Clinical Judgements

by Claire Rayner

  And she went, walking so fast she was up the stairs and out of the restaurant before he could stop her. And by the time he’d paid the bill and run after her, it was too late. Exeter Street was deserted.

  Chapter Twenty-One

  The theatre block was working flat out by eight-thirty a.m. Sister Bridie Whelan had been harrying her nurses and orderlies like an excited sheepdog, her short stumpy legs in their childish white socks and plimsolls flashing from anaesthetic room to operating theatre and back via the set-up area so fast that she looked, as one of the irreverent third-year nurses said, like a toy on wheels.

  ‘You know the kind,’ she murmured in her friend’s ear as they stood setting out sterile gowns and towels and gloves ready for the scrub team. ‘They’ve got three feet and you push ’em along on a stick and it looks as though they’re running like lunatics.’

  ‘Get on with it, get on with it!’ cried Sister, leaping into the set-up area and glaring at them over her mask with an experienced glitter, for no one knew better than she how to look daggers, ‘And a lot less chatter! There’s no sense in masking up if you cluck like demented hens and make your masks wet. That way you spray the air and the patient with organisms. I’m sick of telling you. And move, will you! I’ve got three huge lists and no time for any of your nonsense.’ And she was gone before either of them could say anything. Not that they wanted to. The Whelan in this mood was not to be argued with.

  Kate was early for her list. She liked to be early as a general rule, liked to be able to get herself changed and comfortable before any of the other surgeons came in. They made such a fuss, some of the men, about the fact that she was a female, withdrawing with elaborate care to the men’s lavatory to change their trousers as though she’d never seen a man in his underpants before, and ostentatiously turning their backs if she showed a flash of bra as she got into her theatre dress. It was worth arriving half an hour before anyone else just to get the space she needed.

  And today she needed to be early to clear her mind. She had slept surprisingly well, considering how bitter she had felt when she had slid between the sheets of the spare-room bed on the residents’ floor, the one that was usually occupied by the house surgeon on call for the night. She had had to wander around the hospital to scrounge a new toothbrush and washing gear and then had had to wash her tights and underwear and leave them to dry overnight in the linen cupboard since she had no intention of returning to the flat to pack a bag with clean clothes until she was sure Oliver wouldn’t be there. By the time she had switched off the battered bedside light it had been almost one o’clock and she had resigned herself to a night of tossing and turning as she rehearsed all the awful things they had said to each other.

  And yet she had fallen almost immediately into a deep and heavy sleep and only woke when the phone beside the bed pinged with the early call she had requested from the switchboard.

  But she didn’t feel now as she ought to feel after a good night’s sleep and when faced with a complicated list; two transurethrals and a repair of a messy suprapubic incision to deal with before she got to Slattery, and it had been some time since she had done any gut surgery. She ought to feel more relaxed to be sure of doing his hernia well, and she stood there in the surgeons’ room in just her bra and pants before putting on her skimpy theatre dress, taking a few deep breaths, consciously relaxing. Her patients were entitled to a better surgeon than she was at the moment and she had to work hard to make sure she was in good shape. And slowly her technique took over and she felt her shoulders soften and relax and was able to finish changing her clothes in a tranquil enough mood.

  She spent the next half-hour poring over the patients’ notes, making sure she had each one clearly in her mind, reminding herself of her original examinations of them and planning in her head the operations each would have. If she was lucky, she’d have that sensible third year to scrub for her: Cassie Brandon. She had a real gift for theatre work, always anticipating every surgical want with swift intelligence. Doing a list with her was always a pleasure, especially as Kate often did not work with an assistant surgeon, preferring the help of just her scrub nurse. It was only when she had medical students assigned to her that she used another pair of hands, so the quality of her scrub nurse was particularly important. So, today, would it be worth asking Sister Whelan to make sure she had Cassie? She thought about that for a moment and then decided against it. She had seen Bridie bustling about in one of her paddies at the far end as she had come in through the big double doors and knew she was at her least approachable when she got like that. The mere fact of being asked for a particular scrub nurse could make her bristle at what she would regard as interference. It really wouldn’t be worth the risk. As long as I don’t get that half-witted chap — what was his name? Cantor, Trevor Cantor. The last time she’d had him he’d been so ham-handed she’d almost lost her temper, for he seemed to be at least three beats behind her all the time, whatever she wanted. She’d made no complaint then, but had promised herself she’d object if she ever got him again. And she bent her head to her notes once more, pushing away her niggling thoughts about who would scrub for her; still unrelaxed, that was the problem — mustn’t get obsessive, mustn’t create troubles before they existed.

