Donor

THREE

As the days became weeks, the strain of constant travelling up and down to Glasgow, and guilt over excessive time taken off work, began to tell on Kate and Sandy.

‘I’ll have to resign,’ said Kate as they drove up to see Amanda on the Friday of the third week. ‘It’s not fair on the school.’

‘I’m sure they understand,’ said Sandy.

‘I’m sure they do too, but it’s too much of an imposition on them. They’re bound to be feeling the strain and they’re far too nice to say so themselves. I’ll have to make the decision.’

‘Maybe you’re right,’ conceded Sandy. He didn’t feel so bad because, although his two colleagues were covering for him during periods taken off in the daytime, he was taking on more evening duties to compensate. Both Charlie and Andrew had young families, so they were quite happy with the arrangement. Kate was not so happy. It meant that she seldom saw Sandy in the evenings.

‘I thought we’d have had her home by now,’ said Kate. ‘They said at the outset she’d probably be home within two weeks and we’d just have to travel up on dialysis days. I think something’s wrong. In fact, I’m sure something’s wrong and they’re just not telling us.’

Sandy glanced out of the corner of his eye at Kate in the passenger seat. She was biting her lip and nervously interlocking her fingers as she stared at the road ahead without giving the impression of seeing anything.

‘No doubt Grayson will tell us,’ he said. ‘He’s not one for gift wrapping anything and Clive Turner did say he wanted to see us today.’

‘Do you think our marriage will survive this?’ Kate asked suddenly.

‘Of course it will,’ replied Sandy, taken aback by the question. He took one hand off the wheel and reached over to squeeze Kate’s hand. He felt her grow tense. ‘What brought that on?’

‘We were always so close,’ said Kate. ‘But now things seem different. You don’t even tell me what you’re thinking most of the time.’

‘We’re both under a lot of strain,’ he said. ‘Too many other things on our minds, I suppose. I never knew continual worry could be so exhausting. It’s like being an overwound spring.’

‘If that’s all it is.’

‘Of course it is.’

‘I don’t want this to drive us apart,’ said Kate.

‘It won’t,’ said Sandy supportively. ‘We’ll soon get Amanda home and then we’ll get back to being just as we were.’

‘Apart from the dialysis.’

‘We’ll even get used to that in time, and when we get a home set-up it’ll be practically no bother at all. You’ll see. It’ll become part of our routine. So much so that we’ll hardly notice it.’

Kate smiled weakly and looked across at him. ‘I don’t know what I’d do without you.’

‘Come on, love,’ said Sandy. ‘I need you every bit as much as you need me.’

‘We have a problem,’ announced Grayson with characteristic bluntness as he spread his notes on his desk and moved his glasses to a more comfortable spot on his nose to read them.

‘What sort of problem?’ asked Sandy. His skin tingled in fear and anticipation. It was as if his every sense had suddenly been heightened. He was aware of every raindrop running down the window behind Grayson’s head as he waited for him to begin.

‘Truth to tell, we’re not very sure ourselves,’ said Grayson. ‘Amanda’s blood is becoming contaminated almost as quickly as we clean it. She’s been requiring much more dialysis than we anticipated. We thought things would settle down after a fortnight or so, but that’s not been the case, I’m afraid. We think it may have something to do with a tissue-degradation problem in her kidneys.’

Tissue degradation! The words echoed round and round in Sandy’s head. ‘You mean her kidneys are breaking up?’ he asked. His throat was tight and it showed in his voice. He had to swallow.

Grayson shrugged and said, ‘That’s our theory at the moment. Of course, we’ll have to wait until we get a full histology report before we can be absolutely certain.’

Sandy felt that he was listening to a garage mechanic tell him what was wrong with his car, rather than a doctor pronouncing on his daughter’s condition. What made a man like this become a doctor? It wasn’t the first time he had wondered this same thing. His job had brought him into contact with a number of people in the medical profession who he felt lacked any basic compassion for the sick. They didn’t see people in front of them, only cases, intellectual challenges, problems to solve, games to win or lose in the struggle to advance a career.

‘I take it this means that we’ll not be getting her home in the near future?’ said Kate.

‘Out of the question,’ said Grayson.

Kate looked down at the floor and clasped her hands, twisting her fingers as she listened to Grayson continue.

‘The fact is, I’m sorry to say, that Amanda is one of these patients for whom dialysis just isn’t good enough. It isn’t working. She really needs a transplant.’

