- - -
- - -
Alex hadn’t wanted this job, but that didn’t mean he wanted to start out by making a bad impression.
And as first days on a new job went, this wasn’t going well.
Having got onto Ward 12 at last, and spotted an uninhabited room near the entrance labelled ‘Medical Office’, he chucked his rucksack into it after having first removed his stethoscope, rolled up his sleeves and almost sprinted the rest of the way to the main desk and reception area.
Here, seated and doing something involving blood results forms, patient notes and sellotape, he found a woman in a pale purple tunic whom he guessed (being new to Castellum Trust, he was not yet certain of the local uniform code), to be the ward clerk.
“Did I miss handover?” Alex asked, nearly colliding with the desk in his hurry. “I’m really sorry, I overslept. And then I couldn’t find this ward, either - no one told me it was an outbuilding. I tried the main hospital at first and just got lost.”
Castellum Trust was a district general hospital in the north of England which, in comparison to Alex’s prior experiences in London’s tertiary centres, seemed more like a dollshouse than a serious healthcare facility. To discover that, within it, the ward he had been sent to specialised in the backwater of elderly care – an area with growing patient load and public demand totally outstripping any investment, research or staffing levels – had seemed like merely another inevitable step in the pattern his life had taken since June.
But he would not think back to June, or that night shift. Not ever again. He’d learnt his lesson.
The woman at the desk – her name tag read Shelley Peterson – looked up at him with a raised, heavily pencilled eyebrow. She had complemented her tunic with violet lipstick and dangling earrings comprised primarily of bright purple glitter. In an organisation heavily dependent on paperwork, ward clerks wielded a great deal of power, and Alex desperately wished not to be on the receiving end of the expression she was currently making.
“You’ll be the new Registrar, then,” Shelley informed him, conveying that perhaps it would have been preferable if he’d remained forever lost in the bowels of the main building.
Alex tried to smile brightly. “No, I’m only an ST2 I’m afraid. Are you getting a new Reg this week too?”
“We expected you last week,” Shelley continued, as though he hadn’t spoken. “Hilary’s been all alone,” she added, accusingly.
“I only finished my last rotation yesterday!” Alex shot another glance along what still appeared to be an empty ward corridor. If the doctors weren’t in the office they had to be on the ward round, but if so where were they all? Missing his first handover – the daily session of reviewing the ward list and establishing the outline of the day’s plans and the report of the night’s events between doctors and representatives of the nursing staff - would not have endeared him to whoever his new Consultant was, and the later he got onto the round, the worse it would be.
“I was driving most of yesterday evening just to get up here,” Alex told her. “And then the doctors’ accommodation wasn’t expecting me, even though I spoke to someone weeks ago.”
It had taken an extra hour of time, when it had already been late and he was already exhausted, for the right person and right set of keys to be located on the hospital site to let him into one of the small accommodation flats. He had not been expecting the Ritz – it had been decades since more than a very few doctors had lived in onsite accommodation, and facilities tended towards the most basic – but the state of the bathroom had been so foul he’d had to clean it before he could contemplate washing.
He’d finally fallen into bed at around two in the morning, and even two alarms hadn’t quite shifted him in time that morning, which – being followed by his confusion about the finding the ward - had lead to him stepping over the threshold of Ward 12 at well after nine.
“Do they go somewhere else for handover, or is there another room, or..?” he asked again. “Is the Consultant still on the ward, do you know?”
Shelley gave a snort, indicative, it seemed, that the question was too foolish to be indulged, and went back to her neat sellotaping of results to notes.
“Hilary’s started rounds,” she told him, without looking up. “Just keep going along and you’ll find him soon enough.”
But even with the unexpected information that the doctor called Hilary was male, Alex still struggled to locate him. Walking slowly down the long corridor which ran along the centre of the ward, he saw that the corridor divided patient rooms on one side from offices, sluices and equipment rooms on the other in a typically ward layout. Some of the patient rooms were large, six-bedded bays, and then further down the corridor they became single-occupancy side-rooms. All of the beds had patients in.
In the rooms, patients sat chatting, watching television or working in crossword puzzle books, a few lying back and sleeping. There was the usual odour of antiseptic, offset with a sweet undertone of talcum powder and Werther’s Original Toffees.
He was brought up short in his observations by a hand hitting him hard on the arm and a voice shouting “You stole my dog!” quite shrilly and near his ear. He looked down and round to find a tiny old woman leaning on a zimmer frame and gazing up at him wrathfully. There was real dislike in her eyes, and behind that the slightly glazed look of confused fear.
“Now, Mabel,” said the nurse escorting the woman, her voice low and soothing. “Your dog’s gone to stay with your daughter, remember? She’s looking after him really well, isn’t she? Hello, Doctor, are you the new Registrar? Hilary’s in Side Room 5, I think.”
“Thank you,” Alex said, feelingly, and the nurse grinned back at him.
“You’re all liars, the whole pack of you,” Mabel retorted, but more quietly, and allowed herself to be lead on and towards the bathrooms.
The door of Side Room 5 was closed, and the blinds drawn across the viewing window set within it. Alex saw a trolley of notes folders waiting outside the room, one set out on the top. He had just started reading someone’s scrawling notes – Room 5’s occupant, it would seem, was a 76 year old woman with poorly controlled Parkinson’s Disease and a bladder infection – when the door opened and a tall, thin, pale young man came out wearing – Alex blinked, unsure he could believe his eyes – an actual white coat.
“Um,” Alex tried to regain his power of speech. “Are you Hilary?”
“Dr Aquila, I presume,” the young man answered, and leant back against the doorframe, arms folded, regarding Alex appraisingly. “So you do exist after all. I was starting to fear the personnel department was in the grip of a delusion and our rota a tissue of deceit.”
Alex, too tired for jokes, did his best to smile. “Yeah, the ward clerk told me you’ve been working on your own for a while, I’m sorry about that. Isn’t there another junior or anyone usually to help you out?”
Hilary gave short laugh. He was pale all over, with paper-white skin, sandy hair and eyebrows so blond as to be almost invisible. When he spoke, his accent was smooth, a throwback to the kind of thing one associated with BBC announcers of the 1940s. There was a certain amused languor about him that Alex was already finding quite hard to take, and the irritation was itself irritating, because the last thing Alex needed was not to get on with his colleagues.
“I was still on my gastroenterology rota in London until the end of yesterday,” Alex tried to explain. “And then I had to drive for five hours all the way out here to the sticks, of course.”
Since Hilary was evidently not local, and as a fellow junior would also be constantly changing working location at the whims of rota organisers, Alex expected some sympathy with the observation, but Hilary made no response, instead leaning most of his slight bodyweight against the trolley and writing in the notes in large, near-indecipherable scrawl which took no account of the printed lines on the page.
“Well, Dr Aquila,” Hilary said at last, having finished, replacing the notes folder in its slot in the trolley. “We are of course incredibly grateful to have the benefit of your presence, especially all the way from London. I am fairly sure human physiology remains much the same even at this northerly latitude, but perhaps you should be cautious at first.”
“In London, as it happens,” Alex answered, drawing himself up, too piqued to control himself, “we didn’t wear white coats on the ward. In fact I was under the impression they’d been banned more or less everywhere a good seven or eight years ago for being a terrible infection risk.”
Hilary smiled back at him serenely and then leisurely began to unbutton the coat, peeling off one sleeve and then the other. Underneath his neat shirt and black trousers revealed him to be even skinnier than had at first seemed possible. Alex watched as Hilary carried the coat a little way along the ward, then leant into the sluice room with the elegance of a ballet dancer and threw it into an open dirty linen bag.
“Mrs Reading – the lady in that side room - won’t listen to anything I say, or let me anywhere near her, unless I’ve got a white coat on,” Hilary was saying as he came back to Alex and the trolley. “She won’t believe I’m a doctor without one. Now, I could argue with her, upset her or sedate her, but instead I’ve found some white coats in stores, got them cleaned and when I go in there, I put one on. Is that acceptable, Dr Aquila? So you see, we’re not quite as backward as you might think. Even all the way out here in the sticks.”
Alex felt the heat rising in his cheeks, more anger than embarrassment, and bit his lip. He would not sink to retorting again. He had to work with this guy for six months; he would maintain professionalism even if Hilary had no interest in it.
It did strike him in passing as odd how Hilary used ‘we’ to talk about the ward, as though he belonged to the hospital rather than merely passing through it for a few months of rotations as juniors tended to.
“I’m sorry I missed the handover,” Alex tried again, after a deep breath. “I take it there’s not a Consultant ward round of the patients today.”
“Well, Dr Aquila, then you would take correctly. There is never a Consultant round, for the simple reason that we don’t have a Consultant.”
Alex was so shocked that he forgot, again, to ask Hilary to please stop facetiously addressing him by his surname: “No senior doctor at all? That can’t be legal!”
“Oh, we’ve allegedly got cross-cover from whoever’s the on-call Consultant of the day on Acute Admissions. And I have been assured the post is being advertised, as indeed it has been for the better part of four months now. But for all practical purposes our Registrar is the one in charge here. I’m sure you’ll be wonderful at it, of course, coming from London and all.”
“I’m not a Registrar!” Alex was starting to feel genuine panic creeping over him. “I’m an ST2! And the rotations only switched today, I was still an ST1 yesterday! There’s no way I can do that job!”
Hilary shrugged. His smile suggested a great deal more amusement than sympathy. “ST1 or 2 or 3 - what’s a few numbers between friends? You can go and complain to personnel if you like, get switched over to some other ward that already has a senior where you can feel nice and safe. Then we’ll have nobody again, of course, but, I have to say, the peace and quiet was not entirely unpleasant. That’s the worst of seniors; whenever you get one trained just as you need them, they go and rotate away again.”
Alex narrowed his eyes. Damn this rota and damn Hilary and damn his sarcasm. He obviously expected nothing at all of Alex, and considered him some kind of frightened, soft, lazy idiot.
And perhaps Alex had done little enough to give any other impression.
This was what had been dealt him. All he could do now was deal with it. As Hilary pointed out, Alex refusing to undertake the job would leave no one better off, however inadequate he felt for it.
“Well, if we’re rounding, let’s round properly.” Alex adjusted his stethoscope more centrally on his neck, took his pen from his pocket and grabbed the end of the notes trolley. “We’re going back to the start in Room 1, you’ll hand over each patient to me as we go and I’d like to have the blood results book if you keep one. And the background notes for each bed as we come to it, please.”
“I write a summary sheet for each patient when they transfer to us,” Hilary said, picking up a notes folder and flicking to the relevant page where a neat photocopied proforma had been somewhat illegibly but undoubtedly thoroughly filled in. Alex, taking a glance, was rather impressed, but kept his expression level.
“Nonetheless, just at first, I’d like to see the old notes for myself, thank you.”
“Anything you say, Dr Aquila,” Hilary’s smile was on the edge of mocking laughter again, but Alex thought there was perhaps just a tiny hint less smugness about it now.
- - -
At the end of a very long morning – Alex hadn’t managed to get to the canteen for a sandwich until half past three, at which point the only filling options left were dubious beef and cheese savoury – Alex had learnt several important things.
Ward 12 had in total thirty beds, with four of the six-bedded bays and six side rooms. At least one quarter of the current patients were basically well, but were stuck in hospital waiting for adjustments to their houses to make them safe to return to, or for a place in a residential home.
