GOLDBLATT HAD MET LESLEY when he went back to university to do a law degree. She had been in the final year of a PhD in some arcane aspect of European law before taking up a pupillage, and was giving tutorials on torts to undergraduates. The other five students in his tutorial group were mere callow nineteen-year-olds whereas he was a callow twenty-seven-year-old, which was a year or so older than Lesley herself. He sensed there was something between them. Later on, she denied having felt it. She said she had never given him a second thought. Repression is an ugly thing, Goldblatt told her. It didn’t make her change her story.
Anyway, falsely believing there was something between them, Goldblatt asked her out for a drink at the end of her course of tutorials, and for some reason that she could hardly recall later – more evidence of repression, Goldblatt told her – she said yes. That was almost six years ago. Since then, Lesley had become a barrister and now worked in chambers in Lincoln’s Inn. Goldblatt didn’t expect her to understand what it was like to work on Professor Small’s unit. Her world had its own brand of driven, soul-crunching craziness, and was peopled with a range of creatures only marginally more likeable than the things you might find wriggling around in the droppings below the roof of a bat-infested cave. But she had never worked on a medical unit, even a normal one. What hope did she have of understanding one like the Prof’s? He could barely understand it himself.
He tried to explain. But words failed.
‘The place is just a basket case,’ he said.
‘What’s wrong with it?’
‘Everything! Name anything you like. The people, the patients...’
Lesley looked at him doubtfully. ‘The patients?’
‘Fuertler’s Syndrome. I’m a reasonable man, Les. In small numbers, I have nothing against it.’
‘Malcolm, you’ve only been there a week!’
True. But even during that week, there were things he hadn’t mentioned to Lesley. Like the episode with the Broderip, for instance. And Simmons. And the way Emma kept using the word ‘fine’ as if it was a word from a language he didn’t speak.
‘Les, I’ve never seen anything like it. Of all the places I’ve been... this one takes the cake.’ Goldblatt grinned. ‘You know what my ex used to say.’
Lesley knew. Goldblatt had told her any number of times. ‘If there’s a hard way to do something, Malcolm, you’ll find it.’ From the way he always said it, you would almost have thought he was proud of it.
‘Malcolm,’ she said, ‘you can’t afford for this to go pear-shaped.’
Goldblatt looked at her pointedly. There were some things he was capable of working out for himself.
‘All right,’ said Lesley. ‘Look, you are where you are. You’re just going to have to find a way to make this work.’
He grinned again. ‘I love it when you talk positive.’
‘Seriously, Malcolm. Let’s think about it systematically, one thing at a time. Maybe if you could deal with the worst thing, that might be a start. What is it? If you had to name one thing, the one thing that’s worse than anything you’ve seen anywhere else before, what would it be?’
Worse than the surreal Fuertlerization of the unit? Worse than the Prof’s unctuousness? Worse than Emma’s intransigence?
‘The admissions,’ said Goldblatt, without needing to think twice.
‘The admissions?’
‘I’ve never seen anything like it. We have two or three cancellations every day. Every single day. And they cry.’
Lesley didn’t understand.
‘They cry, Les. On the phone. When I ring to tell them.’
Every morning, before he started his round, Goldblatt talked to Sister Choy or Debbie, the second in charge, to find out how many beds were going to become available that day, barring deaths and disappearances. Armed with that knowledge, he then went to the doctors’ office, sat down, opened one of the desk drawers, and took out a book that was kept there.
At first glance, the book looked like any one of millions of blue A4-size diaries that you would find in offices all over the world. But in reality it was nothing like them. Its bland, unremarkable appearance was just a cunning disguise for its enormous metaphysical power. The admissions book was a metaphor for life, for the relentless progress of time and the extinction of opportunity. When Goldblatt opened it, the past was on his left, page after page of names hopefully entered, and of which at least half had been mercilessly struck out with ‘cancelled’ written in the margins beside them. The future was on his right, page after page of as-yet-unobliterated names – four to a page – in Emma’s handwriting, with a note saying ‘cancelled x 1’ or ‘cancelled x 2!’ or ‘cancelled x 3!!’ or ‘cancelled x 4!!?!’ written underneath. And in the middle, flat on the desk in front of him, was the page of the present, the Here-and-Now, the razor-sharp line separating the Will-Be from the Was, the Could-Be from the Wasn’t, the soft underbelly of time palpitating in all its moist vulnerability beneath his poised pen. And with a stroke and a cursive ‘cancelled’, Goldblatt would perform the irreversible transmutation and send someone’s future and its unlimited potential spinning irrecoverably away into the constricted past.
