THE NEXT MORNING, GOLDBLATT settled down in the doctors’ office with a coffee and the newspaper, giving the first patients in the clinic downstairs a chance to gather before he went and opened shop. In burst a thin, anxious-looking woman with a silk scarf draped over her shoulders.
Goldblatt stared. What kind of a hospital was this? Couldn’t he even enjoy a cup of coffee in the doctors’ office without being disturbed by every Tom, Dick and Harrietta who wanted respite from the ward?
‘Dr Goldblatt, I presume?’ said the woman, exuding an exaggerated, unctuous femininity that almost made Goldblatt spit out the coffee in his mouth.
‘Could be,’ said Goldblatt suspiciously.
The woman laughed, as if that was the most amusing thing she had heard for years.
‘I’m Professor Small,’ said the woman. ‘Dr Goldblatt, thank you so much for coming.’
No. She said: ‘Dr Goldblatt, thank you so much for coming,’ as if she, Professor Small, was a famous society hostess, and the rubber-skidded vinyl floor of the cramped doctors’ office was the marble-slabbed lobby of her mansion, and as if he, Malcolm Goldblatt, was a movie star or concert pianist or at least a major entertainer who had done her the greatest favour just by deigning to appear.
Goldblatt frowned.
The Professor was holding out her hand. Goldblatt stood up and shook it.
‘Well, I’m very glad to be here,’ he said, which is what he supposed a major entertainer would say to a famous society hostess in the circumstances.
‘Are you? Are you really?’ enquired the Prof anxiously.
Goldblatt shrugged. He would be, if only she’d let him finish his coffee in peace.
‘I must rush,’ said the Prof, managing to inject a tone of real regret into her voice. ‘I just wanted to pop by and say hello. I’m sure we’ll work very well together.’
Goldblatt nodded. He had no idea why the Prof was so sure. There were a number of people with whom, regretfully, he had not worked well in the past, and first impressions, he had discovered, were a poor indicator of the harmoniousness of future relations. Still, he appreciated her optimism.
‘And we must have a talk about how we can help to make sure your next job is a substantive one,’ she said on her way out the door, leaving little time – in fact, none – to discuss when this talk might actually take place.
And then she was gone.
Goldblatt sat down again. He picked up the paper and started to read. But it was no use, the tranquillity of the office had been shredded. He got up and headed for his clinic on the first floor.
The phone call came when he was with his last patient of the morning.
Goldblatt interrupted his conversation with the old lady sitting on the other side of the desk and answered the phone. For a moment he couldn’t place the voice. It had a wheedling, whining quality, and he was tempted to hang up in disgust. But whoever was on the other end of the line knew his name.
‘Dr Goldblatt,’ said the voice for the second time.
‘Yes,’ said Goldblatt, and he smiled apologetically at the old lady in front of him, who was in the middle of telling him how she had broken her hip falling out of her wheelchair. The old lady nodded. In the NHS, she knew, the chances of a doctor hearing out the entire story of your hip fracture without a single interruption were pretty slim.
‘Dr Goldblatt,’ said the voice on the phone again. ‘This is Professor Small. I wonder if you could do me a favour.’
Goldblatt doubted it. He rarely did favours for people who asked for them so brazenly.
‘I have a patient with me in clinic who needs to come in. Are there any beds?’
Goldblatt rolled his eyes theatrically at the old lady. She responded with a conspiratorial smile, thinking there was some troublemaker on the phone. She didn’t know how right she was. There were beds, of course, but none that was empty, if that was what the Prof meant. Goldblatt had been forced to cancel three admissions that morning before clinic, following a brief but torrid conversation with Sister Choy. From what Emma Burton had told him the previous day, that was probably the norm.
There was no point beating about the bush. ‘No, Professor Small. We have no beds.’
‘Dr Goldblatt, I have a patient with me in clinic who needs to come in.’
‘We’ve already had to cancel today’s admissions, Professor.’
‘Malcolm, my patient really must come in,’ oozed the Prof.
Malcolm?
‘All right, send her to Emergency,’ said Goldblatt. ‘I’ll see her after clinic and sort things out.’
‘But she might wait hours for a bed in Emergency,’ said the Prof.
It was true. It was truer than true. There wasn’t any might about it. She would wait hours for a bed in Emergency.
‘And she might end up anywhere in the hospital.’
True again. There wasn’t a bed for her on the Prof’s ward, that was for sure.