  The other surgeons arrived with the coffee and she looked up gratefully as Fay Buckland came bursting in in her usual rush, spraying her possessions around so that in a matter of moments the small surgeons’ room looked cluttered and rather shabby, and Kate liked that. It made her feel more at home and she grinned widely at Fay and said, ‘Good morning.’

  ‘I hope so, ducky, I hope so!’ Fay said and began to strip off her top clothes, paying no attention at all to Agnew Byford who had come into the room behind her, an expression of distaste on his face as he saw her. ‘Hello, Agnew — my God, but I must be mad! I put these lists together when I’m feeling hopeful and strong and then when I get here and look at them I could die before I start. I’ve put in two hysterectomies, a Fothergill’s repair and a positive string of damned Ds and Cs. And now they tell me there’s a Caesar cooking up over on Maternity — I’ll be here till the cows come home. Pour me some coffee, Kate, there’s a lamb.’

  Kate obeyed. ‘You too, Agnew?’

  ‘No thank you,’ he said austerely and disappeared with some ostentation into the lavatory carrying his theatre suit on a neat wooden hanger, and Fay grimaced at his departing back.

  ‘Miserable bugger,’ she murmured and bent to lace up her plimsolls. ‘Why he doesn’t come clean and do all his work over on the Private Wing and be done with it, I don’t know. He clearly despises everything we stand for over here.’

  ‘He’d never get his gong on private work,’ Kate said with a little spurt of malice and Fay giggled, and then gulped coffee, fast.

  ‘I suppose not. Though why anyone would want such a thing I can’t imagine — you’d have to have all your stationery reprinted. It’d cost a bomb.’

  Kate gave a little shout of laughter. ‘Only you could think that a good reason for not having an honour!’ she said and Fay snorted.

  ‘There’s another. If he gets a knighthood that boring fart of a wife of his gets to be Lady Byford. If I got a Damehood, there’s no way my old man’d ever become Sir Teddy, is there? No justice. So, they can stuff their bloody honours. Ah, well, this won’t get me anywhere. Time to get going. I hope I’ve got Cassie to do my list —’

  ‘I want her!’ Kate protested as she followed her into the theatre concourse, now alive with trolleys and patients as the first three arrived with their escorts of ward nurses and anaesthetists. ‘And I didn’t ask on purpose —’

  ‘Are you kidding? And stir Bridie up? Never think it. I didn’t say I’d ask — I just said I was hoping … Good morning Sister! Where am I?’

  ‘You’re in Two, Miss Buckland,’ Sister said, busily inspecting the typed lists on her clipboard, even though everyone knew she had it all in her head already. ‘I’ve got you in Three, Miss Sayers. I d
o hope you don’t mind. I’ve had to put Mr Byford in One. His hearts, you see —’

  ‘— are no more important than Kate’s bladders,’ Fay cut in. ‘Or my uteruses. You mustn’t let him push you around, Sister!’

  Sister bridled and Kate’s heart sank. Everyone knew Fay, with her sharp tongue and her total refusal — or was it inability? — to think about the effects of her words before she spoke them, and generally everyone, Kate included, loved her dearly. But Kate could have smacked her for this.

  ‘Well, I’m sure I don’t know what you’re talking about, Miss Buckland! I treat all the patients who come to my theatres with equal care —’ and Sister put considerable emphasis on the ‘my’. ‘And I’d be most disturbed if I thought —’

  ‘It’s all right, Sister,’ Kate said quickly. ‘You mustn’t let Miss Buckland tease you. She’s rather fond of doing that — you ought to know by now. Right, Fay?’

