Chapter 4

The woman facing him was a picture of misery. Mrs Gold was forty-five, twice divorced and childless. To call her plump was to pay her a compliment. She was obese and unquestionably unattractive. Yet, she was a fortunate woman, Andrew thought. Fortunate to be alive. Twelve months previously she was diagnosed to have cerebral glioma. She presented to the family practitioner, unhappy, crying, her second husband had just run off with the manicurist. She complained of terrible headaches which her general practitioner diagnosed as tension headache and who could blame him. Fortunately he had sent her for an MRI scan and that showed a large right temporal glioma which was confirmed on biopsy at Prince Charles and which within three months had completely disappeared after a course of Amaradine.

Mrs Gold, who briefly found happiness because finally a cause for her terrible headaches had been found, was miserable once more. And what’s more, she still had her headaches. And there she was, planted in the chair two sizes too small for her, staring helplessly at Andrew, the first patient in the Glioma Follow Up Clinic that morning. Andrew had been attending the clinic since the second week of starting his new position. At first Dr Edwards was also there but gradually his attendances became less regular and it was apparent to Andrew that George Edwards was all too happy to leave the running of the clinic to him, a task which he took on eagerly. Being the Junior Consultant, he was keen to take on an activity where he was in charge. But on days when Mrs Gold attended he was not so sure. He once again reviewed her history and the more he read her story, the more convinced he was that she was indeed suffering from tension headache and had probably done so all along. The neurological examination was normal, as it always had been. At her previous visit Andrew arranged for an MRI as laid down in the follow-up protocol and this was also normal. For no particular reason Andrew picked up Mrs Gold’s original MRI scan and put it on the screen. The tumour shone out, evil and malignant. It was then that he noticed the left orbit. The changes were quite bizarre but Andrew had seen the appearance before and recognised it to be due to Mrs Gold’s artificial left eye. He could not recall a history of her losing an eye, but then Mrs Gold’s history was so complex and convoluted that this small fact could have easily escaped attention. Instinctively he looked at Mrs Gold’s eyes to look at the left eye. It was certainly a good one. He could not tell it apart from the real one. It even moved. Andrew stopped. Artificial eyes do not move!

Sheepishly he enquired, ‘Mrs Gold. This may sound like a silly question but I can’t find it in your record. When did you lose your left eye?’

‘Lose my left eye. What are you talking about? Lose my left eye. I haven’t lost my left eye. Or my right eye. See, it’s mine, all mine.’

With that Mrs Gold pointed to a quite normal left eye which was by now rolling around as was her right eye. Mrs Gold was less than impressed.

‘I know you are new here Dr Marshall but I would have thought you would take a little more trouble so as not to mix up your patients. Good day. I’d like to see Dr Edwards next time if you don’t mind. At least he knows who I am.’

With that she picked up her bag, dragged herself up off her chair and left the clinic.

Andrew, although secretly pleased to see her go, was also extremely embarrassed. He had learned early on in his career that patients expect a doctor to be able to instantly identify them and their problems, no matter how many other patients they had and no matter that they have seen them more than six months previously. Well, he had lost Mrs Gold. Dr Edwards was certainly welcome to her. With a sigh he closed Mrs Gold’s file and began to replace the X-ray films in the bag. As he did so, the most recent of the scans caught his attention and he immediately knew something was wrong. He felt all at once confused and angry with himself for not noticing that immediately. Mrs Gold’s last MRI scan showed two normal eyes, so did the ones taken three months previously and the three months before that. Only on the initial MRI scan was the artificial eye present. That was the scan showing the tumour. It made no sense at all. It was so bizarre that Andre was tempted to push it out of his mind and forget it. He knew that there could not be any logical explanation for what he had just seen. But the scientist in him would not let him drop the matter. There had to be an explanation. His mind made up, he buzzed the girls at the reception desk to tell them that he was leaving the clinic for a few minutes. He tucked the X-ray bag under his arm and headed down to Radiology.

