The Best Of The Year - Medical Romance

And then there was the guy who’d been ripping off another elderly neighbour a few doors down. Elsie Montgomery employed him to do some gardening and odd jobs but it wasn’t long before he was doing her shopping and taking her to the doctor or on other outings. At first I thought he was doing it out of the goodness of his heart, but then I found out from Elsie—reluctantly, because she was embarrassed—he had been taking money out of her bank account after he’d got her to tell him her PIN.

I wanted Elsie to press charges against him for elder abuse but she thought he’d been punished enough by me shouting at him in the street in front of all the neighbours. That and the naming-and-shaming leaflet drop. That was a stroke of genius on my part. I got a team of local kids to help me distribute them. It will be a long time before he gets to cut any lawns in our suburb, possibly the whole country.

I was walking past the staff change rooms when Gracie appeared. ‘How did it go? What did he say to you?’

I rolled my eyes. ‘He has issues with my project.’

‘What sort of issues?’

I gave her a disgruntled look. I wasn’t going to spell it out for her. Word would spread fast enough. ‘The rooms I’ve been allocated, for one thing. He thinks we can’t afford the space.’

Gracie frowned. ‘But you’re doing amazing things with the patients and families. Everyone says so. Look at what you did for the Matheson family. You brought such comfort to them when they lost their son before Christmas.’

I pictured the Matheson family collected around Daniel’s twenty-one-year-old body as he breathed his last breaths after a long and difficult battle against sarcoma. I spent hours with them, preparing them and Daniel for the end. I encouraged them to be open with Daniel about their feelings, not to be ashamed of the anger they were feeling about his life being cut short, but to accept that as a part of the journey through grief. I taught Daniel’s father, who was uncomfortable showing emotion or affection, to gently massage his son to help him relax. When Daniel finally passed it was so peaceful in the room you could hear the birds twittering outside.

I let out a breath as we walked along the corridor back to the unit. ‘I can’t stop now. I’m only just beginning to see results. I’ve had three nurses tell me how much they got out of the meditation exercise I gave before I went on leave. When nurses get stressed, patients get stressed. It’s not rocket science. It’s common sense.’

‘But surely Dr Bishop can’t block your project now,’ Gracie said.

I held my hands out for the antiseptic gel from the dispenser on the wall, my mouth set in an indomitable line. ‘I’d like to see him try.’

I got busy doing a PICC line for a chemotherapy patient and then I had to help one of the registrars with setting up a patient’s ventilator. I was due for Theatre for an afternoon list with one of the neurosurgeons, Stuart McTaggart. Not my favourite person at St Iggy’s, but while he had an abrasive personality there was certainly nothing wrong with his surgical skills. Patients came from all over the country to see him. He had a world-class reputation for neurosurgery and was considered to be one of the best neurosurgeons of his generation.

I went to the doctors’ room to grab a quick bite of lunch. It was a medium-sized room big enough for a six-person dining table and chairs, a couple of mismatched armchairs, a coffee table, a sink and a small fridge. The daily newspapers were spread out on the table, where a bowl of fruit acted as a paperweight.

Personally, I thought the place could do with a facelift, maybe a bit of feng shui wouldn’t go astray, but I was fairly new on staff, considering some people had been here for their entire careers, so I picked my battles.

I reached for an apple out of the bowl as the door opened. I looked up to see Matt Bishop enter the staffroom. His expression showed no surprise or discomfit at seeing me there. In fact, I thought I caught a glimmer of a smile lurking in his eyes. No doubt he was still enjoying the joke he’d made of my project. I hadn’t heard anyone say anything about it so far but I knew it wouldn’t be long before they did. He wouldn’t be able to keep such a gem of hilarity to himself.

I felt my anger go up another notch. Why did I attract this sort of stuff? Why couldn’t I go about my life without people making fun of me? Now, you might ask why would a girl wear bright, fun clothes and twist her hair into wacky hairstyles if she was afraid of people laughing at her? Duh! If they’re laughing at my clothes and my hair I don’t have to feel they’re laughing at me. There’s a difference and to me it’s a big one.

