17 March 2014
I am home. Back in my own city, my old street, my old bed.
When I started the Anaesthetics rotation last summer, I tried so hard to lose my difficult reputation. But once you’ve got a bad name, it’s almost impossible to live it down. I listened to relaxation tapes and read books on assertive behaviour. Even bit the bullet and tried yoga, though the stress of trying not to fart cancelled out any meditative benefits.
Ninety-five per cent of the time I was the perfect specialty trainee. But my reputation meant even a frown or an under-my-breath mutter would cause eyebrows to rise above the theatre masks. Conversations would stop when I stepped into the locker room, and resume as a whisper as I left. It hurt.
When I went to my consultant, he pretty much told me I’d made my bed so I’d have to lie in it. To my utter horror, my eyes began to fill with tears. We were both so desperate to stop them spilling out that he offered to pull some strings, and a week later, he announced there was the option to transfer for my second ST1 rotation.
My fresh start would mean ending up back where it all began.
Actually, the last six weeks have been better than I feared. Brighton is a village pretending to be a city, so I keep running into old ambulance colleagues, school friends, neighbours, both on the streets and in the hospital corridors.
I pin the smile on my face as I pass the ambulances in the car park and walk through the automatic doors into A & E. A plume of cigarette smoke wafts towards me and for a fraction of a second, I picture Joel’s father, in this same spot on millennium night, before we knew if his son would live or die.
Forget it. These flashbacks are inevitable, but luckily they happen rarely. One of these days, I’m bound to run into Joel for real and that’ll be harder. I couldn’t even watch his documentary last month, though I did read his piece in The Times about genetic testing. I’m glad his little boy is in the clear. I tried not to spend too long analysing the fact he didn’t mention a partner . . .
‘I made St Patrick’s Day cupcakes,’ I say, plonking the Tupperware box down on the ED counter. ‘The green colouring is ninety-nine per cent natural, though I can’t vouch for the last one per cent.’
The baking skills I honed playing housewife with Tim and Elaine are coming in handy again. Any suspicions my colleagues might have about my shameless attempts to bribe them generally disappear after their first bite.
‘I need these,’ the registrar says, ‘it’s been an insane day and I guess we’ll be getting our share of leprechauns later but it seems qu—’ He stops himself saying the Q word, to avoid jinxing it. ‘We’re still busy but manageable.’
Busy suits me. As he starts the handover, the list of patients and their presentations gives me something solid to latch on to.
‘See you in the morning,’ I say, as the reg trudges back to the locker room.
My first patient tonight is homeless. I can smell him even before I pull the curtain aside. Colleagues with more sensitive dispositions, or noses, rub Vicks inside their nostrils, but I’ve learned to breathe through my mouth.
It’s a her, not a him. She looks more like a pile of rags than a person. Another pile, this time of bags stuffed with belongings, is balanced precariously next to her bed. I see from the notes that she’s not been here long. Under an hour.
‘So, Miss . . .’ I look at my sheet . . . ‘Allsop, I’m Dr Smith. Can you tell me in your own words what the problem is?’
She looks up and I think: I know you. It’s the eyes. They’re clearer and younger than the rest of her. I check the DOB on her records. She’s only thirty-four.
‘I’m dying.’
Her speech is slurred. I think she’s drunk, but it could be gas or spice or whatever else she might use to make life on the streets tolerable.
Though that doesn’t mean she’s not dying. Sometimes patients suss it out long before medics do. And rough sleepers die at twenty-five times the rate of the rest of us.
‘Let’s try to get you sorted. You told the triage nurse you had pain in your tummy and back so let’s start there. Why don’t you lie down so I can examine you.’
She gives me a warning look when I try to lift up the layers of clothing, and does it herself instead. The smell gets stronger, even though I’m still breathing through my mouth. I can almost taste its zoo-like pungency. Her skin, what I can see of it, is deep brown from dirt.
Do I recognize her because I’ve seen her in A & E before? There’s not much on her notes, but she’s probably come in under a false name. Plenty do, to try to get hold of opioids.
As I palpate, she cringes. ‘Tell me where it hurts most if you can . . .’
But she doesn’t seem to be able to articulate it. ‘Have you been bleeding when you go to the toilet? Or from your vagina?’
‘No.’
She’s still chatting to me, but I stop hearing her because I feel something pulsing under my fingers and my heart beats faster.
I try to find other possible explanations, because I want to be wrong. But my gut tells me we’ve found what we’re looking for.
I pull the curtain to one side to call out to my colleagues. ‘I think this one needs to go to resus ASAP. Query ruptured AAA. We need a CT and can we bleep the on-call vascular consultant NOW.’
There’s a grim satisfaction in her smile. ‘I am dying, aren’t I?’
Most patients with a ruptured abdominal aortic aneurysm die after surgery. ‘We need to get you a scan now, but if this is what I think it is, you’ll need an emergency operation. It is very serious, I’m afraid. Is there someone we can call?’
She reaches for my hand. ‘No. You’ll stay with me, though, won’t you, Kerry?’
I freeze. I was right. We’ve met before. She knows me.
‘I can’t promise that, but you will be looked after, Miss Allsop.’ I look at her notes, for her first name, because the surname feels too distant for someone who is facing death alone. Zoë.
And now I know who she is.
When they take her off for her CT, I stay behind the cubicle curtains, to give myself a minute to work out what to do.
Zoë is Joel’s ex. Leo’s mother. If she wanted me to call Joel, she would have asked.
