Stronger Than Death Read online

  A full post-mortem takes a lot longer than you might have been led to believe. It can take weeks before all of the lab reports come through, but even the basic autopsy, the first dissection, is a long, slow and tedious process. Speed, you understand, is inversely proportional to detail and Lee has never been one for missing details. If you remember that she was a surgeon once and then imagine micro-vascular surgery performed on every organ system, every cavity, every orifice, every appendage, then you might have some idea of the process and how long it takes. The only difference is that, with the dead, there is no real need to stop the bleeding. And, of course, with the dead, all the bits end up tagged in bags on the floor.

  She was right, of course, I hadn’t had the practice. She, at least, had come close. She did Bridget for me and she was there for Malcolm and if neither of them were her lovers, they were close enough to be family. Dee hadn’t had the practice either, but she wasn’t as close to Eric as either of us, so maybe she didn’t have the need. Either way, she stayed for most of it, with the odd short break here and there to check on the ventilators in the ICU and a bypass in the cardiac ward that was slow in recovering. The second time she came back, she brought a plastic A4 folder stuffed with photocopies and laid it on the stool beside me.

  ‘I was thinking, since you’re staying, did you want to do something useful with the time?’

  Not really. I want to sit here and watch Lee and work out how much more of this she can take before she cracks. She hasn’t started on his face yet. He’s still lying there with the grim rictus grin and the wide-open eyes. If she cracks for anything, it’ll be for his face. About an hour or so yet, I would say. Time enough.

  I opened the folder. The top paper had my name in the author list, somewhere in the middle of a string that started with Dr Deirdre Fitzpatrick and ended with Professor A. Drummond. I lifted it out and flicked through the contents. Four pages and then a half-page of references. Two weeks’ solid work. Last time I saw this, it was in rough-draft with a list of professional comments pinned to it that took another long weekend to sort out. I never really expected to see it in formal print. Twelve hours ago, the sight of this would have made my week.

  ‘Happy?’ There was concern in the music of her voice, as if it mattered that I be happy. I’m not used to that with Dee.

  ‘Yes. Thank you. I didn’t know you’d got it back—’

  The sudden scream of a power saw knifed through us both. Mike, in gloves and goggles, cut down the sternum into the thorax. Lee reached in and lifted out a heart that, three days ago, was beating less than two yards from mine. It lay still in her hands, a red-brown egg of a thing, as cold and lifeless as the air around it. Her face was set in stone. Mike’s was haggard beyond anything I’ve ever seen, old long before his time, his beak of a nose turning blue with the cold, and the rest of it red with the things he was seeing and not saying.

  Of the four of us, he’s the only one showing any reasonable range of emotion. We can’t all keep it up for long.

  I slipped the papers back into the folder and handed it to Dee.

  ‘Not now.’

  ‘Grand.’ She slid the folder on to the floor and sat down beside me. ‘So long as you’ve read it by Monday.’

  Monday … ?

  One eyebrow arced upwards towards the razor-cut edge of her hair. ‘Monday,’ she repeated. ‘The day after tomorrow. You and me are defending this to the gathered sceptics of the West of Scotland Medical Association at two o’clock in the afternoon.’ Her eyes flickered from grey to green and back again. Hard eyes, like her hair, so much harder than her voice. Not comfortable to be with. She leant forward and laid the paper once more on my lap. ‘You hadn’t forgotten?’

  Oddly enough, I had.

  Lee tested the lungs for buoyancy and found that there was air present in the alveoli at the time of death. So he didn’t drown, but then we knew that. My fingers, holding the paper, were damp. In spite of the cold, they were damp.

  The paper was glossy. A reprint of August’s Journal. One of the sharp-edged, expensive copies they send to the senior author ahead of publication. I turned to the third page and looked at the diagrams. It took me close to three working days fighting with Photoshop to get those diagrams right.

  There was warmth in the air behind me and Dee was there, looking over my shoulder. ‘They’ve come out well,’ she said.

  ‘They have.’ And there I was thinking I was wasting my time. ‘I really didn’t believe they’d accept it.’

