Clinical Judgements

by Claire Rayner

  ‘Is that why the police are here?’ Kate said and glared at the policeman and pulled almost violently away from his grasp. ‘Hardly necessary, I’d have thought, to control just one agitated patient. Send them away, Mary, for heaven’s sake —’

  ‘I can’t.’ Sister was now holding the curtain aside to let Kate follow her into the cubicle. ‘I told you, he’s supposed to have hit a copper and I’m here to tell you that they take a very dim view of that. No way do they go away just on my say-so — Hey, Mr Merrall, stop that racket! She’s here, for heaven’s sake!’

  Oliver was lying flat on the couch with a nurse on each side of him trying to restrain him as he struggled to sit up and seemed to want to swing his legs over to stand on the floor. They were young and flustered and one of them had lost her cap in the struggle, and even as Kate came up to the side of the couch, he managed to release one arm from the grip of the nurse on that side and swung it out and knocked off her cap too. He had his eyes tightly closed and his mouth wide open as he shouted and Kate had to lean over and set her hands on both his shoulders, to pin him down as she shouted back equally loudly, ‘Oliver, for heaven’s sake — it’s me, Kate — Oliver —’

  The shouting stopped at once and he opened his eyes and glared up at her and she looked back at him and felt her legs start to shake as her joints seemed to become jellies.

  He looked dreadful. One side of his face was coated with blood and grit from cheekbone to chin, and from his ear to the side of his nose. The eye on that side was puffy and blue with an expanding bruise and his nose had bled and left streaks of mucus and blood along his other cheek and down to his ear. His hair was matted with blood too, clearly from some sort of scalp injury, and he was sweating heavily.

  ‘Kate,’ he said and closed his eyes again and now she saw tears squeeze through his lids. ‘Oh, Kate, tell them, for Christ’s sake, tell them — this is hell —’

  ‘Tell them what?’ she murmured and moved closer to him as the nurse fell back a little, relieved that Oliver was now no longer thrashing about. ‘What is it that — Christ, what’s happened to you?’

  ‘Make ’em let me go —’ he managed. ‘They’re treating me as though I’m mad — I can’t stand this —’ And she nodded, remembering suddenly.

  He’d never made a great deal of fuss about it, trying to dismiss it casually on the rare occasions it happened but he was, she knew, bothered by being in enclosed spaces. Not precisely claustrophobic, she had thought, but very close to it at times. They’d once been in a crowd leaving a theatre which had for some reason stopped moving forwards, while people behind had continued to push onwards, and they had been pinned, unable to move, between burly bodies. And she had laughed and managed to turn her head to share some silly comment about it with him and seen his eyes were wide and staring, with the pupils grossly dilated and he was sweating hard and she had thought — He’s panicking. And had with a massive effort managed to elbow aside the people closest to them and create extra space for him and he’d calmed down a little. They’d moved again within seconds of course; whatever the barrier was it had been removed and they were out in the street within a minute of the episode. But he had been pale and quiet for the rest of the evening and they had gone home to bed early, instead of going out to supper as they had planned.

  Now, looking at his face against the white sheet of the couch, she realised how he must be feeling, to be confined as he was, and said sharply to the nurses, ‘Let him go!’

  ‘But Sister said —’ one of them began and Sister, standing behind Kate, said quickly, ‘Do as Miss Sayers says, Nurse — we’ll be fine. You get on and clear up the other cubicles, will you? That’s it —’ And the two of them escaped gratefully and Oliver lay there and blinked up at Kate, ignoring Sister completely and said, ‘Thanks,’ in a low thick voice.

  ‘What happened?’ Kate said then and perched herself on the edge of the couch and reached for his wrist. His pulse was full and bounding but it was not, she thought with the professional part of her mind, the sort of pulse that would suggest he was bleeding internally. It was steady and strong, if fast, but that was clearly due to the anxiety; and she turned her head and said curtly to Sister, ‘The skull X-rays?’

  ‘They’re still looking to make sure — they’ve asked for an opinion from Dr Cantrip — he’s the consultant radiologist on call — because the registrar says he wants a second opinion, especially as it’s a police case. But he said he saw no fracture —’

  She was speaking in a low voice and looked briefly over her shoulder at the curtain. ‘I really can’t send them away, I’m afraid. It’s a serious charge, you see, assaulting a police officer —’

  ‘A fractured skull would be a great deal more serious,’ Kate snapped. ‘May I see the films? Or are they still in X-ray?’

