A Mistake Read online

  She consulted the instructions David had written out for her on yellow Post-It notes.

  The Personal Excel sheet had cells of data and a banal empty chart with x- and y-axes. Observed, expected, moving range. It represented change over time, with limits to show when mortality went out of control against an external standard. When complications were out of control.

  She deleted the sample entries in the cells and entered her own mortality and complications data for a few years until the previous month.

  She sneered at it and hit enter.

  The chart assembled itself around her work.

  She was a jagged blue line over time, leaping from zero, rising up from perfect, rising back to it. Beneath a ceiling of rose-red—the upper limit, the agreed standard. Then suddenly she leapt again, she was transcendent, she went higher, paused for breath, and higher, and she burst through.

  Abruptly stopping as the data dried up.

  ‘Golf,’ the coding manager had said. ‘Golf. You finish your 18 holes and you have a score. One over par. Two under par.’

  ‘I don’t do golf,’ she said. ‘I’m not a lawyer.’

  ‘Well okay, but you know how it works. There are 18 holes, 18 chances to play. Let’s say those are your months of operations. At Bristol it was babies with malformed hearts. Switching arteries on the blue babies. Now at the end of your game you’ve got a score. How good were you? Pretty good. But did your game change? Did any holes go badly? Perhaps there was a group of them. Close together? How good are you really? When are you particularly good or particularly bad? Are you falling off and you don’t know it? Imagine for every hole every shot over par is one dead baby more than the national average. You lose ten on the back nine you can make that up with the ten under par you saved on the front nine when you weren’t tired. If they’d tracked them at Bristol using cusum they wouldn’t have operated on Joshua Loveday. They’d have known and they wouldn’t have killed him. They’d have known they were going wrong. It was originally used for munitions manufacture. Calibrations of shells. To check when the process was out of control.’

  She sighed.

  It wasn’t that hard. Someone else had done the sums in the workbook template. She deleted the data with Lisa. Her blue line fell. The final few millimetres of blue disappeared and her deviations were within expected limits. She re-entered the data. She changed the name of the final month to Lisa. The blue line soared. It crossed the red, boundless and climbing, failing. She changed workbook from Personal to National. Deleted Richard and Lisa. Built the national chart, a funnel plot of general surgeons. The upper limit was in red and the lower limit was a friendly green and the limits narrowed and narrowed with numbers of cases, an eel trap from which she should never escape.

  There she was, Elizabeth, a dot among dots. Every one a surgeon. Among her peers. Safe inside the funnel plot like a spider, primus inter pares. The expected limits of deaths for surgeons performing laparotomy. Her expected limits. Deaths on the y-axis, number of operations on the x. She was about halfway along the average number of procedures. She could do more. She added Richard, added Lisa.

  She had escaped the trap. Her dot was free of the limits. Free of all limits. She soared. Out there on her own. Out of control. Wrongly machined, wrongly calibrated. A wild munition tumbling in the sky. It was so quiet. That thing in my face. She deleted Lisa, and came back inside. She added her, and flew. Tumbling. She deleted Lisa, added her again. She did it a few more times.

  Then she turned to work on her response to the peer review for Andrew.

  She wrote for an hour. She cut and pasted her long response. She broke down every comment they had and added an asterisk after each comment and responded at length. The reviewer didn’t like the Lancet paper. Paragraph six on small numbers and identifying poor performers is simply wrong and ignores the seminal work of Marc de Leval and David Spiegelhalter in this area (now Sir David Spiegelhalter who examines risk for the NHS). He had three references, all obscure and old. Little evidence is produced to support these authors’ facile conclusions.

  Don’t give in. Double down. Always double down. She wrote and wrote. She restated the Lancet paper’s finding. Rolled her neck in her shoulders. Thanked the peer reviewers. And gutted them. Thank you for this comment. However, we are keen to point out. Thank you for this comment which has helped us immensely in refining our argument. Thank you very much. We are grateful for this reviewer’s comment. Thank you. However. Indeed, although. Despite these important points. She anaesthetised them with praise and she gutted them thereafter. She did that work. It would fly or it wouldn’t. She would fly or she wouldn’t. It was an important paper. NZ was not the NHS. They didn’t need to do this. They didn’t need to do this. She wrote and wrote and wrote and then she suddenly sent it away to the Royal London Journal. She read the comments on the story about the surgery. Where people used her name. She opened the workbooks again. It was too late. Deleted Lisa. Entered her again. There she wasn’t. There she was.

