Clinical Judgements

by Claire Rayner

  If he had really made up his mind completely, she thinks, had really meant what he had said that evening when she had come home and he had been sitting there waiting for her, his mind made up, he had assured her, would he be so very scrupulous about the way he uses the phone? Kate thinks not; and tries not to think about the implications of that thought. Instead she pats her belly, childishly pleased with herself that they have managed to make their plan to underline their commitment to each other so successful so soon, and goes down the ward to see her dialysis patients.

  It is going to be a difficult day. There are seven patients needing dialysis, and only three machines available. Four must be sent home in the hope they will not go into irreversible uraemia. Not very agreeable at Christmas, thinks Kate, and picks up her charts ready to start her ward round with the new sister in charge, Daphne Royden. She is young and ambitious and not nearly so efficient as Esther would have been, and certainly not so much fun, but she does well enough. And Kate smiles at her and leads the way down the ward, wondering whether she will be sick again. It is very agreeable to be in the state she is in, of course, but it has its drawbacks.

  Ten a.m.

  Ted Scribner moves gingerly in his bed and then sighs in relief. It is dry, after all, and he feels a great rush of gratitude for that. He had fallen asleep after having his breakfast instead of going to the lavatory the way the nurses had said he must. Go regular, that was the thing, to get himself trained again, and he had meant to. But the porridge had been good and lots of it, and it was no wonder he fell asleep. He ate better here at Old East than he ever did at home, no error, and he thinks a little wistfully of how nice it would be to stay here over the next few days.

  It is going to be good here for Christmas, he knows that; he has seen the tree all loaded with parcels for the patients — nice of them to do that, he thinks, real nice — and he’s heard about how the turkey is carved by Mr Le Queux, making lots of jokes all the while about how much nicer it is than carving people’s kidneys, and how there are drinks all round on the house.

  But there it is, they said he could go home today and thought he’d be glad of the opportunity and he hadn’t liked to say he’d rather stay where he was. After all, he’d waited long enough to get in here, hadn’t he? And only had his operation less than a week ago? But he is doing fine they say, so he has to go and anyway, the next-doors might be fed up with the cat, so he’d better get back to her.

  And he swings his scrawny legs carefully over the side of the bed and puts on his dressing gown — and he wishes he could take that home too, instead of leaving it behind as hospital property — and goes to the lavatory. It is easier now, nothing like as bad as it was, and he should be grateful. And he is grateful, really. He just wishes he could stay here in the warm with all the good food just a little bit longer. His pension doesn’t go far these days and specially not at Christmas.

  Ten-thirty a.m.

  The meeting in the nurses’ home sitting room is not very well attended and Sian sits and glowers sulkily at the few people who are there. Just the usual ones; how can they ever get anywhere if they have just the usual ones? And she says as much and the others stare at her and shrug and say nothing useful and she launches into one of what the others call her tirades. She knows they are bored but she can’t help it.

  ‘Why are they so stupid?’ she cries. ‘Are they waiting till a nurse dies here? It’s been weeks since it happened to that enrolled chap in that mental handicap hospital. If we don’t make sure they arrange for us all to be vaccinated here, then it could happen to us.’

  ‘They’ve offered people here hepatitis B vaccine ever so often.’ One of the night nurses who is only present because she came off duty exhausted and stopped in the sitting room to sit down by the radiator to get warm, and now can’t be bothered to get to her feet and go to bed, speaks up. ‘But no one took it up. Not even the ones in the path lab and they’re handling blood all the time.’

  ‘And no one here’s likely to get bitten like that other fella did. We don’t have any mentally handicapped here, do we?’ says Peter Burnett. He is only in the sitting room to wait for David Engell because they both have a day off and are planning to go to the West End together and have a bit of fun. ‘I’m buggered if I’d go on strike for anything so daft.’

  ‘It’s not daft,’ retorts Sian. ‘Not if you could die for want of it. And as for being buggered — you should be so lucky,’ and Peter shouts back at her and for a little while it seems there will be a real fight, and the others watch, interested. It is better than watching television which is only schools and a lot of women talking at this time of the morning.

