by A. J. Cronin
‘That’s impossible. They won’t have a married doctor here. It’s in the charter.’
She gave me a lethal stare.
‘Don’t flatter yourself, Romeo. I’d sooner go to bed with a rattlesnake than you. All I need from you is your unwilling co-operation, a kind word to the committee, acceptance of the fact that I’m here for good. Otherwise,’ she paused, ‘you’re out on your ear.’
I glared at her.
‘You’re crazy. I like it here too and I’m going to stay. You’ll never get me out of the Maybelle.’
She looked me dead in the eye.
‘I knew there must be something fishy about your appointment, which is more than you were ever worth. And there is. Matron has copies of your testimonials. I’ve seen them and they’re …’
‘That’s enough!’
‘Yes, it would be a nasty word, wouldn’t it? False pretences. Might even be forgery. And what a bother it might get you into with the General Medical Council.’ While I listened with growing, deep-seated uneasiness, she went on. ‘Doctors have been struck off for less. I hope that won’t be necessary. For you’d need your miserable little medical degree if I sent you back to general practice in Levenford. That’s where you belong and that’s where you will go if you don’t toe the line. You’re the one that’ll go back to old Dr Ennis. He’s losing his assistant and he’d take you, on my recommendation.’ She gave me a thin, bitter smile. ‘ I’m going to get a lot of pleasure watching you sweat it out here with that hanging over you.’
Chapter Nine
I barged down the hill in a state of mind in which rage, resentment and apprehension prevailed over the suspicion that I was dealing with an unbalanced character. Naturally I had left her without a word. I had found it unprofitable at any time to argue with a woman; still less so now with one thrown off the beam by a prolonged stretch of marital frustration. Did she actually imagine I could be yanked out of the best, yes, if you prefer her word, the softest crib I had ever hoped to drop into? I was established at the Maybelle, I now spoke German fluently – there was no need to fake it – and on the two occasions when the committee had visited the clinic they had expressed themselves as fully satisfied with their choice. If the validity of the testimonials were questioned I could explain that I had lost the originals. And hadn’t I been foreseeing enough to protect myself against just such a contingency, this threat to my security? The bold Caterina hadn’t thought of that one. I was safe. No need to worry, Carroll, my boy. And yet I was worried. There remained with me a sense of something in the background, unspoken, unrevealed, retained, so to speak for the Meisterstück. Curse that German, I meant the coup de grâce. No, that was nonsense, yes, rot in any language. Get me back to Levenford? That noxious hole in Clydeside mud? Back to another G.P. Assistantship, stuffed with night calls and surgery grinds, with an old boozer as principal, who was more or less tight half the time. She was right – it would be hell. But, never. No, not on your bleeding life, Carroll. I would fight it to the last ditch.
Suddenly, as I approached the clinic, I heard someone calling me, the voice immediately recognizable as Matron’s. Perched on the rear balcony like a moulting hen, she was flapping me in with a towel. Refusing to be hurried, I slowed to a walk, so that she had ample time to come down to the terrace to meet me.
‘Ver haf you been, Herr Doktor?’ She was practically foaming at the mouth. ‘Eine Stunde almost I am seeking you.’
I permitted myself the liberty of a really dirty look, the first I had ever directed towards her.
‘Where the devil do you think I’ve been? I’m surely entitled to a little time off. I’ve been taking my exercise.’
I perceived with satisfaction that she was taken aback. In a modified tone, though still complaining, she declared:
‘Your patient is not so good. Much sickness. All his good Mittagessen thrown back.’
‘What! Sick again?’
‘Much.’
‘You did stop his codliver oil?’
She reddened uncomfortably.
‘But it is so goot for him …’
‘Damn it all, I told you, instructed you, to stop it.’
She was silent, giving me best.
‘Very well,’ I said shortly. ‘ I’ll have a look at him.’
‘Jetzt? Immediately?’
‘When I’ve had a wash. He won’t harm just because he’s had a vomit.’
This was merely to keep Hulda in her place. When she was out of sight I went across to the guest chalet.
