GOLDBLATT WATCHED HIS FACE mirrored in the window against the blackness outside. The Underground train swept through the tunnel in the rush of its own compressed sound. The seats in the near-empty carriage were yellow and orange, old, worn, and grimy.
The train surfaced into the afternoon light. It ran past the backs of long rows of sandwiched houses. Goldblatt stared at them vacantly. The houses swept past. He caught glimpses of rooms. There were people in some of them. A man at a kitchen table. A woman with a baby. The reflection of his face in the carriage window was very faint now, like an out-of-focus foreground in a film shot. He felt as if he could have sat in the empty carriage for ever, if only the houses with the people in their rooms would keep rushing past.
He felt very detached and already empty. It was a familiar feeling that had arrived, peculiarly, a few hours early. It felt as if the interview was already over. It wasn’t the right feeling to have going in. Not an optimistic feeling. Weary, hopeless, disgusted. He wasn’t sure why he was even going. As an act of defiance? Just because he could? Because there’s always a chance? After the pre-interview, only the most insane optimist would believe that. Mike Coalport didn’t even want him there. Maybe he wouldn’t be able to go through with it. Maybe, when the time came, he’d just turn around and walk away.
The train stopped. His stop.
He got off. Further along the platform another couple of people got off as well. He followed them out of the station.
It was a cold day in late March. The sky was blue. There was a piercing clarity in the air. Goldblatt turned left out of the station and followed the street, walking past parked cars and a couple of corner shops, overtaking an old lady with a blue woollen hat who was going home with a small bag of shopping. He felt as if he had done it all before, over and over again. He felt as if he were watching himself, Malcolm Goldblatt, walking along a street on a bright March afternoon. A man of thirty-three, average height, dressed in a dark overcoat over a blue suit, walking with his hands in his coat pockets for warmth. Dark hair, blue eyes, and a nose probably going red from the cold by now. A man walking along a street, not walking very fast.
Goldblatt glanced up. The main block of the Nailwright Hospital rose over the roofs of the houses ahead of him.
There were three others at the Nailwright that afternoon. There were meant to be four, but one of them had withdrawn, according to a candidate who was already there when Goldblatt arrived. The Mike Coalport treatment had obviously achieved the desired effect on at least one person. They waited in the lobby on the second floor of the medical school building. Chairs had been left out for them. Very dignified. People went up and down the stairs, glancing knowingly and smirking at the suited figures sitting in the lobby.
There’s a dull, insensate, almost inevitable brutality to the way medical interviews are arranged. Another one of those things doctors would do only to each other. The candidates are all asked to arrive at the same time, and then they’re meant to sit there for the next three hours, watching each other go in and come out, and then, as the last twist in the whole excruciating business, after the last candidate has emerged, after you’ve all been sitting around for three hours, everyone is meant to hang around for another thirty nail-biting, quick-chewing minutes while those with the power inside the interview room play with destinies and make up their minds. Then someone emerges and announces a name to the assembled candidates and invites the possessor of that name to come into the room and receive their reward. Just as if it doesn’t really matter, as if it’s only a game and the candidates are all good sports and don’t mind being present to drink to the bitter dregs the experience of someone else stomping on their faces on their way up the ladder, and as if they really mean the forced congratulations they’re ritually required to mutter as the victor leaves them behind to go into the interview room and be formally anointed.
The consultants had already gone into seminar room B, where the interviews were to be held, said the man who knew about the candidate who had withdrawn. He introduced himself as Anthony Thomas. He seemed to know a lot about the other candidates. He predicted the arrival of a woman who was finishing her PhD in Professor Murray’s lab in Oxford, and three minutes later, behold, that woman did arrive. He also knew that the fourth candidate in the group had just disappeared to go to the toilet minutes before Goldblatt arrived. Presumably Anthony Thomas had predicted Goldblatt’s arrival to the other man before he had left to relieve himself.
