Twelve Steps: Mystery Short Fiction By Philip Berry
Philip Berry, a London based doctor and author of Twelve Steps, has previously published short fiction in Liars’ League, Literary Orphans, Ellipsis Zine, Coffin Bell and Metaphorosis among others.
With arms aloft I strutted into the resuscitation bay and shouted, “No! Stop, for God’s sake. It’s hopeless.” It was true, but it looked bad. And it looked more arrogant by far in the lens of a pin-cam. There had been no warning, no polite call to the media liaison officer to advise that at 8PM on Tuesday night a brutal exposé would be broadcast on Channel 4. The heartlessness of modern medicine, its lack of respect for life, the death of sanctity – unfiltered!
There I stood, towering above the level of the false button, the underside of my chin in shadow, the features of my face bleached beneath the fluorescent tubes. Every acquaintance would recognise me, and that distinctive voice – pressurised, trying hard to cut through the hubbub of a busy department. He walks in and without so much as glance at the patient – an old lady, cold and white and desperately thin on the bed – he writes her off. The tape completes with a grin.
Whoever carried the pin-cam must have followed me up the corridor. I’m conversing with another doctor. I’ve moved on to the next problem, something must be funny, something funny enough to distract him from a death. He does not care. He is a monster.
I sat forward, pushed my temples, and cried. It wasn’t right. Then the phone rang.
They asked me to remember the scene. Who was standing where? Slowly I pieced the scene back together. It could have been one of four nurses. The programme had not revealed the name or the face of the nurse with the wire, and the hospital’s legal team ran into a wall at the documentary company. They refused to divulge, and what’s more they informed us that she was still working.
The courts would take a week or more to consider the legality of the situation, and in that time any further instances of misbehaviour could be recorded for future broadcasts. I was put on gardening leave. So I decided to track her down.
One of four. With DVD, pen and paper, I reconstructed the scene and connected dots with dashed lines. The pin-cam was to my right and a little in front. That excluded two nurses. Not necessarily a ‘her’ then. Remaining – a charge nurse (male) and a blank face, a female mannequin. I could not put details on the pale oval. Discretely (I was not supposed to be there) I toured the emergency department in the hope of spotting her; I might recognise the height, the shape, the figure.
The cloud of notoriety that surrounded me obscured my true purpose. Most of those I asked just looked at me and wondered – What’s it like, exposure? But they knew me for a good man, a good doctor, and I sensed sympathy in their questioning expressions. I found Eduardon, a Phillipino charge nurse. He had already been pressed to identify the spy by his manager and shook his head as I approached him.
There was no need to ask him the big question (was it you?), but he gave me answers. Yes, her name was Susan, and she was ‘bank’ – that is, for hire. She did not belong to the hospital, and she had not come back to the department since the night of the exposé. I stood outside, rang the agency, pretended that she’d had an accident at work – and discovered her home address.
I watched her leave her flat with her kid. He was disabled, about seven, stiff legged and slow. I observed their patient progress to the end of the road where they waited. I was close enough, just around the corner, to hear them talk. Inconsequential stuff. His words were distorted, he had trouble controlling his mouth muscles.
Then a green bus stopped by the kerb and the boy was helped into a chair and belted in. Susan waved, lingered for a moment, and walked away. She was in uniform. I could hear the swish of her light raincoat as she passed within two feet on me. Now was not the time to initiate contact, but that was the strategy – to meet, to talk, to reveal the context, to persuade her that I was not evil and mitigate the harm. I trusted myself to do this. I had the skills.
The old lady who died, who I ‘allowed to die’… I knew her. I had looked after her before on my ward. She was 94 years old, and still sharp. But her body had betrayed her. We had made her better over six weeks, and on the eve of her departure, to a nursing home, we had spoken. She did not want to come back to hospital. Not ever. So, we struck a deal; she agreed to go to the nursing home if I promised to ensure that she was not brought back.
On the day of her transfer I called her GP and the manager of the home and explained everything. On no account was she to be sent back in. She wished to die in her own bed (or the bed now reserved for her in the home). If she deteriorated, if the pneumonia recurred, she wanted comfort. That is why, when I heard that she had been rushed into the department, I stormed in with arms held high shouting ‘Stop!’.
Susan caught a bus but I did not join her. If she saw my face, she would surely recognise me, and if she recognised me, she would assume that I was out to damage her. A part of me wanted to damage her. Instead I walked back to the corner of her road and worked out what school her son attended. It took ten minutes to narrow it down to four on my smart-phone, and a call to the bus company to pin it down to one.
I pretended that my fictional son had left a bag on board, and in order to confirm which bus I was talking about the person on the phone mentioned various destinations. I wasted the day then arrived at the school at 3.30PM; closing time. It was, predictably, impenetrable. Each gate was secured with keypads and buzzers. I waited. Susan arrived, flustered, and entered the playground. A teacher recognised her, drew Leo’s attention to his mother through the window and escorted him out. Susan kissed the top of his head and hugged him.
The woman I watched was not the schemer who offered herself to an undercover documentary maker. It didn’t fit. I was missing something.
