Issue 04 - Autumn/Winter 2008

‘A Few Problems in the Day Case Unit’

by Georgina Hammick

First published in the Critical Quarterly in autumn 1986 and reprinted in People for Lunch and other stories in 1987 and 1996

My name is Lettice Pomfrey and I am thirty-four years old. I am sitting in the gynaecologist’s waiting room waiting to see the gynaecologist. I tell you this now, at the beginning, in case gynaecology is not the subject for you; in case you find some aspects of it distasteful; in case you would rather be somewhere else than in this waiting room on a hot and sunny July afternoon. 

I don’t want to be here; I’ve a high failure rate in gynaecologists. The first one I saw was a misogynist and an extortionist, the second a lecher. The third one might have been all right, I can’t positively say he wasn’t, but we moved house before I had a chance to find out. The fourth one, Mr Gamble, I haven’t yet met. He’s been recommended by my doctor and by several people I know who variously say he’s sympathetic, attractive, dishy. A surgeon’s wife I share the school run with told me Mr G. is the envy of his colleagues, who’ve had to watch him sweep the gynaecological board, not just of the county’s childbearers, but of the menopausal. They seek him out, according to her, for hysterectomies, for removal of ovarian cysts and ovaries, and for Hormone Replacement Therapy. This is enough to put me off him, but I’m telling myself to keep an open mind.

The waiting room is in the consulting rooms an ENT man, a paediatrician and Mr Gamble share. They see their private patients here, and their NHS patients at the Infirmary. I’d have been quite happy, not being on BUPA, to see Mr G. at the NHS clinic he holds on Tuesdays, but my doctor explained that because of the consultants’ dispute, and as I can’t be called an urgent case, it’d mean tagging on to the end of a long waiting list. Impossible to say when I’d get an appointment. It could be years, not months. Centuries even, my doctor said, with one of his occasional flashes of humour. Milleniums.

The waiting room is very smart. Its colour scheme is white and fawn and chocolate brown. The ceiling is white, the walls fawn, the carpet fawn with a chocolate Greek key pattern round the edge. The chairs are white tubular with chocolate wool seats. There are two rubber plants, one either side of the fireplace, standing in white, square jardinières. In front of the plate-glass window is a large table with a glass top, and on this are magazines. They’ve been arranged like a game of giant clock patience, but in the centre, where the king of hearts or spades should be, is an enormous ashtray, square and glass to match the table. I would like a cigarette at this moment, but don’t want to be caught smoking. Also it seems common courtesy to keep my breath sweet for Mr Gamble, even if my mouth is not the part of me he’ll be seeing most of.

Mrs Pomfrey, ready for you now.

The nurse who’s come for me is a dark girl, and pretty except for some serious and disconcert-ing spots (no matter how often you come across them, spotty nurses, like dentists with bad breath and hairdressers with hacked hair, are always somehow shocking). I follow her to a little room where I am weighed, and where my blood pressure is taken. As she pumps me up I squinny to see the reading, but she’s too quick for me. That’s fine, she says grimly, unwinding the black mackintosh from my arm.

 Mrs Pomfrey for you, Mr Gamble, she says, opening a connecting door. Mr Gamble gets up from behind his desk and comes forward and shakes my hand. Then he squeezes my shoulder, a gentle pressure that encourages me to sit down on the chair my side of the desk and facing his chair. When he has returned to his place he leans towards me on his elbows.

Well, Mrs Pomfrey, he says, well now.

Mr Gamble is a good-looking man; he may even be attractive. Somebody told me he’s a bit like James Stewart, and he is, about the mouth and chin. His eyes aren’t blue though, they’re brown. They’re kind eyes, and the expression in them of sympathy and concern is intensified by the furrows in his brow. They cannot be a misogynist’s eyes. I’m sure. And there’s no hint of lechery in them.

Mr G. begins to ask me questions – my date of birth; my husband’s date of birth; the dates of birth and sexes of our four children, etc. – the answers to which he jots down with a fountain pen on a sheet of unlined A4. I wonder why he bothers with this: most of the information must be in the letter from my doctor I can see on his desk, or in the file containing my medical notes, ditto. Perhaps he hasn’t read the letter or had time to glance through the notes; or perhaps he prefers to do his own spadework in what for him is new ground, in what for me is old ground, dug over many times before.

