05:45
‘You must be Mrs Nyarko?’
‘Yes, I am. Please, just call me Suki.’ The tearful lady had moved to perch on the bed, next to her husband, whose face was noticeably asymmetrical. Saliva drooled from the corner of his mouth.
‘My name is Philippa, the doctor on-call tonight,’ she said, trying in vain to straighten her hair with her hands without seeming too unprofessional.
‘Is Shinji going to die?’ was her immediate question.
Philippa hesitated. She sighed and smiled sadly. ‘You’re both very alike; so upfront.’
‘He is going to die, isn’t he?’
‘How much have you been told?’
‘Nothing; the nurse outside phoned me to say Shinji had deteriorated and that I should come in to see him.’
Philippa nodded. ‘Can I –’
‘Of course, please do sit.’
Philippa took her place on the vacant chair. ‘How much did you know about his health problems, Suki?’
‘I know about his brain cancer and that it has spread to his lungs. The last I was told today was that he had a chest infection and that the cancer to his lungs was making him cough up blood,’ she replied. ‘Oh Shinji…’ she cried taking hold of the frail man’s hand.
Philippa straightened her lips. ‘Unfortunately, Shinji became unresponsive just under an hour ago. He had a seizure – or a fit – whichever you understand.’
‘No…’ she stammered, placing her free hand over her mouth.
Philippa’s bleep disturbed the peace in the room. She silenced it immediately and regretted not leaving the device outside.
‘We managed to terminate the seizure with medications and stabilise him enough to scan his head. I’m afraid… I’m afraid it’s not good news: the tumour has bled.’
‘Tumours can bleed?’
‘Tumours contain a lot of blood vessels. It’s in part why they can grow so quickly,’ she explained.
‘How bad is it?’
Philippa began to quibble. She glanced at the floor away from Suki’s gaze. It had been a long time since she struggled in this fashion, against the powerful emotional attachment to a patient, but she had to try and be strong in front of his wife. ‘The bleed is severe and is compressing his brain.’
‘What can you do?’
It was one of the toughest tasks, in any medical case, to define a lack of curative option – that now they would just have to wait for the final moment. It was the cruel reality of the situation.
Suki Nyarko accepted this news better than Philippa expected but sometimes the initial reaction was clouded by denial. ‘How long do you think he has?’ she asked.
The million-dollar question, thought Philippa. Every relative would ask it at some point during such discussions. ‘It’s impossible to say, Suki. I wish I had a crystal ball but I’ve seen people stay like this for days, whilst others deteriorate very rapidly.’
‘I won’t hold you to your answer, but from your experience…?’
Philippa’s bleep went off again and she had to clench her jaw to stop her rising inner temperature from getting the better of her.
It was A&E again…
‘Maybe less than twenty-four hours,’ she replied.
Her response was met by a numbing silence, one which Philippa did not think would ever end.
When it did, Suki said boldly, ‘He’s a fighter… he always has been. Thank you for telling me, Dr Philippa… I can see you’re very busy –’
‘No, no please. Don’t worry about anything else. I just want to make sure you’re okay. Ignore this thing, it’s not urgent.’
A tear crept out of Suki’s tear duct and Philippa found it difficult not to mimic the distraught wife.
‘Shinji tried to protect me at first, by not telling me about the cancer but he always gave in. He was the most honest husband anyone could wish for and he was the only person I ever trusted…’
‘I understand,’ Philippa replied solemnly. For she did understand; Shinji Nyarko had been the only person she completely trusted all night as well.
Suki excused herself to use the washroom, leaving Philippa balanced on the edge of her seat, hoping that her stare would miraculously bring the patient back.
Shinji remained unresponsive and his skin had lost all colour. His breathing stopped every few minutes and Philippa’s heart would crumble thinking this was it. Then his lungs started again; his body was teasing Philippa; I’ve died, no I haven’t… I’ve died, no I haven’t…
I’m sorry I could not do more for you, she thought.
A&E attempted to contact Philippa for a third time.
It was a final test of her enduring patience.
This better be urgent.
She stormed out of the cubicle and pulled the receiver towards her with such force that the phone was nearly ripped from its cord.
‘Hello is that the medical registrar?’ It was a voice she did not recognise.
‘Did you bleep me three times?’
‘Erm… yes I did –’
‘Do you really think I’m doing nothing important? Do you think I’m lying somewhere in the hospital having a nap? Actually, I was telling a patient’s wife that her husband is dying. Did you for once think that I might be busy with a patient and that’s why I didn’t answer your bloody bleep?’
‘Sorry I –’
‘Is this referral so goddamn urgent you need to bleep me three times about it? Learn to be patient; that’s what we’re supposed to be as doctors. It’s nearly six in the morning; things can wait a little for Christ’s sake! You don’t need to bleep me three times so don’t do it again,’ she berated. Even the most experienced and resilient medical registrars cracked at some point.
Sarah, the other nurse on the ward shifted uncomfortably in her seat next to her.
‘Sorry.’
Surprisingly, Philippa Haven felt instantly better. Hopefully, he would pass the message on to his colleagues… including Dr Balsack. She had lost count of the rounds between them. ‘Now tell me.’
The A&E doctor wanted to refer a ninety-seven-year-old man known to have moderate dementia. His neighbour had become concerned about a lack of visuals on him for a few days, so had dialled for an ambulance. The door was not opening so the police were called in to help.
The emergency crew found the man on the floor – awake but confused. Multiple investigations including blood and urine tests and even a CT scan of his head had all returned relatively unremarkable.
