The Waiting Rooms Read online

  THE WAITING ROOMS

  EVE SMITH

  For Patricia

  It is not difficult to make microbes resistant to penicillin…

  The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant.

  —Sir Alexander Fleming, Nobel Lecture, 11th December 1945

  There are already widespread resistance mechanisms in nature to drugs we haven’t invented yet … When we dump a new antibiotic into the environment, we apply selective pressure and resistance grows. We need to be smart about this. Bacteria use antibiotics judiciously. Humans do not.

  —Brad Spellberg, MD, November 2019

  Dr Spellberg is Chief Medical Officer at Los Angeles County – University of Southern California Medical Center and Associate Dean for Clinical Affairs at USC’s Keck School of Medicine.

  CONTENTS

  TITLE PAGE

  DEDICATION

  EPIGRAPH

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  CHAPTER 34

  CHAPTER 35

  CHAPTER 36

  CHAPTER 37

  CHAPTER 38

  CHAPTER 39

  CHAPTER 40

  CHAPTER 41

  CHAPTER 42

  CHAPTER 43

  CHAPTER 44

  CHAPTER 45

  CHAPTER 46

  CHAPTER 47

  CHAPTER 48

  CHAPTER 49

  CHAPTER 50

  CHAPTER 51

  CHAPTER 52

  CHAPTER 53

  ACKNOWLEDGEMENTS

  THE INSPIRATION BEHIND

  ABOUT THE AUTHOR

  COPYRIGHT

  CHAPTER 1

  Twenty years post-Crisis

  KATE

  ‘Kate? We’ve got a problem. Bed fourteen. Daughter’s just pitched up with hubby and now she’s raising merry hell.’

  I glance up. Angie’s at the end of the bed, face screwed tight. ‘The usual?’ I ask.

  ‘You got it. Notification was sent this morning.’

  My eyes flick back to the monitor. Why do they always have to arrive at the end of a shift? For once I wanted to get off on time, get things ready for tomorrow.

  Angie starts drumming on the bedrail. It makes a soft padding sound through her gloves. ‘I’m sorry, Katie,’ she says. ‘It’s just … well, she’s pretty worked up.’

  It pulls at me, the same old quandary. I could ask one of the others, but these AD meetings aren’t easy. There was a time when they used to upset me; now they’re just part of the daily routine.

  ‘What time?’

  ‘Two o’clock.’

  I check my watch and sigh. ‘OK. I’ll just finish up here. Give me fifteen.’

  A smile breaks out behind her mask. I’m a sucker for saying yes and she knows it.

  ‘Thanks. I owe you.’

  I check my patient’s pulse as his chest teeters up and down. Grey whiskers straggle across cheeks that look like they’re folding in on themselves. Aspiration pneumonia. One bite of food went down the wrong way and he ended up here. If he lasts the night, I’ll ask Angie to give him a shave tomorrow.

  I gently mop his face, change the drip and reset the monitor. As I roll him onto his side he mewls like a kitten.

  ‘Sorry, Mr Harrison,’ I say. ‘I’ll be quick.’ I scan under his gown for bedsores. ‘There, all done.’ I pull the sheets back up and tuck them in. He stares at the floor, mouth clamped shut, but I can still hear that wheezy rattle. I’ve not had one word from him since he arrived. There’s nothing wrong with his cognitive functions. This is a protest. Dying is an undignified business. And he hasn’t signed a directive, so there’s precious little else he can do.

  I lean over and touch his hand. Ridged blue veins run across it like rivers. ‘Just rest,’ I whisper. ‘Rest is good.’

  His fingers curl away from mine but he shuts his eyes. I wait until his breathing slows a little, until I know the next dose is kicking in. I wonder what he dreams about. What memories he summons. They tried to trace a relative, but couldn’t find one. Looks like no one’s coming to his farewell.

  I rip off my coverall and gloves, and scrub my hands, soaping each finger in turn. The lift whines towards me. I key in the code to the sanitation floor, and the metal doors shudder shut. Thoughts of tomorrow creep into my head, bleeding the breath from my lungs. I focus on the numbers, count down each floor until the lift bounces and grinds to a stop.

