HE GRABBED THE PHONE before the first ring had even finished.
He always woke like that, in a flash, no matter how deeply he had been sleeping. It was all the years of being woken. Then he always broke out in a sweat.
He answered automatically, feeling the familiar, clammy, cold disorientation sweep over him.
It was the HO’s voice. She was on call in the hospital. It was one of the nights when Goldblatt was on call at home for the Prof’s unit and Dermatology.
‘Sorry to wake you, Malcolm,’ she said.
‘It’s all right. What is it?’
‘It’s Sandra Hill. She arrested.’
Goldblatt closed his eyes for a second and shook his head.
‘Malcolm?’
‘Yes. Sandra arrested. What time is it?’
‘Half past four. I resuscitated her, Malcolm.’
‘You resuscitated her?’ Goldblatt sat up. Beside him, Lesley stirred. They were still sleeping in the same bed although most of the time now it felt as if they were strangers in it. ‘Wait a second.’ He got up and took the phone out of the bedroom into the corridor.
‘Malcolm?’
‘Yes. OK. Go on.’
‘What do I do next?’
‘Where is she?’
‘In her bed.’
‘What does the medical registrar say?’
‘He hasn’t seen her.’
‘What do you mean he hasn’t seen her? I thought you said you called a an arrest.’
‘No. I didn’t call an arrest. I was on the ward and I found her and I resuscitated her before anyone called an arrest.’
‘By yourself?’ asked Goldblatt. Maybe he wasn’t quite awake yet. ‘You resuscitated her by yourself? What did you do?’
‘I looked at her.’
‘You looked at her?’
‘Well, that wasn’t all I did. I put her oxygen mask back on her as well. And she started breathing again.’
It was cold in the corridor. Goldblatt shivered. ‘You have a gift. Do you know that? Have you ever thought about becoming a doctor?’
‘Very funny.’
‘What were you doing on the ward, anyway? What time did you say it is?’
‘Half past four. I had to put a drip in someone.’
‘And you say she’s in her bed?’
‘Yes.’
‘And the med reg hasn’t seen her?’
‘No.’
‘Is her blood pressure all right?’
‘A hundred on sixty.’
‘Is she conscious?’
‘Yes,’ said the HO. ‘But she’s in pain.’
‘Chest pain?’
‘Abdominal pain.’
‘Have you felt her abdomen?’
‘Yes.’
‘And?’
‘It feels sort of tight.’
‘Bowel sounds?’
‘I didn’t listen for bowel sounds. Should I have listened for bowel sounds? Hold on and I’ll go and—’
‘No, just wait.’ Goldblatt paused. ‘Let me get the picture. Has she been vomiting?’
‘I don’t think so.’
‘Does she need any analgesia?’
‘I’ve given her diamorphine already.’
‘For?’
‘For the abdominal pain. She was in terrible pain, Malcolm. I had to give her something.’
‘How much did you give her?’
‘Five milligrams.’
‘Intramuscularly?’
‘Intravenously.’
‘That’s a big dose. Is she comfortable now?’
‘I think so.’
‘That blood pressure you mentioned, was that before you gave her the diamorph or after it?’
‘Before.’
‘Have you checked the BP since you gave her the diamorph?’
‘No,’ said the HO. ‘Should I have checked her BP again? Hold on and I’ll go and—’
‘No, just wait.’
‘Wait a second, Malcolm. One of the nurses is here. I’ll get him to check it.’
Goldblatt heard the HO talking to one of the nurses. He tried to think. Decision trees are harder to draw in your brain at four in the morning than on a whiteboard at four in the afternoon.
‘All right, Malcolm,’ said the HO. ‘The nurse is going to check it.’
‘Get an ECG, a chest film, and an abdo X-ray. Make sure you tell the radiographer we’re looking for a bowel perforation, so we’re looking for free gas under the diaphragm, right? Tell the radiographer so they sit her up properly.’
‘I don’t think she can sit up, Malcolm.’
‘Just tell them, all right? They’ll prop her up. Get some blood gases as well. Make her nil orally.’
‘I don’t think she’s going to be eating.’
