by LSF Publications
by Rachel Gordon
For Sister Hannah Matthews it was just another routine Tuesday afternoon appointment. The weather was unusually warm for early May so she decided to open the windows in her consulting room and keep the door open to create a flow of fresh air. Perfect weather for tennis, she thought wistfully.
For Ellen Glaister an appointment at the surgery was far from routine, in fact it was something of a rare event. After quickly glancing at the letter inviting her to meet Sister Hannah Matthews at 2.15 pm, she looked at her watch to make sure she wasn't late. Punctuality, once a weakness of hers, had improved over time, although of late she had come to realise that she had very little to be on time for.
The fact that the letter made a point of highlighting that Hannah Matthews was the 'new Surgery Sister' seemed to amuse her for some inexplicable reason. Probably because it hinted at some grand importance attached to the title which in her mind equated more likely to over-inflated pomposity. Then, for more obvious and personal reasons, the letter made her think of Gregory and the smile on her lips disappeared as quickly as it had formed.
This rare event for Ellen had arisen because, as the letter held between delicate fingers clearly stated, the results of her blood tests and a short medical questionnaire she had completed at the same time, had pushed her just over the surgery's health risk threshold. On first reading the letter she was surprised but then wondered if something sinister had been found, before she finally dismissed that idea. Gregory often commented on Ellen's butterfly mind.
Although Ellen preferred to stay out of any limelight she was, in the main, a positively-minded and healthy individual. Since moving into the area some fifteen years ago - apart from being randomly called in over two weeks earlier for this particular health check - Ellen could not recall visiting the surgery or having need of a doctor for herself. She had no children and had not succumbed to any illness except the common cold and a single bout of influenza.
As to the recent arrival of Sister Matthews, there was no reason why she should be aware of that event, but even if she had known, it would have meant little to her. Ellen had always been a private woman, leading a private life. She met few people now but would never gossip, and never meddled in the lives of others. It is true though that more recently she had often wished her conservative lifestyle could change. The opportunities for that to happen however had simply never presented themselves.
"Hello Mrs Glaister, I'm Hannah Matthews. Thank you for coming in to see me. Please take a seat." There was a pause whilst Ellen sat down, making a mental note of the brusque efficiency and informality of the Sister.
"Now, before we go any further I want to be clear that there's no need for you to worry about being asked to come and see me after your tests. It's really just a formality." Preferring an informal approach with her patients the Sister then asked, "May I call you Ellen?" Ellen nodded her approval and backed this up with a somewhat timid smile.
Hannah Matthews' technique in dealing with her patients said a lot about her as an individual - well prepared, attention to detail, and to the point - a throwback to an earlier career which she had reluctantly abandoned. Now her approach was to peruse a patient's history, explain the issues up for discussion in simple terms, and then listen carefully to what the patient said, and sometimes coax the more reticent patients to speak up. Observation - of appearance, responses, body language and gestures - was however something she put a lot of store by.
So far she had observed in Ellen Glaister the more obvious superficial facts - quite an attractive lady, with long auburn hair, dressed in a pale cerise cotton blouse and a navy, knee-length flowing skirt. She noted too that apart from a watch she could see no other forms of jewellery, though her handbag looked expensive. Her skin was pale but not anaemic and she looked younger, very much younger than the age on her records showed, forcing the Sister to re-check before speaking again.
"Well Ellen, you've been asked to see me because your results just crept over the risk threshold," Sister said, "and that's happened because of three factors - your cholesterol is a fraction above the upper limit, your blood pressure is a little high, and I believe you have a history of heart-related problems in your family." By way of explanation Hannah added, "This last point you must have mentioned in your questionnaire replies."
"Yes, I must have done, but the questions were awfully vague as I recall," Ellen said before asking, "Why am I not seeing the doctor if there is some kind of health risk?"
Hannah Matthews was used to this type of response. It was what she called an 'I would rather speak to the organ-grinder than the monkey' attitude, and had had much experience of this at her previous practice. At first it had evoked a reaction until an older hand had taken her to one side, so now it was like water off a duck's back.
"That's because your risk has been assessed as less than 20%, Ellen," the Sister said calmly looking directly at Ellen. "We use the results of the blood tests and the responses you gave to the survey questions to form an assessment of risk to your health. I accept that it is crude so we use it as a guide. Patients presenting with up to a 10% risk are not called in, those between 11% and 20% are referred to me, and those where a risk of over 20% is indicated are automatically referred to the doctor."
