Control Read online

  ‘I want to say, “Because we went to medical school.” But I keep my cool and say – because Dave has given me the whole story – “Mr Craig McDougall. History of hypertension. Abdominal pain through to his back. Pulsatile mass. Hypovolaemic shock.” Harry isn’t impressed. “Has he had any imaging? Plain films? CT? What do the bloods show?” I’m getting pissed off, now. “We’ve only just got a line in,” I tell him. “He’s not fit for a trip to Radiology. And the results won’t help.” I look at Dave. “Good to go?” Dave looks like he’s not entirely sure, but nods anyway. We’re about to get moving with the trolley when Harry stands in front. “Slow down, doctor. Just started? Right? Your first on-call?”’

  Kash leaned forward. ‘Was it?’

  Angela shrugged. ‘I was right. He was wrong. Then he says, “Let’s just pause for breath, for a moment, not get carried away.” Arsehole. So I think, fuck that, no good telling the bloke on the trolley to pause in the middle of his leaking bloody triple A while we have a nice civilized conversation about it. I kicked the brakes off and start pushing the trolley out of the bay and down the corridor. Harry can’t believe what a silly bitch I’m being. “But theatres aren’t ready!” he says. I keep pushing. Dave’s fully on board now, and helping me navigate the foot end around the corners. But Harry decides it’s time to put his foot down. “We need to stop. Now!” he shouts. He even puts a hand on my shoulder. I’ll be honest, at that point I began to wonder if he was right. Maybe I’d just got carried away.’

  She stopped for a moment, lost in the memory.

  ‘And?’ Kash asked.

  She turned to look at him. ‘Suddenly I heard this voice. Not loud, but it got my attention. Sort of low and fruity, like someone doing King Lear.’

  Kash’s eyes lit up. ‘Trenchard.’

  ‘ “If anyone is going to lay a hand on my SpR, Dr Adams, it will be me.” I looked round and he was smiling, as if he found the whole situation rather amusing. Then he nodded at the trolley. “Keep pushing! So?” Dave started to explain what was going on, but Trenchard held up a hand to shut him up. “Angela?” I remember it was hard to speak. I had this big lump in my throat. “Leaking triple A. I thought we should get to theatres.” He gave me a look. “Where no one is ready. And we don’t have the diagnosis confirmed.” I didn’t have an answer to that.

  ‘Then he puts a hand on McDougall’s arm, feels for a radial then a carotid pulse. Slips his hands onto his abdomen, just for a moment, then gives a little grunt. “We do now. Straight in, please.” So we push McDougall down the corridor and into the anaesthetic room of theatre two. Trenchard looks at Dave. “Get volume in, please. I see you have O-neg blood. Use it. Mr Adams? Morphine, please. And get ready to intubate.” Harry goes white. Literally. “Mr Trenchard? You can’t be . . .” I remember Trenchard’s suit jacket looked like some kind of fancy cashmere blend, but he just kicks it across the floor, together with his yellow silk tie – funny the things you remember – like it’s an old bin bag. He tears McDougall’s shirt buttons open, and pulls down the waistband of his trousers before emptying a bottle of pink chlorhexidine disinfectant over his abdomen. He sloshes more over his own hands and forearms. He rolls his sleeves up, snaps on a pair of sterile size-eight gloves with a little flourish, like he’s a magician about to pull a rabbit out of a hat, then picks up a number eleven scalpel, holds it poised for a moment with its tip over McDougall’s abdomen, just below the ribs in the midline, and turns to Harry, who’s sort of frozen to the spot. “Come on, catch up.”’

  Angela stopped for a moment, smiling at the memory.

  Kash put his hand on her arm. ‘And then?’

  ‘So he just starts operating! Arse to tit incision, grabs a mass of gamgee swab, and plunges his fist deep into the wound, his arm straight and his full body weight leaning through it. He smiles up at me and says, very matter-of-fact, “Like any bleeding, press on it hard enough and it will stop.” I sort of nod but I must have looked as if I was going to say something because he then says, “Oh! Infection?” I think he actually laughed. “You can always treat an infection with antibiotics. But not, of course, if the patient’s already dead.”’

  ‘Blimey,’ Kash said.