  ‘Hmm?’ Fay had been trying on her mask and fiddling with her cotton helmet, trying to get her unruly hair to stay inside its confines. ‘Oh, yes, I suppose so. All right then. Which anaesthetic room is it?’

  ‘Two,’ Sister said icily. ‘I would never risk confusing them. Each theatre has its own anaesthetic room, and always has. I won’t risk getting patients mixed up. I never have so I really don’t think there’s any need for you to —’

  ‘No one was saying otherwise, Sister,’ Kate said soothingly and escaped gratefully, pushing Fay ahead of her and parting from her only as she disappeared into the scrub area to be gloved and gowned. ‘I’ll see you over some lunch, perhaps, Fay. Pace yourself!’ And Fay threw a cheerful but abstracted glance over her shoulder, clearly already so deep in contemplation of her first case she had forgotten every word that had gone before, and Kate followed her, shaking her head in amused irritation. One of these days Fay would get herself into real trouble with her abrupt directness, but meanwhile thank God for her. She made a necessary and welcome antidote to the sleekness of Agnew Byford, who had now emerged from the surgeons’ room in his immaculately pressed operating suit and was being fussed over by a slightly flushed Sister Whelan. He, it seemed, had the easiest list of the day, just two catheterisations and a ballooning to do, and Kate hovered at the entrance to the scrub area, fiddling with her own mask as she listened. She didn’t really care what Byford did, but it was always interesting to know what else was going on while she did her own lists. And anyway, the knowledge helped to keep her personal anxieties in some sort of perspective.

  ‘Even here he’ll have to have his security people with him, Sister,’ Byford was saying in that rather pompous voice that sounded as though it came from deep inside a stuffed owl. ‘I’ve told them they must keep well out of the way, but they will have to be gowned and so forth, of course. And I suppose they might as well get an education while they’re about it.’

  Stupid man! Kate thought, malice returning. He just wants to be watched. He’s not a surgeon, he’s just a showman. But she shook her head at herself again then and went to start her scrub; he was a bloody marvellous surgeon, deft and quick and always getting excellent results. The only trouble was that he was much too aware of his own gifts and much too fond of being admired. But his patients did well enough, and that was really all that mattered.

  And she went to the big sink and pushed on the long taps with her elbows and started the laborious ten minutes of hard scrubbing of hands and arms up to the elbows that were mandatory before the first case on a list. At least while she scoured her slowly reddening skin and stared at the shapes made by the suds she had time to think about what she would do, and she settled down into the routine of an operating day with a small sigh and only the most fleeting of thoughts about last night. Oliver was a million miles away, now. Not at all important.

  Or not very.

  By ten o’clock she was beginning to get into the stride of her day’s work. The first TUR had been smooth and easy, with hardly any blood loss and a clean operating site throughout and she had seen him on his way to the recovery suite contentedly. Even though she had indeed been lumbered with the slow Trevor Cantor and had known she could not complain to Sister in her Fay-flurried state, it was going well enough; she’d have time for a cup of coffee while they got the theatre ready for the next case and got him under, and then with a little luck she might be clear of the suprapubic repair and able to start Gerald Slattery before Bridie Whelan began twittering on about her nurses’ need to go for their lunch breaks. Why they couldn’t work straight through as Kate herself did, and grab a sandwich afterwards, Kate couldn’t understand, but she knew better than ever to say so. Nurses’ health had to be protected while the surgeons’ didn’t and that was the end of it. Boring though.

  She stood in the concourse for a moment, thinking. Fay’s second hysterectomy had gone in; she could see into the recovery suite across the way where they fussed over her first patient, as well as over her TUR man, and she could see into Theatre Two where they were already at work again, and she grinned as she noticed that Fay didn’t have the much coveted Cassie with her either; a new and unfamiliar face peered over the mask that Kate could see through the glass window of the door to Theatre Two. That meant that Byford had snaffled the peach of the theatre staff and she grinned sourly into the folds of her own mask as she thought of that. It was, of course, inevitable, just as it was inevitable that Sister Whelan herself would be running for him. Honestly, it was enough to make you sick —

  She moved over towards the door of Theatre One to peer in to see how Byford was getting on and almost jumped as a burly figure appeared from the anaesthetic room on that side to bar her way.

