Forced to spend their working hours at close quarters with death, medical students in every age and country devote their leisure to the most robust manifestations of life. The young ladies who enrolled at the London School of Medicine for Women were no exception to this rule. True, they did not hurl themselves about the rugger field or propel unstable boats up and down the river or deprive policemen of their helmets in the course of inebriated evenings. But there was a light-hearted gaiety about them which Margaret at first found extraordinary, and then almost at once took for granted. There had been a time, in the bad year of 1878, when she had thought that she would never be happy again. Now, four years later, it seemed to her as she went exhausted to bed each night that she had never been happy before.
The group had its own private language. When an alphabetical list of new students was pinned up on the first day of the preliminary course, they noticed at once that each of the first fifteen letters of the alphabet was represented, and by one surname only. They christened themselves the Alpha Beta class, and addressed each other by their initial letters instead of names. They embroidered the letters on the white linen smocks which they wore in the hospital wards, so that patients and instructors alike found it simple to pick up the habit. Even Margaret and Lydia, who had been friends for so long, adapted their speech to the private language during the term, becoming Miss L and Miss M.
So Miss Lorimer and Miss Morton became holiday people only. It was like dying and being born again, Margaret sometimes thought: she had become a new woman. She could hardly believe that the girl who had lived in Bristol, doing her conscientious best to find some useful occupation for at least an hour or two of the day, was the same person as herself.
Right from the beginning the work had been hard. There were moments during the preliminary course when Margaret was convinced that she would not be accepted for full training - or, if she were, would never be able to endure its more advanced stages. Later she discovered that those first few months were deliberately made taxing as a test of intelligence and staying power. When Ralph wrote anxious letters to her from Oxford during this period, hoping that she was managing to avoid the temptations and wickednesses of London life, she was able to assure him that she had not yet had time to find out what or where they were.
There had been plenty of time, though, to discover the poverty and dirt in which so many Londoners lived. Her midwifery had taken her, often in the middle of the night, into dark and foul-smelling courts round which dilapidated tenements insecurely clustered. She became familiar with drunkenness and foul language and — because so many babies chose to arrive at two or three o’clock in the morning - soon ceased to be frightened by the hurried footsteps of a thief surprised at his work or the glimpse of a body rolled up in newspaper, a dosser who might or might not wake up when morning came.
Even in the most sordid surroundings, she never felt in any danger. The messenger who came to call her, whether husband or child or neighbour of the woman in labour, always escorted her into the slums and out again, calling on the empty streets to let the doctor through, so that there should be no misunderstanding about her errand. Even as a girl she had never been nervous, and now she simply took it for granted that she should go where she was most useful.
It was as a result of this attitude and experience that she saw nothing extraordinary about the Sick Children’s Hospital when she started to work there on the Monday following Beatrice’s fifth birthday. The building had originally been a warehouse, and the change of use had not been accompanied by any conversion of its structure. A hundred iron bedsteads and twenty wooden cradles had been installed, but otherwise the accommodation provided for the children was little better than that enjoyed by the sacks of cloves or ginger whose aroma still lingered. The walls were of wood, pierced by openings from which the old hoist platforms still projected. Arriving in September, Margaret accepted that the ventilation thus provided must have been pleasantly cool in the summer, but wondered with misgiving whether the mists and fogs of autumn and the chill winds of winter would prove healthy for the young patients.
If coldness was still only in prospect, dampness was already in possession. The warehouse was supported half on land and half on piers sunk into the bed of the river. So near the autumn equinox, the tide was at its highest, lapping the floor of the overhanging section and splashing against its side almost into the windows. As a result, all the wood was damp and much of it was rotten.
The ground floor, with no windows to illuminate it, was not used by the children. A pair of oil lamps hung there to welcome new arrivals. Their other greeting came from Jamie, the porter, whose body was powerful but whose mind was dim. Too large ever to stand straight under the low wooden ceiling, he sent the oil lamps rocking with blows from his head even when he stooped. But he was kind and harmless, and lifted the sick children up the steep ladders which emerged through trapdoors on to the main floor; carrying them as though they were snowflakes, weightless and fragile
Margaret’s days in the hospital were busy ones. In the mornings she accompanied the house physician, Dr Ferguson, on his ward round, visiting every bed in the two long lines. It came as a relief on her first day to discover that his views on female doctors were tolerant. He believed that they should confine themselves to the care of children, but since the care of children was what he had agreed to teach her, there was no cause for disagreement between them. It seemed to Margaret, in fact, that he was especially meticulous in his supervision, as though by training her well he hoped to persuade her to choose this specialization. He made her conduct her own examinations and give her opinion before making his own pronouncement on the disease and its treatment. The hospital had no surgical unit. Even the charitable optimists who had looked at a derelict warehouse and seen a vision of care and healing had recognized that the facilities were not good enough for surgery.
