“Good,” said rancid Ranjid. “And you, Dr Callan, did you work for long in Glasgow, or did you perhaps have a problem with it?” He put down his knife and fork although his meal was barely half-finished. “Forgive me, I have work to do.” He got up and took his tray over to the stacker.
Helen watched him with compressed lips; her eyes glittered and her face flushed as it had that time he’d seen her in his room. “Excuse me,” she said abruptly, getting up. She caught up with him, spoke to him angrily as she followed him out.
“Weird,” Fraser muttered to himself… but none of his business.
He got in the next morning to find that Frederick Allsop had died during the night. He’d been admitted the week before with a broken arm after a fall – he was 76 and had Parkinson’s Disease. He’d been made comfortable, but had got a chest infection and been put on ampicillin. What surprised Fraser was that the infection hadn’t responded to the antibiotic and had developed so quickly into pneumonia.
*
“Mind if I join you?”
He looked up to see Helen St John.
“No, of course not.”
He was lunching alone in the canteen. She put down her tray and sat opposite him. She said awkwardly, “I wanted to apologise for yesterday.”
“You don’t have anything to apologise for.” He carefully avoided putting any stress on the “you”.
“Mm.” After a pause, she said, “I take it Philip hasn’t said anything to you about Ranjid?”
He shook his head.
“Then I suppose I’d better.” She paused, picked up her fork and picked at the food on her plate.
She said, “Ranjid hasn’t had much luck in life recently. His wife left him and he was involved in a long, drawn out custody battle for the children. She won and took them back to India.”
“I’m sorry,” Fraser said without expression.
“It would help if you’d try and be patient with him.”
Fraser nodded as he put down his knife and fork. “I’ll do that. Thanks for telling me.”
She gave the slightest of shrugs. “Someone had to.”
After a moment he said, “Can I get you a tea or coffee?”
“That would be nice, but if you’ll wait till I’ve finished, we’ll go to the coffee lounge. More comfortable.”
“OK.”
He glanced covertly at her. She really was beautiful, he realised, not just attractive … it was the combination of her high cheekbones, widely spaced grey eyes and full, almost bee-stung lips. How old would she be? Mid thirties? A bit older than him, he thought, and at the pitch of her beauty – she looked up suddenly, smiling as she put her fork down, the smile instantly banishing the slight look of petulance to her mouth.
They took their trays to the stacker. “Where is he now?” he asked as they went out.
“Ranjid? At a meeting somewhere.” She led him to the lounge and found an armchair while he bought the coffee.
“Thanks,” she said as he handed it to her.
He sat beside her. “I couldn’t help noticing,” he said, fishing, “That he seemed a wee bit sensitive when I asked him how long he’d been here.”
“Mm. It’s not-so-ancient history, part of the baggage we carry around.”
“I’m listening.”
“You don’t remember hearing anything about St James’ hospital a couple of years ago? It was a national scandal.”
He shook his head.
“It was the old workhouse – appropriately. I say was, it’s still in existence – some imbecile’s trying to have it Grade II listed. Anyway, it was the worst type of Geriatric Hospital – ‘Out of Sight, Out of Conscience’ so far as the public were concerned. Then the aged parent of some TV celebrity died there – she’d gone in with a urinary tract infection and ended up more or less starving to death. The TV celeb, who probably hadn’t given dear old mum a thought in years, made a
cause
célèbre
out of it.”
“Exaggerated?”
“Not entirely, no …”
It really had been a terrible place, she told him, standards of hygiene non-existent, nursing not much better and food that had to be seen to be believed because the catering staff stole all the decent stuff …
“Not that it made much difference, nobody bothered to feed them properly, so they all suffered from malnutrition.”
Not knowing what to say, he grimaced.
“They probably didn’t suffer as much as you’d think,” she said, “Since they were all dosed to the gills with diamorphine.”
He said slowly, “I don’t know whether that makes it better or worse.”
“To tell you the truth, neither do I.” She sighed. “Anyway, our TV celeb managed to blow it into a major scandal. I’m surprised you didn’t hear about it.”
“I’d have still been in Scotland at the time.”
She looked at him curiously. “You Scots aren’t kidding about being separate, are you?”
He grinned at her as it occurred to him that he was in no great rush to get back. “What do you mean by major scandal?”
“Oh, it was all over the national press and TV. There were demands for heads to roll – our local MP, Patricia Matlock, was a junior minister in the DOH, an
ambitious
junior minister. She’d been banging on about health standards, so it really was embarrassing for her.”
“I’ve met her,” Fraser said.
“Really?” She looked genuinely surprised and he explained how he’d seen her in Edwina’s room.
“Well,” she continued. “She managed to retrieve the situation by forming a committee with some of the Trust managers to sort it out. Philip was headhunted and redesigned the new hospital. While it was being finished, he got a team together of people he knew or had worked with before – including me and Edwina – then the staff at St James were mostly sacked or moved away.”
“I see. Why wasn’t Ranjid sacked or moved away?”
“He’d been preoccupied with the custody battle. Also, he had tried to warn the Trust about the place, but no one had taken any notice. Anyway, some of the fallout did stick to him and he’s still rather bitter about it.”
Fraser said, “I’m surprised Philip wanted him on his team.”
“Philip’s a rather remarkable man.”
“I’m beginning to realise that.”
“You know he’s giving a talk here tomorrow night?”
“No, I didn’t.”
“You could do worse than go. It’s at the Postgrad Centre at seven.”
“Are you going?”
“I might.”
*
That night, Alice Steel died of pneumonia. She’d been 73 and suffering from breast cancer with perhaps only two or three months to live, but she hadn’t been ready to die and was determined to make a fight of it. Fraser had liked her for her gutsiness – it was he who’d put her on ampicillin for a chest infection.
