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After Effects
A C. D. Sloan Mystery
Catherine Aird
for Margaret, Elizabeth, Sarah
and Nicholas with love
The chapter headings are taken from
The Doctor’s Dilemma—A Tragedy
by Bernard Shaw (1913).
CHAPTER ONE
The patient was a hardy old lady who was not easily killed.
‘St Ninian’s Hospital,’ said the girl on the switchboard. ‘Dr Beaumont? Hold the line, please … putting you through … St Ninian’s Hospital … Forman Ward?… It’s ringing now … St Ninian’s Hospital … I’m afraid there’s no reply from Psychiatric Appointments, caller. Will you hold?’
What the caller said in answer to this simple question brought an affronted flush to the telephone operator’s cheek but she had been well trained and merely offered, in impersonal, detached tones, to try the number again if the caller wished.
‘St Ninian’s Hospital …’ The switchboard operator, whose name was Shirley Partridge, had developed a special sing-song voice quite unlike her everyday speech—which was pure Calleshire—for using at work. This, like the old-fashioned cubicle in which she worked, served to separate her from the real world in more senses than one.
‘St Ninian’s Hospital …’ She gave her response to the next caller with the same sure promptness as a programmed robot. ‘Barnesdale Ward? I’m afraid the number’s engaged. Will you hold or try later?’
Shirley Partridge glanced at the clock and wondered if it was too early to unscrew her thermos flask of coffee. ‘St Ninian’s Hospital … Mr McGrew’s Clinic Secretary? Ringing now … Mr Maldonson? He’s not in yet, I’m afraid, Sister.’
The telephonist knew that Mr Maldonson, the Senior Consultant Obstetrician and Gynaecologist, wasn’t in the hospital because his Registrar, Dr Marion Teal, had asked her this twice already this morning.
‘St Ninian’s Hospital … Dr Byville? No. He said to say if he wasn’t at Berebury he’d be over at the Safety of Drugs Committee at Calleford all morning.’ Shirley Partridge prided herself on keeping tabs on the whereabouts of all the hospital’s medical staff. You never knew when they’d be wanted in a hurry.
‘Switchboard.’ This was Shirley’s usual response to a call coming up on an inside line, the internal telephone system at the old hospital not yet being fully automated. ‘Dr Meggie? No, he hasn’t arrived yet.’ She shifted her head a fraction so that she could see the wooden ‘In and Out’ attendance board better. The line with the name of Dr P. E. L. Meggie, Consultant Physician, on it was clearly showing ‘Out’ still, in spite of the fact that it had already gone ten o’clock in the morning on a busy Friday.
As Shirley Partridge knew very well, Dr Paul Meggie, the hospital’s senior physician, always had a clinic on Friday mornings. She also knew very well—but did not say so to the unknown caller—that Martin Friar, Dr Meggie’s unfortunate Senior Registrar, had been rung up quite early this morning and detailed to start that clinic on Dr Meggie’s behalf.
She knew, too, that this would occasion mixed feelings in the registrar—torn, as he was, between serious overwork and the desire for greater experience. She was also aware that the patients who had come to see the great man himself at his clinic would be unhappy about seeing his registrar instead. She took both facts in her stride, neither being her problem. Shirley Partridge had never been one for taking on other people’s problems.
Both parties had her sympathy.
The Senior Registrar had looked tired out before he had even started work this morning; and the clinic patients naturally weren’t going to like being fobbed off by being seen by someone medically speaking—they thought, anyway—still wet behind the ears. And for another thing they weren’t going to like the way he dressed any more than Shirley did.
‘Informally,’ was how she had described it to her mother. ‘Not even a jacket …’
Now their Dr Paul Meggie was quite different. He always wore a dark pin-stripe suit under his spotless white coat. And he was never seen at the hospital in the mornings without his bow-tie and floral button-hole. ‘A fresh one every day,’ Shirley reported again and again to her mother. This week it had been the tiniest of yellow carnations.
