Beautiful veins

M I C HAEL S M AL L, W RITER SUNDAY, 18 DECEMBER 2011

BEAUTIFUL VEINS Swimming back into consciousness, Kieran Maslow’s first realization was the sweet smell of burning flesh, his own, slightly tempered by the heat of hammers banging down alternately on the femoral replacement. Two oblongs of white material, he gradually realizes, were crossing over continually at the foot of the operating table.

Flickering his eyes about, he discovered his slab of flesh trussed up beneath a net that prevented any movement, unless suddenly shunted side to side as if he were cold turkey about to be carved up.

This second time around, he’d been wise to request a stronger anaesthetic than epidural.

Dozing, adrift. Disoriented, getting bearings by degrees. A cave of dissolving edges hived by dusky darkness. Save a shaft of dim light, a doorway. Occasional figures flitted into the shadows beyond his resting place.

Then at last a visor of shadow up close: ‘So you are awake then.’

For at least an hour. Possibly two. ‘Mm,’ Kieran smiled primly.

‘How are you feeling?’

‘Good, thank you.’

‘Any pain?’

‘No, none.’

‘That’s the way; but you can’t have anything to eat till eight o’clock. I’m Gerd and I’ll be with you till the night nurse comes on duty. Now do you know about the patient-

controlled analgesia?’

‘The what?’

‘Here,’ she said, ‘take this handset. If you need pain relief, push this button once. It won’t let you over-do it.’

Oh, yes, he remembered something from Pre-Admission.

‘You should feel some relief from the infusion pump in a couple of minutes.’

‘Thank you. I’m fine at the moment.’

‘I’ll just give your feet a feel then I’ll fit your catheter.’

O god, no! he groaned inwardly.

Two years previously he’d begged not to have a catheter inserted, pleaded for a whiff of morphine, then gasped and cried out by turns as the apologetic doctor threaded the tube through the eye of his penis. Now he was astonished that a female nurse would be attending to the task, especially when she slapped the cream on rough as old guts, though more measured when she shoved the wire in three incisive thrusts.

He exhaled, incredulous. ‘That time it scarcely hurt.’

‘You’re still under the influence,’ Gerd replied, matter-of-fact.

‘Wakey, wakey, I’ve brought you some tea,’ she announced later. ‘Can you sit up a little? Here, reach up and hold onto the monkey bar. Go easy.’ She swung the tray in.

Quite peckish after fasting for twenty-three hours, Kieran tucked into a modest portion of green salad, a thin slice of tasteless brown bread and a beaker of tea, but at the first sip of the brown soup he felt his temperature rise alarmingly, a rash welling up on the back of his hands, dizzy sensations, nausea and the rush of panic. He groped about for the buzzer.

‘What’s up?’

‘I feel sick, nurse. I’ve got a rash already,’ extending the back of his hand. ‘It was the soup.’

‘Just a moment.’ Gerd whisked the tray away.

‘Was that prawn soup?’

‘No, the kitchen never serves prawns. What else are you allergic to?’

‘Parsnips, turnips and swedes.’ And prawns, but I forgot to mention those on my list of allergies.

‘My, you are hot, aren’t you,’ she said, wiping his forehead with a napkin. ‘I’ll give you something for it and see if your temp’s up.’

Again the same nurse was on duty before breakfast the following day.

‘All ready to rock n roll?’

‘Sorry?’

‘We’re taking you down to the imaging centre to get a scan of your hip. So we need to unhook you and roll you onto the gurney.’

‘Okay.’

‘Which side’s the wound on? Right side, so we’ll do a half-roll onto your left, you move both hands onto this rail,’ she tapped. ‘Good man! Hold it. We’ll slide the under-sheet out.’

‘Uh,’ Maslow gasped and tensed, as Gerd carelessly caught the tube of his catheter.

He could feel the tug on his penis.

‘There. Now, easy does it, roll over onto your left side. Good! All done. Let’s roll ‘em on out!’ she directed to a couple of silent ring-ins.

Hauling the gurney with left hand out into the corridor and swinging wide to avoid the Zimmer frame of an elderly lady in pink woollen dressing-gown, Gerd cannoned into the wall without warning.

‘Uh!’ grimaced Maslow, as the jolt reverberated through every bone.

Oblivious to the patient’s anxiety, Gerd took off down the corridor between empty parked beds and wide-eyed seniors shying back in a huddle, brassed off about the impending strike. Bloomin’ pay could be docked, fines imposed. No way can I depend on a hardship fund. Only that morning she’d read in the Herald Sun that she could even risk jail in defiance of Fair Work Australia. What a downer of a day this is gonna be! She’d paged twice for transport, but the orderlies were too busy.

Anyway, she’d treat herself to a glass of wine tonight and a foot rub. I must get another packet of toe-spreaders from the 2$ shop, she remembered.

