THE BRODERIP–ANDERSSEN PRINCIPLE, LIKE so many fundamental truths of existence, was soon forgotten. Or so Goldblatt assumed, until the day Dr Morris knocked on the door at the end of his clinic.
Dr Morris sat in the chair on the other side of Goldblatt’s desk, which had been occupied until two minutes earlier by a large, sweaty electrician with unusual shooting pains in his fingers, and waited for Goldblatt to finish dictating his letter to the patient’s GP. Having absolutely no idea what was causing the pains, Goldblatt had ordered blood tests, X-rays, and a complicated neurophysiological investigation for which there was probably a waiting list of four months. By then, with any luck, the pain would have gone away by itself.
‘All right,’ said Dr Morris when Goldblatt was finished. He pulled a piece of paper out of his pocket, unfolded it, and tossed it on the desk. ‘Explain it.’
‘Explain what?’ said Goldblatt, hoping that Dr Morris wasn’t going to ask him to justify all the tests he’d just ordered. That kind of thing was always tedious, if not downright embarrassing.
‘I can’t work it out. It doesn’t seem to make sense.’
‘What?’ asked Goldblatt suspiciously.
Dr Morris nudged the paper towards him. ‘This.’
Goldblatt looked at the paper. A strange formula was written on it. He stared at the mysterious symbols. ‘What is it?’ he asked.
‘What are you talking about?’ Dr Morris grabbed the piece of paper, looked at it, and threw it down in front of Goldblatt again. ‘It’s your formula. Broderip–Anderssen. I searched for their paper. 1957, isn’t that when you said it was published? We have an excellent librarian here, but she couldn’t find it either.’
‘Really?’
Dr Morris nodded.
‘Did she spend a lot of time trying?’
‘Quite a lot.’
Goldblatt was silent for a moment. ‘Do you really want to see the paper?’
Dr Morris nodded again. ‘It sounded fascinating.’
‘Well, it’s just that it’s a very old piece of work...’ Goldblatt stopped. Normally he would get out of a spot like this with more of the type of confabulation that had got him into it. Something like Broderip having retained copyright of the paper, for instance, and in a fit of pique at Anderssen, having withdrawn it from circulation. But he had a feeling that with Dr Morris, the more he went on, the worse it was going to be. ‘It’s just that it’s so old that...’ he said instead, ‘you know... it hardly even exists.’
Dr Morris peered at him. ‘I don’t understand.’
‘No,’ said Goldblatt. He picked up the piece of paper Dr Morris had thrown down on the desk. ‘This isn’t really the Broderip–Anderssen formula.’
‘But that’s what you wrote. I copied it exactly.’
‘Dr Morris, there is no formula.’ Goldblatt broke the news as gently as he could. ‘There is no paper. The truth is, there was no Olaf Anderssen and Andrew Broderip.’
‘Henrik Anderssen and Walter Broderip.’
‘Them neither.’
Dr Morris picked up the piece of paper and gazed at it almost wistfully. ‘But you wrote it. This formula.’
‘True,’ said Goldblatt.
‘Then what is it if it isn’t the Broderip–Anderssen formula?’
‘No idea,’ said Goldblatt.
Dr Morris stared at him.
‘I made it up.’
‘You made it up?’
Goldblatt shrugged.
Dr Morris stared at him for a second longer. Then he grinned. His mouth puckered as if he had a slice of lemon inside it. It was a strange but convivial grin, and Goldblatt couldn’t help responding in kind.
‘You made it up?’ asked Dr Morris again, chortling with childish pleasure.
‘So it seems.’
‘Why?’
‘I don’t know. I do things like that. I mean, not all the time, ... ‘ Goldblatt added quickly, realizing that if he wasn’t careful he wouldn’t be playing Bluff the Journal again any time soon, at least not with Dr Morris, who provided him with easily the most challenging and enjoyable games he had ever played. ‘Don’t you ever just feel the need to...’
