Jenna waved a greeting to the security guard patrolling this corridor of the hospital, alert for patients and visitors that were in the wrong place, while she fished her identification badge out of her bag. Similar to Etria’s municipal version for citizens and anyone else who wanted one, it was simply a stiff photograph coated in waterproof resin, but this one announced who she was and what parts of the hospital she had access to—which was nearly everywhere, although there were areas she rarely or never had reason to visit. She wasn’t a specialist or a surgeon; she preferred general medicine.
Splitting her time between here and the free clinic that served the poorest districts of the city, though, had given her a particular interest in the effects of poverty on health. Books had been written about it, grand philosophies pronounced, lectures given and plans made, but the simple fact was that Etria’s population had multiplied too quickly, the city’s infrastructure and economy strained to accommodate it, and even the most pragmatic approaches weren’t entirely filling the need. Someone needed to be able to recognize and address the consequences for individuals.
Besides, the free clinic couldn’t afford to pay much. Her hours at the hospital covered the rent for the townhouse she shared with her beloved spouse and a collection of animals, which the clinic couldn’t do, but she was needed too much at the clinic to commit to the hospital alone. If that meant she was often assigned unpopular shifts, so be it.
This wasn’t, though. It was simply a regular shift that started at seven in the morning.
The ID badge had a hole in one end for a sturdy cord, so she could wear it around her neck, keeping it visible. The staff would, for the most part, know her, but best to set a good example and make sure.
On each side of the corridor, behind whitewashed walls, was a ward; there were more upstairs, and in other wings. Nearly two hundred beds in all, in this particular hospital, everything from maternity wards to infectious illnesses, most of them in open wards of anything from a dozen to twenty, with great open windows along one wall to admit light and fresh air, with a few private or semi-private rooms for those who could afford them—sharing five floors with the offices for outpatient consultation, the infirmary for emergency care, plus the kitchen, pharmacy, laboratory, surgical suites, delivery rooms, patient records, and everything else that contributed to keeping the whole complex facility running.
The building was shaped like an enormous H. A rather new building, it even included the most up-to-date safety elevators, one at each end of the H’s crossbar, to allow porters to move heavy goods and patients more easily. The lighting was a hybrid of gas in the corridors, upgraded to electric in the wards and workrooms where it was the most useful, and the electricity could be used to drive some sorts of equipment that improved safety and efficiency greatly. All in all, it was a world away from the Old Bridge free clinic operating on donations and League support.
She went downstairs to the staff area, first to wash her hands, then to the laundry room to pick up a freshly-washed white coat of the correct size to wear over her regular clothes, and set her pink-trimmed white bag down long enough to put the coat on. It minimized contamination from outside, kept her clothes cleaner, and made her more quickly identifiable.
She slung her compact bag back into place. Her personal things were tucked into one compartment with a flap over it; the rest held things she wanted to have in reach, watch, stethoscope, thermometer, a folding magnifying glass, tweezers, scissors, several cheap handkerchiefs. She’d needed all and been exasperated trying to find them quickly, so it was simpler to just keep them on her.
Ready physically, braced mentally against whatever the day would throw at her, Jenna headed up two floors and into one end of the H to the ward she was scheduled for. It was a familiar route, since it was nearly always the one she was on.
The general wards housed patients who did not belong in any of the others—people who were ill or injured but not in a way that fit clearly within one of the official specialties. They showed no sign of a contagious illness that anyone recognized, no sign of internal organs failing or damage to the brain and its system, no apparent malignant growths, no broken bones. They couldn’t afford even the quieter four-bed rooms, let alone the private ones. So they washed up here, to be cared for by the diligent nurses and the lower-status generalist physicians.
Jenna suspected that they might actually be the fortunate ones. She knew many specialists who were excellent and dedicated and she would ask for their help without hesitation, but had also had patients who had been seen by a specialist who had hyperfocused and missed something not part of their field. Generalists, out of necessity, had to make note of everything and find a pattern that fit.
This children’s ward had sixteen beds, which would probably all be full. One head nurse, two others who were usually one senior and one junior, and sometimes a nursing student, would be caring for them.
She pushed the doors aside, stepped in, and greeted the head nurse. The nurses of all genders stood out: they could wear any practical and presentable clothing they chose, but over it was a bleached-white apron of sorts that covered everything up to their collarbones, and hair absolutely had to be completely confined under a white cap knitted of fine cotton into a dense mesh. The caps of fully-qualified junior nurses had a blue stripe, senior nurses had a red stripe, and a head nurse had a double black one, but those of nursing students were plain. The aprons were cleaned and sterilized in the hospital laundry, like Jenna’s coat, but the caps were their own.