  ‘You’ll learn faith in the end, if we work on it long enough—Oh, fuck it.’ Her pager hummed. She lifted it from her belt and watched a message scroll in green across the screen. ‘Would you believe it? Boy Wonder’s found an appendix. Now doesn’t that just make the night perfect.… ’ She pulled a theater hat from her pocket and jammed it on her head, softening, briefly, the effect of her crop, and smiled a surgeon-eating snarl. ‘See you in the morning.’

  ‘It’s only just gone eleven, Dee.’ Even the SHO can cut an appendix in less than forty minutes.

  ‘I know. The child thinks he’s on a roll. Wish me luck.’

  ‘Luck.’

  She left. What peace there had been in the room went with her.

  I don’t think of Dee Fitzpatrick as peaceful. She brings peace, unquestionably, to her patients, but then for Dee, the patients are the people and the medics are the idiots and that, largely, is what sets her apart from the rest. It’s not a problem, but it makes for a different mind-set and it took me a while, after we started working together, to accommodate. Dee’s not your usual medic. She’s one of those women who found her vocation late in life and the extra ten years spent living in the real world has made all the difference. Even as a student she was different: the single adult in a class of post-adolescent children, all revelling in the discovery of sex, drugs and crossed fingers as a way of life. Some of them have never grown out of it. Dee, as far as I can tell, never grew into it—although, being Dee, if she had, I wouldn’t necessarily know. She’s deeply, obsessively private and she guards the details of her personal life with a dedicated passion. We have shared an office for the past two years, she and I, and I still couldn’t tell you the names of her parents or her lovers or any of her homes before the flat she lives in now. I know the details of her professional career because they’re printed in the register. I know bits of her running career because she took time off last year to run in the Three Peaks and came back to work with the news she’d come in second. I know what she likes to eat, I know how she takes her coffee and I know, in explicit detail, what she thinks of her professional colleagues, me included, but beyond that, I know nothing. I used to think that as a therapist I could reach to the core of a person within the first few hours of meeting. With Dee Fitzpatrick I am discovering that this is not the case.

  All that aside, she is the perfect clinician for a palliative care unit: a fully qualified anaesthetist with a sub-speciality of pain control in the chronically ill. There are not many of those about and even fewer prepared to learn the ropes of terminal care. For a profession that spends so much of its time with the dying, we know very little about what we can do to make the closing stages of life bearable rather than unbearable, to make death an experience to be embraced, rather than one to be denied even after the event. We are learning, but slowly, and with decades of wilful ignorance to be cleared before we can start from a decent baseline. For me, I am growing out of an early scepticism to see the Unit as something deeply worthwhile. For Dee, this is the vocation she has been looking for, and where I might be prepared simply to sit at the bedside and hold a hand and talk and help to build the images that will manage the pain, Dee has the need for the wider world to know and to listen and to be made to understand. So we’ve spent the last eighteen months finding ways to measure the unmeasured, to quantify the unquantifiable, and on Monday, we will present our first paper outlining preliminary work on the use of guided imagery to reduce the dose of analgesics in the terminal cancer pa
tient. Some members of the audience will listen. A few may understand. If we’re lucky, the rest won’t take it apart. And it will all go more smoothly, no doubt, if I have some memory of what we are supposed to say.

  So I did my best. I turned over the pages. I studied the diagrams. I tried to remember the patients by name, because that, in the end, is what matters: people and their pain. Or their relative lack of it. In the meantime, Lee finished the thorax. She went through the abdomen and found nothing. Starting on the skeleton, she measured the breaks and the angles of impact and the bruising on the limbs. The next time I looked up from the whirling diagrams, she was standing at the top of the slab with his head in her hands. The line between her eyes was a chiselled gorge. Her hair had matted again to her forehead and this time it had nothing to do with the salt spray of the sea. Still, she didn’t weep.

  Dee came back, kicking the door shut behind her. It was just gone one o’clock. She looked about as good as you’d expect after an extra hour in theatre. She looked at me and she looked at Lee and she said nothing. She pulled off her theatre cap and carefully, silently, she tied it in a knot and threw it into the clinical waste bin. The soft noise of its landing rang round the room. A very vocal gesture. Very little rattles Dee but the Boy Wonder probably comes closer than most. I leant over towards her. She may not have needed to talk but the silence needed words.

