Maria sat hunched over her computer, blinking sleepily at the gaudy colours of the news website. She had been checking the political news section all evening and had lost count of the number of times she had pressed the Refresh button in the hope that the “vote pending” story would magically change to “breaking news”. Now that an update had finally appeared, she was almost too exhausted to react and glanced impassively over the contents of the page, with its hackneyed illustration of Parliament’s green couches in the left corner and a neat central chart showing the way the MPs had voted. Maria took it all in, then picked up her mobile phone to send a text message to a friend: “Passed with a huge majority, bill cannot fail now. The lie did not come into the world through me.” With that, she slipped her phone into her dressing gown pocket and got up with uncharacteristic weariness.
Maria’s home was made up of two tiny interconnecting rooms in a smart London house owned by an elderly lady who had not been able to bring herself to move out of the family home where she had raised her children. Like many other elderly landladies dotted about London, she rented out the upstairs rooms to “nice girls”, usually single twenty-something professionals like Maria, whilst she herself lived in the converted maisonette downstairs. Perhaps because she charged her girls the lowest rent possible, the house had not been decorated in many years and bore a feeling of faded grandeur as though the best times were long over and the whole edifice might crumble like the House of Usher when its owner died.
The bedroom resembled the cabin of a passenger ship, with its blue walls sloping inward, the floorboards bare and unvarnished and an ancient bed with brass bedsteads tucked cosily into a corner, swamped by a generous duvet. Through a narrow connecting door was a study lined with wallpaper that had been a rich green once but had faded to the colour of ochre. It contained the obvious articles—a desk covered in piles of A4 paper accompanied by a chair in desperate need of upholstering and a heavy old-fashioned bookcase crammed full of books and files. On the wall over the desk was a print of the Madonna and Child next to a black-and-white picture cut out of a literary magazine of Alexander Solzhenitsyn staring pensively into the distance. Immediately below his picture, Maria had written her favourite quotation in her very best florid handwriting: “Let the lie come into the world, but not through me. Not through me.” Solzhenitsyn was an odd choice of pinup for a twenty-two-year-old woman, perhaps, but Maria’s tastes had always been what her friends would have called countercultural. There were no personal photographs.
Maria whispered a brief prayer in the direction of the Madonna and Child, wished Solzhenitsyn an affectionate goodnight and moved towards the small basin wedged into the opposite corner of the room. As she filled the basin with water, she felt the dull vibration of her phone springing into action and the tinny chimes of Big Ben muffled by the folds of her dressing gown. There was a short reply: “Be of good cheer. You were called to be faithful, not successful.”
Maria switched her phone off and absorbed herself in the reassuringly mundane rituals of washing her face and brushing her teeth. Fidelity was all very well, of course, but for once, only for once, she would have loved to have found herself on the winning side. Just to know what it felt like.
“Darling, put the aliens back in their craters before they go in the box, could you?” called out a voice from the landing.
Dr Matthew Kemble was on his knees in his children’s nursery, tidying up with them before bed. At least he was tidying up. Dominic, aged three, had eagerly started putting the books away only to be distracted by the gripping storyline of The Tiger Who Came to Tea, and he was now sitting on his bed with the book open at the part where the tiger drinks all the water in the tap. Little Angelina, adorable in her enormous pink dressing gown, had sat down in the toybox and was smiling endearingly at her father in the happy female knowledge that he was entirely under her control. It was seven o’clock on a chilly February evening, and the Kemble family—its younger members, at least—were winding down at the end of a busy day. A smell of baby powder and strawberry bubble bath pervaded the room, and Matthew could not help feeling a certain despondency that he would soon have to leave the warm chaos of his home for a night shift at the Accident and Emergency unit of the Edith Cavell Hospital. In the meantime, however, he searched for the last couple of squat plastic red-and-green aliens and placed them carefully into the craters of their Manic Martians moon base.
Thomas and Cecilia appeared in the doorway, Cecilia in her Beauty and the Beast pyjamas, Thomas still in his school uniform, waving a glossy textbook with a picture of the night sky on the cover. “Dad, is Pluto a planet or not?” he asked. “Mrs Saunders says it isn’t any more, but the book says it is. I have to draw a picture of the solar system, and I don’t know whether to put it in or not.”
“When I was your age, it was a planet”, said Matthew “Do get out of that box, Angelina, darling—but I think scientists worked out it wasn’t after all. The orbit is all wrong, elliptical unlike the others, and it’s made of rock, when all the other outer planets are made of gas.” He braced himself, grasped Angelina by the waist and lifted her out, causing her to start wailing indignantly as he had known she would. “It could be an escaped moon from another planet in another solar system, which I find rather fascinating, but then. . .”
“Oh, Dad, do I draw it or not?” The textbook fell to the ground with a sad thud. “Did you know Dominic’s taking his duvet cover off?”
