The Choice, episode 1/6: Ward round

 

 

This series was going to be called ‘The Insult’, but one of my favourite authors (Rupert Thomson) has already taken that title. The Choice is about a female doctor who experiences a severe knock to her confidence from an insensitive, bullying consultant. It spans five decades, jumping a decade between each episode. An alternative ending owes something to The French Lieutenant’s Woman. This is fiction, and a stretch for the writer, because a) I am not a woman and b) I haven’t been seriously undermined like this, but it is based on observation and I hope there is some psychological verisimilitude.

 

*

 

Jessica Paley, 27, a surgical registrar in her second year of specialist training, turned up at 7.30 AM to prepare for the 8 AM ward round. She updated the list of patients, checked the results of recent investigations, and rehearsed the ‘headline’ with which she would summarise the condition of each to Mr Jeremy Stackson, consultant vascular surgeon. He had a reputation for high expectations and a short fuse; he was, Jessica suspected, essentially an old-fashioned male chauvinist, though he was probably very nice to his wife, if he had one. Jessica didn’t know. She didn’t much care. She had seen flashes of venom (including an impatient sulk while he watched her sew a femoral-popliteal bypass recently – too slow, it seemed) but she was confident that she knew how to navigate around the sharpest rocks.

The ward round went well, until they entered the penultimate bay. Jessica spotted the frail, pale old man before Mr Stackson did. She recognised the smell of ischaemia, of black extremities, of urgency. Stackson turned to Jessica,

“Who is that?”

“I… I don’t know.”

“Who admitted him?”

“I… he wasn’t on my… I wasn’t informed.”

The nurse in charge of the ward, Dennis, appeared, nervous himself having missed the larger part of the ward round.

“I do apologise Mr Stackson, this patient was transferred overnight from East Cleverton, apparently you had accepted the referral. He needs a fem-fem crossover, the notes he came with say.”

“And has he been clerked?” He was looking at his SHO.

Jessica felt the base of her gut contract and chill.

“No Mr Stackson. He hasn’t… I wasn’t…” But he wasn’t either; wasn’t interested. A tide of annoyance that had been rising through the morning, perhaps through the last two months, now broke in a wave of invective. His volume followed an upward gradient.

“Disorganised! The whole firm. He’s been in hospital how long, eight hours? and none of you have seen him, its UNACCEPTABLE…”

“I’m sorry.”

“I don’t want apologies. I want an efficient, safe, team Jessica. My entire list now has to be reorganised, to fit this man in tomorrow. You’re clearly not in control, after two months, you’re not in control. Transfers are your responsibility. This is surgery. You are way too passive for… for this.” He flung his arm out to indicate the ward, but he meant this specialty, this life, this future… Jessica knew exactly what he meant. As he moved towards the frail man’s bay, he muttered, as though trying to control himself but only partially succeeding, “For God’s sake, get a GRIP!

Stackson saw the patient and made some decisions. After he had left the ward, Dennis tried to comfort Jessica with words like ‘everyone sees that side of him once…’ and ‘It’s not you, it’s the department…’ but Jessica stopped him. “Why didn’t you tell me there was a transfer? Nobody told me. I been here since 8 o’clock, I could have clerked him.”

Dennis had no explanation.

That night Jessica made a decision. Surgery was not for her.

***

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