  T+2 min 08 sec

  Nesbitt: ‘We have no downlink.’

  The flaw

  She woke at six, alone.

  She lay there in the half dark. Then she got up and changed into gym gear, her thigh-long tights and a sports bra, and went into the living room. Atticus lay on the huge leather pouf Jessica had delivered with him. He watched her pass. Just his eyes. Wary, sad crescents of white below the dark brown irises.

  Outside. Clean smell of the bush, and damp. A frighted blackbird rose from the barbecue, flared its wings and disappeared over the fence into the neighbour’s backyard. She’d forgotten socks and she went back in and put on her work ones and took an apple as she came back through the kitchen.

  Atticus lay and watched her.

  Down the side of the house she stood in her sock feet on the dry concrete under the flax and ate the apple down and pitched the core up the back. She turned and crouched and unlocked the padlock and crawled in under the house and came back out in gumboots and overalls with the hammer and jimmy bar in one hand, and in the other a plastic Four Square bag with the Makita electric drill and drill bits along with five old unused borer bombs she’d found in the tool cabinet and then she went back inside the house.

  In the living room she dragged the couch out from the north-facing wall. She unplugged the TV and router and the modem and dragged the chest on which the TV and electronics sat away from the wall too.

  The flaw was at eye level. The previous owners had re-gibbed this wall and this wall only for some reason and the plasterboard was a decent job so she’d left it. But at eye level was the nub of a 5-millimetre bolt, sticking out just enough. The wall got no direct sun so the bolt cast no direct shadow. It was ignorable.

  She laid down an old sheet as a drop cloth and laid the tools on it and put on her glasses and looked at the nub. It was sheared off at a slight angle and there was putty and paint around to smooth it off. She reached to it and she caressed it. Feeling the angle of the shear, where there might be purchase for the drill bit.

  Then she picked up the hammer and she hit it as hard as she could.

  The whole wall vibrated and the sash window rattled in the frame. Atticus laboured up from the leather pouf and walked out of the room with his head down and his tail between his legs.

  She leaned in to examine the bolt. The paint had come off the end but it hadn’t moved.

  She guessed the size of the drill bit by eye and compared it to the nub. The chuck was tied with string to the trigger guard of the drill the way her father taught her, and she used it to screw the bit in tight and looked around for her ear muffs but she’d left them downstairs. She held the drill up high and straight and seated the tip against the nub of bolt and slowly squeezed the trigger. The drill hummed. She squeezed it tighter and the bit turned on the steel. She stopped and looked at the nub. It had made no impression. She squared her stance, raised her elbow, seated the bit and squeezed the trigger and leaned into it. The drill hummed, and the bit tu
rned slowly then faster and then it slid off the bolt and punched through the gib. A neat hole. She tried again, adjusted her grip on the drill, leaning in. The drill hummed and the bit turned and then it jumped off the bolt again and through the plasterboard beside the first hole.

  ‘Fucker,’ she said aloud. She put the drill down and picked up the hammer and beat holes through the gib in a circle a rough metre around the bolt and then tore off the piece of gib hanging from the bolt nub and threw it behind her and stepped back.

  It was a coach screw, 5-millimetre diameter galv steel sawed off as close to the wall as they could get their hacksaw, then filed down. It was impossible to know how deep in the tōtara stud. Not enough sticking out to get at it with the vice grips. She took up the hammer and bashed it a few more times and the windows rattled and clouds of borer dust rose in the room. It went no deeper. ‘Why don’t I use you as a fucking coathook,’ she said. Then she rolled up the Afghan rug and pulled the TV and couch up against the south wall and smashed out the gib on the rest of the wall with the hammer and tore it down bare-handed and threw the pieces on the floor behind her as the room filled with dust. She went round with the jimmy bar snapping the heads off the thin gib screws and then she banged the sheared-off stubs into the timber with the hammer and more and more borer dust rose and then she went back to the bolt and looked at it.