At that moment, as he sat with pen poised, he was the breaker of seals, the father of time. Sitting with the book of remembering and forgetting open in front of him, calculating the difference between the number of beds he had and the number of names on the page, deciding who would come in and who would be struck off, who would be chosen and who would be cast out... for that one moment each morning, Goldblatt was a god. A very minor god, barely a foot-washer to the major deities – but a god.
And then he was just a man again, picking up a phone and calling an Argentinian admissions clerk called Sofia to give her the names of the day’s cancellees, and the dates, three or four months away, on which he was rescheduling them.
The names got into the book in the first place by coming to him on small blue cards, RSVPs to invitations he had never sent out. He would find them like a crop of blue fungus on his desk in the doctors’ office on Friday mornings, having been deposited there by the guardian angel who watches over all Fuertler’s patients after the Prof’s prodigious Thursday clinics.
The cards were filled out in the Prof’s curly script or in the handwriting of the two clinical assistants who worked with her in the Thursday Fuertler’s clinic. There were boxes on the cards to be filled in with important information, like the patient’s name, age, hospital number, address, and reason for hospitalization. There were also boxes for unimportant information, like preferred dates of admission. Goldblatt wasn’t sure if the Prof and her assistants filled that part out as a joke. Reservations at the Hotel Small, which rarely had room for all its guests, weren’t allocated by preference. Sometimes the ‘urgent’ box on the card had been ticked, and then Goldblatt was in a real quandary. For about ten seconds. As far as he could work out, most of the ‘urgent’ patients were coming in for the usual Fuertler’s work-up, and it wasn’t immediately apparent what made one work-up more urgent than another. Besides, the Prof’s performance with the Broderip had shown him that if a patient in clinic revealed the slightest sign of actually being ill enough to require admission, the Prof wouldn’t be writing little blue cards with neat ticks in the boxes.
The card also had a box for Goldblatt to fill in, the putative date of admission. But the moment when he leafed forward in the book of time to find the next empty slot, then wrote the name in the diary, wrote the date in the box, and sent the card off to Sofia in the admissions office – that moment which should have been the end of the process – was only the beginning, the point at which each name took its place in the great, unending chain of cancellations that had wound itself like a python around the Prof’s unit and was inexorably squeezing it to death. One day, he knew, he would come across that name again. When the future had turned into the present, and tranquillity had become confusion, his own hand, he knew, would strike it out once more.
He began to understand why Emma had said it was so stressful. Anyone who has ever been in charge of admissions will have found himself cancelling electives, but the sheer volume, density, and consistency of cancellations on the Prof’s unit was something he had never come across before. They weren’t an exception, they were the rule. Normally it was the admissions clerks who were supposed to ring patients to inform them that their admissions had been cancelled, but Sofia refused to ring anyone who had been cancelled already – which was just about everybody. Even if she had agreed to call them instead of leaving it to him, they would have rung him themselves. The Prof kindly instructed all her patients not to hesitate to contact her registrar, and even provided them with his bleep number in case switchboard lost it. Not only patients rang him, but mothers, husbands, cousins, GPs, MPs, and all sorts of do-gooders who should have butted out. They whimpered, ranted, threatened, pleaded, and tried every kind of emotional blackmail. And they cried, especially the patients. Goldblatt had already come across some whose next six-monthly infusions were due before the last ones had even been done. The anxiety this created was wrenching. Professor Small had convinced them that only six-monthly infusions of the wonder drug Sorain would keep them in one piece, and yet they couldn’t get on to her ward to receive it.
It was like a cruel, horrible hoax, like some kind of endlessly recurring punishment out of a Greek myth, and Goldblatt, the liver-devouring eagle flying in every morning for the feast, found himself the agent of retribution through which the punishment was delivered.
He couldn’t conjure beds out of thin air. There was simply no point asking him to do it, as if, by some exercise of force majeure, he could make it happen. Not only couldn’t he do anything for those who rang him, he shouldn’t have done anything for them even if he could. Was he meant to make exceptions for the people who complained most, wept longest, shouted loudest? Would that be fair? What about the others, the stoics who didn’t ring? Or the lonely people who didn’t have friend or families to campaign for them? The people on the phone grudgingly conceded the point when he put it to them, hoping to make them see his predicament. No, they said, it wouldn’t be fair for him to make exceptions – meaning yes, he should, but only for them. Well, he wasn’t running a discrimination programme against stoics and lonely people. Stoics and lonely people deserved to get in just as much as whingers and the socially successful. Whingers and the socially successful deserved to get in just as much as stoics and lonely people. And there was nothing Goldblatt could do to change the fact that so few of them did.
