While this is spoilery (for the 10th September), it doesn't quite fit with how the episode played out. Also this may not be entirely accurate, I've tried as much as possible. I'm also not entirely sure I've got this characters voice right. It'll probably be a three parter. Hopefully this is ok.
Patients. He scans down the list of names, some he's already seen that day and some still to arrive. Some are names that immediately he recognises – some are women who due to their stories he is unlikely to ever forget even though he may only have met them once or twice before and others are those he has come to know due to the all to frequent visits to his clinics. Other names are less familiar to him, but that doesn't rule out the fact he's already met them, in his profession he has come to learn that some people stick with you more than others. For varying reasons, there are the ones who you are likely never to forget while others simply fade in to the background in the recesses of your mind. A flick through their notes might bring back a memory, a snippet of information that you had learned, but for the most part these are faceless patients – one of thousands, maybe more, who have sat opposite you and awaited what you had to say.
As his eyes scan the list one name stands out, and his heart sinks. Is it that day already? He had tried to block it from his mind and yet now he has this list in front of him and it's there in black and white. She's in that slot somewhat against her will, she'd have rathered doing this later, once the buzz of activity has died away and it is simply you and her left. But it had been his idea to forsake her usual out of hours appointment, and instead take a daytime slot. Not that he had been courageous enough to inform her of this, instead it had fallen to a poor appointments clerk, who he was certain hadn't stopped shaking for hours after that phonecall had been made, having started hours before.
He knows this patient shouldn't get to him, but her fearsome reputation precedes her and he cannot shake that from his consciousness, not helped by how she has seemed to prove it right whenever he has seen her in the past. She has the power to turn him from a professional in to something resembling a nervous wreck, a man whose ability to speak words with any sort of conviction is entirely lost.
He supposes that this strange phenomenon could occur because this woman is in some ways his equal, though in a different field. The words he speaks, she already knows and even if she doesn't, she would tell him otherwise not wanting to appear less knowledgeable. But he has treated colleagues, fellow professionals beforehand and no doubt will do so countless times in the years to come, before retirement beckons and he can leave this life for something more relaxing, less frantic in nature. Perhaps in another country, another continent, with somebody he loves by his side.
It strikes him that this woman, the patient he dreads, is always alone when she comes to see him. Her appointments have been less frequent in recent months due to the developments in her condition, but soon that could change and it worries him that she could be facing this alone. It is partly why he had done this too her, arranged this appointment time. He had checked – hopefully discretely with the registrar who has caught his eye – that she is working that shift and when her theatre slots were. It was in the hope that somebody would know of her disappearing act, would perhaps question her and realise why. It's in the hope that afterwards, someone may be there to help her, even if she cannot ask for it. Seeing her in the day means she will not be going home to an empty flat, to darkness and her thoughts. Even if she phones back to the ward, to say she cannot return, someone will hopefully realise that something has to be amiss and that they will have the sense to twig what. As much as this woman scares him, he feels something of a need to look out for her, though he doesn't quite understand why.
He casts his eye downwards, and feels his pulse rate pick up as he catches sight of a set of notes that have magically appeared in the box next to him. The thick brown file is almost falling to pieces, and he doesn't even need to look at the name to know it is hers. He can recall how in previous consultations, he's had to handle them carefully afraid that this record of her life will fall apart in his hands. It appears to have coped less well with all that life has thrown at the woman, her notes taking on the fragility that she dare not show.