I bit into the apple with a loud crunch. I was down a round and I had some serious catching up to do. I chewed the mouthful and then took another. And another. It wasn’t the nicest apple, to tell you the truth. But I was committed now so I had to finish it. I can be stubborn at times—most of the time, to be honest. I hate giving in. I hate being defeated by something or someone. I’d spent a lot of my childhood being bullied so I guess that’s why. It’s not just about losing face. I hate failure. It goes against my nature. I’m positive in my outlook. I go into things expecting to achieve my mission. I don’t let the naysayers get to me … or I try not to.

‘So where did you go on honeymoon?’ Matt Bishop asked, just as I’d taken another mouthful.

I swear to God I almost choked on that piece of apple. I thought he’d have to give me the Heimlich manoeuvre—not that we do that any more, but still. I coughed and spluttered, my eyes streaming, my cheeks as red as the skin of the piece of apple I was trying to shift from my airway.

He stepped towards me. ‘Are you okay?’

I signalled with one of my hands that I was fine. He waited patiently with his steady gaze trained on mine. Of course I couldn’t pretend I was choking forever, and since—technically speaking—I had been on honeymoon/holiday I decided to stay as close to the truth as possible once I got my airway clear. ‘Skiing … Italy.’

‘Where in Italy?’

‘Livigno.’

He acknowledged that with a slight nod as he reached for a coffee cup. ‘Good choice.’

I put the rest of my apple in the bin. It wasn’t my choice. I’m a hopeless skier. I’d only agreed to it because it was what Andy wanted. And rather than waste the money—because he hadn’t paid the travel insurance as I’d asked him to—I’d doggedly stuck with the plan. I must admit I was proud of myself in that I progressed off the nursery slopes, but not very far. ‘You ski?’ I asked.

‘Occasionally.’

There was a silence broken only by the sound of coffee being poured into his cup. I waited to see if he put milk or sugar or sweetener in it. You’ve guessed it. There’s a lot you can tell about someone from how they take their coffee. He was a straight-up man. No added extras. And he drank it smoking hot. I watched as he took his first mouthful without even wincing at the steamy heat.

‘What does your husband do?’

The question caught me off guard. I was too busy watching the way his mouth had shaped around the rim of his cup. Why had I thought his mouth hard and uncompromising? He had the sort of mouth that would make Michelangelo dash off for a chisel. The lower lip was sensually full and the top one neatly defined. I don’t think I’d ever seen such a beautifully sculpted mouth. I began to wonder what it would feel like pressed to my own …

‘Pardon?’

‘Is your husband a doctor too?’

Something about the way he said the word ‘husband’ made me think he was putting it in inverted commas or even in italics. It was the way he stressed the word. That, and the way his mouth got a slight curl to it as if he thought the notion of someone wanting to marry me was hilariously unbelievable.

‘No, erm, he’s a stock analyst.’

‘In London?’

‘Yes.’

There’s an art to lying and I like to think I’m pretty good at it. After all, I’ve been doing it all my life. I learned early on not to tell people the truth. Living in a commune with your parents from the age of six sort of does that to you. I wouldn’t have lasted long at school if I had Shown and Told some of the things I’d seen and heard.

No, it’s not the lying that’s the problem. That’s the easy part. It’s keeping track of them that gets tricky. So far I hadn’t strayed too far off the path. Andy was a stock analyst and he worked in London. He was currently seeking a transfer to the New York branch of his firm, which, to be frank, I welcomed wholeheartedly. London is a big city but I didn’t fancy running into him and his new girlfriend any time soon. It was bad enough having him come to my house to collect all his things. I made it easy for him by leaving them in the front garden. Yes, I know, it was petty, but I got an enormous sense of satisfaction from throwing them from the second-floor window. It wasn’t my fault it had snowed half a metre overnight. I’m not in control of the weather.

I decided in order to keep my lying tally down I had to ask some questions of my own. ‘Are you married?’

‘No.’

‘In a relationship?’

He paused for a nanosecond. ‘No.’

I wondered if he had broken up recently, or if the break-up—if there had been one—still hurt. ‘Kids?’

He frowned. ‘No, of course not.’

‘Why of course not?’

‘Call me old-fashioned but I like to do things in the right order,’ he said.