  ‘How was it?’ I asked.

  ‘Slow.’ She tore off her mask and it joined her cap in the bin. ‘ “A good surgeon deserves a good anaesthetist. A bad surgeon needs one.” British Journal of Anaesthesia editorial, nineteen hundred and something small.’ She smiled, a dry, wry, self-deprecating smile. ‘I don’t think I’ve got what it takes to compensate for the Wünderkind throwing a late-night technical tantrum.’

  ‘That bad?’

  ‘Worse. The child thought he’d practise doing the whole thing through an incision you could barely get one finger through. Read it somewhere in an American journal. I expect they used a ’scope to go with it and forgot to mention it in the text. Or he didn’t read that far.’

  ‘He only looks at the pictures.’ That from Lee, who can, apparently, draw a scalpel along a scalp line and still join in hospital gossip without losing the place. Mike, I think, held his breath.

  Dee looked at her and nodded slowly. ‘That figures,’ she said. ‘It doubles the surgery time at any rate. And he had to open up to the normal length in the end anyway. I thought I might just mask him down with isoflurane and do the surgery myself next time.’ Her voice carried more humour than her eyes.

  ‘You just bring him to us. We’ll do everything he needs.’ That from Mike, who will do whatever it takes to keep the silence at bay now, because he, of all of us, knows just how much Lee can take.

  Dee tilted her stool back and hooked her heels up on the edge of the slab. ‘I think you’d find the theatre nurses killing each other in the crush to get down here and take over your job,’ she said. The air moved in places where it had stopped before. Mike grinned for the first time since he’d wheeled the trolley off the roof. ‘No problem’ he said. ‘We’ve plenty room. We’ll cut him into wee bits and they can have a slab each to play on for as long as they want …’

  And so the atmosphere warmed, slowly. The air stayed frigid but the chill of it bit less deep in the lungs and the line between Lee’s eyes softened with it. It’s the standard medical response to death, and we do it consciously. If everything is reduced to impersonal nouns and the ritual dismemberment of the boy wonders in theatre, then the unbearable becomes that much more bearable. And tomorrow, which would otherwise be impossible, leans, at least, towards the probable.

  Tomorrow is Monday and by then I will feel different. Today, it is Sunday. It was Sunday when I went to bed; it was Sunday still each time I woke up.

  Early on, I heard Sandy drive into the yard. He called the colt across the paddock behind the pond and tethered him at the gate. Feed buckets rattled and the tap sang and the door to the tack room swung in the breeze as he fed and watered and polished his child. Some men polish their cars on a Sunday morning. Sandy Logan, horseman and yard manager, polishes his colt. It never lasts. By this evening, his lad will have run and rolled and kicked grass. The burnished copper will be matt with dust, the white socks streaked with green. If this is a good week, the star on his forehead might stay white beyond Wednesday. I sleep and dream of copper horses lined up along a cliff edge. They kick something off. I fall into endless water.

  A car door closes down in the yard. Wee Jon calls the rest of the ponies in from the paddocks. Eight of them: the full string for a Sunday. More cars. More people. A clattering of mounts and mounting. A babel of voices: German, Australian, English, a slurring of east-coast Scots. Wee Jon trying to make himself understood. He calls a command to move that the ponies know if no one else does. Horse feet crunch in tandem on the gravel. They head off into the sunrise for a half-day trek up round the loch. In the dream, the sun cracks open on the back edge of the ben. Eric steps out, Eric the clinician all done up in his white coat and his stethoscope. He calls me into a hospital ward where Nina is lying in a bed and explains to me that she is dying and that he has done all he can. He switches off the ventilator. My world ends.

  The back door opens. Someone puts the kettle on the Rayburn. The dog takes the stairs in three strides and lands on the bed with the fourth. I roll over to give her room. Keep rolling. There’s more space in the bed than there was. I hadn’t realized I was alone. Nina has gone. She was never here. The world has ended.

  I can’t handle this. God, let me go now and never come back.

  Air stirs around the bed. The room smells faintly of horse, of surgical scrub and disinfectant, of lemongrass and ginger. I am not alone.

  ‘Kellen?’

