MR LISTER, THE MAN with a PUO whom Dr Morris had admitted with his tragically brilliant sleight of hand, had been on the ward for two weeks and still there was no end in sight to his stay. He was turning out to be one of those patients who transform themselves subtly but steadily into a fixture.
In principle, Goldblatt had nothing against fixtures, especially of the non-patient variety. All wards have them, mostly bolted to the wall. They don’t say much. Or anything. But not Mr Lister. He spoke. A lot. He was sarcastic, dissatisfied, and unpleasant, and he brought to all of these qualities a complete absence of wit, which made him tedious as well. Every day he demanded to know when he was going home. An hour after every test he demanded to know the result. If he hadn’t seen Dr Morris for twenty-four hours, he demanded to know when he was coming. In short, when he wasn’t struck dumb with trepidation at the pain of a needle penetrating his epidermis for one of the thousands of tests that Dr Morris was running, he was a pain in the arse.
You didn’t have to be Sigmund Freud to understand what was going on. Mr Lister was frightened. Underlying the anger and the demands, Goldblatt knew, behind the complaints every time a test was delayed, and the dissatisfaction each time a result was awaited, was fear of what all those tests might show. That was why he stayed, despite his almost daily threat to go home, as they put him through every test – biochemical, histopathological, haematological, microbiological, serological, radiological, and nuclearmedical – that Dr Morris could think of, and as Dr Morris began to procrastinate, asking for previous tests to be repeated and discovering new tests in journals which no one in the hospital laboratories even knew how to perform.
Goldblatt tried to make allowances for him. He told himself that the sheer horribleness of Mr Lister was merely the way his fear expressed itself, as in another patient it might express itself through obsessiveness, bravado, or denial. But as you approached his bed and got ready for the next barrage to hit you, you couldn’t help wondering, if there were so many other ways for fear to manifest itself, why Mr Lister’s fear had to adopt this one. Even though you knew it was his anxiety talking, and you knew that you couldn’t let yourself be influenced by whether you liked someone or not, and you could attempt to make yourself feel sympathy for him, and sit by his bed and try to reassure him, and hold your tongue when you found yourself on the verge of saying what you really thought of him, he was still Mr Lister, he always had a complaint, and nobody found it easy to treat him.
Yet the HO could handle that. Mr Lister’s irritability, sarcasm, and complaints didn’t get under her skin. It was an altogether gentler, more pleasant patient who did, a Polish gentleman in his late seventies called Mr Sprczrensky. And he did it in a completely different way, out of the blue, on a Thursday morning.
Thursday mornings, when Goldblatt was in clinic, were Ludo’s big chance to have her own round and play the starring supervisory role for which she had fought so hard and lied so shamelessly. In theory, Goldblatt would then come up in the afternoon after his clinic and run quickly through the names with the HO in the doctors’ office to make sure everything was all right. But many perfectly sound theories break down in practice, and Ludo, for reasons of her own that she rarely saw fit to disclose, often missed her round. As she did on that particular Thursday morning.
The HO was therefore going happily around by herself, chatting with the patients, failing to recognize various warning signs and abnormalities, or recognizing normalities and thinking that they were warning signs, which is the way of HOs. Mr Lister’s temperature had started its morning rise, and the HO stopped by just in time to see it top thirty-nine degrees and remind herself to add the day’s attainment to the running charts she had started making of his fevers. On Dr Morris’s suggestion, she was plotting the spikes of fever on a grid against the investigation results that were now regularly flooding back from the hospital’s laboratories, in the straw-clutching hope that this cabbalistic exercise would reveal a hitherto hidden pattern and unpick the lock to Mr Lister’s mystical illness. Then the HO moved on to the next bed, which housed Mr Sprczrensky.