Late for his clinic or not, as far as Shirley Partridge was concerned, Dr Paul Meggie was a Great Man and in her considered opinion the patients were lucky even to catch a quick glimpse of him. That alone—just setting eyes on him—did some of the people who were ill a lot of good. They said upstairs at the hospital that he’d only got to step on to the ward for the atmosphere to change at once.
Electrify, some of the nurses said.
‘St Ninian’s Hospital … Accident and Emergency … of course, right away.’ They always answered quickly at that unit, which was something. ‘St Ninian’s Hospital … Lorkyn Ward … putting you through.’ For some long-forgotten antiquarian reason the wards at St Ninian’s Hospital had been named after noted medical practitioners of the sixteenth century. ‘Ringing now,’ sang Shirley in her working voice.
There was nothing in any way electrifying about the way in which Dr Martin Friar entered the Medical Out-Patients’ Clinic that morning. Dr Meggie’s Senior Registrar was so tired that for two pins—or, better still, an unbroken night’s sleep—he would have given up the profession of medicine altogether there and then. He moved into the consulting room at the clinic now with the slow measured step of one consciously conserving his reserves of energy.
‘Big clinic today, Sister?’ he asked.
‘Not particularly,’ she said kindly, bending the truth a little, and knowing that he would be feeling better after coffee-time.
‘Anything interesting?’
‘One or two of the new cases perhaps.’ She placed the virgin folder that indicated a fresh patient in front of him. The sight of thin, unsullied hospital medical records always cheered the young doctors, just as a pile of thick, fat ones awaiting them on the desk sent a sigh of despair through whoever was taking the clinic. The thick folders usually belonged to those who were called ‘heart-sink’ patients, for the very good reason that they caused just that very sensation in the breasts of their weary doctors. Thin folders at least offered the chance of making an interesting diagnosis …
The Senior Registrar picked up the blank record of a new patient. ‘Mrs Mabel Allison of Great Rooden? That’s right out in the country, isn’t it? All right, Sister, just give me half a minute to read the GP’s referral letter and then you can call her in.’ At the same time Shirley Partridge was answering a call on her switchboard in yet another way.
‘Morning, Tracy,’ she said, there being no need to enquire who would be on the end of this particular line. It was a direct land-line connection between St Ninian’s Hospital, which was on the coast at Kinnisport, and the Berebury District General Hospital over in Berebury, the market town in the centre of rural Calleshire.
The hospital at Berebury was a spanking new one with state-of-the-art equipment and all that medical technology could dream up in the name of progress. St Ninian’s, on the other hand, was an old Poor Law institution: not to put too fine a point on it, it had been a workhouse before the advent of the National Health Service. True, it had been upgraded as far as was humanly possible—even now there was an artist labouring away on the painting of a colourful mural in the main entrance hall—but there was still that about the old raw brick building which betokened a more rugged past.
‘That you, Shirl?’ asked the voice at the other end of the land-line.
The two
hospitals were run in tandem under one unified health authority. They shared consultant staff—which was no problem—and some facilities—which was the cause of a lot of rancour. In theory—and at a pinch when beds were short—they would house each other’s patients but it didn’t happen often.
And never without some delicate horse-trading over waiting lists.
‘Listen, Shirl,’ said Tracy, who, as Shirley regularly complained to her mother, had no proper respect for her elders. ‘You got Dr Beaumont over there?’
Shirley Partridge didn’t need to look up at the staff attendance board to answer her. Dr Edwin Beaumont was always on time. He was in, all right. She herself had seen him step delicately round the painter who was working on the wall of the entrance lobby when Dr Beaumont had come in.
Not painter, she reminded herself.
Artist.
‘Good,’ said Tracy swiftly. ‘Then can you put me through to him p.d.q.? Female Medical are carrying on like there’s no today let alone no tomorrow—’
The wards at the new Berebury General Hospital didn’t enjoy names redolent of an historic medical past. They were known by what went on in them and that, even the postmodernists were prepared to admit, did lead to some embarrassing moments.
‘—and Sister Pocock’s going spare,’ went on Tracy, ‘because she can’t get hold of anyone.’
