Doctor On The Job (12 page)

Precisely at ten that Friday morning, and precisely as usual, Sir Lancelot Spratt strode through the plate-glass doors into Virtue surgical ward of St Swithin’s Hospital.

The ward itself had changed vastly since his first entry to the old Virtue Ward in the now demolished building as its consultant surgeon. In those orderly days, it contained two straight well-disciplined lines of patients, drilled by the ward sister, it seemed to Sir Lancelot, to breathe in unison. The rebuilt hospital was all nooks and crannies, patients in twos and threes all over the place. Even men mixed up with women, which would have made the old ward sisters stare and even resign. But Sir Lancelot supposed the mingling was a convenience to his surgical colleague upstairs, who specialized in sex-change operations, and where you could never tell if his wards were male, female or undecided.

But in any modern hospital ward, Sir Lancelot reflected as he marched along, the surroundings made little difference. The patients spent their time staring at television, except the ones who were unconscious. The surgeon progressed with something of his old retinue, like an Emperor fallen on seedy times who must cut down the ceremonial. He was followed by his white-coated assistants, his white-jacketed students and his ward sister, whom he vaguely understood to have become under the modern administration something like Principal Nursing Officer Grade Seven (Female) Permanent and Pensionable.

Sir Lancelot crossed briskly to a bed in the far corner, containing a pinched-looking youngish man staring about him nervously. A few yards from the foot stood the German doctor of philosophy. By the patient’s head was Pip in his brown coat, beside him Faith.

‘Good morning, Mr Chipps,’ the surgeon began.

‘Good morning, Sir Lancelot.’

‘Good morning, Faith. You’re looking blooming. Getting plenty of tennis?’

‘Good morning, Uncle Lancelot.’

Sir Lancelot briefly introduced Dr Langenbeck, then rubbed his hands as though about to start a good breakfast. ‘Well, Mr Chipps. I’m pleased to see you on my round this morning. Perhaps you’d kindly give me your opinion of this case?’

‘Diagnosis first?’ Pip asked.

‘If you wish.’

‘It’s not an emergency.’

Sir Lancelot nodded his head several times sagely. ‘Well, Mr Chipps. You have taken a full case history, and performed your physical examination?’

‘Yes, Sir Lancelot. And it’s definitely not an emergency.’

‘We’ll go over the symptoms,’ the surgeon continued helpfully. ‘Umbilical pain starting at two in the morning, vomiting and diarrhoea.’ Pip nodded agreement. ‘Anything else?’

Pip stood scratching his wiry hair. Sir Lancelot reminded him, ‘And fever.’

‘Am I going to be all right, Doctor?’ asked the patient anxiously.

‘Now don’t you pay any attention to our medical talk, my dear fellow,’ Sir Lancelot reassured him. ‘It happens to be necessary for your own good that I should discuss your case with this other doctor here. Our words may sound rather alarming, but they’re only technical terms, “shop talk”.’

‘He looks more like a porter to me,’ the patient grumbled.

‘We have run out of white coats,’ Sir Lancelot explained, ‘because of industrial trouble in the hospital laundry. I may have to operate stark naked under my gown, but we’re here with the one object of getting you better as quickly as possible. So just lie back in your comfortable bed and relax. That’s the way to help us. Now, Mr Chipps. On examination?’

‘Pain and tenderness in the umbilical region extending to the right iliac fossa.’

‘When can I have something to drink, Doctor?’ came from the pillow.

‘All in good time. Please don’t interrupt. We are having a serious discussion. And rigidity, Mr Chipps?’

‘Yes, Sir Lancelot. In the right iliac fossa.’

‘I could do with a bottle of beer, and no mistake.’

‘Once you’re on the mend, you can consume a barrel, if you feel like it. So you stick to your diagnosis?’ Sir Lancelot raised his thick eyebrows.

‘Yes. Not an emergency.’