  ‘If you don’t mind, madam, may I ask what you want here?’ it said, and she looked up startled.

  ‘What did you say?’

  ‘I said, may I ask what you want here,’ the man repeated.

  She looked down at herself. ‘I’ve come to sunbathe and have a nice swim,’ she said acidly. ‘What the hell do you think I want? I’m a surgeon, dammit. I have every right to be here.’

  ‘But not in this theatre, I think, madam,’ the large shape said and stared at her with wide bovine eyes, much enhanced by the line of green mask that was beneath them. He had absurdly long lashes, she noticed, and wanted to giggle.

  ‘No, not in this theatre,’ she allowed. ‘I’m a bladder surgeon, and I’d be glad to whip out your prostate for you while you’re waiting. I have no intention of doing any such thing to your charge, however, who is a heart patient, right? I take it it’s the ineffable Saffron in there?’

  The man seemed unruffled. ‘Mr Saffron, madam, yes.’

  ‘Hmpph. Well, I have no special interest in Mr Saffron, I can assure you. I was actually much more interested in catching Sister Whelan’s eye. I need to talk to her about my next case. If you don’t mind.’ And firmly and with due force she pushed the man aside and went to the door to set her face against the glass and peer in.

  As always, Sister Whelan, who seemed to have eyes in every part of her anatomy and always looked at the door the moment anyone appeared to occlude the window, saw her and came purposefully across to slip out, just as the burly watcher moved closer to Kate and set a hand on her arm.

  ‘Sister,’ Kate said wrathfully, ‘do I have to put up with this sort of harassment?’ And she shook her arm sharply to make the man let go, which he did as Sister stood there and glared at him. ‘I need to discuss my last case with you. With this man’s permission, of course —’

  ‘He has to be here,’ Sister said shortly. ‘I don’t like it any more than you do, Miss Sayers, but it’s Mr Saffron and who am I to argue? Now, what do you want with me?’

  ‘In the office please, Sister,’ Kate said and marched away, more ruffled than she cared to admit by the silly little altercation. The theatres were a special place, a private place where only the true acolytes should be; it was not a matter to which she had ever given any direct thought but that she felt so was undoubted. Only surgeons and their attendan
ts belonged in the theatres, and patients when they were suitably cowed by drugs and anaesthetics. A sort of holy of holies — and now the thought had come into her mind she was amused and a little ashamed and in consequence was more affable to Sister than she had intended to be. Which immediately put Bridie Whelan on the defensive; the only time surgeons were as friendly as this was when they wanted something out of the ordinary.

  ‘Sister, I was just wondering,’ Kate began. ‘If I could ask some particular help from you —’

  Bridie Whelan looked back at her stolidly and said nothing.

  ‘It’s my last case, you see, Sister. The one who’s due in after this. He’s a special one I’m doing — repair of an inguinal hernia, remember? The thing is I want to use totally no-touch technique and I don’t have to tell you how tricky that is. Well, I was just wondering — by the time I get to him I imagine Mr Byford’ll be finished. He doesn’t take that long on his people, does he? And I was just hoping that perhaps — I mean, Trevor’s a pleasant enough chap and tries hard in his own way, but he isn’t Cassie, is he? I’d be most grateful if I could have her for that case —’

  Almost too late she saw the frown start to creep across Bridie Whelan’s forehead and added hastily, ‘Unless, of course, I could have you? Now that would make ail the difference —’

  The frown retreated but all the same Bridie Whelan still just stood and stared at her. And then said, ‘Why?’

  ‘Hmmm?’

  ‘Why? Why do you want —’

  ‘Well, as I said,’ Kate broke in swiftly, needing to repair any damage she had done to the woman’s self-esteem, ‘I need someone very experienced and good and Trevor’s all right, I suppose, but not as experienced as you. Or Cassie —’