The moment: a tale of three doctors

threedoctors‘…in the raw cold of that leaden crisis in the four-and-twenty hours when the vital force of all the noblest and prettiest things that live is at its lowest…’

Charles Dickens, Our Mutual Friend

_____

‘This seraph-band, each waved his hand:

It was a heavenly, sight!

They stood as signals to the land,

Each one a lovely light’

Samuel Taylor Coleridge, The Rime of the Ancient Mariner

oOo

3.45AM A medical ward

Mark Smithson, two years qualified, held the telephone to his ear and spoke urgently, trying hard not to impart his sense of desperation.

“I am really worried about him. His blood pressure is much lower than earlier, I can’t give him more diuretic, but his breathing needs it.”

“From what you’ve told me there’s nothing more to be done at the moment. Isn’t he end stage?”

“I don’t think so, he only had his heart attack four months ago. There’s something about him I don’t understand. Can you come and see him?”

“Look, it’s pretty clear what the problem is. His heart failure is getting worse, perhaps he’s been run a bit dry as well. Give a few boluses of fluid, see how he responds.”

“When will you be free? There’s something about him…”

“Why don’t you let me know how it looks in a couple of hours, and if he is no better I’ll come and see him. It’s a really busy down here. I think you can manage the situation. Are you okay with that?”

“Yes.” But Mark meant No.

He began to put the phone down. He was deeply tired, working the third of five night shifts and not yet adjusted to the nocturnal rhythm. His tongue was thick with cheap, over-concentrated coffee. The battle, one of many, could not be won right now.

He heard a rasping breath by his ear, and looked up. An old man in a hospital gown, a patient whom Mark did not recognize, stood by his side. He placed a cold grey-veined hand on Mark’s wrist and held it.

“Excuse me! Err…sir, do you want go back to your bed?”

“Shhh! They’re sleeping.”

“What are you doing?”

“You can ask me later. This is your moment. I am your moment. I’m here to show you what happens.”

“What happens to what?”

“What happens to you if you put that phone down. Come with me.”

The old man took away his hand and beckoned. Mark stood and followed, completely in his power. Looking back he saw that the phone’s beige handset hovered in the air above the nurses’ station; he had forgotten to replace it. The two of them, one short and bowed, the other tall and young, left the ward (there were no nurses to observe them – where had they gone?) and entered a corridor. A blue light bathed the floor, and Mark looked up to see what had happened to the lighting.

“Look through this door Mark.” A door had appeared in what had previously been an exterior wall.

He peered through a small rectangular aperture, into what should have been the night air; instead he saw a gleaming new department. A patient was being wheeled through an ante room toward what looked like the doors of an operating theatre.

“What is this?”

“Look at the anaesthetist Mark. I give you the gift of lip reading for now.”

“What’s that thing moving over the patient?” A large white disc, the size of a dustbin lid, emitting the same blue light that Mark had already noted, hung from a gantry.

“That’s just a gamma bath. Patients are routinely sterilised in 2029, there’s global antibiotic resistance. You can’t do an operation if there are any microbes on the skin. The surgeon is under her own gamma shower, round the back. It doesn’t seem to cause any damage over a career, that’s what they are told. Can you hear what he’s saying, the anaesthetist?”

Mark focused on the man’s lips and found that he could understand everything. The anaesthetist was chatting to a younger colleague.

“Sounds complicated.”

“Who should I refer her to?”

“I’d suggest Dr Smithson.”

“I’ve heard he’s…”

“He can be a bit difficult sometimes. Once he get’s a bee in his bonnet he jumps up and down if he doesn’t get his own way. It doesn’t make him a lot of friends, but for someone in your patient’s situation I think he’s the one I’d choose. He doesn’t give up, he doesn’t mind causing a few ripples.”

“I heard he was a bit of a nightmare. You can’t run around demanding the whole hospital does what you want. There are other patients, other consultants. I heard he refuses to give up on anybody, even when the writing is on the wall.”

“Perhaps he over-treats sometimes, but the fact is he’s probably the one you’d want looking after your mother, father, whoever…”

Mark felt the cold hand on his shoulder, a finger brushing his neck.

“That’s enough.”

“They were talking about me. They used my surname.”

“So they were. Now come with me, I’ve got something else to show you.”

They walked to the end of the corridor until they came to another door. Mark looked through another small window, and saw that the door was connected to the back of an outpatient clinic room. He saw the back of his own, more aged head. A patient faced his older self, seemingly unaware of the younger doctor observing the consultation.