‘Or she’ll die,’ said Kate in a flat monotone.

There was an agonized silence in the room before Grayson said quietly, ‘That is a possibility, I’m afraid.’

Sandy saw that Kate had stopped fidgeting. Her hands lay still in her lap and her face was perfectly calm. It unnerved him. He reached across and laid his hand on top of Kate’s. They were ice-cold. The tightness in his throat still made talking difficult but he asked Grayson, ‘Surely there must be some kind of priority given to such cases?’

‘Of course. Amanda will be given urgent status on the transplant register,’ agreed Grayson.

‘What does that mean in practice?’

‘It means that she will be allowed to jump the queue if a suitable organ should become available, but of course we’ll still be constrained by considerations of tissue type. The organ has to be a good match for her.’

‘What about us?’ asked Kate.

‘I was about to suggest that,’ said Grayson. ‘It’s possible that either you or your husband might prove to be a suitable donor and we’ll certainly check your tissue type, but I don’t think you should bank on this. It happens less frequently than people imagine. A brother or sister would be a better bet and a twin would be ideal, but of course Amanda is an only child.’

‘So if neither of us matches her type we’ll just have to wait and hope?’

‘That’s about the size of it.’

‘How much time have we got?’

‘Impossible to say, I’m afraid,’ replied Grayson curtly.

‘Doesn’t it concern you at all?’ said Sandy, his patience with Grayson’s apparent callousness finally giving out.

‘I beg your pardon?’

‘Our daughter’s plight. Aren’t you concerned — as a person, I mean?’

‘Of course I am,’ replied Grayson, obviously flustered by the question.

‘You could have fooled me,’ replied Sandy flatly but Kate put a restraining hand on his arm to stop things going any further. He and Kate got up to go.

Clive Turner, who had been silent throughout, followed them outside. ‘I’m sorry,’ he said when the door had closed behind him. ‘Dr Grayson’s a bit of a cold fish. I’m sure he means well, but he doesn’t always come across that way.’

Sandy nodded. ‘How soon can we be tested for tissue type?’ he asked.

‘We can do it before you leave,’ replied Turner. ‘But as Dr Grayson said, I don’t think you should build your hopes too high.’

Sandy’s look suggested that this was the last thing he wanted to hear.

‘Look, why don’t we all go and get some tea?’ suggested Turner. ‘There’s something I’d like to talk over with you.’

Sandy’s first inclination was to decline the invitation but he changed his mind when he saw that Turner wasn’t just being polite or mounting a damage-limitation exercise on behalf of his boss. The man looked as if he really did have something to say. ‘All right,’ he said. ‘I think we could all do with some.’

The visitors’ tea room smelt of strong tea and plastic. The tall windows looking out on to the courtyard were misted over, thanks to a tea urn with a faulty thermostat which bubbled constantly and sent wafts of steam up into the air. Here and there a cleared patch on the glass permitted views of the rain speckling the puddles in the courtyard below. At Turner’s suggestion, Sandy took Kate across to one of the red-topped tables and sat down with her while Turner got the tea and brought it over on a brown plastic tray. There was a slight hiatus while he righted the cups in their saucers, placed them around the table and poured out the tea. As he sat down, he said. ‘This must be a nightmare for you.’

‘It all happened so quickly,’ said Sandy, searching for something sensible to say in reply. ‘She was as right as rain one moment and then suddenly she’s in here and…’

‘She’s dying,’ said Kate.

Turner’s silence was worse than anything he could have said at that moment, thought Sandy.

‘What was it you wanted to speak to us about?’ he asked, determined to end the silence.

Turner rested both forearms on the table and leaned forward as if to impart a confidence. ‘We have to think ahead about what to do for Amanda if neither of you should prove to be a suitable donor.’

‘I thought we’d just have to wait,’ said Sandy.

‘I don’t know how you’ll feel about this,’ said Turner, ‘but I thought there was one possibility we might explore together for Amanda. It’s only a possibility, mind you, and it might come to nothing, but I think it’s worth considering.’

‘What is?’ asked Sandy.

‘We had a circular from the Scottish Office recently concerning the Medic Ecosse Hospital here in Glasgow. Apparently, because of some political agreement reached between the hospital and the government over funding, they’re taking on a number of NHS patients recommended to them for specialist treatment. They’ve done this occasionally in the past but it was only out of the goodness of their hearts. Now it’s been put on a more formal basis. I suppose it’s still a PR exercise but the fact remains that a patient accepted by them under the new scheme will be treated as one of their own patients and completely free of charge.’