Matthew turned around to find Dominic sitting swathed in a cloudlike duvet, with the vast blue Thomas the Tank Engine cover slowly wrapping itself around his head. He looked like a cross between a cartoon Aladdin and Cupid. At that moment, Matthew’s wife, Eva, appeared before him like an avenging angel. “What on earth have you done to Dominic?” she demanded as though he had personally trussed the boy up like that. “And what’s wrong with Angelina?”
Angelina, in the absence of any attention, was rolling around in a corner of the room building up to a nice little tantrum. “Stop it!” said Thomas. “That’s bad.”
“I not bad!” shrieked Angelina in high-pitched indignation. “I not bad! I not bad!” Every time she made the declaration, her voice became a shade higher, until the words were almost lost in an ear-piercing shriek. “I NOT BAD! I NOT BAAAAAAAAAAD!”
“I think it might be bedtime”, said Matthew decisively, signaling for Thomas and Cecilia to take the toybox out of the room. He bundled Dominic’s duvet back into its cover whilst Eva calmed Angelina down and coaxed her into bed. Somebody turned the lights down, sending out the silent signal that it was the end of the day and time for everyone to settle down.
Guardian angel from heaven so bright
Watching beside me to lead me aright. . .
It was Matthew’s favourite moment of the day. He bent down and kissed Angelina’s soft, fragrant cheek, provoking a broad smile, and traced a cross on her forehead. “Nighty-night.” Then he stepped across the room to say goodnight to Dominic whilst Eva hustled the other children out of the way.
“Do you want a coffee before you go?” she asked, as Matthew emerged onto the landing.
“I’d better not. There was a weather warning about black ice on the roads. I don’t want to be late.”
They went downstairs together, and he heaved on his winter coat, then double-checked that he had everything he needed. “Drive carefully”, said Eva, reaching up on tiptoe to kiss him. “See you in the morning.”
Matthew stepped out into the darkness, and the bitter cold hit him full in the face, causing him to start shivering as he walked the short distance to his car. He was of a rather gloomy turn of mind at times, but could not quite understand why he felt more than usually down at the prospect of leaving the house for a night of heart attacks, black eyes and suicide attempts. He busied himself starting the car and drove away into the night.
“Do you remember anything of what happened?” asked Matthew. The casualty—a woman in early middle age—had been found unconscious on the concourse of a railway platform by a man who had just stepped off a train and had had the presence of mind to call an ambulance. The woman was now fully conscious, if a little confused to find herself amid the bright lights and noise of a busy hospital unit.
“I was running to catch the last train”, she said, in the blank, disengaged tone of a person who has had a serious shock. “I think I must have lost my footing and hit my head on the way down. It was a bit slippery, I suppose.”
“That would make sense.”
“Yes, I think I must have knocked myself out. I can’t really remember much until I was in the back of the ambulance.” She paused. “I can’t feel my fingers.”
Matthew nodded. “It looks as though that arm’s broken. Is it hurting?”
“It’s just starting to.”
“Well, we’ll send you down for an X-ray now that we’re happy your head’s in one piece.”
“I’m all right then?”
“15 out of 15 on the Glasgow Coma Scale, which means. . .”
“Oh, I know”, she interrupted with sudden eagerness. “I’ve heard about that on Casualty.”
Matthew smiled. He had a quiet loathing of medical dramas, which had slowly turned a generation of Brits into a nation of hypochondriacs. Once upon a time, a person had a headache; now they had a brain tumour because they had seen it on Casualty. “You’re very lucky someone got out at your station and found you at this time of night. You would have frozen to death if you’d lain there until the morning.”
The woman suddenly looked alarmed. “Can’t I go home? My husband will be frantic.”
“We can make a call for you if you like, but I’m afraid you’ll have to stay in tonight for observation. Just a precaution because you knocked yourself out.”
The woman was about to start protesting when a young man appeared at Dr Kemble’s side. He had the fresh, eager look of a newly qualified doctor who slightly fancies himself as the romantic lead of one of the aforementioned prime-time medical dramas. “Sorry to disturb you”, he put in breathlessly. “There’s a bit of a situation over here. I wonder if you could possibly. . .”
“Yes, yes, just a moment.” Matthew turned to one of the nurses. “Can you sort out this lady, please?” He nodded to the woman. “I’m afraid I’ve got to deal with an emergency. Nurse Deacon here will take care of you now.”
“What is it, Harry?” demanded Matthew as he was propeled in the direction of another cubicle.
“Suicide attempt”, said Harry. “Multiple drug overdose.”
“What’s so remarkable about that in a casualty unit?” Matthew asked impatiently. “You’ve dealt with them before; you know the procedure.”
“Of course I do, Dr Kemble. I wouldn’t have bothered you with it, but it’s just a little complicated. . .”