Within these pages are the notes taken on their first meeting. He had wondered then, whether the reason for her act was the pain she was experiencing – a pain which she tried desperately to downplay despite how obvious its effect on her was. She had thrown at him a list of tests she had already performed, and told him the results as though she was talking of a patient, an interdepartmental referral that she was making. Occasionally she had grimaced, her breathing altered temporarily as she'd tried to force herself to act like it truly was nothing, and not as agonising as he guessed it was. She had told him the tests that she thought he should perform and given half the chance he thinks she would perform them on herself rather than trusting herself to his hand. Of course being the skilled clinician that he knew she was, she was right in everything she suggested, and in some ways she was consulting herself with him as a passive viewer, the one taking notes. She probably would've completed those too, if she'd had chance to look at his words; his own words not quite to her standard. Finally she had told him what she suspected, and with a nod of his head he had been forced to agree with her speculative diagnosis though as she had then informed him it wouldn't be confirmed until the laparoscopy which she had all but arranged for herself. Somehow he'd managed to be the one to actually undertake the procedure, though part of him had expected for it to be him being anesthetised and her wielding the tools.
He picks up the pack and feels the weight of it in his hands, knowing that the moment he is dreading is growing ever closer. These are the appointments he dreads the most, the ones where he has the knowledge in his head that could destroy so many hopes, so many dreams. He has seen the scans, the reports by his colleague but now the baton has been passed to him. He has to discuss what comes next, and he isn't certain how this is going to go.
He starts to walk from the little office, he sees the anxious face of an auxiliary, the one who had probably deposited the notes by his side without a word. She flashes him a smile, a silent message to wish him luck for what is to come. Obviously this girl, like that poor clerk, had had the pleasure of engaging in conversation with the patient.
The last time he'd had to give her news hadn't gone exactly to plan. Again she had come to him alone, already back in scrubs despite being so few days post-surgery. He'd told her not to go back so soon, but she had given him a death stare at the suggestion and he had quickly decided that holding his tongue was the better option. A pre and indeed post operative patient probably isn't up to sparring verbally, though he is certain she would still have beaten him. She had been trying to discharge herself far sooner than he liked, indeed she'd had staff members close to tears and it had almost gotten to the point where he had given in to her just to bring a lighter atmosphere to the unit. But she had stayed for the allotted time, though not a minute more. He feared for the ward clerk had her papers not been ready the moment the clock had struck the hour; she had fled like Cinderella fleeing though ball though unlike the future princess she had left no trace behind.
In some ways he is surprised she had waited 48 hours to return to the ward. Part of him had been expecting some sort of phone call saying that his patient had collapsed at work, but then it had occurred to him that even then he probably wouldn't have been contacted. It wasn't his place to be, unless there had been complications and with her pushing herself that wouldn't have surprised him. He had read her file, and he knew part of her story, not the full reasoning behind things though a vague knowledge of hospital legends and gossip gave him something of an idea.
So he had come to find her sitting in scrubs, awaiting him. She had seemed to take the news in a way unlike any other patient. Almost a blankness, she just seemed to accept it without question like there had never really been any doubt as to what would result from this meeting. She had balked at his attempts at explaining her newly discovered condition, instead informing him in her way that she already knew this. But he had known, there is a difference between knowing what a condition means and understanding what the emotional implications were on your own life; only she still seemed to barely accept that this was happening to her. She was clinical, cold and yet he had delivered the news that she may never become a mother, that her chances of holding within her arms a child of her own had dramatically reduced with a one word diagnosis in those already bulging notes.
He wondered as he had watched her leave, and marked the arrival of his next patient – the registrar, when the reality would hit and how this woman would deal with it. He couldn't be sure but he had thought it would come in the form of an outburst, her feelings against herself turned outwards on to another. Displacing her own feelings on to a helpless target. She would not, he thinks, take the more productive route of talking, of acknowledging and dealing with her own feelings. He doesn't know the reality of her situation, whether there is a partner – again the snippets of hospital gossip leave him uncertain – on the scene and if she will chose to discuss this diagnosis with him. Part of him believes she won't, not this heavily guarded woman.
