Night Sisters
A thin trickle of blood had started from the corner of his mouth.
My poised hand wavered. For an unreal second we were all of us still as he began bloodily to drool.
I’d seen it all before, of course. Haematemesis and haemoptysis; patients vomiting blood or coughing it up. But suddenly, as I watched that slowly lengthening dribble, strung out with saliva, I felt my stomach go cold and tight inside me. Somehow I’d known that things were about to go horribly wrong.
Kathy turned to me, still awaiting the bowl, and our patient managed one dry heave before coughing a splash of scarlet down her pristine white coat. She swore tiredly, and motioned to Karen to help her support the man as he retched again, convulsing. His mouth yawned open.
And the blood came bursting out.
It was sudden, incredible, horrifying: a niagara of gore that just came and came, dousing him, drenching Kathy and Karen, even spattering me. His body jerked, and jerked again, spraying liquid crimson halfway across the room. For a frozen moment I watched with the numb lightheadedness of sheer panic; then lunged forward, jostling with the others as we struggled to stem the flow. Infection-control procedures went out the window: there’s no point gloving-up when you’re in blood to your elbows, when it’s splashing in your face. And all to no avail; the stuff kept geysering out. Nothing we did could stop him spewing up most of his bloodstream on to our Resus room floor – a spreading crimson lake that threatened to escape under the doors. And as our frantic efforts began finally to slacken, some cold, detached part of me still found time to picture the reaction of the bored line of patients sitting outside the plaster room opposite, as that creeping bloody tide began to emerge.
So there you go. Joseph Kaufmann, vagrant; died very spectacularly in our department some eight months back. My eyes still on the readout screen, I took a sip of tepid coffee.
Just the basics were outlined here of course; his file contained the gorier detail. Kath had written up the summary: if her usual hieroglyphics were indicative of tiredness, then the scrawl she’d used on this occasion suggested a state of near-clinical shock. I knew: I’d looked through the notes often enough since. Not everything had been recorded for posterity, of course. No mention of Dr Kessler, our consultant, bursting in to demand what the fuck we were doing in there; nor of Mike skidding in the mess and spraining his knee. Nor yet of Helen, pale and shaken, finally crying it all out in the duty room, as Karen and I held her tight. One thing, however, did come over clearly: the fact that none of us knew what the hell had gone wrong.
There’d been a post-mortem, of course. It confirmed that death had resulted from massive internal haemorrhage – as if we hadn’t guessed. As to a reason for the bloodbath, the pathologist had been less forthcoming; but his findings had both puzzled and disturbed him. Not that I’ve actually seen a copy of his report to the Coroner, of course; but we get to hear these things. And maybe the tale had been distorted slightly in the telling – but the version that reached us said that friend Kaufmann had recently undergone major surgery. Abdominal and thoracic. Maybe he’d had cancer, because great chunks of his intestines had been cut away completely. Organs had been crudely trimmed and grafted. The strain on his ruined system had given him an infarct; and the whole bloody lot had gone together. Like a failed experiment. That was the rumour I heard.
Records had dutifully been checked, and backs covered; but no record had been found, either here in our hospital or anywhere else. If someone really had been attempting to broaden the frontiers of medical science, it hadn’t been on NHS time. The police had also made enquiries in the private sector – although no one could really see our meths-reeking ex-patient checking in at his local BUPA clinic. There too they drew a blank.
Back to square one.
Mike said it put him in mind of a particularly nasty backstreet abortion he’d had to deal with in his last job. I took his point, but open-heart surgery was hardly the sort of thing you practised on your kitchen table. It was Karen, in particularly ghoulish mood, who’d suggested that the animal experimentation labs had started dissecting people instead, seeing as the Great British Public was obviously more concerned about animal welfare than the human derelicts on their doorsteps.
We’d had a cynical smile over that one, and a couple more crackpot coffee-break theories besides. Resigned now to the fact that we were none of us any nearer the truth: no more than we’d been on that first awful evening, when the body had been wheeled away; leaving me standing in a room that looked as if, to coin Mike’s phrase, someone had loaded a sawn-off shotgun with spaghetti sauce, and let rip with both the barrels.
