IN THE DOCTORS’ OFFICE the following Wednesday, the Prof listened to the HO present Mr Sprczrensky’s case. The Prof already knew about him, of course, from Emma, who had informed her post-haste after Goldblatt suggested that Emma might care to leave the HO alone – or words to that effect – wanting to make sure that the news was delivered with the correct nuance and emphasis. Or to put it another way, wanting to make clear that she had had absolutely nothing to do with Mr Sprczrensky, either before, during, or after his stroke.
As far as Goldblatt was aware, in the six days that had elapsed since then, the Prof hadn’t been up even once to the ward to see him.
‘Well,’ said the Prof pointedly, after the HO had presented the facts.
There was silence.
‘Anything to suggest this isn’t a straightforward stroke?’ asked Dr Morris.
Goldblatt shook his head. ‘Not unless there’s an association between stroke and Fuertler’s Syndrome.’
The Prof glanced at Dr Morris for a moment. ‘I’m not aware of an association,’ she said cautiously, ‘but of course, Fuertler’s Syndrome is such a rare and complex disease that it’s perfectly possible that such an association does exist and we haven’t identified it yet.’
Goldblatt had heard her say the same thing about Fuertler’s Syndrome in one connection or another, or something like it, just about every week. It was wearing thin. Rarity and complexity: the Prof’s mantra. Her excuse for any manner of ignorance and uncertainty.
The Prof looked at Emma. ‘I wonder if it would be worth looking into the files about that?’
‘Yes, Prof,’ said Emma, and nodded her head very quickly, just as a small dog, thought Goldblatt, might nod at the prospect of being thrown a bone.
Thinking this might be a cue for her to achieve some recognition at last, Ludo grabbed the Fuertler’s files on the ward’s patients and held them out to the Prof.
‘So, Dr Goldblatt,’ said the Prof, ignoring her. ‘What’s happening with Mr Sprensky’s discharge?’
‘We’re working on it.’
‘Do you have a date?’
‘Not yet.’
‘Not yet...’ repeated the Prof pointedly.
‘We’ve referred him for rehab.’
‘Maybe two weeks,’ said Sister Choy, consulting her nurses’ cardex.
‘Two weeks?’ said the Prof.
Goldblatt shrugged. ‘He needs rehab, Professor Small.’
‘I know he needs rehab,’ retorted the Prof. ‘I’m perfectly aware of that, Dr Goldblatt.’
Then what do you want? thought Goldblatt.
The Prof wanted Mr Sprczrensky gone. She wanted his bed for admissions for Fuertler’s work-ups and Sorain infusions, and she didn’t want those admissions to turn into cancellations because a patient was sitting in a bed as the result of a stroke that had absolutely nothing to do with Fuertler’s Syndrome and therefore, it followed, had nothing to do with her. Cancellations, on the other hand, had a lot to do with her
Over the last few months, an ever increasing number of complaints had been coming in about cancellations on the unit. Letters arrived from patients, relatives, GPs, and consultants. What had started as a trickle was turning into a flood. They came in all kinds of styles. Some patients wrote simple notes full of spelling mistakes, while others wrote long, stiff letters full of tortured and apologetic politeness. The GPs sent reminders, and the consultants sent pointed demands for clarification. But all of them wanted to know the same thing: what had happened to the admission that the Prof herself had recommended for her patient three, five, eight, or even ten months earlier? It wasn’t pleasant to get these letters. If anyone thought it was fun to face them as a regular feature of one’s life – especially when one’s secretary, who opened all of one’s mail, carefully placed each letter face up on top of everything else, and then lay in wait to watch one’s reaction as one spotted it – they could jolly well try it for themselves. It took all of one’s strength to deal with them, and a lesser person might have buckled. But Andrea Small wasn’t for buckling. She was made of sterner stuff. The Prof prided herself on always facing up to her responsibilities, and she had decided to face up to this problem in the most effective way she knew: by ignoring it. The Prof had great faith in this strategy, which was one of the skills she had learned in the early days in Liverpool, and had used it countless times in the past. She had committed herself resolutely to ignoring the letters, and she was sticking to that commitment with determination, no matter how difficult it proved to be.
