‘Don’t let them have ordinary blood, whatever you do. Order some more irradiated from the transfusion centre.’
‘I’ve done that and it should be here in a quarter of an hour. Shall I cross match it or issue it red label?’
‘Start the cross match while I go and see him. I’ll be with you as soon as I can.’
He glanced at the clock as he quickly dressed – nearly one – then, still swearing, he drove to the hospital.
He should have seen it coming. Brian Goodman was in his fifties and had been diagnosed with acute lymphoblastic leukaemia three months earlier. He’d been put on DAP and within three weeks was in remission. He’d been a cheerful, optimistic man, not particularly intelligent, but determined to ‘have a crack’ at beating the disease.
Then, after his first consolidation, he’d become withdrawn and morose. His wife said he was depressed, but Goodman himself insisted there was nothing wrong and refused the offer of antidepressants.
They should have found some way of persuading him, Fraser thought now – Goodman was naturally the kind of man who’d think admitting to depression wimpish.
He arrived at Accident and Emergency and the harassed young house officer in Resuscitation told him how Goodman had been found in the bath by his wife.
‘It’s only one wrist, but very deep. He’s lost a lot of blood.’
‘What have you given him?’
‘Haemocell and two units of blood. He’s having the platelets now, but he desperately needs more blood.’
‘You can have some more in’ – he looked at his watch – ‘half an hour.’ Seeing the look on her face, he said, ‘In his state, it’s not worth the risk of infection or transfusion reaction to give him red label. Is he conscious?’
She shook her head. ‘He’s in there if you want to see him.’ She indicated a curtained cubicle. ‘His wife’s with him.’
She was on one side of the bed, holding his hand, and a staff nurse was on the other. The shallow rise and fall of his chest was the only sign that he was still human. His wife said, ‘Can I speak to you, doctor?’
He took her to a corner and she told him how he’d seemed much happier that day. ‘I should have guessed it was because he’d made his mind up to do this…’ He’d told her he was going to have a bath and that she should go to bed. She’d dozed off, then woken to find herself alone and gone to look for him.
‘Oh, the silly old fool…’ She wept briefly, then said, ‘Will he be all right, doctor?’
‘I think so, once we’ve got some more blood into him.’
He went back to the bedside with her, then walked over to the lab and found Frances.
‘Has the blood arrived yet?’
She nodded. ‘Should be ready in about twenty minutes.’
‘Well done.’
‘Have you seen him?’
‘Yes, and his wife.’
‘What made him do it? He was doing so well…’
‘I know.’ He repeated what Mrs Goodman had told him.
She said, ‘I didn’t think they did slash their wrists if they really meant it, I thought it was usually a cry for help.’
‘Oh, he meant it fine well, he used a Stanley knife.’
‘Ugh.’ She shuddered. ‘Poor man. His poor wife.’
‘In a way, it fits in with his personality.’
‘How d’you mean?’
‘Old-fashioned, too proud to admit he was depressed, using what he saw as a macho way to finish himself off.’
‘Will it affect his chances?’
‘Well, it won’t help them.’
A timer went off and she went to see to the cross match.
On impulse, he followed her. ‘Can I help?’
She looked at him in mild surprise. ‘D’you know how to issue blood through the computer?’
He shook his head.
‘Then thanks, but not really.’
‘Can I make you a coffee, then?’
‘Not coffee – I’ll never sleep. A glass of squash would be nice.’
The phone rang. She picked it up, said ‘Yes’ a few times and wrote some details down, then replaced it and turned back to Fraser. ‘There’s another cross match on its way, so perhaps I will have that coffee.’
She joined him in the rest room fifteen minutes later.
‘All done?’ he asked.
She nodded as she sat down. ‘Six units.’
‘That should see him through,’ He got up and made the coffee. She’d taken off her lab coat and was wearing jeans and a T-shirt. She wasn’t wearing a bra, he noticed – she’d probably just got into bed when she was called. ‘Milk and sugar?’ he asked.
‘Just milk, please.’
He handed it to her.
‘Thanks.’ She took a sip. After a short silence, she said, ‘Pleased to be back with us?’
‘Yes, I am.’
‘How did you like Bath?’
‘It’s a fine city.’
‘But not really for you.’
‘How did you know?’
She shrugged. ‘Your expression.’
He smiled, said, ‘It’s fine, beautiful place, a bit like Edinburgh. But it’s somehow a mite pleased with itself, complacent.’
‘Also a bit like Edinburgh?’
‘Aye.’ He grinned at her – she was leaning back in her seat, her head slightly to one side, holding her coffee cup in both hands between her thighs. ‘You’ve been there?’ he asked.
She nodded, then said, ‘How long have you got with us now?’
‘Three years and a bit.’
‘So where d’you think you’ll go after that?’
‘Anywhere that’ll have me, within reason.’
‘Not back to Scotland?’
He took a mouthful of coffee before answering. ‘I don’t think so. There are more opportunities in England.’
‘You don’t miss Scotland?’
Again, he paused. ‘That’s a bit like asking an East Ender whether he misses England. What about you?’ he continued quickly. ‘Have you not been tempted to move on? To better things?’