‘How does this affect us?’ asked Sandy.

‘It just so happens that Medic Ecosse has a world-renowned transplant facility.’

‘You mean you think they might accept Amanda as a private transplant patient?’

‘As far as I could see, there was no qualification about what kind of patient could be referred to them. If a case could be made out that a patient would clearly benefit from their expertise or facilities, then the criterion for referral would be met. That, I have to say, may be wishful thinking on my part but on paper there’s no bar.’

‘Do you think Amanda would benefit from such a referral?’ asked Sandy.

‘I think…’ Turner paused as if considering his words carefully. ‘I think that Amanda might conceivably get her transplant quicker at Medic Ecosse than here in the unit, and in her case time is of the essence.’

‘But how, if there’s an international register and a waiting list?’ asked Kate.

Turner paused again, then said, ‘I suspect there may be several international registers, not all of them available to NHS-funded hospitals.’

‘I don’t think I understand.’

‘I’m afraid that where there’s any kind of demand there’s always a supply based on currency rather than need,’ said Turner. ‘The international trade in donor organs is no different from any other commodity in short supply.’

‘How awful,’ said Kate.

‘But even if that were so,’ said Sandy, ‘surely they couldn’t admit to that and accept Amanda on those grounds?’

‘No indeed,’ smiled Turner. ‘But in addition, and this is important, they have the most modern dialysis equipment available anywhere in the world. I think a case could be made out that Amanda would benefit greatly from that alone. What she needs most right now is time. The Medic Ecosse unit could give her that. If they can come up with a kidney for her too, so much the better.’

‘How do we go about asking Medic Ecosse?’ asked Sandy.

‘The referral would have to come from here. I’ll speak to Dr Grayson if you like.’

‘Would you?’ said Kate, gratitude obvious in her voice.

‘Maybe I shouldn’t have rattled his cage,’ said Sandy ruefully. ‘I was pretty rude.’

‘Don’t worry about it,’ said Turner. ‘He’s too thick-skinned to have taken it to heart. He’ll have put it down to your being upset. Insensitive people always put it down to a misunderstanding on someone else’s part. I’ll get back in touch as soon as I’ve talked to him. Why don’t you go up and see Amanda for a while, and I’ll get in touch with the lab about tissue-typing you before you leave. It’s a simple procedure.’

Sandy stood up and shook Turner’s hand. ‘We really appreciate this,’ he said.

‘Let’s hope something works out,’ said Turner.

Turner left and Sandy waited for Kate to finish her tea. She was taking her time, trying to compose herself. She didn’t want Amanda to see that she had been crying. ‘What do you think?’ she asked as she put away her handkerchief and smoothed her hair back.

Sandy gave a long sigh as if suddenly releasing the tension he had been under. It was as if Kate’s question had acted as a relief valve. ‘I don’t know what to think,’ he confessed. ‘I feel numb. Everything seems to be happening at such a rate that I can’t keep up. I keep wanting to yell out, “Stop! Just a minute! Let’s all sit down and talk things over. This wasn’t meant to happen to my family. There’s been some kind of terrible mistake. It’s not really our daughter who’s supposed to have this thing.” But it is happening and time’s ticking away. I’m scared.’ He looked Kate in the eye.

She swallowed, before reaching across the table and taking his hand. ‘So am I,’ she whispered.

Sandy shook his head and said, ‘You know, I can’t believe it. I’m reduced to sitting here praying that some private hospital is going to take my daughter on as a charity case. Me! Ex-treasurer of the university Labour Club, veteran of a hundred campaigns to defend and support the NHS. Jesus! What a fake.’

‘You’re just a father trying to do his best for his daughter,’ said Kate softly. ‘There’s no shame in that.’

Sandy shrugged, not convinced. ‘Let’s go see her,’ he said.

They both broke into broad smiles as they walked into the room where Amanda lay, but the smiles were window-dressing to hide their worry. Amanda looked very ill. She had the distant look in her eyes that Kate had first seen on the day she fell ill. Her skin was pale, and she seemed slow and feeble in her movements. ‘I want to go home, Mummy,’ she said as Kate gave her a cuddle.

