Short fiction by Jo Holloway
In the staff changing room, the junior doctor yawns, oblivious to the chaos on the other side of the door. She looks at her watch, her mouth and jaw trembling as she tries to prevent another yawn. 2:30am. Only half an hour late finishing, not bad. She pulls out her hair band, releasing some of the tension that had been building up in her temples. She glances at herself in the mirror and zig zags her fingers through her dark blonde hair, trying to make it look less greasy. Lost cause. Whatever, I’m only going home, she thinks, giving up. She yawns properly this time, squeezing her eyes closed and realising just how dry they are. She presses the palms of her hands against them and they sting as they start to water.
She is pulling off her green scrub t-shirt, when her bleeper goes off, making her heart sink a little. She stops, like a half dressed mannequin, waiting for the inevitable follow up. The staff room door opens, letting in the familiar noises from the A&E department. A nurse pokes her head round. “Sorry, Doctor. RTA,” the nurse’s head disappears, letting the door slowly fall shut.
The doctor sighs. So close! she thinks. She reluctantly shoves her arm back through the scrubs, and hastily ties her hair back up into a messy bun on top of her head. Focus. You’ll need to for a car accident, she tells herself. She gulps down some water from the fountains and splashes some on her face, then opens the door and steps back out into the night shift.
The alarm will drag her from a drug-aided deep sleep. It will play an annoyingly optimistic tune, which will counter the aggressive vibration against the wooden floor, where it will lie next to an empty wine glass and a half empty bottle of Diazepam. Her hand will fumble to find it, to put it on snooze so that she may disappear back into unconsciousness for another nine minutes. Just a little longer. But it will be futile; the alarm will go off again, and this time she will have to force herself to sit up. You can’t be late, not for this, get up, she will tell herself. She will push herself to sit up on the mattress, feeling every spring as she does so. She will yawn, and then she will remember, and then she’ll push the memory away just as she has for the last two weeks. She still cannot think of it, even though she will be forced to relive it later. Instead, she will think again about how she needs to replace the bed that Danny took when he left. That it will have been almost four months since she’s slept in a proper bed with a decent mattress. She’ll pick up the wine glass to see if there’s any left, and then she will think, What am I doing? Not today. She’ll grab the glass of water instead, and down it in one go.
She will force herself to get up and stumble to the bathroom. She won’t have been up this early for two weeks. She’ll avoid her eye-contact in the mirror above the sink as she brushes her teeth, which is some challenge given how small the bathroom is, instead she will stare at the other toothbrush in the pot. Some blood will be mixed in with the white lather of the toothpaste when she spits it out, but she’ll barely notice, she will still be staring at Danny’s toothbrush. Go to the dentist, love, you don’t look after yourself properly, too busy looking after everyone else.
The grey cotton pyjamas will be dropped on the floor and she will step carefully into the shower. She’ll let the scolding hot water wash over her, enjoying the feeling of the water being too hot. Her long hair, which she won’t have washed for four days, will darken into a dirty blonde as it soaks up the water, forming long yellow rats’ tails. She will scrub herself a little too hard with the loofah, making her skin turn red, then the tears will come, too suddenly to stop, and a hard lump will form in her throat. She will fall to her knees and she will weep, and the water will continue to drench her.
The harsh white lights, reflecting on the newly painted white walls and shiny floor make her eyes throb for a moment, but then she breaks into a run, knowing she’s needed immediately. The Royal London A&E department is the size of three football pitches, so she needs to hurry. The familiar shouts and yells in various languages, some from patients, some from staff, can be heard now.
“What do we have?” she asks, reaching the entrance point. Doctors and nurses hurry over, the transition seamless as the stretcher is passed like a baton in a relay.
The paramedic shouts over the noise to her. “RTA involving two vehicles, one van, one car. Patient is Noah, a five year old male. Suspected fractured skull, unconscious, pulse rate 40 bpm.” The handover successfully made, he leaves them to it to go and help his colleagues.
The child is rushed into one of the resuscitation rooms. He’s unresponsive to the initial examination, but he is still breathing on his own. The nurses work with efficiency; one runs a sharp pair of scissors through his bloodied t-shirt, while another prepares the heart monitor, sticking the wires to his tiny frame. Another nurse prepares the doctor with a surgical mask and gloves.
“Noah? Noah, can you hear me?” She pulls up his eyelids and shines a light into his pupils.