 How old was I, Mr G. wants to know, when I had my first period? Can I give him a brief account of the births of my children? Am I a smoker? Do I have any problems at all with bowels or waterworks?

Mr G. lays his pen on the paper. Would I like to tell him, and I can take my time, about the various methods of birth control I and my husband have tried during the course of our marriage? We started off with my using a cap, I tell him, and Mr G. picks up his pen and writes Diaphragm on the sheet of paper. Then we started a baby – on purpose, I explain, and then after the baby was born I went on the pill. Oral C, Mr G. writes down. And how did that suit? he asks, leaning forward again.

The truth is it made me sick and fat and gave me headaches, and I tell him this. So, he says, looking down at his hands, So what’s the score at the moment? What method are you using now?

I must think about this. I can’t say French letter to him. But the official words, the words I know I ought to use, stick in the throat. My husband is taking precautions, I say. Mr Gamble writes down Sheath, and asks if it’s satisfactory for us, me and my husband.

Pictures float into my head; my husband groping in his bedside drawer, having knocked the lamp over; me lying in the dark with nothing to do and going off the boil, if I was ever on it; our children wandering round our bedroom before breakfast while I’m getting dressed or putting my face on, touching things, picking up things, opening drawers. What are these, Mum? What are they for? Not just pictures. Some man once told me that doing it in a French letter is like sucking a sweet with the wrapper on.

It’s not ideal, I say to Mr G.

No, it’s not. Mr G. says. It’s not much fun for your husband, I can promise you that. Even more important, perhaps, it’s
not really safe. The accident rate is high. Have the two of you ever considered – he pauses, he presses the tips of his fingers together, and then pushes them apart – sterilization? A vasectomy? I tell him we have, but one of us might, you never know, die of a heart attack or get run over by a bus, and the other might then remarry someone who hadn’t had children and who wanted some.

Mr G. glances at his watch. Let’s re-cap, he says. Which method you’ve tried was, d’you think, if not entirely satisfactory, then on balance the best for you, the best for both of you? Remembering, of course, that no method – apart from sterilization, and we’ve ruled that out – is a hundred per cent?

The Coil, I say. Because it has to be the Coil. At least with the Coil you know it’s there, and you don’t have to remember to swallow anything; or coat something with sperm-killing cream and stick it up yourself. And remember to take it out afterwards (but not too soon,not before the sperm-killers have had a chance to be effective), and wash it and dry it and dust it with talcum powder; and not leave it on the basin when the telephone rings.

Mr Gamble, looking at me, opens a drawer in his desk and places what he finds there on the surface between us. He pushes at it with his forefinger. This is the Copper Coil, he says, triumphantly, like a conjuror at the end of a difficult trick, and I think we should give it a try.

The Copper Coil is very small. It is not shaped like a coil; it is a piece of bent fusewire; half a hairpin; a shorthand character; a rest in music. How could it possibly prevent a baby?

We’re not exactly sure, Mr G admits, still pushing the wire around with his finger, but we know it does. Of course there’s bound to be some failure rate, but it’s a low one as these things go. Right then – Mr G. leans back in his chair and pushes at the desk as though he’s trying to get rid of it – I think we’d better have a little peep at you. If you’d like to pop up on the day bed over there. Just remove your tights and pants and bra, but keep your slip on if you’re wearing one.

You may feel this a little, Mr G. says. No, don’t tense, let yourself go. La la la la, porn, porn, porn, porn, let yourself go, I sing to myself, as the plunger, or whatever it is, twists in deeper and deeper, to my very core, centre, kernel, essence, nucleus, thesaurus. Thesaurus? Or thesaurus? Which should it be? If in danger, cross your legs; if you can’t be good be careful; if sex is inevitable, relax and enjoy it; if –

All done, all finished, Mr G. says, you can get dressed again now.

I suppose I’ll bleed a bit, I say to Mr G. when I am dressed again and back in my chair. (I’m an old hand at this; I seem to remember a bloody aftermath to Coil insertions.)