‘I know you do, darling, but you’re not well enough yet,’ crooned Kate. ‘But it won’t be long. All the boys and girls in the class send their love. They’ve sent you this card and look, they’ve all signed it.’

Amanda looked but her distant expression didn’t change.

‘Dr Turner says you’ve been a very brave girl,’ said Sandy but he was inwardly appalled at how weak Amanda appeared. There was hardly a flicker of spirit about her, despite the fact she had been dialysed that very morning. He tried not to think about it but logic insisted that he recognize that the chances of a suitable donor organ coming up in time must be remote.

Turner reappeared and ushered them out into the corridor to say, ‘I managed to see Dr Grayson and he has no objections to a formal request being made to Medic Ecosse. He’s left it up to me to take care of the paperwork so I’ll get on to it right away.’

‘We’re very grateful,’ said Kate. This was echoed by Sandy.

‘In the meantime, the lab people are ready for you, Nurse here will take you down.’

‘Do you really think she’s going to come through this?’ asked Kate as they drove home. ‘Honestly?’ Her voice had taken on a flat quality that Sandy hadn’t heard before. It unnerved him a little. He and Kate were finding out a lot about each other that they hadn’t known before the crisis. Sometimes he felt it was like being with a stranger. He knew false optimism wasn’t an option, even if he could have managed it; and that was in some doubt. ‘I honestly don’t know,’ he said quietly. ‘But if there’s a God up there, and he listens to hopes and prayers and knows just how much we both love her, then she’ll pull through.’

Kate squeezed his arm and said, ‘You know, I’m finding it difficult to know exactly what to hope for. I don’t think we can count on a miracle that will make Amanda’s own kidneys better, and Grayson and Turner were less than optimistic about either of us proving a suitable donor, so where does that leave us? Hoping that some other child with the same tissue type will die soon? Are we really hoping for a fatal accident to happen to someone else’s child?’ She broke down as she said it and searched for her handkerchief. ‘I’m sorry,’ she said.

‘I think in the first instance we should be hoping that Medic Ecosse says yes and agrees to take her on as a patient,’ said Sandy. He wanted to put his arms round her but had to concentrate on his driving. ‘If they really have better dialysis equipment, as Turner says they have, Amanda should start to look and feel better very quickly. That in turn would help us to feel better. As for the kidneys, let’s leave all that up to fate and the doctors. What do you say?’

Kate nodded and blew her nose.

Back at the Children’s Hospital in Glasgow, Clive Turner was filling in the paperwork required by Medic Ecosse for patient referral with fee waiver. He was using Amanda’s case notes as a source of information. The further he got into it, the less likely he felt it was that Amanda would be accepted as a patient. He should have thought of that before he said anything to the Chapmans. You didn’t need a medical degree to see that Amanda was a bad risk publicity-wise, and he could sense from the questions that this was what the free-referral scheme was all about. Medic Ecosse needed some good publicity after all the bad stuff it had received from a local press keen to expose it as a facility for the rich, with all the emotional fall-out that that entailed. People were quite happy to embrace the notion of hotels for the rich, cars for the rich and a host of other things that went with having money, but when it came to health care some special egalitarian principle surfaced. Woe betide the politician who didn’t — outwardly at least — bend the knee before that particular totem.

Common sense said that Medic Ecosse would be looking for patients they could mend or cure quickly and send on their way, preferably with press cameras waiting outside as they left the premises on the arms of delighted relatives. Prejudice against the hospital could be fought with proof of expertise. People respected learning and ability. But, as far as Turner could see, there was nothing to be gained in taking on risky cases who might die. That sort of concern was best left to Mother Teresa.

He became more and more despondent as he thought it through, especially when he realized that this was why Grayson had agreed so readily to his suggestion that they try for a referral. Grayson didn’t want a failure on his books either. He wished he’d never mentioned this to the Chapmans. He had unwittingly raised their hopes and now feared that they would soon be dashed. He wondered if a direct personal approach might help. Maybe talking to someone at Medic Ecosse would be better than just submitting an application form. Concluding that it could do no real harm to try, he picked up the phone and called the Medic Ecosse Hospital. The lines were all engaged.

Turner sat with his finger on the phone rest, watching the raindrops run down the duty-room window for a couple of minutes before hitting the re-dial button. This time it rang.

‘I’d like to speak to someone about your new NHS patient free-referral scheme.’

He was put on hold. He continued watching the raindrops chase each other down the window-pane, to the strains of Mozart’s Eine kleine Nachtmusik.