She gives an excellent performance as a calm, confident and focused doctor, while subconsciously she worries about doing everything perfectly, constantly anxious about missing something or slipping up somehow. She is able to hold her hands steady as she feels for possible fractures and fits a cannula, even though her mind is working a million miles a second, mentally exploring any other possible injuries that the boy could have sustained. Should I double check for signs of concussion? Did I miss a fracture?
The oxygen means his heart rate is starting to normalise and it looks as though he wasn’t in as serious a condition as they first thought. There’s lots of bruising, and he’ll be in some pain, but he’ll live.
The senior sister enters as the doctor is writing a prescription for painkillers. “Sorry, Doctor. The elderly gentlemen in bed twenty-seven is asking for another examination, he thinks he’s broken his hip, even though I’ve shown him the x-ray. And the gentlemen in bed fourteen is sobering up and is in more pain. He’s beginning to get a little aggressive.”
The doctor considers the patients, mentally picturing their notes and their injuries, and tells the senior sister to prescribe a sedative for the elderly man and some painkillers for the drunk. She hands the boy’s prescription to the nurse.
The door opens again, another interruption. “Cardiac arrest in resus room two. The consultant’s not in yet – we need you right away.”
She will squeeze a small amount of tinted moisturiser and rub it into her pale skin, hoping it will give her some more colour. She will not really see herself in the mirror, just the components that form her face as she applies the makeup. The cheeks so pale that she will apply a little bronzer. The eyes so small and tired that she will dab some concealer around her lids and apply some mascara. Her lips so dry and cracked that she will put on some lip balm to help them heal. You’re beautiful without makeup, you know. I know you’re tired, but it’s only you that notices, Danny used to say.
She will find her purse, keys and phone, and shove them into the camel leather bag she bought in India while on holiday with Danny. She will pull on her old navy duffle coat and leave the house, double-checking that she has her keys even though the door will have already shut.
As she leaves she will still be trying hard not to think about the meeting she’s on her way to. Her stomach will flip whenever it forces its way to the forefront of her mind, and the familiar tears will shoot up, as if straight from her heart. Don’t cry, not in the middle of the street. She will take a deep breath and will put her headphones in her ears and listen to Florence and the Machine to try to occupy her mind. She will enter Manor House tube station with the other commuters, everyone in a rush to get to places where they don’t really want to go.
The doctor charges the defibrillator and places the pads on the man’s chest. “Clear.” His body convulses violently, as the electric shock travels to his heart. Everything freezes for a split second as everyone looks at the monitor, but instead it continues its piercing note, reflected in the straight line on the screen. She charges the machine again. “Clear.” The nurses step away, as the doctor prepares to send another electric shock through the man’s body. Once again the man’s body spasms, sending a rattle through the hospital bed. The nurses check for a heartbeat, but still nothing. One more time, then she will have to perform CPR. She’s so tired that she worries she won’t have the strength; the man is not small. The defibrillator charges again. “Clear.” The man arcs upwards and slams back onto the bed. Beep, beep, beep. She breathes a small sigh of relief. She monitors the heart rate, and continues pumping the oxygen bag through the facemask. A nurse provides constant updates on the man’s heart rate. She begins an examination to prepare him for an ECG.
“Where are the other patients?” she asks the nurse while she works.
“The mother is in bed seven. She has a suspected broken collarbone, but she’s conscious. She’s anxious about her husband and son, I’ll update her. The daughter is fine, a bit bruised from the seatbelt, but that’s all. The van driver sustained only minor injuries, he’s having stitches now.”
“Great, thanks. I’ll check in on the mother.”
“The consultant called, he’ll be here any minute.”
The doctor nods, already preparing herself to update him on every single one of her patients in A&E at that moment.
The man is stable, so she steals a moment to herself in the staff bathroom, splashing water on her face to wake herself up. She looks at herself in the mirror and frowns at how much the lack of sleep has aged her since starting the A&E job, she looks so much older than thirty. Where did those crow’s feet come from? She squeezes her eyes shut once more then she dries her face and goes to examine the mother.
The tube will be rammed at that time of the morning. The train will come into the station and won’t have even come to a complete stop before people on the platform will be pushing to get on, as if they’re made of metal and each set of doors is a magnet. For every one or two people who get off, ten will want to get on. She will let the tide of people push and pull her onto the train, where she will be caught awkwardly between two puffa jackets, who seem to speak Polish. She will try to get as upright as possible, but her muscles will tense awkwardly as the train starts to move.