“So there’s nothing more you can do doctor?”

“I can’t see any other options. I’m sorry.”

“So that’s it. I’ve got to live with this. Or not live, if it gets worse.”

“I’ll write to your GP, explain it all.”

“But she can’t help me. I need you to write to them, get them to agree to fund the nano-stems.”

“It’s not my decision, it’s been agreed that patients with renal failure don’t qualify…heart, brain, liver failure yes, but not kidney, not yet.”

“But since the ban on anti-rejection drugs there’s no hope of a transplant, stems are my only option now. You’re sentencing me to death!”

“Not me. We don’t agree with it, but we can’t overturn that decision. I’m sorry. Things might change, I’ll keep an open appointment on the system…”

“Right. Right. I get it.” The patient left. And now Mark’s point of view followed the patient, he flew through the room and into the waiting area, leaving his older self behind. He saw the patient sit down heavily, heard him sigh sadly. Mark watched him as he typed a message to his partner – ‘No luck.’ A nurse came to ask the patient if he was alright, she seemed to know him.

“Final decision?” she asked.

“Seems like it.”

“I shouldn’t say this…but have you thought going to see someone else. There’s a consultant at St. Jude’s, he’s managed to get stems for a few patients off protocol. He just keeps writing letters until they agree…”

The patient left, thanking her politely, not really taking in the advice. Then the nurse walked up to a colleague, and whispered,

“It’s a shame. They can get them, if they fight for it. He doesn’t care, or can’t be bothered, if you ask me…he doesn’t exactly put himself out does he…”

The scene shrank away as Mark felt himself fly back through the small window into the corridor. His scrawny guide was already walking back to the ward, and Mark hurried to catch up with him. They re-entered the ward. The old man walked resolutely to his bed, leant over stiffly to reach the edge of a sheet, drew the linen back and folded his wasted legs into the uninviting space beneath. He lay back, his eyes closed, but spoke again,

“Those are your futures. Now go back to the phone, but before you hang up think hard. Your registrar is still listening.”

“I don’t understand.”

“You have a choice. What does your patient need, right now?”

“Someone who knows more medicine than me to work out what’s going on.”

“And what’s stopping you insisting on that senior review?”

“I asked didn’t I? And I got some advice. What more can I do?”

“What would you do if it was your father?”

“I’d insist.”

“But not for this patient? Why?”

“I…I don’t want to annoy my registrar, he’s busy.”

“So it’s you you’re worried about. Reputation. Ripples. Goodnight.” He rolled onto his side.

Mark’s hand encircled the static, hovering handset. Time restarted. A nurse walked past briskly, a buzzer sounded, a patient groaned in her sleep and asked for her long dead husband.

“No…wait!” Mark’s voice, stern, assertive.

“What?”

“I need you to come to see him. He is deteriorating quickly, I don’t know what’s wrong with him. Sorry, I’ve tried, but I need to you to see him now. It can’t wait.”

“I…I…told you, I’m stuck here…”

“Shall I call the consultant at home?”

“What?! Christ, you mean it don’t you. OK, OK, I’m coming.”

Mark could only imagine what he was saying under his breath.

When the registrar arrived Mark nodded, embarrassed, and led him straight to the patient. His bed was opposite that of the spectral guide. Mark glanced at it, and saw that it was now empty, in fact it was neatly made in readiness for a new patient. The registrar assessed the cardiac patient, scrutinised the ECG and began to smile.

“Very strange. Normal saturations, but this ECG is different. Right heart strain. He needs a scan urgently, he may have a pulmonary embolism. And if we’re right I’d be tempted to thrombolyse him. Nice one!”

“Well we don’t know yet.”

“It’s likely, he’s been in bed for two weeks with those huge swollen legs.”

“Thank you, for coming.”

“You knew it wasn’t right. That’s the lesson I’d take away from this – believe in your instincts…and persist! But you don’t need to learn that lesson, it seems.”

The registrar left Mark to make the arrangements for the scan. Mark returned to his ailing cardiac patient and looked over once again toward the empty bed. There was somebody in it. A bony hand beckoned him over.

“Good decision Dr Smithson.”

“Thank you.”

“You alright doc?” A nurse looked at him quizzically. “Too many night shifts, talking to yourself?”

“I’m fine. I’m fine.”

Mark thought he could discern a faint blue glow beneath the sheet, but the morning sun soon banished the impression.

oOo

With apologies to Dr Who (The Day of the Doctor) and Dickens’ A Christmas Carol

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