  But then David arrives and Peter goes off jeering at Sian and the meeting goes on, and when they get to the vote on the motion which is ‘It is determined all the nurses at Old East should strike in sympathy with the St Kitts demo and that all nurses should be vaccinated against hepatitis B’, the vote is so small there is no hope of getting a strike going, and Sian marches out in a temper. She works so hard to organise the nurses and they are all so wet, they don’t know the price of bloody eggs and care less.

  And she goes to bed, because she too is on night duty now, in the children’s ward, and tomorrow will be a busy day, and sleeps badly because she is so angry. And not only with the apathetic apolitical nurses of Old East. Although she wouldn’t admit it for the world, it hurts that Jimmy Rhoda never phones any more. But there, Old East stopped being in the news weeks ago, and she knows now that was the real reason he used to take her out. Thank God for politics, she thinks as she throws herself over in bed again. It may be tough to get anywhere, but at least it’s more honest than bloody sex.

  Eleven a.m.

  Professor Levy pushes his chair back from his office desk and looks gloomily at the two men sitting on the other side of it.

  ‘You realise,’ he says, ‘that this will not be done smoothly or easily? There will be considerable opposition.’

  ‘There always is opposition to change,’ one of them says. ‘It is in the nature of mankind to resist it.’

  ‘No doubt,’ says Professor Levy a little dryly. ‘But I was thinking less of basic philosophical concepts and more of local feeling about this hospital. There is a well-organised lobby to protect Old East, you know. The woman who leads it has a considerable flair for this sort of politicking. You’ll find to your cost that any attempt to go back on the DHSS’s word at this stage will cause an almighty uproar. We were assured we were safe till the next financial year. Mr Saffron said —’

  ‘Ah yes, Mr Saffron,’ the man interrupts smoothly. ‘But he is no longer Minister, you see. Sad about him, wasn’t it? But there you are — and the new Minister is really quite adamant. He has listened with great sympathy to the representations made to him, but he is certain that Old East, like many other similar establishments, must lose some of its fat and become one of the newer more sinewy hospitals of the nineties — either that or we close down and sell the site.’

  ‘Lose fat?’ explodes Professor Levy. ‘What fat? This place has as much spare on it as a ballet dancer with anorexia. We’re running on a shoestring as it is. We do miracles here on the budget you give us, do you know that? If I could persuade you to do some of the cutting we can’t, at admin level, now that might get us somewhere. But as it is —’

  ‘Well, there it is, Professor.’ The man zips his briefcase and gets to his feet, smiling, and his silent companion copies him. ‘I’m afraid there is little more we can do to help. I’m glad we were able to have this little discussion. It does clear the air, doesn’t it? I see your hospital tree is up — beautifully dressed and lit, isn’t it? Yes —’

  Professor Levy is also on his feet and comes to join them at the window. ‘It was both provided and dressed as a gift from the local Chamber of Commerce,’ he says dryly. ‘I can let you see the correspondence if you wish. We paid for nothing, not even the electricity for the fairy lights. It’s connected to one of the shops outside the gates.
You can see there, the cable is carried over the archway. There —’

  ‘My dear chap, you really mustn’t think we’re Scrooges, you know!’ The Ministry man smiles at him with crinkle-eyed bonhomie. ‘I was just admiring your tree, no more! Well, goodbye, Professor. Merry Christmas!’

  After they have gone Professor Levy stands staring out at the tree for a little while, and then goes to his desk to pick up the phone. He has just time to deal with this before he goes to the medical students’ last lecture round before the festivities overtake them all.

  ‘Mrs Blundell?’ he says into the phone at length. ‘Ah, how are you? I just thought I’d call with the greetings of the season —’

  Eleven-thirty a.m.