So life had gone on; until
JOHNSTON, MICHAEL arrived in our department. This was a month or two later, and too many patients had come in through the doors for us to be giving the Kaufmann case more than the occasional thought. Mr Johnston – the late Mr Johnston – had been a more urgent admission than most, having just driven a stolen car full-tilt into a brick wall.
Into Resus he’d come, bloody and wrecked and yet still raving. The ambulance crew had to help us hold him down. The team crowded round in that brightly-lit room, and once again it was all beginning to look routine. We scissored off his clothes and pulled them clear, while the doctor set about checking bones, and wounds, and reflexes: bending in close to shine his penlight in the patient’s rolling eyes.
‘What’s his name?’
One of the ambulancemen supplied it.
‘All right, Michael. Michael? can you hear me, Michael?’
But Michael was in a world of his own: a private hell of pain and panic. From his disjointed ramblings, I gathered he didn’t like doctors much. Well, he’d come to the wrong place. The doctor – it was one of the locums that night, Sayeed or someone – slipped his stethoscope back around his neck. ‘Right … I’ll need X-rays of left tib & fib, pelvis, chest, both arms … and a CT scan. That first of all, I think.’
I nodded, told Brenda to get the duty radiologist on the phone. When she answered, Sayeed conversed with her while we cleaned Johnston up as best we could and prepared him for his transfer to the CT unit on the other side of the building. He seemed quieter now; his eyes glazed over. With everything under control, I stepped outside for a moment, and found a couple of policemen hovering vulture-like in the corridor – par for the course with RTAs.
‘You won’t be able to talk to him for a while yet,’ I pointed out, a little impatiently. ‘He’ll probably be in theatre for the rest of the night.’
The taller of the two shrugged. ‘We’ll hang on for a while anyway.’
‘Joyriding, was he?’
‘Dunno. We get a report of a stolen car, and then whammo. He didn’t even slow down, according to the eyewitnesses.’
‘You’ll want to breathalyse him, presumably.’
‘At some stage.’ He glanced round. ‘Anywhere we can get coffee round here?’
‘There’s a machine round the front,’ I told him, and went on into the cubicle area to see how things were going there.
They managed to get their coffee; they never got their interview. Nor their breath sample. Michael Johnston died at ten past six that morning.
According to the CT scan, his skull was still intact, but his brain had suffered irreversible damage.
And some of it was missing.
Another post-mortem. More puzzles for the pathologists. Because Johnston too seemed to have undergone recent surgery. Brain surgery. Which came as quite a surprise, because the only medical history he’d had with us was one of drug addiction. A policeman who’d spoken to him a week or so before the accident reported that he’d seemed rational enough – yet after what had been done to his cerebral cortex, he’d have been practically a walking zombie, driving that car by sheer desperate instinct alone. There was another finding, too. Though the trephine and lobotomy seemed at one level to have been sophisticated – even audacious – there was indication once again of a certain crudity. And evidence that it had been carried out under conditions that were far from sterile.
‘Another backstreet job?’ Mike had wondered cheerfully. Me, I was just waiting for the tabloids to pick up on it all with screaming POLICE HUNT DERANGED DOCTOR headlines. And what had Johnston been muttering? Something about doctors, ‘fucking doctors … still after me. Still coming …’ Except he hadn’t called them doctors but something else – a more specialized term he could only have picked up from professionals.
Clinicians. He’d called them clinicians. A cold word. But I’d wondered why its mention made me shiver.
Three
The phone rang as I was typing in the third name.
Startled despite myself, I reached over the keyboard for it, spilled the last of my coffee, and was still swearing as I brought the receiver to my ear.
‘If I’d wanted the Scatology Department,’ Mark said mildly, ‘I’d have dialled 221.’
‘I think that’s Pathology you’re thinking of, Dr Drew,’ I pointed out with completely informal formality: still checking to see whether I’d managed to get any over my uniform. ‘And by the way, where are you?’
‘The on-call room.’
Which was just up the corridor. ‘So why didn’t you just shift your bulk round here, you lazy sod?’
He grinned: his voice was full of it. ‘It’s what the telephone was invented for. But I might stagger round in a minute, if you insist.’
‘I won’t hold my breath.’ After a pause I added: ‘You guess where I was?’
‘And what you were doing.’ Some of the banter had faded from his voice. ‘Why don’t you let them rest in peace, Rachel?’