Yet surely there can’t be anything worse than dying alone. Do I follow the regulations, or follow my heart? Breaching her confidentiality would be a grave disciplinary offence, and I arrived here with a shady record as it is.
I could be sacked.
But sometimes medicine isn’t about the rules, it’s about what’s right. I already know what I have to do.
I go into the corridor to call Ant on my mobile. ‘Is Joel in Brighton at the moment?’
In the background, I can hear the twins screaming for more of something. A bedtime story, maybe. ‘Think so. Why?’
‘His ex is here, in the hospital. Zoë, Leo’s mum. It’s serious, she may not have long to live. She recognized me and so she must know I know Joel, but she hasn’t asked me to call him. Would he want to know? She’s got nobody else.’
‘Shit. Shit. Poor Leo. Yes, I do think Joel would want to know. Let me call him now.’
‘Thanks. Tell him to go straight to the gastro ward, Zoë’s going to theatre so she’s not my patient anymore. And it’ll probably complicate things if we see each other.’
‘Even now?’ Ant asks, and I wonder what he knows, or suspects.
I hesitate. Whatever happens tonight, this will be tough on Joel. ‘All right. Tell him . . . tell him, I’m here if he needs me.’
It’s past midnight when my skin prickles and I know he’s behind me.
I’ve finished with a patient who sprained her ankle in the middle of a drunken jig and it’s been a struggle to keep my patience with her mates and their chorus of ‘Danny Boy’.
When I turn, Joel has that untethered look family and friends get when the worst happens to the people they love.
But he also looks well. Healthy, especially without that silly TV make-up. My pulse still quickens at the sight of him, but I don’t step towards him to embrace or shake his hand.
‘Hey, Joel. You’ve been to the ward, I guess. How is she?’
‘In surgery.’ His eyes focus on mine, as though they’re asking the question he daren’t articulate: Is she going to die?
I check my list, tell the charge nurse I need two minutes to talk to a relative, and take Joel into the family room. It’s been refurbed since I waited here with Tim and Ant fourteen years ago but sometimes – now – I do remember exactly how terrifying it felt.
‘The doctors have explained what’s wrong with her?’
‘Something’s burst in the blood vessel coming out of her heart?’
I nod. ‘Yes. The surgery is to try to repair it. But the level of bleeding means there’s a very big risk she won’t make it. I’m really sorry.’
Joel shakes his head. ‘How did it happen?’
‘It’s rare in someone her age but family history or smoking could be a factor. There may not have been many symptoms. By the time she came to us, the aneurysm had already burst.’
He doesn’t move. ‘I didn’t even know she was back in Brighton. I’ve been writing to her, sending her photos of Leo at different addresses. Weston-Super-Mare. Hartlepool. She likes to be near the sea.’
‘I’m so sorry, Joel.’
‘The last time I saw her was just after she’d told me she was going to end her pregnancy.’ He stops. ‘I don’t know what to do about Leo.’
I wait for him to say more. The second hand on the clock does a full circle before he speaks.
‘Leo hasn’t had any contact with his mother since he was a tiny baby. This might be his last chance.’
I nod. ‘How old is he now?’
‘He just turned nine.’
Nine years since it ended between us. How can it feel like a decade and yesterday at the same time?
‘Do you want to tell me what you’re thinking, Joel?’
‘I . . . it changes second by second. But mostly I’m thinking, shouldn’t he have the chance to meet her? What if he grows up and thinks I kept him from her?’
I take a deep breath. I’ve seen children dragged from their beds in the middle of the night to say goodbye to parents or grandparents. Who knows if it helps them, or not, in the years that follow?
‘You know, Zoë may not even make it out of theatre. Is he OK with hospitals?’
Joel nods. ‘Yeah. He’s had check-ups because of the Neonatal Abstinence Syndrome. And he took it in his stride after I had my ICD replaced. But . . . he doesn’t know his mum. Will she be in a bad way? I mean, I know she will, but to look at, when she comes round?’
The patient I saw was smelly and dirty and lost. She’ll have been cleaned up a bit for surgery but still . . . ‘She’s been living on the streets, I think. She looked quite neglected.’
‘Kerry . . .’ He holds up his hand and I want to grasp it. ‘What would you do?’
It’s the question we’re not meant to answer. But am I a clinician now, or a friend? I stare at the blue-grey floor. ‘This isn’t a medical opinion, Joel. But I personally would wait until the morning, when we’ll know more. Bear in mind she didn’t even ask me to call you. Maybe if she comes round, you can ask her yourself what she wants?’
He nods. ‘That’s what Liv said too.’
Liv?
I hate the name even before I am sure who it belongs to.
‘Liv?’ I make my voice casual.
But he looks up sharply. Guiltily? ‘My . . . well, “girlfriend” seems wrong at our age. We met at work. It’s quite a recent thing.’
‘It’s important you have someone there. To talk to.’
Joel nods. ‘I ought to go back to the ward.’
I smile. ‘Yeah. I’ve got patients waiting. But take a minute in here, if you need to be on your own. And the surgeons are excellent. With her being so young, it might be OK . . .’
As I turn around to go, he touches my arm, and all the sensations he used to make me feel rush through me, like a time machine back to my teens.
‘Before you go, there’s something else. I need to thank you, Kerry.’
‘For what?’
‘For telling me what a piece of shit I was not to find Leo. Without that, I would have missed out on so much. I did try to tell you, not long after we broke up, but—’
‘Kerry! We need you in resus!’
Joel lets go. ‘Off to save another life?’
‘More likely something involving bodily fluids.’
And I leave the room before I can say anything stupid.