I see no reason for that, Mr G. says. He looks puzzled. Oh I see – I should have made myself clearer. What you’ve had was merely a routine smear test, long overdue. If all’s in order in that department, you’ll get an appointment card from the Infirmary. Until very recently, he confides, I did Coil insertions here, in the Consulting Rooms, but it’s safer and more hygienic in Theatre, where everything’s to hand. It’s better for the patient. More comfortable.

I’ve never had it done in a hospital before, I say. (I’m not at all sure.) I’m not sure –

There’s absolutely nothing to worry about, believe me – Mr G. stretches a pinstriped arm across the desk and pats my hand – Feeling all right now, dear?

We get up. Mr G. walks with me to the door, one arm lightly around my shoulder. There’s nothing sinister about this, I’m certain. I’m quite sure this is the way he dismisses all his patients.

******
And now it is evening, our children tucked in their beds, what’s left of the fish pie back in the larder. My husband is sitting in an armchair, reading a book. I am sitting in an identical chair, cobbling a seam in a pair of my son’s jeans. There was no blue cotton in the sewing box, so I am making do with green.

I went to see the gynae today, I say to my husband.

My husband turns two pages at once of his book, Alan Moorehead’s Gallipoli. He has read it before, a long time ago, but is looking something up.

What? Oh yes. How did it go? Is he a good egg, d’you think, your Mr Whatsisname?

I don’t know. I think he may be. He took a lot of trouble (for it’s true; he did take a lot of trouble). His name is Gamble.             

Ho ho, my husband says, going back to the index. You’d think he’d change it. He runs his finger down the page. Can’t seem to find it, damn, he says.

He’s giving me another Coil, I say. I’ve got to have it done in the Infirmary.

Why’s that? What for? my husband asks, his eye still on the index. What does that mean exactly? In nuce, mind you, not verbatim, says my husband who is a Latin tag man, a man for whom all invoices are, per se and ipso facto, (if a priori) pro forma, all payments ex gratia, all evidence prima facie, all quids pro quo.

It’s safer and more hygienic in hospital, in Theatre, Mr Gamble says.

That makes sense, my husband murmurs to the index, that makes sense.

I’m not too keen on the idea of Theatre, I say. I’d rather have it done in the Consulting Rooms, or the Clinic, like last time.

Don’t then, my husband says. He takes off his spectacles and puts them back on again. You’re the customer, I’m paying for this, remember. Do what you want to do. Have it done where you want.

But Mr Gamble doesn’t do it in the Consulting Rooms any more. He said –

You told me what he said, and it makes sense to me, my husband says. He clearly has a causa movens. Stop worrying, he says, nil desperandum.

There is silence for a while. My husband leaves the room and returns with the whisky bottle, which is nearly empty. We must have clobbered it before supper, he says.

I had to have an internal examination today, I tell him.

I’m sure you did, my husband says. He sips his whisky. Poor you, he says, how horrid for you, poor you.

When we were newly married my husband came with me on my first visit to a gynaecologist. I wasn’t sure I wanted him as a matter of fact, but he insisted. He was very distressed. I cannot bear the idea of another man touching you, even looking at you, he said as we drew up outside the surgery. I cannot bear it, you are mine – and he thumped the steering wheel in despair. When I came out an hour later I found him hunched in the driving seat, and when I got in beside him he clung to me. My baby, he said, his eyes full of tears, my precious, precious baby. I imagine that my husband, who is a positive, forward-looking man and, Latin tags and military campaigns apart, never one to dwell on the past, has long since forgotten this incident.

I bite off the end of my cotton and take another item from the mending pile at my feet. Emerald green will not do for the rip in Angelica’s scarlet party dress, but there’s a reel of crimson Sylko in my lap which will have to.

*******

The queue in Reception is very long, and I join the end of it. I’m annoyed by this queue because it wasn’t easy getting here on time. I had to organise, which means beg, someone else to do the school run; we had to have breakfast before seven; I had to drive my husband to the station, get back, make sand-wiches for two school lunch boxes, put the dustbins out, and then walk the dogs - because who knows how long they’re going to be shut up for. All this so I could leave the house by ten to eight, so I could be here by half past.

There’s a telephone on the Reception desk. It rings and rings. It rings all the time I’m waiting, all the time I’m inching up the queue. No less than three people to deal with appointments and enquiries, and yet none of them can answer this telephone. None of them so much as looks at it, and it’s odd. I know I couldn’t work at a desk where a telephone was ringing without doing something about it, without at least taking it off the hook, or shouting at it.