I rang the agency again and pretended to be from a hospital’s Human Resources department, looking for references. They listed the hospitals where she had done shifts during the last three months. I had worked in one of them, City, and knew the emergency department, so I drove in and asked around. One of the senior nurses knew Susan quite well.
“Good, competent. Hard to know though. Her life revolves entirely around her boy. Never comes out, has to leave bang on time.”
He thought for a moment and added,
“Yeah, he was admitted not long ago, City Infirmary, had a seizure I think. Epilepsy ever since he was a baby. That’s why she always works bank, she has to take so much time off at short notice…”
The boy. His damage was her damage.
I had done much of my training at City but I was no longer an employee. One ID card looks much like another, and a confident demeanour trumps the misgivings of the subordinate. I walked into the medical records department, put both hands on the desk and requested that the girl retrieve the notes of Leo Baker. She asked who they were being signed out to and I mentioned the name of a neurologist. This satisfied her. The case file was thick.
“D’you want the old volumes too?”
There were three, each two inches thick. I carried them in a stack. On the way out I passed several people I recognised, but it had been three years since I worked here, and none of them looked up. In a quiet corner I slipped a dustbin liner over the buff folders – removing notes from hospitals breaks every rule – and walked to the car.
The notes began, logically enough, on the day of his birth. The pages were well preserved, though the edges were thin and torn where larger or misaligned documents stuck out. Leo had been born prematurely but was of a good weight. There were no problems at first, but during the fourth night he had a seizure. The doctor on call was bleeped to the ward. By the time he arrived the seizure had terminated.
He did the usual checks, examined the eyes and the arms and the legs, requested a glucose level, and was reassured. He wrote brief seizure, no persistent signs, likely benign phenomenon and left the ward. He wrote neatly, and appeared to order his thoughts well. Documentation had always been a strength for this young doctor, it was a quality that had reassured nurses and colleagues all around the region. I knew this, because the handwriting was mine.
Leo did not go home as planned. He had a second seizure next day, and was reviewed by a senior paediatrician. That doctor suspected meningitis, and prescribed antibiotics immediately. A lumbar puncture was performed which identified bacteria in the cerebrospinal fluid and confirmed the diagnosis.
But the infection had taken hold and irreversible damage had been done. His physical and cognitive development was impaired, leading to numerous referrals to speech therapists, physical therapists, orthopaedic surgeons, neurologists with a special interest in epilepsy, dieticians… a childhood overlain with challenges, interruptions and pain.
Would you really expect me to remember that day? Honestly? One patient among so many, a single clinical interaction in the course of thousands. No, we do not have enough memory for that. Yet, as I drove away (having returned the notes first), the darkness of the ward, lit by the glow of a single lamp, enlarged in a corner of my mind… and I remembered.
I caught her at the bus stop. She gasped. For a second or two I think she feared the worst. I held my hands up and tried to smile.
“I know. I know it was me. With Leo. Can we talk?”
“Why? It won’t change anything.”
She scrutinised me carefully. I had surprised her, stolen her advantage. Too much time had passed for her to be angry. Instead, she displayed a kind of ruthless calculation.
“Please. Can we get a coffee, just talk?”
I slipped a hand into my pocket and touched the screen of my smartphone.
[Rustling of clothes. Clink of crockery. Background conversation.]
“Thank you. I didn’t mean to scare you.”
[Thirty second pause.]
“Why did you pretend? I knew you weren’t sure. I could tell, but I trusted you. You were the doctor. You came out of the darkness, held my baby, and told me that it was okay. A one off seizure. But you were so wrong. He, and I, slipped out of your mind as soon as you walked away. There’s a word I have always thought suits you well – blithe – that’s how you floated in and floated out of my life. Why? Why didn’t you think about meningitis? If you had just considered it, and treated it, Leo would be a different boy now. He would have a normal life.”
“But there were no signs. No clues.”
“No! Don’t justify. You didn’t know enough to do that job. You were clueless. Be honest?”
“That’s how it was then, we were put on the wards, told what to do, what was expected of us…”
“It’s no excuse. If you didn’t know how to do the job you should have refused, and you should have got help when you came to see Leo. A seizure, in a four-day old! God! How could you think it wasn’t serious? How?”
“I’m sorry. I know I can’t do anything to make it better now, I know that…”
“Well I can. I can show people what really happens, how doctors like you are allowed to see patients with next to no knowledge. It’s criminal.”
“It’s not true.”
“What isn’t true? That you are lazy and ignorant? That we put ourselves in the hands of unqualified children?”
“No. The film. What it shows isn’t accurate. I knew that patient, I cared about her. What you saw represented the final chapter of a long story. I had a duty to protect her from more interventions, that was why I sounded so emphatic. If you’d asked, if the documentary company had asked, I would have explained.”
[Pause. Sound of cup being slid across table.]
“I don’t care if it’s accurate or not. It wasn’t about truth. It was about you.”
“To teach me a lesson?”
“Wait. What do you mean? Why are you leaving?”
[Sound of chair scraping back]
I turned, held up my phone and said,
“It was an honest mistake. I’m sorry Susan…for everything. But this is all I need.”
If you’ve enjoyed Twelve Steps, you can visit our free digital archive of flash fiction here. Additionally, premium short fiction published by Mystery Tribune on a quarterly basis is available digitally here