‘What?’
Goldblatt shook his head.
‘I heard you don’t manipulate beds, either,’ said Dr Morris.
‘Very rarely.’
‘So what about this principle?’ enquired Dr Morris.
‘The Broderip–Anderssen Principle?’ Goldblatt sighed. Suddenly he felt weary. There was no reason for all this laughter and bonhomie. If there was such a principle, it embodied a hopeless, churning endlessness. ‘The Broderip–Anderssen Principle, broadly speaking, states that for every patient sitting in a bed there’s at least one equally if not more deserving patient lacking a bed.’
Dr Morris nodded. Then he frowned slightly. ‘By the way, did I see you with a squash racket the other day?’
‘Possibly.’ The hospital had a pair of courts, and a couple of evenings previously Goldblatt had played with an SHO he knew from an earlier job.
‘We should have a game one day.’
Goldblatt smiled. When would Dr Morris conceivably have the time for a game of squash?
‘Thursday afternoons,’ said Dr Morris, as if he could tell what Goldblatt was thinking. ‘I can make an hour on Thursday afternoons. Not this Thursday, though.’ He got up. ‘Let me check, and I’ll let you know which Thursday I can do it.’
‘I’ll be ready.’
‘I’m serious. I’ll let you know.’ Dr Morris went to the door. ‘And your Broderip–Anderssen Principle, by the way, it’s not true.’
‘It is true.’
‘It isn’t.’
‘It is,’ said Goldblatt, who couldn’t bear these optimistic medical types who obstinately refused to succumb to the overwhelming inadequacy of the system in which they worked.
‘It isn’t. For every patient sitting in a bed there isn’t at least one equally deserving patient lacking a bed.’ Dr Morris opened the door. ‘There’s two.’
Dr Morris was a new consultant. Only five months earlier he had been a specialist registrar, and most of the time he still acted like one. He wrote orders on drug charts, and came up to the ward to see patients without organizing an entourage, and made appointments to see relatives, and actually kept the appointments he made. He also took blood in clinic from patients who were too frail or elderly to go to the second floor and wait three hours to have their blood taken in the Pathology department. The last of these activities was a step too far for Rosa, the gargantuan West Indian nurse who ran the clinic, and whose great speciality, until Dr Morris came along, had been taking blood from the frail and elderly patients. Rosa still got to take blood from ninety per cent of them, since none of the other doctors had any interest in doing it, but it didn’t seem so special after Dr Morris turned up and started sticking his needles in where they weren’t wanted.
Dr Morris was a very new consultant, Rosa told everyone knowingly. Soon enough he’d be too high and mighty to be taking blood from little old ladies, and then they’d all come back to Rosa. Oh, yes, they’d all come running back to Rosa, and Rosa would take them back, like the big-hearted fool she was, even though they’d lost their heads and gone running off the minute a consultant beckoned.
Goldblatt wasn’t so sure that Dr Morris would ever be too high and mighty to take blood from little old ladies. True, Dr Morris was only five months old as a consultant, and there was still bound to be some moisture behind his ears, but there was something different about him, something slightly odd. Dr Morris loved medicine.
Medicine. Not the prestige, the power, the academic kick, the money to be made from private practice, the fawning gratitude to be had from patients, the sexual favours to be sampled from nurses, the harrowing stories to be told at parties, or any of the other things that usually masquerade as a love of medicine – but medicine itself. Wherever he went he was always shooting off curious and investigatory glances, as if searching for new medical challenges inside sluice rooms, under desks, behind computers, in notes trolleys, and anywhere else they could conceivably be hiding. Dr Morris just loved medicine. He loved everything about it.