Hilary and Alex made up the entirety of the medical team. There was a rumour, Hilary had said, that they could get the Medical Registrar from the hospital’s daily on-call team if something utterly dire required doing that neither of them could manage, like a tricky lumbar puncture or an external cardioversion. There was also the F1 on the orthogeriatric ward, who they could contractually call on for help with jobs if either one of them were on call or on leave. This, though, they should probably refrain from, Hilary said, as “she’s got enough on her plate dealing with the orthopods, and if we actually kill her with work then we’ll only end up handling her patients too.”
Hilary himself, Alex had been surprised to learn, was holding a standalone F2 post as a trust doctor. This meant that he was permanently employed by the Castellum Trust in a junior role, with no prospect of promotion or progression to a training scheme such as the one Alex had entered after his own completion of Foundation. In fact, Hilary had actually been working professionally a year longer than Alex had.
Wrestling out seniority was going to be important, Alex could tell. Working as equals, in a team, was all well and good as far it went, but in a medical environment it had to be very clear where the buck stopped, and who made the final call. And he outranked Hilary, so that was that.
Which made Alex, it would seem, the most senior Elderly Care doctor in the entire hospital. Now there was a thought which would lead to a nervous breakdown if he couldn’t forget it quickly enough.
The last thing he’d wanted after June was more responsibility.
Not that any of that made any noticeable impact on Hilary. Alex could see already that he was going to have to fight him for every decision he made. Thank fuck the rotation was only six months long - Alex thought he might start marking the days off on the wall like a man in prison, just to give himself the hope and motivation to keep going.
Since June, he’d struggled to figure out his path forwards. He still didn’t have any clear plan yet. But success is more than a little dependant on simply turning up, and he knew that if he put his head down and got on with it, he had a half-decent chance of toughing this out and moving on to something better.
Having opted in the end, and not entirely happily, for cheese savoury, Alex took a bite of his sandwich and looked around the canteen. There were the usual mixed bag of various specialities eating at their own tables in cliques of similarly-coloured uniforms, then the small ones and twos of worried relatives muttering as they pushed food around and a few harassed junior doctors trying to shovel food with one hand and scribble on their jobs list with the other. As a piercing bleeping noise split the air, and a junior looked at a pager before scrambling over to a wall-mounted phone to answer, Alex realised that neither PDA organisers nor deck-phones had yet arrived at his new Trust.
Hilary could mock him about the airs and graces of London all he liked, but this place was genuinely stuck in a time-warp.
“Mind if I sit here?” Alex heard someone asking, and on turning realised that the someone was addressing him.
The voice had been in a devastatingly pleasant Belfast accent, and the someone was tall, russet-haired and dressed in blue scrubs which left a pleasing amount of his considerable arm muscles on display.
“Sure!” Alex managed, hoping he was giving an impression more of nonchalance than of drooling.
Chalk up one point to Castellum Trust, Alex thought. Very nice scenery.
“Aw, cheers mate.” The man kicked a chair out, put a Tupperware box of salad on the table, and sat. “I’m Connor, by the way, I’m one of the surgical trainees.”
“I’m sure you are,” Alex said, vaguely, and then - blushing, thank god that on his darker skin it wasn’t always apparent – he swallowed and added, “I mean, um, Hi. I’m Alex. I’m the Elderly Care, um, Registrar, it seems. I just started today and, well, apparently there’s no Consultant and no Reg, so it’s basically me?”
“Ward 12?” Connor made a face. “Fuck, yeah, I’ve heard about that place. Swear to god, this is an odd hospital, but Elderly Care is the back of beyond of the back of beyond. Didn’t someone say something about, like, some totally bonkers trust grade doctor out there?”
Alex made an ambiguous noise and took another bite of sandwich. Hilary might be somewhat unbearable, but he was team now, and not to be laughed at. That was how it worked.
Connor laughed, which made his hair fall over his eyes. Alex forgot to chew for a moment. “You’ll see, my friend, it only gets worse. I think I saw an actual mercury sphygmomanometer this morning on my ward – who still uses those for Christ’s sake? I thought the next thing was going to be having to tie up my patient’s abdominal wall with cat gut.”
Alex grinned back. “Well I’ve written out so many blood forms my hand’s fallen off. I can’t believe there’s no computer ordering system. And we have to send the samples over to the lab by calling a porter, because the vacuum tube network doesn’t extend to our building. I can’t imagine any of the potassium levels survive that un-haemolysed more than one time in ten.”
“Oh, tell me about it. You just wait till you try and request an MRI. Although at least there is an MRI machine - when they’ve got the right people in to operate it anyway.” Connor smiled again, bright and energetic, poking around his salad with a plastic fork, taking a bite and then licking away the stray dressing from his lips. Alex found it relatively hard to focus as he heard him saying, “So, tell me, Alex, where did you settle on to live in this town?”
Connor asking him where he lived did not necessarily mean anything, Alex told himself firmly, as he took another bite of sandwich. He winced at the taste. Now more than ever he wished he wasn’t eating a sandwich filling of blended cheese, raw onion and mayonnaise.
“I’m just in the accommodation at the moment,” Alex explained. “Based on a quick view overnight it’s about as bad as you’d imagine. Can you recommend any area to look at for something else? I wasn’t sure I’d rent, given it’s only a few months, but if the price was OK...”
“Oh, sorry, I don’t know, I drive in from Prenderford. That’s a big town, the way over...” Connor made a vague waving gesture at one of the windows. “Had a job in Newcastle, before, so kind of made sense... Anyway, where was your last job?”
“London. St Alfred’s. I was on gastroenterology there. That’s what I want to go into, really.”
“Guts, vomit and shit?” Connor was grinning again – good humour rolled off him in irresistible waves – “As a trainee General Surgeon, I approve.”
“I liked it.” Alex sighed.
“So why here then?”
Alex bit his lip, looking away, and rolled out the lie: “I got my preference form in two hours after the deadline. And you know how that goes - they shove you right to the bottom of the pile and use you to plug a gap in whatever rota they need you for, wherever in the country they like.”
“Do not pass go, do not collect two hundred pounds. Happened to a friend of mine. Harsh deal, man,” Connor held up a bottle of mineral water and chugged it back, his throat muscles working under tanned skin. Which Alex was not looking at, definitely not. “If it makes you feel any better, I pretty much had to choose to come here. This is my white elephant rotation. If you want to do the tertiary cancer centre job in the city, this comes with it. So I guess I’ll be taking out appendixes and fixing ruptured ulcers for four months and then I’m out of here.”
The air was rent again by the squawk of a bleep going off.
“Speaking of getting out of here, that’s me I’m afraid,” Connor studied the bleep at his side (the motion, Alex noted, pulled his scrubs trousers ever so slightly away from the tanned skin of his hips) and stood up, wiping his mouth with the back of his hand and grinning again. “Listen, catch you around, OK?”
“OK,” Alex said, softly, watching him leave.
He felt suddenly floored, as if something momentous had happened, rather than just a quick, unremarkable chat over a few bites of food.
Alex had lived in London during university, his Foundation training and his first year as a Speciality Trainee. He’d known all the same group of friends from the age of eighteen – some even further back than that – and they all knew him as a guy who was into girls. And it wasn’t like he wasn’t. But once people knew you as one thing, it was kind of daunting to be something else, especially if you’d figured it out late in the day.
He’d not imagined this job would provide much scope for adventures in that department, but perhaps unscheduled adventures were the best kind? And even being around Connor had given him, along with various longing aches and frustrations, a wonderful sense of intense identity; he did want this, want that.
But he really shouldn’t let himself think about it anymore. More than likely, their paths would barely ever cross again.
“Didn’t get lost on the way back from the canteen then?” Sister Richards remarked as Alex got back onto the ward. He followed her gaze to the clock and was surprised and somewhat guilty to realise he’d been away for just over an hour.
“Anything I can do for you?” he asked, as politely as he could.
“I gave the jobs list to Hilary,” she told him, already turning away. “There’s four or five IV cannulas to re-site, I know that much.”
Alex closed his eyes, took a deep breath, did a ritual prayer to the gods of venesection, and went to get the equipment and a sharps tray.
As Alex worked through the list from the nurses – Hilary had a stack of discharge letters to dictate, and since Alex didn’t know the patients he reckoned it made sense to let Hilary get on with it, even if more senior doctors doing more manual tasks wasn’t the usual way of things – he double-checked why the IVs were needed in each case, purely out of habit, and so came across Mr Fields’ IV nutrition, delivered via a central line fixed into his neck, but supplemented with fluids via the cannula.
“Excuse me,” he asked, when he’d tracked down the nurse responsible for the bay Mr Fields was in. “It looks like bed 3’s been on TPN for nearly two weeks now. And he’s not a surgical patient or an ileus or anything.”
“No, he wouldn’t tolerate the nasogastric tube,” the nurse explained, looking at the sheet. “He was so confused when he came in, you see. So we had to use TPN just to get it into him, and he’s still got no appetite at all.”
“Well no, he won’t, not with three thousand calories getting pumped directly into his veins every day. Could we try and wean him down on this and back onto the oral intake, please? I’ve just seen him drinking tea so I’m guessing there’s not a swallowing issue.”
She looked at him. “Individual intravenous to oral conversion protocols need a dietician to organise. And you won’t get one, not on a Wednesday afternoon, they’re in a meeting.”
“Could I try and bleep someone? I’m sure one can pop over. I’d really like to get this underway, his blood sugars are really creeping up.”
“They don’t do ward visits at all on Wednesdays.”
Alex drew a long, slow breath. He hated pulling rank and drawing attention to the fact that he could give an order and everyone else had to follow it, but the fact was that if the structure of Ward 12 was going to survive, he had to.
The buck had to stop somewhere.
“I want this patient to start having oral intake before his pancreas gives up the ghost altogether. And I want to get these IV lines out of him before he gets an infection. I am going to ask the nutritionist to kindly come over. Please tell me what number to reach them on or how to find that number.”
The nurse raised her eyebrow at him and walked away, returning with a laminated sheet covered in printed numbers, heavily annotated with additions in biro.
“Thank you,” said Alex.
“You’re welcome,” she replied. He wondered if he was imagining the slight approval in her eyes, as if he’d passed some kind of test.
An important aspect of power, of course, was how you used it, and what for. He’d made it clear that he intended to fight for the good of the patients. The next part would be demonstrating – and only actions ever won respect in this environment, never merely words – that he wasn’t going to abuse his position or fail to pull his weight in his own responsibilities.
His responsibilities, his brain reminded him, as the lead doctor on the entire ward. He winced. That was something he really didn’t want to contemplate, lest the urge to run screaming out of the door and drive all the way south again completely overcame him.
“You want a cup of tea, doctor?” another nurse asked, coming past. He recognised her as the one who’d been escorting the patient called Mabel, and who had pointed Hilary out him, earlier. Her name tag said Alison.
“Oh please. That would be wonderful.”
He told her, gratefully and asked them all to call him ‘Alex’, then went to get onto the phone at the main desk. The nutritionist he reached was perfectly agreeable, professing that she would be only too delighted to come and see Mr Fields and that she had been concerned about the regime herself.
The promised tea arrived, in a cup bearing the legend 40 years young and another with it (this with logo suggesting to Stop NHS Fraud), which Alison asked him to take through to Hilary. Alex carried both mugs carefully into the small room he’d spotted at the beginning of the day – it felt like weeks ago now; another, more innocent life – with ‘Medical Office’ on the door. The room contained a small desk, computer and chair, and the walls were lined with many shelves, all of them heaving with volumes of paper notes. In the middle sat Hilary, dictaphone in hand, busy with his letters.