They descended by lift into the catacombs of the hospital, where the light grew gritty grey, the temperature dropping ten degrees. The stack-up of gurneys slewed like abandoned supermarket trolleys. Maslow felt a streaming freshness wash over his face.

‘Scanner techs are already twenty minutes behind,’ muttered a male orderly.

‘I’m not a happy camper,’ replied Gerd. ‘I’ve got to pick up meds from pharmacy, get meds into patient two on time and change his dressing, and this patient,’ nodding down at Maslow, who was beginning to feel guilty at the trouble he was causing, ‘will miss his first doctors’ round.’

Somehow with her strident voice and rough-caste complexion, she contrived to thread a way forward. Maslow braced when she hovered to roll him, but all of a sudden he was winched onto a Hover Matt and floating on a cushion of air without being bruised and battered about the privates.

On the second evening one of the doctors poked his head round the door, circumspectly, a stumpy-short man of Asian extraction. Shiny black hair, high cheek bones that lent plumpness to a boyish, unlived-in face. Plodding in his over-long white coat like a superintendent of a toy factory. Must’ve been in his early thirties, but could’ve been eighteen. Except that his training as orthopaedic surgeon cost fourteen years.

And closed the door behind him, discreetly.

‘How are you feeling?’ asked Dr Pang, without the usual heartiness or brisk efficiency of the surgeons who’d greeted him in theatre; more like the distracted air of a worry wart.

‘Really good, thank you,’ croaked Maslow, a soreness gumming the roof of his mouth.

‘Any pain?’

‘No, none at all. Unless I try to move my dodgy leg sideways.’

‘Try to keep that leg close to the mid-line and not roll the knee outwards.’

‘Okay.’ Then, because of the ominous silence and his own hazy drifting mood: ‘Actually I’m as smug as a mug in a hug. No, you goof. I’m as snug as a bug in a rug,’ he chirped, savouring the cerulean after-glow of anaesthetic and paracetamol and snuggled-up warmth in the soft mound of pillows. My blue heaven, what a cocktail!

The stumpy doctor didn’t register a smile. Perhaps he wasn’t ready to listen. ‘Do you mind if I ask you a few questions?’

‘No, of course not.’ In his current state of post-operative bliss, Maslow would answer to anything.

‘Some of them might seem rather . . . invasive.’

Gee, he is solemn. Maslow was intrigued. ‘Be my guest!’ Certainly, his anxiety before the hip operation had floated off on wisps of ether. His utter thankfulness that the op

was all over together with his new-found sense of peace were lubricating his dry mouth with the flow of speech. He carefully reached for the glass of water on the side-tray.

The youngish or inexperienced doctor paused, still wondering how to begin. He picked up a chair one-handed from the corner, shuffled forward sheepishly and deposited himself directly behind the foot of the bed. ‘How would you describe the general condition of your health?’

Jeez, how many more times? ‘Let me see: before the accident two years ago I was fit as a trout. But while hanging out all this time for the repeat operation, I’ve occasionally been bitten by the black dog.’

‘Par for the course, I'm afraid. Depression is quite common when queues for major surgery are so long in public hospitals. What about when you were younger?’

Still no nibble. What is he banging on about? ‘Just the usual illnesses of a kid growing up in the fifties: boils on the legs that my infants teacher, good old Miss Minette, used to bathe at the front of the class . . . mumps, measles, chicken pox, tonsillitis . . . a stream of heavy colds and catarrh, all that free creamy-thick school milk in bottles . . . the very real scare of polio . . . oh and whooping cough at the age of two. I’ve still got the scar across my lung,’ he said with a trace of pride, as if he’d fought on the front line in the sombre glazed green and bog-brown wards of his morbid youth. And he recalled a picture of his mother in a hospital bed at Mayday, her ashen face twisting round to give a final glance of goodbye to Kieran and his younger brother and sisters, as if the grim reaper were stalking all of them. ‘Lady’s problem,’ their father muttered in the creepy cold corridor to kill their fretful whines of enquiry.

‘I see,’ though the earnest doctor sounded dismissive. ‘And what about more recently?’

‘Occasional bouts of flu. Generally, I’ve been in pretty good nick. Sometimes I get a bit run-down with my lecturing load. Bigger classes, the expectation to publish or perish. Low energy levels. But the next day, I’m right as rain. Soon as I mount the podium and claim that lectern, the energy kicks in. Has to. Otherwise you’re a

candidate for sick leave big-time.’

‘Forgive me,’ he murmured, conspiratorially, ‘do you do drugs?’

‘Huh, didn’t have to in the sixties and seventies. Just breathed in deeply,’ Maslow chuckled. ‘But seriously, since then I’ve been clean.’

Too quickly, as if to cover his own embarrassment, the doctor spoke: ‘Have you ever had any sexual diseases?’

An almost imperceptible wince about the patient’s eyes didn’t escape the inscrutable Doctor Pang, even allowing for the subdued light of early evening in a windowless one-bedroom ward.

‘For the first time in their conversation, Maslow’s delivery was slow and hesitant.