The music was interrupted and another female voice came on the line. Turner repeated his request for information.

‘I can send you out a form, Doctor. You just fill it in, giving the patient’s details and why you think a referral would be of benefit, and send it back for consideration by the relevant office.’

‘I already have the form,’ said Turner. ‘I guess I want to speak to someone in the relevant office about my patient.’

‘One moment, please.’

More raindrops. More Mozart. Outside in the corridor a child was crying as its mother scolded it over some misdemeanour.

‘This is Leo Giordano, administrative secretary of Medic Ecosse. How can I help you?’

Turner explained about Amanda and wondered about her chances of admission to Medic Ecosse.

‘We don’t usually take on transplant patients for free,’ said Giordano. ‘For obvious reasons. We’re talking big bucks here.’

‘Does that mean never?’

‘No,’ replied Giordano hesitantly. ‘I wouldn’t say never but, frankly, transplants are awfully expensive and our hospital is not in the best financial position it’s ever been in. You may have heard.’

‘I was rather afraid you were going to say something like that,’ said Turner. ‘But really our main problem with Amanda at the moment is that she’s not responding well to dialysis. The machines you have up there are much more efficient than ours. Putting her on one of those might give her the extra time she needs while she waits for a donor match.’

‘I see,’ said Giordano. ‘I take it she has no brothers or sisters?’

‘She’s an only child,’ replied Turner. ‘We’re checking her parents’ tissue types, but of course the chances aren’t good.’

‘So we’re talking about a kid who might not make it any other way?’

‘Yes.’

‘There’s a very real chance that she might not make it here either,’ said Giordano.

‘Of course. Look, Mr Giordano, let’s level with each other,’ he said. ‘It doesn’t make any political or commercial sense for you to say yes to Amanda. I’m asking you purely on humanitarian grounds. She’s a lovely kid with a couple of real nice people for parents. I’d like to see them all get a break simply because they deserve it.’

‘I appreciate that,’ said Giordano, ‘and thanks for being honest with me. But the final say is not up to me. In this instance we’d have to put the request to our medical director, Dr Kinscherf, and, of course, to Dr James Ross, who’s in charge of the transplant unit.’

‘Would you at least do that?’ asked Turner.

‘Sure,’ agreed Giordano. ‘If it were up to me I think I’d say yes right now. I think it’s good if the local hospitals can help each other out. The trouble is that if we at Medic Ecosse so much as ask for the loan of a pint of blood it hits the headlines as the scandal of NHS blood subsidizing the rich. You know how it goes.’

‘Yup, I know.’

‘In the meantime, why don’t you send over the paperwork anyway? It’s as well to be prepared.’

‘Thanks. I’m grateful.’

‘Think nothing of it. Hope it works out for you and the kid.’

Turner put down the phone and tapped his pen end over end on his desk. He’d done his best; he just wasn’t convinced it was going to be good enough. He finished filling in the form and signed it. Grayson as head of unit would have to sign it too before it could be submitted. He looked at his watch. Grayson would have left by now. He’d get him to do it in the morning. He was about to put away Amanda’s case notes when the lab form listing her tissue type caught his eye. He moved over to an adjacent desk with a computer terminal on it and logged on to the International Donor Register. He had checked availability that morning but there would be no harm in checking again as he had the details in front of him. He entered Amanda’s details then requested a search for a match.

DEGREE OF HOMOLOGY? requested the computer.

80 PER CENT, entered Turner.

NEGATIVE.

Turner punched in, 70 PER CENT. NEGATIVE.

Turner logged off. Maybe tomorrow. ‘Tomorrow and tomorrow and tomorrow,’ he murmured as he left the room and returned to the ward.

Sandy looked at his watch and whispered an expletive. The traffic had been heavy on the way back and road works on the dual carriageway had reduced a five-mile section to single-carriageway with no overtaking.

‘Are you going to have time for something to eat before you start work?’ asked Kate.

‘’Fraid not,’ he replied. ‘I’ll just drop you at home and then get on up there. I’ll have something later when I get home.’

‘I’m sure Charlie won’t mind if you’re half an hour late,’ said Kate.

‘Normally no,’ agreed Sandy. ‘But it’s one of his kids’ birthday today. I said I’d be on time.’

Sandy dropped Kate at the foot of the hill leading up to their cottage, at her suggestion, and drove on up to the district hospital. He was only five minutes late.