He knocked on the door of Dr Howard Bell, the Director of Radiology. Dr Bell had been at Prince Charles for as long as anyone could remember. He was good at his work but was not well liked. There was something shady in his background that Andrew had heard about but could not recall what. Andrew did not particularly like Howard Bell and had been a little frightened of him as a junior doctor and that feeling had never left him.

‘Come in,’ barked the voice from the other side of the door.

Andrew entered to find Dr Bell sitting at his desk dictating a report. He was a large man with sandy, ruffled hair which was always out of place. His half frame glasses were pushed down his nose and as Andrew entered he stopped dictating and peered up at Andrew out of his glasses as it to ask, ‘What do you want?’

‘Hello… Howard. I’ve got some MRI scans here which I would like you to look at,’ Andrew began.

Howard Bell gestured with his left hand to a large viewing screen on the wall and waited as Andrew put up Mrs Gold’s scan. Andrew took care to put them in chronological order and was about to explain to Dr Bell what it was that concerned him when Howard Bell stood up, leaned over his desk and, eyeing the scans said, ‘I suppose you want to know where the artificial eye has gone?’

Andrew had previously had first-hand experience of Dr Howard Bell’s prowess at reading X-ray films. He was again impressed but how quickly Bell had sized up the situation and focussed immediately on the problem.

‘Leave it with me Dr Marshall. I will do some checking and let you know. I will have to go back to our computer files on this one.’

And with that Dr Bell sat down, pushed his glasses up the bridge of his nose and resumed dictating. Andrew presumed his audience was over, turned and left the office taking care not to slam the door, although the urge to do so was almost irresistible.

Arrogant bastard, he thought to himself, but if he was so casual about it then there can’t be too much the matter. It probably happens all the time.

Andrew headed back to the clinic and within a few minutes was totally immersed in the succession of ex-tumour patients that he soon forgot about Mrs Gold, her MRI scan and her disappearing artificial eye.

The clinic over, he headed to the dining room. The food had improved in his absence and the meals were tasty and being subsidised, were cheap. Andrew was just taking his seat when he saw Lisa heading towards him, her tray bare with only a dry cracker and cheese and a small bottle of orange juice on it. She is still dieting he thought. He did not understand why. Lisa had the prefect figure. Always had and probably always would have no matter what she ate.

‘Hi Andrew. I’m glad that we can have lunch together. It’s the first time this week.’

Andrew was glad too. He was also glad that what was once a doctor’s only dining room had now been incorporated into a general dining room so that doctors, nurses and everyone else for that matter, could eat together. It took the hospital administration five years to overcome the medical staff’s resistance to that change and for once Andrew was on administration’s side.

‘Good to see you, Lisa,’ was Andrew’s reply. He went on. ‘Have you thought any more about my proposition?’

‘Please Andrew,’ she replied. ‘Give me time. It’s not that I don’t want to move in with you. It’s not so simple. There’s Linda to think of. She is counting on me sharing the expenses on our flat. The lease still has six months to run. I can’t just walk out on her. And then, well, you know. I don’t know if it’s right. For a second time. I don’t think I could cope with being hurt again. You know I love you, but that’s not everything anymore. I have learned that lesson hard.’

Andrew did not reply at once. He knew that he wanted Lisa with him. He wanted that more than anything. But he also knew what she said made sense. The flat lease was not the problem. He could take care of that. It was Lisa’s fears that were the issue. He loved her. But was he ready for a lifetime commitment? And if not, he had no right to hurt her again. Not right at all.

‘Sorry Lisa,’ he said. ‘I didn’t mean to rush you. What you say makes good sense. Take all the time you want. I’m patient. I’ll wait.’

And to change the subject, he launched into the tale of Mrs Gold’s eye, artificial or otherwise. The story seemed to amuse Lisa who did not seem to really appreciate the medical problem or if she did, made no mention of it.

Andrew made a mental note to check with Dr Bell in the next week regarding Mrs Gold’s scan. But the next week was taken up with meetings and the research committee and the week after that was the week of the final year medical students’ examination and Andrew had forgotten completely to follow it up. Dr Howard Bell also did not get back to him.