‘Just make her nil orally,’ said Goldblatt impatiently. ‘Make sure it’s done so no one goes pouring anything down her throat. Are you writing this down?’
‘Yes. ECG, chest film, and abdo film. Look for gas under the diaphragm. Blood gases. Nil orally. Anything else?’
‘Get the surgical registrar to see her.’
There was silence.
‘Did you hear me?’
‘I can’t ring the surgical registrar.’
‘Why can’t you?’
‘I can’t, Malcolm. You know what they’ll say. She has to be seen by my registrar first.’
‘No, she doesn’t. Just ring the surg reg.’
‘I can’t, Malcolm. Can’t it wait until you see her?’
‘No, it can’t wait until I see her. Listen, just do what—’
He stopped, imagining what it would be like to be an HO at four in the morning with that voice talking to you on the other end of the line.
‘OK, that’s fine. I’ll ring him from here.’
‘Thanks, Malcolm.’
‘OK. And one other thing. Make her Not For Resuscitation.’
There was another silence on the phone.
‘Did you hear what I said?’
‘But we made her For Resuscitation today.’
‘Well, you’ve saved her life now and it’s time to make her Not For Resus again.’
‘Malcolm,’ said the HO, ‘you know what happened today,’
‘Listen. At this point, it’s my decision. I’ll take the consequences. I know what Sandra would want. She’s Not For Resus. Right?’
‘Can’t it wait until you see her?’
‘No. This can’t wait. If she arrests before I see her I don’t want anyone jumping up and down on her chest. Understand? She’s Not For Resus. She doesn’t get intubated. You don’t shock her. She doesn’t go to ITU. She gets fluids. She gets antibiotics. She gets pain relief. That’s it. Nothing else. She’s Not For Resus.’
The HO was quiet. ‘I can’t do it.’
‘Why not?’
‘You know the rules. A registrar has to do it.’
‘Do it. Do it. Just write that I told you to do it.’
‘That’s circular, isn’t it?’
Goldblatt realized he had created a monster.
‘Do it! I’ll fix it up as soon as I come in.’
‘Are you coming in?’
‘Of course I’m coming in.’
The tapping of his footsteps was loud as he crossed the dimly lit lobby of the seventh floor. Goldblatt went through the doors and on to the ward. A murmur came from somewhere. Somewhere else, a door closed. A piece of equipment beeped. His own footsteps. The sounds of a darkened ward at night. How many times had he heard them? How many times had he moved through this muffled night-time world?
He dropped his jacket off in the doctors’ office. He went around the corner and saw the surgical registrar standing in front of the X-ray box on the wall behind the nurses’ station. The fluorescent lights set into the front panel of the desk formed an island of light. Behind it, the X-ray box sent a white glow into the high-dependency area, where a nurse was checking a drip.
The surgical registrar looked around as Goldblatt came towards him. He was a big, cuddly-looking Asian guy, like a teddy bear, and the crumpled greens in which he had been sleeping bulged over the roll of fat around his middle.
‘Malcolm Goldblatt,’ said Goldblatt when he reached him, ‘I’m the registrar looking after Sandra Hill. I’m the one who called you.’
‘Ravi Menon,’ said the surgical registrar.
‘Thanks for coming up. I appreciate it. Have you seen her yet?’
‘Just finished.’
‘What do you think?’
Ravi Menon looked back at Sandra’s X-ray. Goldblatt scrutinized it over his shoulder. It was a messy film. They hadn’t managed to prop her up very far and she had slumped to one side and there were ribs everywhere. Even so, they could see that Sandra’s abdomen was full of fat sausages of dilated, thin-walled, gas-filled bowel. If one of those sausages hadn’t already burst its skin, it probably soon would.
Ravi Menon shrugged. ‘Probably paralytic.’
‘No bowel sounds?’
‘Not that I could hear.’
‘Perforation?’
Ravi Menon blew a puff of air out between his lips, shaking his head. ‘Look at that film. How can you tell?’
The nurse came out of the high-dependency area and passed them silently, heading for a storage room.
‘If she’s perforated, would you operate on her?’ asked Goldblatt.
Ravi Menon puffed again. ‘She’s sick. I met your house officer. She’s got something wrong with her lungs, hasn’t she? Your house officer was getting gases.’