"Oh, so there really is nothing too concerning then?" Ellen offered meekly, detecting the merest hint of steel in Sister's reply, and for the first time she took more notice of Hannah Matthews. She noticed first her beautiful blue-grey eyes that complemented a soft and friendly face framed within almost white, stylishly-cropped short hair. Taller than her own average height, she thought, probably not chunky though her shape appeared indistinguishable under the unflattering navy smock with its white piping. All-in-all, Ellen thought this pretty woman looked like she was no-one's fool, enjoyed life to the full and was most likely fun to be with or around.
"As I said Ellen, there's no need to worry about your tests, so let's deal with those things we can shall we?" Hannah Matthews said with authority. "We can't do anything about your family history, but potential problems with your blood pressure and cholesterol we can address. Now before you came in to see me today the nurse took your blood pressure and I see that the lowest of the three readings was still a little high. Do you have a machine for measuring blood pressure at home Ellen?"
Ellen said she did but used it only rarely now. When the Sister asked why it was used infrequently Ellen's reply took Sister by surprise.
"Just over two years ago my husband Gregory died suddenly of a brain aneurysm. He was only forty-three years old and it was quite a shock as there were no warning signs. Ironically Gregory was something of a health fanatic. He would insist I check my blood pressure at least twice a week but of course since his death..." The words trailed off until Ellen recovered enough to continue, "We never had children and moved here soon after getting married. That was when my husband was appointed Headmaster of the Peltham Grammar School for Girls."
"I'm so very sorry, Ellen, to hear of your loss," Sister said sympathetically, sensing Ellen's distress, "but you made friends locally I take it or perhaps have close family members you're still in touch with?"
"I am slowly getting over Gregory's death thank you Sister. Time is a healer, is it not? As for friends, yes we did make a few but oddly they seemed to evaporate quite quickly after Gregory died. That coincided with the appointment of a new Headmistress. Our friends tended to be teachers you see, a very fickle lot from my experience! We both, that is to say Gregory and I, were only children, so I have no siblings to turn to but I suppose I do have cousins somewhere." There was a moment's pause before, "I have survived though and I am quite content with my lot."
Sister Hannah Matthews knew that a patient's visits to the surgery quite naturally involved discussing relevant social issues and that chatting about family ties can be important if support is necessary. She had a rule, however, that any such discussion should simply be to put the patient at ease and gain further information to aid his or her treatment strategy.
"Right Ellen, I want you to use your own machine again please and set aside ten minutes to take three blood pressure readings, writing down the lowest of the readings on this chart." Hannah Matthews handed Ellen a sheet of paper. "You don't have to take them at the same time each day, in fact, don't take them every day - perhaps three or four days each week. Then come back in a month's time and we'll review what you've recorded. OK?"
Ellen nodded her agreement and rose from her seat about to leave.
"We haven't quite finished yet Ellen!" Sister said more abruptly than intended, and Ellen sat back in her seat again noting the firm tone of Hannah's voice.
As she pushed a booklet and a few dietary leaflets across the table towards Ellen, Sister enquired, "How well would you consider you control your intake of fatty foods?"
"Oh I suppose I am less watchful now Gregory is not there to advise on such things. Now I tend to eat whatever I fancy. My shopping habits regarding food have definitely changed since his death." She gave a small hollow laugh as if to suggest she enjoyed some new sense of freedom, though Hannah Matthews was not entirely convinced.
Sister Matthews looked at her notes again and then at Ellen, "Mmmm. You're still only thirty-six according to my notes so you married when you were, say, twenty-one and your husband was, what, older by about ten years. From what little you've told me it sounds as though he made sure you stayed on the straight and narrow health-wise."
Ellen nodded. "I was twenty when I married and Gregory was almost eleven years older. He was quite old fashioned in many ways, which I found - still do find I suppose - an appealing trait. He was rather strict about some things though and..." Ellen paused giving Sister a strange look.
"And?" the Sister pressed.
"Well... I am not sure I should continue. It is rather personal you see." Then hesitatingly Ellen asked, "This is all in the strictest confidence I take it, Sister?"
Sister Hannah Matthews rose from her chair and closed the door to her consulting room and then the windows before sitting down again. "I can assure you Ellen that whatever is said in this room is between you and me, but if you don't wish to tell me that's quite all right. What you do tell me might be useful and please remember my role is one of simply trying to help if I can. I make no judgements whatsoever."
Ellen realised the decision to continue would be hers alone but she felt somehow reassured by this woman sitting opposite who made her feel protected, in a familiar yet also in a different way. Yes, there was perhaps something about Hannah Matthews that reminded her of Gregory.
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