No one on the ward could pronounce Mr Sprczrensky’s name properly and they all called him Mr Sprensky. He didn’t mind. Everyone called him Mr Sprensky, he said. He had white hair, pale blue eyes, a quiet, reserved manner, and he had fought at Monte Cassino. Apart from having a name unpronounceable by Anglo-Saxons – which can be either a handicap or an advantage, depending on your point of view – Mr Sprczrensky had only one problem, a case of moderate Fuertler’s that manifested as skin lesions on his back and occasional pain in his hands and feet. He was an elective admission for the six-monthly work-up that was routine in every way, including the two cancellations that had preceded it and the fact that eleven months had passed since the last sixth-monthly admission. It went without saying that he was getting a Sorain infusion. Mr Sprczrensky had been very polite and considered when asked whether he thought Sorain had helped in the past. He couldn’t say for sure that it had, but he couldn’t say for sure that it hadn’t. Except when he had seen the Prof on her round the previous day, when it had.
When the HO arrived to see him, Mr Sprczrensky was sitting in the chair beside his bed and a nurse had just connected the infusion pump to the cannula in his arm.
The fluid was stinging. The drip was in his right wrist. He held out his right arm, rolled back his sleeve, and rested his wrist on the edge of his bed so the HO could look at it. The skin at the puncture site around the top of the cannula was reddened.
‘Does that hurt?’ asked the HO, pressing the skin gingerly.
Mr Sprczrensky winced. ‘A little.’
‘Turn your hand over, Mr Sprensky,’ requested the HO, peering at Mr Sprczrensky’s wrist and trying to see how far the redness went.
Nothing happened.
The HO looked up. ‘Would you mind turning your hand over, please?’
‘I can’t, doctor,’ said Mr Sprczrensky.
‘What do you mean?’
‘It won’t move, doctor.’
‘But you moved it a second ago. I saw you.’
‘I’m sorry, doctor. It won’t move now.’
The HO stared at him. Mr Sprczrensky wasn’t the type to play games. If this was a game, it was a silly one. ‘Turn your hand over, Mr Sprensky.’
‘I can’t.’
The HO put two fingers into the palm of Mr Sprczrensky’s right hand. ‘Squeeze my fingers.’
Mr Sprczrensky’s fingers didn’t move.
‘Squeeze please.’
‘I’m trying, doctor.’
The HO whipped her fingers away from Mr Sprczrensky’s hand as if it was red hot. ‘Lift your arm up!’ she shouted.
Mr Sprczrensky lifted his left arm up.
‘Not that one. The other one!’
The muscles in Mr Sprczrensky’s neck tugged. Nothing else moved.
The HO spun around to turn off the infusion pump. Panicking, she couldn’t find the switch. She jerked on the cable and yanked the plug out of the wall.
An alarm beeped.
‘Doctor?’ said Mr Sprczrensky.
‘What?’
‘Doctor, what’s happening? I don’t feel so good.’
The HO froze, staring at Mr Sprczrensky, breathing heavily. ‘I don’t know,’ she said, and ran away to find out.
When his bleep went off, Goldblatt was explaining the finer points of using a soft collar to an old lady in clinic. Soft collars are big pieces of wraparound sponge with a notch for the wearer’s chin. These complicated pieces of equipment can be worn in many ways – back to front, for instance, or upside down – and the old lady, who was using it for arthritis of the neck, had managed all of them. ‘So when you go to put the collar on,’ Goldblatt was saying to the old lady when he heard his bleep go off, ‘remember, first of all place it on your neck with the Velcro strips at the back...’
He looked down at his pocket, recognized the number that had flashed up on his bleep as one of the ward phones, and ignored it. He had already been up on the ward in the morning to sort out the admissions and cancellations with Debbie and draw lines through the names in the Book of Time. There was only one way to teach nurses to collect their queries into one big bunch, he thought irritably, instead of ringing him every time one of them wanted to check something.
‘At the back, doctor?’ said the old lady.
‘Yes, and then you do it up after that.’
‘Tightly, doctor?’
‘Not too tight. We want you to breathe.’
‘Ooh, doctor. You are a one!’
Goldblatt smiled modestly. His bleep went off again. He checked the number. This time it was the other ward phone. He sighed.
‘Excuse me,’ he said, and dialled the ward.
Someone picked up the phone before the first ring had finished. ‘Hello!’
‘Yes. This is Mal—’
‘Malcolm! We’ve paralysed Mr Sprensky!’