That left me nonplussed for a moment. Then: ‘What’s that supposed to mean?’
‘You know. Always poring over the same cases. You know you couldn’t have saved them – and the police have got nowhere. So what are you looking for?’
Silently, I had to admit I wasn’t sure. Certainly the deaths had been bizarre enough to have a morbid fascination of their own – but it wasn’t just that. Something about these particular cases still gave me the strangest feeling. A dull, persistent niggle of unease: like a slow, dripping tap in the darkness of my mind.
He took it upon himself to break the lengthening silence. ‘I’ll be round in a minute. See you.’
‘See you,’ I echoed, absently, as he hung up. I’d already guessed that recent events had a lot to do with my digging now. Jenny’s baffling fate; my own close encounter. A week’s inactivity to brood. And the cases had been weird enough to start with; but now, almost despite myself, I was beginning – just beginning – to wonder who the hell was really out there.
The third death had shaken me the most; and that a week or so before Jenny’s own murder. That was a night when the drip … drip … drip … had strengthened briefly to a startling, chilly trickle.
ALISON SCOTT
The full admission summary was unfolding onscreen as Mark stuck his head round the door, then came over to sit in the chair next to mine: wearing his sterile greens like pyjamas, his white coat unbuttoned over them. I gave him a sidelong glance: he hadn’t shaved yet, but otherwise looked quite fresh – his sandy hair tidied and brown eyes clear. Then again, he, at least, had had the best part of a night’s sleep. He returned my look, eyebrows innocently raised – then followed my gaze back towards the screen. Our proximity was relaxed enough: no hidden agendas. I think he knew I rather fancied him, but he was spoken for already. A purely professional relationship, then – but we liked and trusted each other a lot. And worked together well.
Alison Jane Scott, twenty-two years old, known prostitute, self-admitted with suspected post-operative infection. Died in department 02:20.
This one had been the least messy, but in its way the most shocking of all. She’d wandered in just after midnight, looking dazed and haggard. Complaining of a high temperature, sweats; an unpleasant discharge. An examination revealed she’d recently undergone a gynae op of some kind, and it seemed she’d developed an infection.
She wasn’t wilfully unco-operative most of the time; just listless, staring back at me or Mark (he’d been on that night as well) with dull, wary eyes. But when it came to the matter of the operation itself, she’d refused point-blank even to acknowledge it had taken place. Mark had pushed her a bit, clearly suspecting an illegal abortion, but got nowhere. And I’d had the distinct impression, as she’d relentlessly stonewalled, that her silence was born of fear: that the prospect of even mentioning her op was so frightening as to be quite simply unthinkable. It was looking more and more like a backstreet job. I assumed the person who’d performed it had threatened her – terrified her into silence.
I’d been right, too. In a way.
Anyhow, at length we’d given up trying to find someone we could pin the blame on, and Mark decided to get a second opinion from the gynae registrar. While he was out of the cubicle, I rechecked her pulse, and was making conversation in a perfunctory sort of way when her hand suddenly shot out and grasped my wrist: squeezing so tight it hurt. I turned in surprise – and the look in her eyes killed my word of remonstration stone dead. Her face was ashen and gleaming with sweat: I tried to tell myself it was the fever, but those haunted, hunted eyes assured me otherwise. Worst of all was the cold intelligence in them: the fact that she knew exactly what she was saying made the words that followed all the more unnerving.
‘Tell them I must be cremated,’ she whispered. ‘As soon as possible – so there’s nothing left for them.’
Somewhat taken aback, I’d opened my mouth and shut it again, before managing: ‘Don’t be silly – maybe a few days on the gynae ward and a course of antibiotics, and you’ll be fine. Nothing to –’
‘Forget it. They’re here. They’re here already. And I can’t run any more.’ She looked at me earnestly. ‘Just leave me alone – or they’ll do for you too.’
There was a pause. ‘How do you mean?’ I asked carefully.
Her patience snapped then: there was an edge of hysteria in her tone. ‘You stupid bitch, just leave me alone! Please …’
I kept very calm. ‘Who is it you’re afraid of ?’
‘Them. The Clinicians.’ Her voice had faded to a dry whisper again. ‘Can’t you feel them?’
