The night shift, p.7
The Night Shift, page 7
‘This is true,’ said Violet. ‘Sorry about that. But I have been working on my communication skills as regards other healthcare professionals. I can’t be expected to do it all in one day.’
His mouth cracked into a smile at this, revealing a glint of broken teeth. Violet considered herself to have scored a minor victory.
‘But your bloods aren’t great,’ she said.
He nodded, serious again. ‘So, I am dying?’
‘Well, we’re all dying,’ she said matter-of-factly. ‘From the moment we’re born, we’re dying.’
‘You’re a right little ray of festive sunshine, aren’t you?’ He barked his dry laugh. ‘You know what I mean, Doctor. Don’t mess about.’
Violet nodded. ‘I do understand the question, yes. But it’s like last night, I can’t give you a definitive answer. We don’t even really know what’s wrong with you yet. We’ll need to do several further tests before we can confirm a diagnosis.’
‘Tests?’ His voice was wary.
‘Yes. Scans, likely an ultrasound and a CT scan, in the noisy tunnel, you know.’
He nodded. ‘What else?’
‘Maybe an endoscopy. A little camera on a tube, either down your throat, or…’
‘Up me arse? Speaking of noisy tunnels.’
She nodded. ‘Maybe both. Top and tail. Although not at the same time.’
He winced. ‘Well, I guess I should be thankful for small mercies.’ His eyelids fluttered as he took in the information. ‘And what’ll they be looking for then, with these cameras? Cancer?’
‘Mainly. We do endoscopies for other reasons but I think in your case that’s what we’d be trying to exclude.’
‘And if they do find a cancer? Or loads of the bloody stuff? What happens then?’
‘Maybe an operation.’
‘Well…’ He sucked on his lower row of dentures. ‘I can’t see as I’d want to bother with all that. Cutting me open? Never needed nothing like that before. And I suppose you’d be wanting to pump loads of poison into my veins as well?’
‘If you mean chemotherapy, that could be a treatment option, yes.’
There was a pause before he spoke again. ‘And hows about if I didn’t want any of that stuff?’
Violet nodded. ‘Nobody’s going to force you into anything, Mr Zeller. It’s your body.’ As she said this she was aware of how many times in the space of her short career she’d seen people undergo procedures with a very slim chance of success, procedures that most doctors wouldn’t put themselves through. Patients not having treatment physically forced upon them but going along with investigations because they thought they should, because the doctors said, ‘Maybe this might work,’ and families said, ‘Definitely – let the doctors do what they need to, Dad.’ Patients persuaded to take hefty doses of multiple medications in order to prevent a heart attack in the next twenty years, when they were already ninety-seven and might prefer a heart attack to a few more decades of frailty and deterioration.
‘To be honest, Mr Zeller,’ she said, ‘we’re getting a bit ahead of ourselves here and I don’t really like talking about hypothetical situations. Why don’t we take this one step at a time? I can see that your scan has been requested. You might even have it later today. Then we’ll know more, and we can have a think about what happens next.’
Mr Zeller gave a little ‘hmmph’ which Violet took to be acquiescence. He still didn’t look terribly reassured, but she wasn’t sure whether it was her job to reassure him. She thought she might have one last attempt. ‘Nobody can operate on you or do anything to you without your consent, Mr Zeller,’ she said. ‘That would be assault.’
He struggled up onto his elbows and glared at her.
‘I just know I don’t want nobody leaping about on me chest and electrocuting me if I die,’ he said, suddenly vehement. ‘That’s what happened to my Magda and she never woke up after. She’d already been in hospital for weeks, getting thinner and thinner, all the life gone out of her. And she said to me, just before, “Jakub”, she said, “I don’t want this anymore. I want it to be over. I want to go home.” Except I never got her home, did I.’ His voice caught in his throat. ‘Her heart stopped and instead of leaving her in peace they leapt all over her, pummelled her about for twenty minutes, packed me off to some nasty little room instead of letting me stay and hold her hand like she would’ve wanted…’
Violet had the horrible feeling that he might be about to cry. She wasn’t good with tearful patients, never knew what to do with herself. Often, she’d simply stare at the floor until they’d finished and then carry on talking as if nothing had happened. ‘Do you, uhm, do you want some water?’ she said.