  ‘I’ll find out,’ Sister said and turned to go. ‘Will you be all right with him? He seems quiet enough now —’ And indeed Oliver had closed his eyes and seemed to be sleeping, though there was a rim of white to be seen under his closed lids and his mouth seemed tight and twisted in a way that was not usual on sleeping faces.

  ‘Oh, he’ll be fine now,’ Kate said. ‘He just can’t cope with being crowded. Nor can I — nor can most people. Putting on restraint causes more problems than it solves —’ She let go of his wrist and slid her hands round his fingers and they tightened against her grip and she knew then he wasn’t asleep. ‘He’ll be fine,’ she said again. ‘I can manage. Look, Sister’ — and she raised her voice — ‘can you tell those policemen I have to make a careful examination and discuss the symptoms this patient is having? I can’t have anyone listening to that. It wouldn’t be right. Take them to the other side of the waiting room where they’ll be able to see the cubicle clearly in the usual way, so that I can do my job quietly and they can still do theirs. I just don’t want them within a few feet of us.’

  ‘Certainly, Miss Sayers,’ Sister said equally loudly and marched out through the curtains, and Kate heard her saying firmly to the policemen, ‘You can come and sit down, over there, outside my office. You’ll be able to see everything that happens here and can intervene if there’s the least need, but Miss Sayers, the consultant, you know, has to make her examination in peace. You can’t stay here — now come along and I’ll see that someone fetches you both some tea. You look as though you need it —’ And though there were some rumbles of complaint that Kate could clearly hear, they let her push them in front of her like so many children in a school crocodile and went willingly enough across the waiting area to ensconce themselves on chairs outside her office door. After a moment Kate went and peered through the space between the edge of the curtain and the wall and watched them settle, and then went back to Oliver.

  He had his eyes open now and was looking at her and she leaned over him and touched his forehead, just above the huge contusion that marked his cheek, and said softly, ‘Darling, what happened? Has anyone done anything to this yet?’

  He shook his head on the white sheet and then winced and screwed up his face into a tight grimace.

  ‘Christ, that hurts —’ he murmured thickly. ‘My head feels like — have I broken it?’

  ‘I can’t be sure,’ Kate said. ‘Sister’ll get me the X-rays. But it’ll be Cantrip’s opinion that matters most. He’s the best radiologist there is — look, I’ll start on that face. This may hurt a little, but it’s necessary —’ And she turned to the trolley that stood at the side of the cubicle, all set up ready to do dressings, and pulled it closer.

  ‘I’ll wash my hands and then start. And while I do it, you can tell me quietly what all this is about. And whether you did hit a policeman or not. And if you did, why — well, let’s get you cleaned up first —’

  She washed her hands at the basin in the corner and rubbed in the antiseptic lotion and the smell of it filled her nostrils and managed to bring her professionalism back to the top of her mind again. She had come alarmingly close to dissolving into tears at the sight of
his battered face, and was still trying to recover from the great wash of fear that had filled her when she had first seen him. Now she had to behave like a doctor again and not like a woman whose lover was injured. It wasn’t easy. But having something to do to help was important; it took away some of the sense of powerlessness that had filled her. And so took away the terror.

  Slowly she began to swab the crusted cheek and he lay there, his eyes open, staring up at her face as she worked and she avoided his direct gaze, afraid that if she didn’t she would weep, for he looked so very woebegone and so very trusting at the same time that it took all her control to continue working smoothly.

  But she did, slowly cleaning away the filth and picking out of the torn skin and underlying tissue the largest pieces of grit she could retrieve, while moving with great delicacy, for it was clear he was in considerable pain. He winced occasionally, and tears of pain dripped from his eyes, but he managed to keep his head still and she was grateful for his stoicism, for it gave her some of her own. While he was so still she could get on and do the job she had been trained to do, even though it was on the face of someone she now knew that she loved far more than she had realised she did.