The next time he had seen her, he had tried to broach the subject. Amidst discussion on how she coped with pain, he had tried to enquire as to how this had affected her personally. Somehow forcing the words from his lips as this woman had seemed just that little bit quieter in that appointment, not quite the fearsome person he had seen before. He had heard of a death of one of her colleagues, a young woman who by all accounts had shown a lot of promise, who was taken far too soon. But while she had seemed different, he wasn't quite sure that he could see emotion or not the more visible emotion he had seen in the faces of others who had known the young doctor. Still this had seemed the best time to broach the subject, to tread this path with her. He had asked, gently, whether she had a partner. He had seen the shift in her face, the moments hesitation and the breath she had drawn in before she'd answered in the negative. The look on her face after she'd said the word telling him not to press further, he had overstepped the mark and she was close to the edge. So he had gone back to the clinical questions, though he had lost her once more. She closed herself off and talked over him when she had been vaguely open to a discussion on why she had chosen to cease taking the pill he had prescribed her, due to the affect the hormone had, had on her body. She had no elaborated much, but at the very least she had engaged and sort his opinion on other options. Afterwards though, she no longer engaged instead she became her own physician once more, and he merely nodded and wrote it up as though it were his suggestion and not hers.
Hesitantly he raps on his consulting room door. It had come as something of a surprise to discover that she had chosen not to hear this from the colleague who had undertaken her scan, but instead had requested that she wait for an appointment with him. After dealing her the blow of her diagnosis and then the discovery of what came next, she had been reluctant to continue under his care instead moving over to the private clinic on the other side of Holby, and truth be told there had been a small part of him that had felt relief at knowing he had a few months of respite from her.
He'd somewhat wimped out on the last piece of news he'd delivered her. In all fairness, he hadn't ever expected to have to deliver that particular diagnosis, not to this woman at least, but a quiet tip off from the registrar had given him the kick he needed to ask for a urine sample - to at least check up on her. She'd been missing her appointments since the one where he'd tried to discover the status of her personal affairs, she'd tell him it was work when he tried to chase her but he suspected it was more an avoidance tactic, her way of not having to face reality. Had it been one of her patients treating appointments so casually, he is certain they would face her wrath but she is a person not overly concerned with her own health, instead her professional life comes first and in that world, in her head at least, there is no place for self. She hadn't told him of the symptoms she was experiencing, perhaps she'd failed to recognise them though those around her seemed to have felt the effects of hormonal swings. He had told her to inform him of any changes, even insignificant things but of course he should have known she would never do such a thing. Instead it had been a whisper in his ear from someone who was concerned, perhaps not a friend of the woman but someone who at least showed a degree of caring.
He hadn't quite known what to expect when he'd finally received those results, he had known the suspicion of the registrar but her diagnostic test – which she had informed him of with a laugh - was far from clinically recognised and he'd struggled to understand how she could work this out from that. And yet she had been right, in front of him was an undeniable result that told him that his patient – the one he'd told of potential fertility issues – was pregnant.
He could've told her in person, probably should've done given the circumstances but the shake of his hands hadn't quite settled from their earlier encounters. Her reaction to this test being done made him wonder, albeit briefly, if she had considered the possibility of this result but he couldn't quite see that. Nor could he quite understand how given she had made it clear that she had no partner, though her hesitation in answering had come back to him. He wondered whether she would blame him for this, his diagnosis making her think her chances were so low that precautions were no longer so needed when it came to these matters. Perhaps she had been careless once, and now this had happened – and so rather than face her, he had used the phone. He'd heard how she'd struggled to take it in, to make sense of his words. In some ways her anger would perhaps have been easier to deal with but instead he'd had to try to get out words about appointments with obstetrics and taking folic acid before he had finally given up realising she wasn't really taking any of this in, before ultimately realising the phone had been hung up on him.
He steps in to this room, with that phone call he'd given her the news of something of a miracle, and now with this consultation, he feels like he is stealing that away from her. He shouldn't like to wish this sort of appointment on any of his colleagues, and yet so much of him wishes that the person stepping in to this room was not him.