‘Malcolm, I wonder if you would do me a favour,’ the Prof continued to ooze. ‘Do you think you could manipulate our beds and get this lady in on our ward? I’d be so grateful.’
Goldblatt didn’t answer straight away. The Prof’s gratitude was a powerful incentive. But what about his principle, his big, important principle that he had invented only yesterday and which he had enjoyed repeating to himself so much. Was he going to throw it away at the first temptation? Was he so capricious? So fickle?
He gazed at the patient on the other side of the desk. What would she think of him if she knew he was even considering that? But she had other things to worry about. Her dentures had slipped out of place, and she was busy working her lips surreptitiously in and out and over each other in a desperate attempt to reposition her teeth without using her fingers.
‘Dr Goldblatt?’
He sighed. ‘Professor Small, I’ll see your patient in Emergency as soon as I’m finished here. I promise. I won’t be long. I’m with my last patient.’
Professor Small had gone very quiet. There was only a tiny, mouse-like breathing on the other end of the line.
‘Don’t worry. If she’s sick enough to come in, I’ll get a bed for her somewhere.’ Goldblatt waited for the Prof to say something.
‘Oh.’
‘What’s her name?’
‘Broderip,’ whispered the Prof.
‘Is that B R O D E R I P?’
‘Yes.’
‘I’ll call Emergency and tell them to expect her, shall I?’
The Prof didn’t answer. Goldblatt heard the muffled sound of a conversation on the other end of the phone. First the Prof’s voice, then another.
‘Dr Goldblatt, don’t call Emergency,’ said the Prof eventually. ‘Mrs Broderip will think about it. I’ll get back to you.’
The Prof hung up. Goldblatt put the phone down. He stared at it for a moment. He had a hunch that the Prof’s patient – who wanted to think about whether she should take up the offer of being admitted – might not be quite as sick as the Prof had represented.
By the end of the day, he hadn’t heard anything more about her. Goldblatt thought he had handled the situation pretty well. He had found the Prof’s wheedling, whining tone oddly nauseating, but he had managed to hold down his breakfast and provide a textbook response, he thought. In fact, he was quietly confident that he had probably earned quite a lot of credit with the Prof for his calmness and rationality.
Or not. The next morning, when he arrived to do his round with Ludo and the HO, Goldblatt found a new patient propped up comfortably in bed twelve, enjoying a cup of tea and the fine panorama of north London that was visible from the seventh-story windows of the ward.
Goldblatt stared at the name-label on the chart in disbelief.
‘Where did she come from?’ he demanded hoarsely of the HO.
‘Hornsey,’ the Broderip informed him helpfully from her sickbed. ‘The registrar didn’t want me to come in. Ooh, if I catch that boy I’ll give him a piece of my mind. Professor Small says to me: “Don’t worry, Mrs Broderip, I’ll get you in.” Course I’ve been under her for years, I have. Started with her when she was just a doctor. Doctor Small she was, and now she’s a professor. Hasn’t she done well for herself? Still, she deserves it. She deserves everything she’s got, that’s what I say. Lovely person. Isn’t she lovely?’
Goldblatt kept his opinion to himself.
‘I won’t stay long, love,’ said the Broderip. ‘Be no bother. It’s just the Fatler’s,’ she informed him confidentially.
‘She means she’s got Fuertler’s Syndrome, Malcolm,’ whispered the HO.
Goldblatt glanced pointedly at the HO. He was just about capable of working that out, even after only two days on the ward, since hardly any of the Prof’s patients had anything else.
‘That’s the one, love. Had it for years, the Fatler’s. Still, can’t complain. Suppose I should be grateful. Never had it as bad as some of them others. Awful, what it does to some of ’em. Gets ’em on the face, you know. Not me, touch wood. Bit on the arms, bit on the legs. Not too bad, considering. Got a little patch on me tummy, as well. I come up yesterday for the check-up and Professor Small says am I feeling tired? Well, who isn’t? So she says I better come in for a bit. Have that Surlane profusion.’
‘She means the Sorain infusion,’ whispered the HO.
‘That’s it. You see, she knows. She’s a clever one, this one. The Prof says: “Do you good, Mrs Broderip.” Do me good. I knew her when she was just a doctor, you know. Isn’t she lovely, bless her? She’s lovely, isn’t she?’
‘Yes, she’s lovely,’ said Ludo, as Goldblatt grabbed the HO’s collar and dragged her away.