Her heart rate will start to increase, refusing to beat quietly or regularly. She will try to ignore it, but it’ll get worse until it is pounding in her mouth and ears, making her headphones feel tight and making her wish the song that was playing wasn’t called Drumming. Her breath will start to shake as she attempts to calm herself down by sucking in a deep breath through her nose and letting it out slowly through her mouth. A cold sweat will form on the back of her neck and on her forehead and she will begin to feel like she is going to throw up or faint. She will clench and unclench her fingers, which will start to tingle. She will try to imagine Danny holding her hand to try to comfort herself and calm the beating in her chest, but it’ll be useless. He’s not here anymore. She will only be going one stop, but time will slow and it will feel like hours.
The train will start to brake and she will be thrown slightly into one of the puffa jackets. She will look up and mumble an apology to the puffa jacket’s collar. It will shrug, not revealing its face, and will carry on talking Polish to the other puffa jacket. The train will continue to brake as Finsbury Park station begins to whizz past the window. Thank God, she will think, and she’ll realise her heartbeat has calmed down along with the relief that she’ll be off the tube in a few seconds.
The doctor goes in to examine the mother. The daughter is with her, curled up in the crook of her mother’s elbow. She is sat up in bed, her eyes red and her hair dishevelled, some dried blood tangled in with the curls. She sits awkwardly, a neck brace keeping her spine straight.
She looks at the doctor as she enters. “Doctor, please… my husband, my son…?” she starts to cry again.
The doctor explains their conditions to the mother, who continues to cry, now in relief. She examines the mother’s collarbone, but is interrupted yet again, by news of yet another drunk man, who is being aggressive to staff and thrashing around too much to be sedated. Inside, she sighs to herself, wishing she could just deal with one person at a time. Outwardly, she smiles and apologises, and leaves to help sort out the new patient.
As she draws the white curtain behind her, she realises that she has a splitting headache.
Thankfully, the consultant has arrived by the time she gets to the drunk, and he’s restraining him along with the senior sister. She tries to update the consultant on her patients, their conditions, their prescriptions and x-rays, but the drunk is thrashing around so much that she gives up and helps restrain him. Eventually she inserts a cannula and they sedate him so that they can examine him properly.
“Will you be okay in here for the moment?” The consultant asks. He’s not even had a chance to get changed yet, having been called in from home.
She nods, and waits for the man to calm down. She glances at her watch; 3:15am. The drugs work quickly, and the man loses consciousness and lies back on the bed. She inserts an NG tube so that the alcohol can be pumped from his stomach.
She will look at her phone as she makes her way through the narrow tunnel to the Victoria line platform in a futile attempt to keep her mind from wandering. Her phone will connect to the wifi, so she will go on Facebook to see how Danny is. She will swallow the bitter taste in her mouth that she’ll get when she sees his new girlfriend cosied up in his arms. I can’t do this anymore! You’re never here, and even when you are you’re knackered. We used have fun, and now – well, now we just don’t. She will go back to her newsfeed and angrily scroll through it, not properly looking at anything, especially photos that involve her friends with their boyfriends, their husbands or their babies. Finally, she will abandon trying to find anything that will distract her and shove her phone back into her pocket.
It will feel like there’s a thousand other people on the platform, and they will all try to dodge through the crowd trying to find a clear spot, a fruitless search. They will sigh passive-aggressively at those they deem to be walking too slowly. She will be one of the slow-walkers. She won’t be aware of this. She will have the sudden overwhelming urge to turn around and go back home, straight back to the bed she’s spent the last two weeks in. She will try to keep her breathing steady as the panic threatens to engulf her again.
She will find a new song, her hand will shake as she’ll select Muse’s Supermassive Black Hole, which will help keep her mind on other things. There will be too many people on the platform, and in some places it’s four or five people deep. She will queue behind them to to get on the train, already feeling a little claustrophobic. She will want to go home again. Three trains will have to go past before she’ll be at the front of the platform. By this point, she will be right at the end of the platform, and she’ll stare down the tunnel, willing the next tube to come through faster.
The drunk is stable and they are able to start draining the alcohol from his system. She realises she has to go back to see the mother, who still hasn’t had her x-ray, so she leaves the resus room and makes her way down the corridor to the ward beds.