  She hasn’t gone. She’s there now, sitting at the end of the bed, caught in the small triangle of sunlight which is all that’s left of the morning. She has wood-shavings in her hair: two or three fragments caught up in the wild chestnut tangles, another hooked on the short sleeve of her shirt. The wind lifts the edge of the open curtain and the smell of surgical scrub is stronger than the smell of horse or of her. ‘Kells? Are you OK?’

  I sat up in the bed.

  ‘You’ve been in to work?’

  An unnecessary question. One day she will manage to stay away from that place for a full twenty-four hours. Just not yet.

  She smiled and scooped the cat on to the bed, a wilful and effective distraction. I moved over to give him space, ran my fingers down the ratchet of his spine, scratched along the old-cat fuzz of his coat. He rasped and dug his claws in the pillow and pushed his head at the back of my hand. We played games, old-cat games, the three of us. In time, I asked it again.

  ‘So? Did you go to work?’

  ‘Only for a wee while,’ she said. ‘Mo’s away and Steff’s got a mare in the ward with a bad sinus. I gave her a hand to flush it out.’

  ‘I thought that’s what the students were for.’ A token protest, out of habit.

  ‘It’s exams next week. They’re all locked in the library.’

  ‘No stamina.’

  ‘No.’

  There was a gap, a comfortable, comforting silence. Outside, a car engine cut off in the lane. I never noticed it arrive. The silence settled closer like an old duvet. The dog slid off the bed; her nails clattered loudly on the wood of the stairs. The cat followed, more slowly. Outside in the yard, two dogs and a man joined in a frenzy of greeting. In the bedroom, still, there was peace.

  She doesn’t push, Nina. She gives me the space to sort myself out when I need it. If I didn’t love her for anything else, I would love her for that.

  I stretched and rubbed the dreams from my eyes. I found all the muscles the climb had stretched, the bruises on both knees from the scramble for the ledge, and the hardening scabs on the backs of both hands. He was a good climber, Eric. There are no scars on the backs of his hands.

  Nina sat on the edge of the bed, w
atching, appraising, waiting. Her eyes are walnut, a shade or two darker than her hair. Once, they were the only gateway to the hell inside. Now, they stay peaceful unless she’s angry. There’s no anger now, just a simple concern and the warmth of the morning.

  I slid across the bed, reached for her hand, lifted it and kissed the palm. I ran my fingers, by habit, up the snake-line of the scar on her forearm. There was a time when she would never have let me touch that scar. A time, later than that, when I would have left the room to keep the scar, or the arm that bore it, safely remote. Other times and other places. Now, this close, the warm smell of her outweighs the rest: the smell of horse and of lemongrass, of home and of peace. I wrapped my fingers round the curve of her elbow and tugged her close—a reflex born of the night. Nina smiled her half-smile and her hand slid on past mine, smoothing across the arc of my ribs, moving round to knead the muscles of my spine, brushing across a graze I didn’t know was there.

  ‘Sorry.’ The hand moved on. ‘Did that hurt?’

  ‘Mmm.’ It did. It does. Did.

  ‘Let me look.’

  She pushed on one shoulder, turning me sideways. My legs hung loose over the edge of the bed as they had over the cliff. I watched the shrinking triangle of sunlight play shadow patterns on the old wood of the floor beneath my feet and felt her fingers explore grazes and bruises and the places in between. Fingers of warm, drifting laughter moved forward round the lines of my ribs and on and up to places where there were no bruises. I tilted my head back and she slid in behind me. Her knees held me close, bony and angular, with a small crescent on the left one, just under my fingers, where a foaling mare kicked out and caught her with the edge of a shod hoof. She’s all scars, this woman.

  The breath of her voice fell on my shoulder, erratic and damp. ‘You OK?’

  ‘Kind of.’ As close as I can get.

  I felt the silk of her shirt brush across my shoulders as she opened it and then the skin-warmth of her mould to my back. My head rested in the crook of her neck. Her arms crossed around me, pulling me tighter. One hand reached down and lay flat across a bruise on my thigh. Damaged purple tissue splayed out beneath her fingers. We looked down at it together. ‘You’re pushing too hard, Kells.’