‘Pulmonary fibrosis. She’s on forty per cent oxygen all the time.’
‘Could she survive an operation? You tell me. You’re the physician.’
‘Unlikely,’ said Goldblatt.
‘Well...’
Ravi Menon turned away from the viewing box and sat down at the desk of the nurses’ station with Sandra’s notes in front of him.
‘Why’s she got pulmonary fibrosis?’ he asked as he opened the notes.
‘Fuertler’s Syndrome.’
‘Never heard of it. They get a lot of this?’
‘Not a lot.’
‘I’ll see her again later today. Let us know if she gets fit enough for an operation. I’ll write something in the notes.’
‘Thanks,’ said Goldblatt.
The HO came around the corner.
‘Malcolm,’ she said.
‘Hi.’
‘I’m sorry to have to get you in here.’
‘You made the house officer’s mistake.’
‘What? Waking the registrar?’
‘No. Resuscitating the patient.’
The HO managed a laugh. She was pale and drained, with dark smudges under her eyes. She looked as if she was going to keel over and fall flat on her face, squashing her already squashed nose even more. All she needed was a bowl of bean soup in front of her.
‘Have you got other stuff to do?’ asked Goldblatt.
‘There’s a drip up here again. And I have to write up some drugs on someone the SHO’s just admitted from Casualty. And they just rang me from some other ward about a patient who’s having chest pain.’ The HO pulled a piece of paper out of her pocket. She frowned, turning the paper upside down and then back to front. The writing on it consisted of names and numbers, and went in all directions.
‘Have you been to bed?’
The HO narrowed her eyes and looked around furtively. ‘Bed? What’s that?’
‘What happened with Sandra?’
‘A nurse found her on the ground next to her bed. She must have tried to get up.’
‘And?’
‘I was in the next room and they called me in to look at her. I put the oxygen back on her face and she started breathing again.’
‘Did she have a pulse when you found her?’ asked Goldblatt.
The HO frowned.
‘You know, a pulse?’
‘I know what you mean.’
‘Did you feel one? Did you check?’
‘The nurse said she couldn’t feel one.’
‘But did you feel one?’
‘She started breathing again, Malcolm!’
‘I hate to say this, but I don’t think she had an arrest.’
‘You mean I didn’t resuscitate her?’
‘You normally have to do more than put an oxygen mask on a patient for it to count as a resuscitation.’
Ravi Menon glanced up from the notes and grinned.
‘I really thought I resuscitated her,’ said the HO. ‘I’ve never resuscitated anyone.’
‘You’ll get your chance,’ said Goldblatt.
The HO shook her head bitterly, as if she had been going to cut a notch in her stethoscope. She tried one last time. ‘I’m sure I resuscitated her, Malcolm, really. Are you sure I didn’t?’
Goldblatt turned to look at Sandra’s X-ray again.
‘Do you need me?’ said the HO. ‘Only I’ve got this drip to do and there’s still that patient with the chest pain and the patient from Casualty.’
‘No, go on.’
The HO headed for the supply room to get a cannula for the drip. Goldblatt went to see Sandra.
The glow of a light filtered out from behind the screens that were drawn around Sandra’s bed. Goldblatt saw a pair of frightened eyes watching from one of the other beds in the gloom. He smiled reassuringly as he went past. The patients in the other two beds were pretending to sleep. But who could sleep while doctors, nurses, radiographers, and X-ray machines as big as elephants spent the whole night going to and from the bed in the corner? Who could sleep while someone there was dying?
He went behind the screen. Sandra’s eyes were closed. A nurse was checking her blood pressure. You never really got to know the nurses who worked nights as their regular shift. Goldblatt had seen her a couple of times when he had been on call before. He waited until she finished. The nurse let out the pressure from the cuff, took the stethoscope out of her ears, and turned around.
‘Malcolm Goldblatt,’ he said. ‘I’m the registrar looking after Sandra.’
‘Hi.’
‘Is she comfortable?’
The nurse looked at Sandra. ‘I think so.’
‘What’s the BP?’