I tilted my head at him. ‘So let me guess … you haven’t lived with anyone?’

‘No.’

I pondered over that for a moment while he took a packet of sandwiches from the small fridge and sat down at the table. He opened one of the newspapers on the table and began to eat his sandwiches in what I could only describe as a mechanical way. I’m the first to admit hospital food isn’t much to get all excited about, but the sandwiches for the doctors’ room were always freshly made and contained healthy ingredients, or at least they had since I’d spoken to the head of catering a few weeks back.

‘That’s bad for you, you know,’ I said. I know it was none of my business what or how he ate but the silence was there and I wanted to fill it. Needed to fill it, more like.

Matt Bishop didn’t bother to glance my way. He turned the newspaper page over and reached for another sandwich. ‘What is?’

‘Eating and reading. At the same time, I mean.’

He sat back in his chair and looked at me with an inscrutable expression. ‘You have something against multitasking?’

I didn’t let his satirical tone faze me. ‘Eating while performing other tasks is a bad habit. It can lead to overeating. You might be full by page three but you keep on eating until you get to the sports page out of habit.’

He closed the newspaper and pushed it to the other side of the table. ‘How long were you going out with your husband before he asked you to marry him?’

There, he’d done it again. I wasn’t imagining it. He’d stressed the word ‘husband’. What was with the sudden interest in my private life? Or did he think it impossible anyone could be remotely interested in me? With the end of my engagement so recent I was feeling a bit fragile in terms of self-esteem. Come to think of it, my self-esteem has always been a little on the eggshell side. ‘Erm, actually, he didn’t ask me,’ I said. ‘I asked him.’

He lifted one of his dark eyebrows. ‘Oh?’

‘You don’t approve.’

‘It’s none of my business.’

I folded my arms and gave him a look. ‘I fail to see why the man has to have all the power in a relationship. Why should a girl have to wait months and months, possibly years for a proposal? Living every moment in a state of will-he-or-won’t-he panic?’

‘Don’t blame me,’ he said mildly. ‘I didn’t write the rule book.’

I pursed my lips, not my most attractive pose, but still. Jem calls it my cat’s-bottom pout. I had the strangest feeling Matt Bishop was smiling behind that unreadable look he was giving me. There was a tiny light in his eyes that twinkled now and again.

‘So how did he take it when you popped the question?’ he asked.

‘He said yes, obviously.’ Not straight away, but I wasn’t going to tell Matt Bishop that little detail. Andy and I had discussed marriage over the years. He just hadn’t got around to formally asking me. I got tired of waiting. I know it’s weird, considering my non-traditional background, but I really longed to be a proper bride: the white dress and veil and the church and the flowers and confetti and the adorable little flower girl and the cute little pageboy.

My parents had never formally married because they didn’t believe in the institution of marriage—any institution, really. They have an open relationship, which seems to work for them. Don’t ask me how. I’ve never said anything to them, but every time I looked at the photos of their thirty years of life together I’ve always felt like something was missing.

Matt picked up his coffee cup and surveyed me as he took another sip. ‘How long have you been at St Ignatius?’

‘Ten and a half months.’

‘Where were you before here?’

‘St Thomas’,’ I said, and tossed the question back, even though I already knew the answer because I’d overheard two of the nurses talking about him in the change room. ‘You?’

‘I trained in London and spent most of my time at Chelsea and Westminster, apart from the last twelve months in the US.’

I wondered why he had gone abroad and if it had anything to do with a woman, here or over there. I hadn’t heard anything about his private life. Word has it he kept it exactly that—private.

My phone beeped with an incoming message and I glanced down to see it was a text from Jem.

How r u doing? it said.

I quickly typed back. Fine.

Within seconds she typed back. What did everyone say?

I typed back. I haven’t told them.

She came back with, Y not?

I typed back the emoticon smiley face with red cheeks. She sent me a smiley face with love hearts for eyes. It was times like this I was truly glad I had a sister. She knew me better than anyone. She knew I needed time to sort my feelings out, to get my head around the idea of being single again.