After Margaret had made up her notes for the morning, it was time to help with the out-patients. Officially her task was to keep the records, but from the start she was expected to offer practical help. The area was one of the poorest in London, and its children appeared either to be particularly adventurous or particularly unlucky. They crashed through rotten floorboards, they were hit by cargoes swinging from cranes, they were hauled half-drowned out of docks, they were bitten in bed by rats. For Margaret’s first day or two the responsibility frightened her, but there was too much work for time to be spent in wondering whether she was doing it in the right way. She advised on convulsions, set broken limbs in splints, and identified spots and rashes before sending their owners off to the isolation hospital. Each night she arrived home exhausted and could do no more than exchange a few experiences with Lydia over supper before falling into bed.
It was on the Wednesday of her sixth week that she arrived in the morning to find a strange difference in the atmosphere. It was not easy to discover what had caused it. Most of the babies in the wooden cradles seemed to be crying, and there was a smell of vomit in the air, but this was normal. The older children in the beds, irrepressible even in sickness, were engaged in throwing at each other whatever articles were in reach; and even some of those who lay flat, with only their white faces showing above the scarlet blankets, were able to shout a cheerful insult from time to time, although it might take them five minutes’ panting to regain their breath.
All this was normal too, and so unfortunately was the fact that a few children lay with their eyes closed, too weak to contribute to the noise and bustle. One of these was in the bed beside the trapdoor through which Margaret had just appeared. She looked anxiously at his dead-white face and blue lips and put a hand to his wrist even before taking off her cloak. His neighbour, a cheerful boy with the mark of his father’s drunken anger stitched in a livid scar across his forehead, leaned forward informatively.
‘’E’s croaking, Miss.’
Margaret made no comment. She pushed aside the curtain which cut off Matron’s tiny cubicle from the open ward and let it fall back behind her.
‘Peter’s gone,’ she said.
Matron - an elderly woman, neat in a long blue dress with stiffly starched cuffs and cap - nodded gravely.
‘Ten minutes ago,’ she said. ‘I’ll have Jamie up from below to fetch him in a moment or two. But we’ve had an emergency here. Young Kelly’s leg. Gangrene, I’m afraid. He’s too ill to move. St Bartholomew’s have sent a surgeon to amputate. I want to be free when he’s finished, so I’m hoping none of them will notice Peter for a moment.’
The operation explained the atmosphere. All the children were terrified of being ‘cut’. It happened here only in the gravest emergencies, but whenever a surgeon was seen to arrive, a tension grew like the feeling in a prison on execution day. The young patients themselves fought against the anaesthetic as fiercely as they would have sought to evade the knife, and even the noisiest of the other children were silenced by the sound of the screaming. Jamie, too, who was called upon to hold the child down until the chloroform had taken effect, was upset by this duty. He loved children, and wished to be kind to them. His limited intelligence could not comprehend that a child must be restrained and hurt for his own good. Jamie did whatever he was told, but he was not happy about it.
As Margaret turned to hang up her cloak, the curtain was pulled aside again. The stranger who came in - a man of about thirty - was almost as tall as Jamie. He had thick fair hair and troubled blue eyes in a strong and handsome face.
The overwhelming impression of the young surgeon was one of bulk, for in addition to his height he was broad-shouldered and solidly built. Margaret stepped back as though only some such movement would enable them all to breathe in Matron’s tiny cubicle. Even then they were so close that she could see the fresh blood which stained his frock coat: the sawdust which clung to his boots was coloured in the same manner.
‘I’ve had to take the leg off above the knee, Matron,’ he said. ‘And even now …’ He shrugged his shoulders compassionately. ‘I don’t give much for his chances, I’m afraid. You’d better get his mother here.’
‘No family,’ said Matron. ‘He’s been working as a crossing-sweeper and living rough. That’s how he came to be walking round with a rusty nail stuck in his foot for the best part of eight days.’
‘Mm. Well, keep him warm. Hot drinks as often as he can take them. If you’ve a drop of brandy to spare, that would be his best medicine. He won’t feel the pain for a few hours. I’ll come back this evening to see how he’s getting on.’
‘Thank you, Doctor,’ said Matron. ‘We’re very much obliged to you, I’m sure.’
He stepped backwards, raising one hand above his head to move the blanket aside. As he did so, he glanced at Margaret for the first time. It seemed to her that what he saw disturbed him, for he frowned slightly to himself and stood for a moment without moving as though holding a pose for a photograph. Then, almost imperceptibly, he shook his head. Whatever was puzzling him was not worth the time he would need to unravel it. He ducked under the beam and within a second could be heard clattering down the ladder, with a thud as he jumped the last few feet.