‘Eighty on fifty’
Goldblatt nodded. Not too bad, considering the dose of diamorphine the HO had walloped her with. He picked up the charts and examined them while the nurse stood by. He saw the HO’s five milligrams of diamorphine timed, dated, and signed off. He flicked through the charts for a moment longer.
‘Has she got a catheter in?’ he asked.
‘No.’
‘Would you mind organizing that after I finish?’
‘Certainly,’ said the nurse.
‘Thanks.’ He handed the charts back to the nurse, who took out her pen to record the blood pressure.
He went to the head of the bed. Sandra was breathing evenly behind her mask, knocked out by the diamorphine. The oxygen made a bubbling noise in the background. The light above her shone straight down on Sandra’s face and Goldblatt reached up and angled it away.
‘Sandra,’ he said.
Sandra breathed. Goldblatt shook her shoulder gently. Her head lolled a little.
‘Sandra.’
Her eyelids fluttered.
Goldblatt smiled down at her. ‘How are you feeling, Sandra?’
She mumbled something.
‘All right?’
Sandra nodded. Her head moved slightly. ‘All right,’ she mumbled.
‘Have you got any pain anywhere?’
Sandra shook her head.
‘Is your breathing all right?’
Sandra didn’t answer.
‘I’m just going to have a look at you.’
He pulled aside the sheet that covered her and examined her briefly. Her belly was tight and distended, and when he pressed on it gently she winced.
‘Does that hurt?’
Sandra nodded. Her eyes were closed and she was drifting in and out of sleep.
Goldblatt laid his stethoscope on the skin of Sandra’s belly, just beside her umbilicus. He looked at his watch and listened for a full minute. Nothing. Not a single one of the bowel sounds you normally hear plentifully gurgling and rumbling away when you put your stethoscope to a healthy abdomen. Silence in the belly. Silence of the grave, as one of his surgery lecturers used to put it.
He pulled the sheet over her again.
‘Sandra,’ said Goldblatt. He shook her shoulder gently. ‘Sandra.’
Sandra’s eyes opened reluctantly.
‘Sandra, you haven’t got any pain?’
Sandra shook her head. Her eyes closed again.
Goldblatt hesitated, wanting to explain. But she wouldn’t understand, the diamorphine had muffled everything, her perception of pain, her ability to think, consciousness. He looked at her. Under her oxygen mask, the skin of her nose was thickened and pocked with Fuertler’s. Her face was scarred and puckered.
And he didn’t know, even after all these years, after all the patients he had seen pass by before him. How important was it to know that you were about to die? That the time had come. How important was it to know why it was going to happen?
But Sandra knew already. She had known for days. For weeks, probably.
‘Sandra,’ Goldblatt murmured. He stroked her forehead, brushing back her hair.
Sandra breathed steadily. He was talking to himself.
‘We’ll keep you comfortable, Sandra.’
He adjusted her oxygen mask. He reached over to the dimming switch and dimmed the light right down. Then he stroked her forehead again, gazing down at her. He took a deep breath and turned to go.
The nurse was still there, watching him.
He stopped for a second, then smiled self-consciously. ‘We’ll keep her comfortable,’ he said stupidly, and the nurse nodded.
Goldblatt went back to the desk at the nurses’ station. Ravi Menon had gone. The HO had gone. He could hear the sound of a bedpan being flushed in the sluice room. He looked at his watch. Almost six o’clock. He looked out of the window on the other side of the ward. Still dark outside.
He pulled Sandra’s notes across the desk and opened them. He looked over the ECG that the HO had done, and checked the arterial blood gas results that she had recorded. He read over the HO’s note. It started with ‘Patient arrested’ and ended with ‘NOT FOR RESUSCITATION ACCORDING TO DR GOLDBLATT’. She had underlined ‘ACCORDING TO DR GOLDBLATT’ three times. Goldblatt made a mental note to tell the HO that underlining didn’t reduce circularity. He read Ravi Menon’s note. Towards the end it said ‘Unfit for surgery according to Med Reg’. It was true. All of it was indisputably true. He had said these things. It was funny how people took you seriously when you told them something. You say words and they become reality. Goldblatt took out his pen to add some more reality to the record.