Clinicians. Again that word. And though I didn’t answer her question directly, it did indeed occur to me that the temperature in the cubicle had altered. It hadn’t dropped, exactly; but it had … subsided. The air felt cooler on my skin. As I stared at her, I realized it was becoming cold.
‘Clinicians: you mean doctors?’
‘I mean Clinicians. Now for fuck’s sake leave me be.’
‘All right,’ I relented, ‘I’ll just go and see how the doctor’s getting on. Back in a minute, okay?’
I found Mark writing out an X-ray request form over by the desk. ‘You know that woman in cubicle two … ?’
‘Alison Scott? The gynae reg. is coming down to take a look at her: they’ll probably want to admit …’
‘I think you should speak to the duty psychiatrist as well. She’s really coming out with some weird things.’ And even as I was speaking, I knew she wasn’t a psychie case. I just needed someone to assure me that she was.
‘Want me to talk to her again?’
I shrugged. ‘Might be an idea.’
By the time we’d got back to the cubicle, Alison Scott was dead.
We found her slumped in one corner of the cubicle, all huddled up: her face pinched and wretched with fear. All attempts to resuscitate her proved unsuccessful. The post-mortem results pointed to death from heart failure; the precise cause remained uncertain.
I turned to Mark. ‘Remember how cold that cubicle was, when we went back in? And back to normal a few minutes later?’
‘So you said,’ he came back, a little guardedly; he’d never actually admitted to feeling it himself. ‘So what?’
Not having told him about the eeriest aspect of my road-crash experience, I just shrugged. ‘Just seemed strange, that’s all.’
But he’d begun to pick up on it now. ‘So what are you suggesting? That she saw a ghost? That she was scared to death? Come on …’
‘Look, I’m not suggesting anything. Okay?’ It came out sharper than I’d intended.
He held up his palms. ‘Sorry. But that girl was suffering from the early stages of septicaemia …’
‘It doesn’t kill you that dramatically.’
‘Okay, point taken. We don’t know why she died so suddenly. But you can’t let it obsess you like this. Same goes for those other cases. Maybe there are some things we can’t explain; but we just have to carry on. I know you’ve had a rough time recently, but …’
He tailed off awkwardly, but I knew his unspoken thought was that Jenny’s death was getting to me. And so it was – but I still reckoned I was rational. We see it all in this place: all the misery and mess. But I hadn’t seen fear like those three showed before.
Something was wrong, I knew it. Out there. In our town.
Something was wrong.
But dawn was creeping up on us now, fading in through the double entrance doors; and it seemed that the hospital, an island universe through all the long hours of the night, was joined to dry land once again. A last dark thought dripped down against the stone of my scepticism; and then the mental tap was closed. I screwed it tight. It stopped.
I checked my fob-watch and managed a smile. ‘Soon be time for bed.’
He seemed to accept that the previous subject was now closed. ‘Glad to be through your first night back?’
‘You bet I am.’ I pressed the exit key, and the VDU screen cleared as data – and dark memories – returned to the disks where they’d been stored.
The night ended as quietly as it had begun. With handover completed and the early shift of day staff settling in, I stopped off in the toilets to splash cold water on my face: clearing the muzziness that was settling over me – and snapping me out of my more disturbing night thoughts. The sun was fully up now; the outside world alive and awake once more. Back to the world of dreams, Sister Young.
I studied myself for a moment, there in the mirror. Fatigue didn’t do me any favours, but I reckoned I still looked the professional I sometimes didn’t feel. You might think of Sisters as older women, with years of experience behind them, but I’m twenty-six, and Ravensfield General is my first senior post. I’ve been a Trauma or Surgical nurse ever since I qualified, and I’ve seen a lot; but actually running the place is a different proposition entirely. Sometimes it scares the shit out of you.
While I was at it, I decided I wasn’t looking too bad altogether. Maybe a little waif-like, what with my pale complexion and wide blue eyes, offset by the dark straight hair that hung to my collar; but I’d heard my smile called winsome, and I knew that I was pretty. In my own quiet way.
On to the changing room, where I divested myself of my uniform dress, tights and sensible shoes, in favour of blouse, sweater, jeans and trainers; chatting with Fran as she shrugged out of her own work clothes. She seemed to have settled in well over the last couple of weeks; a pint-sized and perky young Scouser, blessed with the essential A&E prerequisites of cool head and keen sense of humour. I reckoned she’d make a good member of the team, which was a relief: your face has to fit, in a department as close-knit as this one.
