by A. J. Cronin
And then, out of high heaven, the bolt fell.
On the evening of the 5th of November, the wife of a neighbouring petty tradesman came to his consulting-room at Chesborough Terrace.
She was Mrs Vidler, a small sparrow of a woman, middle-aged, but bright-eyed and spry, a regular Londoner who had all her life never been further from Bow Bells than Margate. Andrew knew the Vidlers well, he had attended the little boy for some childish complaint when he first came to the district. In those early days, too, he had sent his shoes there to be mended, for the Vidlers, respectable, hard-working tradespeople, kept a double shop at the head of Paddington Street named, rather magnificently, Renovations Ltd – one half devoted to boot repairs and the other to the cleaning and pressing of wearing apparel. Harry Vidler himself might often be seen, a sturdy, pale-faced man, collarless and in his shirt-sleeves, with a last between his knees or, though he kept a couple of helpers, using a damping-board, if work in the other department was urgent.
It was of Harry that Mrs Vidler now spoke.
‘Doctor,’ she said in her brisk way, ‘ my husband isn’t well. For weeks now he’s been poorly. I’ve been at him and at him to come, but he wouldn’t. Will you call tomorrow, doctor? I’ll keep him in bed.’
Andrew promised that he would call.
Next morning he found Vidler in bed, giving a history of internal pain and growing stoutness. His girth had increased extraordinarily in these last few months and inevitably, like most patients who have enjoyed good health all their lives, he had several ways of accounting for it. He suggested that he had been taking a drop too much ale, or that perhaps his sedentary life was to blame.
But Andrew, after his investigations, was obliged to contradict these elucidations. He was convinced that the condition was cystic and although not dangerous, it was one which demanded operative treatment. He did his best to reassure Vidler and his wife by explaining how a simple cyst such as this might develop internally and cause no end of inconvenience which would all disappear when it was removed. He had no doubt at all in his mind as to the upshot of the operation and he proposed that Vidler should go into hospital at once.
Here, however, Mrs Vidler held up her hands.
‘No, sir, I won’t have my Harry in a hospital!’ She struggled to compose her agitation. ‘ I’ve had a kind of feeling this was coming – the way he’s been overworking in the business. But now it ’as come, thank God we’re in a position as can deal with it. We’re not well-off people, doctor, as you know, but we ’ave got a little bit put by. And now’s the time to use it. I won’t have Harry go beggin’ for subscribers’ letters, and standin’ in queues, and goin’ into a public ward like he was a pauper.’
‘But, Mrs Vidler, I can arrange –’
‘No! You can get him in a private home, sir. There’s plenty round about here. And you can get a private doctor to operate on him. I can promise you, sir, so long as I’m here no public hospital shall ’ave Harry Vidler.’
He saw that her mind was firmly made up. And indeed Vidler himself, since this unpleasant necessity had arisen, was of the same opinion as his wife. He wanted the best treatment that could be had.
That evening Andrew rang up Ivory. It was automatic now for him to turn to Ivory the more so as, in this instance, he had to ask a favour.
‘I’d like you to do something for me, Ivory. I’ve an abdominal here, that wants doing – decent hard-working people but not rich, you understand. There’s nothing much in it for you, I’m afraid. But it would oblige me if you did it for – shall we say a third of the usual fee.’
Ivory was very gracious. Nothing would please him more than to do his friend Manson any service within his power. They discussed the case for several minutes and at the end of that discussion Andrew telephoned Mrs Vidler.
‘I’ve just been on to Mr Charles Ivory, a West End surgeon who happens to be a particular friend of mine. He’s coming to see your husband with me tomorrow, Mrs Vidler, at eleven o’clock. That all right? And he says – are you there? – he says, Mrs Vidler, that if the operation has to be undertaken he’ll do it for thirty guineas. Considering that his usual fee would be a hundred guineas – perhaps more – I think we’re not doing too badly.’
‘Yes, doctor, yes.’ Her tone was worried yet she made the effort to sound relieved. ‘It’s very kind of you, I’m sure. I think we can manage that some’ow.’