When he was finished he turned to the front registration page of Sandra’s notes. He found the number of the person listed as her next of kin, Mrs Jones, one of her sisters. He had met her briefly a couple of times on the ward.
He dialled the number. He heard it ring, imagining the darkened rooms of a house where its unwanted, ominous tones were cruelly slicing through the early-morning silence.
Goldblatt found the HO in the doctors’ mess, slumped forward with her face in yesterday’s newspaper, when he left the ward. The on-call night had only a couple more hours to run.
‘Coffee?’ said Goldblatt.
The HO jumped. ‘Where?’
‘It’s Platonic,’ said Goldblatt. ‘The coffee hasn’t been made yet. But it exists in our minds, as the form of coffee...’
The HO slumped forward again.
‘We can make it real, if we want. Do we want?’
‘Yes,’ came the HO’s muffled reply.
‘I thought so,’ said Goldblatt.
The HO keeled over sideways on the sofa.
‘What happened with the man with chest pain you were going to see?’ asked Goldblatt as he waited for the water to boil.
‘It got better,’ said the HO, dragging herself up to a sitting position.
‘What was it?’
‘No idea.’
‘How did you treat it?’
‘I didn’t treat it. It went away by itself.’
‘It’s a gift,’ said Goldblatt. ‘I keep telling you.’
The HO shook her head wearily.
‘Milk?’ said Goldblatt.
‘Yes, please.’
Goldblatt sniffed the milk. ‘No, I don’t think so.’
‘How’s Sandra?’ asked the HO.
‘The same. Five milligrams of diamorph intravenously is a big slug. For someone that size you should start with two point five.’
‘I always give five milligrams,’ said the HO.
‘What do you mean, you always give five milligrams?’ Goldblatt looked at her incredulously. The HO was too new to the business to ‘always’ do anything.
‘Dr Warren always gives five milligrams.’
‘Who’s Dr Warren, the local euthanasathist?’
‘No,’ replied the HO stoutly, ‘he’s one of the medical registrars. He says you always need five milligrams to get rid of real pain.’
‘And real blood pressure. And real breathing. You don’t need five milligrams intravenously. Not in someone that size. Intramuscularly, maybe. But intravenously, hardly ever. Maybe with a severe MI.’
‘But she was in pain, Malcolm! You should have seen her.’
‘You can always give more. Start with two point five next time if you’re giving it intravenously, all right? See how that goes, and check her BP and respiratory rate before you give any more.’
The HO looked discontented.
‘Say: “I always start with two point five milligrams when I give diamorphine intravenously,”’ said Goldblatt.
‘No.’
‘Say it.’
‘Why should I?’
‘Because the water just boiled and you won’t get any coffee otherwise.’
‘I always start with two point five milligrams when I give diamorphine intravenously.’
‘Good.’
‘Sometimes,’ said the HO.
Goldblatt brought the coffees over and sat down beside her.
‘I did an ECG on the man with chest pain.’ The HO pulled a spooled ribbon of paper out of the pocket of her white coat. ‘I wasn’t sure if it showed anything.’
‘Did you check it with the med reg?’
The HO shook her head. ‘The pain went.’
Goldblatt held out his hand and the HO passed him the ECG. He unwound the long strip of paper and examined the saw-toothed trace.
‘Inferior myocardial infarction,’ he pronounced after a few seconds. He rewound the ECG strip and held it for the HO to take.
She stared at him in horror. ‘But the pain went!’
‘Pain does sometimes.’
‘So you mean he had a heart attack? You mean he’s had an infarct and I just left him there?’
‘He’s had an infarct at some point in the past.’ Goldblatt paused. ‘They’re old changes on the ECG. Years old, probably.’
The HO closed her eyes in relief. ‘Not last night?’
‘Not last night.’ Goldblatt held out the strip. ‘You must have seen it on his old ECGs.’
‘I didn’t look at his old ECGs.’
‘That’ll explain why you didn’t see it.’
‘Should I go and check it against his old ECGs?’
‘Yes,’ said Goldblatt. ‘You should always check an ECG against old ECGs. In fact, you should always check any test against old tests.’
‘I should, shouldn’t I?’ said the HO, as if realizing a truth that had long eluded her.
