not sure I do.’ She lifted her chin and stared at him very directly. ‘I don’t want to diminish the value of what you do, but how can it help people to start digging around in the private lives of patients like Kim Hynes? How can it be of any value to anyone to —’

  ‘Don’t forget she wants to sell her story. Once she does, you’ll be involved, like it or not. That’s what I wanted you to realise.’

  ‘Well, that’s up to her. But you don’t have to be part of the buying and selling, do you?’

  ‘I have a story to write,’ he said. ‘And to broadcast. It needs to be told. The NHS is being shaved down to its barest necessities, and people should know it. I’ll try not to get involved in too many value judgements about which patients deserve care and which don’t, but if it happens, well, it happens. And as I say, it’s difficult when one of the most likely candidates for publicity happens to be the girl I live with.’

  Suddenly she frowned. ‘What matters most? The fact that it could be embarrassing for me to be labelled as a surgeon who does sex-change operations — or the fact that I live with you, the disinterested journalist?’

  He thought for a long moment, and then looked up at her. ‘Both,’ he said. ‘I have to be honest. Both. It’s very embarrassing indeed for me. If anyone apart from Jimmy finds out the connection I could have a rough time of it. But —’

  ‘No buts,’ she said and stood up, gathering her bag and her jacket from the back of her chair. ‘I’ll move into the residents’ quarters at the hospital. It could save us all a lot of trouble.’

  He tried to get to his feet too, but was slowed down by the fact that his chair was too close to the next table. She added then, with all the malice she could and with a sense of amazement that she could behave so, ‘And that will give you all the time you need for your Sonia, won’t it? Goodnight. And thanks for dinner.’