But if she was completely honest with herself – which she was disinclined to be in this instance, for obvious reasons – the Prof was beginning to think that it would be impossible to ignore the rising flood of letters for much longer. A memo from the Director of Patient Services had washed in on the flood, and that had proven even more difficult – although not impossible – to ignore. The Prof was finding it harder and harder to avoid the sickening feeling that something, some time, would happen to make it impossible to ignore it all any further.
The prospect of having someone sitting in one of her beds for two whole weeks – and it could be more, because transfer to a unit like Stroke Rehabilitation was nothing if not a moveable feast – brought that sickening feeling bubbling to the surface. And with it, as she looked at Goldblatt, came another sickening feeling: the boy was enjoying it. She could tell. Look at the way he sat, look at the way he shrugged. Suddenly the Prof was certain he couldn’t be happier that a stroke patient was blocking one of her beds, and that as a result there were going to be even more cancellations piled on top of the mountain of cancellations that at moments like these the Prof could feel weighing her down as if they were balanced precariously on top of her head. In fact, considering all the other things he had already done, she wouldn’t have put it past him to have arranged this stroke deliberately. She didn’t know quite how that would have been possible – but she wouldn’t have put it past him.
‘Who asked for this admission?’ she demanded abruptly.
Goldblatt had no idea. Emma had booked it before he arrived.
Emma stared at the Prof.
‘Give me the notes!’
Emma tore them out of the HO’s hands. The Prof leafed through the pages feverishly, then came to a page and jabbed it with her finger. ‘Just as I thought! It wasn’t me, it was one of the clinical assistants!’
Goldblatt glanced at Dr Morris. He was sitting with his head resting against the X-ray box, his face composed in the Zen-like expression that he reserved for the most excruciating of the Prof’s digressions.
‘Well, he’s here now, isn’t he?’ said the Prof, shooting a look at Goldblatt. She closed the notes and pushed them back at Emma.
There was silence.
‘Go on,’ said the Prof impatiently to the HO. ‘Next patient. What are you waiting for?’
The Prof remained distracted and irritable throughout the HO’s case presentations. When they went out on the ward, however, the outward signs of her anger magically evaporated. She drifted regally from bed to bed. When they came to Mr Sprczrensky she stopped, gazed at him sympathetically, placed a consoling hand on his forearm, and said: ‘How are you, Mr Sprensky?’ You might almost have been forgiven for thinking that she cared. She even left her hand there for a few seconds when Mr Sprczrensky cried and said he was frightened. Not that she made the slightest move to examine him, or ask any details of how the stroke had happened, or assess his recovery since then, or do any of the things that a doctor might have done. She stood back while Dr Morris, purely to satisfy his own insatiable interest, did it in front of her.
She threw an imperious glance at Goldblatt as she walked away from the bed, as if to say that whatever he chose to do, however many strokes he managed to put into her beds, she was still a professor, and he nothing but a jobbing locum registrar. Or at least that was what she hoped it showed, because inside, she almost felt as if the roles were reversed.
Goldblatt watched her walk on to the next bed with a faint feeling of disgust. He could just about have predicted everything the Prof had said and done on the round. So much about Professor Small was image, he thought, and so little was substance.
If Goldblatt had found the round demoralizing, Ludo had found it even more depressing. As far as she was concerned, its only redeeming feature was that it offered her something to whine about. Ever since the Constantidis Affair, the Prof had kept her distance from the Fuertler’s files, and each Wednesday they sat neglected in a pile on one of the desks while the HO presented the patients, as if the Prof feared that merely opening one of them, Pandora-like, might unleash another whirlwind of chaos upon the round. This Wednesday, when Ludo had actually tried to force the files into the Prof’s hands, had been no different, as she didn’t hesitate to point out to Goldblatt when they were in the cafeteria that afternoon.