  ‘You can say that again,’ said Angela. ‘You might even go so far as “crikey” or possibly “good heavens”. So we finish up, and then Trenchard strolls casually back into the anaesthetic room, picks up his coat and drops it into a yellow clinical waste bag for incineration. “You can never get blood out of wool,” he says. “Trust me.” I couldn’t help glancing at the waste bag and he just shrugs and says, “It’s only money.”’

  ‘And Mr McDougall?’

  ‘Complete recovery. I still get a Christmas card. It’s Mr Trenchard he should be thanking, though. I still can’t quite believe what I saw him do.’

  ‘What? Throw away an expensive jacket?’

  Angela picked up the remains of the bread roll and threw it at him. ‘You know what I mean.’

  Kash nodded. ‘Yes, Angela, I think I do. Good thing this isn’t wool, by the way,’ he added, brushing himself down.

  4

  The next time he saw Mr Trenchard was on ward fourteen. Not Kash’s favourite part of the hospital, if he was honest. Fourteen was the long-stay ward. Not that all of its patients necessarily stayed long; it was just that once they’d arrived there, they didn’t go anywhere else. Not back home, anyway. At best, a home. But usually the choice was more teak or pine. Fourteen was sometimes referred to as ‘Professor Whitley’s Waiting Room’, Professor Whitely being a histopathologist, which meant he performed all the hospital post-mortems. Kash looked around at the old, exhausted faces. It was definitely quieter than the other wards. Breakfast had come and gone. Bedpans had been emptied, soiled bedsheets removed. Most of the patients seemed to have lapsed back into a semi-comatose state. The expression on the faces of those that had not was one of resignation. They knew that once they put you on ward fourteen, you were just waiting for the end.

  He was beginning to wonder why Mr Trenchard had asked to meet him here, when he spotted him by the nurses’ station, leaning casually on the desk. Trenchard crooked a finger, and Kash trotted over.

  ‘If you ever fancy a bit of peace and quiet, this is the place to come, eh, Kash?’

  Trenchard was wearing a lavender shirt with a bright red tie. He didn’t exactly look as if he was in search of peace and quiet.

  ‘Er . . . yes, Mr Trenchard.’

  Trenchard grinned, clearly enjoying Kash’s bemusement. ‘Right.’ He pointed across the ward to a white-haired old lady propped up on her pillows, taking delicate sips from a cup of tea gripped in a shaking claw. ‘That’s Liz. Liz Murray. Admitted eight months ago after suffering a stroke at an old folks’ ballroom dancing class. What we charmingly call “domiciliary support services” looked after her until Christmas, when her son’s family were asked to do their bit for three days – which was three days too much, apparently. They took the traditional approach to unwanted things you get landed with at Christmas: immediate re-gifting, parking just long enough to dump her in the emergency department, before legging it back to Penge. Nobody’s seen hide nor hair of them since. Of course, once she was in our clutches we gave her a battery of blood tests – which revealed her chronic lymphocytic leukaemia. Already pretty end-stage. Must have had it for years. When Dr Carney put it in layman’s terms and told her she was dying, she shrugged her shoulders and told him, “I’m ninety-one. Tell me something I don’t know.” Well, now she’s ninety-two. Let’s introduce you.’

  As they crossed the ward, Kash tried to work out what this was all about. Despite what Trenchard had just told him, there must be some medical mystery about Mrs Murray, some puzzle he was supposed to solve. He felt a bead of sweat forming on his forehead.

  ‘Liz? I’d like to introduce a young colleague of mine, Dr Kash Devan.’

  Liz put her teacup down carefully on the bedside table and gave Kash a mostly toothless grin. ‘Pleased to me
et you, Kash,’ she said in a surprisingly steady voice. ‘You haven’t seen my glasses, have you?’

  Trenchard chuckled. ‘Don’t worry, she asks everyone that. We’ll ask a nurse to have a rummage in a minute, Liz. Now, I’m going to ask Dr Devan here to examine you. Is that all right?’

  Liz shrugged her bony shoulders. ‘I’m ninety-two, and I’ve got blood cancer. That’s quite enough to be going on with, so if you find anything else, Kash, I’d be grateful if you could keep it to yourself. Unless it’s my glasses, of course,’ she added.

  Kash smiled. ‘Sounds good.’

  As Trenchard watched, he gave Mrs Murray a thorough examination, paying particular attention to her breathing and heart rate. But for the life of him he couldn’t find anything you wouldn’t expect in a ninety-two-year-old cancer patient. In fact, she seemed in remarkably good nick, all told. He blinked away a drop of sweat. What was he missing?