He found Edwina and told her. “We seem to be having a lot of fatal pneumonia at the moment,” he said.
“Well, it is a common cause of death in old people.”
Fraser thought for a moment. “It would have to be either Haemophilius or pneumococcus, wouldn’t it?” he said, naming the two types of bacteria usually responsible.
“Probably,” she agreed.
“Well, if it was Haemophilius, it wouldn’t have developed into pneumonia so quickly, and if it was pneumococcus, it would have been sensitive to ampicillin … wouldn’t it?”
“Haemophilus can be virulent in older people,” she said, “and we do sometimes come across resistant pneumococci.”
“Is it worth trying to find out which?”
“Oh, I don’t think so, do you? It wouldn’t have altered anything.”
*
There were about forty people in the Postgrad Centre when Fraser got there, mostly housemen and nurses, he thought. He spotted Helen by herself towards the back and went to join her. She was wearing a pink top that heightened her complexion. Armitage was on the platform with a man in an immaculate dark suit and Fraser asked who he was.
“Patrick Fitzpatrick. He’s Director of Community Medicine.”
The chatter died away as Fitzpatrick got to his feet and introduced Armitage in a flamboyant Irish brogue. There was polite applause as he came forward.
“I wonder if it might have been better if you’d waited until I’d finished,” Armitage said, “To see whether you felt I was worth applauding.”
There was a ripple of laughter.
“When I was a houseman,” he began, “Geriatrics, as we called it then, was regarded as the fag end of medicine. By the time I retire, I hope that ‘Care of the Older Patient’ will be regarded as one of medicine’s most important as well as most rewarding areas.” His voice was light and intimate and he had a way of looking round that made everyone there feel as though he was addressing them personally.
People dreaded old age, he told them, which when you thought about it was ridiculous - it ought to be the most pleasant stage of life, the time when you could take stock and take the time to enjoy your family and friends.
“So why do people dread it so much?” he asked, looking round again.
Because for some, there was good reason to dread - sickness and incapacity of both mind and body, and as if they weren’t bad enough, a lack of proper care.
“I’m sure you’ve all heard of the death wards where old people were incarcerated until they died – the irony is that they weren’t only appallingly cruel, but uneconomic as well. By treating older patients humanely, you can actually save money. We’ve proved that here.
“How? By keeping them out of hospital for as long as possible and, when they do have to be admitted, making their stay as short as possible.“
He went on to describe the practical means by which they’d achieved this. He finished to solid applause and Fitzpatrick took questions. There were a lot, and by the time the meeting broke up, Fraser was surprised to find that over an hour had gone by.
“He’s a good speaker,” he said to Helen. “He made it interesting.”
“Why don’t you tell him that?”
“I will.” He stood up, paused. “D’you fancy a drink afterwards?”
She hesitated, then, “All right,” she said.
They made their way down. Armitage thanked Fraser for his comments, then introduced him to Fitzpatrick.
“A fellow Celt, if I’m not mistaken,” Fitzpatrick said, shaking him heartily by the hand. “Patrick Fitzpatrick. I’m the original Irish joke.”
“Fraser Callan,” said Fraser, not quite knowing how to take him. He was about five feet nine, an inch shorter than Fraser, with a round face, very blue eyes and dark hair beginning to go grey.
“So what brings you to the land of the Sassenachs, Fraser?”
“Er - gainful employment, I suppose.”
“Ah,” he said sonorously. “Another who has had to leave the land of his fathers in order to live.”
Helen and Armitage, who were standing together, exchanged resigned looks.
“Aye,” Fraser agreed, “I’ve sold my birthright to the mighty pound.”
Fitzpatrick laughed, then said, “Well, you couldn’t ask for a better colleague than Philip – or indeed the fair Helen here.”
“Shut up Patrick,” she said. “Or I’ll go.”
“Are you coming next week, my love?”
“I’ll try.”
“Oh, do,
please
, my heart of hearts. And why don’t you bring Fraser with you?” He turned to Fraser before she could answer. “I’ve become a father and I’m welcoming the fruit of my loins into the world with an orgy. Tomorrow week, my house. Do come.”
“I’ll – er – do my best,” said Fraser. He thanked Armitage again and they left.
“Is he real?” he asked Helen in a low voice.
“I’m afraid so.” After a pause, she said, “I can never make up my mind whether he really is a fool, or whether he’s fooling the rest of us.”
She led the way to a lift. As it rose, he said, “You don’t have to take me to his party, Helen.”
“I know. I haven’t decided whether I want to go or not to go, anyway.”
“Why don’t I take you?”
She smiled. “Because I might want to leave earlier than you.”
The lift stopped and the door opened.
“I’ll be going back to Bristol, so I’ll have to leave pretty early.”
“I’ll think about it.”
The Doctors’ Bar was crowded. He bought her a glass of wine and himself a beer.
“How old is Patrick?” he asked.
“About fifty, I think. Why?”
“Is this his first child?”
“Oh, I see … no, he’s got four daughters by his first wife. He only plucked up the courage to leave her when his girlfriend got pregnant. He’s Catholic,” she added, as though this explained everything.
And so it did, to an extent, he thought - also perhaps the slightly desperate edge to all the badinage, he put the thought to her.
“You could be right,” she said with a shrug.
He wondered if her sudden coolness was due to Fitzpatrick’s clumsy attempt at pushing them together, so he turned to neutral topics while they finished their drinks, then went with her to the entrance.
Strange how she blew hot and cold, he thought as he walked back to his flat. Why had she come to the talk? She must have heard Armitage speak on this before …
He wondered about their relationship – she clearly admired Philip Armitage and he’d felt their closeness earlier, even though they weren’t obviously in each other’s pockets … close, yes, but platonic.
Not that it concerned him. It wasn’t as if he fancied her or anything.