Violet
Thursday night
‘D on’t you be giving me a load of old bzdury !’ Mr Zeller’s voice was audible halfway down the corridor of ward ten. ‘Where’s Dr Winters? She’ll tell me straight. Where is she? I’m not talking to anyone else.’
‘Luckily, I am she,’ she said and gave the surgeon a look to suggest that he shouldn’t be distressing her patients in such a fashion.
‘Well. We should probably have a chat then,’ the surgeon said, ignoring her stern expression as he cast an appraising eye across the rest of her person, mainly from the neck down.
‘About the plan for tomorrow’s procedure.
He’ll have to be nil by mouth. I’ll let the girls know.
’ He inclined his head in the general direction of the nurses’ station to indicate ‘the girls’.
‘I’ll just speak to Mr Zeller first,’ said Violet coolly, ‘if that’s alright with you?
’ She pulled the curtain shut behind her, blocking him out in an efficient, if slightly aggressive manner.
She’d only just started her shift and for some reason had a prickly anxious feeling about the night ahead.
Dev had been jittery prior to her departure, nervous about Marv’s evening performance and his journey home.
Apparently, a talent scout from the production company, World of Wonder, was likely to be at Rainbow Punters tonight.
When she’d left them, Dev been fussing over Marv’s outfit even more than usual, as well as scolding him not to stay out too late ‘schmoozing television execs’ because ‘he knew how difficult it was to get an Uber during Christmas week’.
It had been a rare moment of tension between her two favourite men and her mood hadn’t been improved by this surgical idiot upsetting her favourite patient, or by being assessed by said idiot like a piece of meat in the butcher-shop window.
‘What’s going on then?’ she said to Mr Zeller who was looking even more mutinous than usual. She noticed his eye mask was positioned ready on his bedside table and there was a pleasant aroma of lavender still permeating the region of his pillow as she pulled up a chair.
‘Told me I’ve got to have a test tomorrow morning,’ Mr Zeller said crossly. ‘Not allowed any breakfast, cameras and tubes and incisions and biopsies– and being put to sleep– and something about an RCGP?’
‘Hmmm.’ Violet looked thoughtful. ‘RCGP stands for Royal College of General Practitioners, so I doubt it’s that. ERCP maybe? It stands for endoscopic retrograde cholangiopancreatography which basically means a camera to look at your bile duct and pancreas.’
‘Yeah, one of them things.’ Mr Zeller folded his arms more tightly across his chest and stared directly ahead.
‘Didn’t ask me if I wanted any of it,’ he said sadly.
‘Just told me that’s what’s happening. He’s bringing the paperwork back in a minute so I can sign my life away.
I’ve never been put to sleep before, not sure I fancy it to be honest. Not that anyone here gives a monkey’s what I want. ’
There were tears in his eyes and he blinked them away furiously. Violet pretended not to have spotted them, she was well-practised in this. Usually, it was to save herself an awkward discussion, but this time, she noted with surprise, it was done to spare her patient’s feelings.
‘He didn’t even tell me what the scan showed,’ Mr Zeller continued.
‘Just said it was nothing much to worry about and that it had all been agreed, this ERC-whatever business, just sign on the dotted line, and if I had any other questions to ask the nurses. Well, the nurses don’t know, do they?
That Cindy, she does her best but she hasn’t got time to go through those results with me and even if she did, she doesn’t know what their plan is, all these bloody doctors, wanting to cut me up and mess about with all me innards. ’
Violet had heard enough. She rose quietly from her chair.
‘I’ll go and have a word,’ she said. ‘You leave it with me, Mr Zeller.’ She gave the curtain a brisk tug and it swung back a bit more dramatically than she’d anticipated.
No matter, perhaps it would lend her some gravitas as she marched over to the nurses’ station where the surgeon was scribbling out a consent form.