He gave her a scathing look. ‘Water? What would I want bloody water for?’
‘I don’t know,’ Violet admitted. ‘It’s just something people say, isn’t it? When someone’s upset or whatever… I – uhm – of course, you’re right. Why would you want a glass of water. Sorry. Carry on.’
He shook his head and she thought she might be able to see a tiny smile playing on his lips. ‘I don’t need to carry on,’ he said eventually. ‘You don’t need to know any of this. Don’t know why I mentioned it really. I just felt like I let her down, my Magda. Should’ve stood my ground and told them doctors that she wouldn’t have wanted all that fuss and nonsense and what did they think they were playing at.’
‘You didn’t let her down,’ said Violet, although she had no particular evidence to confirm this assertion. ‘I’m sure you were a wonderful husband and that you supported her as best you could, or, uhm, whatever. Come along now. Magda wouldn’t have wanted you to feel like this.’ She patted in the general direction of Mr Zeller’s left foot, feeling confident that this was a strong concluding statement.
‘I think you might have reached your limit on sentimentality, Doctor – am I right?’ His mouth had creased up at the corner again although Violet wasn’t sure whether it was in amusement or emotional pain.
‘You might be. Sorry. I’m not very good at this stuff. Which is fairly self-evident.’ She picked up the sheaf of notes. ‘What I am good at though is thorough history-taking and precise documentation. Which is why next time I see you I think we should complete a Do Not Resuscitate order to put in your notes – make sure you don’t end up going through what Magda did.’
Mr Zeller nodded and at last looked a little more reassured. ‘That would be a relief, yes.’
‘And finally, did you get any Christmas presents, Mr Zeller?’
‘Is this part of your thorough history-taking?’
‘Exactly.’
‘No. I did not. I have no family now Magda’s gone, and very few friends. And, as I told you last night, I absolutely hate Christmas.’
‘So, you did. Righto. I’ve got to get on with the rest of my shift. There are other people in need of my attention, astonishing as that may seem. Shall I turn off your light, what with it being nearly two o’clock in the morning?’
‘You may,’ he said. ‘I think I might be able to get to sleep now after all.’
‘Have I made you feel better?’ she asked with genuine surprise. ‘Put your mind at rest?’
‘No,’ he said with another wry smile. ‘It’s just that talking to you is bloody exhausting.’
Gus
Gus’s eyelids felt heavy as he sat alone in the mess, the noise from the television reduced to a low hum. He had just finished a pre-op assessment for a man awaiting emergency surgery on his leg, both knees having fractured at multiple points when he’d attempted to fly out of the window of his girlfriend’s second floor apartment. It hadn’t been entirely clear what level or combination of recreational drugs had been taken to precipitate this event but when the patient had told him, in a quiet conspiratorial voice, that he had known, known he was possessed by the spirit of at least three of the X-Men and that they were responsible for his powers of flight, Gus had called orthopaedics and suggested that they wait a little longer before consenting him for surgery, at least until the delusions of grandeur had seeped out of his system along with the ketamine. Thinking you were possessed by Wolverine was not a great marker of mental capacity.
The door creaked open bringing with it a waft of fresh citrus fragrance that made him open his eyes. Violet Winters was resting against the doorframe in a way that he assumed was intended to appear casual but actually looked quite uncomfortable.
‘Coffee or tea?’ she said. ‘I’ll make it. You look knackered.’
‘Thanks. I thought I looked pretty good.’
‘Well, yes,’ said Violet. ‘Sleep deprivation doesn’t make people less handsome. It just means they look tired. Not that you, uhm, anyway. What’ll it be?’ She gestured to the kitchen counter.
‘I’ll just have whatever you’re having,’ he said. He rubbed his eyes, partly from fatigue, but also to disguise the fact that he was really quite flattered she’d inadvertently called him handsome. ‘Anything with caffeine in it.’
‘Really?’ She gave him an incredulous look. ‘You have no opinion on whether you want a tea or a coffee? Completely ambivalent?’
‘Yeah,’ he said. ‘Just whatever’s easiest.’