Margaret stared at the place where he had stood. If he had gone straight out without pausing, it would never have occurred to her that she had seen him somewhere before. But his moment of puzzlement had proved infectious. His face was somehow familiar, but she could not remember any occasion on which they could have met. Clearly he had had the same difficulty. Perhaps his name would give a clue.
‘Who was the surgeon?’ she asked Matron.
‘Come to think, he never gave me his name,’ said Matron, unconcerned. ‘When he arrived, he said that his Resident Surgeon had asked him to come, and where was the boy? I was too glad to see him to be bothered about introductions.’
A hysterical shout came from the other side of the partition.
‘’E’s croaked. Matron, come ‘ere. Peter’s croaked.’
‘This is going to be a bad day,’ said Matron. ‘When I saw young Kelly this morning I thought we were starting with the worst, but now I’ve got that feeling in my bones that there’s more to come. A bad day.’
She hurried out of the cubicle. Margaret heard her voice - an artificial sharpness to it - ordering Mickey to get back in his bed and Johnny to stop making that terrible noise. Jamie was called for and came heavily up the ladder, still disturbed by the operation. From the other direction a young nurse came hurrying to help. Margaret watched the activity through a gap in the curtain, but thought it best to keep out of the way. Unlike Matron, she had no gloomy feelings about the day. Her brief exchange of glances with the surgeon had aroused her interest. His appearance was attractive. Whoever he was, she would like him to notice her.
It could easily be arranged, she thought. He had promised to return in the evening. If she were to stay a little later than usual, she could ask him to discuss the effects of the operation with her.
This plan was foiled, unintentionally, by Matron. The Sick Children’s Hospital undertook no night casualty work; and because there was no lighting in the long ward except for the lamps carried by the nurses, the in-patients were settled to sleep as soon as darkness fell. On this particular evening that moment arrived early, for the first of the autumn’s sea fogs came swirling up the river to be trapped beneath the pall of smoke which at this season thatched the roof of London’s atmosphere. Margaret had written up her notes for the day slowly and painstakingly but by six o’clock it was clear that there was nothing more for her to do at the hospital. Dr Ferguson had left long before, and Matron frowned to herself as the thick yellow fog blanketed the building more closely.
‘You should be on your way, Miss L.’ Like everyone else, Matron used the initial as though it were Margaret’s full name. ‘In half an hour it won’t be safe to walk through the streets. Jamie had better go with you to the station.’
‘No, thank you, Matron. That won’t be necessary.’ Even at the best of times Jamie had always to be given a note in his pocket to state his destination, ready for the moment when he lost himself. He would never find his way back to the hospital in the fog. But Margaret realized the wisdom of Matron’s advice. Besides, in such weather it was likely that the surgeon would cancel his journey, so that any further procrastination would be for nothing.
She clutched her cloak tightly about her while she climbed down the ladder to the ground floor and called a cheerful goodnight to Jamie. He was stumbling about in the shadows, groaning to himself, and did not answer her as she stepped briskly out. The fog was not yet dense, but swirled up the street in tall columns, like ghosts walking. At one moment she could see the buildings across the way clearly: then they were gone, and with them went all sound. Even her own footsteps were muffled when she reluctantly began to move away.
Twice she thought she heard a horse approaching: twice she stopped to listen and told herself she was imagining the sound. On the second occasion the pause was longer, for it was necessary to deliver a short lecture to herself. What did she think she was doing, loitering like a shopgirl? Was she trying to force herself on the attention of a busy professional man who had no reason to give her a second glance? Margaret felt bewildered by her own behaviour. She was twenty-five years old and dedicated to the calling she had chosen. She had loved a man once and would never love another. Her life as a doctor lay clear ahead. How could she have allowed a brief glimpse of a stranger to complicate her feelings? She resolved to put him out of her mind at once.
With this settled, she took at least two brisk steps before finding another excuse to pause. The fog, settling more thickly, had trapped the black smoke which rose from a million chimneys and filled the lower air with grit. Margaret began to cough as the irritation, more smoky than she ever remembered it before, reached her throat. She untied her scarf and wound it round her mouth to act as a mask. While she was doing so, she heard the sound of a horse’s hooves and the rattling of wheels.
This time there could be no mistake, but the perverse acoustics created by the fog made it impossible to tell the direction of the carriage. She turned to look back, and caught her breath in horror at what she saw. As the yellow fog eddied and briefly rose along the river bank, it revealed glimpses of a bright orange flame through the doorway she had recently left. The children’s hospital was on fire.