Page 6 of The Night Shift
‘I’ve only been in hospital once before,’ he said. ‘Dose of typhoid in my twenties.’
‘And nothing else at all?’ She gave him a dubious look.
‘I try to avoid doctors and hospitals,’ he said meaningfully.
Violet raised her eyebrows. ‘And how’s that working out for you?’
He barked another laugh and she moved on to the social history, aiming to get a brief outline of his domestic situation– only anything that might be medically relevant.
‘I live alone and I manage absolutely fine,’ he said, shutting the line of questioning down.
‘Cigarettes, alcohol, drugs?’ she said, working her way down the page.
‘Are you offering?’ Mr Zeller almost cracked a smile.
‘No. I meant do you smoke, or drink alcohol, or use any recreational street drugs?’ Violet said seriously.
‘I realised,’ said Mr Zeller.
She then moved on to her examination, knowing from the previous notes what she was likely to find: the yellowing skin of jaundice, a knobbly liver edge protruding through a gaunt sunken abdominal wall, and a crackling noise indicating fluid at the base of his lungs. Again she made sure she was satisfied these clinical signs were indeed present, it would have been foolish to rely on someone else’s findings.
‘I’ll be off now,’ she said once she’d finished. ‘I’ll ask the staff nurse about turning the lighting down. You don’t want me doing it. I’d probably short-circuit the entire system and cause a blackout across the hospital.’
‘Dr Winters.’ Mr Zeller’s voice was thick with fatigue, but his eyes were alert. ‘Can I askyoua question now?’
‘Of course.’ Violet nodded, her hand stationary on the curtain she’d been about to pull back.
He took a breath in. ‘Do you think I’ve got cancer?’
Violet paused. She could easily fudge the answer. After all, there was no firm diagnosis despite the clinical evidence stacking up. On the other hand, she wasn’t generally a fudger– in fact, she prided herself on being exactly the opposite of a fudger, whatever that might be. Mr Zeller had asked her a direct question and deserved a truthful response.
‘I don’t know for certain,’ she said. ‘And I couldn’t give you a precise predictive value at this stage. But based on your clinical presentation it looks quite likely. And by likely, I mean around the eighty-five per cent probability mark. That’s if you find numerical references and percentages helpful. I know I do. But I also know that other people prefer narrative descriptors; chances of winning the lottery or being hit by a bus for example.’
Mr Zeller nodded. ‘And sounds like this one might be a double-decker,’ he said quietly. ‘If it is a cancer, do you think it’s a bad one?’
Again she paused; what did a bad cancer actually mean?Badwas such a subjective word and she much preferred objective terminology that couldn’t be misinterpreted. Probably best to break her answer down into factual information. She was always on safer territory if she stuck to that. ‘If it is a cancer, it may well have metastasised,’ she said. ‘Which means spread. Maybe to your lungs, maybe to your liver. Something like that would account for your symptoms: the weight loss, the breathlessness. Your skin is quite yellow, you might have noticed? And the whites of your eyes are the same, that sort of lemony colour. That’s jaundice. It can mean that something is blocking the liver, specifically the bile duct. And a blockage can be caused by something as simple as gallstones or something nasty like a tumour. But, like I say we don’t know for certain. Once you’ve had your scan things will be clearer. It’ll give us a picture of what’s actually going on inside.’
They looked at each other for a beat of time. Violet wasn’t sure if she’d said too much, or not enough. She never really knew what patients wanted to hear and it was so hard to judge their need for information from the way they phrased their questions. Her usual response was the plain unvarnished truth, but as Anjali had pointed out with her weird American-accented impression earlier, some people couldn’t handle the truth. The problem was that Violet never knew who these people were or how to talk to them. Thankfully her bleep went off before she could overthink it and it seemed on this occasion at least that she’d got the tone right.
‘Thank you for being honest,’ Mr Zeller said, rolling back onto his side away from the festive cartoon animals and away from Violet. ‘None of those other buggers would tell me anything.’
Gus
Gus was in the doctors’ mess waiting for the kettle to boil when that funny, skinny girl from the cardiac arrest walked in and peered around the room.
‘You looking for Anjali?’ he said, calling through the serving hatch, his face partially obscured by steam from the kettle.
The girl jumped, visibly startled, and then gathered herself. ‘Erm, yes, sorry, I didn’t see you there.’
‘She was in a moment ago, but she got bleeped by admissions. Said if I saw you to let you know she’d be back in twenty minutes.’
‘Oh. Right. Yeah. I guess I’ll wait a bit then.’ She stood awkwardly, adjusting her weight from one foot to the other before deciding suddenly to cross the room and sit on one of the sofas in the furthest corner near the Christmas tree. She stumbled slightly on her way over there, likely tripping on a corner of threadbare carpet tile. The flooring, like everything else in this place, was ancient and decrepit. Gus pretended not to have noticed.
‘Do you want anything?’ he called through the hatch which was strung with fairy lights. He felt like he was working in Santa’s grotto.
She peered at him, confused and he gestured to the kettle for clarity. ‘Tea? Coffee?’
The light dawned and she made a small ‘oh’ shape with her mouth. ‘No thanks, I’m fine.’
