The Dilemma Read online

  About the Book

  Call yourself a nurse. I thought you could help me. You’ve just left me here to suffer.

  Haunted by her grandmother’s dying words, Dawn can only take comfort in the oath she took on becoming a nurse: first do no harm. It’s a promise she believes in, and takes seriously.

  But when a terminally ill patient begs Dawn to end her suffering, Dawn is faced with an unimaginable choice. Except this wouldn’t be murder, it would be mercy – wouldn’t it?

  When she starts receiving threats, Dawn realizes that someone knows her terrible secret … and that their silence will come at a price. She risked everything for what she believed was right once before – but will she know when to stop?

  Previously published as IN SAFE HANDS

  Contents

  Cover

  About the Book

  Title Page

  Dedication

  Acknowledgements

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-one

  Chapter Twenty-two

  Read more

  About the Author

  Also by Abbie Taylor

  Copyright

  THE DILEMMA

  Abbie Taylor

  To Peter and Jemima

  Acknowledgements

  Sincere thanks to Marianne Gunn O’Connor, Pat Lynch, Vicki Satlow and Jessica Broughton.

  Chapter One

  ‘Nurse!’

  The shout came from somewhere out on the ward.

  Sister Dawn Torridge glanced towards the door of the side room. Someone wanting a glass of water, most likely, or the commode. Clive and Elspeth were both out there. One of them would see to it.

  She turned back to her patient.

  ‘All right, Mrs Walker?’ She smiled at the elderly lady propped up on her bank of pillows. She was helping Mrs Walker to drink, holding the cup to her lips, supporting her head so that she could swallow. ‘How are you getting on with that tea?’

  Mrs Walker wasn’t in a position to answer but it was clear from the way she sucked at the cup that the dark brown liquid, tepid and unpleasant as it must be, was very welcome. From outside the window, six floors down, came the distant rattle of a train hurtling over the railway bridge, but up here in the little room all was peaceful, the only sounds the little gasps between mouthfuls as Mrs Walker drank her tea and the regular beep of the antibiotic pump beside her bed. Mrs Walker’s lips were dry, cracked and sore-looking. How long had she been lying here like that with the cup on her bedside table just out of her reach? Dawn made a mental note to remind the junior staff to check that the patients were able to feed themselves before leaving them alone with food or drinks.

  ‘Nurse!’

  That shout again from the ward. Something in the tone of it. Dawn frowned and lifted her head.

  ‘NURSE!’ The panic was unmistakeable. ‘Somebody! Come quick!’

  Dawn jerked the cup of tea back on to its saucer. ‘Just a moment,’ she said to Mrs Walker.

  She put the saucer down and hurried to the door.

  Clive and Elspeth were nowhere to be seen. Halfway down the long, high ward with its rows of blue-curtained cubicles, a man in brown pyjamas was kneeling on his bed, peering towards the nurse’s desk. As soon as he saw Dawn, he raised his arms over his head and began to semaphore wildly.

  ‘Sister!’ He jabbed his finger towards the curtains around bed eleven. ‘In there. Quick!’

  Dawn was already running down the ward. Her mind flew ahead, recalling what she knew about the patient in bed eleven. Mr Jack Benson, aged seventy-two. Post-op thyroid surgery earlier that morning. He had been perfectly stable when she’d last seen him, not two hours before.

  ‘Keep a close eye on him,’ she had warned Clive, the senior staff nurse. ‘Thyroids can be dangerous. I’ve got a budget meeting to go to, but any problems, just page me and I’ll come straight back.’

  The budget meeting had gone on longer than expected but there had been no word from Clive which Dawn had taken to mean that all was well. Now, as she approached the bed, a harsh, scraping noise, Huuuh, huuuh, from behind the curtains made her heart shrink back towards her spine. Oh no, please. Not this! She hadn’t heard that sound in years, but you only needed to hear it once to know immediately what it was. She grabbed the curtains and flung them back.