  She replaced the drill bit with a smaller diameter bit and tightened it up with the chuck. She drilled 20 neat holes in the stud in a circle around the nub. The drill kicked and screamed when it hit the galv steel and she swore. Then she took up the hammer and bashed and bashed the bolt side to side and it barely moved so deep in the wood was it buried. She swung and hit and missed and dented the timber into shiny pits but the bolt was seated so deep she’d have to cut the stud through to the weatherboard to get it out and it was a load-bearing wall so she hit it and hit it and hit it and then she gave up.

  She showered and walked down into Newtown at 6 p.m. for dinner at Monterey. She sat and ate curly fries and looked at her fingers and then finally turned on her phone. No one but Richard had texted her.

  Hello Liz. I just wondered if we might have a chat please. Can I buy you a coffee or something?

  At montrey, she replied. U at hosp? Come over.

  He replied immediately.

  She ate her burger. She ordered a ginger beer. He was there in ten minutes. Stood at the door in chinos and a polo shirt in Nantucket red. She raised her eyebrows for him and he came over and he sat and he examined the table.

  ‘Thanks. Sorry to interrupt,’ he said.

  ‘You’re not interrupting. What can we do for you, Richard?’

  He took a breath and went to speak and didn’t. There was something so generic about him. His good skin. Polo shirts and natural wool sweaters and woven belts. A sweet posh boy working overtime. Paddling hard underwater just to stay in place. The kindness in his tired eyes like a warning.

  ‘I think it’s ridiculous,’ he said at last. ‘Ridiculous and wrong.’

  ‘What are we talking about that’s specifically ridiculous today because I’m swamped in it,’ she said.

  He looked at her. It was safe to be appalled on her behalf and she didn’t like it or trust it.

  ‘That they’ve restricted you. You.’

  ‘Well,’ she said. She dropped a curly fry back in the basket. ‘I’ll work private till it sorts itself out. No shortage of work.’

  ‘What does Alastair say?’

  The waiter came then and he was a skinny 20-year-old and unknowably beautiful but still there was the air of decline and the threat of age that maybe was just the country and beautiful 20-year-old boys serving gourmet burgers. Richard looked down at the table and didn’t look up when the waiter said, ‘Hi guys, and how are we going here.’

  Elizabeth smiled up at him and closed her eyes and shook her head. ‘We’re fine thanks.’

  ‘Okay, just scream if you need me.’

  ‘Yep.’

  They waited till he was behind the counter.

  ‘Alastair,’ Elizabeth said towards the waiter far away, ‘hasn’t quite summoned up the sack yet.’

  ‘Really? Nothing?’ He shook his head at the table then he looked in her eyes. Hiding in his outrage. Performing for her.

  ‘It’s not how these things are done, Richard.’

  ‘He told me it would be all right.’

  ‘It will be.’

  ‘But this is you.’ He shook his head again. ‘This is you.’

  ‘You’ll understand it. It will go to the College now. Watch it play out.’ She looked past him. Assessing the clientele. She spoke very quietly and her face didn’t change. He frowned and leaned in to hear her. ‘You’ll be all right. Just keep your head down and work. Don’t start looking unlucky.’

  He looked baffled, astonished. The restaurant seemed full of children. Anointed, some oil in their skin, in their hair, that placed them in a dream. Lisa’s eyes over the CPAP mask, trying to breathe, in her dream, so late, so silver-blue, seeing Liz looking back, in her dream too. Rotorua girl, she wouldn’t fit in here.

  ‘We did the right thing, Richard,’ she said to him. ‘We did everything in our power inside and outside theatre. Mistakes may always happen.’

  His eyes were twitching and red. She sat with her back straight and looked back at him.

  What were the Williams family having for tea tonight?

  ‘What does your father say?’ she said.

