Clinical Judgements

by Claire Rayner

  ‘It is also the legal way,’ Impey said and squinted over his glasses at Kate. ‘You were worried about the — um — tradition of practice. What some people call medical ethics — but they are not what we regard as ethics, surely? The matter of poaching of patients and who refers to whom and all that — important to the practitioners, no doubt, especially in lucrative private practice, but of no value whatsoever to the patient. In fact many of these so-called medical ethics could more accurately be labelled restrictive practices, and should be —’

  ‘Indeed, yes,’ said Bulpitt, clearly breaking into what was a familiar track. ‘The patient must always be regarded as the prime issue. How is he now, Kate? Recovering well?’

  ‘Indeed. I sent him home.’ She looked again at Levy but not for encouragement this time. Just for confirmation. ‘He’ll have his stitches taken out by his GP to whom I’ve spoken, and he’ll come back to see me in Outpatients. He seemed to be in excellent spirits when he left us. And very well.’

  ‘Good,’ Bulpitt said heartily. And then smiled at her. But it was different suddenly and she felt the change in atmosphere and looked sharply at him. ‘This might be a good point at which to ask you about your other patient, um — Hynes, isn’t it? The reassignment of gender chap —’

  ‘What about her?’ Kate’s head had come up and she looked at him very directly.

  ‘Has he — she been discharged yet?’

  ‘No, I have some tidying of the wound to do. To prepare her for future plastic work.’

  ‘Well, far be it for us to tell you how to care for your patient, Kate. We do of course have full confidence in you. But we are a bit worried about the publicity the hospital is getting because of — all the fuss about Fay Buckland, you see, and also about your Hynes. We could do with a respite, I think. If the time comes soon for Hynes to be discharged I think it would help us quite a lot.’

  ‘I’m as anxious to release beds as anyone else,’ Kate said. ‘But I won’t apologise for admitting her or for treating her. She’s been under the care of Barbara Rosen for three years, you know. She’s no sudden arrival here. All the talk about the waiting list — it’s a travesty of justice to suggest that Kim’s occupation of a bed has any bearing on the shortage of care for other patients —’

  ‘I agree with you totally, Kate,’ Bulpitt said soothingly. ‘It’s just that —’

  ‘I worry about the nurses, you see, Miss Sayers.’ Miss Barber leaned forwards earnestly. ‘We try to teach them not to gossip to outsiders and we do stamp on such behaviour when we can, but they’re very young, you know, and it is difficult for some of them to understand … If a patient is on the premises, you see, it’s hard to make sure they don’t gossip. Once they’ve been discharged, of course — well, memories are short. You know how it is with these youngsters. They’ll go on to the next piece of excitement. I really think the whole fuss will die down once this patient goes.’

  ‘I’ll arrange it as soon as it’s right for the patient,’ Kate said with a note of stubbornness in her voice and Levy grinned at her. ‘But I’ll keep what you said in mind. May I go now?’

  ‘Of course. And thank you once more —’ Bulpitt got to his feet. ‘One word though before you go — I’m afraid Mr Lemon is far from happy with us at the moment. He left here in a — shall we say, highly emotional state. I had to tell him that as far as we could see there was no ethical case for you to answer. Only on traditional grounds, as Impey here said which we, as a committee, discount. And he took that rather badly. Blames you, I fear, rather more than he should —’

  ‘He should be blaming me,’ Levy said. ‘But Kate’s an easier target, I suppose.’

  ‘I’m just saying you should take care.’ Bulpitt patted her on the shoulder and led her to the door. ‘I wish you could stay, my dear. We now have to deal with the matter of poor Fay Buckland and her dilemma which is rather more difficult. But I’m sure you’ve got other things to do. But remember what I said — Mr Lemon could be tiresome for a few days. I’d keep out of his way if I were you.’

  Chapter Thirty

  Suba used her day off to deal with it. She should have gone home, of course, and she had worried a good deal about that. She had gone home on her day off every week since coming to Old East, and if she didn’t this week Daddy would be very annoyed but this was too important; it would be worth risking Daddy’s rage. So she had phoned him at the shop and for the first time in her life told him a lie. And got away with it.