Next morning Ivory saw the case with Andrew and on the following day Harry Vidler moved into the Brunsland Nursing Home in Brunsland Square.
It was a clean, old-fashioned home not far from Chesborough Terrace, one of many in the district where the fees were moderate and the equipment scanty. Most of its patients were medical cases, hemiplegics, chronic cardiacs, bedridden old women with whom the main difficulty was the prevention of bedsores. Like every other home which Andrew had entered in London it had never been intended for its present purpose. There was no lift and the operating theatre had once been a conservatory. But Miss Buxton, the proprietress, was a qualified sister and a hardworking woman. Whatever its defects, the Brunsland was spotlessly aseptic – even to the furthest corner of its shining linoleumed floors.
The operation was fixed for Friday and, since Ivory could not come early, it was set for the unusually late hour of two o’clock.
Though Andrew was at Brunsland Square first, Ivory arrived punctually. He drove up with the anaesthetist and stood watching while his chauffeur carried in his large bag of instruments – so that nothing might interfere with his subsequent delicacy of touch. And, though he plainly thought little of the home, his manner remained as suave as ever. Within the space of ten minutes he had reassured Mrs Vidler, who waited in the front room, made the conquest of Miss Buxton and her nurses, then, gowned and gloved in the little travesty of a theatre, he was imperturbably ready.
The patient walked in with determined coolness, slipped off his dressing-gown, which one of the nurses then whipped away, and climbed upon the narrow table. Realising that he must go through with the ordeal, Vidler had come to face it with courage. Before the anaesthetist placed the mask over his face he smiled at Andrew.
‘I’ll be better after this is over.’ The next moment he had closed his eyes and was almost eagerly drinking in deep draughts of ether. Miss Buxton removed the bandages. The iodined area was exposed, unnaturally tumescent, a glistening mound. Ivory commenced the operation.
He began with some spectacular deep injections into the lumbar muscles.
‘Combat shock,’ he threw out gravely to Andrew. ‘I always use it.’
Then the real work began.
His medical incision was large and immediately, almost ludicrously, the trouble was revealed. The cyst bobbed through the opening like a fully inflated wet rubber football. The justification of his diagnosis added, if anything, to Andrew’s self-esteem. He reflected that Vidler would do nicely when detached from this uncomfortable accessory and with an eye on his next case he surreptitiously looked at his watch.
Meanwhile Ivory, in his masterly manner, was playing with the football, imperturbably trying to get his hands round it to its point of attachment and imperturbably failing. Every time he attempted to control it the ball slithered away from him. If he tried once he tried twenty times.
Andrew glanced irritably at Ivory, thinking – what is the man doing? There was not much space in the abdomen in which to work but there was space enough. He had seen Llewellyn, Denny, a dozen others at his old hospital, manipulate expertly, with far less latitude. It was a surgeon’s job to fiddle through cramped positions. Suddenly he realised that this was the first abdominal operation Ivory had ever done for him. Insensibly, he dropped his watch back into his pocket, drew nearer, rather rigidly, to the table.
Ivory was still straining to get behind the cyst, still calm, incisive, unruffled. Miss Buxton and a young nurse stood trustfully by, not knowing very much about anything. The anaesthetist, an elderly grizzled man, was stroking the end of the stoppered bottle cont
emplatively with his thumb. The atmosphere of the bare little glass-roofed theatre was flat, supremely uneventful. There was no high sense of tension or steam-heated drama, merely Ivory raising one shoulder, manoeuvring with his gloved hands, trying to get behind the smooth rubber ball. But for some reason a sense of coldness fell on Andrew.
He found himself frowning, watching tensely. What was he dreading? There was nothing to be afraid of, nothing. It was a straightforward operation. In a few minutes it would be finished.
Ivory, with a faint smile, as of satisfaction, gave up the attempt to find the cyst’s point of attachment. The young nurse gazed at him humbly as he asked for a knife. Ivory took the knife in slow motion. Probably, never in his career had he looked more exactly like the great surgeon of fiction. Holding the knife, before Andrew knew what he was about, he made a generous puncture in the glistening wall of the cyst. After that everything happened at once.