I had a feeling she also knew it was not so much my heart that was broken but my pride. It’s not that I didn’t love Andy. I loved him from the moment I met him. He was charming and funny and made me feel as if I was the most important person in his life … for about a month. I know all relationships take work and I put in. I really did. It’s just he hadn’t factored in my career. His always came first. It caused many an argument. I mean, it’s not as if someone’s going to die if he doesn’t show up for work. He never seemed to understand I couldn’t take off a day whenever I felt like it because he was bored and wanted company.

I put my phone back in my jeans pocket and met Matt Bishop’s inscrutable gaze. I wondered if he could see any of the thought processes of my brain flitting over my face. I like to think I can keep my cards pretty close, but something about his intense grey-blue eyes made me feel exposed, as if all my insecurities and doubts were lined up on show for his perusal.

‘Any further questions?’ I asked, with a pert look.

He held my look for an extra beat. ‘Not at the moment.’

I turned on my heel and scooted out of there. Colour me suspicious, but I had a feeling there was not much that would get past Dr Matt Bishop’s sharply intelligent grey-blues.

Theatre was tense but, then, Stuart McTaggart always operated that way. He wasn’t one of those surgeons who chatted about what he did on the weekend or how well his kids were doing at Cambridge or Oxford—yadda-yadda-yadda. He didn’t have classical music playing, like a couple of the other surgeons on staff did. He insisted on absolute silence, apart from when he had something to say. I’d had to learn early on to button my lips while in Theatre with him. He was gruff to the point of surly and he barked out orders like a drill sergeant. Some of the junior theatre staff found him terrifying. Some of the more senior staff hated working with him.

Funnily enough, I didn’t find him too hard to handle. I understood the pressure he was under. Patients were more demanding of good outcomes than in the past, or at least they had better access to legal representation and were more aware of their rights. The litigious climate meant a lot of clinicians at the pointy end of medicine were under far greater pressure and scrutiny than ever before. That could be a good and a bad thing depending on the circumstances. It was part of why I wanted to pursue my research. Reducing the stress of the hospital experience was a win-win for everyone. Apart perhaps from the greedy lawyers, of course, but don’t get me started.

Stuart McTaggart was operating on a twenty-seven-year-old man with a very vascular and awkwardly placed benign brain tumour. Jason Ryder was a recently married man with a baby on the way. He was a keen sportsman, playing semi-professional golf. He had collapsed whilst playing in a tournament and been admitted to St Iggy’s via A and E. All was going well until he developed a bleed. Alex Kingston, the surgical registrar, was the first to cop the flak from Stuart.

‘Suck the blood out of the way, Kingston!’ he said. ‘I can’t diathermy bleeders if they’re underwater!’

Next in line was Leanne Griffiths, the scrub nurse.

‘Be aware of what’s happening in the operation, Sister Griffiths. I can’t wait around while you call for more swabs. They should be open, on the table, ready when I need them. Which is now!’

Then it was my turn. Woot. Woot.

‘What blood pressure have you got this patient running at, Dr Clark? He looks hypertensive to me and that’s not assisting with this blood loss!’

And on it went. Everyone was to blame except Stuart. But, then, really, no one was to blame—it was just the nature of the tumour and the stress of trying to remove it with minimal damage to the normal brain. The human body was not always predictable. Things didn’t always work out. They weren’t working out now. The only way to eventually stop the haemorrhage was to ligate a couple of largish vessels, causing irreparable damage to a large part of what had been a normal brain.

The person I’d anaesthetised wasn’t going to be the person who woke up … if he woke up. I hated even thinking those words. I always focussed on the positive. It gave great comfort to loved ones if they could hold onto hope for as long as possible.

I went down to ICU with the patient, keeping an eye on the monitor as we went. I was trying not to be influenced by the air of doom and gloom that had blown up in Theatre. I had seen patients much worse than Jason recover. It was a setback, certainly, but with time and patience and careful monitoring he had a chance, maybe even better than expected, given his level of fitness.

Once Jason was settled on the ventilator I went out to the family waiting in the relatives’ room. His wife, Megan, was about six months pregnant and stood with Jason’s parents as soon as I came in. ‘How is he?’ she said, holding her hand over her belly as if to protect her baby from hearing bad news.