‘Yes, you should. And if you find any changes you can’t understand, you should call your med reg.’
‘Even if the pain goes?’
‘Especially if the pain goes.’
The HO nodded. She got up.
‘Not now. It’s an old infarct. Trust me. The old ECGs aren’t going to change if you drink your coffee before you check them.’
The HO sat down. She sipped her coffee. Goldblatt watched her. She looked ill with exhaustion.
‘Got anything on tonight?’ he said.
The HO nodded.
‘What?’
She shrugged.
‘Are you going?’
‘Don’t know. Too fucking tired to think about it.’
‘We need to get you home on time,’ said Goldblatt.
The HO laughed bitterly.
Goldblatt didn’t blame her for laughing. How many times had he said that to her over the past couple of months? And how many times had she actually been able to do it?
‘How old are you?’ he asked suddenly.
‘Twenty-three,’ she said.
‘I was right.’
‘What were you right about?’
‘Lots of things.’
The HO shook her head. ‘Is Sandra going to die?’
‘Yes. Her bowel will perforate. It’s perforated already, I think. Nothing we can do. She wouldn’t survive an operation. And even if she did ...’ Goldblatt shrugged helplessly. ‘What for?’
The HO nodded. ‘Why did her bowel dilate like that?’
‘It’s paralytic. It stopped contracting.’
‘Why?’
Goldblatt shrugged. ‘The Fuertler’s? Hypoxia? Who knows? It’s preterminal. Dying people have to die of something.’
Goldblatt listened to what he had just said. It sounded like a law. He was too tired to think of a name for it.
They finished their coffees.
‘Come on,’ said Goldblatt. ‘Let’s go up and see what’s happening with her, then you can go and check that patient’s ECGs.’
The screens around Sandra’s bed bulged, outlining the shapes of the people sitting on the other side of them. There were five members of the family around Sandra’s bed. The nurses had been trying to organize a side room for Sandra to die in, but she was still in the four-bed room where everyone had been awake since the HO found her on the floor at four in the morning.
The family looked around as Goldblatt and the HO put their heads in through the gap in the screen. Mrs Jones got up. ‘Hello,’ she said. She introduced the other members of the family, starting with Sandra’s mum. Goldblatt shook her hand.
‘Should we have a talk?’ said Goldblatt.
‘I think Mum would appreciate that,’ said Mrs Jones.
Goldblatt took Mrs Jones and her mum to the doctors’ office. The others stayed by Sandra’s bedside. Sandra’s mum was a squat woman in her sixties who looked as if she had put on her best clothes. She was wearing a hat and clutching a small white Bible. Goldblatt invited the two women to sit down, but neither did, so Goldblatt didn’t either. Mrs Jones held her mum’s elbow all the time he was speaking to them.
Goldblatt had ended up being very frank with Mrs Jones on the phone when he had rung her earlier. She had demanded it. She had said to him bluntly: ‘Sandra’s dying, isn’t she?’ Mrs Jones was the kind of person who wants to know the facts, undiluted, unconcealed. Goldblatt gave them to her. It was people’s right to demand as much or as little as they wanted. It wasn’t his place to decide how much that was for them.
Sandra’s mum wasn’t like Mrs Jones, you could see that at a glance. Sandra’s sister wanted a crisp and certain answer. Sandra’s mum didn’t believe in crisp and certain answers, and therefore didn’t ask for one.
But she knew. She didn’t need Goldblatt to tell her.
‘Well, it be in the Lord’s hands,’ she said in a strong Caribbean accent, after Goldblatt had assured her that they would keep Sandra comfortable as they watched to see what happened. ‘If the Lord want Sandra, he take her.’
Goldblatt nodded.
‘It been a terrible hard life for Sandra, doctor. She been so sick. So many years. Sandra is my daughter. I love her, doctor. But she so sick. It be best for her now. The Lord take her.’
Goldblatt nodded again. Sandra’s mum wasn’t crying. She was looking straight into Goldblatt’s eyes, and Goldblatt was looking straight back into hers. Soft brown eyes, bedded in densely wrinkled skin.
‘Come on, Mum,’ said Mrs Jones, and she led her by the elbow back to Sandra’s bedside.