Once started, this particular whine on the devastating unfairness of the fate of the Fuertler’s files – which was far from her first – promised to be one of Ludo’s most accomplished. Goldblatt gazed absently at a nearby table of doctors as her voice droned on. The Fuertler’s files had been her one chance to bring herself to the notice of the Prof, and that chance had been snatched away through no fault of her own. The Prof didn’t care about them any more. But did that mean she could stop filling them in? No, she had to keep filling them in. It was Emma’s fault. But did Emma care? No, Emma didn’t care. Well, Emma could fill them in herself. But did you see Emma filling them in? No, Emma didn’t fill them in. Emma came into the office at night to check them. But did Emma really want them to be—
Goldblatt looked back at Ludo sharply. ‘How do you know Emma comes and checks them?’
‘Of course she comes and checks them,’ replied Ludo impatiently. She hadn’t reached the end of her litany, and thought Goldblatt ought at least to have let her finish. ‘She told me the Prof asked her to check every one and let her know if there’s a single thing missing.’
‘Well, don’t worry then. The Prof knows you’re still filling them in.’
‘The Prof only knows what Emma tells her,’ said Ludo bitterly. ‘The Prof doesn’t know I exist.’
Ludo may have been right. Obviously, there had been a period of at least a day when the Prof did know that Ludo existed, since she had invited her into her office to give her the chance to cry and lie her way out of being an HO, but who knew how good the Prof’s memory was? Since then, there had been no sign from the Prof that could be unambiguously interpreted to mean that she was aware of the existence of a person called Ludo, much less that this person had some kind of a connection, however tenuous, with her unit.
‘She never even talks to me,’ whined Ludo, and she glanced impatiently at the coffee bar, wondering how much longer Goldblatt was going to keep her waiting before he bought her another coffee. ‘The Prof’s awful. She doesn’t care.’
Goldblatt couldn’t argue with that.
Ludo gave a disheartened sigh. She glanced longingly at the coffee bar again.
Goldblatt glanced at his watch.
‘It’s your fault, Malcolm. It’s all your fault.’
Goldblatt stared at her.
‘You know it is. Ever since that day with Mrs Constantidis. The Prof doesn’t care about anything I do. Why did you do that to me?’
‘I’m sorry, Ludo.’ Goldblatt frowned, trying to understand. Really, he was trying. ‘Just... Do that to you? What the fuck are you talking about?’
‘And Emma as well. Ever since she stopped talking to you she won’t say a word to me either.’
‘Rubbish. You’re always telling me what Emma told you. Emma told you this, Emma told you that...’
Ludo glared at Goldblatt resentfully. She shook out her hair as if it were weighing down her brain.
‘Look, Ludo,’ Goldblatt said wearily. ‘You can always go and talk to the Prof.’
‘And what am I going to say?’
‘Tell her you’re... enjoying working on her unit. Consultants love hearing things like that.’
Ludo looked at him mistrustfully.
‘Tell her... you want to talk about the Fuertler’s files. Tell her you’d like to use them to do a study.’
‘I don’t want to use them to do a study!’ Ludo wrinkled her nose in disgust, as if something in what he had said reeked of putrefaction.
‘Listen, Ludo,’ said Goldblatt in exasperation, ‘what do you need from the Prof?’
‘What?’
‘A reference.’
‘Thank you. I’d never have realized that.’
‘You’ve got to build a bridge.’
‘A bridge, Malcolm?’
‘A bridge, Ludo, is a thing over which a reference moves, so it doesn’t get lost.’
‘Where?’
Goldblatt thought for a moment. ‘In the river.’
Ludo looked at him sceptically. Goldblatt himself was beginning to wonder where all this bridge and river stuff was taking him. Still, having come this far...
‘Imagine a river. All right? You’re on one side of the river and the Prof’s on the other. A reference moves over the river, on the bridge, from her to you. You just have to build it.’