The head nurse inclined her head, with a smile. “Always good to have you on. The little girl in seven started complaining...” she fished her watch out of one of the pockets of her apron, “eighteen minutes ago that her stomach is hurting and, as she says it, bubble-boiling like water for tea. We’ve been trying to comfort her but decided that since you were about to start, we’d hold her breakfast and medication and wait. Could you check on her first?”
“Absolutely.”
Meris, a nursing student who had been working here intermittently for the past couple of weeks, was sitting in the hard chair next to bed seven, holding the hand of a small girl a couple of years older than Olwen and telling her a story. There really weren’t enough staff for that, not while making sure that all the children actually swallowed any prescribed medication with their breakfast and, for that matter, ate, but for a short time, the others could and would work around it.
Jenna picked up the clipboard and folder of notes from the pocket welded to the high foot of the bed, and scanned through the contents quickly; Meris glanced up and flashed her a smile, but kept telling her story to give Jenna a moment to get caught up.
She’d been admitted because she was alarmingly underweight and kept gagging on most foods, even though her family made enough money that they could eat reasonably well. The nurses had checked her pulse and found it steady, checked her temperature and found it normal. There were also behavioural notes from the two days she’d been here. She shied away from interactions with the other children and refused to use the common play area at one end of the ward. She appeared to be quite intelligent, but needed instructions spelled out clearly, not just implied. She got overwhelmed if too much happened at once, and had panicked when another child had had a loud episode of crying and wailing. She desperately missed her best friend, a pet dog. Earlier notes, on the other hand, said that she’d been directed here, not to a specialist in the digestive tract, because she appeared to have delayed intellectual development and poor emotional control, and she had a peculiar habit of rocking and humming, which raised suspicions of neurological issues.
To Jenna, that painted a suggestive picture.
She raised her eyes to Meris’, and the young nurse nodded.
“I’ll tell the ending to you later, I promise,” Meris said. “Let’s see now if Doctor Jenna can help you feel better. This is Beka.”
“Hi, Beka,” Jenna said, crouching next to the bed as Meris quietly left. “I hear you’re feeling pretty sick right now. Can you tell me about it?”
The little girl wouldn’t meet her eyes, but shyly told her more or less what the head nurse had said.
“What have you eaten lately?” She was on medication that was meant to suppress nausea, but the chart said she still wasn’t eating much.
“I had tea. And a little toast with butter.”
“Not with jam?”
“I don’t like the little seeds in it.”
That was an interesting detail. Further questions about specific foods led to a single conclusion.
“I’m going to send a note to the kitchen about a special diet for you,” Jenna said. “I’m going to tell them to blend some tasty fruits together and then strain them so that there are absolutely no surprise chunks in it, it will be smooth and you can trust it. I’m also going to ask them to send you some chicken broth that has been strained to take out absolutely anything except the liquid. They’ll send that up for you as fast as they can. It’s really important that you try to eat it, okay? If you can eat that, then I’ll make it a standing order and I’ll talk to the nurses so we can make sure your parents know what to do.” The child had yet to meet her eyes, though she seemed willing enough to talk.
“I’ll try,” Beka said doubtfully. “But food won’t go down if it has chunks.”
“This won’t. And it will help settle your stomach and make you feel stronger. The faster we can get you strong, the sooner we can get you home to your furry friend... what’s his name? Her name?”
Beka brightened. “Mama calls her my shadow. I call her Joy.”
“That’s a lovely name. I have two dogs at home, they can be such wonderful loyal friends, can’t they? I’m sure she misses you and wants you to come home, and we’ll try to get you there as fast as possible. I’m going to ask the nurses to give you a pill that will help you feel better right now, but you can’t stay on it forever and the best thing we can do is find food you can eat. Okay?”
“I’ll try. Thank you.”
“You’re very welcome. And I’m going to leave a note for your parents, suggesting that they bring you to the Whitesmith Square free clinic. There’s a doctor there who tries to help people who have trouble with food textures, and trouble meeting people’s eyes, and some of the other things that I bet you struggle with. It isn’t anything that can be changed, it’s just part of who some people are, but she helps people find ways to work around other people who don’t understand and ways to stay healthy. And she’ll be happy to have Joy come with you.”
Beka nodded. “I want to go home to Joy. I’ll do my best to eat.”
“Good. I’ll come back and check on you later today. There are lots of other people who need me to visit them and try to help, but the nurses like Meris will take good care of you.”
“Thank you.”
“You’re very welcome.”