‘Right away.’ Actually, Shirley had been all ready to complain to Tracy about how the smell of paint in the hall was upsetting her delicate digestion—stomach was not a word used in the Partridge ménage—but that would have to wait.
Tracy drew breath and went on, ‘Sounds like there’s open warfare up there on Female Medical. You know what Sister Pocock’s like.’
‘You’re through.’ Shirley Partridge, much as she disapproved of Tracy’s free and easy way of putting things, hooked in the telephone connection without delay.
‘Ta, ever so ta.’ Young Tracy usually used what spare time she had on the land-line talking to Shirley about her current boyfriend and what she’d been up to the night before—well, nearly everything—but this was not the moment for that.
‘Dr Beaumont’ll soon sort it out,’ said Shirley confidently as the telephone connection was made. She liked him. Dr Beaumont dressed properly and was always polite to switchboard operators, too. ‘Whatever it is.’
‘Something to do with one of Dr Byville’s patients,’ responded Tracy, taking this as a question. ‘He’s gone over to Calleford for one of those funny Region Committee meetings this morning and can’t be reached.’
‘I think that’ll be where Dr Meggie must be too,’ murmured Shirley, who didn’t like not to know what was going on and who wasn’t above pretending that she did when she didn’t. ‘He’s not in yet today either.’
‘Well, old Merrylegs is certainly not over here,’ declared Tracy with spirit. ‘Our Colin’s been trying to get hold of him on the phone ever since he came in this morning.’ She giggled. ‘I said to him did he want me to try the “him and her” florists—without letting on to Bunty.’
‘Dr Meggie told us he wouldn’t be in,’ said Shirley Partridge repressively. It was well known that Paul Meggie, made a widower a couple of years ago, was squiring a good-looking widow—and that his daughter, Bunty, wasn’t happy about it. ‘I’m surprised he didn’t let your Dr Hulbert know, too.’ She thoroughly disapproved of the use of either nicknames or the Christian names of the medical staff by anyone who wasn’t a doctor and never encouraged it in others.
‘At least he’s not over at the Golden Nugget then,’ said Tracy disrespectfully.
‘Sorry, Tracy,’ said Shirley, pursing her lips. ‘I’ve got another call coming up.’ The Golden Nugget was the non-medical staff’s name for the clinic where all the local private medical and surgical work was done. ‘Hello, caller … St Ninian’s Hospital … Hatcher Ward? Hold the line, please …’
Holding the line was exactly what Dr Edwin Beaumont was trying to do at this moment. That he was trying to do it over the telephone did not help.
‘What is the patient like now?’ he asked with a professional calm that was intended to be both exemplary and reassuring.
‘Breathless, disorientated, and with a marked cyanosis,’ said the young housewoman at the other end of the telephone line. Dilys Chomel knew perfectly well that she should have said ‘dyspnoeic’ instead of ‘breathless’ but to tell the truth she was feeling a bit short of breath on her own part just at this moment.
‘I see.’
‘I’m very sorry troubling you, sir, but I can’t get hold of Dr Meggie either.’ She consciously steadied herself against the desk in Sister Pocock’s office. After all, she told herself firmly, she’d have to deal with her first death on the ward sometime if she was ever going to make the grade as a doctor. She just hadn’t quite expected it to be this morning, that was all. ‘It’s a Mrs Muriel Galloway,’ she said, ‘and I’ve put her on oxygen and set up a saline drip just in case we need a line.’
‘Good,’ said Dr Beaumont in normal, everyday tones, also meant as an example of correct medical behaviour in times of stress.
‘I didn’t like her staring eyes,’ hurried on the young housewoman, who in the heat of the moment had completely forgotten the medical synonym for that sign in a patient. She gulped and added naïvely, ‘Or the way she’s plucking at the bedclothes.’
‘Floccilation,’ said Dr Beaumont, who took his teaching duties towards the newly qualified more seriously than did the absent Dr Byville, who was something of a cold fish.