  For that was the worst part of the situation. That he was a person who mattered to her she was well aware. She had not decided to live with him lightly, nor had it been a merely physical need she had been satisfying with him, important though that was to her. She had admired him, enjoyed him, found him to be the best companion she had ever had, but she had thought for the past fifteen months that that was as far as it went. Yes, she had been jealous of his ex-wife, yes she loved him, but after all, what did the word mean? Different things to different people —

  But now she knew that what it meant to her was a deep and total involvement with this man. Seeing him in this state was agony, a much greater pain than she would have thought possible. She was angry for him, and with him too for letting it happen to him, and at the same time felt immensely, fiercely protective. Altogether she couldn’t understand her own tangle of feelings at all; all she knew was that this man was the most important person who existed in the world and that if anything happened to him it happened to her as well.

  ‘Did you hit a policeman?’ she managed to say at last when his face was looking a little less dreadful and she had applied a layer of richly emollient antibiotic cream and covered it lightly with tulle gras. She started to work on his scalp, gingerly exploring the matted hair to find the site of the injury that had shed so much blood on his clothes and snipping away the locks of hair to reach it more easily once she had located it. It was easier to talk to him while she did this, for she could not see his face, standing as she now was behind him.

  ‘I’m not sure,’ he said after a moment. ‘I can’t really remember properly. It all started with —’ He frowned and his scalp moved under her hands. ‘Dammit, I’m not sure. I wanted to record something, and —’

  He stiffened suddenly. ‘My Uher? Where’s my Uher?’ And he moved, tried to sit up and turned his head at the same time, and she had to push him back down again firmly.

  ‘I’ll ask Sister. No point in getting agitated about it now. Your broken head matters more than any damned tape recorder.’

  He subsided, but was clearly agitated about the loss, and she looked at his upside-down face and saw the tears escape again from his closed eyes to creep oddly upwards, as they seemed to do from her vantage point, and again felt that great wash of protectiveness. Poor darling Oliver, weeping for his lost toy, she thought absurdly, and slid her hands down on each side of his neck and bent her head to set her face against his uninjured cheek. It felt damp and hot at the same time, and he smelled disgustingly of blood and dirt and sweat and the antiseptic and it was a queasy mixture. Or was it her own mixed feelings that made her feel so dreadful?

  ‘I think I did hit him,’ he said suddenly and his voice seemed oddly loud and heavy for her ear was so close to his lips. ‘Oh, God, I think I did. He was being officious. I remember now. Wouldn’t let me record, was being officious, wouldn’t let me come in to find you and talk to you, wouldn’t fetch his Inspector and suddenly —’

  His eyes flew open and she lifted her cheek from his and looked down at him and he stared back, and his eyes looked extraordinarily deep and dark, and so odd, upside down. ‘Oh, Kate,’ he said. ‘Oh, Kate, I did. I do remember. I just couldn’t stop myself. It’d been such a pig of a morning and then that bloody man — I hit a lousy policeman … Now what?’

  ‘Now I feel better about you,’ she said, trying to sound practical and cool and relaxed and finding it exceedingly difficult. ‘If you’ve remembered then you have no retrograde amnesia and that means there’s not been any real damage done. I doubt you’re even that much concussed. You actually remember hitting him and then being hit by him?’

  ‘Not just him,’ he said and now there was more expression in his voice, a rueful self-mocking tone that was a great improvement on the miserable way he had sounded so far. ‘Half the bloody police force jumped me. Christ, it was like juggernauts. They landed on me in a great rush and I hit the ground so fast it was — I couldn’t breathe, you know? That was — I can’t tell you. Hell. And then someone dragged me and I couldn’t get my face off the road and that was when this happened.’ And he lifted his hand gingerly towards his cheek, though she stopped him touching it well before he got there.

  ‘Leave that alone,’ she said. ‘We’re going to have enough of an infection problem as it is. I’ll have to give you systemic penicillin. Can you remember anything else that happened?’

  ‘All of it, I think,’ he said. ‘I can’t see any gap — it’s a consistent picture — the bastards —’ And his voice rose a little. ‘I know I was wrong to lose my temper, but Christ Almighty, they didn’t have to land on me the way they did —’

  ‘Sister says it’s a serious charge,’ she said after a moment.