He loved the patients who were the substrate on which medicine thrived. He loved talking to them, listening to them, reassuring them, and smiling at them. He loved having his finger on the pulse. Literally. He loved to apply his stethoscope to a neck and hear the turbulent whoosh of blood being forced through a narrowed carotid artery, to tap a tendon and watch a limb jerk with pathological briskness, to press probingly under the lip of a ribcage and feel the shy tip of an enlarged spleen nuzzle into his fingers. He loved making diagnoses and ordering tests that confirmed them and prescribing drugs that alleviated them and reviewing patients who had them. He even loved the side effects of these drugs, which engendered new clinical signs for him to elicit, new diagnoses for him to make and new drugs for him to prescribe.
To Dr Morris, there was nothing more enjoyable than the diagnostic conundrums posed by sick, complicated patients in whom a hundred different investigations had already been done without turning up a single abnormality. The motor of his formidable mind roared into life, and he dragged the seafloor of medical rarity like a curtain-net, reeling off long lists of unimaginable diagnoses, and thinking up another hundred tests to try. His face beamed with intellectual pleasure, and his eyes sparkled with boyish delight. Nothing, in his opinion, was beyond diagnosis, and no condition, in principle, could not be elucidated.
In reality, plenty of conditions can’t be elucidated, and there was nothing more depressing, in Goldblatt’s view, than a blind refusal to recognize this reality. He didn’t think that the patients who obsessed Dr Morris with their Byzantine conditions were necessarily the most interesting. Frustrating, maybe. Tormenting, possibly. Tedious, certainly. But interesting? Goldblatt wasn’t so sure. More interesting to him were conditions that you diagnosed at a glance, treated at a stroke, and reviewed once a year. But not to Dr Morris, for whom even the whiff of a gangrenous toe was interesting, the cue for a thousand fascinating conjectures.
Fascinating was a word Dr Morris used a lot. He used it so much that Goldblatt suspected it had lost virtually all meaning for him and had become nothing more than an undifferentiated positive signifier in his vocabulary. Whenever you got hold of Dr Morris he was with a fascinating patient, or he had just come from a fascinating patient, or he was just on his way to see a fascinating patient. Fascinating patients sprouted like toadstools wherever he went or wherever there was even a rumour that he was going to appear. Yet by the time Goldblatt arrived, the fascinating patient had invariably disappeared, replaced in the bed by just another sick, elderly person whose body systems were falling apart at unsynchronized rates.
Needless to say, all this clinical hyperactivity didn’t leave Dr Morris with a lot of time, and in case it did, there were plenty of other things to do. He loved research, and was collaborating on projects with professors in three other hospitals. He loved teaching medical students, and made irrational arrangements to come in early or stay back late to give them extra tutorials. He loved the warp and weft of the very organizational fabric of hospitals, and in the five months since becoming a consultant he had already volunteered for the Dean’s Committee for Undergraduate Education, the Interdisciplinary Committee for Ancillary Services, the Medical Department Audit Committee, and the Consultants’ Dining Room Committee.
Curiously, Dr Morris was reputed to have a wife and two small children, and mathematically, subtracting the number of hours he worked from the number of hours in the week, it was possible that he actually glimpsed them from time to time. Whether they suffered as a result of this was a matter of conjecture. But that someone else suffered from the effects of Dr Morris’s unmanageable energy and his insatiable appetite for work, perhaps even more than his wife or his occasionally glimpsed children, was beyond dispute. And the bitter irony of it was that Professor Small was utterly responsible for bringing it all upon herself.
As part of the Prof’s Seriousness Drive, the appointment of Dr Morris had been nothing short of a coup. Not only did the Prof now have a junior consultant on her unit, but what a consultant she had! Her colleagues couldn’t fail to take her seriously when they saw what a brilliant young man she had recruited. Or to put it more accurately – or at least as the Prof preferred to put it – what a brilliant young man had sought her out as a mentor.
