Violet
‘We told her the bus to the seaside would just be another hour or so,’ whispered Cindy smiling fondly at her patient who was now snoring like a freight train. ‘She was happy to wait, especially when Pete said he’d phone ahead to the station and let her mother know that there had been a delay.’
Cindy nodded. ‘Just good patient care,’ she said.
‘Oh, yeah, I think so. There was definitely a chap here when I came on to the shift. Middle-aged, probably her son. I think she lives with him and his wife. He wanted to stay but I explained about visiting rules. She started wandering soon after he left.’
‘And they’ve adopted the policy in this hospital?’ she said.
Violet shrugged. ‘If they haven’t they probably should do,’ she said. ‘I’ve not thought to ask until now, but it would make sense, wouldn’t it? Having a designated carer able to stay with the patient outside of normal visiting hours.’
‘Hmmm.’ Cindy made a note on her handover sheet.
‘Leave it with me,’ she said. ‘I’ll ask the day staff.
See if they know anything about it. John’s Campaign, wasn’t it?
’ She dotted the paper with her biro, still looking thoughtful, and then turned to Violet.
‘Thanks, Dr Winters,’ she said. ‘Sounds like it might be helpful.’
Violet smiled broadly, not really used to the warm glow of feeling appreciated. ‘No problem,’ she said. ‘And it’s Violet. You can call me Violet. Anybody else you need me to look at while I’m here?’
She regretted this uncharacteristically generous offer almost as soon it was out of her mouth, aware that she still had a long list of patients and jobs on other wards– but Cindy smiled kindly. ‘I don’t think so. Unless you want to pop your head round the curtain of bed fourteen, Mr Zeller?’
‘Oh, yes, I clerked him in last night on ward four. He’s moved here, has he? How’s he doing?’
Cindy shrugged. ‘His obs are stable. It’s just he didn’t have any visitors today, apparently.
Christmas Day and no visitors at all. I mean, he is a grumpy old bugger but still…
He’s wide awake now. Staring at the ceiling.
Although maybe he’s just traumatised by Mrs Jenson trying to get into bed with him earlier. ’
‘Nothing medically wrong with him though?’ Violet clarified.
Cindy shook her head. ‘No, like I say, he’s stable. Says he’s got no pain or anything– didn’t want any fuss, truth be told.’ She pursed her lips. ‘Look, don’t worry. He doesn’t need to see a doctor, it’s fine, ignore me.’
Violet was just about to agree. It didn’t sound as though her time would be best spent trying to talk to a cantankerous old man who had no acute medical needs, but when Cindy mentioned Mr Zeller staring at the ceiling she was suddenly reminded of last night and how isolated he’d seemed.
‘Go on then,’ she said. ‘I’ll say hello. It is Christmas after all.’
Cindy looked at her watch. ‘Boxing Day, technically,’ she said. ‘But I think it still counts.’ She brought Mr Zeller’s notes up on the computer. ‘Thanks for doing this,’ she said, gesturing for Violet to take her chair as she went to attend to the woman in bed seven.
Violet scrolled through the notes deep in thought.
That exchange with Cindy had been nothing like the clipped combative conversations she usually had with colleagues who wanted her to do extra jobs.
Maybe it was the festive time of year, or maybe it was just that things were a little less hectic and rushed during the small hours of a night shift.
Either way, the feeling of solving a problem together was certainly nicer than that problem being dumped solely on her shoulders, another responsibility transferred off someone else’s list of things to do and onto hers.
She clicked through the pages of Mr Zeller’s notes, not expecting much more to have happened since she’d clerked him in.
Only urgent investigations would have been conducted on Christmas Day and he probably wouldn’t have definitive proof of his diagnosis until later in the week.
He had a new set of blood results though, the doctor on day cover must have taken them.
They didn’t look great. His liver function was definitely deteriorating and she wasn’t sure whether it was the knowledge of these results or the ward lighting that made him appear even more jaundiced tonight as she stepped in behind the curtain.
‘You again.’ He turned his head, yellow eyes fixed on her like a cat’s.
‘Me again, Mr Zeller,’ Violet said.
‘You here to wish me a Happy bloody Christmas?’
‘Nope.’
‘Good. What are you here for then? Sticking more needles in me?’
‘No. Not that either.’ Violet wondered what to say next.
She usually found it hard to predict people’s responses but she felt a strange affinity with Mr Zeller– she got the impression that he would hate to think the staff were worried about him being lonely.
‘I just wanted to uhm, check that you were, uhm…’ It was no good.
She was a terrible liar and hopeless at dissembling.
‘I wanted to talk about your blood results,’ she said finally.
‘The blood tests I had today?’ He scowled at her. ‘You want to talk about them at one o’clock in the morning?’
‘It’s as good a time as any,’ she said. ‘May I?’ She gestured to the foot of his bed.
He waved a frail hand in her general direction. ‘Sit down?’ he said. ‘Sure, why the hell not! Make yourself comfortable, why don’t you.’
Violet perched next to Mr Zeller’s blanketed feet, smiling inwardly at his attitude. And people said she was prickly!
‘Hit me with it then.’ His eyes were beady and alert now as he peered down the length of the bed to where Violet was sitting. ‘Will I make it through the night?’
‘Well…’ She pursed up her mouth as she considered his question seriously.
‘Your observations are stable so I think on the balance of probabilities your chances of remaining alive for the next few hours are fairly good,’ she said before realising, somewhat belatedly, that he’d been joking.
He hadn’t genuinely believed for a moment that she was going to tell him death was imminent.
‘That’s enormously reassuring,’ he said wryly. ‘Glad to see the bedside manner hasn’t improved much in the past twenty-four hours.’
‘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.’