‘And where are you working at present?’ Goldblatt asked him.
‘Oh, I’m just finishing my MD.’
‘Really? And where would that be?’
‘In Mike Coalport’s lab,’ said Anthony Thomas.
Of course you are, thought Goldblatt, and he heard the last piece of the puzzle clunk into place.
This job had probably been waiting for Anthony Thomas for two years. All they needed to do now was get enough Wise Men together to make sure it wasn’t indisputably obvious.
The panel was assembled. The charade began. Soon enough the first candidate had been dealt with, and Goldblatt’s turn came around.
Seminar room B contained a long table, a jug of water, and as fine a collection of Nailwright consultants as one could ask for. Goldblatt sat down, and they were soon under way.
The first interviewer on the panel took it upon himself to demonstrate comprehensively and without risk of ambiguity or omission, using Goldblatt’s CV as prima facie evidence, that Goldblatt didn’t have a research degree. This was an important public service, and Goldblatt understood why he spent so much time on it. Mike Coalport interrupted once or twice when there seemed to be a danger that he might not linger sufficiently on the point. Interrupting out of turn was usually considered to be a disruptive and unhelpful form of behaviour that threatened the precarious perfection of the medical interview, but everyone understood there were circumstances that justified it.
Well, thought Goldblatt, at least they’ve finished with the research degree.
‘So it’s true, Dr Goldblatt,’ asked the second consultant, ‘that you don’t have a research degree?’
‘It’s true!’ said Mike Coalport.
Goldblatt nodded briefly in Coalport’s direction. Always acknowledge another’s help, that was Goldblatt’s maxim.
‘May I ask why you chose to break off your career to do a law degree?’ enquired the third interviewer when it was his turn, passing on to the next of Goldblatt’s crimes.
Goldblatt had an answer. He had been asked the question so many times that he certainly had one. More than one.
But suddenly he felt just as he had felt in the train on his way to the hospital. It was exactly the same deep, hopeless feeling. It rose out of his bone marrow, seeped into his blood, and welled up into his brain.
Why did they always ask why he had left medicine? Why did they never ask why he came back?
Goldblatt gazed wearily at the consultant on the other side of the table who had asked the question. He had been introduced as a professor of something or other, the dean for postgraduate education in the region. He was a tall, well-built man with bronze skin, brown eyes, and thinning silver hair. Haemochromatosis, thought Goldblatt. That would be the diagnosis, if he had to hazard a guess. ‘Bronzed diabetes’, to give it the old-fashioned name. The body, genetically unable to process iron properly, lays it down all over the place – skin, liver, heart, pancreas, joints, pituitary gland, gonads. Iron in the balls. Why didn’t he ask him about that? Ask about something relevant, for once, instead of asking why he did law. Why didn’t this professor-whoever-he-was roll up his sleeve and ask Goldblatt to give him a diagnosis? Why didn’t he then ask him to demonstrate how he would break the news to him if the diagnosis had just been made?
The bronzed professor with the iron balls was watching Goldblatt quizzically, waiting for an answer.
‘Dr Goldblatt?’
Goldblatt had betrayed himself too many times answering that question for people like the ones on the other side of the table and still ending up a Wise Man. He couldn’t bear the prospect of spilling his guts to yet another medical vivisectionist who was going to scoop them up and sniff them and throw them back in his face.
Yet finally he began, starting reluctantly on the well-trodden path of one of his standard explanations. Like a lamb, knowing exactly where the foul-smelling path leads, yet unable to stop himself following it.
‘I wanted the challenge, I think. I thought I’d be able to combine both aspects of my training in a medicolegal career.’
‘Defend your old colleagues, eh?’ said Iron Balls sardonically, finding something amusing, apparently, in the thought.
Goldblatt gazed at him. All of a sudden, the empty, detached feeling was gone. It had welled up so far that it had blown the top off his skull, and now he was a wild, half-headed maniac with steam and anger belching out of his ears. What did they want from him? Why did they bother bringing him here if it was for this? Couldn’t they think of anything better to do with their time, or at least something more original?