  I turn left to the women’s section and place my feet on the circle. A red light slithers over my eyes. There’s a click as the lock releases. Strange. Never usually works first time. I grab my kit from the locker, dump my scrubs in the laundry and turn the shower on full blast. Jets of tepid water spill over my head. I remember when I used to turn that temperature dial up to scalding: now they’re all pre-set. Another lesson we learned the hard way. Not a good idea to let your pores open up, when you’ve done time on these wards.

  Soap fizzes on my skin: bursts of lemon overwhelmed by antiseptic. I press my hands against the tiles and rest my head on my arms. Let the water pummel my neck until it’s numb. You don’t just wash off the germs, you leave the rest behind too. So you can become that other person: wife, mother, friend. But today my work isn’t quite done.

  I step into the scanner and hold out my arms. A violet beam sweeps over my skin as water crawls down my back. The green circle flashes and the dryer clicks on: I am clean. I pull on my regulation green trousers and white shirt, turn my back to the mirror and scrape the brush through my hair. Reflections are best avoided. After a ten-hour shift, I barely recognise myself.

  On my way to the public building, I rehearse what I’m going to say. They’ll ask the impossible, they always do. The next shift is clocking on, and some of the nurses nod at me as they file past. I head into the lobby and press the button for the lift. Just as the doors are closing a middle-aged man prises himself in. His eyes meet mine for a second and drop to the floor. He takes off his glasses with tremulous hands and starts to polish them. He rubs the same lens over and over. As if it might make the difference he needs.

  I step out onto plush oatmeal carpet: sheer luxury after all those hours on cold tiles. The man follows me and turns right, down a different corridor. A hint of lavender softens the clinical white walls; wooden-framed prints hang at respectful intervals. Trees, lakes and waterfalls. Moss, rocks and flowers. It’s all been meticulously planned. This is, after all, the family floor. The place where we are judged.

  Room 15.

  My fingers hover over the handle. There’s no noise from within, only the faint hum of air filters. I push my hair back behind my ears and adjust my collar. I take one more breath. And go in.

  There’s just the two of them. He’s by the sofa and she’s by the window. The room smells of perfume and s
weat. She’s late forties I’d say, maybe a little older. All kitted out in designer skirt, jacket and heels, her hair scraped back in a tight bun.

  ‘Mr and Mrs Atkinson? I’m Kate Connelly, ward sister.’ I raise my palm, the now-customary greeting. ‘Pleased to meet you.’

  No one touches each other’s hands anymore. Not unless they’re intimate.

  She dabs at her swollen grey eyes with a white cotton handkerchief that is clenched in one fist. She doesn’t return the greeting.

  The husband steps forward, sneaking his phone back into his pocket. His thick brown hair is just about keeping the grey at bay around the edges. ‘Roy. Roy Atkinson.’ He nods his head as if he’s at some kind of business meeting.

  ‘Sorry to keep you waiting,’ I say. ‘I’m sure you understand, we have to put the patients first.’

  She gives a strangled snort. He shoots her a look. It’s the sort of look I get from Mark sometimes.

  ‘Before we get started, would you like another drink?’ I say. ‘I could organise more coffee? Or something cold perhaps—’

  She reels round. ‘I’m here for an assisted dying, not bloody afternoon tea!’

  I don’t respond. It’s best to leave the anger there, hanging. Let them enjoy it or regret it before you move on.

  ‘Sorry,’ he whispers, his eyes scurrying past my face. ‘She’s just, you know … very upset.’

  ‘Of course, I understand.’ I indicate the sofa. ‘Shall we sit?’ I’m praying he says yes.

  He hesitates and takes a seat. She remains standing. A painted thumbnail digs into the web of skin between her left thumb and forefinger. It’s already raw. Soon it will start to bleed.

  ‘I’m here to answer your questions.’ I address her first and then him. ‘To support you in any way I can, while respecting your father’s wishes. I understand you received the notification this morning?’