“...following which he was treated with three days of IV antibiotics comma converted to oral on the twelfth of January full stop We have given him a prescription for the remainder of his course open brackets see above close brackets and an appointment has been made for him in... Ah, Dr Aquila, finished all those cannulas already?”
“I have, actually, Hilary” Alex said, perching on the desk edge and handing the tea over. If Hilary wanted to go on with this stupid mode of address, let him. Alex would not let Hilary intimidate him. “Except Mr Fields. Room 2 Bed 3? I’m converting him to oral diet. He shouldn’t be on total parenteral nutrition anymore.”
Hilary frowned, and looked, Alex thought, rather embarrassed. “There’s been a lot of sick ones the last two weeks,” he said, “it must have slipped my mind. I apologise.”
It would be so much easier to warm to him, Alex reflected, if he didn’t insist on being so formal.
So stiff. So difficult. So different from, well, from Connor.
But then hadn’t Connor described Hilary as ‘the bonkers doctor’? Clearly Hilary’s affectations were well known around the hospital.
“Well you’ve been on your own,” Alex said, gently, and left it at that. One doctor to thirty patients was just asking for trouble, and for all he didn’t like Hilary much, he hadn’t found much else at fault with his clinical decision making. “Speaking of which, how long does a social services referral take round here, anyway? Half the ward seem to be pending carer placement. Mabel, in particular. Keeping her here is just cruel, to her and to the other patients.”
Mabel had spent a large part of the afternoon shouting for her dog. It was hard to win with her, the nurses had explained. In a side room, she became lonely and agitated, but in a room with other people they would swiftly lose patience with her, and especially her habit of trying to get into other people’s beds with her shoes still on.
“There’s some kind of mess with the local authority,” Hilary sighed and took a deep swig of his tea. “Budget, contract, all that stuff. Something to do with who pays the carers, basically, and when you’re entitled to government assistance.”
There was a knock at the partially-open door and Alison poked her head in. “Hilary? 2-5 is vomiting blood again.”
“Why do you tell me these things, Alison?” Hilary asked her mournfully, swigging another improbably huge gulp of tea and pushing back his chair. “Haven’t you ever heard the expression ignorance is bliss?”
“Do you want me to come?” Alex asked, putting his mug down.
“Oh yes, Dr Aquila, I would appreciate your guidance to my poor self,” Hilary muttered, already moving.
I didn’t mean it like that, Alex thought, and tried to breathe deeply. If Hilary was determined to dislike him then that was just how it was going to be.
Only six months, he told himself. Only six months to go.
- - -
- - -
“That patient of yours is doing alright,” Connor remarked, having come across the canteen as usual to join Alex at his table. Today Alex had actually managed to arrive before the hot food had run out – only nineteen patients at present (whisper it) and a shorter ward round as a result - and was rejoicing in a curried heap of non-specific protein and watery rice.
Hilary’s habit was to eat a packed lunch in the Ward 12 doctors’ office whilst battling the ongoing war against the ever-present paperwork pile. Having not invited him to join him for lunch at first, Alex had found no reason to embarrass both of them by doing so now, and in any case, the time with Connor was too pleasant to share.
“Oh, the 79 year old?” Alex asked with interest, poking at his plate. “The bleeding ulcer?”
“Three ulcers, actually, and a nice background of severe gastritis. That was a long endoscopy list. But a very neat bit of injection to the vessels, if I do say so myself, and he should be stable and back with you tomorrow.” Connor folded his arms contentedly, proud and powerful and glowing with his own knowledge that he was so.
“Thank you,” said Alex, “that’s brilliant.” And winced internally, and kicked his foot against the carpeted floor and wished he could come up with something more intelligent to say, or a more elegant way of expression his general appreciation of Connor and all he did.
Presuming, of course, that Connor would wish to hear that. That the news wouldn’t send him running back to the table where most of the surgeons gathered to eat and to regally fail to notice the existence of other life-forms. It was not generally the done thing, for medicine and surgery to mix.
But despite his own self-doubt, Alex was getting ever closer to being certain that he was almost sure that Connor knew exactly what he was doing when he chose to seek Alex’s company.
Connor, Alex had observed over the last few weeks, always had a packed lunch, usually salad. Today was rocket, quinoa and seared salmon steaks. Probably that was the way you needed to eat to keep looking like Connor did, with those arms and broad chest (in the vee of Connor’s scrubs top, there was just a hint of the line of the division of his pectorals, and the merest scattering of hair, not that Alex let his eyes linger). But certainly those boxes of food meant Connor didn’t have to come to the canteen just to find his lunch. There had to be some other motivation.
“So what was it today?” Connor was asking, his voice heavy with sympathy.
“What did Hilary do today? You’ve got that look, like he’s got right under your skin again.”
Alex sighed and scratched his eyebrow, trying to figure out how to explain without sounding petty. It had mattered, when the argument had happened, or it had seemed to, with Hilary’s unimpressed gaze meeting his own as Hilary leant back in his office chair, all the way over on the two back legs the way one wasn’t supposed to, sinuous and calm in his disdain.
“It was nothing. Just a stupid argument about blood tests. He had a point, actually, it’s just he’s so... Well, he’s just...”
“Oh I know.” Connor leant forward, speaking low. “I was on a week of nights on call team with him last month, remember? He was just like you said - arrogant arsehole.”
Alex bit his lip. That was not actually what he’d said, at least not exactly, and he gave a nervous glance around, even though Hilary never ever came to the canteen.
“So what was it? Come on Alex, get it off your chest.”
“Well, it was stupid, like I said. Just a thing about serial C-reactive protein blood tests. Hilary doesn’t like sending them. Said that before I came he never ran them unless he was monitoring a known soft tissue infection, certainly not as an infection screen in itself. And he has a point. A lot of our patients have multiple long term conditions, and quite a few are the post-surgical ones you lot have kicked to us on the rehab process, so honestly CRP will be raised in them whatever we do – it’s a pointless measurement.”
I was always told to treat the patient, not the numbers, had been how Hilary had actually phrased it. And if you don’t mind my saying so, Dr Aquila, if we run CRPs on a daily basis on every patient who comes through here, we’ll consume our entire departmental budget and end up getting another nursing post cut.
“I didn’t actually know how much any of these blood tests cost,” Alex said now. “Did you? Hilary has a sheet in the equipment room with the itemised expenses. Did you know a vitamin D assay is the better part of £40?”
Connor snorted. “I’m sorry, Alex, but he’s going about this totally the wrong way. He needs to be thinking gold standard, in everything, for everything. In surgery we certainly do CRPs on all our patients, and I can tell you if any of our transfers to your ward don’t get them, Mr Jodhri will not be pleased.”
It had been a long time since Mr Jodhri had come to review any of ‘his’ patients on Ward 12, but Alex didn’t want to bring that up in case it sounded like a criticism of Connor, who was no doubt trying his best.
“The point is, Hilary’s been on that ward a long time,” Connor continued. “It’s always been his little kingdom. But that’s not how it is any more. You have to know how to keep control of these juniors. Did I tell you my house officer’s latest? I honestly think I’m going to have to attach some kind of shock-collar to her for whenever she starts reaching for Gynaecology referral forms...”
The story went on, and Alex listened good-humouredly, only wincing a little inside for the F1 – he’d made the same mistakes himself as a junior, he knew, or as good as. Surely Connor had done too? Everyone did. It was how everyone learnt.
Connor shifted a little in his chair as he spoke, folding his arms. Alex tried and failed not to watch his scrubs ride over his muscles. When, in the following silence, Alex looked up, Connor was looking at him with a warm, rather intense grin and Alex blushed again, but felt his heart fluttering not unpleasantly.
He was still smiling to himself, nursing the moment over and over, as he walked back onto the ward. Here, he found Hilary busy with the notes for the inevitable new arrival – the ward never stayed less than full for long.
There was, it seemed, some confusion between the referring GP, the A&E doctor and the Acute Consultant on the Admissions Unit as to what was actually wrong with said patient. Going by the notes, she’d gone the GP about a rash, been sent in by him with a cough, treated in A&E for high potassium and sent on to the ward diagnosed with an as yet unspecified kidney disease.
“I don’t know what you think of this chest x-ray, Dr Aquila,” Hilary said, pointing to the image on the computer. “It’s not been formally reported yet, but those look awfully like granulomas to me.”
“Tuberculosis?” Alex squinted at the screen, altering the black/white contrast with the mouse.
Hilary sat forward, chewing on his pen. “Possibly. But her kidney function is so bad - I really doubt it’s just acute insult from an infection. I think we should be sending blood to test for c-ANCA and exclude Wegener’s Syndrome.”
Alex looked at the computer screen again and tried to dredge up the immunology section of his undergraduate degree. “Yes, alright, do it. Good call.”
Some hours later, in the company of the esteemed immunologist who’d arrived from the city hospital himself to excitedly review their patient, Alex found himself shaken by the hand heartily.
“And most of all, well done for thinking of it. I shall be writing to your Educational Supervisor, you may be sure. Not one in fifty registrars would have thought of that diagnosis, as classical as it is.”
“I’m afraid I can’t take the credit, Dr Brown.” Alex smiled. “I was still semi-comatose from my lunch when this patient arrived. No, it was all my SHO, Hilary.”
“Ah! And where is she?”
“That would be me, actually, Dr Brown,” said Hilary, and Alex saw that he had been standing just a little way along the corridor, listening.
“Thank you, Dr Aquila,” Hilary said later, when they were in the office, trying to catch up on paperwork since they were only running an hour late on their official finishing time and Shelley had muttered something rather dire about the consequences of any more of August’s results remaining unsigned. Hilary was affecting Dr Brown’s bombastic, formal tone as he spoke, but he flashed up a quick grin as he commented: “There’s not one in a hundred registrars that would have done that for their SHO.”
“I don’t make a habit of lying,” Alex said, calmly.
“No, you don’t,” Hilary observed. “I say, do you want a cup of tea? I think we might knock all these on the head with a bit more caffeine-triggered adenosine inhibition.”
“Now you’re just showing off.”
“Thank you for noticing,” said Hilary. “You take milk but not sugar, don’t you?”
- - -
It was just after seven in the evening when Alex emerged from Ward 12 and out onto the main hospital site. And right in the way of his path to the accommodation, he saw a figure that for a moment he thought had to be a delusion of his own.
“You’re late,” Connor told him, smiling. It was the first time Alex had seen him in normal clothes – jeans, a hoodie, a leather messenger bag – and he looked younger and more like an Abercrombie and Fitch model than ever.
“You’re even later,” Alex retorted, trying to suppress the part of him that wanted to emit a high-pitched giggle and skip up and down. “I thought you didn’t have an afternoon surgery list today?”
“I don’t,” Connor’s grin grew wider. “I was waiting for you.”
Alex just looked at him for a moment. Connor looked back. It was as if the entire conversation occurred within that glance, and when Alex spoke again it was only for the form of the thing.
“Why?” Alex asked. “What do you want me for?”
“My car’s broken down,” Connor said, with a shrug. “So I was wondering, you know, I hate buses and they’re full of germs, and with you living on site, I was wondering... could I crash at yours?”
“You’ll probably catch legionella, brucellosis and bubonic plague from the shower, just so you know.”
Connor stepped a little closer. “I’m a big boy. I’ll give whatever there is to catch at your flat a try.”
They were kissing practically before Alex had got the door closed. Connor was so big, so wide, so – so unlike Hilary, Alex’s brain supplied, which was not a mental image he wanted, thank you. His mouth was warm and he kissed like he wanted you to know you were being kissed, and by someone with a plan. Alex melted down against him, struggling to get close, trying to fit them together everywhere.