Each of the wards had a telephone linked to a central switchboard; there were a limited number of connections to anywhere outside the hospital, but reaching other departments was easy. She made her instructions clear to the kitchen, which often had very specific requests and this one wasn’t even unique—it was quite likely they had something on hand, even. Then she explained everything to the head nurse in detail while writing out notes about her observations, diagnosis, and recommendations. It was a syndrome that was only beginning to be recognized, unfortunately, but awareness was gradually spreading. Until it reached enough, Corvan’s goal of registered assistance animals for this kind of issue was unlikely to succeed, but they could hope and work towards it.
At least in this one case, she could do something about it, and if Beka’s parents—who, according to the notes, were deeply concerned and willing to do anything necessary—could take her to the one person making a concentrated effort to study this oddly-mixed combination of traits, it might make a big difference for Beka’s future.
With that taken care of, she closed the folder and stretched.
“That’s a positive way to start the day. All right. Anyone else I should prioritize, or just start somewhere and work around the room?” She knew physicians who ignored the nurses, but that struck her as self-defeating and poor medical care. A qualified nurse provided far more than meals and clean bedding. The Vixen performers weren’t the only ones who were vastly more successful when they worked as a team.
“The infection in the leg of the boy in four looks much better, we can probably send him home if you’re comfortable with that. The boy in sixteen, I suspect needs to be seen by a GI specialist, he can hardly keep anything down. Filia’s worried about the girl in eleven, she has an arm wound that keeps breaking open, Filia can give you all the details when you check it.”
“Thank you.”
She investigated in that order.
It took her very little time to confirm that the infection was retreating rapidly and sign off on discharge papers. She had no qualms at all about leaving the nurses to talk to the parents about what to watch for in case it recurred and to emphasize the necessity of following care instructions exactly with nothing added or left out, including finishing the entire bottle of penicillin tablets as directed.
It took only a quick read through the notes, a brief conversation with the boy, and a physical examination of his abdomen for her to ask for a transfer form, referring him to a specialist who would have better luck sorting out what was going on.
That was three beds taken care of efficiently, emptying at least two of them, but she suspected that trend was about to come to a halt.
She caught the eye of Filia, the junior nurse, on her way to eleven; Filia nodded, finished clearing the tray from another bed and handed it to Meris, and caught up with her.
“Lunch?” Jenna murmured.
“Definitely,” Filia said.
“What’s the situation here?”
“She tore her arm open helping in her parents’ workshop. They’ve been in Etria less than a year and they’re deeply ambivalent about our medicine, so they tried their traditional approach. No one’s gotten a really clear answer as to what that involves. That was two days ago, and it’s still bleeding so easily that they finally brought her to the infirmary. The mother in particular started to get extremely upset over the idea of stitches. Infirmary just told the parents they’d do what they can and whisked her up here. At least they cleaned and bandaged it first, but there’s blood on the bandages and she’s trying very hard to pretend she’s not in pain even though she obviously is. She doesn’t want to eat and I’ve caught her struggling not to cry. She’s had pain meds twice now but it’s not enough.”
Jenna nodded. “Let’s see what it looks like.”
“Maylin?” Filia said gently. “This is Doctor Jenna. She’s going to do everything she can to make your arm stop hurting. I’ll stay right here with you, all right? Just so you have a hand to hold.”
The girl, who was maybe twelve, did her best not to cry while Jenna carefully cut the bandage away, but tears leaked down her cheeks and her knuckles went white around Filia’s hand.
Jenna got up and went to the cabinet that held medical supplies, and came back with a jar of sterilized water and a basin.
Still leaking fresh blood, and there were subdermal tissues visible, some of it looking less healthy than she was comfortable with, although nothing suggesting that a major vein or artery was involved. The edges were red and warm to the touch and swollen. No red streaks yet, there was that at least. She was less sanguine that the cleaning job had been as thorough as it could have been, but distressed parents made care difficult at best.
“This is pretty bad,” Jenna said to the girl. Lying to a child this old who was clearly from a culture that saw pain as weakness wasn’t going to inspire trust. “It’s a deep injury.”
“Cut it off?” the girl asked, turning pale.
“Oh, no. Not that. I’m going to clean it very well, and I’m sorry, that’s going to hurt. Then I’m going to stitch it. I’ll sew the skin back together. That way it will stay closed and it will stop bleeding. It will heal much more quickly. We’ll bandage it with some ointment that will help, and we’ll start giving you some medicine to take every day that will make sure that it heals properly. It’s very important that you take all of it exactly the way the nurses tell you. But if you can do that, and keep your arm clean the way they’ll show you, then no one is going to have to cut your arm off. Do you understand?”
