by John Collee
'Mister Kingsley.' It was Sister McReady's rallying call. The emphasis on the i of 'Mister'.
The ward round had moved on. Kingsley found himself gazing down at a middle-aged woman.
'Mrs Dalgleish,' said the houseman.
Her nightgown was parted to reveal a slack, flattened breast. Kingsley spotted the mass immediately. It had produced a pitting of the overlying skin – an exaggeration of the sweat pores, classically caused by infiltrating tumour.
'Fine.'
'Don't you want to examine her, sir?'
'. . . No.'
'She's on your list for tomorrow, sir; mastectomy and clearance of nodes.'
'I see,' said Kingsley absently. He could now be certain that any cancer sufferer he had examined since Sheila was further living testimony to his power. But then the situation had already snowballed out of control. Saving Mrs Dalgleish's life did not make his own situation any more or less hopeless than it had already become. With a sense of impending, overwhelming disaster, Kingsley bent towards his patient. He palpated the lump, not as he might normally examine it but more roughly, squeezing and probing the mass in an attempt to cover the entire tumour with his touch. Mrs Dalgleish winced.
Jennings mistook his boss's thoroughness for diagnostic uncertainty. 'It's already been confirmed by truecut biopsy.'
Kingsley ignored him. He continued working at the lump, then moved to her armpit. There was a single bulky node in the posterior wall. Kingsley rolled it between his fingers, then searched for its neighbours.
With the first intimations of his healing touch he had worried about it on a fairly selfish level, afraid of grouping himself with the quacks and charlatans, the purveyors of groundless hope from whom the medical profession dissociated itself. Now it was dawning on him that it was not isolation he had to fear. Conversely, it was sudden and overwhelming publicity which threatened him. He had observed, in some of his more flamboyant peers, the damaging effects of popularizing their profession. And their small vanities were nothing compared with his terrifying cult potential. If the testimony of his patients should spark the public imagination, he, Kingsley, could be amplified, despite himself, to the stature of some grotesque guru figure, forced into administering, arbitrarily and unsystematically, to hordes of frantic supplicants. Isolated instances of human suffering Kingsley could encompass and alleviate. But the sheer scale of the new obligation appalled him.
'What do you think, sir?'
'What do I think . . .?'
'About Mrs Dalgleish here, sir?'
'Yes. Send her home for now.'
'Pardon?' The houseman, utterly confused, looked to Jennings for explanation.
'Pardon me, sir,' whispered Jennings. 'That lump is definitely malignant. We need to operate as soon as . . .'
'I don't agree,' said Kingsley. 'Send her home.'
'But the biopsy . . . ?'
'Send the patient home, Mr Jennings. We'll discuss it later.'
'Yes, sir.'
From below this exchange the patient, Mrs Dalgleish, looked to Sister McReady for interpretation. But McReady's expression did not change. She watched, as she always watched Kingsley, with her heavy, contemplative stare, her jaw thrust to one side, outwardly betraying neither criticism nor endorsement of his decision. To her patients, Kingsley was God. And more than all the sophistication of modern surgery, McReady valued that illusion. Her secret anxieties manifested themselves indirectly. Now on impulse she shoved her head out between the screens and bellowed down the ward. 'Nurse Michie! Why hadn't this patient been properly undressed?' Then she retreated, poker-faced, to listen for the staff nurse's footsteps.
The round continued. Normally Kingsley's inner conflicts could be resolved by his cramping sense of duty. Indeed he was prepared, if the common good dictated, to be hounded by the public and ostracized by his profession. It occurred to him, however, that confessing to his power was not in the interest either of the public or of the medical establishment which served it.
Ideally his power should be analysed and assessed, then carefully incorporated into the known scheme of things. But seized by the public now in its crude state, it could only form the nidus for a holocaust, capable of destroying suddenly and violently the whole delicate structure of medical inquiry.
He became aware of the silence around him. A naked abdomen stretched below him. It belonged to another middle-aged woman, fatter than the first, with the silver stretch-marks of past pregnancies fanning from her pubis. Kingsley crouched low, rubbing his hands to warm them.
'What's the story here?'
