I thought briefly about lecturing him on safe sex, but discarded the idea. Lin seemed to be in charge of things, including Nevins.
“If you really want to know any more detail, you probably need to ask someone who isn’t gay,” I said helpfully. “What about Dr. M? I think he’s been married.”
Nevins looked horrorstruck at the suggestion and I left him quietly whimpering at the thought and went back to join Lin.
Perhaps she would ask me new and exciting questions about what men like, questions that I actually knew the answer to.
I stayed close enough to Andrew to be able to ogle him unobtrusively, just for the entertainment value. He was sombre, everyone was, standing around in groups, talking quietly amongst themselves. No mobiles rang, no pagers buzzed, the young woman from the BMA meeting had swollen eyes from crying. I wondered what it felt like to leave your patients like this. I hadn’t really developed a feeling of attachment to any of the patients yet, and I guessed I wouldn’t until I was really working, perhaps on my long placement next term.
I ate my curry sandwich at about eleven, starving as always, and my eyes settled on Andrew. His key was safely on my key ring, the security code for the alarm system was in my pocket. We were lovers, I was eating his sandwiches, tonight he was going to take me somewhere…
A PCA from our ward came out of the hospital, distinctive in her hideous mint green uniform and pressure- bandaged legs, and I heard her say, “Excuse me, Dr. Maynard, there’s a problem with a medication chart on the ward. You’re needed.”
His eyes caught mine as he turned around to pat Dr.
Seagate’s shoulder. He looked completely exhausted.
He walked beside the PCA back into the hospital, the crowd of doctors between him and the door parting silently to let him through. It was the least militant picket line I’d ever heard of.
Chapter Thirty
There was an unfamiliar nurse waiting for me at the nurses’ station, a medication chart in her hand.
She was an agency nurse. Damn.
“I’m Dr. Maynard,” I said to her. I couldn’t raise a smile, not under the circumstances.
She held the chart out to me. “I think there’s been a prescribing mistake, doctor. Mrs. Silva has two opiates prescribed for her. I’ve withheld her ten a.m. dose of pethidine until you can clarify the chart.”
There was nothing I could do, so I took out a pen and wrote ‘cease’ across the orders for morphine and pethidine and blocked out the chart to reflect this. I wrote Mrs. Silva for the maximum legal dose of methadone, added as much oxycodone as I could prescribe, and handed the chart back to the nurse. “I’ll call pharmacy to arrange the methadone.
Please give Mrs. Silva a dose of oxycodone stat.”
The nurse narrowed her eyes at me a little after she had checked the changes to the chart. “Doctor,” she said. “This is a very high dose of opiates for Mrs. Silva. She’s already having trouble maintaining her airway and her respirations are suppressed.”
“Thank you for pointing out the obvious,” I said to her, my patience wearing thin. “If you noticed, Mrs. Silva is NFR. I have no intention of going against her family’s wishes and intubating her. And I have no intention of allowing her to die in pain. Dr. Jackson is the senior consulting physician if you would like to contact him. Excuse me.”
I stalked off down the ward. Hopefully she’d page Dr. Jackson. He wasn’t on strike; he was at his private practice on Mondays. And he’d rip her a new one if she disturbed him there. He was rabidly pro-euthanasia, had even gone to the Netherlands to a euthanasia conference at his own expense, and he was on Jack Kevorkian’s personal mailing list.
I pushed the door to Mrs. Silva’s door open quietly. David, one of the ward nurses, was specialing her, and he looked up from where he was doing mouthcare. John was asleep in a chair beside the bed, his sister’s hand in his own, his face on the bed beside her hand. God, I hoped somebody would care for me so conscientiously in my last few hours.
David stood up and handed me the fluid balance chart and pointed at the tally. I nodded my agreement, flicked through the file to find the IV orders, and ceased the hydration. Her kidneys had shut down; there was no point in continuing to hydrate her.
I could trust David to keep Mrs. Silva’s skin moisturised and to treat her eyes with the tear replacement drops.
David turned the hydration IV off and I just stood for a moment. Mrs. Silva looked younger now, some of her deep wrinkles plumped out by the fluid that was overloading her.
Her colour was bad, her breathing irregular. I didn’t disturb her by listening to her heart and lungs; there was nothing to be gained, there was nothing I could do now.
Good nursing care was what she needed.
“Wake him,” I whispered to David. “He’ll be heartbroken if he’s not there.”
David nodded, and I slipped out of the room.
Clive was the CN on duty, and he was in the treatment room when I went looking for him.
I stood in the doorway while he drew up the antibiotics he was making up and waited for him to finish. Never startle a nurse with a loaded syringe, just in case.
He looked up at me and nodded a greeting as he squeezed the IV bag to mix it.
“Dr. M,” he said. “You came up to see Mrs. Silva? The agency nurse demanded we call you and wouldn’t be talked out of it.”
“Yeah,” I said. Fuck, I was tired. “I’ve put her on oxycodone and methadone. I’ll go and do the request form for the methadone now. Send someone down for me when she dies and I’ll pronounce her.”
Clive nodded. “Will do,” he said.
I left him and went and sat at the nurses’ station where I filled out the requisition form for the methadone, and called the pharmacy to expedite it. The stuff was horribly addictive and pharmacy always wanted to check the usage and counter-approve before dispensing. Paranoid bastards.
I looked up to find myself being smiled at by one of the administration’s flunkeys. He was a human resources case manager according to his ID card, and it sounded ominous.
“Dr. Maynard?” he said.
I nodded and he handed me an envelope and walked off.
Looked like I wouldn’t be pronouncing Mrs. Silva after all. I pushed my dismissal notice into my pocket and got into the elevator.
Matthew was sitting on the pavement, waving what I suspected was a curry sandwich around with one hand as he talked to Lizzie from Micro. The sun was making his hair shine and it was the most gorgeous colour. Not brown at all, more like titian.
Being sacked certainly made one thing easier.
F was drinking a takeaway cup of coffee and it smelled great. I spotted the boxes of coffees lined up beside the statue of some git in a greatcoat with an inadequate gun. I agreed with the pigeons.
I took my coffee back to F and handed him my letter for him to read.
He scanned it and handed it back to me, then took my elbow and walked me across the courtyard to the dank walkway where the homeless lived.
Two shaggy old men looked up at me and one of them grinned toothlessly and held up his cup of takeaway coffee. I held my own up in greeting. Guess it was a good day for them; no rain and free coffee.
F said, “Had you thought about a change?”
“Looks like change has been thrust upon me,” I replied.
“No, a real change. London have headhunted me, offered me a consultancy there, along with a research grant. Come across with me, change to renal.”
I stared at F.
“Nephrology?” I said.