  ‘Well,’ she said, ‘have I passed my MOT?’

  Kash smiled warily. ‘A bit of wear and tear, but mechanically sound, as far as I can tell.’ He tensed, waiting for Trenchard to tell him the obvious symptom he’d failed to spot.

  ‘Jolly good,’ Trenchard said affably, steering Kash back towards the nurses’ station. ‘Thanks for your time, Liz, and I’ll be back to have more of a chat soon. I’m sure Dr Devan will be popping in from time to time from now on, too.’

  Kash smiled over his shoulder and Liz gave him a little wave, before turning to pick up her tea.

  ‘So,’ Trenchard said, once they were out of hearing.

  Kash was sure whatever he said would be wrong. ‘So, I missed something?’

  ‘As a matter of fact, you did. I was asked to review her because of a change in bowel habit and a microcytosis on top of the anaemia from the leukaemia.’ Small red blood cells – microcytosis was a common sign of iron deficiency – usually meaning chronic blood loss. ‘She’s got a low rectal carcinoma. But you’d not have found that without doing a rectal examination. And no, Kash. I didn’t tell her. She’s right. The leukaemia will get her long before the cancer. But that wasn’t the point, Kash.’

  He raised an eyebrow.

  ‘Since you don’t seem to have grasped the point, Kash, let me ask you a question. What do you think is the commonest cause of death in this hospital? And don’t try and be clever and say heart failure.’

  ‘Well, infection, I would imagine, must be—’

  Trenchard loomed over him. Kash thought he was about to get a slap.

  ‘Unhappiness!’ he boomed. ‘Why do you think Liz Murray, ninety-two-year-old stroke victim and cancer sufferer, is clinging on to life so tenaciously? Why do you think I am willing to bet a week’s wages – mine, not yours – that she will outlast every other patient on ward fourteen, and possibly several of the staff to boot? Because she enjoys being alive. Look at the sparkle in those eyes. She probably extracts more pleasure from a dollop of that slop we call tea than you would from a glass of vintage champagne. Do you see what I’m getting at?’

  Kash nodded tentatively. ‘I think so, Mr Trenchard. I suppose you’re saying it’s no good operating on patients and then just leaving them lying in bed being miserable. We need to make sure they have, um . . . stimulating interactions with, er . . .’

  Kash stopped. Trenchard was literally rolling his eyes. He put his hands on Kash’s shoulders.

  ‘I’m not talking about the patients, Kash. I’m talking about you. All work and no play. I’ve seen your type before. You might think what you need is sleep, but you’re wrong. What you need is some fun. Otherwise you’ll be the one having stimulating interactions with Mrs Murray – from the adjoining bed. Carpe diem,’ he added, with a meaningful look.

  Kash looked confused.

  ‘If your Latin’s a little rusty,’ Trenchard explained, ‘that means if a pretty young nurse invites you out for a drink, you bloody well say yes!’

  5

  The consultants’ offices were buried like a bunker deep in the outpatients block, and had a sense of sanctuary after hours. It was only here, of all the thousand corners of the Victory, that the ordinary chaos of hospital life leeched away with the light at the end of each day. Kash sat behind the desk in Mr Trenchard’s office, a tower of papers and patient folders teetering at his side. He was working on an audit of surgical waiting times across all major surgical specialities. Trenchard wanted three months of work audited from across each of three years, and Kash was determined to complete the task quicker than Trenchard expected. Perhaps he was putting more pressure on himself than was sensible, but at least the seclusion of Mr Trenchard’s office meant he could lose himself in the work, and the truth was that compared to the pressure of making instant life-or-death decisions on the wards, this was almost like a rest cure for his frazzled brain. It was a part of doctoring that took Kash back to that golden first year as a student, when his head was happily lost in his books and everything seemed possible. He’d had to put up with some ribbing from his fellow students for never going anywhere without a book in his hand and for having mastered the art of reading while walking, eating or watching TV (not that he did much of that), but he knew that really they were jealous, frustrated that their powers of concentration and mental stamina couldn’t match his. He’d never felt that he was missing out: what was the point of going out and having fun when you could use the time to learn? Wasn’t that what they were at medical school for? You’d have the whole of the rest of your life to watch movies and eat over-priced meals in noisy restaurants. But the truth was he preferred to get his teeth into a tasty medical textbook. And he felt genuinely sorry for students for whom it was a chore, or even a form of painful torture to be endured rather than enjoyed.