‘Not that I know of . . .’ as if trawling through the strategies of recent campaigns. venereal a. Of sexual desire or intercourse; relating to a disease (contracted by sexual intercourse with person already infected); hence –LY adv. [ME, f.L. venereus (pertaining to sexual love) + -AL] ‘Oy, Purity! Betcha didn’t know you can catch the pox from sitting in the bog or drinking from a dirty cup or kissing a girl who’s got it?’ bragged Joey Benwell, taking a playful swing at Maslow’s balls in the schoolyard.

Like a flash, it comes back to haunt the thirteen year old naïf - Dreaded Monday afternoon: cadet parade after lessons in full battledress. The heavy, prickly khaki impinged on one’s genitals. After square-bashing and rifle drill, his knob was strangely tumescent. Once home in his bedroom, he wrenched it out. Trembling fearfully, for the first time he unsealed the whorls of foreskin. Flecks of dried skin mottled the crown. Then on the ring, what? ‘Smegma’, was that the word? Christ Almighty! Spots! Tiny white spots! His abdomen gave a huge yawing lurch, he felt sick, faint, slumping down onto the bed, his heartbeat thumping.

God, o God! he whimpered, rubbing himself frantically, but the spots stayed fast, horribly real, condemning. Beside himself with fear, panic more like, he snatched up

a pen-knife and began scraping at the hideous white pinheads, now and now and ouch, Christ that hurt! The loathsome shaft had turned raw and crimson, beads of blood settling into the folds of stinging skin. In wild desperation, he clutched at his testicles to examine. Larger white pimples on his scrotum!

‘Chancre’, ‘lesion’, ‘gonococcus’ . . . such were the words he secretively uncovered in the Oxford Dictionary in the darkest corner of the school library. They burned into his consciousness every sleepless night for the next eight years. Millions of spiralling spirochete he saw boring up and through his spinal cord, gummas invading his liver, buboes burrowing into the lymph nodes of his groin. Stooped, slumping, bilious, he was knocked every which way by his shameful disease. Hardly a crumb of comfort, but in his clumsy research he came across a theory that the bard himself was tainted by the chancre. He read the de Goncourt brothers, Edmond and Jules, men of letters in nineteenth-century Paris. In his diary, Edmond records how his brother’s face becomes more flaccidly unrecognizable by the day, a rubbery mask to his brother’s consternation, as the syphilis eats its way up the spine. Adolescent Kieran terrified himself witless. He could hear the very chomping.

O Guy de Maupassant, how did you cope? Weren’t you committed for insanity?

Twice? Christ, I might be dying for another twenty-five god-damned years!

Although he’d learnt to swear in a hurry, he’d somehow lost the art of shedding tears.

‘I’m very sorry to ask this question,’ the white-coat stumbled on, casting his blackeyed gaze downward, running his thumb-nail over the tips of his fingers. ‘Do you have any . . . er sexual partners?’

‘Three. No, just a couple. The other . . . defunct,’ Maslow said with a finality edged with irritation. And welling regret, he was surprised to feel.

‘How long have you known them?’

‘Ten years at least.’ He didn’t care to count.

‘And what sort of women are they?’

‘What do you mean?’ Maslow’s face crinkled with indignation. He tried to sit up with the aid of his knuckles pressing down on the mattress, before realizing he wasn’t supposed to move, couldn’t in fact.

‘Did they . . . do they have any other sexual partners?’

‘Is this interrogation really necessary? I’ve already provided answers to both PreAdmission and again yesterday morning to Admission.’

‘Yes, I know.’

‘Aren’t there privacy laws to protect against prying?’

‘Yes, you are right to be annoyed. Please believe me, I need to know. Honestly. More for my benefit than yours.’

This is a bit rich. But the guy did seem a humble sort, penitent. ‘I’m not a hundred per cent certain, but I don’t think so.’ To be precise, he trusted one; about the other two he was doubtful. But then because of this nagging rancorous doubt, his passion had ebbed away over the years. One can tire of so much howling anguish. And the unforgiving body or soul, or restless, jealous mind slowly gnaws away at sensitivity, even requited love. ‘Oh, I’ve just remembered. I did get thrush one time. One of these ladies owned up when I expressed my agitation, but she hurriedly apologized and rushed me a tube of Canesten anti-fungal cream.’

The doctor remained stony-faced. Spoke even more slowly: ‘What about sexual relationships with men?’

Kieran frowned, almost blurted a chuckle. This is absurd. ‘Not at all.’ A pause. ‘Oh, wait. Just once. I was twelve. My best pal and I were getting changed at the swimming baths. Same cubicle. Ogling the girls in their costumes. One-piece in those days. There was a gap at the top of the cubicle door. It was just a quick hand-job. We never spoke about it afterwards.’

‘But you didn’t ever practise . . . entry?'

‘Of course not,’ Maslow broke in quickly. ‘Never even thought of it. Never with a male. Rarely with a woman. Even then it felt bizarre.’