Matthew and Harry arrived at the cubicle and the all-too-familiar scene. A young woman, Matthew guessed in her mid to late twenties, lay unconscious in the bed, whilst another woman of around the same age sat at her side with that rather guilty air about her that so many accompanying friends and relatives had, as though she imagined herself to be personally responsible for the terrible predicament her companion was in. Matthew would barely have noted it if it had not jarred with her otherwise slick, professional demeanour. The companion did not belong by the side of a medical emergency somehow, so beautifully made up for an evidently quite different evening, not a carefully styled hair out of place. It only made the girl in the bed appear all the more pathetic: pale, disheveled and frail like a Victorian portrait of a consumptive waif. There was the offensive smell of alcohol and stale vomit all around her, with traces of it evident around the girl’s mouth and on the tips of her hair where her body had rebeled against being poisoned before she had finally passed out. A sorry sight indeed, but a common one.
“I called the ambulance as soon as I found her”, said the companion, standing up when she became aware of the doctors’ presence. “I wasn’t really sure what else to do. I kind of went into autopilot.”
“You did the right thing”, Matthew reassured her. “Have you any idea how long ago she poisoned herself?”
“No, I’ve no idea. She was already out of it when I found her. There was sick everywhere.”
“Right, well, we’d better get to work. Do you know what she took?”
Harry intervened. “She’s diabetic. According to her friend here, it looks as though she took an overdose of insulin, but there were other things. She found the remains of a bottle of vodka and empty packets of other pills—Tamazepam, paracetamol. It looks as though she just took anything she could lay her hands on.”
“Right. She’ll need a gastric washout.” Matthew turned to the companion again. “You—erm—you might want to step outside. It can be rather distressing to watch.”
“That’s the problem, Dr Kemble”, said Harry awkwardly. “This lady says she has a living will.”
“I’m sorry, Doctor”, the woman said. “I probably shouldn’t have even called an ambulance. I just kind of acted on impulse. I thought maybe you could make her comfortable or something.” She handed Matthew the advance directive, a crisp, formal legal document, neatly printed on good-quality paper. “She was always very adamant she would not want treatment in a situation like this; she’s never liked doctors and hospitals. Sorry.”
“No offence”, promised Matthew. “What people say and what they want, though. . .”
“The living will is quite specific, Doctor. She showed it to me when she made the thing.”
Why does she have to sound so relentlessly cold? thought Matthew, then felt immediately guilty for thinking something so harsh as she was almost certainly in shock. What people failed to consider in situations like these was quite how traumatic it was to stumble unsuspectingly over a friend in such a horrendous state, and the woman might well not have had time to take in the enormity of what had happened.
“Would you excuse us a moment, please?” Matthew took Harry’s arm and pushed him out of the cubicle. “If I didn’t know better, I’d think you were passing the buck.”
“Maybe we can get someone to look at this”, suggested Harry. “There might be some loophole.”
“There’s no time. We’ve no idea how long it is since she took the overdose. She could be dead by the time we’ve finished looking for a way to cover our backs.”
“These things are legally binding. We were warned about this. If you go against her living will, you could end up in really quite a lot of trouble.”
“Yes, and if I don’t, she will be dead by the morning. She’s hardly made it easy for us as it is.”
“If it’s what she wants.”
Matthew stood at the entrance of the cubicle, staring at the piece of paper that was causing all the trouble. The fact was that it was the first time he had ever been presented with such a thing, and he felt an unfamiliar sense of confusion overtaking him. The practice of medicine held very few surprises for a man his age, all those endless little disasters that brought men and women to this place, helpless and frightened. After a few years, it all became quite mundane and perfunctory, but this was different; this was repugnantly, terrifyingly different.
Matthew stepped forward and glanced through the gap between the curtains at the woman lying in the bed, happily unaware of his dilemma. He could hand the case back to Harry now, and no one would be any the wiser. They would keep the woman comfortable as her friend had requested, and in the morning, they would cover her in a sheet and take her to the mortuary. It was hardly as though he had never lost a patient before, and if she were really that determined, she might well be the type to make suicide attempt after suicide attempt until she was finally successful. . . .
A second later, Matthew was glaring in Harry’s direction, and he knew with the guilt of age and experience that he was going to raise his voice, not because he had anything particular against the man, not for that matter because he was actually angry, but because he would rather come across as the most monstrous tyrant in the patriarchal hegemony than admit he had considered abandoning a patient for a single second. “If she were my daughter, I would want someone to treat her. I wouldn’t care about this piece of paper.”
“She’s not your daughter. You need to be a bit more objective.” Matthew wondered afterwards—and he was to have plenty of time to wonder—whether he would have hesitated just a little while longer if he had not felt so irritated at being lectured by a kid he had lectured himself not so long ago. “I did not train as a doctor so that I could stand back and leave a vulnerable patient to die. I’m sorry you do not feel the same way.”
Harry looked away in evident embarrassment. “There is a small question of the patient’s rights.”
Matthew climbed down from his invisible podium. He knew he sounded like something out of a campaigning leaflet, but it was almost becoming a habit. “I don’t have time to have an argument with you, Harry. Call a nurse. I’ll need an orogastric tube. . .”
“Yeah. Like you said, I know the procedure.”
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