'Intermittent excruciating right hypochondrial pain over two years, once associated with dark urine and pale stools.'
Kingsley examined her automatically; normal abdominal movements, soft abdomen, kidneys and spleen not palpable, no obvious masses, slight liver enlargement . . .
'When I press here, take a deep breath, does that . . .'
The patient's face creased with pain – a strongly positive Murphy's sign.
'Right. That's all.'
'Well?' It was Jennings.
'Well what?'
'Do you think it is a . . .'
'Gall bladder. Yes,' said Kingsley vacantly.
He continued to brood as he left the ward. Even Sister McReady was worried by his total preoccupation. When she said 'Goodbye, Mr Kingsley,' it was not her normal good-natured clarion blast, but a softer, cushioned tone; the tone adopted by convention by the nursing profession when dealing with the seriously ill or mentally unstable.
Dhangi stood in the mortuary, his lips moving silently. The long white plastic apron hung limply around his neck, bagging out under his arms. He was studying the corpse from its head end. It lay, neck hyperextended, with its opaque fish-eyes towards him. Cranley stood with a long knife. He in turn was studying Dhangi. They had been like this for what seemed to Cranley's reckoning an excessive length of time. He was growing impatient.
'Is there something the matter?'
Dhangi did not look up. 'Open the abdomen.'
Cranley thrust out his jaw and applied himself to the abdomen. His incision started at the foot of the sternum and ran the length of the chest and belly. It was a slow, meditative cut of precise and unvarying depth, parting skin and fat and muscle in a single sweep. Too shallow and one was obliged to take several separate cuts, inevitably shredding the wound edges. Cut too deep and one could perforate the peritoneum, damaging the abdominal organs. Cranley, lips pursed, scowling, reached the pubis. The bloodless cleft had parted slightly, shining purple at its base.
'I will open the peritoneum,' said Dhangi.
Cranley obstinately took a pair of heavy scissors to the remaining strands of muscle and transparent sac below.
'. . . Please go now, Mr Cranley!'
'It's my job to remove organs for examination, Dr Dhangi.'
Cranley placed a dour, sceptical emphasis on the title 'doctor'. Dhangi did not seem to notice. He had already picked up a short blade and was impatiently hacking around the inferior margin of the rib-cage. Cranley could no longer contain himself.
'You can't do that.'
Dhangi turned and straightened. He shook himself free of Cranley's restraining grip. The knife was in his right hand. 'Please do not forget yourself, Mr Cranley,' he said.
'Don't wave that knife around, you silly twat. Someone might get hurt.'
Dhangi lowered his hand. His cheek was twitching. The knife hung at the level of Cranley's upper thigh. 'In this place I will now be making the decisions.'
'Twenty-six years I've lived for this hospital.' Cranley's eyes pricked from the formalin.
Dhangi stared hard at him, then abruptly returned to the corpse. Cranley's fury brought a fit of coughing, bending him double over the white tiles. When he raised his head his complexion had darkened, his eyes streamed. 'I fought in the war for people like you,' he shouted.
Dhangi half turned. He glanced down at Cranley's bad leg, then back up at the old assistant. The disparagi
ng expression crossed his face for an instant, and was gone, but to Cranley it cut home like a blade. 'That was an accident.'
'So you say.'
'That was an accident, Dr Dhangi.'
Dhangi wheeled round, impatiently. 'They happen,' he said.
Cranley did not think to ask Dhangi his source of information concerning his leg wound. It fitted, in Cranley's eyes, with the other's moral complexion–subversion, spying and ugliness, that he should have access to the dregs of each man's life. Now he took a step towards his tormentor, noticed the knife, faltered, turned, and plunged through the mortuary doors.
For the first time in seven years, Cranley took his black coat from the peg and left the hospital early.
Turning through the back gate his lurching, irregular step took him down past the meths drinkers, past the port authority and out on to the criss-crossed plain of concrete. He passed the dry dock, the cluster of Portakabins, the bollards and piles of rope. He stumbled blindly over the rails and the irregular, pocked tarmac towards home.