‘I see.’

‘Why? What’s all this leading up to?’

Another weighty pause. The doctor levelled his gaze, his soft-spoken voice a flat monotone. ‘Do you remember when I was emptying your catheter into the bag this morning?’

A small, white-coated shape bending low by the foot of the bed. ‘Vaguely.’

‘Some urine splashed into my eye. At least, I blinked and my eye was suddenly very moist.’ He gave a hapless shrug of his shoulders. ‘Of course, it could’ve been purely imaginary.’

‘I’m so sorry.’ And suddenly Kieran genuinely was. Flippancy had escaped like hot air from a Hover Matt on the fritz.

‘No, no, it was not your fault. My own silly lapse in concentration.’ Dr Pang let the weight of exoneration sink into the fuzzy consciousness of the patient lying prone and puzzled. ‘Do you mind if I give you a blood test?’

It had been a long day for Dr Pang. He’d woken at five, spent an hour rounding on the patients, those who’d had recent surgery then the prospective patients for procedures.

Later that morning he’d assisted Dr Chew on a double knee operation, set an adolescent’s fibula and repaired a mother’s patella.

Fortunately, Kieran Maslow’s repeat op the previous morning had proceeded satisfactorily but required close monitoring. The scan of patient Maslow’s first hip operation two years ago had clearly indicated that the shaft of the replacement prosthetic was slightly skewed. How come the doctors taking the two later reviews

had missed it? Overwork, fatigue, utter carelessness? It was only when Dr James Harley Ogg, the Head of Ortho, had responded to an urgent request from a sports therapist advising that the latest scan showed no cement had been used – not in itself unusual – but a glaring gap at the top of the prosthesis indicated unwanted movement. Understandably, the patient was suffering from increased referred pain in various loci of his right leg. Dr Ogg’s first reaction when he clapped eyes on that scan was outrage. A blight on the division; indeed, on the public hospital itself.

‘Good God!’ the stern-faced Dr Ogg had declared at the review before Pre-Admission to the repeat operation.

Maslow’s mouth dropped open. Fear stoked his pale green eyes. Oh god no, what’s wrong?

‘How old are you?’

‘Fifty-six.’

‘And you’re pretty fit?’

‘Before the accident, yes. I used to enjoy an hour’s walk every evening backed up by a regular fifteen-minute stint on my rowing machine.’

‘That rorty toff did the wrong operation. I don’t comprehend why he was cutting corners. This is the operation he should have done on your mother,’ Dr Ogg fulminated at the scan on the screen before him.

What do you mean? My mother died ten years ago.

‘He should never have given you a hemi-arthroplasty, a partial hip replacement.

You’re too fit and too young.’

‘Crikey! No wonder the discomfort was steadily growing worse. Sometimes I can barely walk.’

But Dr Ogg wasn’t listening to the patient’s demonstration of various hot spots on his

right leg, in particular the sorely sensitive knee, but already barging into the adjacent consulting room to berate the culprit responsible to young Dr Pang.

Dr Pang had become accustomed to such blame-storming. Thank god, the hospital had operated on the correct hip. But what if patient Maslow were tempted to sue the hospital, especially after Ogg’s outburst, or rather his candour? Fancy owning up to the shocked patient that not only had the original surgeon performed the wrong operation, but botched it into the bargain. Damage control’s been thrown right out the window. Most unprofessional.

It had indeed crossed Maslow’s mind to sue the hospital. Odd though it seemed, the more confident he felt each day about eventual and possibly full recovery, the more he considered the idea. Both mental and physical strength were slowly returning; he was preparing to take on the world like his old self. Yet at the same time, he was so thankful that finally someone had given him a sense of hope. Dr Ogg had spoken out courageously, at risk of facing the consequences of excoriating a colleague and the hospital itself. Of course, he couldn’t seriously contemplate suing. From the understanding lass at the desk in Outpatients, who slotted in the appointment for the second operation at the earliest cancellation, to the attentive and warm-hearted nurses and the two surgeons who encouraged confidence in others with their genial spirit, he was only too grateful and delighted that the job had finally been done and the prognosis sounded promising.

So very different from the aggro he felt boiling up at Pre-Admission when one of the other triage candidates, Jim Sparkes, a burly man in a wheelchair, his left foot bandaged on the footrest, asked, ‘What are you in for?’

‘Repeat surgery for a fractured hip,’ replied Maslow.

‘Another poor bugger fitted out with that shonky hip implant, eh? Over two thousand of ‘em last year in Oz alone. And they’re still using the bloody things!’

The pusher of the wheelchair nodded, his mousey wife, thin lips pursed with the injustice of it all.

‘Mm . . . the Doddleson De L’Oreole prosthesis. I’d already been growing ulcers for eighteen months to get on the waiting list for a third review. My right leg wasn’t getting any better; in fact, it was a damn sight worse!'

‘Bloody hell, you must be angry as a cut snake.’