  Jack Benson was sitting upright against his pillows. The buttons of his paisley pyjama jacket were open to the chest. Studded around his neck, like a gruesome, Frankenstein-monster necklace, was the row of metal staples from his thyroid surgery that morning. But that was not what made Dawn step back in shock. Mr Benson’s neck had swollen to twice its normal size. It looked as if a giant, mottled, inflatable tyre had wrapped itself around his throat, throttling him, squeezing the air from his lungs. The pressure of it made his eyes bulge. He was clutching at his neck, gasping for breath.

  Dawn acted immediately. She jabbed her finger on the emergency button over the bed. As the high-pitched jangle sounded over the ward, she yanked the oxygen mask from the wall and stretched the elastic around the patient’s head.

  ‘All right, Mr Benson.’ She forced her voice to sound calm. ‘Breathe this.’

  Jack Benson pressed the mask to his face with both hands, sucking frantically at the oxygen. Huuuh, huuuh. The plastic of the mask fogged and cleared, fogged and cleared. Then he looked at Dawn, his eyes wide with terror. It’s not working. Do something.

  Running feet sounded outside the cubicle. Clive and Elspeth appeared around the curtains.

  ‘Oh God.’ At the sight of the swelling, Elspeth put her hand to her mouth.

  ‘He’s haemorrhaging,’ Dawn said. ‘The pressure is blocking his airway. Clive, get the crash trolley. Elspeth, you stay with him while I page the surgeon.’

  She ran to the nurse’s desk and punched the pager numbers into the phone. Hurry. Hurry. Over by the bed, Elspeth stood twisting her fingers around each other. ‘Take his BP,’ Dawn mouthed at her. The phone rang. She snatched up the receiver.

  ‘Coulton here.’ A bored drawl.

  One of the new registrars. Dawn couldn’t put a face to the name. She wasted no time filling him in. ‘This is Sister Torridge, from Forest Ward. The post-op thyroid in bed eleven is haemorrhaging.’

  A sigh from the phone. ‘You mean there is a slight bleed from his wound.’

  ‘No. I mean there’s a major—’

  Dr Coulton interrupted her. ‘What’s his blood pressure?’

  ‘We haven’t done it yet, but—’

  ‘Well, Nurse, surely that would be the first thing? I’m up to my eyes here in A&E. If you could make sure to have the complete information next time you call, that would be extremely helpful.’

  Dawn blinked. Did this patronizing-sounding junior doctor seriously think that a ward sister was incapable of recognizing a seriously ill patient when she saw one?

  She kept her tone neutral. ‘Dr Coulton, you may not be aware, but Mr Benson had his thyroid removed only this morning. The haemorrhage is now pressing on his trachea. If something is not done about it in the next ten minutes, I am warning you, Doctor, he will die.’

  She didn’t wait for him to argue but put the phone down and hurried back to the
bed. Even in the couple of minutes she had been away the swelling in Mr Benson’s neck had increased. His face was dark red, suffused with blood; the pressure was blocking his circulation as well as his breathing. He was scrabbling at his neck as if to literally tear the flesh away from his airway. Huuuh, huuuh. His shoulders heaved with the effort; it must have been like trying to suck air through a tiny straw. Dawn dropped her gaze to his bedside locker, searching quickly through the objects there for what she wanted. A bottle of purple grape juice. A pair of glasses, folded on top of a book. A sheet of paper, folded in half, covered with shaky green print: Get well soon Grandad. Then she saw it: a set of staple-cutters, still in their sterile packaging. The strict rule on Dawn’s ward was that a set of these cutters was kept beside every thyroid patient at all times so that in an emergency no one would have to hunt for them. The only way to release the intense pressure in Jack Benson’s neck was to cut the staples in his wound. Open it up so that the haemorrhage could escape. She snatched the cutters from the locker and ripped them from their package, ready to hand them to Dr Coulton as soon as he arrived.