He was lying fully dressed, on his bed, with his eyes on the ceiling. Beside him an enamel basin seemed to contain most of his lunch, but it gave out no stink of fish oil. One hand was placed protectively on his stomach. He removed it quickly as I came in, an action I did not fail to observe.
‘So you’ve been at it again, you little rat?’
As may be imagined my mood was not attuned to sympathy and loving kindness.
‘Sorry,’ he said.
‘You may well be. Damned little nuisance. You knew I’d put you off the oil.’
‘Of course. And I didn’t take it. When Matron wasn’t looking I poured it down the wash basin.’
‘You did?’ This shook my preconceived opinion. ‘ Come on then, pull up your shirt and let’s have a look at you.’
‘It’s all better now, Dr Laurence.’ He half smiled. ‘ Let’s let sleeping dogs lie.’
‘None of that smart guff, strip to the waist.’
I didn’t altogether like the look of him and while he got ready I reassembled the evidence. His von Pirquet had proved negative, his temperature varied no more than a fraction of a point and beyond that cervical swelling I had found nothing specific to confirm the presence of T.B. or, indeed, to account for his obvious pallor, shortness of breath, palpitation and general asthenia. I began to suspect that the good Dr Moore before leaving for the wide open spaces had landed me with a stumour of a diagnosis. With this in mind I took a new look, considering that recurrent sickness, giving particular attention to the abdomen. As I had previously observed, his was somewhat distended, but this ‘big belly’ was a not uncommon feature in the rundown children who came to the Maybelle, and I had rather taken it for granted. Now, however, I began carefully to palpate. Once again everything seemed in order, but suddenly there it was: I no more than caught the edge of it: a tender and slightly swollen spleen.
‘That hurts you?’
‘Somewhat … yes, a little,’ he admitted, wincing despite the understatement.
‘Does it pain you when I don’t press? I mean when you’re up and around.’
‘Not really … just a sort of dragging feeling sometimes.’
So now what? A palpable, tender spleen, at that age, and instinctively my eyes went back to the inner surface of his arms on which I could just make out a faint purpuric staining of the skin. It had me puzzled.
‘Nothing bad I hope, Dr Laurence?’
My silence had worried him.
‘Don’t be a toad. This probably means you don’t have T.B. at all. Coming here with a false tag on you and all that rot about scrofula.’
He looked at me doubtfully.
‘That’s a relief. Or isn’t it?’
I ignored this and said: ‘ What else have you been hiding, you little coward? You’ve had these sick attacks for some time?’
‘For a little while. But when they pass off I’m quite hungry and can eat anything.’
‘What about these red blotches on your skin?’
‘Well, yes, I’ve had them off and on. But they fade very quickly. I thought they might be just an irritation.’
‘Naturally.’ Then I took a shot in the dark. ‘ Have you had bleeding recently from the inside of your mouth, I mean from your gums?’
His eyes widened with surprise and, actually, admiration.
‘That’s remarkably clever of you, Dr Laurence. Yes, as a matter of fact I have. But I think, I mean, I thought it was my hard toothbrush.’
&nb
sp; I was silent, staring at him with ill-concealed misgiving intensified by this sudden and unanticipated prospect of further trouble. What had I let myself in for? Wasn’t it enough to be saddled with his bitch of a mother? There wasn’t a trace of T.B. in this obnoxious little smartie. At a guess I was faced by one of these obscure idiopathic blood syndromes, of which there were probably a score of different varieties, conditions that never properly clear up, run on for years, and break the back of the average G.P. with the need for repeated tests, to say nothing of probable haemorrhages and transfusions. I would not stand for it. In this instance my own modification of the Hippocratic oath was never more applicable: when stuck with a difficult and prolonged case, get rid of it. Yes, I would put through a couple of basic tests and if the results spelled trouble he would have to go to hospital. The Winton Victoria would take him if he proved pathologically interesting. With a brightening of my mood, I reflected that if he were sent home his mother could have no excuse for remaining at the clinic. I would be rid of them both, kill two birds with one stone, and be free again.