‘No, not really,’ he lied, recalling bitterly some nights when he was close to tears of rage, tears of self-pity, unadulterated frustration just lying there, a lump of helpless flesh. Not to mention that all the surgeons attending his first hip procedure had declared the operation was a great success, which the subsequent doctors at both first and second reviews had confirmed. Even his fuzzily benign and warmly upholstered GP commented two months after the operation, ‘Are you still limping?’ but showed no undue concern. Then the therapist referred by the GP had tried him on the Polites bars, but on two occasions following those sessions his unsteady right foot had refused to touch the ground; he couldn’t straighten his leg for several minutes to resume the walk home. Surely, something was not quite right.

Yet the operation was a great success, he kept telling himself with mounting sarcasm. ‘What can you do? Anger without outlet just eats of itself. Erodes selfconfidence.' For god sake, will I never be able to walk again?

‘Me, I’d be ropeable, wouldn’t you?’ Sparkes said, turning to his neighbour slouched on the next chair along, left arm in a sling, hand thickly bandaged.

‘My word! What’s more, I’d sue the buggers for everything they've got if they mucked me about.’

‘When the scandal of the faulty hip implant broke, my blood froze. At first I tried not to think about it. Your operation was a great success! I lay on the rack, not sleeping a wink. My innards turned to slush. I just had to face the fact. I was in meltdown. I took a taxi to the hospital - I’m not supposed to drive with this leg - and found my way to the Hospital Patient Manager, who directed me to Health Information Services.’

‘How’d yer go?’

Maslow was staring straight ahead, as if he still couldn’t believe it. ‘Not only was that first operation botched, but I’d been gutted with the Doddleson.’

‘Sons of bitches!’ exploded Sparkes. ‘Unbelievable!’

The missus nodded furiously.

‘Isn’t that class action still running?’ said the stranger, no longer slumped but riveted upright.

‘Yes, I did get six thou comp,’ conceded Maslow. 'Even so, I've lost two years of wellbeing. My legal eagles argued the case that the faulty prosthesis caused complications in the operation, not the neglect of the surgeons or hospital. Any rate, I’m more frustrated at not being allowed to walk, my fitness gone right down the gurgler. I was sixty-five kilos before the op, would you believe? Now,’ he said, making a semicircular gesture with his arms, ‘I’ve blown out to a stodgy seventy-five.’ Maslow checked himself with a frown. Repressed anger was leaking out dangerously.

‘Anyways, you don’t know how lucky you are, mate,’ replied Sparkes. ‘I’m sixty-one and one hundred and fifteen kilos. At fifty, I was still running 10.7 for the 100 metres.

Then I got diabetes 2 and had to give up smoking.’

‘How could you possibly run that time and smoke?’

‘Easy. The race is all over in ten seconds. But because of the diabetes they removed my big toe so I can’t hardly walk.’

‘Mm, big toe,’ mumbled the wife with a mild nod or three.

Marlow didn’t know whether to feel better or worse.

Nurse Angelica Simmons preferred working nights. If you were lucky, the long ten and a half-hour shift contained small oases of hushed stillness, perfect peace, apart from the administering of patient meds every couple of hours. Her restless DIY husband did odd jobs about the neighbourhood, noisy tasks all of them, installing

empty olive barrels as water butts beneath sawn-off drain pipes, buzz-sawing overgrown branches or vacuuming leaves onto neighbouring nature strips. In his workshop out back he moulded toys of wood that he promoted in his candy-striped van spray-painted with Tony’s Toys in rainbow lettering across the panels. Sundays, her two uni boys would descend with a swag of dirty laundry and scoff the sausage sizzle round the pool.

Besides, you gained an extra day off in the week to do your banking, visit the gallery, take a coffee Grand Marnier in the Gardens. Whatever the circumstances, the division one nurse with twenty years’ experience at the Alfred Hospital and Peter MacCallum Cancer Institute was reputed for her composure, efficiency, and warm bedside manner. However, storm clouds were banking up on the industrial front. The ANF (Australian Nursing Federation) was calling for a rally at Festival Hall. Victorian nurses feared that the ratio of one nurse to eight patients (one to four on the two daytime shifts) might be abandoned for a more flexible system. There was even talk that aides with limited experience would replace nurses made redundant by such government changes. But Angelica’s immediate concern was the closure of beds and the postponement of elective procedures. The nursing profession would surely be vilified by the general public, especially those already suffering long delays for surgery. And what about patient safety? Unqualified health assistants couldn't possibly be the ears and eyes of doctors. They wouldn't have sufficient training or experience to detect the slightest change in a patient's condition that might spell a sudden deterioration.

Which reminded her to give patient Maslow his meds and update assessments and chart meds for her eight patients.

I can’t afford to take any chances, Dr Pang considered. If I’ve been infected by even the slightest drizzle of patient Maslow’s bodily fluid, I must take preventive measures. Nowadays treatment with anti-retroviral drugs has reduced both the mortality and morbidity of HIV infection, but I’d feel mortified if word got out.