‘We’ve what?’ said Goldblatt, recognizing the HO’s voice.
‘We’ve paralysed him! The Sorain’s done it!’
Goldblatt frowned. The old lady was examining her collar intently.
‘What are you talking about?’ he asked.
‘Mr Sprensky’s paralysed.’
‘When?’
‘Now! He’s paralysed now. Right in front of me. One minute he could move, and now he can’t.’
‘Wait a minute. Hold on. Where’s Ludo? Has she seen him?’
‘Ludo?’ retorted the HO sarcastically.
‘She’s supposed to be with you.’
‘Ludo?’ demanded the HO. ‘When was the last time Ludo was around when someone actually needed her? When was the last time Ludo—’
‘All right. Tell me about Mr Sprensky. Quick. Is he conscious?’
‘Yes.’
‘Is he speaking?’
‘Yes.’
‘What part of him is paralysed?’
The old lady looked up sharply.
‘His arm, Malcolm.’
‘You mean his— Wait a minute. I’ll call you back.’
‘When?’
‘Now.’
‘Malcolm!’
‘Put the phone down. I’ll call you back.’
Goldblatt hung up. He told the old lady to practise with the soft collar and said he’d be back in a minute. Then he went into an empty clinic room down the corridor and rang the HO again.
‘Malcolm!’
‘What’s going on?’
‘Mr Sprensky’s arm’s paralysed, Malcolm. The nurses turned the Sorain on and five minutes later it was paralysed.’
‘And you think the Sorain paralysed it?’
There was a silence on the phone. ‘Didn’t it?’
‘What’s his blood pressure?’
‘Ah... I haven’t checked it. Hold on! I’ll go—’
‘No. Just wait. Can he move the arm at all?’
‘No! No! That’s what I’ve been telling you!’
‘What about his other arm?’
‘Yes.’
‘And his legs?’
‘It’s not his legs. It’s his arm!’
‘And his speech. Is it slurred?’
‘No.’
‘And his vision?’
‘Ah... I haven’t checked his vision. Hold on! I’ll go and—’
‘Wait. Just wait. Just calm down. Calm down, all right? If he’s conscious, if he’s breathing, you’ve got time. Stop. Let’s think about this.’
‘I turned the Sorain off.’
‘OK,’ said Goldblatt. ‘That’s all right. Look, it sounds like he’s had a stroke.’
Silence.
‘A stroke?’ said the HO at last. Her voice was quiet, baffled, subdued. ‘Why has he had a stroke?’
‘I don’t know,’ said Goldblatt.
‘I didn’t know Sorain gave you strokes.’
‘It doesn’t.’
‘Then why has he had a stroke?’
‘I don’t know.’
There was a silence again. ‘Malcolm?’
‘What?’
‘It couldn’t be a stroke.’
‘Why not?’
‘Because he was all right!’ cried the HO, her voice rising again. ‘One minute he was moving his arm and the next minute he wasn’t!’
‘That’s what strokes do. That’s why they’re called strokes. Strokes. Like lightning.’
Silence.
‘Listen,’ said Goldblatt.
‘What?’ said the HO. Her voice sounded hollow once more. Detached. Lost.
‘Go back and look at him. Check his pulse and blood pressure. Do a proper neurological examination. I’m coming up.’
‘When?’
‘Now. Don’t worry. I’ll be straight up.’
Goldblatt put the phone down. For a moment he continued to sit on the edge of the desk in the empty clinic room, thinking. Then he went back to the old lady with the arthritis in her neck.
She had managed to put her soft collar on the right way around all by herself.
Goldblatt sat down and started writing a return appointment slip for her. She watched him expectantly.
‘Doctor?’ she said. ‘Is this right?’
‘Yes. Very good,’ said Goldblatt.
‘Don’t you want to check how tight it is?’ she asked inanely, continuing the joke that had been cut short at a stroke.
No, thought Goldblatt. He got up and poked a finger between the old lady’s chin and the collar. ‘Feels right to me,’ he said, sitting down again.
‘I wouldn’t want to get in trouble with my breathing,’ said the old lady, who obviously came from the milk-it-till-it’s-dry school of humour.