  He looks at her but she is silent. He runs his tongue over his lips. ‘Yes. That’s right.’

  He has nice eyes, I think, a deep turquoise, like the Alboran Sea. Our last holiday before they shut the borders.

  He stares at his feet and frowns, as if he’s just trodden in something. ‘My wife and I, we don’t want … I mean, we don’t believe it’s necessary. To make that level of decision. At this stage.’

  She is watching me. Waiting for me to speak. I don’t.

  ‘What I’m trying to say is … well, we feel this is all very sudden. There must be options.’ He sighs, his pockets of words already dwindling. ‘I mean, he must still be in shock; he can’t be thinking straight.’

  I make my move. ‘Mr and Mrs Atkinson,’ I keep my voice soft and slow, ‘I understand how difficult this is. But your father has thought this through. It’s not an impulsive reaction to his latest results. He’s in pain. A lot of pain. He’s been preparing for this for a long time.’

  She erupts. ‘It’s his prostate, for Christ’s sake! He’s only seventy-three. Surely there’s something you can do?’

  She has broken the skin. A dark line of blood gathers in the crease.

  I turn to her. ‘Your father’s cancer is advanced. His tumour is what we call T4. That means it has spread beyond the prostate and is affecting his other organs. His Gleason score is nine, which means it is a high-grade, fast-growing cancer.’ Her eyes are fixed on me, jaw clenched tight, as if she’s battling to hold her tongue. ‘He’s no longer responding to hormone therapy. The longer we leave it, the further it will spread.’

  ‘I don’t understand,’ says the husband. ‘What about radiotherapy? Or at least a blast of chemo? I thought they were still eligible for some procedures.’

  ‘Even a mild course of chemotherapy would have serious consequences.’

  He looks at me like a confused child, mouth agape. People just don’t get it, no matter how many times they’re told. It’s as if they think we’re making it up.

  ‘All cancer treatments increase the risk of infection,’ I say, trying to be kind. ‘Chemotherapy depresses the immune system. Radiotherapy kills healthy cells as well as bad ones. Surgery opens up patients to all kinds of bacteria. Your father would end up going through considerable pain and discomfort, including some highly unpleasant side-effects for no benefit. Without effective antibiotics, these treatments simply won’t work.’

  Tears spill onto her cheeks and carve their way down to her chin. I think of Pen and my chest constricts. This is too soon, much too soon; I shouldn’t have agreed to come.

  ‘I understand how hard this is,’ I say. ‘But your father doesn’t want things to be drawn out.’ I swallow. ‘You have to let him make his choice.’

  She buries her face in her hands. The husband tentatively wraps his arms around her, as if she might break. I feel sorry for her, of course I do, but these people mistake their passionate pleas for love. It isn’t. It’s their own grief, getting in the way.

  ‘You were aware of his intentions?’ I say to them. ‘You were both witnesses to his directive?’

  ‘Yes, yes, we were.’ He gives me a desperate look. ‘But that was a long time ago. And, well, we never thought that … We never imagined that he’d actually ever have to…’ His voice trails off. It’s like a swear word, dying. Some people just can’t say it.

  She steps away from her husband. A wisp of hair has escaped from her bun. She claws it back behind her ear. ‘Convenient, isn’t it?’ At first I think it’s her husband she’s speaking to. ‘Patients shipping themselves off. Unblocking those beds.’ Her words sound swollen. ‘You have targets, I suppose?’

  ‘Helen. Please.’ He draws in a long, staggered breath. I glance at the clock and brace myself for the next stage of this meeting.

  Mrs Atkinson casts her eyes around the room. She gazes at me with an intensity that’s all too familiar. ‘We’re wealthy, you know,’ she whispers. ‘We have money—’

  He shakes his head. ‘Helen, don’t!’

  She thrusts her hand in her bag and starts tearing through it. ‘We can pay!’ She brandishes a burgundy leather purse with gold buckles. ‘We can give you whatever it takes!’

  ‘Stop it!’ Her husband snatches it from her. ‘You’re just making things worse.’