How serious was the guy when he spoke of inhaling bad smack in the sixties? Or was that just Aussie understatement? At least, the screening of blood products for HIV has eliminated transmission through blood transfusions, thank god. Let me see, what were the symptoms? Fever, swollen lymph nodes, sore throat, myalgia,

malaise . . .

Dr Pang was already feeling limp and very tired.

Not in her usual good spirits, Angelica. She’d heard on the news about the threat of a superbug outbreak in hospitals if the nurse-to-patient ratios were cut and aides were introduced. And it was the militant nurses who were generating these fears. For if registered nurses were replaced with aides, it wasn’t just golden staph that would spread but VRE (Vancomycin Resistant Enterrococchi), which does not respond to antibiotics. Patients who have suffered transplants or heart and lung operations were most at risk.

After she’d parked her yellow Hyundai in the staff car park for the 21:30 night shift, she was disappointed that her model patient, Kieran Maslow, who was due to commence his course of iron tablets today, was no longer in the single-bed unit.

Instead, swapped over, a grizzled old-timer with a hook nose of dew drops pointing up from the sheets, baying with a faltering rasp, ‘Nurse, I shouldn’t be here! Where am I? I have to go home’, ‘Nurse, nurse!’ he cried, struggling to get out of the covers.

‘Nurse!’

Holy Moly! Not post-operative delirium! she thought, rushing into the one-bed ward, apprehensive about what she might find. 'Oy, you just stay there in bed.’

‘I’m in pain for chrissake!’he wailed, flailing his gnarled fists.

'SSh, be quiet, you'll wake the other patients!

'I've gotta go home!'

'Just you lie down! She caught his wrist long enough to read his name. Horrified, she saw that he had pulled out the IV tube from his arm and blood was leaking out.

Warding off the blows as she wrestled him back, she wondered how she might call a Code Grey for an unarmed personal threat and grab some gloves to avoid smears of blood while restraining him in bed. Shit! Other staff must be answering bells. What the hell! 'Be a good man, Dirk, you're not well enough to go home.'

Okay, so the customer/patient is always right, so let the hits keep coming. Shield up, my girl!

Suddenly pushed out of his comfort zone, Maslow found himself in a four-bed ward with three chatty patients, so was relieved when Aileen, the charge nurse, drew the curtains round each bed, bade goodnight and turned off the lights. As soon as she had departed, Arie scrambled out on the side not railed up, gasping and muttering in low Dutch, darting with a swaying motion into his corner and issuing forth a tintinnabulation of urine into what sounded like a pannikin, at the same time blasting an extenuating fart from Jeremiah Clarke’s ‘Trumpet Voluntary’ with no compunction at all. And scuttled back into bed with nobbled knees knifing like thin scissors.

It wasn’t long before the rhythm of whistling snores and occasional snorts was broken by strange yelps of nightmare or threats of skulduggery spurting from along the corridor. An hour later Maslow was still awake, wishing he could turn onto his side or front instead of keeping vigil about the exact position of his gammy right leg.

One false cross-over and he’d be up for a third hip op. So the medicos said.

Groping around in the dark for the control to call nurse, he knocked his beaker onto the floor with a rolling clatter. Suddenly, everyone was wide awake, three snufflers and the on-rushing charge nurse.

‘Maslow’s had an accident,’ mumbled the thick-accented Arie, whose observation was drowned in the bustle.

‘What’s up, darl?’

The eighty-four year old Dutchman, a former central defender with Wilhelmina, the ethnic ‘wogball’ club in the fifties, now skin and bone in a baggy polythene nappy, refused to be railed in at night. ‘I can’t pee lying flat,’ he wheezed, ‘it’s not natural. I have to stand up.’

‘You’ll have to use the bottle, darl. It’s too dangerous for you to get out of bed in the dark.’

‘No, no, I cannot do zat,’ with a jut of grey-wizened jaw.

‘I don’t want you falling out of bed and suffering a re-fracture.’

With a cunning glint of the eye, ‘No, zat is not possible.’

‘All reet,’ said Aileen in decisive Scottish brogue. ‘But press the buzzer when you need to get out of bed.’

‘No, I must go now!’

‘All reet,’ said Aileen, eyes following Arie’s wavery stick legs across the ward.

Turning, she noticed the old feller had soiled his bed with a slushy yellowy turd. At once, she hauled off the offensive sheet, bundled it up, fetched a starchy white one from the cupboard, re-made and smoothed down the bed, all before Arie had flushed the toilet and stuttered back.

‘Now try to get some sleep, darl,’ she said, tucking him in and taking away Maurie’s bottle.

Amazing how frequently the nursing staff wring their hands with sanitized rub at all those dispensers liberally spaced about the hospital, Maslow speculated, admiring Aileen's calm and discreet professionalism. How many thousands of microbes are squatting on my face, I wonder? Or millions of probiotic bacilli breeding in my gut? Ah, the contents of Pandora’s Box have nothing on the Maslow eco-system, he sighed.