  They waited in a tense semicircle around the bed, Dawn gripping the cutters, Clive parking the crash trolley, Elspeth still with her hands to her face. Dawn looked towards the doors of the ward. Any minute now, Dr Coulton would be here. He would have known from her phone call to drop whatever he was doing and run. Jack Benson continued to struggle. Huuuh, huuuh. Sweat rolled down his face. Veins like blue worms bulged on his temples. He was leaning forward, supporting himself by gripping his hands on his thighs, concentrating utterly on each breath. The oxygen mask sat askew, the elastic pushing his grey hair into spikes around his face. He stared wildly around the circle of nurses. Help me. For God’s sake. Why are you all just standing there? It was extremely distressing to watch. Dawn straightened the mask, turned the oxygen up further, cranked the back of the bed upright to give him some extra support. ‘The doctor’s on his way now,’ she said. ‘He’ll be here any second.’

  She hoped. Something poked hard against her shin. The corner of the crash trolley, dislodged by Clive.

  ‘Not doing too well, is he?’ Clive said as Dawn looked at him.

  She couldn’t help herself. ‘Weren’t you watching him, like I asked you to?’

  Clive folded his arms, jutting his jaw forward. ‘Didn’t get a chance, did I? Ward’s been mayhem all day.’

  The ward was not busy and Dawn was sure she had seen him and Elspeth come from the direction of the coffee room just a few minutes ago. But now was not the time. The doors to the ward were still closed. Where was Dr Coulton? Jack Benson was getting worse by the minute. The longer that pressure remained around his trachea, the more it would be crushed until eventually the entire airway would swell up and close. If that happened, no matter what they did it would be too late to save him.

  ‘Page that doctor again, please,’ she told Clive. The skin on Mr Benson’s neck was bulging between the staples. Dawn felt the spring of the cutters in her hand. She could cut the staples herself, quite easily. Nurses removed stitches every day. But this was no normal wound. Opening it would release the massive pressure, not just on the airway but on the haemorrhage itself. With no surgeon or equipment to control it Mr Benson might well bleed to death. The strict rule, handed down from Professor Kneebone himself, was that it had to be a doctor who made the decision.

  Mr Benson’s hands slipped on his thighs. He fell back against his pillows. Had his breathing begun to quieten? The harsh Huuuh, huuuh sound begun to fade? He lay motionless, appearing to stare at something ahead of him in the distance, the terror in his eyes replaced by a filmy gaze.

  ‘He’s getting better.’ Elspeth clasped her hands to her chest.

  Dawn did not correct her. Mr Benson was not getting better. The fading breath sounds meant that hardly any air was getting through to his lungs. He was exhausted. In a few more minutes the sheer effort would become too much for him. When it did, he would lose consciousness and it would all be over.

  ‘Go on home,’ Dawn had advised his wife and daughter only that morning. ‘Try to get some rest. He’ll sleep here for most of the day.’

  ‘Are you sure, Sister?’ His wife, a slim, well-dressed woman in her sixties, looked as if she herself hadn’t had much sleep the previous night. ‘It was such a big operation. I don’t like to leave him.’

  ‘He’ll be fine.’ Dawn had looked her straight in the eye. ‘I promise. He’s in good hands here.’

  And so they had left him just three hours ago, trusting her that he would be safe.

  She looked again from the staple-cutters to the doors. No matter what she did, the odds were against her. Open the wound: Jack Benson might bleed to death. Do nothing and he would suffocate right here in front of her eyes. Behind her, Clive, back from the phone, said with relish, ‘Very grey, isn’t he? I don’t think he’s going to make it.’

  Dawn stood straighter and gripped the cutters. ‘Yes. Yes, he is.’

  She couldn’t wait any longer. Rules or no rules, this man’s life was in her hands. She was the Matron; he was her responsibility. If she made the wrong decision, so be it. But she would not stand here, do nothing and watch him die.

  Her hands were steadier than she would have expected as she placed the cutters over the first staple. The clip was almost buried in the swollen skin but she managed to prise one of the blades beneath it. Mr Benson didn’t react. He was beyond feeling anything now. Dawn brought the handles of the cutters together.

  Snap! The first staple cracked in two. She moved on to the next.

  Snap! Snap! Snap! No going back now. One by one, the staples flew apart. The wound opened. A wave of scarlet gushed down over Mr Benson’s chest.

  ‘Jack.’ Dawn shook his shoulder. ‘Can you hear me? Can you breathe?’ His eyes remained shut. Was his chest still moving? She leaned forward to listen. Anything? Any air coming out? She shook him again. ‘Jack!’