Unfortunately, Philippa did not have a magic wand to reverse dementia and the classic phrase of: ‘the patient’s not safe at home,’ was used as a bargaining chip but strictly speaking, no one was completely safe at home.
The man’s circumstances were exacerbated by the absence of a care package and his daughter who lived with him had uncaringly disappeared on holiday, which may have accounted for the man’s in-house accident. That meant he had to be admitted into a germ-filled institution to be given basic care by highly trained nursing staff. There was simply no emergency respite option for this sort of case.
‘Have we checked whether this is a new confusion or just his normal baseline, if he has dementia?’
‘We can’t get hold of the daughter, so we’re not sure. He’s also lost a lot of weight. My consultant has asked to admit him for an NG tube to feed him up.’
Philippa was wondering where Dr Balsack would play a part in all of this. An NG or nasogastric tube was a feeding tube inserted via the nose down the back of the throat and directly into the stomach. If somebody had an unsafe swallow following a stroke for example, the tubes were used to bypass the swallow mechanism in order to deliver feed that reached a patient’s calorific requirements.
For a patient with irreversible dementia, a condition that would only progress with time and who was unable to consent to having such an uncomfortable procedure however was a different issue altogether and one that was often inappropriate.
‘What’s your name?’
‘Louis.’
‘Louis, I can tell you now, he is not going to have an NG tube overnight as that would be frankly quite cruel, but seeing as his family have essentially dumped him onto the NHS then we’ll have to take him and hope he doesn’t catch anything more sinister whilst he’s in.’
With only Karan seeing the referrals from A&E, this was a potentially unnecessary addition to the never-ending Take list and another hour’s work to slot into the already rammed schedule. The healthcare system was being brutally forced to pick up the pieces from the frailties in social care.
Sarah jumped in her seat as the handset came crashing down. ‘Can I get you anything?’
‘No thanks.’ Philippa took a moment to catch her breath. Her head was throbbing and the circulating adrenaline that had been at a continuous high all night was poisoning her.
She closed the door to Bed D and sat on the bed next to Shinji Nyarko. It was warm from the imprint of where Suki had been sitting. The noise of the oxygen swishing in his mask was all too familiar. For a moment, her mind turned irritatingly towards that lumbar puncture Dr Steer had demanded – a job which remained most outstanding.
Overwhelmed by the stress and the dying patient before her, Philippa Haven closed her eyes and allowed the tears to run. Julia had once taught her to ‘sob it out’. This was a man who had been her final hope, who began the shift as her patient but ended it as her mentor and friend.
Now she was on her own.
Forget the lumbar puncture, she thought. There had been multiple cardiac arrests and a member of staff had died; it was a long shot, but maybe Dr Steer might show some compassion in the morning. That’s if she even made it to the ward round…
Her cheeks had not stung like this for quite some time and Philippa wanted to curl up into a ball like Mary Surrey and no longer exist.
Why? Why did this have to happen to you Shinji, of all the patients in this hospital? She crossed her legs. He looked gaunt and as grey as mountain rock.
The small airway tube that Justin had inserted into his mouth had been removed. There was a hoarse crackling from the back of his throat. A fresh vomit bowl stood empty on the bedside table. The blood bag had been detached from his cannula, which would never be used again. Comfort measures only now…
Effy entered the room and Philippa hid her tears swiftly. ‘Are you okay, Philippa?’
‘No, I’m not…’
The nurse was astonished by her candour. ‘Erm… is there anything I can do for you?’
‘Have you got two paracetamols? My head is pounding,’ she asked.
‘Of course.’
The nurse returned shortly with the analgesia and a plastic cup of water.
Philippa was most grateful and guzzled the rest of the fluids immediately. She felt a broken woman.
Effy tiptoed across to the bedside and checked Shinji over. She did not detect any signs of pain or distress but she did note the secretions in his airway.
‘I’ll prescribe some glyco for that,’ Philippa said.
‘I’ll get some now.’
‘Effy,’ began Philippa, before the nurse could leave the cubicle. ‘Tell me again; what happened exactly?’
‘Shinji pressed his buzzer so I came to find out what he wanted. He said…’ she paused to concentrate the continued, ‘He said he wanted to show or tell you something very important. He asked me to get hold of you as quickly as possible because he wasn’t feeling well; he said his vision was going funny and he wanted to vomit. But before I could do so, he suddenly became unresponsive and his whole body went stiff. Then he started to fit so I pulled the alarm and the rest – well, you know the rest….’ She shrugged sheepishly and retied her lengthy ponytail.
Philippa’s nod acted as a cue for her to depart.
He wanted to show or tell you something important… the nurse’s words echoed in her mind. He must have discovered something to do with the case.
Her eyes wavered over the laptop, which was on sleep mode. She poked at the mouse and the login screen appeared.
Password.
Was there any means of hacking into the device?
She picked up the Polaroid photograph of the brick wall and tiled path and slotted it within the heaps of paper buried in her pocket.
And then Philippa spotted the map she had printed for the detective earlier in the night folded neatly in half, next to the computer. It flapped gently at the mercy of the computer’s fan as if waving to her for attention. Each time the page rose, a pen mark was temporarily unveiled.
She reached over and unfolded the sheet of paper curiously.
A dominant bloodstain bared itself by the top right corner.
More importantly however, Philippa had uncovered what Shinji Nyarko must have been meaning to show her.
Every few days... 