‘The bridge?’
‘That’s right.’
Ludo stared at him as if she were looking at something very, very pitiful.
‘Look,’ said Goldblatt, ‘if you want the Prof to give you a decent reference you have to find a way of putting positive thoughts into her brain.’
‘Like you do, I suppose.’
Goldblatt ignored that. Or tried to.
‘Or perhaps you don’t need a reference.’
‘Ludo...’
‘When’s your pre-interview for that job at the Nailwright again?’
‘Next Tuesday. You’re covering me, remember?’
Ludo nodded with a look of satisfaction, as if she had made an extraordinarily telling point. Goldblatt wondered what she thought it was.
‘Ludo,’ he said, ‘if you didn’t want me to help you, why did you ask?’
‘Oh, Malcolm,’ she teased, ‘are we getting upset?’
Goldblatt restained himself.
‘All right, Malcolm. I have to build a bridge? Is that what you said?’
‘Yes,’ replied Goldblatt cautiously.
‘Over the river?’
He nodded.
‘So the reference can cross?’ said Ludo, and she grinned.
‘Ludo, you’ve got to work at it! You can get her to like you. Tell her you want to do a study with the Fuertler’s files. You heard her today. Strokes. Say you want to use the Fuertler’s files to see if there’s an association with strokes.’
‘In case you didn’t hear, Malcolm, that’s what Emma’s going to do.’
‘Then think of something else. You know what? It wouldn’t hurt you to do it. You might get a publication.’
‘Why don’t you do it?’
‘We’re not talking about me.’
‘What about your bridges, Malcolm? Do you ever build them, or do you only burn them?’
Goldblatt stared. That was quite clever. The way Ludo was looking at him, she obviously thought so as well. He wondered for a moment whether it was possible to burn a bridge that had never even existed. To burn the possibility of a bridge, the prospect, the concept... His mind lingered on the idea.
‘Anyway,’ said Ludo, ‘I’m not sure how strong the Prof’s bridges are even if you do manage to build one.’
‘What does that mean?’
Ludo smiled. ‘Do you know what happened to the SR before you came?’
‘Do you?’
Ludo continued smiling – the smile of a very skilled, very experienced interrogator who always got to the truth, no matter what it took.
‘How did you find out?’
Ludo arched an eyebrow.
‘Was it from Emma?’
The smile on Ludo’s face, if possible, got smugger. Goldblatt shuddered to think what lies she had told – probably about him – to prise the information from Emma’s lips.
‘The SR went for a consultant job,’ said Ludo, ‘and asked the Prof for a reference.’
‘As one does...’ said Goldblatt.
‘Yes, and the Prof said she’d give her a reference, as one does.’ Ludo stopped to let Goldblatt connect the dots.
‘The reference was... unhelpful?’
‘Dr Goldblatt, I believe you’ve got it in one.’
‘And she didn’t get the job?’
‘Right again.’
Goldblatt nodded. No wonder Emma hadn’t been keen to divulge this particular example of her adored leader’s behaviour. Within the profession, to promise a good reference and deliver a bad one was regarded as one of the most dishonourable things one doctor could do to another. The etiquette was to suggest to the putative referee that it might be wise not to request a reference at all.
‘She walked out the same day,’ said Ludo. ‘Which left a gap. Which I believe is where you came in. So you see, I’m not sure about the Prof and her bridges.’
Fair enough, thought Goldblatt. But he didn’t see how that helped her. Yet there Ludo sat, the smile lingering on her lips, as if the fact that she had just talked herself into not trying to get a reference from this job was some kind of victory.
Ludo glanced at the coffee bar. A group of house officers came into the cafeteria. Goldblatt thought about the HO. He was still worried about her. Whenever she went near Mr Sprczrensky she was quiet, solemn, withdrawn, and yet something constantly drew her back to him.
‘Does someone over there interest you?’ said Ludo. ‘Do you like them young, Malcolm?’