Cranley lived fifteen minutes from the hospital and up two flights of stairs. He arrived at his front door without once having stopped for breath. Leaning heavily against the door jamb he clattered the key against the lock until he found the hole. When he finally staggered in to his front room the air had become thin and insubstantial and a great clamp had tightened round his chest. Cranley's temples pounded, his head swam. Heaving like a stranded fish he slumped backwards into an armchair.
Ten minutes later he managed to focus on the table in front of him. On it there stood one of his matchstick models – a ship in full sail. Cranley reached for it. It had taken him two months to build, but in his clumsy, trembling hand it crushed instantly.
In the mortuary Dr Dhangi abandoned his work on the body, leaving its limp arms folded over its eviscerated abdomen. Returning into the anteroom he quickly changed out of the apron, Wellington boots, shirt and trousers. The dhoti was bundled into the top shelf of his locker. Dhangi wrapped it round his loins, pulled the free ear between his legs and tucked it into the waistband at the back. On the shelf at the far end of the mortuary he arranged the gilt-framed pictures of Shiva with his consort Parvati and of Lord Vishnu supported on the black water by Shesha, the serpent king. He filled bowls of incense around the small altar, drew the blinds, lit two candles and anointed his forehead from a small pot of sandalwood paste, then he lowered himself, cross-legged to the floor, raised his head and began to hum:
Hansa Mantra – the sound which is inherent in all of us, born of Akshar the primordial sound which was the first cause of the universe . . .
On the shelves around him, the steel instruments began to sing and rattle. The massive brown-glass flagons took up the sonorous, booming refrain and the plate glass of the windows rattled in their frames.
In the rest room to the operating theatre, sitting exhausted with his face mask under his chin and the stains of iodine and blood on his theatre pyjamas, Kingsley considered the shimmering concentric circles which had appeared on the surface of his coffee.
In the mortuary Dhangi rose with no apparent effort, almost floated to his feet – a dark, white-clad figure in the incenseladen atmosphere. His eyes were turned upwards; only small slivers of pupil showed beneath his upper lids. He moved towards the corpse
I have been flooded with the ultimate divinity
I represent God
I see the guru, Kingsley, inside my eyelids
In my forehead
In my heart
And in my soul
Oh Brahman
That you may flood the paleface with your vital wind
Accept through me the maya of this sacrifice.
Dhangi placed his hand in the runnels of the empty abdominal cavity and smeared his body with the foul soup of clot and bowel content. Then he stopped and raised a sliver of the pale yellow flesh to his lips.
Chapter 17
It had begun as a coffee break story in the Infirmary theatre rest rooms. The witnesses to Sheila's aborted amputation were sought out and interrogated. The story was related above the hum of television in the mess and in a series of dressing-gowned enclaves in the nurses' quarters. Thereafter, Sheila Kingsley's progress in hospital had become the subject of numerous interim reports, from the Infirmary kitchens to the Douglas Calder dining room, from the boiler room at Kircaldy to the labs at Bangour. Richard Short had no need to inquire as to Sheila's wellbeing. He heard every sequence in the story of her recovery from Rhona, who heard it from a nursing friend, who heard it from a biochemistry technician. He picked it up in turn from the van driver who collected the blood and urine specimens.
The day after Sheila Kingsley was discharged, Roland Spears got his first inklings of the story. It took him four phone calls to assemble some interesting facts. At the end of half an hour he had covered a sheet of foolscap with his jottings. Around him the typewriters clacked and chattered. He tapped the Biro on his teeth and sat back in his swivel chair. To his right, out of his window, he could see the shopfront of Jenners' store. Christmas was already sneaking into the window displays. Further down the hill a wide bridge spanned the city's central valley, shunting traffic northwards towards Leith. Spears rattled the pen over his incisors. Then he put it down and, leaning forwards, picked up the phone.
The Douglas Calder switchboard put him through to west theatre.
Kingsley was in clinic when switchboard found him. He was inspecting the results of a hernia operation. The patient's trousers were round his ankles and Kingsley' s hand was all but lost in the damp groin. Kingsley was asking him to cough.
Satisfied, he straightened, took his hand to the sink and washed it.
'You can pop your trousers on, Mr Reedley. That's all fine.'