  Fay Buckland’s antenatal clinic is nearly finished. There are just four more patients to see, but since between them they have eleven children the waiting room is noisy and hectic as the children roll around the floor and fight with each other and make a great deal of noise. Fay Buckland, although she can hear the noise, will not be hurried, however; the woman she is examining has a difficult breech presentation and she is seizing the opportunity to show her students how to make an attempt at manual version.

  The third-year nurse running the clinic because Sister is busy elsewhere is irritated and restless because she has a great deal to do to get the big waiting area ready for the outpatient children’s Christmas party this afternoon, and she can’t get going with those spoiled noisy brats all over the place. So when one of the patients comes and tells her truculently that her appointment was for ten-thirty and she’s damned if she’s going to wait another minute, and even though the woman looks pasty and tired and has somewhat swollen ankles she does not remonstrate with her and try to make sure she stays as Sister would have done. But then the third-year nurse has not done her midder training yet, nor even worked on a midder ward, so she does not notice this and is quite happy to get the woman to go and take her two children with her, especially as one of them, a little boy, is the noisiest and bounciest of them all.

  So Prue goes, pushing the baby’s pram and dragging Danny along with it, miserably aware of her aching head and her dreadful tiredness. She hasn’t see the doctor for ages and she ought to have seen her today but how could she sit there any longer? They had no notion of what it was like to have two screaming kids and another on the way and no husband here to help, because he wasn’t supposed to get to England till the end of January, bloody Gary; and she feels the tears, the all-too-frequent tears, slide down her nose again as she sets out on the long walk back to the messiness of Lansbury House and another long and miserable day at home with the kids. And tomorrow bloody Christmas Eve too. And she thinks about Ida Malone as she trudges on her way and wishes she hadn’t moved away the way she had. She’d been horrible, but all the same, it had been someone who looked after her, hadn’t it? And there wasn’t anyone else around to do it.

  One p.m.

  Mr Holliday has been watching TV all morning. There has been nothing on, just a lot of talking people and stuff for schools, but it is better than nothing, and now the programme is changing maybe it will be better. The news. That wasn’t better. But maybe, after the news? She’d be back from the shops soon and then it’d be the end of watching anything. She’d talk and jabber at him and he’d not be able to hear a word from the screen. It is funny, thinks Mr Holliday, how the best programmes are always on when there are other people around to spoil them, but there’s never anything worth seeing when you are on your own and really have the chance to concentrate.

  There is something then on the news that is worth concentrating on; another bit of news about brain operations. A doctor somewhere is doing them for epilepsy now, using the same sort of baby cells, and Mr Holliday listens, staring hard at the screen, slumped in the chair with his hands twitching as usual on his lap and his useless legs swathed in a rug and thinks — did anyone listen to them when they asked about it? Were they the sort that got to know what it was all about? It must be easier to be epileptic, he thinks. At least you can make them listen to you, make them understand what worries you. They never listen to me.

  Three-thirty p.m.

  Kim Hynes is the last appointment on Dr Rosen’s clinic list, and she is there well on time. When she walks into the consulting room she sets a cake box in front of Dr Rosen and says, ‘I made it for you. Myself. It’s a very good recipe — high fibre, low fat, everything just as it should be. I hope you like fruit cakes.’ She giggles then. ‘What a thing to say to a shrink! Fruit cakes — of course you like them. Well, how could you manage if you didn’t?’

  Dr Rosen smiles, and looks at the cake and says gravely, ‘It looks delicious. I shall take it home and have it tonight. My daughter will help me eat it. How are you, Kim? You look well enough —’

  ‘Really? You like the new-look Kim? Are you sure?’

  She does indeed, thinks Dr Rosen, look new. The rich tumble of curls has become a sleek French pleat, pinned high on her head. The make-up, though still obvious, is less heavy and the clothes are a little less outrageous. Still very soft and frilly, but lacking the extravagances that had once been so much part of the Hynes Effect, as Dr Rosen had described it in the notes of this most interesting case.

  ‘I’m sure,’ she says at length. ‘Does it mean anything more than a look, though? Or are you new in any other way?’