Outside in the corridor, Mark called goodbye as he went through to a meeting with Kessler; and as I left, Steve – one of the night porters who’d covered us for the shift – made a point of mentioning how good it was to see me back. I was feeling tired but happy as I walked across to the bus stop. The thoughts that had gnawed at me through the night seemed distant and insubstantial now – fading back into my subconscious beneath the bright cold morning sun.
Behind me, the buildings of Ravensfield General Hospital loomed up dour against the sky: great blocks of sixties concrete grafted on to dark Victorian brick. Row after row of windows watched me: ward-floors stacked up one on top of the other. We had beds for nearly six hundred patients here – though the cutbacks meant that some were never used. That wouldn’t have been obvious to the rather awestruck casual observer, of course – unless they passed the hospital at night, and saw that while the windows overlooking the road were brightly aglow, or showed at least the muted glimmer of night lights, the upper floors of the old north wing remained in darkness. We had several wards and a couple of theatres closed up there: slowly gathering dust behind locked doors.
I knew myself that it made for a vaguely ominous sight: that slice of shadow and silence cut into the brightly-lit evening bustle of the hospital. And of course there were staff who’d claimed to have seen ghosts up there, and heard old, shuffling footsteps in the gloom. But it was daytime now, and I was going home to sleep in a flat with sunlight pressing against the drawn curtains, and the ordered life of a quiet, leafy suburb going on around me.
Whatever vague unease still lurked within me, it could wait until dark.
Four
The next two nights were nearly as quiet. Minor injuries: cuts and cracked bones. Bread and butter stuff for us. The high point (relatively speaking) was Adrian Bell asking me out again.
That was Friday – or Saturday’s small hours. He’d been chargehand porter for the shift, and come down to keep an intimidating eye on one of our more aggressive customers. After the latter had wandered sullenly off, back into the night, I’d returned to my office to catch up on some reading; and was halfway through the accompanying cheese and pickle sandwich when Adrian stuck his head round the door.
‘Caught you.’
‘In-flight refuelling,’ I pointed out, mouth impolitely full. He made a show of nodding, his eyes amused. ‘All okay now?’
‘Fine,’ I told him gratefully. ‘Thanks for coming down.’
‘No problem.’ He paused for a moment, looking thoughtful; not quite meeting my eye. Then: ‘Listen … what are you doing next week?’
‘Oh. Well …’ I smiled, and let my own gaze drift while my mind went into fast forward. ‘I’m not sure of my Off-duty yet …’
The nursing equivalent of I’m washing my hair, and he knew it. Accepted it too, with a rueful smile of his own, and left it lying. ‘Fair enough. By the way … how’s Danny getting on?’
Our departmental porter. I pulled a face which probably spoke volumes.
His smile became a grin. ‘Not that bad, is he?’
I hesitated, feeling suddenly almost guilty. ‘Well, no he’s not. He’s all right, actually. It’s just …’
And that was it: there was nothing I could put my finger on. No aspect of his work that I could fault. He was off tonight, but he’d have handled that drunken loudmouth competently enough. A tested member of the team, now: conscientious and quiet. I just didn’t like him. For no good reason, he gave me the creeps.
Mea culpa, I suppose. Nobody’s perfect.
‘He’ll settle in soon enough,’ Adrian predicted drily: his tone suggesting he knew what I meant. ‘You get any problems, let me know.’
I nodded.
‘You know …’ he added musingly. ‘If I was to have, like, a cardiac arrest right here … you’d be duty-bound to start resuscitating me, wouldn’t you? Mouth to mouth, and …’
I grinned. ‘Oh, I’d probably have to shove an airway down your throat first – make sure your breathing wasn’t obstructed. Then cannulate a nice large vein …’
‘Mm. On second thoughts …’
‘… and zap you with a couple of hundred joules on the defib …’
‘Yes. Good job I’m feeling fine, really, innit?’ He winked. ‘I’ll see you, Rachel.’
I gave him a cheerful little wave, and listened to his slow departing footsteps; then took another bite of sandwich, and returned my attention to Burns and Their Treatment (Illustrated).