‘You won’t get in trouble with your breathing,’ said Goldblatt, finishing off the appointment slip. He gave it to the old lady and managed a smile as he ushered her out of the room. He followed her out, told Rosa he’d be back in ten minutes, and left the clinic with Rosa calling after him that she hoped he knew he was already half an hour behind and his next four patients were waiting for him.
When Goldblatt got up to the ward it wasn’t only Mr Sprczrensky’s right arm that was paralysed. His right leg had gone as well. And the right side of his face drooped heavily.
He had been put back into bed. The HO was bending over him, listening to his heart.
‘Mr Sprensky,’ said Goldblatt. ‘What’s happened?’
The HO looked around. She put her stethoscope in her pocket and made way for him.
Mr Sprczrensky smiled crookedly with the half of his mouth that would still move. ‘Dr Goldblatt,’ he said, slurring the words.
‘Let me just have a look at you.’
Goldblatt felt the pulse at Mr Sprczrensky’s right wrist. He looked at Mr Sprczrensky’s face and smiled reassuringly at him as he counted the beats.
‘Can you lift your arm?’ he said.
Mr Sprczrensky shook his head.
‘Try,’ said Goldblatt.
Mr Sprczrensky tried.
‘All right,’ said Goldblatt. ‘Let me move it.’
He moved Mr Sprczrensky’s arm, testing for the tone of the muscles. He tapped his reflexes, and tested Mr Sprczrensky’s ability to feel touch on his skin. Then he went on to Mr Sprczrensky’s other arm, and then his legs, and then he went up to his face, and tested his pupils, vision, feeling, and the movements of his facial muscles. Then he briefly examined the rest of him, his heart, the arteries in his neck, his chest and abdomen. The HO stood silently at the foot of the bed as Goldblatt did all this.
After he had finished, Goldblatt sat on the edge of the bed beside Mr Sprczrensky. ‘Do you know what’s happened?’ he asked.
Mr Sprczrensky blinked. At least, his left eye blinked. His right eye rotated, but the lids didn’t close properly. Fluid had dribbled out of the corner and left a snail track down his cheek.
‘You’ve had a stroke, Mr Sprensky,’ said Goldblatt.
Mr Sprczrensky nodded.
‘Do you know what that means?’
‘Yes,’ said Mr Sprczrensky.
Goldblatt explained anyway. ‘Have we rung your wife?’
‘Not yet,’ said the HO. ‘I was waiting for you.’
Goldblatt nodded. ‘We’ll ring to let her know.’
‘Thank you,’ said Mr Sprczrensky.
‘Mr Sprensky, we’re going to do a couple of things. We’re going to do a CT scan of your brain to make sure we know exactly what’s happened. We’re going to do some blood tests. And we may need to do a scan of your neck. Is that all right?’
Mr Sprczrensky nodded.
‘Have you ever had a CT scan?’
Mr Sprczrensky shook his head.
‘It’s no problem,’ said Goldblatt. ‘You just lie there while it happens.’
Mr Sprczrensky gazed at him.
Goldblatt knew the look. He knew what was going to happen next. He knew Mr Sprczrensky didn’t want it to happen, but he knew he wasn’t going to last much longer.
The tears started rolling down Mr Sprczrensky’s face.
Goldblatt was still sitting beside him on the edge of the bed.
‘Dr Goldblatt?’ said Mr Sprczrensky.
‘Yes.’
‘Dr Goldblatt. I’m frightened.’
Goldblatt nodded. He reached out for Mr Sprczrensky’s hand.
‘Frightened... Frightened.’
Goldblatt nodded again. He got a tissue and put it into Mr Sprczrensky’s left hand.
Mr Sprczrensky cried.
‘It’s all right,’ said Goldblatt. He continued to hold Mr Sprczrensky’s other hand.
Mr Sprczrensky cried. Goldblatt sat with him and waited.
The HO stood watching at the end of the bed.
‘Mr Sprensky,’ said Goldblatt gently, ‘you’re at your worst now. You’ll improve. It’s early. It’ll take some time. But you will improve. We’re going to help you do that.’