The walk seems longer than before, as if the A&E department has grown. The lights seem brighter, and the floor shinier. Her legs are beginning to ache and her eyes throbs in time with her heartbeat. A nurse runs past her, knocking into her. The impact makes her stumble and come to a halt. Something is not right. The alarm is sounding from resus room six.
Who’s in there? She thinks. The boy… Noah.
Her heart jumps into her throat, banging faster and faster. She gasps and then she knows. Her face feels cold all of a sudden, her hands sweat and shake, and there seems to be too much feeling in the tips of her fingers. She knows. Somehow she knows. It was the wrong dosage. She just stands there, unable to move, trying to picture the prescription that she wrote, begging whoever might be listening to her thoughts for it not to have been her mistake, even though she knows it was, and mostly, for the boy to be ok. Please let him live.
She thinks she might be sick, but she forces herself to put one foot in front of the other. The small movement brings her back to the noise and sounds of A&E. A nurse asks if she’s ok and she looks vaguely in her direction. Her breathing has become ragged in panic and she starts to run towards the boy’s room.
The consultant is still sweating and slightly red in the face from performing CPR, the nurses are still monitoring the boy’s vitals, but the expression is the same on all their faces. The heart monitor sings its tuneless note.
“Time of death,” the consultant says, looking at his watch. “Three forty-seven a.m.”
No, she thinks. It can’t be… She stands with her hand over her mouth. I can’t have… she barely moves, apart from a slow shake her head and the tremors in her hand, unable to believe what has happened. The consultant is saying something to her, trying to get her to leave the room, but she can’t make her body do anything, she just pictures the prescription, her own handwriting on the piece of paper, her signature signing off on a dosage of painkillers that was far too high for a child. She notices the sound of sobbing coming from the nurse to whom she had passed the prescription. He is stood, staring at the child, his fists clenched and tears streaming down his face, her disbelief reflected in his eyes.
Then she feels herself being turned around by a strong pair of hands that pull her out of the room. They take her away from the noise, the shouting, the rushing, the chaos, back to the staff room. The door closes behind them and the resulting silence pounds in her ears.
The consultant tries to be comforting, he tells her it’s not her fault, that she should go home and get some rest and take the next few days off. He asks if there’s anyone that can pick her up and take her home, but there’s no one. The gravity of what has happened overwhelms her then, so suddenly and violently that she can’t respond to the consultant. She holds her hand over her face and cries, her breath catching every time she tries to exhale, her body shakes with the sobs. Once again she sees the prescription in her mind’s eye and the tiny, delicate body lying lifeless on the bed. Those are the two images that will haunt her over the next two weeks.
She will feel her heartbeat start to speed up again, and the sweat will return to the back of her neck and the palms of her hands. She will swallow, but the lump at the back of her throat will cause the air to catch, her eyes will water. The wind will pick up, as the train further down the line speeds towards her pushing the air through the tunnel onto the platform. She will not be able to block it out anymore; she will think about the meeting and what the outcome of the investigation might be. She will wonder if she will be suspended, unable to practice medicine anymore. She will wonder if the nurse feels the same as she does and if he will be found at fault too. What has happened to him? She will wonder if the hospital chaplain will be there, he sent her a letter of support and guidance should she need someone. She will imagine that the findings of the investigation by the people that she’s never met before will be like some sort of judge and jury, that they will find her guilty and she’ll be thought of as a murderer, which is what she will already think about herself anyway. Her heartbeat will quicken at the thought, and her breathing will become even more laboured and irregular. I can’t do this. She will hear the tube coming. Tears will fall silently down her cheeks, she will not be able to keep them back. She will see the lights of the tube speeding towards her. I can’t do this.
She will not know that the people who had been brought in to investigate the incident have found her not at fault, that it is rarely the case that just one person is to blame. She will not know that Noah’s death was a combination of the drug overdose and fluid on his lungs, and that there was no way of her knowing about the latter as it hadn’t shown in the chest x-ray. She will not know that if there had been no fluid on his lungs, he probably would have survived the overdose. She will not know that his parents had not made sure that he was wearing his seatbelt because they didn’t want to wake him up, and that his dad had had a small heart attack while driving which had caused the accident in the first place. She will not know that the nurse had also been cleared of blame and would be allowed to return to work as soon as he felt ready.
She will never know that it wasn’t her fault.