He startles slightly, to see that she is not alone and that for once in her appointments the second patient chair does not sit empty. He recognises the anxious young man, the friend of the registrar and the object of gossip when it comes to the women's love life. He takes a breath as he walks across the room, offering both of them his hand, and an introduction to the man who nods, and quietly states his own name. Finally he takes his own seat, the one he is always surprised not to find she has taken, given how she takes the lead in her appointments.
"I've spoken to my colleagues," he starts slowly, opening the file to find the reports. His colleague, a fellow consultant, has detailed everything and it makes for difficult reading. He had read the pages numerous times over, hoping to spot something, a slight mistake that would indicate the need for another rescan by his own hand, viewed through his own eyes. But he knows his colleagues, knows how thorough he is, each I dotted and t crossed. The report in front of him is meticulous in detail, and he knows he could not have done it better, "and I've read through the report from your anomaly scan"
"Just tell us" the man, presumably the father, speaks before she does. She looks strange to him, face blank, eyes unseeing as her gaze dances between the paper on his desk and his face. The man on the other hand is visibly on edge. It cannot have been easy waiting the days between the scan and this appointment, when they could have been seen by somebody straight away, but he had done it for her and there is something in that. He nods his head.
"Now I can't give you a definite diagnosis, but the scan is indicative of soft markers in a number of your baby's internal organs" he pauses as he watches the deflation of the younger man's body, how he seems to fall backwards slightly as if he has been hit while simultaneously his body seems to shrink down in to the chair, "these could be the result of a number of conditions, and because of this we'd recommend further testing before you make any decisions"
"Decisions" the word comes from her almost breathlessly. As an almost reflexive action, the man reaches and takes her hand in his. To his surprise she does not pull away but instead their hands curl together, entwined to the point it would be difficult to tell where hers started and his stopped. He runs a hand over his head; he didn't want to do this today, not without answers, "you mean to terminate don't you?" she adds the words and the hands squeeze tighter together.
"Let's not get ahead of ourselves" he tries to slow this, he looks again to the report and then back up at the couple, "we still don't know for certain the extent of your baby's condition, or the full diagnosis. What we can recommend is an amniocentesis, which would allow us to …" only she cuts him off.
"Test for genetic conditions by drawing away amniotic fluid" but she does not say it quite as she would have before, the slightest hint of emotion beneath her words betraying her attempts at acting the clinician and not the mother-to-be, "and then when you get the results, then we talk decisions even though you already know what's going to come out of that appointment, you already know" it comes in an accusatory whisper, but laced with pain. It's a pain he has never quite seen in her before, it runs deeper and she is fighting hard to keep it buried only with each passing second, its strength increases.
"Until I have the results, we cannot have a definitive diagnosis" he sees in her face the disbelief, the lack of acceptance of his words and he understands why. She isn't like his other patients, she is like him. Through training and years of building up knowledge, she has learned to read in to scans and reports to make a speculative diagnosis before further diagnostic tests are carried out and how experience increases the likelihood of this being correct.
"But you know, you know that in two weeks time, you'll be saying to me, that the foetus has a condition which means its quality of life will be reduced, and then you'll offer a medical termination," she swallows hard, as he feels his heart racing in his chest, he cannot control this now, "and in that two weeks, I will have felt this foetus move, it'll be alive inside of me while I have to live with the knowledge that in ever decreasing days I will be told that a termination would be for the best" though he can hear in her tone the pain she feels, she is masking it well with a voice so calm when he would have expected something incredibly different.
"And you know I cannot say without knowing the results of any further tests what I'd recommend" he shakes his head, "these indicators could be wrong, or could show something less serious which is why I'd recommend that we get you booked in for the amnio and we'll go from there" he knows though where she is coming from, the potential delaying of what she now considers as inevitable. From the look of the results in front of him, he's near certain she is right but there is always a chance, this child has been her miracle before and it could prove to be so again.
"I just … I'm … I …" she starts and stops her sentences, the hesitant blocked words that he knows in her presence suddenly affects her more so than it has ever done him. Her eyes flit around the room, looking for something that isn't there, something to answer her unasked questions, to give her what she needs. He places his hands upon his desk, and looks to the man who has slipped from his chair to kneel before the woman. He has been so quiet beyond his first few words.