She smiled briefly, recognising the equivocal nature of the question, but took her time to reply.
‘Events have conspired to keep me here,’ she said at last. ‘At the moment – it’s my mother – my father died last year and—’
‘I’m sorry to hear that.’
‘Thanks. It would hurt her if I moved away just now, especially as my brother’s living abroad.’ She spoke with a slight, but perceptible Avonian accent, rather attractive.
‘You could always move to one of the other labs round here.’
‘Easily, if I was prepared to downgrade, which I’m not. Besides, that kind of move usually involves swapping one set of problems for another. And anyway’ – she smiled to show him she knew what he was getting at – ‘Terry doesn’t bother me so much as he does some of the others.’
‘I’ve noticed,’ he said. Then: ‘What kept you here before your mother?’
He immediately regretted asking the question, but was saved by the buzzer at the lab entrance.
‘That’ll be the sample for the cross match,’ she said, getting up.
He watched as she left the room – her T-shirt had rucked up slightly over her backside and the sight of it as she walked away sent a shot of pure gold into his veins.
He washed up the mugs, then went to find her.
‘I’ll take another look at Brian, then I’ll be away,’ he said. ‘I hope you’re not up all night.’
‘So do I.’ She smiled. ‘Thanks for the coffee.’
‘My pleasure.’
Goodman still hadn’t regained consciousness, although his colour had improved and his breathing was easier. Fraser reassured his wife again, then drove home.
Sleep wouldn’t come. Images flickered: her face with its delicate colours framed by her dark, almost black hair, the T-shirt painted over her body, her long legs…
He got up, padded naked downstairs and pour
ed himself a whisky. Lust? he wondered as he sipped. Something more?
He’d had a brief and rather unsatisfactory affair in Bath with a nursing sister called Emma. She’d been clever, sophisticated and superficial. A girl. Whereas Frances, for all he’d thought of her as the raven-haired girl, was a woman… How old would she be? She was a Senior, so she’d have to be twenty-five… and he’d have bet anything that the other ‘event conspiring’ was a long-term affair…
Was she interested?
More to the point, was he? Did he really want an affair with someone he worked with?
Aye, he rather thought he might in this case… although Connie wouldn’t approve of him fraternising with the lab staff.
And there was something else Connie wasn’t going to like, he remembered – having resolved one problem in his mind, he turned it to another.
The next day, between clinics, he spent an hour going over patient records in the computer, then another on the phone. Then he went to Connie’s room.
‘Can I have a word?’
‘Of course you can, Fraser. Come and sit down.’
He closed the door and sat. ‘You’ll have heard about Brian Goodman?’
‘Yes, Ian told me, D’you think he meant it?’
‘Yes, I do.’ He explained why. ‘The thing is, Connie, I’ve been looking back over the records and I’m beginning to wonder whether maybe JS was right.’
‘Right about what?’
‘Alkovin causing severe psychotic effects.’
She frowned. ‘You’d better explain.’
In the four treatment centres in the area, he told her, they’d had twenty-one cases of ALL treated with DAP in the last nine months, and in ten of these the patients had suffered from depression. In three of them, they’d also suffered from paranoia and/or dementia.
‘Is that all, Fraser? I’d have expected all of them to be depressed, not just ten.’
‘I’m talking about clinical depression, occurring—’
‘How exactly d’you define that?’
‘Profound, prolonged, accompanied by feelings of guilt and self-blame – not to mention suicide.’
‘The fact is, Fraser, people do tend to have these feelings when they’re told they’ve got leukaemia.’
This was turning out to be even more difficult than he’d thought. ‘The symptoms I’m talking about are occurring after consolidation, not immediately—’
‘That’s a list of them, is it?’ She nodded at the paper in his hands. ‘Can I see?’
He handed it over and she quickly scanned it.
‘How many of these have you actually seen for yourself?’
‘About half,’ he admitted.
‘So your diagnosis of severe psychosis applies to only five patients, not ten.’
‘I’ve checked on the others inasmuch as I can—’
‘There’s been nothing in the literature – has there?’
‘Not so far as I know.’
‘Haven’t you checked?’
‘Not yet.’ He silently cursed himself.
‘Well, don’t you think you should?’
‘I take your point, Connie, and I will. But I still think we should look into it.’
‘You check the literature and I’ll have a word with Ian about it. But I do suggest you check your facts more thoroughly in future before raising alarms like this.’
A week later, Connie convened a meeting in her room with Fraser, Ian, Leo and Robert Swann, the new consultant. She started by asking Fraser to reiterate his concerns about Alkovin, which he did. He hadn’t found anything in the medical journals, although he had researched further into some of the cases.
The husband of one patient had told him how his wife had threatened suicide and that he was convinced she’d meant it. Antidepressants had helped her. And a woman had told him how her husband had suddenly become violent, hitting her and then threatening her with a kitchen knife. Afterwards, he’d broken down and begged forgiveness and a day or so later had apparently erased the whole thing from his mind. Both patients had subsequently relapsed and died.
After a moment of silence, Connie said, ‘Tragic though these cases are, we must remember that we’re dealing with people who have, effectively, been told they’re likely to die. We can all produce anecdotes of patients who, in similar circumstances, have behaved outrageously – because, with respect, Fraser, that’s all you’ve given us – anecdotes.’
