Blue days

She looked sallow, even though her complexion was dusky. Her nails were beautifully manicured. I can see them even now: long curved nails painted a deep blue, each decorated with a silvery glittered swirl. Her index fingernail even had a little jewel stuck on the end, and it sparkled under the harsh hospital lighting.

I looked down at my own nails - filed short, with raggedy half moons - and hid my hands behind my back.

Madam Nails had terrible needlesharp pains in her ribs on and off for several months, and had been coughing up small amounts of blood daily for almost two years now. She had been seeing a respiratory consultant who had done some tests and lung biopsies, and was due to see him again in two days. But over the last few days, the pain had gotten much worse despite regular painkillers, and she came to hospital for advice on pain relief.

I asked her if she had used any pain relief stronger than paracetamol. Shaking her head, she replied that she was worried about using stronger analgesia, in case it interacted with her medications.

I enquired after her medications, and found out she was on a pill for her cholesterol. I smiled and told her that painkillers wouldn't interfere with the cholesterol lowering tablets. Then I ran through the usual list of questions. Any other changes you've noticed? No. Taking any other medications for anything else? No. Any allergies? No.

Any other medical problems? (pause) No.

Something went 'ping' in my head after her response to my last question. But I ignored it.

Anything else you think I should know? (long pause) No.

Another 'ping' in my head. I ignored it again.

I gave her some painkillers and she seemed pleased. Before she left, she asked if I had the results of her biopsies and blood tests. I had a quick glance on the computer at her results file and nothing was on it, so I told her that they were probably not ready yet. She nodded. I asked her to return if she was feeling worse. She smiled a tired, watery looking smile, and exited.

A few days later, I arrived at work and the departmental boss called me into his office.

"Did you see Madam Nails on Sunday?"

"Yes."

"She's dead. She was being rushed back into A&E about 18 hours after you saw her, and she died on the way. Looks like she had pneumonia."

My heart turned into ice. I looked down at my nails. They looked blue.

"Did you know that she had AIDS?"

I shook my head. I remembered the pauses. She had not told me. Why hadn't she told me? Did she not trust me as a doctor? If she had told me, I would have asked her to at least stay for observation, blood tests and Xrays. As it was, I thought she was being well looked after by a lung specialist.

Boss had looked through my notes and realised that I had acted as any other doctor would have acted based on the information I had been given. But that brought me no reassurance. In my mind's eye, I saw her cobalt nails, the dullness of her eyes, the deathly pallor of her lips, the rusty stains on her handkerchief, and I heard her voice, rasping in my ear.

I walked through the department, looking at my raggedy half moons, at the azure linoleum floor, at the distinctly navy nursing tunics, at the cerulean tinted hair of the old biddy pushing the tea trolley. Outside, the sky was sapphire.

Sighing, I picked up another folder of medical notes (indigo) and began to read.