At first, the Prof found it wonderfully comforting to have Dr Morris around. More comforting, if she was to be completely honest with herself – which was something the Prof never did lightly – than a mentor should find it. Patients are allowed to have more than one disease, even patients with Fuertler’s Syndrome, and the Prof couldn’t very well refer every swing of blood pressure or incident of indigestion to one of her specialist colleagues. In theory, at least, she was supposed to be able to treat those things herself. Now all these difficult decisions on ward rounds, which she had been forced to validate in the past by surreptitious glances at her SR or Sister Choy, could be put openly for erudite discussion with Dr Morris as a fellow consultant without fear of humiliation. And problems that came up in clinic could be explored in passing when the Prof called Dr Morris into her room on the pretext of conferring on some organizational matter. With his encyclopaedic grasp of medicine, Dr Morris was brimming with knowledge, and all the years that had gone by before he arrived now seemed unbearably lonely in retrospect.
In short, when Dr Morris first joined the Professor’s unit, it had been a delight to have him around.
Yet all this knowledge and energy came at a price. The Prof soon discovered Dr Morris’s nasty habit of sniffing around the hospital and returning with news of horrendously complicated patients sequestered in wards and recovery rooms all over the place. The three beds that she had given him, the Prof began to suspect, and the endless parade of Fuertler’s patients in the other beds, wouldn’t satisfy him for long. A couple of months after Dr Morris arrived, on one horrible day that would long live in infamy, the suspicion turned to grim conviction. Dr Morris suggested the unit should do Takes.
Professor Small stared at him.
T- T- Takes? Was that what the boy had said? Takes?
It had taken the Prof five years of fiendish plotting to free her unit from medical Takes, and now this overeducated prodigy with his fetishistic medical infatuation was suggesting that they should start doing them again.
Professor Small’s head shook tremulously. ‘Takes?’ She managed a weak and vulnerable smile, desperately trying to think of a way to get Dr Morris out of her office so she could be alone with the Scale to recover her poise.
Tom de Witte had laughed when she told him of Dr Morris’s appointment. It had flattered her to think that she would have someone like that working under her, he said, and he laughed his big, booming laugh again. The Prof denied the accusation, and treated it with complete disdain. But Tom was right. Normally he showed absolutely no insight into anything but the bronchoscope with which he habitually peered down the airways of diseased lungs, and this lack of awareness was one of the most satisfying things about having a liaison with him. His decision to be right in this one specific case felt like a terrible betrayal.
In so many ways, thought the Prof bitterly, Tom de Witte was just like all the others.
Yet the truth had to be faced. Had she not overreached herself by appointing Dr Morris? Andrea, she was forced to ask in a moment of searing but cathartic honesty in front of the Scale, was your unit really ever going to be able to satisfy a medical dynamo like him? The irony was almost unbearable. She could have chosen one of any number of compliant mediocrities who had applied for the post without fear of being dragged back down into the dreadful morass of general medicine that she had struggled so hard to escape. Any one of them would have counted themselves lucky to have their three beds and their three clinic sessions, and would happily have spent the rest of the time surreptitiously building their private practice, like any sensible person. But no, she had thrown it all away by impulsively choosing the brightest, the most energetic, the most intelligent, and the most promising candidate she had ever seen in any interview anywhere, just like a flighty girl sacrificing everything for one mad moment of romance.
Yet hindsight, Andrea knew, solves no problems. She had appointed Dr Morris, and she couldn’t just unappoint him. Even if she could, imagine how her fellow consultants would laugh at her then. No, something special was needed, a solution, a plan, one of the brilliant evasions that were the foundations of all her truly great strategies.
In the end, the Prof fabricated a counter-manoeuvre of genuinely Napoleonic proportions. Dr Sutherland, one of the other physicians in the hospital, had just gone on sabbatical, and no one had been found to cover his duties. The hospital management was desperately looking for a solution, preferably one that would cost them nothing. Here it was! Dr Morris could cover Dr Sutherland’s Takes. He could also do Dr Sutherland’s rounds, and look after Dr Sutherland’s patients, and do Dr Sutherland’s clinics. And he could do all of that while still doing the work on the Prof’s own unit, which was meant to be a full-time job in itself. There! If that didn’t knock the stuffing out of him, the Prof thought, and make him yearn for a nice quiet life on her unit, she didn’t know what would.