Reedley had already hoisted his underpants, like a limp white flag, to above his knees.
A nurse entered. 'Telephone for you, Mr Kingsley.'
'I'll take it in the office . . . excuse me, Mr Reedley.' He passed the nurse. She stayed behind to help the patient.
In the office the phone receiver lay on the table by the remains of a coffee tray. Kingsley took the Hunter from his waistcoat. It was half past twelve. It was a while before he recognized Spears's voice.
'I'm from the Courier. I'm doing a short piece on the state of play with your cancer research down at the Douglas Calder hospital.'
'Who did you say?'
'From the Courier – Roland Spears.'
'Ah yes . . . Roland Spears.'
There was a pause, then both men started to speak at once. Kingsley's voice won over. 'Look here. I'm all for informing the public, accurate information that is. As it happens the research being carried on by the pathology department has so far drawn a blank.'
Kingsley did not admit that Mukesh's previous line of research had, to his certain knowledge, been discontinued.
'I believe Dr McMillan at the Royal is currently analysing some of our early specimens. I'm sure he'll keep you up to date. Now I'm quite busy so . . .'
'Just one small personal matter,' Spears interjected.
Kingsley flushed. He was aware of rumours being spread around the hospital circuit, but he had not guessed until now that the stories had spread beyond these confines. Spears represented a new and redoubtable threat. Kingsley's nervousness translated itself to anger.
'Listen, Spears, you've not done much to endear yourself to me. If a personal matter means what I think it means I'd say it was none of your business.'
Behind his desk above North Bridge, Spears crossed his ankles, then plunged in with both feet.
'Your wife has bone cancer. I gather there has been some delay in going ahead with the necessary amputation.'
'Spears, I can only say that you're demonstrating the remarkable lack of taste and sensitivity which I've come to expect from your profession.'
'Don't get me wrong . . .'
'I don't think I get you wrong, Spears. I have very clear views on your sort of person.'
Kingsley came down on that one like a boot on a rattlesnake.
'Yes, I think it is unreasonable to make that link I also think it's unreasonable to make your living out of what are for me and my wife rather distressing circumstances. I'd be obliged if you'd restrict your speculative articles to the racing columns.'
'Can I . . .'
'No. Good-bye.'
Kingsley returned to the consulting room with his hands in the pockets of his white coat. He had said he was all for informing the public. Until a few weeks ago he had believed above all else in honesty and straight dealing, but now lies had somehow become his necessary currency – given and received. He knew, for instance, that many of his peers in the profession now asked after Sheila with false sympathy. Most of them secretly held that he had mismanaged Sheila's cancer. Cullen himself believed that the presumed response to chemotherapy was temporary, that Sheila would ultimately die as a result of delaying her amputation. Richard Short had said as much. Others of his trade either equivocated, or avoided the subject with weighed care.
But Spears was outside the tight-lipped etiquette of the medical establishment. And it was Spears, with the volatile, emotive public he represented, who was most likely to recognize the truth.
There was a small newspaper seller on the corner of Hanover Street and Princes Street. He stood over his flimsy stall wearing two coats, a scarf and a cap. He pronounced 'Evening Courier' as a word of four syllables which was translated by the notice of his stand. Kingsley halted at the lights and bought a copy. He found Spears's article on the third page.
'Alistair Kingsley, Edinburgh's Cancer-Cure Surgeon, once more finds himself the centre of speculation. Reports have reached us of a recent operating theatre drama at the Royal Infirmary, in which Kingsley (50) allegedly interrupted a potentially life-saving operation on his wife Sheila, known to be suffering from an incurable bone cancer. Anthony Cullen, orthopaedic surgeon at the Infirmary, declined to comment on the cancelled operation. But he has recently admitted that Sheila Kingsley has since enjoyed an unprecedented 'temporary recovery'. Cullen (52) attributes this to the effects of a course of drugs administered in the month prior to operation. But, by his own admission, her response to these drugs had previously been poor. Is Alistair Kingsley on the verge of a world-beating medical breakthrough? More immediately the question must be asked whether Edinburgh hospitals are involved in unethical experiments on human cancer sufferers. The Courier investigates . . .'