Goldblatt smiled. ‘Defend my old colleagues? No, I’m more of a prosecutor by nature. I wanted to see every negligent, ignorant, arrogant doctor who had ever damaged a patient standing arraigned in the dock.’
Iron Balls didn’t say anything for a moment. He stared at Goldblatt icily.
Goldblatt stared back. On closer examination, Iron Balls’ bronzed diabetes looked as if it came out of a sunlamp. Goldblatt could easily picture him in the dock. An old-fashioned dock in an old-fashioned court. His tanned skin would go nicely with the wood panelling.
The room was quiet. It had been quiet to start with, a bland, cream-coloured quiet of boredom and predictability. Now it was a hideous, lurid, violet quiet of expectancy and strain.
He’d got their attention, anyway. No fidgeting. Everyone was looking.
‘And now?’ said Iron Balls eventually, taking up his supplementary question.
‘Negligent, ignorant doctors?’ said Goldblatt. ‘I still want to see them in the dock. Don’t you?’
Iron Balls gazed at him for a moment longer, his brown, appraising eyes disapproving. Then he looked at the pad in front of him and jotted something down, shaking his head.
It was disappointing. If the regional dean for postgraduate education didn’t want to see negligent doctors in the dock, who would?
Now there was only one thing for Goldblatt to decide. Get up and walk out, or stay for the rest of the interview?
He realized that he had just thrown away all the chances he had never had of getting this job. That wasn’t the problem. The problem was that now he had nothing to lose. And he still had just enough sanity left to recognize that that was when he posed the most danger. To himself. If he stayed, he didn’t know what else he might end up saying to this bunch of Nailwright jackasses whose braying, he had discovered, was starting to irritate him. He sensed that in another moment even that last shred of sanity would be gone.
He needed to decide quickly. Now. Before he opened his mouth again.
He ought to leave. He knew it. The medical world is a small place. Word gets around. It would be unwise to stay. Too dangerous. It might be fun.
The next consultant to question him was Mike Coalport.
Fuck it, thought Goldblatt. He couldn’t leave now.
Having seen the main issue of Goldblatt’s interview dealt with twice over, and having just watched Goldblatt shoot himself in the foot – blow his foot right off, in fact – Mike Coalport squared his shoulders with relish and got ready to inflict more damage, hoping to see Goldblatt amputate his other leg. There was nothing he enjoyed more than seeing a candidate stagger out on two bloody stumps. He launched into one of his stock questions.
‘I’d like to get your thoughts on a social issue,’ he said.
Nine times out of ten, the social issue raised in a medical interview just happens, coincidentally, to be the same social issue that has been highlighted in one of the main medical journals the week before. Nine times out of ten the interviewer can’t resist the temptation to provide his own thoughts on the subject as a preamble to the question, usually at far greater, meandering length than any answer he is prepared to tolerate from the candidate. Goldblatt had often been advised by consultants and successful candidates never to disagree outright with the interviewer’s opinion. At most, if agreement was impossible, it was necessary to acknowledge the legitimacy of that view before briefly mentioning an alternative. But no consultant who had ever advised him could actually think of an opinion with which, for a period of five minutes and with a job hanging in the balance, they would find it impossible to agree.
‘No, I don’t agree,’ said Goldblatt, when Mike Coalport had concluded his introductory oration, for which he had assumed the famous tone and posture with which he had delivered so many coups de grâce at conferences both in Britain and abroad.