  ‘I’ve got to study, Daddy,’ she said, staring at the scribbled wall in front of her in the stuffy little phone box on the ground floor of the nurses’ home. ‘We should be having exams soon and I really ought to get down to it —’

  And he, rushed because he had a shop full of customers — she could hear the chatter in the background — had huffed a little and complained but he’d accepted it. And she had hung up, feeling ashamed and deeply exhilarated at the same time. It wasn’t as hard as it seemed sometimes to do what you had to do. If this could all be sorted out over Miss Buckland, then maybe in the future some time — because there would be a future for her then at Old East — perhaps in the future some time she could lie again and have a whole day just for herself? It was an intoxicating thought.

  She considered carefully what would be the best time to go, and decided on the morning. People went shopping and took children out, she knew that, but most people didn’t do it too early. If she turned up there at about ten o’clock, that should be about right. She’d thought of phoning at first, finding Mrs Roberts’ number in the phone book, but decided against that. Suppose she said not to come? What could Suba do then? No, she would just arrive on the doorstep. Then she’d have to talk to her; yes, that was the way to do it.

  It was difficult finding the place. She had the address carefully written down: Flat 179, Lansbury House, Tarling Street Estate, and she knew where Tarling Street was; she would walk it — but it was a rather long walk — or take a bus up Cannon Street and then along Commercial Road and walk a little way down Sutton Street. So she did that, and that part of the journey went well. She sat on the bus in her new tweed coat and her brown boots — she had been given those as a special present when she’d started at Old East, from her aunt, and she was very proud of them — her hands folded on her neat bag as she stared out of the window at the passing street and rehearsed in her head what she would say.

  Every time she tried to plan it, though, it came out differently. Mrs Roberts kept saying different things in reply to what she, Suba, said in her imagination, and that confused and worried her. And then, as she reached the end of the bus journey and jumped down she decided wisely to stop thinking about it. Just go and tell her, simply and easily, that would be enough. She’d be sure to understand and want to help.

  But then it all got very difficult. Block after block of flats lifted themselves lumpishly into the dull September sky and although she had looked carefully at the map of the estate she had found at the entrance to the great sprawl of buildings, it was difficult to work out exactly which was Lansbury House. So she walked what seemed to be miles looking for it, as her boots creaked their newness and her feet ached more and more.

  But she found it at last, a tall building exactly like all the others, with the same spray-paint graffiti on the concrete walls around the base and the same litter of garbage in the concrete walkways between. She stood and craned up at the building and thought — Suppose the lift doesn’t work? And the prospect of climbing seventeen floors in her creaking new boots nearly made her turn and run. But then she saw someone emerge from the battered lift, and took a deep breath and went on. She was here now. She had to do it.

  The lift creaked dreadfully and she was frightened for a while that it would stop between floors and trap her there and she’d never be able to get out; but at last there was the seventeenth floor and she was standing on the windy walkway that encircled the building and staring down at the foreshortened people below and the map of Shadwell spread out
before her. She looked eastwards, hoping to find the huddle of buildings that was the hospital, needing a sight of the familiar place to reassure herself, but it wasn’t possible to work out exactly where it was, and with her pulse now thumping unpleasantly in her ears, she walked along the rubbish-strewn walkway, peering at door numbers.

  There was someone in at number 179; she could hear the sound of a child crying, but she had to ring the bell three times, loud and long, before someone came shuffling along to the door to open it.

  Suba was quite shocked when she saw Mrs Roberts. She was wearing a pink dressing gown which was badly torn and her hair was rumpled yet greasy. Her face was pale and she looked half dazed as she stared at Suba, quite without any recognition in her face.

  ‘Er, hello,’ Suba said. ‘How are you, Mrs Roberts?’

  There was a little silence as Prue stared at her and then she said, ‘Who are you?’

  But before Suba could answer there was another wail, and Prue muttered and turned and let go of the door and walked back into the flat, and after a moment, Suba followed her and closed the door behind her.