“What do you like?” Connor whispered, his brogue deeper and rustier with arousal, and Alex struggled to make any string of coherent noises for a while, as they clambered over each other on the mostly-collapsed sofa, fighting to get their clothes off.
It wound up in the end with Alex on his knees, between Connor’s legs, taking Connor’s dick into his mouth and trying his best to do it as well as possible. He’d never blown a man before, and he hoped Connor wouldn’t mind, but Connor seemed pretty happy, leaning back, groaning and guiding his head gently every now and again.
Before Connor came – and Alex was relieved, he would admit, to realise that that wasn’t happening anywhere near his taste buds – he dragged Alex back up to his mouth and kissed him until Alex felt like one giant ball of exposed nerve endings, thrumming and desperate. Then he put one hand between Alex’s legs and rubbed, tickled and stroked, heading back and back and towards something Alex had been wondering, thinking and dreaming about for weeks now.
“Do you have any stuff?” Connor asked him. “Oh yeah, you do, don’t you? I can see by that lovely shade of pink you’ve gone.”
Alex always kept condoms, and the lube had been a recent buy at the local Asda – eyes-down at the self-service tills, incredibly self-conscious of a lingering customer service assistant watching him. He’d never had the energy to give it a proper try on his own, though.
Now he lead Connor into his bedroom, right up to the drawer where said supplies were kept, and then lay back on the lumpy bed as Connor proceeded to touch him.
Excitement, arousal and a certain awareness of oddness swirled in Alex’s belly. Connor’s hands were warm, certain, practised, and Alex was shivering; half desperate, half afraid. The realities of certain intimacies are well known to doctors, but Alex had no idea whether he was supposed to mention it, as joke or apology.
Connor didn’t seem bothered. Having finished the preparation, he grunted out Alex’s name as he finally thrust in, and Alex felt a new and extraordinary thrill. It was a little uncomfortable; not painful but equally not quite as fabulous as research and fantasy had led him to expect. But then anatomies varied, and maybe he wasn’t built quite right to enjoy it. He could try it the other way round, perhaps, if Connor was willing...
“Oh god, Alex, Alex, fuck...” Connor continued, still moving on him, and Alex let himself be taken and held, Connor kissing the back of his neck, reaching round to stroke him, and loved the feel of it, of being so enclosed and held by Connor’s strength. Connor came inside him and then pulled out, disposed of the condom and sucked Alex’s dick down his throat in a way that made Alex forget every other fact in the universe but heat and wet. Afterwards, Connor lay back on the bed and Alex wondered for a while if it would be OK to try and curl round him.
“Aw, come here, gorgeous,” Connor said, after a few seconds, laughing, and drew him close. They fell asleep that way, and in the morning Connor shook him gently awake for a kiss goodbye before heading into the hospital to get muesli for breakfast from his stocks in the surgical locker rooms, not too enchanted, it seemed, by Alex’s Coco Pops.
In the hour of leisure granted Alex by the medical day starting an hour later than the surgical, he sat at his table cradling a cup of tea and grinning at nothing. He had a lovely residual burn in his muscles, just enough to remind him of what he’d done, maintaining a delicious consciousness that he’d crossed a bridge of some significance.
And Connor had kissed him goodbye. Connor had said “See you at lunchtime, eh?” Connor was not going anywhere, it seemed, at least not yet, at least not till they both had to, as the great wheel of training rotations kept spinning, or maybe grinding, depending how you looked at it.
- - -
“Good Morning, Dr Aquila,” Hilary greeted him, as Alex came into the doctors’ office that morning, only slightly delayed by having suddenly realised he had a love bite on his collarbone and having to change his shirt. “It seems to have been another memorable night at Castellum Trust.”
For a moment Alex was frozen – how on earth could Hilary know about it? Then he saw the death certificate book on the table in front of Hilary, and, with a sinking heart, the notes that he was referring to whilst filling the form out.
“Mabel Simmonds died? She wasn’t even that unwell.”
Hilary shrugged, not looking up. “Sudden cardiac arrest. Her angiogram last year did show pretty blocked arteries, and they didn’t do any interventions then in view of her general health and the dementia.” Then, putting down the pen and turning. “What pisses me off, Dr Aquila, if you’d like to know, is that the entire on call team came and jumped up and down on her chest for half an hour, breaking one of her ribs in the process, before declaring the whole thing futile. She should have had a ‘do not resuscitate’ form in place from the start.”
Alex closed his eyes and recalled an argument some days earlier between them. He’d been unwilling to sign forms ordering not to attempt resuscitation on patients with no prospect of imminent arrest. He had thought – and still did – that they confused the issue in the community and could prejudice care on future admissions.
Hilary had stated that he agreed, at least to a point, but felt the risk of an undignified, protracted end to be the greater evil.
Alex had pointed out that, either way, he was not comfortable taking those decisions himself –whether or not he was the most senior doctor available, he was still not senior enough for that. And even if not doing something is a decision in its own way, Alex had made that decision for reasons he believed to be right, and not without some consideration, some fear of exactly this situation happening.
It was not a subject Alex had any reason to take lightly, and not something he had any wish to explore further.
“I do appreciate, Hilary,” Alex said now, “that you can’t possibly be any ruder about me behind my back than you are to my face.”
“Glad to oblige, I’m sure.” Hilary finished laboriously writing out the certificate in the requisite capital letters, then recapped his pen – Hilary, as Alex might have imagined, used a genuine fountain pen rather than a ballpoint from a cheap multipack – and sat back, sighing. He ran a hand over his face, pinching the bridge of his nose.
“Listen, I always say what I mean, Alex. And I mean what I say. If I criticise your decisions, I’m criticising the decisions, not you. I don’t believe in being the sort of doctor that smiles and nods to their seniors one day, and bitches and complains to everyone else. If I think you’re wrong, you’ll be the first to hear about it. That doesn’t mean I’m right. You can argue straight back at me if you want to. And I’ll always do what you tell me, or, at least, if I ever felt I couldn’t, I’d tell you so at once.”
Alex would not have thought Hilary had the capacity to get any paler, but during this speech his porcelain skin had seemed to get even whiter, and as he fiddled now with the pen cap, his hands were ever so slightly shaking.
After a moment of heavy silence, Alex came forward and sat on the edge of the desk, facing Hilary and looking down at him.
“You know, when you call me ‘Alex’, it’s a lot easier to remember that we’re in the same boat here.”
Hilary glanced upwards. His pale grey eyes were, Alex saw, rather bloodshot, with the faintest smudge of darkness shadowing the sockets.
“What are you so worried about?” Alex asked, softly.
Hilary shrugged. “Nothing. It was only... I mean, I was here, I mean...”
The office door creaked open. It was Shelley the wad clerk, with a large cup of tea and a small packet of biscuits.
“Get that down you pet, come on now,” Shelley instructed Hilary, standing over him as he obeyed. She glanced briefly at Alex, and raised an eyebrow in answer to his confused expression.
“If you ever arrived here on time,” she observed, “you’d have been here too, with Hilary, when poor Mabel arrested.”
Hilary gave a short laugh, and patted Shelley’s arm. “No such thing. It happened before eight even. It’s insane to be that early, really, I only do it to keep on top of the paperwork.”
“You witnessed the arrest?” Suddenly it Alex’s mind, it was all fitting together. “Did you have to lead it, Hilary? Have you ever done that before?”
Biting his lip, Hilary shook his head.
Back in June, no one had given Alex a kind word. Now, looking at the lines of tension on Hilary’s face, he realised that any words of real meaning, anything more than platitudes, were hard to find.
“Well, look, would you like to go home, get some rest?”
“No, thank you.” Hilary took another swig of tea and stood up. “I’d rather be doing something. And it’s nothing, anyway, it’s not like I haven’t been on arrests before, just not... It’s different, being in charge of it all.”
“Yes, I know that.” Alex looked at him, and Hilary seemed almost to flinch as he got his meaning.
Alex stood up, stretching. He was reminded as he moved of the events of the night before, of Connor; it seemed so odd, thinking of that here, as if one or other reality could only be a dream. “Shall we go round, then?”
Hilary looked at him. “OK, Alex,” he said, carefully.
“And in amongst all this team bonding,” Shelley remarked, crisply, “don’t forget to wash those cups out yourselves. I’m not employed to keep this office tidy.”
“What if we hid them behind the unsigned blood forms, Shelley?” Alex asked. “Would that help?”
“Do you want your payslip to arrive this month or not?” Shelley asked him. “Honestly, you two. If I’d wanted more kids to look after, I’d shag my ex-husband again.”
Alex grinned to himself as he carried the mugs to the sink, whilst Hilary got the notes trolley onto the corridor, ready to begin all over again.
- - -
- - -
Alex’s domestic routine had, after a period of living and working at the Castellum Trust, become well established. Throughout the week he lived on his beloved chocolate cereal and the canteen food, sometimes getting a second hot meal to take away at night, supplemented with liberal use of the local pizza delivery outlets. At the weekend, required as he generally was to buy other things for the flat, he made the trip in his car to the nearest supermarket and wandered the aisles trying to convince himself to buy the raw components required for genuine cooking.
It would be nice, he reflected, if Connor ever stayed around for food, to be able to whip up something healthy and delicious rather than offer dried macaroni cheese in a packet and syrup pudding in a tin.
Connor’s visits had become frequent but remained irregular, subject to him being called away all too often by his bleep or the requirements of his rota. The two of them had also fallen into something of a pattern; Alex on his knees for various activities, culminating in Connor blowing his mind and various other parts of him. It was extremely pleasant, of course it was, but Alex was keen to explore further, and he was, as he walked along the aisles, trying to compose a way of broaching the subject of swapping certain roles.
The trouble would be getting onto the topic. He and Connor tended to talk about work, more than anything else, and that was not a subject that segued easily to the bedroom.
“Why, Dr Aquila,” said a voice, one which had no part in his fantasies, “fancy meeting you here! Planning some research into monosodium glutamate, are we?” And Hilary pointed at the contents of Alex’s shopping basket with something like a smirk.
“I thought we’d agreed on you calling me ‘Alex’ these past few weeks?”
“Really, though it doesn’t sound nearly as elegant, does it?” Hilary grinned again. The blue light of the shop’s refrigeration units gave his skin an almost unearthly glow, but somehow the effect on his hair made the sandy red colour brilliant and deep. He was in the skinniest of skinny jeans and an oversized woolly jumper without any apparent intention of ironic cool.
“Honestly, are you planning to eat any of that?” Hilary asked, looking at the food more closely. “Oh god, Alex, Pot Noodle? Seriously?”
“The kitchen I have is completely rank and disgusting,” Alex protested, feeling himself flushing. “So, yes, adding boiling water to a pre-prepared sterile container suits me pretty well. Not that it’s any of your business what I eat.”
“It is my business if I lose my best Registrar because he’s in the grips of acute Metabolic Syndrome, or having a processed sugar withdrawal crash.” Hilary poked the basket again. “Sachet rice, tinned sponge pudding, frozen pizza – that has a vegetable on it, at least – and UHT milk. No wonder you’re always in a mood.”
“Look, the oven is broken, I have two out of four working electric hob points, which are slow at best, and a nasty microwave, I’d like to see you do better.”
Hilary folded his arms. “Is that a challenge?”
“Yeah, Hilary, do you know what? It is.”