Mike Coalport looked up at him in outrage. He had just given what he felt to be a scholarly, sweeping, and masterful exposition of his theme, which wasn’t some plagiarized Social Issue culled from the previous week’s Lancet, but was, in fact, his favourite Social Issue and of his own particular construction. The argument, in brief, was that doctors who focus their research on rare diseases are misguided, profligate and irresponsible. Instead, they should direct their efforts to more common illnesses, on the grounds that they would thus relieve more suffering. Coalport’s technique was to deliver it in a tone that intimated that he was prepared to brook no opposition. When the candidate duly offered no opposition, he would then counter with an equally aggressive argument for the opposing point of view and demand to know what the candidate thought of that!
Goldblatt would have happily argued for the position that Coalport was advocating. On the other hand, he was happy to argue against it. After all, the gloves were off. The holds were unbarred. Even as he had listened to Coalport’s punchy voice droning on, his mind was peering with alacrity down the many alleyways by which he could attack. It was like being a barrister again, or at least a trainee one, which was all Goldblatt had been. If Mike Coalport really wanted to debate a Social Issue, it was his lucky day.
‘So you disagree?’ asked Coalport, gazing at him in delighted contempt.
‘Yes,’ said Goldblatt.
Mike Coalport licked his lips, the pleasure of the entertainment in prospect making him look more like a debauched cherub than ever. He glanced from side to side, as if making a special and particular invitation to each of his colleagues to come to the Coliseum and enjoy the slaughter. Iron Balls, who was obviously an inveterate jotter, shook his head and jotted some more.
‘Why?’ asked Coalport eventually.
‘How would you feel?’ retorted Goldblatt quickly.
Coalport snorted. ‘Is that how you would make a decision on a social issue?’
This was already Coalport’s fourth question, and it was clear that he was going to run amok. Goldblatt appealed mutely to the lay moderator at the interview, who happened to be a professor of cardiology, giving her a final chance to stop proceedings. If she let it go from here, everyone knew, she would have to let it go to the end.
The professor of cardiology had no intention of missing the spectacle.
Goldblatt turned back to Mike Coalport. ‘Is this a social question?’
Coalport guffawed. He looked around again to see if anyone present had ever witnessed such a stupid man on the other side of an interview table.
‘Or a question about you, Professor Coalport, as a moral agent?’
Coalport glanced back at Goldblatt abruptly. For a second he looked just like any fat, confused man. He blinked. Then he recovered his balance in the only way he knew.
‘Do you think you’re qualified to make that distinction?’ he enquired sarcastically.
‘That depends,’ said Goldblatt. ‘Are you qualified to think?’
Coalport was speechless with rage. Iron Balls dropped his pen and stared. Other mouths opened.
‘I ask this in an ontological sense’ Goldblatt continued, since no one appeared to be in a fit state to stop him. ‘When you ask me “Are you qualified to make that distinction?” you’re making the common mistake of confusing a moral with a technical judgement. The question you have asked is a moral one, not a technical one. Once we understand this, Professor Coalport, then we can see why your question entirely misses the point. This is a moral judgement, and by definition, we’re all qualified to make moral judgements. That’s why we’re all subject to legal process. Those of us who aren’t capable of making moral judgements – infants, or the insane – aren’t subject to legal process. If I stood up right now and punched you in the face, for example, I would be subject to legal process, correct?’
Coalport stared at Goldblatt with hateful incredulity.
‘Correct,’ said Goldblatt, helping him out. ‘Therefore I don’t stand up and punch you in the face. Not that I’d want to, of course. But even if I did want to, I wouldn’t, because I’m capable of making a moral judgement. Therefore it goes without saying that I’m capable of making this distinction.’
Goldblatt sat back in his chair and folded his arms. He glanced along the line of faces opposite, looking for a sign of life.
‘But I haven’t answered your question, have I?’ he added.
‘No, you haven’t!’ retorted Coalport, instinctively recovering his scorn even as he struggled to remember what his question was.
Wrong answer. Coalport should have taken the chance to bring the exchange to an end, not prolong it. No one pauses in an argument to remind you that he hasn’t answered your question because a sense of fair play has suddenly forced him to own up to his evasiveness. He’s asked you because he’s got something else in store for you, and it isn’t going to be pretty.