The HO was still there, speaking softly to the other family members. Sandra had slipped into a pattern of terminal respiration, taking a stuttering series of two or three deep, snoring breaths every minute or so, without breathing at all in between.
The oxygen was bubbling. It was pointless, but Goldblatt left it on. To turn it off in front of the family now, when Sandra was still breathing, would be too cruel.
Sandra snored in deeply. She had slipped down the pillows, and her head was slumped to one side. Goldblatt leaned over to straighten her up. He put his left arm under her back. Her head lolled against his shoulder. He felt her warm, listless weight in his arms, and braced to pull her up.
Sandra snored again. The breath cut itself short.
Goldblatt was still holding her. He frowned. Surreptitiously, he slid his hand on to Sandra’s neck and felt gently for her carotid pulse. He probed deeper, trying to detect it. Then he glanced at the HO, who met his eyes questioningly.
Goldblatt straightened Sandra up. He arranged the pillows behind her head. Then he stepped back and smiled briefly at Sandra’s mum. The family continued to sit around the bed as the oxygen bubbled, waiting for Sandra’s next breath. Goldblatt left them behind the screens. The HO followed him out. In the corridor, they met one of the nurses coming towards them.
‘Sandra Hill has just died,’ Goldblatt said quietly to the nurse. ‘The family doesn’t know yet. Could you go in there and have a look at her, and then say you’re going to get the doctor? I’ll give them a few minutes, and then come back to declare her dead.’
In the doctors’ office, the HO perched on one of the desks.
‘You all right?’ asked Goldblatt.
She nodded.
‘Really?’ He wondered if the ghosts of Mr Sprczrensky and the VIPoma were on their way back, if this was going to be the moment the HO broke.
‘I’m OK. It was time for her, Malcolm. I’m glad she was Not For Resus.’
Goldblatt smiled.
The HO looked at him quizzically. ‘She died in your arms.’
Goldblatt thought about it. So she had. The only one of his patients who had ever done it.
‘She would have liked that,’ said the HO.
‘Right. Like she liked me giving her a pneumothorax.’
‘No, Malcolm. She would have. You were her protector.’
Goldblatt glanced at her. The HO’s tone was certain. As if she knew. But the HO never knew anything.
But maybe sometimes she did.
Goldblatt nodded. ‘Thanks,’ he said quietly. He frowned. For a moment he didn’t trust himself to speak. You don’t cry when your patients die.
The HO was silent. Then she noticed something on the desk. ‘You’ve got a letter.’ She picked up a small yellow envelope and handed it to Goldblatt.
Where had that come from? He had been here only ten minutes earlier with Sandra’s mother and sister.
‘I’m going,’ said the HO. ‘I’ve got to check those ECGs. I’ll see you at the Grand Round.’
‘Maybe.’
‘Aren’t you coming?’
‘I’ll see.’
‘Come on, Malcolm, you’ve got to come. Emma’s presenting. Can you imagine what will happen if she makes a mistake? It’s worth going just to see that.’
Goldblatt smiled.
The HO looked at him seriously. ‘I’ll have to write a death certificate for Sandra, won’t I?’
‘Have you ever written one?’
The HO shook her head.
Of course not, thought Goldblatt. No one dies on a Fuertler’s unit. Until today, anyway.
‘We’ll talk about it later. Go on, I’ll go back and declare her. Check that ECG and then get some breakfast. I’ll see you at the Grand Round.’
The HO left. Goldblatt picked up the envelope and stared at it. His name was handwritten on the front. Nothing else. He turned it over. Blank on the back. Sealed.
Goldblatt opened the envelope. It contained a piece of yellow notepaper. He unfolded it. He recognized the curly, strangely girlish writing.
Dr Goldblatt
On reflection over the past week and after yesterday’s ward round I am now convinced that the unit’s best interests are served by you leaving. May I suggest today as a suitable date. I will inform Mr Titherington in Human Resources to make the appropriate arrangements in lieu of your notice.
Andrea Small
Goldblatt let the note fall on the table in front of him.
He went out to shine a torch in Sandra Hill’s eyes and lay his stethoscope on her ravaged, now-silent chest, and declare that she was dead.