‘Oh …’ Dilys Chomel remembered with surprise that she’d learned that that action by a patient was often a precursor of death not at medical college at all but at school in her English Literature lessons. ‘Of course …’
Now she came to think about it, she realized that it had been William Shakespeare’s description of the death of Sir John Falstaff which had been with her on the Women’s Medical Ward while she regarded her own dying patient, not those stark clinical notes in her student textbooks. The poet and playwright had described the nose of the moribund Falstaff ‘as sharp as a pen’ and the ‘smile upon his fingers’ end’ more memorably than any medical writer. ‘Of course, sir, of course.’
‘What is she on?’ asked Dr Beaumont, who was only on call for Dr Byville and Dr Meggie while they were away from the two hospitals and naturally didn’t have the Immortal Bard in his mind at this moment.
The housewoman reeled off a long list of medicaments.
‘Give her an intramuscular diuretic statim,’ instructed the senior doctor, more because it would give the girl something positive to do than aid a patient already beyond aid, ‘and see that the relatives have been sent for.’
‘Yes, sir,’ said Dilys, adding, still surprised at what she had seen, ‘and, sir, she’s grasping at things that aren’t there.’
‘Carphology,’ said Dr Beaumont briskly. ‘We, on the other hand, my dear, are grasping at straws. Mrs Galloway’s dying and you must tell the family so—and that we’re very sorry but there’s nothing more that we or anyone else can do for her now.’
‘Yes, sir. Thank you, sir.’ She paused and then said, ‘Sir—’
‘Yes?’
Dilys Chomel said uncertainly, ‘I’m afraid there’s something else, sir.’
‘And what is that?’ enquired Dr Beaumont with carefully controlled impatience.
‘I understand that this patient—Mrs Muriel Galloway—was one of those taking part in Dr Meggie’s Cardigan Protocol.’
‘Hell and damnation,’ said Dr Edwin Beaumont quite unprofessionally and without thinking at all.
CHAPTER TWO
The medical contention is, of course, that a bad doctor is an impossibility.
It wasn’t only Dr Byville and Dr Meggie who were not available at their hospitals.
‘No, Dr Teal, I’m afraid Mr Maldonson isn’t in yet,’ said Shirley Partridge for the third time that morning.
She’d watched the lady doctor pacing u
p and down the entrance hall of St Ninian’s earlier on looking tired and anxious and now she was back on the phone again. It wasn’t, Shirley Partridge knew perfectly well, any obstetric emergency that was bringing about all that stress. It was the unkind behaviour of Mr Maldonson, her boss.
‘Oh.’ Dr Teal sounded drained. ‘Oh … then I’ll have to … would you put me through to this number, please?’
‘Ringing now,’ sang Shirley Partridge.
‘And then,’ said Marion Teal wearily, ‘I think I’ll just come down to the front hall and wait for him to come in. It’s not,’ she added more to herself than to the telephonist, ‘as if there’s anything more I can do here now anyway.’
The Obstetric Registrar, who had been on night duty all the week, was exhausted enough to have subsided on to one of the benches in the front hall and gone to sleep there and then but by now she was much too wound up to have done any such thing. Resting while you could was the action of someone with a quiet mind and Marion Teal’s mind was not quiet. What she needed to do was to unload some of the bottled-up anger and irritation she was feeling over Mr Maldonson’s blatant misogynism on someone somewhere—and preferably male.
The artist, Adrian Gomm, though admittedly of rather epicene appearance, was the nearest man. He was almost out of reach on a ladder.
‘Do you mind,’ she called up to him, ‘if I ask you about your work?’ It was more than Mr Maldonson ever did about hers. All he seemed interested in was making her so late going off-duty in the mornings that all her careful arrangements for child care were disrupted.
‘Go ahead.’
‘It’s all very symbolic, isn’t it?’
‘That,’ said Gomm, ‘is the general idea.’
‘That’s St Ninian at the top, isn’t it?’ The figure of a distinctly substantial saint clothed all over in white, complete with halo in gold, was spread across the whole of the upper part of the mural, his arms benevolently encompassing the painting.
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