Dr Sutherland wasn’t there to object. In any event, it was unlikely that he would have. He was a suave, ingratiating man who had spent the last twenty years building a booming private practice, and retained his public appointment primarily and almost solely because it was good for business. He spent far more time at his rooms in Harley Street than at the hospital. In fact, by a freak of physics, even when Dr Sutherland was in the hospital he was often in Harley Street. One of his clinic slots was mysteriously cancelled every week right up to the expected date of his retirement in eight years’ time, and no one expected him to appear even for the other clinics that hadn’t been cancelled.
None of this was a secret. The Director of the Department of Medicine and the hospital Chief Executive both knew that Dr Sutherland treated the place as a front for his private activities. But they also knew that at any one time twenty per cent of the patients on the hospital’s private floor belonged to him, and that he was responsible for perhaps another third of the patients there through his extensive contacts and his indefatigable efforts on behalf of private medicine, which created a certain financial argument in favour of turning a blind eye to his idiosyncratic way of doing business.
Much of what Dr Sutherland did was idiosyncratic, and not only his invisible approach to clinics. When it came to his medical Takes, he saw himself as more of a middleman than an executive, his unit more of a clearing house than a depot. Unlike other consultants, who generally saw their patients first thing in the morning after a Take, Dr Sutherland insisted on scheduling his post-Take rounds for late in the afternoon. Occasionally he turned up for them. By then, he expected his registrar to have distributed or otherwise disposed of the majority of the admissions. The reg was under strict instructions to enquire of each patient whether he or she was privately insured, and, if so, to recommend immediate transfer to more conducive surroundings. The name of a physician practising privately in the appropriate speciality could be obtained from Dr Sutherland’s secretary, who would also make the necessary arrangements.
For the rest, other measures were available within the public facilities of the hospital. Heart failures went to Cardiology, diabetics to Endocrinology, peptic ulcers to Gastroenterology, and strokes to Neurology. The beds on these specialist units were usually reserved for complicated cases, and their registrars would have laughed in the face of anyone else from a general medical unit who tried to flick such straightforward patients at them, but they too were under strict instructions. When Dr Sutherland’s registrar called them to ask for a transfer, their consultants instructed them, they said yes. No arguments, just yes.
The amazing power of Dr Sutherland’s registrar to flick patients to other units originated in nothing more mysterious than the amazing power of his boss’s list of preferred private physicians. No one could afford to be left off this legendary list – which was exactly what would happen to a consultant who refused referrals from Dr Sutherland’s registrar. The list was kept in a locked drawer, and Dr Sutherland’s secretary was under strict instructions not to release it to anyone. The entire hospital bristled with strict instructions attached to Dr Sutherland’s name. The world he had created for himself within it was like a serene, exclusive, and strongly gated community, and it would have taken a consultant who was new, young, bright, with no interest in private practice, and almost unbelievably idealistic to have blundered into this genteel microcosm without even being aware that it existed...
‘Where have they gone?’ Dr Morris demanded in astonishment when he turned up for his first post-Take round in charge of the unit, and the registrar informed him that there were only three left to see of the fourteen who had been admitted.
He soon discovered the truth. Well, Dr Morris didn’t flick patients. He had never knowingly flicked a patient in his life.
A change came over the Sutherland unit, which had a nominal allocation of twenty beds and normally had trouble filling a quarter of them. Two weeks and three Takes later it had thirty patients groaning and moaning all over the hospital. The Sutherland doctors, who had signed up for the cushiest little number in London, found themselves dancing to the tune of their bleeps from the minute they arrived at nine in the morning until they finally stopped running dementedly between wards at ten o’clock at night. The ward rounds, which used to take twenty minutes, became three-hour slogs through the thickest, densest marshes of medicine. The customary haemorrhage of private patients out of the Sutherland unit slowed to a trickle, and the number on the unit kept rising. One horrible Friday afternoon it topped forty, and the reg went off sick. The SR, who had gone to the States on holiday, rang to say she wouldn’t be coming back. The house officer was off for two days during the following week, and then had to take emergency leave because of the death of a grandmother in Iceland. He refused to say whose grandmother it was.