  ‘Mrs Atkinson,’ I say, stepping back. ‘I’m sorry. That’s not only illegal, it’s not even possible—’

  ‘I know it happens! You look after your own, don’t you?’ Her voice slices through the room. ‘I’ve read the stories. I’ll bet you’d do it if it was your own father—’

  ‘I don’t know what you’ve read, but the truth is that the drugs simply aren’t available.’ I slow things right down, as we’ve been taught. ‘We don’t have access to them in this sort of hospital. None of them do.’

  ‘You’re lying!’ she shouts. ‘Why won’t you help us? What is it? Don’t we fit your criteria? Aren’t we the right kind of people?’

  I’m about to respond, but she cuts in.

  ‘Is it you? Do you do it?’ Her breathing is quick and shallow; she has composed herself now, channelled her anger.

  ‘I’m sorry?’

  ‘Do you kill them? Or does someone else?’

  I hold her gaze. My pulse sounds amplified, like Sasha’s heartbeat, all those years ago when I had my prenatal scans.

  My eyes flick up to the security camera and back again. ‘If you’re asking me whether I assist patients to end their lives, then the answer is yes.’

  She recoils with a suck of air as if I’ve just bitten her. They’re prepared to put their pets to sleep but not their parents. I wish I could show them the horrors of the alternative, but we’re not allowed to interfere.

  ‘How many? How many have you done?’

  I pause, weighing honesty against diplomacy. Almost twenty years since the act was passed. It must be thousands.

  ‘I’m not sure,’ I say, eventually. ‘I don’t keep count.’

  Her eyes widen as her husband darts between us. She shoves him aside. ‘They should lock you up! Murder, that’s what it is. You can dres
s it up with your fancy names but it doesn’t change what you’re doing.’

  ‘Helen, that’s enough!’ He grabs her by the arm. I can hear the feet already, running down the corridor. ‘She didn’t mean that,’ he says, flushes of pink breaking out across his face. ‘I’m so sorry, it’s the grief talking.’

  I swallow. ‘Mrs Atkinson. I know this is difficult. But if you wish to be present, you’ll have to compose yourself.’

  She breaks away from him and thrusts her finger in my face. ‘You know where you’re going? You’re going to hell!’

  What do you call this? I think. I look at her red, screwed-up face, the mascara running down her cheeks. I used to rant like her. I used to beat my fists. But it doesn’t do anyone any good. It doesn’t change anything.

  The door bursts open and two security officers march in. They move him aside and seize her. She squirms like a feral cat. One of them yanks out the restraints.

  ‘It’s OK,’ I say, raising both hands. ‘That won’t be necessary. Mrs Atkinson just needs a moment.’

  The officer’s tongue pushes round his mouth as if he’s about to spit. He doesn’t loosen his grip. There’s a reason we have the cameras and security up here.

  I check the clock and sweat prickles up my neck. ‘Please. Just give her five minutes. Then you can escort them both to the Peace Chamber.’

  His eyes fix on mine. ‘OK. But that’s your call. Not mine.’

  I hurry along the carpet to the large double doors at the end. I key in the code and the doors sigh open. The Peace Chamber is a beautiful room, a bit like a lounge in a show home: pleasing to the eye but not entirely welcoming. Because it’s never lived in. Plump cushions recline on low sofas with bleached-beech arms; parcels of light stream through white wooden slats onto the walls. A slender-leafed plant arcs towards the window. The only imposter is a stubby brown bottle waiting patiently on the side.

  I press the remote and violins glide into the room. ‘The Lark Ascending’: one of my favourites. You get to know them all, in time.

  I check the volume on the camera and adjust the blinds. Just in time. The lock clicks and an elderly man in a pale-grey suit is wheeled in by two porters. His jacket hangs off him; a starched white collar gapes at his throat. I picture him as he would have been: at a business meeting or perhaps the cricket, his MCC Member’s tie curled snugly around his neck. The porters lift him carefully onto the sofa. One could do it: he must weigh barely more than a child.