Fuertler’s Syndrome – or Fatler’s, if you were Mrs Broderip – had been gifted to the world by Jacob Fuertler, a Viennese dermatologist who published a landmark paper in 1908 describing the illness in three Viennese women. The cardinal manifestations of this rare disease are skin lesions that range from a brawny thickening at one extreme of the spectrum to thinning and ulceration at the other, with the colour of the affected areas ranging from a deep brown discolouration to an almost entire loss of pigment.
No one really understood what caused the lesions in Fuertler’s Syndrome. Acres of Fuertlered skin had been cut out, sliced up, and peered at under the microscope, but no one knew why they occurred in the first place. People with Fuertler’s Syndrome have unusual antibodies in their blood, but are these antibodies cause or effect? Do they provoke the disease, or are they produced as a response to fragments of damaged cells released into the tissues? No one had been able to settle the question.
In addition to skin changes, Fuertler’s patients sometimes develop various other problems. Chronic tiredness, dryness of the eyes and mouth, and low-grade inflammation of the joints are common. Nerve problems occasionally occur, with tingling in the hands and feet, and some patients develop mild muscle weakness. Less commonly, irregularities of the heartbeat, thyroid dysfunction, low-level anaemia, and mild deficiency of the blood’s clotting components are seen. These problems are almost always manageable with treatment, never quite going away, never quite causing any trouble. The combination of skin lesions with internal problems means that the disease is sometimes treated by dermatologists and sometimes by physicians in other areas of internal medicine. In keeping with medical tradition, each group typically derides the other’s ability to manage the illness – although in the case of Fuertler’s Syndrome, with faint enthusiasm. Outside the tiny world of committed Fuertlerologists, no one is much interested in treating the disease. They are greatly outnumbered by those who couldn’t care less about it and would gladly hand it on to anyone prepared to assume responsibility. Fuertler’s Syndrome is an ungrateful illness. It grumbles along with its tapestry of depressing and disfiguring skin lesions, and its accompanying panoply of irritating but minor ailments, rarely doing anything to cause alarm, rarely repaying the treating physician with discernible signs of improvement.
On the other hand, there is one really serious complication that does occur in Fuertler’s Syndrome. Pulmonary fibrosis, a thickening of the lung tissues blotting out the delicate membranes across which oxygen passes to the bloodstream, develops in a small percentage of cases. In the majority of these patients the process of fibrosis eventually comes to a halt, leaving them with nothing more serious than breathlessness on exertion, but in rare instances the fibrosis is aggressive, progressive, and resistant to treatment. Even the most powerful forms of chemotherapy are unlikely to arrest it. For these patients, after every conventional therapy has been exhausted, the only option is a lung transplant, but it’s generally believed that the fibrosis will recur in the transplanted lung and therefore, given the scarcity of lungs for transplant, Fuertler’s patients are hardly ever offered the operation.
Nothing that Goldblatt had seen suggested that Mrs Broderip was one of those rare cases, and much that he had seen – her hale and hearty demeanour, her robust complexion, her impressive weight – suggested the opposite. The HO gave a clear, succinct and passionate account of Mrs Broderip’s arrival, her ruffled red hair standing on indignant end and eyes blazing with resentment. Ten minutes after Goldblatt had left the previous evening, Emma Burton had rung her up and told her that she had cleared a bed for a patient called Broderip, and the HO had better stay around to clerk her in because she was being admitted as an emergency from clinic, and the Prof had a special interest in her. No, it wasn’t good enough for the on-call person to clerk her in. The HO had to do it herself. And four hours later this ‘emergency’ from clinic, who had taken the Underground back to Hornsey to get a nightie and prepare dinner for her husband – who couldn’t be left alone just like that, love, without so much as a hot meal to give him strength – turned up, and the HO had been waiting all that time just to clerk her in.
‘So don’t blame me!’ said the HO, fingering her stethoscope as if she was going to swing it at the first person who made a wrong move. ‘I was here until ten o’clock!’
Goldblatt nodded. He had no intention of blaming the HO.
It had been too easy, he realized. How could he imagine that his reasonable, measured, and calm response could have any effect on a prof? Especially a prof like the Prof.
‘Let’s go,’ he said to the HO.
They went back out on to the ward, where Ludo was still with the Broderip.
‘She is lovely,’ Ludo was saying.
‘She is, isn’t she?’ said the Broderip.
‘Come on,’ Goldblatt said to Ludo.
‘Don’t you think she’s lovely, Malcolm?’ said Ludo.
‘Come on, Ludo,’ he repeated through gritted teeth.