‘Excuse me,’ she said politely. ‘My patient has a couple of questions. I don’t think he understands why he is having an ERCP tomorrow or what it entails. If you could just?—’
The surgeon glanced up, evidently irritated by the interruption. ‘Don’t blame me if you haven’t told him what’s going on, love, your boss referred him to us.’ He looked back down at his list and read aloud from it. ‘Zeller– pancreatic mass, probable liver mets.’
‘He is not just a pancreatic mass,’ said Violet coldly. ‘He is an eighty-four-year-old man who has never been in hospital before, let alone had an operation.’
The surgeon snorted and looked back down at the notes. ‘Hardly an operation,’ he said. ‘It’s just a procedure under anaesthetic.’
‘Yes, but Mr Zeller doesn’t know that,’ said Violet.
‘He thinks you’re putting him to sleep and that he might never wake up.
’ She folded her arms, much as her patient had done moments ago.
‘And it still has risks, like most procedures. I’m assuming you’ve talked him through the possibility of cholangitis and sepsis, and haemorrhage, and pancreatitis?
And I’m hoping that you’ve also explained the potential benefits in terms of furthering our understanding of his diagnosis and aiding our ongoing management.
I mean that would be the basics, wouldn’t it? The bare minimum of informed consent?’
‘Yes, thanks. I do know how to do my job,’ he said. She couldn’t tell whether he was amused or irritated but she didn’t really care either way.
‘Well, that’s interesting,’ she said, her voice perfectly calm.
‘ And surprising. Because at the moment Mr Zeller appears to be completely clueless as to any of those things I’ve mentioned.
In fact, it’s almost as if you’d waltzed in here without so much as a please or thank you and scared my patient witless with a half-arsed attempt at gaining consent, as opposed to sensitively talking him through the procedure, explaining what it would entail, and the reasons it was an appropriate and necessary investigation in order for him to make an informed choice.
Is it possible that your recollection of the consenting process differs slightly to his? ’
The surgeon raised his eyebrows and she wondered if she’d overstepped the mark– possibly by quite some margin.
Although she’d kept her tone neutral and her face deliberately impassive, she maybe shouldn’t have said ‘half-arsed’ but sometimes phrases popped into her head and straight out of her mouth.
This man was evidently senior to her and could probably cause a lot of trouble if he added a complaint to the growing list. The words, patronising and rude sprung into her head for what felt like the hundredth time.
Perhaps she needed some damage limitation.
She uncrossed her arms, having read somewhere that this was a good technique for de-escalating tension, but then wavered.
What if she’d misunderstood? Perhaps uncrossing your arms looked aggressive, like you were about to attack?
She compromised by awkwardly holding one arm with the hand of the other.
‘Have you spoken to him?’ she asked, trying to look relaxed about her odd limb arrangement. ‘My patient. Mr Zeller? Have you listened to his concerns at least?’
‘Don’t be giving me a load of communication skills bollocks, sweetheart,’ said the surgeon, an infuriating smile on his face.
‘He’s been informed of the risks, he’s happy to sign and then I need to get to theatre, okay?
Don’t get your knickers in a twist about whether I’ve explored his hopes and expectations. I’m not a GP.’
‘Well, I think the wider primary care community can probably be extremely grateful for that,’ she said, her brief attempt at conciliatory body language now forgotten. She pulled herself up to her full height of five foot seven and wished she had more physical presence.
He looked her up and down, his eyes roving across her hips and her breasts before finally settling on her name badge where a bedraggled piece of attached tinsel had not quite obscured her rank.
‘You’re just a foundation year,’ he laughed.
‘Jesus, you’ve got some attitude, haven’t you?
Shall I maybe just add a little line to this chap’s notes saying that Dr’— he leaned in to read her badge, his face closer to her chest than was necessary—' Dr Violet Winters has been actively obstructing the delivery of appropriate care for this gentleman? Or maybe I’ll have a word with your boss, man to man.