"Look at me," he speaks with a gentle command, their hands still entwined as her head bows to see him. For the first time, her eyes seem to focus and she seems to become altogether human as watery eyes look in to ones, he can no longer see, "we're gonna do this together right? We'll get the tests and then whatever happens, we're going to do this together" the younger man's voice cracks as he speaks, trying to control his emotions but not quite as adept at it as the woman.
"but what if he's right, what if we, I …." Again she cannot speak the end of her sentence, she had glanced up at him as she'd said he as though a diagnosis had passed his lips. Her body shivers slightly, though she is wrapped warmly, clothing which can mask an abdomen which though rounded is still so easily concealable. She can hide it from the world, but no amount of disguising will take the truth that this is her body, her child.
"He hasn't said anything though has he? We don't know anything yet, just that there's signs that something might – might not definitely – be wrong" the man reaches up and cups the side of her face, her skin flushing slightly as eyes dart to his face before returning to her partners, "and if – if – there is something wrong then we'll face that together, but right now we don't know, and we have to face that too but you don't have to do this alone"
It's altogether a strange thing seeing her react to his words, how her shaking had seemed to reach a fever pitch as she tried to cling on to the words. He had never seen her like this, and it's an image he knows he will never quite forget. How the woman he had seen so little emotion in had seemed to crack just slightly; a single tear rolling down her cheek as she nodded her head slightly, eyes not leaving the face of the young man in front of her.
"We can book you in for an amnio, tomorrow if that's convenient?" the slot had been pre-booked for them, he'd seen that too on his lists and he'd panicked at the mere idea of a procedure of this woman with her fully conscious but perhaps with this man by her side she won't be quite as he feared, "we'll need to go through the paperwork and explain the procedure to you of course" and it is then that he feels her eyes on his face.
"I know the procedure, the risks and all of that" and she's back in the room, he thinks with a slight shake of his head.
"Right well, yes, of course." And a slight roll of her eyes accompanies his struggle for a response. He doesn't understand how she does it too him.
"We'll see you tomorrow" the younger man tells him, giving him a slight look of sympathy though really it is not he who deserve it but instead this couple. He watches as the man pulls the woman to her feet and wraps an arm around her waist, guiding her from the room. It's a wonder that anyone would ever be able to lead this woman, and yet she leans slightly in to the man accompanying her, their bodies not touching though there is little more than a hairs width between them. He shakes his head, he cannot read them, they are not like the other couples he sees – there is something so separate about them, and yet they seem to fit together.
He looks at the empty space in the notes in front of him, preparing himself to write the next part of her medical story. So much of what is written within these pages had the power to destroy her, and yet it hasn't and now he has to add more, knowing that there is more to come. As he writes the words, he frowns to himself, he said so much in telling her and yet he told her so very little. She didn't take in his words, another had told her, had made her see.
He lowers his pen. There will be more to tell, more words he will be forced to find but it will not be him she hears. It's the voice in her head, her colleague, the man she loves but never him. He looks to the empty space beneath his written words, the unknown.
He closes the tome that is her notes, stands and stretches before he lifts them from his desk. He walks the short corridor between his room, and the office, far quicker this time. He is torn between relief that the appointment is over and foreboding of what is to come but he feels safer in the knowledge that there is someone by her side, the man who will quieten her interpretation of his words, who will tell her what she fails to hear. He places her notes to be filed, knowing they will be waiting for him tomorrow.
He looks to the list, more names, more women. The next blessedly unfamiliar to him, he looks to the auxiliary, and gives her, her cue to bring this unknown patient through. He lifts up her notes, a far slimmer set, and flicks through them trying to discover why she is on his list that day. He has to push away the thoughts of his previous patient and concentrate on the next. He reads the notes, until the girl reappears and he takes his cue – he continues his day.