She snorted in disbelief and crossed to the kettle.
‘Wait.’ He sat more upright and checked his watch. ‘How many hours until the shift’s over…? Oh, okay, four. Yeah, caffeine’s fine. Caffeine’s good. As long as it’s out of my system before I get home otherwise I’ll never get to sleep.’
She nodded and took two mugs off the draining board.
‘Takes me at least a couple of days to get into the pattern.’ Gus continued to speak as Violet busied herself with their drinks. ‘And then, just as I get used it, sleeping in daylight and up all night, the week’s over and I’ve got to resynch with the rest of the human race in a normal circadian rhythm again.’
‘I didn’t sleep much yesterday,’ agreed Violet as she brought over his mug. The tea she’d made him was a deep stewed orange. ‘This is the colour you like it?’ she checked as she handed it to him. ‘The tea? This is how you had it yesterday.’
Gus was too touched by the fact that she’d remembered the exact shade of the previous night’s mugful to tell her that he wasn’t an enormous fan of really strong tea and that last night’s attempt had been a bit of an error, the taste of tannin remaining on his teeth until he got home and had some cornflakes. ‘It’s fine,’ he said, taking a sip and trying not to grimace. ‘Perfect.’
‘Yeah, so sleeping through Christmas Day is a bit weird anyway, right?’ Violet continued. ‘But it’s also my first week of nights so I’m not sure how it will work out. The body-clock reset and everything.’ She took a sip of her own milky tea. ‘I’ve got a plan though.’
‘You have?’
‘Yes.’ She tucked her feet up onto the sofa. There was a little hole in one of her socks and he was suddenly tempted to poke his finger through it, feel the delicate pink skin of the tip of her toe – it must be all this talk of sleeping, or rather, the thought of being in bed, unable to sleep and what other activities Violet might be getting up to under the covers.
‘I’m going to the lido as soon as tonight’s shift’s over,’ she continued, clearly oblivious to the sordid direction of Gus’s thoughts.
He dragged his mind back from Violet’s warm bed. ‘The lido? In town? Why?’
‘For a swim.’
‘But the lido’s outside?’
‘Yes. An outdoor swim.’
‘But…’ Gus felt certain that Violet had overlooked a basic seasonal fact here. ‘But it’s December. It’s Boxing Day.’
‘I know. I did wonder if they’d be open but I checked the website.’
‘Hang on.’ Gus wondered if the sleep deprivation really was getting to him. ‘You’re going to an outdoor swimming pool. For a swim. In December?’
‘Yes.’ She put her mug down on the side table. ‘It helps me sleep,’ she said. ‘Cold-water swimming. It really helps. I used to have massive issues with insomnia. I’m a bit of a stress cadet.’
He smiled at this admission.
‘But then,’ she said, ‘last summer a friend of mine suggested I come wild swimming with her. Emily’s a member of The Blue Tits. It’s a wild swimming group. They’ve got members all over the UK – anyway, there’s a filtered lake out near Long Ashton. Part of the golf course. We went there. I told Emily I couldn’t be doing with the whole “sploshing about in a murky river” thing. I don’t want to suddenly realise I’m doing front crawl next to a sewage outlet. But that’s the great thing about the lake; it’s outside, and it’s cold – even in summer – but it’s clean. Cleanish anyway. A few ducks on it, the odd heron, but otherwise, just the water and the swimmers.’
‘And you enjoyed it?’
‘I loved it,’ Violet said, laughing at his reaction. ‘It’s really invigorating. You don’t need to swim for long to get the effect, and afterwards you feel all wholesome and pleasantly fatigued, like you’ve run a marathon or been to some two-hour high-impact spin class, without having had to endure the reality of either of those things.’
‘And it helps you sleep?’ He was genuinely intrigued now. His sleep hadn’t been great in recent months: anxiety dreams, waking up in the early hours gritty eyed and unrefreshed.
‘Oh, God, yes! I had the best night’s sleep after that first swim with Emily. Best night I’ve had for years. I fell into bed and slept like a stone.’
‘Like a log. You slept like a log.’
‘A log, a stone, whatever. Something heavy and inert. Anyway, you don’t strike me as the type to be pedantic about correct use of idiom.’