She and Ian had been busy as well and had the advantage that, between them, they had seen all the patients involved. They went systematically through all the others on Fraser’s list. Yes, they’d suffered from depression, but in their view, not to any exceptional degree. Even episodes of violence were not uncommon in very sick people. The only possible exception was Brian Goodman…
‘Attempted suicide is far from unknown in leukaemia,’ Ian said, ‘and it was only a matter of time before our turn came round.’ He turned to Leo. ‘They’ve had a lot more experience using the drug in America. We haven’t found anything in the literature – have you heard of anything from the trials there?’
‘Not a thing,’ Leo replied – predictably, Fraser thought.
Sure, patients with leukaemia got depressed, maybe even a little psychotic occasionally – Prednisolone had been known to have mild effects of this nature.
Robert, who hadn’t said much until now, spoke up.
‘Since Fraser’s seen fit to raise this problem—’
‘Alleged problem,’ Leo corrected.
‘All right, alleged problem,’ Robert agreed. ‘The thing is, it can’t hurt for us to keep an eye on things, be ready to treat with antidepressants as soon as any symptoms appear, maybe even prophylactically in some—’
‘I’m not keen on prophylactic treatment,’ Connie interrupted. ‘By all means treat symptoms when, and if, they arise, but to treat them before they even appear would be to wish the problem on us.’
Which is all damn fine, Fraser thought a few minutes later when the meeting ended, but… But, when it came down to it, he’d achieved nothing except to lower himself a few more yards in Connie’s estimation.
Serves you right for sleeping with the boss, he told himself, although, as he remembered it, there hadn’t been a deal of sleeping.
He started towards his office without much idea of what he was going to do there when he saw Frances making for the way out. On impulse, he followed and caught up with her in the corridor.
‘Going to lunch?’
‘Into town. Shopping.’ She sounded in a hurry.
‘Ah…’ A poster he’d seen on the way to work floated into his mind and he said, ‘There’s a Stoppard on at the Foundry I’d like to see. Would you like to come with me?’
She’d stopped, looked at him without expression for a moment, then she’d said, ‘Yes, I would.’
7
July 1999
She was home from hospital again, for ten days, and Fraser had taken time off. The treatment had put new lines round her mouth now, giving her face a slightly pouched look, adding several years to it.
‘I’m sorry, but I don’t think I could,’ she said in bed, a small voice, when he ran his fingers over her breast. ‘Please, just hold me.’
She didn’t want to go out, she just read or watched TV. On the second evening, he made a lasagne, one of her favourites. She took a couple of mouthfuls and put her fork down.
‘It’s very nice, Fraser, but I’m not really hungry.’
‘Are you all right?’
Her face soured as she stared at him and her mouth pursed. ‘God, you have no idea how sick I am of hearing that phrase – Are you all right?’ she mimicked. ‘Are you all right?… Of course I’m not fucking all right, I’ve got fucking leukaemia, haven’t I?’
She made to get up and go, but he caught her wrist.
‘We’ve got to talk about this, Frances—’
She snatched her hand away. ‘Leave me alone… and get something into your head, I am not fucking
depressed – OK?’ Without warning, she picked up her plate and propelled it into his face as though it were a custard pie, then she stared open-mouthed at him for a moment before collapsing on to her arms on the table, weeping hysterically.
‘Help me please Fraser help me help me help me…’
He hurried round the table, trying to wipe the mess from his face with a serviette. He pulled up a chair, sat beside her. ‘I’ll help you, please let me…’
She threw her arms round his neck. ‘Please, please help me…’
After a while, when he’d calmed her down, he left her on the sofa and phoned his GP’s surgery. His doctor was there, but with a patient. Fraser asked the receptionist if he could call back, urgently. He came back to him after five minutes, listened, then said he’d be there as soon as he finished his appointments.
He was there in an hour. He examined Frances, listened to Fraser, then prescribed Prozac and a sedative to help her sleep.
Fraser put her to bed and stayed with her, waiting for it to work. When she was asleep, he went downstairs. He knew there would be no sleep for him that night without bottled assistance.
She was still sleeping when he woke in the morning, turned towards him and snoring slightly. Sleep had smoothed the lines round her mouth so that, with her hairless head, she looked like a baby, so vulnerable that he lay there watching her for a while.
Fraser didn’t feel too bad, considering the booze he’d put away the night before, although there was an ominous fuzziness around his forehead. He showered, hoping the jets of water would drive it away, which they did for a while. She woke as he dressed.
‘What time is it?’ she asked drowsily.
‘Half-past eight.’ He sat on the bed beside her. ‘How are you feeling?’
‘OK.’ She looked up at him. ‘Why do you ask me like that?’
He studied her face. ‘You don’t remember last night?’
Her brow furrowed. ‘Oh… did we have a row? I thought it was a dream.’
‘You don’t remember Dr Parker coming here?’
‘No… we had a row and then you put me to bed… didn’t you?’
Bad Medicine- A Life for a Life; Bed of Nails; Going Viral Page 6