‘See you soon,’ called out the Broderip cheerfully, and went back to sipping her tea.
They did the rest of the round. The HO pushed the notes trolley back into the doctors’ office.
Goldblatt sat down. He glanced at the notes trolley and saw the Broderip’s name on one of the files. He shook his head.
‘What’s wrong, Malcolm?’ asked Ludo knowingly.
Goldblatt didn’t reply. He looked around the doctors’ office. Tatty brown Manila folders lay amidst the papers and X-ray folders that littered the desks. He gazed at one of them. Suddenly he felt like throwing it out. Goldblatt’s first instinct was to throw most things out unless they had a clear and useful purpose that he could identify within ten seconds, especially in hospitals, where every document exists in duplicate except for those that are really necessary, which often don’t exist at all. He practised wholesale disposal whenever he could, particularly with medications. This was a legacy of six months that he had spent as a registrar on a Geriatrics unit, where every patient came in clutching a bag bursting with drugs, a good portion of which had side effects that were far worse than anything they were supposedly meant to treat. Most of the others had been prescribed to counteract the first lot. From his very first day on the unit, Goldblatt had joyfully slashed long lines across the medication charts, often cancelling half a dozen drugs at a time.
‘Let’s get rid of these, shall we?’ Goldblatt said, picking up one of the brown folders.
The HO’s face was buried in the drug formulary, where she was trying to work out whether a drug called Cetirizine, which one of their patients was taking, could give you a rash. Goldblatt thought he should let the HO discover for herself that Cetirizine was normally prescribed as treatment for a rash. With luck, that would teach her to find out the easy way next time, by asking the patient why she was on it.
Ludo glanced at the folders doubtfully. ‘What are they?’ she said.
‘No idea,’ replied Goldblatt, gathering the rest of the brown folders up from the desks.
‘Shouldn’t we look before we throw them out?’ asked Ludo.
‘Why?’
‘To find out what’s in them.’
‘Do you want to know?’ asked Goldblatt.
Ludo shrugged.
‘I had a professor of Ophthalmology when I was a medical student,’ recounted Goldblatt, sitting back and switching seamlessly into old-timer mode. ‘He had a saying I’ve never forgotten. “If you don’t look, you won’t see it”. Has a nice ring, don’t you think? “If you don’t look, you won’t see it.”’
Ludo watched him suspiciously. ‘Isn’t that obvious?’
‘Yes. So obvious you might never realize it for yourself unless someone told you. Ask yourself how many times have you not quite managed to see the full retina with your ophthalmoscope – or listened to every part of the lung fields with your stethoscope, for that matter, or got every limb positioned so you can test every reflex properly – and you’ve said to yourself, it’s OK, I’ve seen enough?’
Ludo rolled her eyes. Probably every time she examined someone, thought Goldblatt.
He glanced at the HO, who had looked up from the formulary and was watching him. ‘Never cut corners in examination,’ he said. ‘Never just assume it’s OK. The one time you make that assumption, I can guarantee you, will be the one time you’re wrong.’ He repeated the mantra solemnly. ‘If you don’t look, you won’t see it. They only gave this professor four lectures to cover all of Ophthalmology, and he didn’t really expect us to remember any of it, but he wanted us to remember that. That, and one other thing he kept telling us to remember.’
‘And?’ demanded Ludo derisively, pretending she didn’t care what the old ophthalmologist had said.
‘He was right. We didn’t remember any Ophthalmology.’
Ludo and the HO jeered.
‘Now, this is Goldblatt’s variant of the rule,’ said Goldblatt, holding a finger up in the air.
Ludo and the HO waited.
‘If you don’t want to see it – don’t look.’
Ludo frowned. The HO glanced questioningly at her.
‘If you don’t want to treat the renal failure in a terminally ill patient who’s got two days to live and really doesn’t need your treatment, don’t do the test. If you don’t want to reinforce someone’s obsession with their blood pressure, don’t put on the cuff. If you don’t want to see it – don’t look. Both of the principles are right. The trick is to know when each one applies. Look – or don’t.’ Goldblatt held out the folders to Ludo. ‘Here you are.’
Ludo stared at the folders, as if transfixed by some barely resistible force emanating from their brown covers. They were just folders. But Goldblatt had done something to them. Suddenly the act of taking them had become an enormous, wrenching test of moral courage.
Ludo wasn’t big on moral courage. And failing tests was one of her specialities.