Naturally I could not fling any of this at him. He had been watching me intently as if trying to discover what was going on in my head. Assuming an air of cheerful camaraderie, a useful aspect of my best bedside manner, I picked up the enamel basin.
‘Can’t have you wasting good food like this, young fellow. We’ll have to do something about it.’
‘You can?’
‘Why not? There’s nothing wrong with your stomach. You’re anaemic. I’ll just take a sample of your blood to make sure.’
‘Bleed me? Like the old apothecaries?’
‘Oh, cut out that nonsense! This is simple, and scientific. It won’t hurt you a bit.’
I had some difficulty in finding and puncturing his saphenous vein, which was almost threadlike, but he was quite good about it, almost too passive. I drew off 5 c.c., stoppered the test tube after I had smeared several slides, and exclaimed cheerfully:
‘There we are. When these slides are dry we’ll stain them. By tomorrow we’ll know all about your red corpuscles. You can even take a peep at them under the microscope yourself.’
That perked him up slightly.
‘What an interesting situation. A boy examining his own blood. What about that little tube?’
‘We’ll use that for your blood haemoglobin, and,’ I added indefinitely, ‘other things.’ He was obviously admiring me a lot and I scarcely liked to admit I would send it to the Kantonspital in Zürich. ‘Now relax for a bit. I must let them know in the kitchen about your diet.’
‘Bread and water?’ He gave me a wan smile.
‘You deserve it. Still, what would you like?’
‘I’m rather hungry now after that emptying.’ He thought for a moment. ‘Mashed potatoes and,’ with another smile, ‘the meence.’
Impossible not to smile back at him.
‘We’ll consider it. At least you can have the mash and some of that good gravy. Now cheer up. I’ll do what I can for you.’
I went out of the room with my own words ringing derisively in my ears. ‘I’ll do what I can for you.’ Well, damn it, I would – at least I’d do as much as I reasonably could.
Naturally I avoided the office where I knew that both of my enemies would be expecting me. Instead I lit a cigarette and went into the test room. It wouldn’t hurt the kid to wait for his supper and although I had told him I would leave the slides till the morning – since I did not want him cliff-hanging on my neck all evening – I was rather curious to have a look at them.
Still smoking, I stained them, a quick simple job, and put one on the stage of the excellent Leitz. Rather than waste my cigarette, one of the oval Abdullas Lotte got me duty free through her airline, I sat down comfortably and finished it before rising to take a look.
At first I thought my oil immersion lens was maladjusted, but as I focused and refocused the same picture came up. It made me catch my breath. Although I am no virtuoso as a biologist there was no mistaking this – it hit me full in the eye. Fascinating, actually, in its own morbid manner, the sort of thing you might never see once in a G.P.’s lifetime. This was it: the field crammed with lymphocytes, white corpuscles multiplied five or six times over. I could even make out immature forms, myelocytes, large immature corpuscles from the bone marrow never present in healthy blood. Obvious, of course, what was taking place. A hyperplasia of white cell precursors in the bone marrow, progressive and uncontrolled, crowding out the progenitors of red cells and platelets, probably even eroding the bone itself. I clipped on the second slide with the measuring scale, dropped on fresh oil, and made a rough count on one square and multiplied. That settled it.
I could scarcely unlatch myself from the eyepiece. It was one of these moments, so rare in my dreary run of the mill experience, when you strike the exceptional, have been good enough to uncover it, then see the whole sequence of events, past, present and future, laid out before you. The future? I had to stop patting myself on the back. This was bad news for young Capablanca – in fact the worst. Oddly enough, at the airport, the first time I sighted his sad little pan, I felt he was unlucky, marked out in some queer way for disaster. Born for trouble, out of that impossible failure of a marriage, the mark of the Davigans upon him. And now he’d had it. Still, though God knew it was the last thing I would have wanted, there was no denying that it solved my problem. I thought this over thoroughly for several minutes, then took up both slides and went into the office.