‘Ooh, excuse me,’ giggled Perdita, who’d just let rip a ripe raspberry. ‘I’m lactose intolerant but can you believe there was milk on my tray for tea?’

‘It’s the most natural sound in the world,’ Maurie said calmly. ‘Don’t worry about it.

You’re very quiet, Kieran.’

Maslow pretended to be asleep, reminded of the low-colonic sounds of the Temperance Seven’s wind section warming up for a concert at the Elephant and Castle.

‘Unlike your predecessor, Kieran,’ added Maurie, trying to coax his neighbour from behind his curtain. ‘Now he was barking mad. Kept us all awake the whole night through.’

‘He was a mental case,’ muttered Arie. ‘You can hear the bugger's yelling even now.’

‘Yeah, a proper fruit cake,’ chimed in Perdita, never one to be ignored. Her loud, cutting squawk must’ve woken the poor blighters in Ortho 10 next door. ‘Did you get that disgusting oily honey drink purgative? Jeez, whenever I call for the bedpan it’s so embarrassing. “It’s really really urgent, nurse,” I say when she rocks up. “You must turn to the side to hit the pan,” she says. I haven’t got the faintest if I’ve settled flush plum in the centre of the frigging pan, then I push and strain and the angle’s all skewy and bugger me there’s not a bloody thing there.’

Ever reassuring, Maurie said, ‘We’re all in the same boat’.

In the bowels of, mused Maslow, who’d been shocked at the sight of his first postoperative stools – hard black lumps of coke painfully extruded into a toilet bowl of liquorice-coloured urine.

‘How’s your leg?’ asked Maurie, though all too frequently he’d heard Perdita’s story of choking on a doughnut as she descended the stairs, falling and breaking both tibia and ankle, a story with which she’d waylaid every new nurse, visitor, Maurie’s wife and Arie’s daughters and grandchildren.

‘It’s a bit of a worry. I can barely feel my toes.’

‘Best tell the nurse. Thank your lucky stars you had Dr Chew. Same as Kieran. He’s a top cutter.’

Top cutter! On his first-ever hospital visit, Maslow’s picture of ‘a top cutter’ would have flashed Jack the Ripper stalking skint prostitutes among the starving middens of Whitechapel. But now, for the repeat operation of having the same muscles, tendons and nerves sliced through, he was readily accepting. He couldn’t go on limping in pain for the rest of his days. Even now Maslow, the shaft of his penis lying

snuggled in the neck of the bottle nestled between his thighs for fear of reflux or splashing or even missing the neck on waking suddenly with a burning sensation at the tip of his projectile, felt strangely relieved by the Rabelaisian banter. Which meant he’d managed to swallow his apprehension about the removal of the catheter

by Aileen, anxiety which could have caused retention of fluid again. Two years ago his bladder had retained 600 mls of urine, forcing a three-day delay of his discharge and the insertion of a second catheter for his return home. Thank god, I’m fluent!

Behind his half-closed curtain he was flourishing his bottle three quarters full from beneath the blankets and resting it on the bed rail. In the half-light it possessed the golden glow of apple cider.

With a look of pride, a satisfactory night’s work, Aileen collected the bottle, held it up and winked at him. She’d make a note of the measurement. This patient wasn’t a urological case after all.

Further along the corridor, Angelica was feeling like a wet rag.

On the fourth morning Maslow fell from grace. He’d been so puffed with satisfaction at the encouraging comments from both doctors and nurses that one moment of carelessness reduced him to infant shame, a moment that flashed back from the fifties, a grizzling Morris Maltby trailing across the playground, an abject solitary, the tell-tale tokens of diarrheia bobbling down his leg and staining his grey shorts and socks, an image of a boy he’d never once spoken to, a boy from whom you kept your distance and disgust to yourself, apart from a ghastly stare frozen on your innocent chops. And the shame that he now felt, pushed in the wheelchair from bed to toilet, relieved after the first crescendo of gas that readily gave way to the effluvium of loose bowels, only to discover with a self-pitying whimper that he had peed a torrent through the two-inch gap between the over-chair seat and the toilet bowl. The tide of urine was spreading towards his feet.

He forced himself up with a yelp on his strong leg, shuffled gingerly round the puddle, wiped himself clean and mopped his brow. No way could he bend down, of course. The slough of shame had opened up beneath him.

There was nothing for it but confess. Joy, the effervescent Asian nurse who invariably

called him ‘darlin’ and fluffed his pillows and ‘How’s my sunshine?’ as she placed the tympanic thermometer in his ear, glided across to oversee his hoisting both legs conjoined back up onto the mattress. Joy, always lifted by the gentle green vista of parkland beyond the hospital precinct, the soundproof windows maintaining a constant temperature, without the hot-tempered northerlies or chilling southerlies.