  The place smelled of urine and dirty nappies and stale food and Suba picked her way past the pram which took up most of the width of the hall, following Prue to the far end, where she disappeared into a bedroom. And Suba went in too.

  It was a very cluttered room with a cot, and a large Moses basket on a table, as well as a chest of drawers and a wardrobe. It must have been a pleasant room once, because an effort had been made to make it pretty, with wallpaper covered in Disney characters, and matching curtains much embellished with frills, but now it was unbelievably untidy. There were dirty clothes on the floor and the half-open drawers of the chest were filled with a tangle of garments and more were hanging over the open door of the wardrobe. In the cot a child of not yet two was standing holding on to the bars and shrieking at the top of his voice. The reek of ammonia was so strong that it caught in Suba’s throat and she could have retched. But she didn’t. Instead she stood there as Prue lifted the child out of his cot and laid him down, still shrieking, on the top of the chest of drawers and began hunting in a desultory fashion in one of the drawers.

  ‘Here,’ Suba said, pushed by a sudden impulse. ‘Let me —’ And she came to stand beside Prue just as she fished a rather grey nappy out of the drawer.

  ‘What?’ Prue stared blankly at her. ‘What do you want then?’

  ‘Let me help you with this little chap —’ Suba said, and turned to the child. ‘What’s his name?’

  ‘Danny,’ Prue said. ‘Oh, do shut up, you little —’ as Danny shrieked ever louder

  ‘We’ll soon get him right,’ Suba said and pulled off her coat and after a moment added it to the drapery on the wardrobe. And she began to undress the child who stared up at her and stopped shouting and lay there occasionally hiccupping.

  Before starting her training at Old East Suba had spent a good deal of time with small children, not only her own younger brothers and sisters, but also the ones in the nursery her school had adopted. It had been part of her social studies O level to spend some time there and she had enjoyed it, and found she was good with the small ones. Now Danny seemed to know she could be trusted and lay there, his thumb stuck in his mouth as she took off the reeking nappy that covered him and looked round for a bucket to put it in.

  ‘It’s in the bathroom,’ Prue said sulkily. ‘Here, give it to me —’ And she took it and went away leaving Suba to look at the raw red bottom and belly and thighs the child was displaying.

  ‘I’ll need some water, Mrs Roberts,’ she called after a few moments. ‘And have you some zinc and castor oil cream? He’s a bit sore —’

  For the next ten minutes or so, there was an agreeable enough silence in the little room as Prue came back with the cream and a wet flannel; and Suba did the best she could to make the child comfortable again, and when eventually she had pinned on the clean nappy and taken off his shirt and found a reasonably fresh one to put on so that he could be put back into his cot, she felt a great deal more relaxed.

  Prue Roberts stood at the door of the room and said, ‘Who are you anyway? I’ve seen you before. I have, haven’t I?’

  Suba smiled over her shoulder at her from the cot, where she was still standing murmuring down at Danny. ‘Yes, you remember me. I was on the ward at Old East, when you had your operation —’

  Prue went a sudden mottled red. ‘I didn’t have no operation —’ she said loudly and Danny let out another wail, and Suba turned back to soothe him.

  ‘Well, when you were ill then,’ she said, puzzled. Of course she’d had an operation; Suba could clearly remember her being sent up from the operating theatre with a unit of blood dripping into her arm and looking as pale and as dead as — well, some sort of shop-window dummy. But she didn’t want to argue with her; she looked too ill now to be argued with and she gazed anxiously at her and said carefully, ‘How are you feeling now?’

  ‘I’m all right,’ Prue said. ‘What are you doing here then? Is it that I didn’t go to the clinic for my appointment? I didn’t want to and that’s the end of it. I’ve got — I made — there’s other arrangements.’

  ‘Oh?’ Suba said carefully, not wanting to say the wrong thing and floundering a little. ‘Oh!’

  ‘Yes, that’s it. My friend — it’s been arranged, you see. I’m to have this one at this other hospital, and I’m seeing the doctor there. Well, I will be doing. So I don’t have to go down to Old East. Much good they were to me anyway, when I needed ’em most —’ And she looked mulishly at Suba and Suba thought — She’s scared of me.