  A tiny flutter, like a heartbeat, at her side. She looked down. The flutter was Mr Benson’s hand, moving in the air. The hand groped for her arm, found it, gave it a feeble squeeze.

  Dawn took his hand and gripped it back. ‘All right,’ she whispered. ‘All right. Well done.’

  He was breathing. She could hear him now. The massive pressure had left his trachea; the air could flow through it again. But now they had a new problem. The blood was still pouring from his neck, soaking into his pyjamas. Grimly, Dawn eyed the widening crimson circle on the sheets. They needed to get that stopped; needed to get him to theatre as soon as possible. How much blood was in the bed now? One litre? Two?

  ‘Call transfusion,’ she said to Elspeth. ‘Tell them Mr Benson needs six units.’ She turned the spigot up on his bag of saline so that the fluid stopped dripping and poured into his arm like a tap.

  With a rattle, the curtains swished back further. Standing in the gap was a tall, thin, balding man in a gleaming white coat. Dr Coulton, Dawn presumed. His eyes held a bored, supercilious expression: This had better be good. One look at Mr Benson, however, and the superciliousness was wiped from his face.

  ‘What’s happened here?’

  ‘I cut the clips,’ Dawn said.

  ‘You cut the clips? What the hell—?’

  He pushed past her, rushing at the patient, feeling his hands, pulling his eyelids down, barking out orders. ‘What’s the Hb? Let’s get some blood up here. Now! Have we called theatre? Tsk, Nurse.’ He spun to Dawn. ‘I hope for your sake that what you’ve done here was necessary.’

  If he had bothered to come up sooner he could have seen for himself whether it was necessary. But Dawn didn’t attempt to argue. It was she who had made the decision to open the neck. If she had been wrong, she would deal with the consequences. Right now, the most important person here was the patient. She returned to the phone and quickly made the calls necessary to organize theatre, transport, ITU. Then, as the theatre porters crashed through the doors with the trolley, she gathered up everything Mr Benson
would need for his trip: oxygen tank, monitor, spare bags of saline, jets of adrenaline.

  The last thing she did, so that the team would not have to pause for even those precious few seconds, was to walk ahead of them to open the heavy wooden doors.

  Light streamed from the ward into the hall. Down the corridor they flew, the two porters in their dark green theatre scrubs; the pompous new registrar, his white coat flapping importantly; Mr Benson, pale and still in his pool of scarlet. Dawn watched him on his way, motionless in her navy uniform, her long shadow lying before her as she stood between the doors of her ward.

  ‘The airway was almost completely crushed,’ Francine, the ITU sister, reported later that afternoon. ‘Another few minutes and it would have been too late.’

  Around them, the rows of heart monitors and dialysis machines clicked and beeped. In his high bed, Mr Benson lay unconscious, his head and neck wrapped up with long strips of gauze, covering every part of his face except his nose. From somewhere in the middle, his breathing tube stuck out, connected by a plastic hose to the ventilator. He looked like a giant white mummy. But after a fraught three-hour battle in theatre to get the bleeding under control, he was finally safe.

  Francine was adjusting the flow on the blood bag over his bed. ‘Professor Kneebone told the theatre staff that if that wound hadn’t been opened when it was, he would have died.’ She nudged Dawn with her elbow. ‘Well done, Dawn. The only reason he’s still here is because of you.’

  Mr Benson’s hand lay white and still outside his sheet. ‘It should never have got that far.’ Dawn touched the waxy skin. ‘I thought I could trust Clive to watch him. If the patient in bed ten hadn’t looked round his curtain to borrow some headphones …’ She shuddered.

  Francine quirked an eyebrow at her. ‘Cuppa?’

  ‘Yeah, lovely.’

  In the tiny, toast-smelling ITU kitchen, Francine switched on the kettle and spooned powdered coffee into mugs.

  ‘Clive’s that new nurse, isn’t he?’ she called from the draining-board. ‘Scruffy-looking bloke? Looks like he could do with a good wash? Maybe he didn’t realize how serious it was.’