  Kim nods, very satisfied. ‘Oh, yes. It’s — I can’t say how wonderful it all is. I nearly went all wrong, you know. After the operation — losing my job and all, it made me act — well, I’m really embarrassed now when I think of it.’ She giggles, bright-eyed and not really ashamed at all. ‘Very naughty I was there for a while. Films, a bit of tarting — the lot. But it’s not for me, not even for the money. I’m a nice girl inside. You know that, don’t you, Dr Rosen?’

  Dr Rosen smiles and says quietly, ‘Yes, Kim. I know. A very nice girl.’

  ‘But not everyone does. So I thought — I’d better make sure I look the part, eh? It used to be I just wanted to look like a woman, so I suppose — I went a bit OTT, you know? But now, as I am a woman, aren’t I? A real woman — the operation’s only a bit of it — the drugs and all — anyway, now, I thought, I don’t have to look like I did. Now I can be more like me. The real woman. The elegant sort — yes?’

  ‘Yes,’ says Dr Rosen. And doesn’t look at the very red nail varnish and the little gold chain Kim has round one ankle, the one she has crossed over so far that most of her thigh shows under her sleek skirt.

  ‘I’m still trying to get the business going,’ Kim says. ‘The bank’s being — well, forget it. You know how banks can be — full of the nastiest people! But I’ve met this lovely man, very high class, you know, a businessman and he’s advising me.’ She flashes her brilliant smile at Dr Rosen and then says, ‘Now, do tell me. When do you think we can persuade Miss Sayers to do the next bit? It’s not that I’ve got to have a proper you-know-what — I mean I’ve proved you can get away with murder and the poor devils don’t know what’s there and what isn’t, you know what I mean? But I’d feel, you know, better. I know I’m a real woman now, but that would make all the difference —’

  Five-fifteen p.m.

  There are three women in labour in the maternity unit and Fay Buckland gets there just in time to deal with the most worrying of them. She is almost forty and has been under the care only of a midwife, refusing any sort of doctors or hospital intervention at all. But after being in labour for almost a day and a half the midwife has become very anxious and has insisted on transferring her to Old East. Now Fay has to see why the delay and see what she can do to help, for the baby’s heartbeat is very poor and the foetal monitors show it is fading rapidly.

  It is difficult to do a Caesar so far on in labour, Fay tells her students, but what else can she do? And when afterwards she and Sister stand and look down at the gasping pallid baby with the massive meningocele sprouting from its back like a great obscene piece of leftover meat, they say little to eac
h other. They watch and hope the baby will stop breathing of its own accord. But it is a tough baby for all its dreadful defect and slowly loses its poor colour and begins to breathe more easily. And Sister wraps it and puts it in its special cot and says to Fay Buckland, ‘Well?’

  And Fay Buckland shrugs and shakes her head. ‘Sad,’ she says briefly. And goes away and Sister stands there and tries to think what they will say to the mother when she comes round from her anaesthetic.

  And what will they do about the baby? Because a meningocele, which would have been detected early enough for her to have had a termination if only she’d been having proper care, she tells herself, a meningocele baby has a hell of a life to look forward to.

  If we let it look forward, that is.

  Severn-thirty p.m.

  The annual hospital Christmas show is in progress. The medical students, the third-year nurses, most of the physios and the occupational health students have put it on and it is very funny and very noisy.

  There are rude sketches about the senior medical staff, all very insulting, and even more rude sketches about the sisters. There is dancing more energetic than elegant, and there is singing and a lot of noisy stamping from the audience who are watching with a great deal of glee and not a little scorn, especially those who wanted to be in the cast but were turned down by the committee who organised it. They are the ones who shout and jeer the loudest. But the patients who have been brought over to the big lecture room in wheelchairs and allowed to come hobbling over on foot are liking it well enough, because it is, after all, Christmas and these young doctors and nurses, well, they work so hard, don’t they? So good and caring and so, well, good.