‘And you haven’t answered mine,’ said Goldblatt.
‘May I remind you that this is an interview, Dr Goldblatt,’ interjected the moderator.
‘Thank you, m’lud.’ Goldblatt turned back to Mike Coalport. ‘You haven’t answered it.’
‘What was it?’ demanded Coalport combatively. He wasn’t going to back down in front of some would-be SR who didn’t even have a research degree.
‘How would you feel?’
‘How would I feel if what?’
‘If you had some rare disease.’
‘Oh, please. Do you really mean—’
‘How would you feel if you had some common disease?’
Coalport frowned.
There was another one of those silences in the room, but it was different, all at once it was aimed at Mike Coalport. Maybe one or two of the consultants had realized where Goldblatt was taking him.
‘Do you know how you would feel?’
Mike Coalport hesitated.
‘Do you or don’t you?’ asked Goldblatt evenly. ‘Do you really know?’
‘Of course I don’t!’ retorted Mike Coalport with all the bluster he could muster.
‘Well your analysis of this social issue, as you call it, presumes that you do.’ Goldblatt shook his head and heaved a heavy, disappointed sigh. ‘You know, Professor Coalport, your way of thinking is very old-fashioned. It used to be called utilitarianism. It requires a notion of a calculus of pleasure – or suffering, in this case. But I’m sure you require no instruction in the fact that the problem with utilitarianism is that it fails on the impossibility of intersubjective comparison. You can’t tell me how much a person with a rare disease suffers, and you can’t tell me how much a person with a common disease suffers. Only they can do that – which means that you can’t quantitatively compare them. It’s perfectly possible, for example, that a person with a rare disease but with exactly the same degree of objective physical disability as a person with a common disease experiences a much more intense degree of subjective psychological suffering precisely because of the very rarity of his or her disease. The fact that no one understands it, the lack of fellow sufferers with whom to share it, the sense of abandonment generated by people who go around saying that... well, making the intellectually contemptible argument that you just made. Or possibly they don’t. The point is that this calculus of suffering that people like you would like to construct – it can’t be built. Which means you can’t say whether treatment of a few people with a rare disease relieves more suffering than treatment of many people with a common disease. Can you?’
Coalport wanted to say that he could. He wanted to say it. But he didn’t.
‘And that’s why I disagree with your analysis, Professor Coalport.’ Goldblatt smiled. ‘Such as it is.’
Mike Coalport stared at him. Goldblatt couldn’t remember ever having seen such malevolence and disbelief mixed together in a single pair of eyes. He could feel himself still smiling, ever so slightly. The icy smile of the ruthless but professional executioner, who can offer his victim only the comfort of his technical expertise, the sharpness and speed of the blade. He couldn’t help it. For that one moment, and in front of all these people, he was Mike Coalport’s executioner, even though he already knew that for the rest of his life Mike Coalport was going to be his.
Mike Coalport looked away, glancing down at the CV in front of him. After a second he shuffled it pointlessly.
There were muffled snickers. Iron Balls, who had picked up his pen again, smiled despite himself as he resumed jotting. The moderator allowed the pause to drag on a little longer before turning to the next interviewer. She didn’t like Mike Coalport. Nor did anyone else. Naturally, she was thoroughly appalled at the insolent and subversive performance she had just witnessed from the candidate – but that was no reason to hurry on as if it had never happened.
Anyway, it turned out that the other interviewers didn’t have many questions. And Goldblatt didn’t wait around after his interview to witness the calling of Anthony Thomas and add to the glory of the anointed one’s ascent by his own self-effacing presence.
He knew it was wrong to leave. For a Wise Man, it was an inexcusable dereliction of duty. It cast in doubt the entire point of his attendance at the interview in the first place.
Goldblatt thought about that as he retraced his steps to the Underground station. Maybe, he thought, he just didn’t have the stomach to be a Wise Man any more.