The unpalatable truth was that the numbers didn’t add up. Professor Small didn’t have the beds to give her patients the care she promised them. But she refused to face it.
She could have asked the hospital management for more beds. Given the income that the Prof’s unit generated, they might have been agreeable. But the hospital management, she knew, had other demands to balance. The Prof’s Seriousness Drive over the past year to secure an extra consultant and an SHO had been nothing less than heroic, fought tooth and nail against stiff opposition from consultants who felt that her unit was already too big for its Fuertlered boots. The very idea of starting all over again for extra beds frankly left her exhausted.
Alternatively, she could have extended the utterly arbitrary six-month interval that she had chosen for her patients’ work-ups and Sorain infusions, reducing the frequency of admissions and solving the bed crisis at a stroke. But that was even less attractive, if possible, than going into battle for extra beds. Already the other consultants at the hospital didn’t take Fuertler’s Syndrome seriously enough. How much less seriously would they take it if her patients needed to come in less frequently, making it seem that Fuertler’s was getting easier to treat, not harder?
At the very least, she could have cut down on the Broderipian ‘emergency’ admissions that came out of her Thursday clinic. There are patients in any clinic who, for murky reasons of their own, have an unwholesome desire to be admitted to hospital, and the doctor’s role, as Goldblatt understood it to be traditionally defined, is to keep them out. But that wasn’t how Professor Small operated. It was enough for one of her Thursday patients to say she had been feeling a bit under the weather and could do with a rest – and she was in. The Prof would be on the phone to Emma, who could be relied upon to manipulate beds, substitute names in the admissions book, and dance scantily clothed on the desk in the Prof’s clinic room if required.
This was because of a deep need at the heart of Andrea Small’s personality. Doctors are no different to anyone else. They have their fears, they have their desires. Constantly prickling with self-doubt, the Prof dreaded to discover that she wasn’t respected. But not being respected was merely her fear. Her craving was to be loved.
Andrea Small’s need to be loved controlled her behaviour with a complete lack of selectivity, and for precisely as long as the object of this need occupied one of her senses of physical perception. She wanted to be loved by whoever was in her field of vision or was speaking to her at the time, by friends and enemies alike, by secretaries, filing clerks, receptionists, doctors, nurses, physiotherapists, social workers, and the tea ladies in green smocks when she passed them on her rounds. Above all, she wanted to be loved by her patients, to whom she made promises of admissions she would never be able to keep, and who, perversely enough, were the only ones who did love her, blaming anyone but the Prof for the disappointment that inevitably followed her smiling reassurances. They didn’t see the chaotic effects of her divisive and impossible quest for universal affection. The Prof walked around in a self-generated and self-validated haze of approval, while colleagues and subordinates shot spiteful glances in her direction that she interpreted as signs of warmth.
At some level, she must have known that what she gave with one hand to someone sitting in front of her, she was taking away with the other from someone who was absent. She must have known that when Emma manipulated the beds to get some grumbling non-coper in from clinic, she was bumping someone else who had been waiting patiently for months. In short, she must have understood the Broderip–Anderssen Principle, even if she didn’t know it by that name.
But it made no difference, because at any given moment the Prof’s concrete need to be loved outweighed any abstract understanding of the consequences to which this might lead. And the only person who could love her was the person physically sitting in front of her in the clinic, or the person physically lying in bed on the ward round whose name Emma had just whispered into her ear. Not the person who was just a name that was going to be bumped further along the Book of Time. The name that was going to be bumped further along the Book of Time would get its own chance, when it finally materialised in front of her as a person on the ward, to fulfil the Prof’s need to be loved, and most were so pathetically grateful at having finally got hooked up to their Sorain drip that that was precisely what they did.
Goldblatt, who had been on the unit for barely more than a week, didn’t know any of this about the Prof. But he knew what a few minutes of simple arithmetic could tell him.
‘Rubbish,’ said Emma, when Goldblatt pointed out the incontrovertibility of the numbers to her, having walked into the doctors’ office and found her slyly leafing through the admissions book with a pen in her hand.
‘Emma, there’s no way we can get them in and out quickly enough.’
‘Of course we can,’ she snapped.
‘We can’t. Look, Emma, do we really have to book them at four a day?’
‘The Prof told me to. That’s the only way we can keep up.’