They were both waiting for me, one on either side of my desk, and brave Hulda actually occupying my chair. She looked at me uncomfortably, but with a glint of defiance, which told me they had been putting in more overtime on my character.
‘We attend to ask what is for Daniel’s supper.’
‘Later.’ I brushed it aside. ‘If I can have my desk, Matron?’
I stood there waiting for her to get up, which she did, though with reluctance. When I had seated, myself I faced up to the widow Davigan. That was how I meant to think of her now, or simply as Davigan, she had joined the tribe of her own free will, and after all she never called me anything but Carroll, and I would let her have it straight. She could expect no mercy from this throne.
‘It’s like this,’ I said. ‘For some time I’ve suspected that we’ve been misled by a false diagnosis. We’re not dealing with a tubercular infection. Your boy has never had T.B.’
‘Then what …?’ She broke off suspiciously.
‘I’ve just made a blood smear. Here are the slides. They show a massive increase in the white cells. Instead of the normal five to ten thousand lymphocytes per cubic millimetre there’s not far short of sixty thousand … plus an abnormal proliferation of myelocytes.’
This meant nothing to her, but it chilled the Matron.
‘You are not serious, Herr Doktor?’
I liked that Herr Doktor, the first in several days.
‘Only too serious, unfortunately.’
Davigan was looking confusedly from me to the Matron.
‘This is something bad?’
‘It coot be … but natürlich we are not sure.’
I cut in firmly.
‘I regret having to tell you that I’m only too sure. It’s an open and shut case. The boy has Myelocytic Leukocythemia.’
Did Davigan really get the message of these two words? I think not. At least, not entirely, for she didn’t wilt. She flushed up and her suspicions of me, never absent, deepened.
‘I don’t understand this sudden change and I don’t like it.’
‘Are you suggesting that I like it, or that I’m in any way responsible for the sudden change?’
‘It’s all very peculiar … I don’t understand …’
‘We have been trying to make you understand.’
The Matron, recovering herself, suddenly cut in.
‘Who is we? Caterina hat recht. There must come more advice. Ein zweiter opinion, und der beste. You must bring specialist Herr Professor Lam
otte from Zürich.’
‘You’d only be wasting his time. And he has none to waste. Anyhow, he’d never come this far …’
‘Then you must take the boy to him at the Kantonspital,’ Hulda persisted.
On the point of refusing, I suddenly changed my mind. A second opinion, particularly Lamotte’s, would take the pressure off me. They could never get round his diagnosis. It must stick. And that was all I needed. I was calm, quite sure of myself.
‘Very well. I agree. I’ll ring up and make an appointment for the earliest possible day. Meantime,’ I turned to Matron, ‘as you were so anxious about Daniel’s supper, perhaps you’ll see that he gets some consommé and Kartoffel püree with meat gravy.’
She had something to say, but thought better of it. When she had gone I stood up, and made for the door. But Cathy caught me on the way out. Her flush had left her. She looked drawn, tight-lipped.
‘I know you’re up to something, Carroll, so I’m warning you. Don’t try any of your dirty tricks on me or it’ll be the worse for you.’
I stared her out, in chilly silence. What else could you do with such a troll?
Chapter Ten
The Zürich Kantonspital is agreeably situated on the Zürichberg, in a residential district high up on the left bank of the Limmat. An excellent site typically ill chosen, since approaching from the river by the interminable line of steep steps, you are half way to a coronary by the time you get there. The hospital is a massive structure, lamentably in the Swiss taste, with modern additions, offset by some tall and beautiful old trees, and to such patients as may be interested, it affords a striking view of three ancient churches; the Predigerkirche, the Grossmünster and the Fraumünster which, with the innumerable banks, suggest the split personality of this city – a devotion to both Mammon and the Lord.
On Saturday afternoon, of the following week, I came through the swing doors and out of the Medical Department with Daniel. It was a beautiful day and as the late autumn sunshine and crisp cool air greeted us he let out a long breath of relief.