Mr Sprczrensky nodded. He tried to smile and snuffled with the effort. The corners of his mouth went in opposite directions.
Goldblatt smiled back. He let go of his hand. Mr Sprczrensky wiped his eyes. He had stopped crying. Goldblatt looked around. At the end of the bed, the HO was just starting.
She turned and ran off.
She wasn’t in the doctors’ office when Goldblatt went in there to write his notes. He bleeped her number and didn’t get an answer. He bleeped Ludo and dragged her out of the Dermatology clinic in the cafeteria and told her to get up to the ward and get an urgent CT scan organized for Mr Sprczrensky. Then he went back to the clinic and set to work on the backlog that had accumulated in his absence.
He headed up to the ward after he had finished in the clinic. The HO was there now. So was Emma, who had heard about Mr Sprczrensky’s stroke. He found them near the nurses’ station. Emma had the HO pinned with her back against the wall, giving her a dressing down in front of the passing cleaners for not having written her findings on Mr Sprczrensky in the notes.
‘Emma, it’s all right,’ Goldblatt said. ‘I’ve written in the notes.’
Emma ignored him. She wasn’t talking to him, so why should she listen to him?
‘It’s not good enough!’ she shouted at the HO. ‘What would have happened if something else had happened to him? There was nothing in the notes. Don’t you know about keeping notes?’
The HO stared at the floor.
Emma watched her in mock exasperation, her eyes narrowed, like a big, blonde cat toying with a mouse. Emma still hadn’t forgotten the way the HO had run off to Goldblatt on her very first day when she had asked her to do an extra round. Well, if an HO chose to behave like that with her SR, she had to take what was coming when she did something wrong. And something was wrong. Very wrong. One of the Prof’s patients had just had a major stroke, and the wrongest thing about it was that Emma couldn’t be sure how the Prof was going to take it. The stroke would probably tie up a bed for weeks. Someone, somewhere, must be at fault.
‘Well?’ said Emma, still glaring at the HO.
‘Fuck off, Emma,’ said Goldblatt, and he dragged the HO away to see Mr Sprczrensky again, do a brisk round, and try to put some order back into the shambles of the day.
Each time they went back to see Mr Sprczrensky over the next few days, the HO stood by silently as Goldblatt examined him, watching with wide, grave eyes. Goldblatt was puzzled. Why was she so affected by this particular patient? Why did she stand there every day as if condemned to visit and revisit the scene of a crime, like some kind of Promethean punishment for a sin that she had never committed? She hadn’t been this upset when the man with the VIPoma had died, and she had killed him almost single-handedly. And she had already publicly celebrated the death of one patient on his way in to hospital, or at least had celebrated it with Goldblatt, and who knew how many more deaths she had rejoiced in privately? All in all, she had been showing every sign of hardening up nicely, and could soon have been expected to have as tough, resilient, and scaly a clinical skin as anyone. Besides, she must have clerked in at least one stroke whenever she was on call. What was one more? Not enough to shed your skin over, surely.
‘Do you want to talk about Mr Sprensky?’ Goldblatt asked her in the doctors’ office.
The HO shook her head.
‘You know, these things happen,’ he said, stating the obvious.
‘I know,’ said the HO.
‘It wasn’t your fault.’
‘I know,’ said the HO.
Goldblatt looked at her. But then the HO turned away and started doing something at the computer, hitting the keys very hard and very fast.
And he wondered, was she having nightmares of Mr Sprczrensky?
Or perhaps it wasn’t really Mr Sprczrensky she saw. Perhaps, when the HO looked at Mr Sprczrensky, it was the ghost of the VIPoma she glimpsed there, hiding behind Mr Sprczrensky’s gentle and half-paralysed Polish face. The VIPoma, whose barrel chest had crunched under the compressions of Steve’s hands, and whose skin had burned under the paddles of the defibrillator that Goldblatt had applied, as the HO stood by and watched on that awful Sunday night five weeks before. Only five weeks before, yet a lifetime in the past.
Or perhaps it was the ghost of herself, of what she once had been, that she saw hiding behind the both of them.