‘But we’re not keeping up. All we do is end up cancelling them.’
Emma stared at him.
‘Emma, I’m not saying it’s your fault. Okay, you’ve been told to book them like this, but it can’t be done. Look at the cancellations. Look at them. Every day!’
‘That’s only recent.’
‘How recent?’
‘Recent.’
Goldblatt shook his head. He took the Book of Time from under Emma’s hand and turned over the pages of the past, one after the other, page after page of cancellations. He flipped to the future, page after unrelenting page with quartets of names. ‘We’ve got sixteen beds, Emma. Take Dr Morris’s three beds away, that leaves thirteen. But we’re booking four patients a day, and they’re supposed to stay for five days.’
‘So?’
Goldblatt clenched his fists in frustration. Emma wasn’t stupid. She just refused to acknowledge the reality. He got up and wrote the figures on the whiteboard in the doctors’ office. ‘It’s lumpy,’ he said, turning around with the numbers on the board behind him. ‘Monday or Tuesday? No problem. Beds empty out over the weekend. In steady state – theoretically – you could admit up to nine on one of those days and four on the other. Other days, with thirteen beds – none. If you want to bring in four consistently, even on those days – add four, and another four – you need twenty-one beds. And that’s with a hundred per cent efficiency. Patients getting their last infusion on the morning they leave, going home, the new patients coming in and getting their first infusion that afternoon. Not a single overstay. Not a single emergency admission. In reality, you’re probably going to need twenty-five beds. Maybe thirty.’
Emma was unimpressed.
‘Emma!’
‘What about weekends?’ she demanded suddenly. ‘Why don’t we book them for weekends?’
‘They’re electives, Emma. We can’t admit them on weekends. Besides, I looked at that. You’d still need sixteen beds – that’s at maximum efficiency, no emergencies. Make it twenty.’
‘The Prof says we can always sneak a couple in,’ murmured Emma.
‘Does she? And is the Prof going to come in and clerk them?’
‘The house officers will clerk them.’
‘Which house officers?’ enquired Goldblatt.
‘The ones on call,’ said Emma.
‘Oh,’ said Goldblatt. ‘Those house officers. You mean the ones who have to manage fifty emergency admissions already. Well, I suppose the Prof’s right. What’s another couple of patients if you’re going to be up all night anyway?’
Emma stared at Goldblatt intransigently.
‘Emma, please, I’m not trying to be difficult. I’m just pointing out the reality. Look at the numbers. Booking them like this, you’re going to be cancelling two fifths of your patients routinely. Routinely. That’s before you take into account the work-ups that take longer than normal, or someone who gets ill, or one of the emergencies our leader brings in from clinic.’ Or clinical coups of your own, Goldblatt added silently, like Simmons.
Emma looked.
‘That’s why we’re actually cancelling half. In fact more than half. And it’s going to get worse.’ As more cancellations piled up, they would occupy more of the slots for new admissions, creating even more cancellations, which in turn would occupy more of the slots... Suddenly Goldblatt realized what he was really saying. They were sitting on a gigantic juggernaut of cancellations that was picking up speed under the momentum of its own ever-expanding mass until, burning white hot, it would eventually overtake itself and explode in one final luminescent cataclysm through the logical impossibility of its continuing existence before collapsing into a black hole that would suck them all irrecoverably into its fathomless depths.
‘Rubbish,’ said Emma
Goldblatt hugged his arms around his shoulders and hunched over in pain. He thought he was going to start hyperventilating. ‘What do you mean “rubbish”? I haven’t made this up. Look at the book! The book doesn’t lie.’
‘People cancel,’ said Emma.
‘They what?’
‘They cancel.’
‘On this unit?’
‘You have to book in enough people so you never waste a bed when one of them cancels.’
‘What are we running? An airline?’ Goldblatt gave her the book. ‘Find me a patient who cancelled. Find me one.’
Emma began to leaf through the pages. Page after page after page.
‘Here,’ she cried at last, thrusting the book at Goldblatt.
‘Where?’ said Goldblatt.
‘There!’
‘Here? The fifth of January?’
‘Can’t you read? Robbins. “Husband rang to cancel.”’
Goldblatt read. ‘She died, Emma. He cancelled because she died.’
‘So? She still cancelled.’
‘For fuck’s sake, Emma! The woman died!’
‘We can’t keep beds free for dead patients, Malcolm,’ retorted Emma primly. ‘Perhaps you’ve done that in other jobs, but we can’t afford those sorts of luxuries here.’