  He looked away over the restaurant, then back at her. ‘I haven’t told him anything yet.’

  ‘Isn’t that something you’d talk to him about anyway? You talk about work don’t you?’

  He winced, a sneer. ‘Oh, I think he’d agree with you. Get on with it. And anyway, he’s just been made head of surgery at Dunedin. So I’m not comfortable with what, you know, what position my telling him would sort of put him in.’

  He shook his head at what he’d said, at what he meant, she couldn’t tell.

  ‘Oh?’ she said.

  He looked at her again. ‘You didn’t know? I assumed you knew all about the political stuff.’

  ‘I’m suddenly finding myself a bit out of the loop.’

  ‘You . . . I actually don’t know what he’d say.’

  ‘He’d probably say you’re better than this.’

  ‘Oh, probably. Maybe. I don’t know if I am though.’

  ‘Oh come on. Feeling that’s part of it isn’t it. How you get better.’

  He eyed the waiters back behind the counter. His face swollen up, red around the eyes from the allergies.

  ‘I’m—I’m actually having dreams about her,’ he said.

  There was a moment’s pause she quickly sought to destroy.

  ‘About the patient.’

  ‘Yeah.’

  ‘Oh. Well. Well, I’d say that’s probably normal, isn’t it? I’d say that’s probably quite normal.’

  ‘Not just her though.’

  ‘Okay.’

  ‘Other ones.’

  ‘Right.’

  ‘Sorry.’

  ‘No.’

  Elizabeth found herself looking away from him as his face worked. Ashamed for him, ashamed for being ashamed. For not being ready, not doing the required reading in time.

  ‘Well,’ she said. ‘We should look into some ways of getting through it. Put together some coping strategies.’ She could hear Atelier in her voice and hated him. ‘Look, Richard, you’re doing all right. This is normal.’

  ‘Sort of scary dreams,’ he laughed.

  ‘They’re just dreams.’

  ‘Yep.’

  ‘Would you be interested in, I mean, would you like some confidential counselling or something like that? I can speak to Alastair or go around him if you’re not comfortable.’

  He looked at the waiter and there was something new in his face when he looked back at her. There was a small silence and then he said, ‘I know what you did for me. I just want you to know that I know what you
’ve done for me.’

  ‘Oh for God’s sake,’ she laughed. ‘Don’t be stupid. We’ll talk more. Are you going to get something?’

  He looked appalled.

  ‘No.’

  From the kitchen in a break in the music they could hear a cook talking.

  ‘Dude if you fall over I might not catch you but I will help you up,’ the voice said.

  ‘Legit, I accept those terms,’ a waitress said too quickly back at him.

  They were all hopped up on hospo, maybe high, maybe just frazzled. Maybe this was just how they were. Elizabeth and Richard looked at each other, and Elizabeth tried a small smile. He looked at her, coldly, then he half imitated it and looked down at the table and there was a silence.

  ‘Okay, well I’ve got to get going,’ Elizabeth said. ‘To be continued,’ she said with false brightness.

  He looked at her again and was unhidden.

  Gauging what she had to get going.

  Buried now, Lisa, anyway.

  Going private

  She rose at five, fed Atticus. Sat down with him. Scratched at the nubs behind his ears. He raised his head and then he lay down again, sighed, sad and heavy. She squeezed his ears and they were warm and she felt the fine leather inside, the fine hairs, the hint of wax greasy and clean on her fingertips. He sighed. She drank coffee and ate buttered toast on the rug beside him in his leather pouf, squeezing his ears, looking away from the skeleton of the stripped wall. Steam from her cup rising undisturbed in the silent room.

  When she was dressed she went out and walked in the cool sunrise down a near-empty Adelaide Road to the private work. It was all clean and white and quiet in reception and the receptionist greeted her by name and gave her her credentials for the day. In the tearoom was a plastics surgeon she’d gone to med school with named Michael Garvin.

  ‘Lizzy Loo!’ he said and laughed loudly. ‘How do you do.’

  ‘Hi Michael.’

  ‘My God, you’ve got fat!’ he said. ‘Look, you’ve got to come.’