Alex was rather surprised he’d spoken. Hilary had got under his skin again, made him say things he’d hadn’t intended to voice aloud. He didn’t want to invite Hilary back to his flat, and was convinced Hilary had no wish to spend any more of his Saturday with him either, but the words were spoken and unless one of them came up with an excuse quickly, they’d end up having to roll with it just to maintain the benign balance they’d achieved together over the past few weeks at work.
Hilary was blinking at him, and giving him a searching glance, as if waiting for an un-guessed punch-line. But Alex had said it, and could think of nothing more to mitigate it now.
“Fine.” Hilary shrugged and straightened his shoulders. “Then lead on.” And he broke into a smile that for once didn’t seem mocking at all.
And so somehow Alex found himself followed by Hilary back to the hospital site, parking their cars side by side by the accommodation, and Hilary following him up the winding, smelly stairs with the sticky, brown carpet and into his flat.
Hilary had brought his own bags of shopping up with him, and instantly began unpacking them onto the small worktop of the kitchenette in the corner of Alex’s living room. The room was tidy and as clean as Alex could make it, and yet he was strangely conscious of its Spartan aspect and the fact that there, there was the sofa where he and Connor had so often made out. Could one tell that from the room in any way? Any odour or strange psychic footprint? It had meant so much to Alex, it felt like it couldn’t be that there was no sign of it.
And then there was the mug Connor had used, the first time Alex had made him coffee, and somehow ‘his’ mug since, left out by Alex on the worktop, a happy reminder. And Hilary was unthinkingly measuring out flour into it – a lack of any kind of weights or scales had often held Alex’s cooking back, but Hilary seemed undeterred.
“Chop the onions, please. I’m not here just for demonstration purposes.” Hilary shoved the said vegetables and a knife towards Alex.
“I don’t have a chopping board.”
“Use your imagination,” Hilary told him, and reached into Alex’s paper recycling bin, pulling out an old cereal packet. This he opened, flattened out, and turned over, offering Alex the grey inside. “There, that’ll protect the table from the food and vice versa. Mostly versa, I think - you weren’t joking about the state of this place, were you?”
Gradually, a spicy chicken and lentil curry, rich with raisins and cream and some spices Alex had never even heard of, evolved from Alex’s two pans and Hilary’s rough measurements. Alex couldn’t restrain a low moan as they finally sat down to consume it.
“Fair enough,” Alex conceded. “You can cook in my kitchen. I acknowledge your victory.”
Hilary grinned broadly and inclined his head in gratitude. The cooking had made a flush rise in his cheeks, and he’d grown hot enough to roll up his sleeves and undo his shirt collar, revealing a trail of light brown freckles across the dip of his throat.
“It’s not just about the cooking,” Hilary admitted. “You have to have good ingredients to start with. That’s no supermarket factory chicken, I buy from the farm shop on the way to Prenderford.”
“So you know the area pretty well?”
They’d never talked about anything as personal, not that they’d had time, ever, on the wards, to talk about much of anything. But Alex realised that if he’d been working here years, Hilary must have put down some roots.
“I was more or less brought up around here,” Hilary told him. “Oh, I know, I don’t have the accent. I was born in Surrey. But my parents travelled, and I was, well... I spent a lot of time with my grandmother, and she lived here in Castellum.”
“So you came back to work here to be near her?”
“No, actually. I came back because she left me her house. She died four years ago.”
Hilary gave a quick, rueful grin. “She had a long life and a peaceful end. I couldn’t want more for anyone. But I miss her, of course. Anyway, I thought you said I was getting some of that behemoth of a tinned sponge pudding?”
Talking about his emotions softened Hilary’s face to a surprising degree, Alex thought, as he went to get the pudding into the microwave. An expression that seemed so angular, almost alien, became warm and slightly elfin instead.
“My mother was from Greece,” Alex found himself saying as he sat down at the table again. “Well, actually she was half Indian, half Greek. She died when I was five, and my dad didn’t ever really like having the sort of food she cooked, afterwards. And she was a good cook, so that meant, well, yeah. We ate a lot of pizza and fish and chips.”
“I was wondering where you got your genetics,” Hilary admitted, after a pause, in which his face had shown all the sympathy he was evidently too British to voice. “I’m always envious of people who can be out in the sun for more than five minutes without developing third degree burns.”
“When does the sun ever shine up here, anyway?”
“Oh look, it’s a joke about the north. You’re both hilarious and innovative.”
“Why thank you, Hilary, I believe I am.”
Hilary snorted, pretended to throw a spoon at him and laughed. Hilary’s brand of humour, Alex was coming to see, was rather easy to swing into once you’d got used to it.
They were washing up the plates, having got onto the subject of Game of Thrones – Hilary refused to read the books in case of spoilers for the TV series, and Alex was teasing him with hints – when Alex heard his phone going off.
Free tonight gorgeous? Connor had texted.
There was a program on BBC2 that Alex had been hoping to watch, and he realised as he thought about it that he’d been vaguely imagining Hilary might enjoy it too, and that they could eat the box of chocolates that Alex had been presented with by the generous, grateful family of a patient who’d really never been ill enough to need much from him in the first place.
Connor didn’t like television dramas. But with Connor there would be other activities... Alex felt a shiver of heat go through him, and was sure he wanted Connor to come.
And very, very sure, somehow, that he didn’t want Connor and Hilary to cross paths.
“Well, that’s all of it,” Hilary was saying, as Alex came back across the room. “I suppose I’d better be going. I’m planning to watch this Dr Who thing on BBC2 later and if I miss it I’ll only end up spoiled online.”
There was no request in his words or voice to stay, and for that Alex was deeply grateful. Whether there might have been a question in his face, Alex didn’t want to let himself think.
So he said, brightly, “Well, don’t want to miss that!” and offered to help Hilary carry the rest of his shopping back to his car.
“I’ll be fine, please don’t bother yourself,” Hilary told him, hands raised as if to push him away, polite and formal as he always was, whether happy or not. He left, bags in his hands, smiling and yet not quite smiling – it was funny how, the better you got to know people, the more emotions you could read from them.
Connor turned up about an hour later. He brought a six pack of lager, and though Alex didn’t usually drink much, he was glad of it, helping to blur the edges and bring his focus in on Connor, on his heat and his mouth and his warm, clever hands.
“That’s it, gorgeous, that’s it, oh god,” Connor was muttering as he slid into Alex – it had got easier, and a little more pleasurable, over time – and Alex held on tight and tried to repress a sudden, unwelcome image of Hilary still in the room listening, laughing and adding in, in affected tones, Oh, Dr Aquila! Carry on, Dr Aquila!
“Fuck, yes, tighten, like that,” Connor told him, and Alex blinked and tried to do it again.
- - -
“Did you like the Dr Who thing?” Alex asked on Monday, as Hilary was industriously piling up the week’s blood request forms in the relevant places for the phlebotomists.
Hilary looked up at him and blinked. Alex wondered, idly, how he’d ever thought Hilary’s eyes were grey; they were golden-flecked, and had rings of blue and hints of green within them. “Oh. Yes, actually. It was rather interesting.”
“Good,” Alex said. “Tell me about it later, I might catch it on iPlayer. At least, when I’m back in civilization and have Wifi again.”
“OK, sure.” For a moment Hilary was frowning, as if Alex presented some kind of riddle. Then he shrugged: “Hey, cup of tea?”
“Oh, yes please.”
“That was a request, not an offer.”
“You’re a terrible subordinate.”
“And proud of it, sir,” said Hilary, saluting.
And, as ever, the pressing needs of the ward, of cannulas and repeat bloods, of IV charts, of dose adjustments, of scans to order, of mysterious pyrexias, undiagnosed stomach pains and gradual declines, swept in and occupied all of both their consciousnesses.
- - -
- - -
The ‘winter bed crisis’, as the newspapers liked to call it, was now fully upon the hospital, and despite three staff being off sick with gastroenteritis, Ward 12 was as full as ever and had eleven patients under their aegis boarded out across the hospital in theoretically surgical or orthopaedic beds. Alex had to review all of them daily, and even the prospect of running into Connor did little to alleviate the stress of keeping forty-one different, constantly changing cases straight in his mind.
“I love you, Shelley,” he said as he sank into the office chair back on the ward and saw her approaching with a cup of tea. “And, I swear, I’ll wash it up as soon as I’m done.”
“You’re behind with the blood forms again,” Shelley told him. “This pile needs done before the end of the day, or else you’d better arrive here before I do on Monday to finish them. And I arrive at seven.”
“Shelley, where do you get your energy from? Tell me your secret, please.”
Shelley rolled her eyes. “Young people today. You ought to have tried working round here before they invented all this limited hours rules. I saw juniors falling asleep in corners of the wards, collapsing with hunger, all of it. You had to be tough back then.”
And insane, Alex thought, but said nothing.
He’d just had about half his cup of tea when Hilary came and adopted his customary posture leaning against the door frame. “Alex? Could you come and see Side Room 6? I’m not sure where to go next with the IV fluids.”
“Sure.” Alex stood up and made himself walk down the ward, trying to cajole his tired, dehydrated brain into order. He wouldn’t have minded a drip himself.
Side Room 6 was currently occupied by Mrs Helen Gregory, an 87 year old lady with unexplained anaemia. All the various samples and test results were still awaited, and Alex wasn’t sure yet if he was looking at cancer or just a vitamin B12 deficiency. Mrs Gregory’s family were extremely attentive and extremely interested, and he found it hard to tell them, repeatedly, that no, he just didn’t know any answers at all yet. As he approached the room he spotted today’s visitor, her sister – Mrs Thomas, her name was, he was pretty sure – waiting outside, watching Hilary reading the charts.
Mrs Gregory was in moderate acute-on-chronic kidney failure, but they’d had to administer fluids cautiously in view of her chronic heart condition. It was a very difficult tightrope to balance across, and even picking the right electrolytes to go in the bags, let alone how fast to give them, was something Hilary and Alex had had long discussions about for the past two days.
“We’ll go with the 5% Dextrose again first, I think,” Alex concluded in the end. “Then DexSaline overnight and we’ll review tomorrow.” Coming out of the room, he spotted Mrs Thomas still waiting and went over to explain to her.
“Are you alright?” he asked, as he finished his brief spiel. “You look a bit wobbly.”
She waved him away. She had to be around her sister’s age, but neither of them looked as old as their chronological age, and she was walking and breathing more easily than many women he’d seen twenty years her junior, despite being more unsteady than usual that day.
“Oh don’t worry about me, dear, I’m fine, just feeling a bit nauseous.”
Alarm bells rang in Alex’s head: “You might be best to go home then. I mean, it could be the winter vomiting bug, and we really don’t want that spreading to the patients.”
“OK, sorry, doctor, I just...”
“Don’t worry.” Alex rubbed a hand over his head and tried to smile. “You just go home and look after yourself, OK? And keep washing your hands.”
“Do you have any plans for the weekend?” Hilary asked, coming out of the room behind him.
“Not having norovirus,” Alex told him, and went to wash his own hands thoroughly at the nearest basin, despite not having touched Mrs Thomas, just in case. Then, more seriously, “I’ve got this thing Saturday evening, not otherwise. Why?”
Saturday night? I’ve got an on-call, but say eight? Connor had texted him earlier in the day, and Alex had agreed readily, as he always did. He’d still not managed to have any discussions with Connor about changing up what they did together, and this weekend he was determined that would change, and more than a little excited at the prospect.