Goldblatt took a deep breath. ‘We should talk to the Prof. Let’s go to her. Both of us.’
Emma looked at him as if he was out of his mind.
‘I’ll go myself.’
‘No!’
Goldblatt gazed at her quizzically.
‘She knows. She doesn’t need you to tell her.’
Goldblatt took another deep breath, ‘All right. Listen, let’s at least agree to stop booking people on Fridays. Look at the book. No one’s got in on a Friday for the last month. The Prof floods the place from her clinic on Thursdays, and we’re way over our bed count until Monday at the earliest. Let’s leave Friday open, all right? Let’s start with that.’
Emma looked at him suspiciously. ‘The Prof wouldn’t agree.’
‘Then let’s do it for her. That’s our job. To do the little things the Prof doesn’t want to do for herself.’
Emma shook her head.
‘Why are you always defending her?’
‘Who? Who am I defending?’
Goldblatt didn’t answer.
Emma got up. ‘I’m not defending anyone,’ she said angrily, and walked off to her office.
Why Emma defended the Prof was her business, but she not only defended her, she aided and abetted her, and that made it Goldblatt’s business as well. If he left a day in the Book of Time with fewer than four names, the page would miraculously fill up with the extra names in Emma’s handwriting. And every Friday morning he would arrive to find a Broderip or two from the Prof’s clinic who had arrived courtesy of Emma’s underground railway, occupying beds that had been earmarked for people who would shortly, as a result, be receiving one of the dreaded phone calls from Professor Small’s registrar.
And in order that the Prof could play the darling nymph to her adoring patients, Goldblatt continued in his unwanted role as the wrathful god. Each morning, as the mountain of cancellations grew steadily higher, he sat down with the Book of Time and made his selection.
He didn’t want to be a god. He had never wanted to be one. Even when he saved someone’s life by pumping on their chest and sending just the right dose of electricity through their fibrillating heart – those times when you step out from behind the screens in front of the terrified relatives, and you are, you just are a god – even then, he never wanted to be one. How did you know what was going to happen next? How could you know what was happening behind you? What if the same heart started fibrillating once more as soon as your back was turned, only this time it wasn’t going to be persuaded so easily to get working again. Before you knew it, you would be back in front of the same expectant crowd, but this time it was with a different speech. ‘I’m sorry but it was quick and painless and would you mind signing a form so we can do an autopsy please?’ That one never got quite the same reception.
But people wouldn’t let you do it. They wouldn’t let you get away without the halo. When you tried to turn it down they thought it was false modesty and added it to their catalogue of medical arrogance, merely proving, as everyone already knew, that all doctors think they’re gods. Like the ancients chipping statues to Augustus, when people want divinity, they find it.
It was just one of the things medicine did to you, just one of the ways it devised to make you both more and less than a normal person. It was like the stony, bleary trudge through the nights on call that brought you to the lowest level of snarling humanity and showed you how low you could sink, while simultaneously setting you apart, so that afterwards you would always think of yourself as special, different, just for the fact that you’d been through it and survived, as if your soul had been forged in a white heat that was reserved for you and your profession alone. Or like the dealing with death, the dreadful familiarity that robbed you of something soft, fragile, and precious, and put in its place an equally precious hardness and strength. The being a god was one of these things. Like the others, it gave with one hand and took away with the other.
And here it was once more, in a new manifestation, a different guise. Old Mother Medicine was doing it to him again, finding a new way to get to him, just when he thought he had seen it all.
Because when push came to shove, he was no better than any other deity. He was fickle, and his whims were inscrutable, most of all to himself. Compassionate one moment, impassive the next, stern then yielding, sympathetic then unrelenting, his moods swung from hour to hour and day to day. The phone calls were endless, the pleas, the tears. With one weeping cancelee he would be gentle, understanding, reassuring, and helpful, listening with infinite patience to the story of the week taken off work, or the arrangements made with the mother to look after the kids in preparation for this admission that, he had rung to say, wasn’t going to happen. And with the next one –having already spoken to one too many that day, or having been interrupted in the middle of a busy clinic that was already running an hour late with a benchful of patients still waiting for his attention – he would be brisk and unwavering, repeating bureaucratically that the hospital was very clear in its communications that it couldn’t guarantee a proposed admission date, as the pleas of the patient on the other end of the phone became increasingly tearful. He would put the phone down and feel sick at what he had just done. Why had he done it? At those moments, he hated himself. He hated being put in that position, and he hated not being able to change it. Most of all, he hated what it did to him.
There was no real mystery about it. He was human. Not a god at all.