The cyst burst, exploding a great clot of venous blood into the air, vomiting its contents into the abdominal cavity. One second there was a round tight sphere, the next a flaccid purse of tissue lay in a mess of gurgling blood. Frantically Miss Buxton felt in the drum for swabs. The anaesthetist sat up abruptly. The young nurse looked like fainting. Ivory said gravely:
‘Clamp, please.’
A wave of horror swept over Andrew. He saw that Ivory, failing to reach the pedicle to ligature it, had blindly, wantonly, incised the cyst. And it was a haemorrhagic cyst.
‘Swab, please,’ Ivory said in his impassive voice. He was fiddling about in the mess, trying to clamp the pedicle, swabbing out the blood-filled cavity, packing, failing to control the haemorrhage.
Realisation broke on Andrew in a blinding flash. He thought: God Almighty! He can’t operate, he can’t operate at all.
The anaesthetist, with his finger on the carotid, murmured in a gentle, apologetic voice:
‘I’m afraid – he seems to be going, Ivory.’
Ivory, relinquishing the clamp, stuffed the belly cavity full of blooded gauze. He began to suture up his great incision. There was no swelling now. Vidler’s stomach had a caved-in, pallid, an empty look, the reason being that Vidler was dead.
‘Yes, he’s gone now,’ said the anaesthetist finally.
Ivory put in his last stitch, clipped it methodically and turned to the instrument tray to lay down his scissors. Paralysed, Andrew could not move. Miss Buxton, with a clay coloured face, was automatically packing the hot bottles outside the blanket. By great force of will she seemed to collect herself. She went outside. The porter, unaware of what had happened, brought in the stretcher. Another minute and Harry Vidler’s body was being carried upstairs to his bedroom.
Ivory spoke at last.
‘Very unfortunate,’ he said in his collected voice as he stripped off his gown. ‘I imagine it was shock – don’t you think so, Gray?’
Gray, the anaesthetist, mumbled an answer. He was busy packing up his apparatus.
Still Andrew could not speak. Amidst the dazed welter of his emotion he suddenly remembered Mrs Vidler, waiting downstairs. It seemed as if Ivory read that thought. He said:
‘Don’t worry, Manson. I’ll attend to the little woman. Come. I’ll get it over for you now.’
Instinctively, like a man unable to resist, Andrew found himself following Ivory down the stairs to the waiting-room. He was still stunned, weak with nausea, wholly incapable of telling Mrs Vidler. It was Ivory who rose to the occasion, rose almost to the heights.
‘My dear lady,’ he said, compassionate and upstanding, placing his hand gently on her shoulder, ‘I’m afraid – I’m afraid we have bad news for you.’
She clasped her hands, in worn brown kid gloves, together. Terror and entreaty were mingled in her eyes.
‘What!’
‘Your poor husband, Mrs Vidler, in spite of everything which we could do for him –’
She collapsed into the chair, her face ashen, her gloved hands still working together.
‘Harry!’ she whispered in a heartrending voice. Then again, ‘Harry!’
‘I can only assure you,’ Ivory went on, sadly, ‘on behalf of Doctor Manson, Doctor Gray, Miss Buxton and myself that no power on earth could have saved him. And even if he had survived the operation –’ He shrugged his shoulders significantly.
She looked up at him, sensing his meaning, aware even at this frightful moment of his condescension, his goodness to her.
‘That’s the kindest thing you could have told me, doctor.’ She spoke through her tears.
‘I’ll send sister down to you. Do your best to bear up. And thank you, thank you for your courage.’
He went out of the room and once again Andrew went with him. At the end of the hall was the empty office, the door of which stood open. Feeling for his cigarette-case, Ivory walked into the office. There he lit a cigarette and took a long pull at it. His face was perhaps a trifle paler than usual but his jaw was firm, his hand steady, his nerve absolutely unshaken.
‘Well, that’s over,’ he reflected coolly. ‘ I’m sorry, Manson. I didn’t dream that cyst was haemorrhagic. But these things happen in the best regulated circles, you know.’