‘The operation was very difficult, Megan,’ I said in a gentle but calm tone. ‘The tumour had a lot of blood running through it. Mr McTaggart was able to get it out, but not without bleeding, and there is likely a bit of damage to some of the surrounding brain. It’s impossible to tell at this stage how he’s going to be. There’s no choice but to wait and see what effect the tumour and the operative trauma has had. But it’s important to keep positive and try not to feel too overwhelmed at this stage. Everything that can be done is being done to bring about the best possible recovery for Jason.’

There was a sound behind me and I turned to see Matt Bishop come in. ‘I’m sorry to keep you waiting,’ he said, briefly shaking hands with Jason’s parents and then Megan. ‘I’m Matt Bishop, the head of ICU.’

Jason’s father Ken swallowed thickly. ‘What’s happening to our boy?’

‘He’s being ventilated and kept in an induced coma,’ Matt said. ‘During surgery there was a major bleed from the tumour bed. Mr McTaggart was able to stop the bleed, but it’s possible normal brain may have been damaged in the process. When the brain swelling has decreased, we’ll gradually reduce the sedation, and see what effect the surgery has had. But I should warn you that surgery to a vascular tumour like this, and the bleeding that goes with trying to remove it, can cause a lot of damage. I’m sorry but there’s a possibility he won’t wake up.’

Jason’s mother put a shaky hand against her throat. ‘You mean he could … die?’

Matt’s expression was grave. ‘A bleed like the one Jason suffered can damage vital areas of the brain. In the morning we’ll repeat the CT scan and try to assess what physical damage has occurred. We might be able to predict from that how he might recover. In the end, though, we just have to wait, try to wean him off sedation and see if he wakes up.’

The word lingered in the air like a toxic fume.

If, not when he wakes up.

I watched as the hope on Jason’s mother’s face collapsed, aging her a decade. I saw the devastation spread over Megan’s, distorting her young and pretty features into a mask of horror. Jason’s father’s face went completely still and ashen. All their hopes and dreams for their son had been cut down with one two-letter word.

Matt answered a few more questions but it was obvious to me that the poor family weren’t taking much in. They were still trying to get their heads around the fact the son and husband they had kissed that morning on his way to the operating theatre might not come back to them.

My heart ached for them. I know as a doctor you’re supposed to keep a clinical distance. And I do most of the time. But now and again a patient comes along who touches you. Jason was such a normal, nice type of guy. He was exactly the same age as me. His family were loving and supportive, the sort of family who loved each other unconditionally. I thought of the baby in Megan’s womb who might never get to know his or her father. I thought of the implications for Megan, trapped in a marriage to a man who might be permanently disabled, unable to talk, to eat or drink unassisted. Then there were the bathing and toileting issues—the whole heartbreaking scenario of taking care of someone who could no longer do anything for themselves. Her young life would be utterly destroyed along with his.

Once Matt left I took the family to my relaxation room where my aromatherapy infuser was releasing lavender and tangerine, which had a calming effect and was shown to be beneficial in helping with anxiety and depression. I sat with them for a few minutes, handing them tissues scented with clary sage, another stress reliever, and listened as they talked about Jason. They told me about his childhood and some funny anecdotes about him as a teenager, and of his passion for golf and how hard he worked at his game. How they had mortgaged their house and forgone holidays for years in order to sponsor his career because they believed so unreservedly in his talent.

That’s the thing about busy hospitals these days. No one has time to sit with patients and their families and chat. Nurses are under the pump all the time with other patients to see to. The doctors have the pressure of clinical work and administrative duties, and in a teaching hospital such as St Iggy’s the responsibility of teaching medical students, residents and interns and registrars leaves little time to linger by a patient’s bedside. Often it was the cleaning or catering staff that counselled patients most, but even they were under increasing pressure.

I made a point of keeping some time for the patients, even though it meant my days were a little longer than normal. Looking back, I think that was one of the reasons Andy strayed. I just wasn’t around enough for him. That, and the assumption that because my parents had an open relationship I, too, would be happy with the same arrangement. Shows how little he knew me. But he knew how much I love my work. It’s not so much a career for me but a vocation. I love being able to help people and being with them through the darkest times is the most challenging but in many ways the most rewarding.