Alert him to the fact that the most junior doctor on his team doesn’t know her place? ’
Violet’s mouth set in a determined line.
‘I am perfectly aware of my place, thank you,’ she said coolly.
‘And I don’t think that my raising concerns about you bullying patients and junior colleagues would be particularly beneficial to your career either, would it?
’ She watched a flicker of annoyance cross his face.
‘Now, all I’m asking you to do is go back in there and consent my patient properly.
That shouldn’t be too difficult, should it, sweetheart ? ’
She marched away from the desk and managed to maintain a haughty demeanour as far as the treatment room where she promptly tripped over her own shoes, but at least she was out of his sightline. Cindy caught her arm as she flailed dangerously close to the bags of saline.
‘Thanks,’ she said breathlessly. ‘Uhm, Cindy, could I ask you a favour? Could you make sure somebody is with Mr Zeller when that surgeon tries to consent him for his ERCP?’
Cindy narrowed her eyes. ‘It’s old Barney Big Balls, isn’t it?
Or “Mr Snell” to mere mortals like you and me, now he’s got his membership.
He’s insufferable. Don’t worry– I’ll go in there myself.
I’m not leaving our Mr Z to that oaf’s tender ministrations.
’ She patted Violet on the arm. ‘Now you try and stay upright for the next few hours at least,’ she said, ‘and I’ll bleep you when Barney’s done– likely all of five minutes. ’
Violet thanked her and went to the ward office, the only place one could make a call in relative privacy.
‘I’m really sorry,’ she said, as soon as Anjali picked up the phone. ‘Have you finished with your asthmatic lady? Good. Look. I need to tell you something. I think I’ve probably pissed someone else off.’
Anjali was only slightly disgruntled by the confession. Clearly Barney was renowned for his arrogance and Violet wondered if her colleague actually sounded quite pleased when she relayed certain elements of their disagreement.
‘You managed to get him to go back and consent the patient again?’ Anjali spluttered. ‘And you called him sweetheart ?!’
‘Well, he hadn’t consented him properly,’ said Violet, wondering if she was in for a bollocking. ‘And he did call me sweetheart , and love , and other diminutive terms intended to make me feel inferior. I thought I’d just “reflect it back”– see, I do pay attention to some communication skills.’
Anjali hooted with laughter. ‘I sometimes wonder if we should actually teach your brand of communication skills, Violet,’ she said. ‘Don’t worry. If there’s any kick-back with Dr Corbishley I’ll handle it. Sounds like you did the right thing for the patient.’
Which is all I ever try to do , thought Violet to herself as she placed the phone back in its cradle.
Just odd that it sometimes gets right up other people’s noses.
She remembered back to her third year as a medical student, fresh on the wards when a different surgeon had shouted at her in front of the whole team for refusing to do a rectal examination on an elderly man with bowel cancer.
The patient clearly had advanced dementia and was unable to consent to twelve students sticking their finger up his rear end just so they could feel the craggy consistency of his adenocarcinoma, so Violet had refused, point blank.
‘How are you supposed to learn about signs and symptoms if you don’t examine them?
’ the surgeon had roared as he put a large cross against her name on his clipboard.
‘You need to know what you’re looking for, Miss Winters, otherwise you’ll fail to diagnose a cancer in the future and who’s going to thank you then, hey?
As we always say, put your finger in it or you’ll put your foot in it. ’
The rest of her classmates had tittered along sycophantically.
They were used to Violet causing a scene and most of them thought her aloof and superior.
They welcomed seeing her taken down a peg or two.
She didn’t care. Even when she was stood in front of the undergraduate dean she refused to concede.
Her own grandmother had been diagnosed with dementia a few months earlier and the thought of her being subjected to multiple distressing examinations against her will just for the purposes of furthering someone else’s education, was anathema to her.
She knew she’d done the right thing. And at the end of the day, her distinction-level exam results were difficult for the undergraduate dean, or anyone else in the medical school, to argue with.