Maylin nodded, some of the colour coming back to her face, though she swallowed hard. “I’ll do what you say.” There was an accent there, but Jenna saw no reason to believe that she wasn’t able to understand the language and follow what she was being told. Filia, for one thing, would have spoken up by now if she had concerns about that. Children picked up languages quickly, even if their parents were sometimes slower at it.
“Before I do that, we’re going to give you some medicine that will make this... well, I wish I could keep it from hurting at all, but it will hurt less. There’s no harm in that. I’ve had to have stitches before and I know that I’d rather have medicine that will help. And I’m going to see if I can find some ice so we can numb it at least a little.” She was wary of laudanum, having seen it abused on Fortune Street, but if a dozen drops of purified laudanum on a small piece of crystallized sugar could help in this situation, she’d take it. She’d need the head nurse to fetch that personally, since Etria had at least some restrictions on highly-addictive substances.
The parents were presumably overwhelmed. She got that. It happened. They were new to Etria, and to some immigrants, Etria’s focus on technology and science, including evidence-based medicine, were confusing and even alarming.
But if they’d brought her immediately to a physician at the hospital infirmary or the nearest free clinic, this could have been so much less pain for Maylin, and Jenna wouldn’t have to do what she was going to have to do.
And if the parents complained, well... it wouldn’t be the first time Jenna had invoked her right as a physician to make a judgement call for a patient’s wellbeing. It wouldn’t be the last, either. Saving Maylin’s arm and possibly her life was worth another discussion with a city investigator or even a medical hearing. She was not the one jeopardizing a child’s safety.
Some hours later, when Filia got her turn for a meal break, Jenna claimed hers at the same time.
The head nurse nodded, unsurprised. Jenna wasn’t entirely sure who on the staff knew about their relationship, or how many thought she was actually cheating on Corvan—as though anything could be worth that. Privacy could be hard to maintain sometimes, even though they were careful to stay professional while actually on the ward. “You’ve more than earned it. We’ll manage everything until you get back.”
In the stairwell down towards the staff cafeteria, both paused long enough for a loving kiss.
“Life’s too busy these days,” Filia said, her hands on the wall on either side of Jenna to keep her from escaping. She smelled faintly of coconut and ginger, ingredients in her favourite shampoo for the thick black hair that she had to cut short and braid tightly to secure under her nurse’s cap. “I need to convince my family we should move over to Gardenwood, closer to you and Corvan so I see you more often.”
“I’m not sure it would help even if you could,” Jenna said ruefully, thinking of how often Nikki dropped by their house, yet Jenna saw him typically only in brief moments before leaving or after getting home. The occasional times that worked out better were treasures. “How is it that there’s always more to do than hours in the day to do it in?”
“I know why you don’t stay with one job, but between them, they add up to more than one. Please be careful. We need skilled doctors who care. Beka’s eating now, which is a miracle, and she’s talking nonstop about going home to her dog because you understand. And now poor Maylin is done throwing up and can keep at least soup down, well, she’s actually hungry and looking less flushed, so I think the pain’s finally dropping and she’s definitely less frightened. We need you and your unique combination of skills and knowledge. But you can drive yourself into exhaustion, and then where will we be?”
“If I ask the hospital to limit my hours much more, they’ll replace me.”
“Then I’ll quit, and come live in your sewing room, and we’ll start a private practice and ask, oh, Harry Wright or someone like that to be a patron.” She was joking: Filia lived with her aging parents, caring for them now all her older siblings had moved on to careers and marriages. She was neither likely to move nor likely to have the energy to devote to a full-time relationship any time soon, nor would she risk her secure job. Her light tone sobered. “Just be careful, okay? How long do they have you on the schedule today?”
Both heard footsteps on the stairs, and resumed their descent, no longer touching.
“I’m on until four. Corvan has a talk until seven-thirty and I can at least be over there to help her collect everyone to go home.”
“Well, now, isn’t it a good thing that you know someone who will be finished work at three and lives only fifteen minutes’ walk from the hospital, who can offer you a comfortable place to spend that time in between?”
“Extremely lucky.”
“Make sure you tell her I sent a hug, and give Mint a cuddle for me. I really hope they have something good today, not the barely-edible salad with shrimp they had yesterday. Ever since, I’ve been craving Anissa’s sweet salad. I need to bring my parents down to the Vixen for dinner.”
“Let me know and I’ll try to meet you there. Hm, chicken stirfry today. This could go either way.”
“Onward with courage, then, and let’s hope for the best!”