Follow the sign to B2, the Receptionist says when I hand her my card, and she jerks her head to her right. Your telephone is ringing, by the way, I tell her. Card please, she says to the person next in line.

I follow the signs to B2. Left from the desk through swing doors, right at the end of the corridor, up two levels in the lift, more swing doors, B2. A nurse is heading towards me. She’s going fast, and when I accost her she has to brake, so that her black shoes squeak on the lino. I tell her my name and what I’m here for, and she turns back the way she’s come and points to a door on the right. Go in there, she says, take off your clothes and put on a theatre gown and a dressing-gown, and I’ll be back in a jiff.

In the room there’s a cupboard, partitioned down the middle: theatre gowns on the left, dressing-gowns on the right. I take off my clothes and put on a theatre gown. It is like a high-necked apron with sleeves, and it fastens at the back with tapes, one of which is missing. I bend my head into the cupboard and sniff the dressing-gowns to see if they’ve been worn, but they smell of nothing. I put one on. It is voluminous. Its sleeves come down over my hands, its skirts trail over the floor. I hitch it at the waist, and blouse and bag it over the tie-belt. I don’t like these clothes, and the nothing smell of them.

I get off the bed and shuffle to the window. Far below two tiny figures in navy capes are being blown along a concrete walkway. They weave in and out of the buildings, disappear, reappear beside a grove of sapling poplars, vanish into Pathology, a shack like all the other shacks. Angelica’s classroom is a shack. She will be in it now – arithmetic, first period after prayers. She didn’t want to go to school today. She didn’t feel well, she said. She had a headache and a tummy ache, she felt sick. She says this, or something like it, every morning. Every morning I want to keep her at home and let her mess up the kitchen table with paintwater and scissors and gummed squares; every morning I send her to school.

I go out into the corridor. There’s a cleaner with a hover-craft outside my door. She shows me where the lavatory is, just in time.

I am back on the bed, curled up, reading the mail that came as I was leaving the house. My mail is one postcard, from a friend who’s on holiday in Kenya (was on holiday, I should say. I saw her in Tesco yesterday, at the cheese counter. She was busy, I was busy, we pretended not to see each other). The card is addressed to Memsahib Pomfrey. It says Jambo! Habari? We are having a fantastic time. See you soonest, Love V & C. I turn it over. The picture side has a hippo with its mouth open, half submerged in a pool, surrounded by smaller hippos.

A man’s head appears round the door of my room. I’ve come to take you to Theatre, he says. Leave your handbag and your clothes in the locker – and your watch if you’re wearing one.

Are you a nurse? I ask the man when we are in the lift together, descending to G level. The man has his arms folded across his chest and is staring at the ceiling the way people tend to in lifts. I know I do, because it’s the only way to avoid eyeball to eyeball confrontation with strangers. He uncrosses his arms and points to a badge on his overall which says Porter, green letters on white.

At G Level we follow signs to X-Ray and Haematology, but at the last moment bypass these and make now for Pharmacy, Out-patients Surgical, Gynaecology and Shop. We walk out through plastic swing doors, Emergency Exit 2, and I lift my skirts, costume drama style, onto covered concrete, uncovered concrete, covered concrete, through swing doors, into lino corridor, where we stop. Put on a pair of overshoes, the porter says, and take a seat here.

Against the wall are two chairs and a row of see-through galoshes, all the same size; it doesn’t matter which pair I choose. I take a seat in the corridor.

The doors of Theatre 2 open, a stretcher trolley shoots out, swings round, one person behind it pushing, another in front steering, holding the drip steady. I keep my head down as they trundle past at a trot, but I see because I want to see, because I have to, because I must: a white face, a dead face, surely, chin tipped up, mouth hugely open,a tube in the nose - or was it the mouth? Gone.

How long have I been here? Ten minutes? Twenty? I keep checking, but on my left wrist, printed across unbleached hairs and a mole, is only the ghost of my watch. Where is Mr G.? Why doesn’t Mr G. come?

Ready for you in theatre now, dear.