‘Joy, I’m terribly sorry . . .‘ he began, in a low, penitent voice.

‘What’s the matter, darl?’ At least, this patient wasn't about to dip into lifethreatening oedema.

At his wretched confession, her breezy, sunny features clouded over for the first time on her watch. As she opened the toilet door, a louring disgust froze her expression.

She said not a word but stormed out to the staff toilet. For the first time since removing herself by sponsor from the leaning towers and concrete canyons of Shanghai, Joy’s tear ducts were piqued.

Waiting in the solitude of the transit lounge, Kieran Maslow sat in a too low armchair that threatened the stability of his repaired hip. Processed from the orthopaedic ward, he longed to be released into the warm, dappled sunshine of a spring afternoon. Physically, he was still vulnerable. He’d had next to no practice on his forearm crutches and already a slight ache cramped his hands, while his thumbs were already sore from gripping tight. Examining his inner left wrist, he noticed a pallid yellowy green bruise left by the placement of the drip, undid the cuff of his right sleeve and made out the faint yellow almost dun-coloured bruising beneath the band-aid and cotton wool over one of the blood tests. His right thigh was ridged by dressings becoming itchy and still damp from the shower that morning. The nurses hadn’t worried about the dried liver-coloured weeping from the operation. Even the age spots between raised blue veins on the back of his hands stood out more obviously tawny like markings on a Melway map.

He cast his mind back to Monday morning, day one, when he reported to Admissions at seven o’clock. Was it only four days ago? He’d tensed up over whether the operation would proceed, given that the ANF was threatening to close beds and he’d already counted three staff sporting red T-shirts emblazoned at back with Respect

our work. A nurse who walked with upright robotic elegance that stemmed from the straightest back and blank expression had prepared him for the first procedure for the day. She asked a series of basic questions about his identity and general health, medications and allergies, then told him to change into the medical gowns behind a drawn curtain and wait. He recalled his crestfallen resignation, for he’d drawn on the white elastic stockings and short red socks with white flocking on the soles and reassured himself that he could still boast Cyd Charisse’s legs, when the nurse made the comment as she adjusted the green motif of the sole, ‘You’ve got thin ankles,’ and stretched the gusset firmly up his thighs. ‘And thin legs.’

And the lower half of his back was itchy with raw bed spots that Angelica had chastened with cream early on the first two mornings. Yes his body, suddenly old and blotched with unaccustomed shades of colour and gristly ultra-marine veins and deltas of spidery veins on the lower part of the operated leg that he’d never noticed before and screws in his back from a too soft mattress.

Then he recollected Angelica in his emersion from a dreamy swoon in the blankness of night in the single-bed ward, her blonde curls brushing across his face as she reached across. Had he been thirty-five years younger, he might have locked onto her.

No, you wouldn’t, he challenged. You just needed a symbol of hope.

‘Time for your blood test,’ she’d said. ‘Just a slight prick.’ And taking hold of an arm, ‘Oh what beautiful veins!’

He was taken aback. There was nothing aesthetically attractive about the pallid spindle of his upper arm. He could scarcely make out any veins, let alone any of Tiepolo opalescence.

‘The blood’s flowing very easily,’ she explained, at the same time noting an absence of needle tracks and punctures.

His wilting ‘oh’ must have sounded disappointed or confused, but his blood pressure went skyrocketing.

And earlier that morning, some memorable moments to rejoice. Roistering into the

ward like strolling players at the curtain-up of a Shakespearean play attired in bespoke slim-fit dark grey suits, cheery red ties, pointy black shoes and smiles gleaming beneath thick sheeny raven-wing hair, the leading two male surgeons, Asian in appearance, effusing youthful bonhomie and self-confidence or a sense of pride in their skills, the slim female surgeon also Asian, more reticent, wearing black pant-suit, white blouse, sharply cropped hair and air of calm professionalism, followed by the manager of the two rehab centres and, lastly, frowning note-taking students scurrying to keep up.

The two genial surgeons approached Maslow’s bedside. ‘Your healing is going extremely well, Kieran. You can go home today,’ said one, consulting his notes.

‘Rehab, isn’t it?’

Jeez, after only four nights!

‘Yes,’ the manager called over. ‘We’ll give him discharge info after lunch.’

‘Splendid.’

As the surgeon turned to go across to Perdita, his bespectacled colleague moseyed up close and confided: ‘Oh, by the way, your blood test was satisfactory.’

‘Thank you,’ said Maslow, somewhat bemused. Blood test? What blood test?

When Dr Pang skirted the foot of his bed, downcast, scarcely daring to meet his eyes and offering only the slightest of nods, Maslow was touched. Seconds later, it clicked.

He couldn't help chuckling inwardly. Why, of course! The good doctor was no longer at risk.

Michael Small October 31-December15, 2011 P O S T E D B Y MICH A EL A T 15:42 EMAIL THISBLOGTHIS!SHARE TO TWITTERSHARE TO FACEBOOK

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