“I just wondered if you’d like to see some of our countryside,” Hilary was leaning against the wall, idly rubbing at a mark on his fountain pen. “It’s not bad at this time of year, with the snow on the hill tops, and we’ve got some bits of Hadrian’s Wall not too far away. Just, you know, if you were in need of novel diversion.”
“I make a rule of never saying ‘no’ to offers I don’t have the vocabulary to understand,” Alex told him, and smiled.
Hilary grinned back.
“Doctors,” said a staff nurse, coming up to them. “That cannula for the blood transfusion in 3-2 still isn’t working. I think you’ll have to re-site it again.”
- - -
“I’ve never seen anything like it,” Alex said, gasping, looking around at the rolling dark green hills, stretching out in every direction below his gaze. The tiny specks of sheep grazing, the small groups of coppiced trees, skeletal in the autumn cold, and over to the west the strange scars of the abandoned mining sites, machinery still emerging from the ground like the remnants of some invading army from the underworld.
In the bottom of the valley, the river ran deep, and some horses had gathered at the banks to drink. Moving the gaze upwards, there were only a few houses to be seen, blobs among the criss-cross of low stone walls, and then more hills and then the sky, wide and vast and bright.
“See that dark line, over there?” Hilary stepped in a little closer behind him and pointed. Alex followed the line of his finger. “That’s part of the Roman wall.”
“Just there, just like that?”
Hilary grinned at him. “Just there, just where the Romans left it.”
They walked on, crunching underfoot the thin cap of ice which had formed on the muddy paths. As they came closer to the stones, Alex realised that the structure was standing taller than he had at first imagined, well over the top of his head. Large, heavy blocks, still holding together after two millennia of war and weather.
“It’s just amazing...” Alex stepped closer. Pulling one glove off, he brushed his hand over the rough, cold surface. “I mean,” he tried to assemble his thoughts, to make them coherent. “I mean, to think that whoever made that cement died hundreds and hundreds of years ago. And he stood here, and now I am, and there’s nothing between us right now but time.”
“He might have liked your gore-text jacket,” Hilary commented, but grinned. He came and rested his hand on the stone next to Alex’s, just close enough to not quite be touching. Alex felt the heat that comes after exercise and was bemused at where all the emotion suddenly surging through him had come from. His chest felt heavy, his eyes stinging and a low, sweet, mournful pressure running through him, somehow sadness and joy at the same time.
“You can feel it too, can’t you?” Hilary was saying, softly. “How the wind howls and the birds sing, and we could have been wandering here forever and just not known it.”
Alex looked at their hands, Hilary’s pale skin and his own darker tan, resting together against the weathered stone. Hilary was right; they could be any two people, any time, the ancient past or the distant future, and in standing here, seeing this, they connected themselves somehow with the land, and the people who had walked this land before them.
“My Gran and Granddad used to bring me here, when I was little,” Hilary was saying quietly. “My Granddad’s family came from these hills, going generations back. He could play the Northumbrian smallpipes, and she would sing, and he knew songs so old the words didn’t even make sense any more, but the music did, always, I mean...”
Alex looked at him. Hilary had stopped, and was licking his lips, flushing a little.
“Do you know any of the songs?” Alex asked.
Pulling his hand away, Hilary turned. “Don’t tease.”
“No, I’m not, honestly. Tell me, please.” He went to reach for Hilary, but Hilary had already got a little distance away.
“It’s too cold,” Hilary called back. “Come on, we ought to eat before we start back to the car.”
A little further along the wall they came to the roofless ruin of a building the wall abutted. A sentry post, most likely, Hilary explained. Here, wedged in and sheltered from the wind, they ate their sandwiches and drank hot soup and then tea from the thermoses Hilary had provided. It was Hilary’s home-made soup, he explained, parsnip and honey; Alex found it rich and unexpectedly delicious, and said so, which made Hilary go a rather pleasant pink.
On the grass of the building’s floor was a patch of scorched ground, presumably the work of previous visitors. Intrigued, Alex went over, dug a wodge of mostly clean tissue from his pocket and put it down, reaching out to grab a few more twigs from the floor, and put to the little bundle the fire lighter from the emergency kit he kept in the back of his walking bag.
The flame blew out at once.
“Help me, then,” he called, and, laughing, Hilary came over and crouched next to him, cupping his hands over the small pile of kindling against the breeze. As the flame caught and licked through the pile, they took turns reaching out for more fuel and carefully building the fire up. It would, Alex saw, have made a great deal more sense to gather the sticks first and then have had them to hand, but this was scarcely an area in which he was an expert.
He had lit the fire purely because it amused him to do so, but something in the flames and the light re-awoke the strange feeling he’d had in his chest earlier.
“One of the songs was a story,” Hilary said, sitting back against the nearest bit of wall; Alex, driven by cold, went to sit next to him, not answering for fear of stopping him talking. In front of them the flames danced, and there was the satisfying cracking of burning wood.
“It was about a lord of the border country, who went out riding in the night time,” Hilary continued. “And on the road he met a young man whose own horse had a mane of fire and teeth of diamonds, and claws like a panther. He was the most beautiful young man the lord had ever seen. And the young man invited him to come and join his hunt. And the lord agreed, and was enchanted, and was never seen again.”
Alex felt a delicious shiver run down his spine. “I’m guessing Disney won’t be adapting that any time soon, then?”
Hilary chuckled. It was warmer, now, and Alex found himself feeling more than a little sleepy, after the week they’d had and now the long walk and the food, and he was having to fight not to lean sideways and onto Hilary’s shoulder.
“You know, if you like,” Hilary was saying again, and Alex blinked, not sure if he had fallen asleep, and if so how long for, or whether he had in the end leant in, “the thing is, I was planning to make a big lasagne tonight anyway, four portions. I usually freeze them and eat them throughout the week, you see. And anyway, if you wanted, I mean, you could come and eat one, save me from myself and my béchamel addiction.”
Tonight. Saturday night. Connor. Alex sat forward abruptly, looked at his watch and winced. If he didn’t start moving soon, he’d be late for Connor getting off his on call shift. He’d never expected to want to stay out in the countryside so long.
“I’m sorry, I’ve got this thing...” Alex stood up, kicking pins and needles from his limbs. “I’m meeting someone, actually, it’s just... I mean, I’d really like to, but...”
He really would like to, he realised. He really didn’t want to leave. Even for the promise of Connor, and all he might do with Connor, he’d trade that for the prospect of sitting chatting and laughing with Hilary, and trying to discover more about him, or hear even a little more of his stories.
Looking at Hilary’s face now, watching the features recompose themselves – regret, it had to be regret, and hurt, and Alex was slightly thrilled and yet desperately sorry to see it – Alex realised he wanted nothing more than to crouch down again, to get close and to...
“I’m sorry, I have to go. I really have to go.” Alex didn’t know, didn’t dare guess, what it was Hilary wanted, but before he could think any more of any of that, he must speak to Connor, and do this properly by both of them.
He saw that now.
“Listen, I do wish I could stay,” he allowed himself to add, truthfully, and only hoped Hilary could detect some of the earnestness with which he felt it.
“Let’s get going, if we’re going,” was Hilary’s only reply, as he stood up and began to kick the fire out.
- - -
Connor came to the flat almost an hour and a half late.
Alex, who’d been sitting on his sofa half-watching television and nervously eating cold pizza, had had plenty of time work himself into a state of nervous tension. A delayed end to the shift meant a long, stressful shift, which would leave Connor in no mood to discuss anything.
Indeed, “Fucking A&E nurses!” was Connor’s opening comment as Alex let him in from the corridor and into the flat. “Thinking they know everything!”
Alex frowned and tried to look sympathetic, though in his experience the acute care nurses at Castellum did very well on small resources, and knew a great deal.
“Long one, was it?”
“Swear to god, one of the worst I’ve ever had.” Connor sank down onto the sofa, toed off his trainers, and sighed heavily. “I tell you, I was so, so glad I didn’t have to drive home tonight. Well done you for living on the doorstep.”
Alex bit his lip. This was rapidly becoming a worse and worse context from which to launch into what he had determined to say.
“Would you like some coffee?” he asked, knowing he was partly trying to buy himself time.
“Oh yeah, that would be heaven, thanks. Hey, come here babe,” and Connor was pulling him in for a hug, leaning into him to plant a smacking kiss on his neck. Feeling his heart beating faster, and not in a pleasant way, Alex extracted himself to get to the kettle.
“The old lady I just finished with, right?” Connor began, gesticulating. “Fucking hell. Referred to me with ‘abdominal pain query gallstones’ and I do a quick history, chat to the A&E doctor, and she’s only got sodding left upper quadrant pain, intermittent, relieved with indigestion remedies. I said to the doctor, I said, ‘OK mate, anatomy in university was a long time ago but tell me you can remember the difference between the gallbladder and the stomach’ and he asked me if we still wanted her as a surgical case! He was just trying to get her out of there and into a bed.”
“Did she get admitted?”
“Yeah, think she went to your ward actually. Lucky you.”
“Mmmm, lovely Monday morning post-take ward round,” Alex agreed, trying to make a joke, and brought the hot drinks over to the sofa.
Connor accepted the coffee, took a sip and groaned happily. Alex, sitting next to him, pinched and fiddled at the sofa upholstery and tried to figure out how to begin.
“Connor, listen,” he said at last. “This thing, with us two, I mean...”
Frowning, Connor put his coffee mug down on the table and turned to look at him. “Thing?” he said, and his tone was more than a little wary.
“This, um...” Alex didn’t know a word for it. They weren’t friends with benefits because it was more benefits than friendliness, he could see that now. They’d never dated. They weren’t anything he could put a name to. “This relationship we’ve established, with you and me and coming here and...”
“You want to have this conversation now?” Connor asked, rather plaintively.
Alex stared right back at him.
“You want to have this conversation now,” Connor repeated, resignedly this time, and nodded his head. “Wait a minute,” and he downed the rest of his coffee. “Look Alex,” he said as he brushed his hand over his mouth, “I thought you knew what was going on here. This isn’t a relationship, mate. I mean, it’s not, is it? We hang out, we have sex, we shoot the breeze – that’s all I’m on the market for. You get that, right?”
Alex was so floored that for a long moment he couldn’t think what to say, or how to respond at all. He had concluded for himself that he and Connor didn’t really have much in the way of emotional intimacy, but he’d never imagined that that might be purposefully so on Connor’s part – perhaps that in itself said a great deal about them.
Connor, leaning forward, sighed. “I’m sorry, perhaps I should have... It just happened, though, didn’t it? Just a bit of fun, yeah? We don’t have to put labels on things all the time.”
And Alex found he was laughing. Not quite happy laughter, not quite bitter either, more like shock, like when a terrible collision has been perfectly avoided, and cannot now happen but the feeling of utterly useless fear still resonates all the same.
“Are you OK?” Connor asked, dubiously.
“I’ll get there.” Alex held up his hand. “Don’t worry, you’re not going to drive me to Victorian style insanity and wailing in the tower just yet. Thing is, what I wanted to say was, well, I’ve met someone.”
“Oh, I get it.” Connor was chuckling now. “And they’re not cool with you and me carrying on? Hey, no need to look like that, it’s not just you that isn’t Victorian, lots of people play away without hurting anyone. I’m kind of seeing a guy back in Newcastle, but he doesn’t mind me hanging out with you. ”
“That’s big of him,” Alex said, and had to get up and walk away for a moment, because he wasn’t sad and he wasn’t cross – why should he be, when this was exactly the sort of outcome he’d wanted from the conversation? – and yet he was feeling both all the same. Connor, in Connor’s eyes, by the way of living Connor was clearly used to, the relationship culture to which he had become accustomed, had done nothing wrong, never lied, promised nothing.