It isn’t Mr G., it’s a nurse, in green, masked and gowned, who leads me, clopping in my overshoes, out of the darkness of the corridor into the light of Theatre 1.

It is very bright in Theatre. Interval time. The house lights are up and there’s a party going on. It’s a tea party, I can tell, because the six or seven people wandering about chatting have cups and saucers in their hands. It’s surprising really, all this activity and chat and tea drinking, because you tend to think of hospital theatres as sterile, hygienic places, as Mr G. said, places (or areas, or zones) you can only enter if you’re wearing overshoes.

Someone comes forward and helps me out of my dressing-gown. Someone asks me to take off my overshoes and my shoes. This same person gives me a hand onto the stage. (No, not a stage, a table. An operating table, for operations.) I lie down on my back, feet together, arms by my sides. Lift your tail, please. And at once, when I comply, the theatre gown is rolled back, up over my knees and thighs, and then folded above my waist. My legs are separated into a V. My right leg is carried up and away and placed in a sling and strapp-ed; my left leg is carried up and away and placed in a sling and strapped. I raise my head. The slings are attached to a contrapt-ion suspended from the ceiling. It’s like a Big Top up there: lights, wires, machinery, all the gear for tightropes and trapeze.

My bottom, my tail, is no longer on the table. Somebody slips a pillow underneath me, wedges it into the small of my back.

And that’s all. Nothing else happens. I am on my back, with no knickers on, my legs wide apart and in the air – andnothing happens. The tea party is still going on, to be sure, all round me I can hear chatter and laughter and cups being returned to saucers – but I’m not part of it somehow, no one offers me a cup, no one chats to me.

This is not the first time I’ve been in this position; our second daughter, in no hurry to be born, had to be induced. But that time there were only two people in the Treatment Room - me, and the hospital doctor (Brown? Yes, Brown) who explained nothing, who said nothing, as he strapped up my legs. I remember the pain when he ruptured the membranes; I remember thinking it must be blood that gushed out and ran back underneath me and soaked the hospital gown and the sheets; I remember the ward sister in the corridor who, as I staggered out into it, took one look and snapped her fingers: Nurse! That girl needs some pethadine! I can think of all this, and concentrate on the detail and the pain because nothing that happens today, nothing that Mr G. has got up his sleeve, can be as bad as that.

Or can it? At least last time there was an end-product, a baby, Michael, to be born, at least there was someone to look forward to. What Mr G. is going to do (why doesn’t he do it?) is prevent a baby being born; and at the same time rob me (when I am tired or cross, or simply not in the mood for love) of the best, the most convincing, the least hurtful, of my nocturnal excuses: D’you think we should, darling, when we know it isn’t safe?

There’s a game I used to play with my brothers, that I daresay everyone plays with their brothers – or sisters – if they have them: the Would You Rather Game. Would you rather be (here describe the worst horror you are capable of inventing) or go to bed with (here name the most repellent specimen, of either sex, known to you all). Would you rather be on your back under a search light with your legs apart and no knickers on in the midlle of a tea party, or...

All right, Mrs Pomfrey, dear? I’m afraid you will feel this, it will be a bit painful. But if you can relax and just allow yourself to go floppy, it will make it easier for you. It’s Mr G.’s voice. It’s Mr G.’s face, bending over mine, I recognize his eyes. He has pulled his mask down, below his chin, so that he can speak to me. I can see the bristles on his top lip and the hairs, wonderfully luxuriant hairs, in his nose. Has he been here all the time?

There is less chatter now, no chinking of cups. But no one has left the Theatre; I’m certain of this because if I roll my head to the right I can see the doors, and even if I couldn’t see, even if I were blind, I’d feel the draught. Mr G. prepares to insert the Coil. While he does so, he gives a commentary, an ex tempore lecture, my husband would say, to the throng at the end of the table because, yes, that is where the tea party is now assembled. They are students, of course they are! And I am the demonstration model. Watch closely, Mr G. says, I’m just going to lubricate the vagina prior to insertion. Can you tell us about the relative safety and efficiency of this Coil? a male voice, eager beaver, enquires. How does this Coil, the copper Coil, compare with other Inter-uterine devices currently available?

All over, Mr G. says at last, all done. Good girl.