  ‘Of course it is.’ He sounded very tired now, and she bent her head again to the cleansing of his scalp wound. The sooner he was settled in the ward and could sleep it all off the better. ‘I know that as well as anyone. They’ll throw everything at me —’

  She had found the cut now, a deep one, but not too ragged, and she snipped away the rest of the surrounding hair and then cleaned it. It wouldn’t need stitching, she decided, but careful cleaning was a must. And she set to work on it and then reached for a dressing. He’d have to have a proper bandage put on; there was no other way to fix the dressing in place, and she touched his cheek and said softly, ‘I’ll have to get Sister to bandage this. It isn’t one of my major skills She’ll do it better-besides, I have to talk to her. Hold still here for a moment. I won’t be long —’

  She ignored the policemen across the waiting hall who got to their feet as she emerged from the cubicle, and went across to one of the cubicles on the other side with its curtains drawn where Sister could be seen talking to a patient on the couch there.

  ‘Sister,’ she said as she came up to her purposefully formal in the presence of a patient. ‘I need to talk to you about Mr Merrall —’

  ‘Merrall?’ the man on the couch said thickly and stared at her malevolently. He had a split lip and was clearly in considerable discomfort. ‘Is that the bastard who did this to me? I’ll have him for it, you see if I don’t. Don’t let him con you, Doctor — the man’s a rough and a —’

  ‘I have no wish to discuss my patient with you, sir,’ Kate said freezingly. ‘Sister, if you will give me a moment?’ And she moved outside the cubicle and well out of earshot. Sister followed her.

  ‘Who is that?’ Kate said softly.

  ‘Sergeant Parson,’ Mary said, equally quietly. ‘He was the one in charge out there. It’s a nasty split — it wasn’t so much the violence of the blow that did it, but he’s got uneven front teeth, and the lip caught on one of them —’

  ‘Can you put that in the notes?’ Kate said eagerly. ‘Oliver’ll need all the help he can get on this one. Only i
f you’re sure, of course —’

  ‘Oh, I’m sure,’ Sister said grimly. ‘He’s a nasty one, this chap. Most of the men in the force round here are good enough chaps. We know ’em well of course. But this one’s always been a bighead, fancies himself as important. I’ll see it makes the notes. There’s no bruising, you see, which you’d expect from a blow violent enough to make a split in the skin. It really was just bad luck, I reckon. I’ll get the houseman to see it too. He’ll agree with me —’

  ‘Will he?’ Kate let her doubtful anxiety show in her voice.

  ‘Oh, he’ll agree,’ Sister said firmly. ‘He’s a good lad and he’s learning fast. He knows who to listen to. How is he then, your friend?’

  ‘Not too bad. The contusion’s nasty but the scalp wound’s clean and small — no stitches needed. And he’s not too head-injured, I think, because he has full recall now. Which is a comfort. But I want him admitted. Can we fix that? Can you get your houseman to —’

  ‘Just watch me,’ Sister said promptly. ‘Anyway, it’s Alan Kippen’s firm which is on intake today, and he’s on holiday so his wards are fairly thin. I’ll see to it your chap’s admitted for observation of head injury query concussion, and if you have a word with Sister in whichever ward he gets into I dare say you can keep him there as long as you like. Want to get the lawyers going, hmm?’

  ‘Yes,’ Kate said. ‘And the sooner I start the better, I reckon. This one is not going to be a nice one at all. Is it?’

  And Sister, who had a lot of experience of situations like this, said regretfully, ‘No, I’m afraid it isn’t.’

  Chapter Twenty-Eight

  Audrey was sitting in the day room while they sorted Joe out. At the beginning she used to stay there while they did what they had to do, helping them, passing them things, jollying Joe along, but not any more. She couldn’t bear to do it now, to see his poor body so thin that his ribs looked like a fence, and to see his skin so yellow and so lax. It wasn’t as though he really knew her any more, anyway. There were times he did of course, times he opened his eyes and looked at her and said, ‘’Allo, ducks,’ and it was just like the old days really. Well, not exactly, but a bit. And she would smile back and say, ‘Well, get you, doin’ nothing but sleep all day — where do you get off being so lazy?’ And he’d grin and drift off again and she’d hold his hand and watch him.