But for Alex this had been something else, or might have been, and for all he wanted to laugh and walk away, he couldn’t quite. Not just yet.
“If you’re tired, I can ask the on call porter to get me the key for the spare flat, and you could stay there and sleep tonight,” Alex said finally, after several deep breaths. “But I hope you’ll understand that I don’t really feel like I want you to stay here anymore.”
Connor drew another heavy sigh. He looked irritated, and moderately downcast, but in no way sad or even very surprised. Alex was willing to bet that, of all the outcomes of the last few minutes, Connor was regretting the loss of the onsite bed and breakfast the most.
And suddenly Alex was feeling quite sick and really rather shaky, a nasty heat rising under his skin and his eyes prickling. He shouldn’t care in the slightest, except to be relieved, he told himself again, but it didn’t help much.
“Fair enough, I’ll get out of your hair.” Connor rose and looked about the flat, grabbing his backpack. “Honestly I’d sleep on an x-ray trolley or a bloody morgue gurney, right now.”
“That first night, back in September, when you asked to stay with me. You said your car had broken down. Had it really?”
Connor frowned. “Well, yes. Did you think I’d made that up just to see you?”
Alex bit his lip.
“I would have made a move on you, either way,” Connor continued, his tone reassuring. “Maybe not that fast, though. But it all worked out, you wanted it and, you know, Alex, it’s been good, hasn’t it?”
Alex took three deliberate steps to the door and opened it. “Goodnight, Connor.”
With a shrug, Connor left.
- - -
Sunday was one of the most miserable days Alex had ever passed, including the aftermath of that June night shift when he’d been questioning everything about himself.
This was both more and less awful – more, because it affected him, his own intimate life, so much more closely and then less because at least no one had been hurt but himself. And then more awful, again, because how was it OK for him to feel so much more upset by something with so little real impact, than over what had happened that June night?
Personal and professional cannot be the same. You cannot feel personally all the things you encounter professionally, not in medicine; no one would last two weeks in the job. But the cognitive dissonance of being constantly around so much grief and joy and panic and tragedy and life-defining events in the lives of others can make processing and experiencing one’s own moments of importance significantly more complicated. Alex lay on his sofa, watched six solid hours of sitcoms on the television, ate cereal, drank too much caffeine and wished he had Hilary’s mobile number and then was relieved that he didn’t, that he couldn’t possibly text and risk saying too much when he still had no real idea how it might be taken.
He did not sleep well, and finally got up at around six in the morning on Monday, ate two digestive biscuits and an apple for breakfast (he’d consumed his entire cereal supplies, and in no way had felt up to the supermarket trip), and then went out and over to the ward to get stuck in on the post-weekend jobs.
The truth about what had happened with Connor was starting to fade to the back of his mind. Now, all he could think about was Hilary, about seeing Hilary, about what Hilary might be thinking about him and how he’d left their last meeting. Anxious jitters made him skip and dance along the ground, and he twirled his pen so energetically as he got it out of his bag that it flew clear across the office and into the confidential waste bin.
There were six new patients on the ward. Alex started at the beginning and reviewed the notes of the man who’d gone into Room 1, putting his details into one of Hilary’s neatly designed summary proformas; early stages of dementia, chronic kidney disease secondary to hypertension, dehydrated.
The next set of notes he pulled up were for a woman who’d gone into Room 2. He noticed one thing about them before he’d even got them open.
He carried them over to the desk where the one of the outgoing night shift nurses was yawning over a drugs requisition form. “Hey, sorry, but do you know, is this the same Mrs Thomas who’s the sister of Side Room 6? Mrs Gregory’s sister?”
The nurse cast a look at the notes and nodded up at him. “Yeah, shame isn’t it? Bit easier for the family, though, at least, than if she’d gone off somewhere else and they’d had to visit both places.”
“What’s wrong with her?”
“Reflux, indigestion, something like that,” the nurse got her own handover sheet out of her top pocket. “It just says ‘abdominal pain’ here. I tell you what though, there was such a to-do about her on Saturday evening. The surgeons took her as a GP referral and then decided she wasn’t surgical just as a bed got sorted out for her on the surgical ward, and then she was going to go to Gastro, but then their planned discharge got flu and stayed in so there wasn’t a bed there, and so in the end she came to us.”
“Surgery? Oh, right...” Alex thanked the nurse – she offered him a tin of Roses chocolates and he took a toffee penny – and flicked through the admission notes until he found, as he’d expected, Connor’s neat, firm handwriting. This was Connor’s left upper quadrant pain lady. Despite himself, Alex grinned. He could picture Connor writing these words, full of subtly phrased anger at the A&E doctor’s referral; they came off the page in his voice.
Still carrying the notes, Alex went to Room 2 and found Mrs Thomas in bed 3. He was at first expecting her to be ready to laugh and share the joke about being here with her sister, but he could see even from the end of the room that she was pale, sweating and breathing heavily.
“Mrs Thomas? Hi! You’re not supposed to be a patient here! What’s gone on?”
She was genuinely panting, and he saw that she had gripped the bed rail, trying to keep her torso in a classic tripod position framed by her arms, to get the most benefit from every breath.
“Sorry doctor,” she said, holding up her hand for a moment. “It’s just happening again just now.”
“This the same pain you came in with?”
She nodded, and coughed.
Moving forwards, he took her wrist up to feel her pulse, but the radial artery beats were scarcely palpable. He checked in her neck. Here too the beat was only weak and thready.
“Just put this on for me,” he said, reaching behind her bed to get the oxygen mask connected to the piped supply in the walls, and switching the valve to high flow. “And excuse me one moment.”
“Bed 2-3,” he called, as soon as he was out on the ward, searching frantically for some of the nursing staff. “She’s really not looking good, can someone please get the ITU Outreach team over here?”
Alarmed, one nurse went to the telephone, the other following him back into the bay and going at once to Mrs Thomas’ side, checking the flow of the oxygen and placing the back of her hand on the patient’s forehead.
“Apyrexial,” she commented.
“Never had a temperature so far,” Alex agreed, having picked up the obs chart from the clipboard at the end of the bed. “Pulse has been going up, though, and BP down, and I don’t like her oxygen sats.”
The nurse took a look. “That’s all within parameters though. Even the oxygen, if you consider that she has a smoking history.”
“Yes, but looking at her...”
“I agree,” the nurse bit her lip. “What would you like?”
“This room isn’t ideal,” Alex began, looking round at the other five patients in the bay, all watching with the intense interest of those denied all usual forms of entertainment. “But we can’t move here, I don’t think – where on earth would we put here? - so get the trolley in. I need a set of observations at once and an ECG. And check that outreach team is coming. Does your chest hurt at all?” he asked Mrs Thomas, going to her side again.
“Yes, this pain, this is the pain...” Her lips were going blue and dusky at the edges.
“This is the same pain you came in with?”
Confused, reflexively asking himself all the basic screening questions taught in medical school about chest pain, Alex turned to the notes in his hand and flicked through the pages of writing, trying to find... – there it was, tucked in the middle, the admission ECG. He’d noticed earlier that it had been signed off as normal by Connor, and thumbed past it.
Now, pulling out the paper record of the heart tracing and looking at it properly, for a moment he couldn’t believe what he was seeing.
He looked from the paper to the patient and back again, and swallowed, and then drew himself tall, clearing his mind of all the feelings he could besides calm, logic and reason.
Turning, he saw the night shift nurse pushing the cardiac arrest trolley – loaded with resusicitation equipment – into the bay, the other patients looking every moment more interested.
“She needs aspirin, she needs clopidogrel, she needs morphine,” he began, urgently but in as low a voice as possible. “Attach the electrodes from the defibrillator and monitor her on that. I’m going to fast bleep the crash team.”
The nurse nodded and started moving again, calling another in to help her. Shelley, who had materialised like a benign spirit, came into the bay and quietly began closing the curtains round all the other beds with an expression that no one seemed inclined to question.
“Good morning to you too,” said Hilary, just as Alex walked through the door still looking back at Shelley, and almost barged straight into him. His tone was light but the concern was clear on his face as he saw Alex’s expression. “What’s happening?”
“Patient in 2-3 was transferred here over the weekend,” Alex held out the ECG. “She’s been having a heart-attack for 48 hours and we’ve been treating it as indigestion.”
“Fuck,” was Hilary’s comment. “But someone saw this tracing! It’s been signed off.”
“I know.” Alex took a deep breath. “It doesn’t matter right now. Get the crash team, get an anaesthetist, get the cardio registrar or the on-call Consultant or whoever’s best that you know in the hospital and just pray we’ve got time to...”
A rapid, blaring alarm began sounding from Room 2; someone had pulled the emergency buzzer. Shelley ran out, straight to the desk and picked up the phone. “Cardiac arrest, Ward 12,” she said into it.
Alex and Hilary took one look at each other and ran into the room.
- - -
It had been in June, in his old job in London, that Alex had had a newly admitted patient collapse in front of him in the Acute Admissions Unit. He’d sounded the alarm and started chest compressions when he’d discovered her to have no pulse, and the staff on the unit had come to help him. All to no avail, as the patient, who was terminally ill with Stage 4 breast cancer, had failed to respond to anything they did.
Later in the day, it had emerged that she’d requested a permanent ‘Do Not Resuscitate’ order for herself some months earlier – paperwork that hadn’t arrived in hospital with her due to some mix up in the ambulance – and her family had lodged a formal complaint against Alex for initiating CPR against her wishes.
The complaint review board had concluded that he had acted the only way he could under the circumstances, and had made a recommendation regarding improvements in patient notes transfer. The case had never gone to court.
But Alex had been left with the image of that patient’s family, especially her adult daughter, staring at him as if he’d personally set out to injure their loved one, and known that he’d denied them and her the peaceful end with which perhaps they had consoled themselves and helped them reconcile to the inevitable.
He found he couldn’t bear to be on that unit, to see the faces of the others who’d been involved or to know that people were talking about him and pointing – he’d been complained about, and rumour and gossip swiftly forgot why and what the outcome had been.
And so he’d requested a transfer, said he’d go anywhere. And ‘anywhere’ had been just about what he’d got. And he’d thought his life could only really get worse.
- - -
“You’ll have to put in an incident report,” Hilary was saying, as they sipped their tea. Hilary was sitting on the floor, leaning back against the bookshelves; he had, for once, ceded to Alex the use of the office chair.
They had undertaken CPR on Mrs Thomas for nearly forty minutes before they’d regained a spontaneous pulse. By then the entire crash team had arrived, and she’d been intubated, sedated and taken away to Intensive Care for further treatment. She might wake up in three days feeling essentially fine, or she might never wake up again; it was impossible, yet, to tell, and so Alex had just finished explaining to her relatives. He’d emerged from that meeting feeling numb, with a sort of throbbing background despair; everything was combining in his mind, the hour just past and June and Connor and Connor’s role in what had just past and...
Hilary had taken him by the arm and dragged him gently to the office and put a cup of tea in his hands. Alex had sat for a moment starting at it, then had to put it down quite quickly as he began to shake with emotion.
Hilary came to stand over him, put an arm over his shoulders and just stroked his back, for a while, and then passed him the box of tissues and the tea again, and didn’t say anything.
“There has to be a report, I agree, but I can’t do it.” Alex put his now empty mug down on the desk, and braced his hands against the surface. “The thing is, I was...The surgeon who saw her, Connor Redgrave? I was sort of dating him till yesterday. Well, he says it wasn’t dating but, either way, for legal purposes, it still makes me an inappropriate complainant.”