To the pseudo-Sutherland, absenteeism was a challenge. He refused to read the message that lay behind it, and lurched exultantly from one Take to the next with half a team, a clapped-out locum SR who was older than himself, and an irrepressible desire to see more, do more, and treat more.
The Prof observed him with growing terror. If her Sutherland manoeuvre was designed to knock the stuffing out of Dr Morris, it had failed miserably, or worse, it had merely replaced the stuffing with brimming reserves of energy that even Dr Morris hadn’t known were in him. He drank deep and lustily from the supposedly poisoned chalice she had thrust at him and then held it out for more. What kind of a monster had she created? One day, the Prof knew, Dr Sutherland would come back to reclaim his rightful place, and then Dr Morris would be stalking her again, fizzing with even more unexpended energy than he had at the start. How long then until the terrible T-word was uttered once more?
But other consultants came to value him. For a time, while Dr Sutherland was away, one of their principal flows of private patients might be choked off at the source, but in the longer term, Dr Morris would be a useful colleague to have. The reason was simple: Dr Morris had an interest in seeing any case that was complicated or difficult, and sometimes arrived, even without being invited, to examine a patient for his own education. There’s nothing the average consultant values more than someone who’s interested in their difficult and drawn-out cases because, with a bit of luck, he might be persuaded to take these hopeless cases off their hands – which as far as Goldblatt was concerned, meant on to his hands. Because when Dr Morris wasn’t running around the hospital as the pseudo-Sutherland, he was back on the Prof’s unit as Dr Morris, and as the numbers on the Sutherland unit doubled and then threatened to triple their nominal bed allocation, Dr Morris had decided that he was going to use his three beds on the Prof’s unit for the most fiendishly difficult of the difficult referrals that were starting to come in to him from all his new friends.
Goldblatt regularly got calls from other registrars in the hospital asking him to bring Dr Morris along to see the latest fascinating medical conundrum that was going to rewrite the textbooks. According to the etiquette of the profession, a registrar is obliged to see any patient referred to a consultant before daring to mention the patient to that consultant. Since it was perfectly obvious that neither he nor Dr Morris would have anything new to suggest about these patients, who had already had every test under the sun and were being referred only to see whether Dr Morris would transfer them to his unit, the whole exercise amounted to a double waste of time and effort. Besides, it soon became painfully clear to Goldblatt that Dr Morris would readily agree to transfer these patients as soon as one of his beds became available, or even sooner. In short, Dr Morris was being exploited. He had to be protected from himself. As his registrar, the responsibility fell to Goldblatt, and Goldblatt was never one to shirk his duty.
He employed a variety of techniques. Simply failing to answer his bleep was surprisingly effective at warding off the most speculative advances. In other cases, the referring registrar could be persuaded that unless a cleaner went postal and cleared twenty beds on the seventh floor with a shotgun, there was no hope of their patient being transferred. Others didn’t call back to find out when Dr Morris was going to see the patient after Goldblatt conveniently forgot about the referral for a day or two. By one means or another, Goldblatt was able to shield Dr Morris from many fruitless referrals that would otherwise have occupied him. But he couldn’t be in all places at once, and without putting a tap on Dr Morris’s phone it was impossible to prevent unscrupulous characters calling directly and taking advantage of him.
A woman with recurrent neuropsychiatric episodes and a fleeting rash on her neck? A man with hypertrophy of his left tibia and a renal bruit? A woman with cystic lesions in her metatarsals and intermittent abdominal pain? Send them across, send one, send all! Fascinating!