‘No, you’re right, you can be whichever inanimate object you like.’ To be honest Gus felt ridiculously flattered that she’d given any thought to what type of person he was, pedantic or not. ‘So, you reckon it’ll help with sleeping between night shifts?’
‘I don’t see why not,’ she said. ‘You should give it a try. Come with me.’
‘What? Today?’ He nearly choked on his tea.
‘Well, no, you probably haven’t got your trunks with you. And you do have to – you know – have some swimwear. It’s wild swimming but not that wild. I think some of the pensioners at the lido might have a coronary if you swam past them in the buff.’
‘Good point. I think I might be on the verge of a coronary myself.’
‘But normal trunks are fine. You don’t need a wetsuit. They keep the water in the pool at twelve degrees.’
‘Positively balmy.’
‘Indeed. Positively barmy, my dad says. But that’s just him trying to be hilarious.’
Gus smiled along, knowing that this was exactly the comment he’d been about to make himself. Great – he’d reached the ‘dad jokes’ stage of life and he hadn’t even hit thirty. Witness the comedy genius of saying Boo! in order to surprise Violet yesterday or trying lame chocolate-based puns to tempt her along to the ward office earlier. Surely, he was a bit slicker than this? What had happened to the Gus who always had a well-judged, witty rejoinder? Mental and physical exhaustion had obviously finished him off. Still, Violet didn’t seem to mind that he’d turned into some kind of slapstick idiot. It was actually quite relaxing not having to watch what he was saying the whole time and he felt the little niggle of tension he perpetually held between his shoulder blades start to ease off.
‘Gloves and boots are good, if you’ve got anything neoprene for your extremities it makes a real difference.’ She was still talking about the swimming kit – as if this was an expedition she seriously wanted him to accompany her on.
‘Starting to sound marginally less appealing,’ he said. ‘I think I would be quite concerned about all my extremities, and you can’t get neoprene accessories for every part of your body presumably?’
‘Nothing’s going to fall off at twelve degrees,’ she said wryly.
‘You sure of that? There are some very important bits of me I’d like to keep.’ He raised his eyebrow suggestively and then worried it had been too much.
She smiled, evidently humouring him. ‘Look, it’s up to you. I can’t guarantee you’ll like it. But you seem the sort who’d give things a try. Open-minded. Easy-going.’
He gave a dramatic sigh. ‘Well, I’ve got to come with you now you’ve said that. Otherwise you’re just going to think I’m some uptight control freak.’
‘No. Don’t worry,’ she said. ‘I’ve got the monopoly on control freakery around here.’
He laughed. ‘You really haven’t,’ he said honestly. ‘If anything, Violet, you seem completely the opposite. You’re very down to earth. The control freaks I know – and I know a few – they’re all about maintaining appearances. You don’t seem remotely concerned what other people think of you. It’s quite refreshing.’
He noticed that she was blushing and wondered if she was surprised that he had formed a definitive opinion about her, just as he had felt earlier when she’d told him he wasn’t the pedantic type.
‘That’s a nice thing to say,’ she said. ‘And you’re right. I don’t usually worry about what other people think of me. But sometimes, that’s not a terribly helpful approach. Particularly in this kind of job.’
His first instinct was to reassure her again but on reflection he understood what she meant. ‘I think it can be useful,’ he said cautiously. ‘But I guess you’ve got to be carefu—’
‘I just don’t like working with people, with patients, as much as I thought I would,’ she blurted out before he could continue. ‘Sorry – I – I interrupted you.’
‘No, no you carry on.’
She took a deep breath. ‘Trouble is I find a significant portion of the human race intimidating and scary, and to be honest, completely unfathomable. And as a result, my bedside manner is pretty lacklustre. Patients can tell. They’re like horses, they can smell fear. Or is it dogs that can smell fear? Or maybe it’s bees?’
He snorted a laugh through his nose.
‘They can!’ she said, laughing at herself now, while also sounding a little close to tears. ‘I’m not like you. I don’t have any of that easy banter, I don’t give off a relaxed vibe. I’m what my friends politely describe as socially awkward, and what people who don’t know me would describe as standoffish and rude.’