  ‘I’ve got nothing to do with that,’ she said. ‘Listen, can we take him into the kitchen and give him something to eat? That’s why he’s crying, I think —’ because Danny had started bawling loudly again — ‘and then I can explain it all to you, why I’m here and everything.’

  Prue stared at her and then shrugged. She came into the room and leaned over the Moses basket and picked up the baby that had been sleeping in it and Suba bit her lip in embarrassment. She hadn’t even noticed there was a baby in there.

  ‘She’s easy, this one,’ Prue said suddenly and, moving awkwardly, lifted the baby and set her cheek to its head and the baby woke and opened its mouth and cried, a little mew of sound that made the older child now sitting on Suba’s arm yell even more loudly.

  The kitchen was marginally tidier than the children’s bed room and Suba put Danny in a high chair that was standing there and looked round for something to give him to stop the shouting. Prue, appealed to, moved heavily to a corner cupboard and found a biscuit and the child grabbed it and at last was silenced.

  ‘Is the baby breast-fed?’ Suba ventured, looking at the infant who was now rolling its head towards its mother in an unmistakably hungry way. ‘Don’t mind me if —’

  ‘No,’ Prue said wearily. ‘Not in my state. I couldn’t manage and — I’ll get her a bottle.’ And she went to the grimy refrigerator and reached in it for a bottle. Suba saw the teat was uncovered and worried about that; she knew that such things should be kept sterile if the baby was to be protected from dangerous infection. She hadn’t done her children’s wards yet, but she knew that much. But she said nothing; there seemed little point anyway, looking round at the kitchen. Not precisely dirty but far from clean.

  ‘What does he have now?’ she asked, looking at Danny, as Prue ran the bottle under the hot tap to warm it. ‘I’ll get his for him if you like.’

  ‘I don’t see why you should,’ Prue said and stared at her with suspicion now very clear on her face. ‘If you’re not from the clinic what do you want here? Checking up on me, are you? I’m well enough. You don’t have to come checking up on me. I’ve got myself all sorted out, don’t need you social workers hanging around.’

  ‘But you said you remembered me!’ Suba said and tried a smile. ‘I’m one of the nurses at the ward you were in at Old East. And a very new one, too. I couldn’t be a social w
orker — I’m not old enough —’

  ‘Never you think it,’ Prue said with a suddenly savage note in her voice. ‘You should see some of ’em. Still got milk teeth and think they can tell me what to do. I sent ’em packing, I can tell you. So why are you here? Oh, Danny, shut up! Here, he likes that rusk stuff. Mix one with some milk and he’ll eat that.’

  Suba took the packet Prue had pointed to on the dresser and extracted one of the rusks, a big sugary thing, and tried not to say what she thought — that these days people gave babies fibre and not so much sugar, the way she’d learned in her nutrition lectures. But she didn’t. That wasn’t what she was here for, after all. And she didn’t want the sort of response the social workers had clearly got from Mrs Roberts.

  She mixed the rusk and milk from the fridge into a sticky porridge and began to feed it to Danny, who wolfed it down.

  ‘I came to ask your help, actually, Mrs Roberts,’ she said, and her diffidence made her voice rather low. ‘I thought you might be able to give me the sort of — well, support I need. Not just me, actually. Miss Buckland.’

  ‘Miss Buckland? Who’s she?’

  Prue was sitting now with the baby on her lap who was sucking steadily at the bottle. Suba felt a moment of shock. Surely she couldn’t have forgotten already?

  ‘She was the surgeon who looked after you,’ she said a little reprovingly. ‘She saved your life, you know. And your baby’s. The new one, I mean.’

  Prue’s shoulders came up into a defensive posture and the baby seemed to have recognised it too, for it stopped sucking and began to wail. Prue pushed the teat back into its mouth sharply and said, ‘Oh. Her.’

  ‘Yes,’ Suba said. ‘I wanted you to help me with her if you would.’

  ‘What sort of help?’

  ‘Well, it’s a bit difficult —’ Danny finished the rusk and still seemed hungry and Suba fetched another biscuit for him from the packet Prue had left on the dresser.