My legs are unstrapped, removed from their slings and returned to me. I am helped down from the table. An S2, please, Mr G. says, and someone springs forward with a cello-phane packet which, snipped open, contains two sanitary towels, individually and hygienically wrapped. You will have a period now, Mr G. promises, placing one of the sanitary towels between my thighs, but if the loss is unduly heavy don’t hesitate to give us a ring. Take two aspirin four-hourly if there’s any discomfort.

Dressing-gown on, shoes on, overshoes on. Out of theatre. A six-yard stumble on cardboard legs. Overshoes off. And here is the porter, come to take me back to my clothes.

There are some questions I forgot to ask Mr G. and the tea party in Theatre 1. How do you hold a sanitary towel in place when you haven’t been given a belt or a pair of pants? How do you keep up with a porter in a hurry when your legs refuse to function properly, and when you’re trying to glue your thighs together so that your ST won’t leak or land on the floor? When your dressing-gown was designed for a giant and is intent on tripping you up? When your insides are falling out, when your eyes are blurred and you can’t see where you’re going, when the pain is so bad you will surely faint, if not actually die?

In the lift, ascending to B2, a trickle – hot, sticky, but which cannot be amniotic fluid, not today – descends the inside of my right thigh, circumnavigates the knee muscle, finds a route down the calf, steers between the ankle and heel, arrives in my shoe, collects there.

Outside my door the porter and I part company. Here we are then, he says, the first words he’s spoken since we left the theatre, and he goes. I reach out for the door handle of sanctuary, and then I notice it, a red-black splash on the beige lino at my feet, the size of a coin, a little ragged around the edge. I turn, and look, there are more of them, all down the corridor back the way we’ve come, dark two-penny pieces, regularly spaced, as far as the eye can see. I’ve left a trail, like Hansel and Gretel did in the forest! Supposing, just supposing, I wanted to go back to Theatre now, I wouldn’t need a porter to show me the way.

*
Afterword 1: The Letters

Unposted letter to Mr Gamble.

Dear Mr Gamble,

A week after my experience in the Infirmary I wrote you a letter.

I decided to write to you for two reasons: a) because I felt you should know what it was like to be on the receiving end of your lack of attention, and b) because I thought it incumbent on me, being articulate, to suggest ways of improving your set-up.

I took trouble over my letter. The first two drafts were too emotional (you mustn’t be allowed to excuse yourself on the grounds that you were dealing with an hysteric); the third too rude. In the end my letter was polite, neither sarcastic nor acrimonious. I gave you a matter-of-fact account of what happened to me. I said I thought you’d want to know about it, so that the experience couldn’t be repeated for anyone else. I suggested a few things (a female nurse to take the patient to and from Theatre; fewer people, if possible, present in Theatre; the provision of a sanitary belt or pants afterwards) to make it less of an ordeal for other women in future. Yours sincerely, etc., etc.

Nineteen days later I got your reply: seven typewritten lines, sincerely regretting ‘the problems you encountered in the Day Case Unit’, hoping the Coil was ‘proving satisfactory’ – signed in your absence by your secretary, and enclosing your bill.

Could you please tell me, because it wasn’t quite clear, which part of the Infirmary was the Day Case Unit?

Afterword 2: The Titles

I had difficulty deciding on a title for this story. I hope I chose the right one (the right one, that is, for the story, and also for you). It cannot be said to mislead, although it may be on the dull side. If you did find it dull, you might be interested to see, in case there’s one here you prefer, the other titles I rejected in favour of it. Before I list them, I’d like to tell you my reason for discarding them. It’s that, when I typed them out, I saw they could all be construed as containing bitter little ironies; they all seemed to smack of, if not quite feminist, womens’ or alternative writing.

I was worried they might,if you’re a man, put you off.

Here they are, then, in order of invention, not merit:

1) The Would You Rather Game
2) That’s Enough Gynaecology - Ed.
3) Volenti Non Fit Injuria *
4) How to Make Your Man Happy in Bed.

*Which is what Lettice’s husband said, not unsympathetically and among other things, when she told him what happened in Theatre. It seemed quite neat for a while, perhaps the best of the bunch, I nearly settled for it; but not everyone appreciates Latin tags, some people consider them a joke or pretentious, not everyone understands them.