‘You’re disgusting.’
Ludo shook out her hair.
‘I’m just worried, that’s all.’
‘About what?’
Goldblatt rolled his eyes. ‘Mr Sprensky’s really knocked her.’
‘You’re so sweet,’ said Ludo in the tone of voice you’d use with a maiden aunt of ninety who has long ago lost touch with reality. ‘Malcolm, I didn’t know you were such a sweetie.’
‘I’m not a sweetie,’ said Goldblatt, almost gagging on the word.
‘She’s fine. What are you worried about?’
‘I told you.’
Ludo shrugged. ‘It’s only because Mr Sprensky had his stroke in front of her.’
‘She didn’t care this much about...’
‘What?’ said Ludo.
‘Nothing.’ Goldblatt had never told Ludo about the VIPoma. There was some ammunition that was just too powerful to put into her hands.
Ludo watched him with an expression that said not only that she knew he was hiding something, but that she’d find out. They could do it the easy way, or they could do it the hard way...
‘You should have been there when Mr Sprensky had his stroke!’ said Goldblatt suddenly. ‘Why weren’t you on the ward?’
‘Oh, Malcolm,’ whined Ludo, ‘don’t start that again.’
‘What were you doing?’
‘Something. What difference would it have made if I’d been there? It wouldn’t have stopped Mr Sprensky’s stroke, would it?’
Goldblatt grudgingly shook his head. Ludo rarely employed logic, but when she did, there was nothing more irritating. ‘It’s not Mr Sprensky I’m thinking about,’ he growled eventually.
Ludo ignored that.
Goldblatt glanced at his watch.
‘It’s just because she’s a house officer,’ said Ludo. ‘It’s natural when you’re a house officer.’
‘Maybe.’
‘Of course it is. Patients upset you. Things happen to them and you don’t know how to deal with it. Can’t you remember a patient who ever upset you like that?’
Goldblatt thought about it. He nodded. ‘We had this patient who came in with lupus. I’ll never forget her. She happened to look just like this girl I’d been going out with. We’d broken up a little while before. And then she went mad.’
‘You were lucky you weren’t still going out with her.’
‘The patient, Ludo! She went completely mad. The lupus had involved her brain and she had the whole neuropsychiatric thing going on. One night I was on call, and they called me up to the ward, and she was climbing the walls. We had to sedate her. I had this syringe full of haloperidol, and I was trying to get it into her bum and she was crawling away, scratching at me and the nurses and the porter and clawing at the sides of the bed and shouting all kinds of things. It felt like what I was doing was violent. I mean, I had to do it, she was a danger to herself and everyone else, but honestly, at that moment, I felt like the Gestapo.’ Goldblatt paused, staring into his coffee cup, remembering that night. He smiled reflectively. ‘It really had an effect on me. Must have been because she looked like this girl I’d been going out with. When I got back to my room, I cried. I actually sat down and cried.’ Goldblatt looked up at Ludo. ‘What about you?’
‘Me?’
‘Ever had a patient who affected you like that?’
‘Don’t be stupid, Malcolm.’
Ludo! He should have known that was coming.
Ludo laughed.
‘You’re sick.’ said Goldblatt.
‘Am I?’
‘Yes.’
‘How sick?’
‘Very.’
‘With what?’
‘Don’t you know?’
She shook her head. ‘Diagnose me, Malcolm.’
Goldblatt laughed. He put a hand on her wrist, like a mock doctor feeling for a pulse.
But they weren’t mock doctors. Neither of them.
Ludo looked down at Goldblatt’s hand.
Her mouth opened a little. She looked up at Goldblatt, her eyelids hanging low over her blue irises.
‘Some people would say that’s sexual harassment, you know,’ she murmured.
Goldblatt eased his hand away from her.
Ludo stood up. She put her white coat on with slow, deliberate movements, almost as if she were dressing in front of him. She shook out her hair over her collar.
‘Thanks for the coffee, Malcolm.’