She squirmed away, shaking her head. Some primal survival instinct told her that to take the folders was dangerous, to receive them was to create an unseverable bond between herself and those folders – whatever they were – which might exert malign and unforeseeable consequences over her far into the future.
Goldblatt held them over the rubbish bin.
‘Don’t!’ cried Ludo.
‘What?’
‘Don’t throw them out, Malcolm.’
Goldblatt smiled. Perhaps the bond had already been created. ‘All right.’ He tossed the folders on the floor under one of the desks.
‘What was the other thing?’ asked the HO.
‘What other thing?’
‘The other thing the Ophthalmology professor told you.’
‘Beware the unilateral red eye.’ Goldblatt turned to Ludo. ‘And the causes of the unilateral red eye are...?’
‘Please, Malcolm,’ whined Ludo.
He put out his thumb, ready for the first answer.
‘Look at the time! I’ve got a Dermatology clinic,’ said Ludo, and walked out.
Goldblatt glanced at the HO. ‘Incidentally, the Cetirizine Mrs Lamb is on. The one you were looking up. In the formulary. It’s the cure, not the disease.’
The HO frowned.
‘It’s the treatment for her rash.’
‘Oh. Right.’ The HO paused. ‘I would have worked that out.’
She soon left on what would become her daily visit to the Radiology bazaar to barter over the X-rays that hadn’t been performed the previous day. Goldblatt pulled the admissions book out of a drawer in one of the desks. Thanks to the Broderip’s miraculous appearance, he now had one less bed than he had previously assumed. He looked at the names of the patients who were scheduled to come in that day and chose the one with only two previous cancellations. Everyone else had three. He paused for a moment, took a deep breath, and dialled.
A woman answered the phone.
‘Hello,’ said Goldblatt. ‘Is this Mrs Anderson? It’s Dr Goldblatt here from Professor’s Small’s—’
Goldblatt stopped. Mrs Anderson was already crying.
As he listened to Mrs Anderson weep, Goldblatt could just glimpse the Broderip through the open door of the office. Propped up in what could have been Mrs Anderson’s bed, she had finished her tea and fallen asleep, mouth gaping, snoring contentedly.
It took ten minutes to console Mrs Anderson. He promised to reschedule her quickly and swore the delay wouldn’t worsen her condition. Even so, she was still sniffling when he put down the phone. He stared at the undeservedly snoring Broderip, and thought of the weeping Anderson. There were too many Andersons and too many Broderips, he thought. There were too many Andersons and too many Broderips, and they were inextricably linked by a cruel and immutable mathematical relationship...
He had discovered a new law of medicine, if not of nature! Because what was the Broderip–Anderson Principle, as Goldblatt immediately named it, if not such a law?
But what was the message buried in the Broderip–Anderson Principle? There was no joy to be had from it, no reason for him to smile. It was a monumentally depressing discovery. And yet, the very simplicity of the Principle’s flawless, depressing perfection – its essential truth, so elusive yet so obvious when laid bare – gave Goldblatt a grudging satisfaction, much like the guilty pleasure that he imagined his medical predecessor and fellow humanitarian, Dr Guillotin, must have felt when he heard the first dull thud of a head falling from the block of his newly invented machine.
Broderip–Anderson. Goldblatt toyed with the name. He could see it in his mind’s eye. He was dissatisfied. It lacked something. Not exactly a name to die for. Not even a name, as Khrushchev might have said, for a shrimp to whistle for. What was in a name? Everything. Shakespeare, who famously denied it in print, was either a complete madman or more probably was trying to keep a commercially sensitive discovery to himself. Goldblatt frowned. The name needed something. Exoticism, mystery, allure. Anderssen, he thought suddenly. Yes. Anderssen. There was something Scandinavian and tall about it. Blond, bearded, with the kind of craggy, bleak, Kierkegaardian intellect that could cook up such a principle. Or lithe, slim, blonde, and ready for sex. Whatever. Anderssen it was.
The Broderip–Anderssen Principle. Perfect!
No, it wasn’t perfect. It was far from perfect. Not the principle, but the events that had led to its discovery.
It wasn’t just the Prof, flying in the face of his utterly rational and calmly delivered response to her request to admit the Broderip. Profs fly in the face of rationality all the time. It was Emma Burton. Hadn’t they had a conversation? Hadn’t they agreed who was going to do what? Hadn’t they concluded the admissions were going to be handled by him? And hadn’t it all been – not to put too fine a point on it – fine?
Or had he just imagined the whole thing?