It was a small room with the only chair pushed underneath the desk. Andrew sank down on the leather covered club fender that surrounded the fireplace. He stared feverishly at the aspidistra in the yellowish-green pot placed in the empty grate. He was sick, shattered, on the verge of a complete collapse. He could not escape the vision of Harry Vidler, walking unaided to the table – ‘I’ll be better after this is over’ – and then ten minutes later, sagging on the stretcher, a mutilated, butchered corpse. He gritted his teeth together, covered his eyes with his hand.
‘Of course,’ Ivory inspected the end of his cigarette. ‘He didn’t die on the table. I finished before that – which makes it all right. No necessity for an inquest.’
Andrew raised his head. He was trembling, infuriated by the consciousness of his own weakness in this awful situation which Ivory had sustained with such cold-blooded nerve. He said, in a kind of frenzy:
‘For Christ’s sake stop talking. You know you killed him. You’re not a surgeon. You never were – you never will be a surgeon. You’re the worst botcher I’ve ever seen in all my life.’
There was a silence. Ivory gave Andrew a pale hard glance. ‘I don’t recommend that line of talk, Manson.’
‘You don’t.’ A painful hysterical sob shook Andrew. ‘I know you don’t! But it’s the truth. All the cases I’ve given you up till now have been child’s play. But this – the first real case we’ve had – Oh, God! I should have known – I’m just as bad as you –’
‘Pull yourself together, you hysterical fool. You’ll be heard.’
‘What if I am?’ Another weak burst of anger seized Andrew. He choked: ‘You know it’s the truth as well as I do. You bungled so much – it was almost murder!’
For an instant it seemed as if Ivory would knock him senseless off the fender, a physical effort which, with his weight and strength, the older man could easily have accomplished. But with a great struggle he controlled himself. He said nothing, simply turned and walked out of the room. But there was an ugly look on his cold hard face which spoke, icily, of unforgiving fury.
How long Andrew remained in the office, his forehead pressed against the cold marble of the mantelpiece, he did not know. But at last he rose, realising dully that he had work which he must do. The dreadful shock of the calamity had caught him with the destructive violence of an explosive shell. It was as though he, also, were eviscerate and empty. Yet he still moved automatically, advancing as might a horribly wounded soldier, compelled by machine-like habit to perform the duties expected of him.
In this fashion he managed, somehow, to drag round his remaining visits. Then, with a leaden heart and an aching head he came back home. It was late, nearly seven o’clock. He was just in time for his surgery and evening consultations.
His front waiting-room was full, his
surgery packed to the door. Heavily, like a dying man, he took stock of them, his patients, gathered, despite the fine summer evening, to pay tribute to his manner, his personality. Mostly women, a great many of them Laurier’s girls, people who had been coming to him for weeks, encouraged by his smile, his tact, his suggestion that they persevere with their medicine – the old gang, he thought numbly, the old game!
He dropped into his surgery swing chair, began with a mask-like face, the usual evening rite.
‘How are you? Yes, I think you’re looking a shade better! Yes. Pulse has much more tone. The physic is doing you good. Hope it’s not too nasty for you, my dear girl.’
Out to the waiting Christine, handing her the empty bottle, forward along the passage to the consulting-room, stringing out the same interrogative platitudes there, the same bogus sympathy, then back along the passage, picking up the full bottle, back into the surgery again. So it went on, this infernal circus of his own damnation.
It was a sultry night. He suffered abominably but still he went on, half to torture himself and half in empty deadness because he could not stop. As he passed backwards and forwards in a daze of pain he kept asking himself: Where am I going? Where, in the name of God, am I going?
At last, later than usual, at quarter to ten, it was finished. He locked the outer door of the surgery, came through the consulting-room where, according to routine, Christine waited, ready to call out the lists, to help him make up the book.
For the first time in many weeks he really looked at her, gazed deeply into her face as, with lowered eyes, she studied the list in her hand. Piercing even his numbness, the change in her shocked him. Her expression was still and fixed, her mouth drooped. Though she did not look at him there was a mortal sadness in her eyes.