  Still, Mr Trenchard’s advice had made him stop and think. Did all work and no play make Jack a dull boy? He’d always been proud of being a bookworm. Didn’t knowing things make you more interesting? Now he wondered if, in fact, it was in danger of making him boring.

  A firm tapping at the door derailed his train of thought. Who would come here this late looking for Mr Trenchard? Outpatients was closed. When the door opened he was surprised to see Sister Vale. She was wrapped up in her grey woollen coat, fastened with its silver brooch, a look of matronly concern on her face.

  ‘I thought I’d find you here. Don’t you have a home to go to, Kash?’

  He might have asked her the same question. Kash checked his watch. ‘I’ve got a couple of hours left in me yet, Sister . . .’

  ‘You young men think stamina’s an endless reserve. Well, Dr Devan, I’m here to tell you it’s not.’ She came further into the room, and perched on the edge of Mr Trenchard’s desk. Kash was momentarily taken aback, knowing she would never have done that if it had been Mr Trenchard sitting behind it, and Sister Vale smiled at his embarrassment.

  ‘I know you admire Mr Trenchard, Kash. And so you should. I’ve never known a talent to compare to his. He’s not the only good surgeon in this hospital, of course. Not the only good doctor. There’s Dr Carney, for one. Quite brilliant in his field, a ground-breaking researcher, but he never quite had the . . . flair of Mr Trenchard.’ She smiled wryly. ‘And, of course, he’s acutely aware of it. That’s why he’s not top dog, and there’s nothing he can do about it.’

  Kash nodded. ‘How long have you worked for Mr Trenchard?’

  Sister Vale’s expression changed, and Kash wondered if he’d made a mistake, like he’d asked her how old she was.

  ‘I’m sorry, I didn’t mean . . .’

  Sister Vale laughed. ‘Oh, I’ve known Michael a long time. I used to work for him down here, in outpatients, long ago. I learned very quickly how he hates powdered surgical gloves, or when the lights go out on his sigmoidoscope. I know what he loves as well. A decent biscuit, a tape measure on a trolley. The little things, I suppose, but they can be important sometimes.’

  She stood up and gave Kash a look he was very familiar with; an expression of maternal concern
with a glint of steel underneath.

  ‘I know you want to impress Mr Trenchard, and by all accounts you’re doing a good job, but it’s no good if you spend all your time when you’re not on the wards doing his paperwork, when I’m sure you have plenty of your own.’

  Kash nodded towards the pile of papers on the desk. ‘But Mr Trenchard’s snowed under, Sister. If I can—’

  ‘Oh, snowed under.’ Sister vale gave a little snort. ‘We’re all snowed under. But do you know why he hasn’t got time to finish his own patient records? Because when he’s not here, he’s seeing private patients, Kash. I’m not saying he doesn’t work hard. But he’s being paid handsomely for it. And he relies on faithful junior doctors like you to tidy up after him. He flatters you. But it’s all about control in the end.’

  Kash frowned. He might be dull, but he wasn’t naive. Of course Trenchard did private work. They all did. But at least he was treating patients. It wasn’t as if he was playing golf while Kash was slaving away in his office.

  ‘Sister, you don’t need to worry that I’m being exploited. Maybe I’m doing all this to impress Mr Trenchard so I can get promoted, and then I’ll be able to do my own private work.’

  Sister Vale smiled wryly. ‘I don’t believe that for a moment, Kash. I could see you ending up in a refugee camp somewhere, maybe, working for nothing, but not in some plush Harley Street clinic. Still, suit yourself.’

  She turned away with a shrug, then stopped with her hand on the door, as if she’d just remembered something.

  ‘Oh, Kash, there was one more thing. The real reason I came down here. You see, about an hour ago, a young nurse left the Victory with a spring in her step. I’d let her leave early so that she could miss handover. Not something I’m in the habit of doing. But she said something about . . . a date with a handsome young doctor? She was beginning to think he’d never ask. Maybe he was just too shy. Or perhaps he was just . . . snowed under? And then suddenly, out of the blue, he asked her if she’d have dinner with him. She seemed rather excited. He must be quite something, I thought to myself, if Nurse Barker’s interested in him. I wonder who—’