He looked sideways at where Hilary was sitting.
“Ah,” Hilary said. His tone was very flat. “Good. Another form for me to fill in. If there’s one thing I don’t have enough of in my day-to-day life, it’s forms.”
“I didn’t mean for anything to happen the way it happened, you have to believe me.”
Hilary fixed his gaze on him. “Do I? And why would that be, exactly?”
“I didn’t know if I should tell you, if he would want me to,” Alex protested. “And it’s not like we talked about that kind of thing, or that I ever thought...” He tailed off. This was getting far too close to conversations they maybe couldn’t have, and certainly not in the middle of the working day.
“I’m sorry, Hilary,” he said, instead. “I was wrong. A lot.”
Hilary tilted his head to one side and studied him for a minute. “This may be hard to believe, but I am in fact not always perfect myself. Now, Dr Aquila – shall we be Dr Aquila and Dr Coates for a while? It might be more restful? Dr Aquila, unless anyone else has tried to shuffle off their mortal coil since we came in here, I think we’ve got another forty patients to review.”
- - -
- - -
For just over two weeks after Mrs Thomas’ cardiac arrest, Hilary had treated Alex with a sort of generic politeness which if Alex never known him be any other way, he might have considered pleasant enough.
As it was, he found himself wishing for Hilary to slip into teasing again, or joking, or even mocking him. But Hilary had retreated into himself, sometimes literally curling up in his chair as he worked away, and Alex didn’t feel he had the right to demand more of him.
Bizarrely, he found himself recalling the day of the arrest almost wistfully. The time for which he and Hilary had been working together to run the arrest, smoothly integrating their actions, combining perfectly as a team despite the chaos around them. And then afterwards, Hilary’s almost tender care of him, which it was dangerously tempting to think stemmed from something deeper.
Alex didn’t really have any right to think about that, either.
Hilary had filed the clinical incident report regarding the misread ECG. Alex only hoped Connor would have the sense to admit his mistake right away, and to try and learn from it in the future.
He’d not seen Connor again, other than occasionally at the very end of a corridor. Alex went to the small cafe in the Outpatients Department for his sandwich, now, and Connor had never tried to get in contact.
Alex wasn’t even as hurt by that as he might have expected to be. But he had thrown away Connor’s mug from his flat. And washed all the sofa covers, a thankless, surprisingly challenging task. i
“Guess what?” Alex said one day as he came, with his sandwich, into the Ward 12 Office. “Mrs Thomas got discharged home today.”
“From the cardiology ward?” Hilary looked up from his paperwork. He’d seemed a little distracted that morning, Alex had thought, but he smiled now. “That’s excellent.”
“It’s lucky, very lucky,” Alex sat on the office’s second chair – a new addition, liberated from the Ultrasound Department – and put his lunch down on the desk. “She was very lucky.”
“She was lucky you got in early to look at those notes. Even having had that oxygen mask on before she arrested might have made a difference, you know.”
“I suppose so.” Alex picked at the packaging of the egg sandwich and sighed. “I have to say, it’s a really good team you’ve got here, with the ITU involvement and everything. The patients get sorted here more quickly than at the big hospitals I’ve worked at, that’s for sure. Just less far to come, apart from anything, I guess.”
“Look, I know you haven’t taken an annual leave yet,” Hilary was saying, and Alex, surprised by the turn of the conversation, looked at up at him. “So I don’t know if you know, but it’s a rule here that there has to be a minimum of a week between the application going in and the start of the leave. Which means that if you want any time before Christmas off, you’ll need to get in there soon.”
“Oh yeah, well,” Alex sat up, “what leave do you want then? Because honestly I’m not bothered. I don’t need any extra besides the bank holidays themselves, not really.”
“You’re not going back south?”
“My Dad and his girlfriend are having Christmas away in France, at her parents’ house. They invited me, but...” Alex sighed. “I’d be glad of an excuse, in a way, not to go. I don’t feel like... I don’t really feel like people, not at the moment.”
“Ah, right,” was all Hilary’s response at the time, followed by “Cup of tea with your sandwich?”
It was funny, Alex thought to himself as the tea was being made. He’d thought that June had made him unhappy, but now, more and more, he wasn’t sure if he’d been happy before that, either. He’d not wanted to come to Castellum, but had he been so sure what he’d wanted in London? Had he wanted anything there?
The nearest he’d felt to being contented, in a very long time, had been out on the moorland.
When Hilary returned with the two cups of tea, he had a thoughtful expression.
“Alex,” he said, as they sat drinking, eking out a few last minutes of their lunch break before going to get stuck in on the jobs list again. “Thing is...” He sat forward properly in his chair, cradling his mug, and seemed to compose himself. “Thing is, Alex...”
Alex had never seen Hilary at a loss for words. He leant forward in his turn, moving cautiously, as if around an animal he didn’t want to spook.
“Basically, I’ll be going to my aunt and uncle for Christmas, right?” Hilary swallowed. “That’s my Mum’s sister and her husband. They live up in Northumberland. And that’ll be probably only barely tolerable, admitted, because they have four children under the age of six and he was one of my Granddad’s Northumbrian smallpipe pupils, and far from prodigious, and every year she tries to do something out of Heston Blumenthal and we end up with pine-flavoured goose or something similarly post-modern, but...”
Alex’s chest had become tighter, and his mouth dry.
“But would you like to come and spend some of the day with us?” Hilary finished. “Just lunch and the evening, that might be the best way to avoid the children. And on Boxing Day I’ll be at my house doing a Who-a-thon and bitching about Steven Moffat to myself, so if you’d like to come and contextualise my ranting by being someone listening who isn’t my goldfish, then...” and he looked up, finally, and met Alex’s gaze, and his eyes were anxious.
Alex took another sip of tea, to loosen his tongue and to give him strength.
“You don’t have to be nice to me, Hilary,” he began, carefully.
“If you think I’d put up with someone I didn’t like through my lone two days of holiday in the last seven months out of the sheer goodness of my heart, you’ve really not been paying attention.”
“Actually, I don’t really think I have been,” Alex admitted. “You do know... I mean, are you OK with, with what I...”
“You mean the fact that you date guys?”
“I mean the fact that I want to date you.”
For a moment the words hung between them in the silence. Alex was strangely conscious of the cramped familiarity of the room, the ugliness and awkwardness of it, and how harsh the neon strip lighting was, and the abandoned box of incorrectly-sized mask filters in the corner. This room would be another place he’d never manage to erase from memory. Or might it be somewhere he’d never want to forget?
“Ah, I see. I wasn’t certain. But I see. And all things considered,” Hilary said, slowly, “I think that is a truth to which I could resign myself.”
And he grinned, broadly and beautifully, and only the entrance of a staff nurse with a sheaf of blood requests the phlebotomists had been unable to complete, prevented Alex from showing him exactly what he thought of his vocabulary.
- - -
“I want you,” Alex said again, purposefully. “I want to touch you, and hold you, and, this is going to sound stupid, but I want to have sex right now more than I ever have before, ever.”
Hilary smiled and reached out for him, curling his fingers into Alex’s hair. They were standing in front of the gas fire in the living room at Hilary’s house. It was Christmas Eve, they’d managed to leave the ward at half past three, and they’d spent a great deal of the past few hours talking, until finally Hilary had risen to adjust the fire and Alex hadn’t known how not to follow him, how to spend a moment longer not touching him.
“Well,” Hilary was saying, smiling, “you did say you’d always be honest with me. Perhaps a full flow of consciousness is a little disconcerting, but I have to say I rather like it.”
“I just can’t think about anything but you, you’ve always made me do that, I don’t know how.” Alex sighed, stroking his hands along Hilary’s shoulders and arms in turn. “It annoyed the hell out of me for so long, before I realised what was annoying wasn’t the having you around, it was the not having you around enough.”
Hilary drew him closer and kissed him. Alex let his hands wander down Hilary’s back to mould round his behind. Hilary sighed into his mouth beautifully and Alex drew him closer, pressing their erections together, which was met with a gorgeous murmur, and a squirm that Alex found most pleasing.
“You’re really far too handsome,” Hilary informed him, a touch of breathlessness making the words rather less supercilious than perhaps he’d intended. “When I saw you that first day, standing there, I didn’t know half what to do with myself. I was petrified I was being a total prat, and all I wanted to do was, well, this really.”
“From the beginning?” Alex couldn’t quite believe it. “All that ‘Dr Aquila’ and teasing and being utterly impossible, that was your way of fancying me?”
“I never claimed to be normal,” Hilary retorted airily.
“I never accused you of being anything of the sort,” Alex told him, and kissed the tip of his nose.
- - -
“Fuck!” Alex gasped, and leant his forehead forwards against Hilary’s.
“Action correctly identified, full marks,” Hilary panted out, from his position on his back, legs spread, looking up at Alex and just, just opening, just taking, just...“I don’t recall any of the words I’ve said in the past ten minutes being ‘stop’”, Hilary was saying now, and shifting a little, and Alex couldn’t actually see any more, it felt so good.
“I feel like I ought – oh god – to get you to stop talking,” Alex confessed, bracing himself and trying to start moving without totally losing it and finishing everything in the next five seconds. “But your pedantry is strangely erotic.”
And for some reason it was this that made Hilary flush, all across his chest and neck, and pant and crack a little, and put his arms round Alex’s neck and start to just whimper at him, until Alex wasn’t thinking or counting or planning to move at all, they just were, together, chasing and catching and falling down, still tangled, slippery skin sliding, and holding each other.
“You know, I’ve never been myself so much for so long around one person.”
A little surprised by the words, Alex sat up to get a better look at Hilary’s face. They’d been dozing a while, the room had darkened, and it was getting pleasantly warm as the heating came on. Outside Hilary’s bedroom window, the very lightest flakes of snow were starting to fall, illuminated by a lamp over the nearby lane.
Alex leant in and kissed him again. He wondered if it would ever be less intoxicating, less marvellous, the taste of Hilary’s mouth, the way he moaned and yielded and kicked at the same time to let you know what he wanted.
Alex had come to Castellum injured and angry, and Hilary had brought him back to life, so slowly and so surely Alex had scarcely noticed it. And he’d never realised how much pain was there until, now, it wasn’t any more.
“I’ve never really known myself at all,” Alex confided in return. “Not until you.” He swallowed, looked away, and then steeled himself to speaking again, because with Hilary he could, he did, and it was stupidly amazing how good that freedom was, up there with the touching and all of it.
“I told you I’d always tell you the truth,” he began. “So you might as well know I’ve arranged to stay in the North, at least for the rest of this year. I like it here, and that’s not just you, I mean... I mean, I don’t want to pressurize you in any way or freak you out, but I want you to know when my rota shifts in January, that doesn’t necessarily mean I’ll be going anywhere.”
Hilary gazed up at him for a long moment. It was hard to tell in the darkness, but there seemed to be a certain sparkle about his eyes.
“Never thought you could bear to leave my tea-making skills.”
“That must be it.”
Hilary kissed him. “You’re still coming down to help me brew the pot now. And then there’s dinner to cook. And the mince pies for tomorrow. I’m teaching you to make pastry if it’s the last thing I do. Which, going by how it went with the cake, it may well be.”
“Remind me why I put up with this insubordination?”
“Oh, well, if you don’t mind waiting for the tea,” Hilary was curling back towards him, grinning. “I suppose I could dispose myself to put on a small demonstration.”
- - -