‘Come now,’ he invited amiably. ‘Think again. My dear Mr Chipps, even in your first week here as a surgical dresser, you could hardly have missed a barn-door diagnosis like this. Umbilical pain, vomiting, fever, right-sided tenderness and rigidity – that can’t add up to anything but acute appendicitis, surely?’

‘What about the diarrhoea?’ Pip asked with a crafty look. ‘That doesn’t fit in.’

‘You get diarrhoea frequently in appendicitis,’ Sir Lancelot told him abrasively. ‘Listen, you stupid berk – I mean, my dear sir. If you don’t believe me, you can go down to the hospital library and look it all up in Bailey and Love’s textbook of surgery.’

‘
I
think it’s bacillary dysentery.’

‘Balderdash.’

‘Well, it’s my opinion that counts,’ Pip pointed out to the surgeon politely.

‘It’s an appendix, you bloody fool,’ roared Sir Lancelot.

Pip drew his brown coat round him. ‘That’s hardly the way to address a colleague. Very unprofessional language. Might I ask you to observe normal etiquette?’

Sir Lancelot’s beard appeared to bristle. ‘If this patient isn’t operated upon within the hour, he’ll die.’

The patient gave a shriek. ‘Don’t take any notice of our doctors’ talk,’ Sir Lancelot instructed him hastily. He turned to Pip. ‘So stop obstructing the work of this hospital with your arrogant and obstinate ignorance.’

‘I don’t want to die,’ whimpered the patient, pulling bedclothes to chin.

‘Please, what in German is “balderdash”?’ interrupted Dr Langenbeck mildly.

‘
Dummes Zeug
,’ Sir Lancelot threw in her direction.

‘
Me
arrogant,’ returned Pip hotly. ‘For years, Sir Lancelot, you’ve been parading round this hospital as a complete autocrat. Without one word of kindness, of acknowledgement, even of recognition to your fellow toilers in the wards with mop and bucket or a tea trolley.’

‘If he does die, he’ll be on your ruddy conscience to the end of your days, not mine.’ Sir Lancelot jabbed a finger towards the patient, who gave another shriek and started climbing out of bed. ‘Just relax, my good fellow, relax,’ Sir Lancelot advised him. ‘If you don’t, you may burst something nasty inside.’

‘Conscience! You talk to me about conscience. What conscience have you got about the staff of this hospital, who are exploited on poverty wages for all the heavy shifting and swabbing?’

‘Listen, you maladjusted Tolpuddle Martyr,’ barked Sir Lancelot, not noticing that the patient was now lying under the bed. ‘I came along this morning perfectly confident that I could get your little nonsense called off by showing you up in public as a bloody fool. I failed. Simply because you reveal yourself as a more ruthless, desperate and inhuman little upstart than I imagined. But I happen to put my patients first, even before my principles. I am therefore now trying to talk to you sensibly, as a fellow member of the medical profession, as a former student of St Swithin’s who might well become one again –’

‘What’s that? Again?’ Pip interrupted eagerly. ‘I could be reinstated?’

‘Of course you could. That is a solution to everybody’s difficulties which I am at a loss to understand was conceived by nobody. I shall have a word with the dean this morning. The medical school may be outside my province, but the need for action is desperate and when it comes to twisting the dean’s arm he is compliantly double-jointed. Where’s the patient?’

The man was crawling on his elbows, trying to get through the ring of feet round the bed.

‘That’s a genuine, sincere offer?’ asked Pip.

‘I never make offers which are otherwise. Providing you allow me to operate on this patient, of course.’

Pip grinned. ‘I was going to, anyway. I was just enjoying putting you in your place. I’ve been longing to do precisely as much for years. So has everyone in St Swithin’s, if it comes to that.’

Sir Lancelot glared for some moments. ‘Pick this patient up from the floor and get him down to the theatre at once. Tell anaesthetics that he has had no pre-medication,’ he instructed his assistants, repeating the orders in Hindi. ‘Don’t go away, Chipps,’ he added, as Pip began sidling from the bedside. ‘Nor you, Faith. I have something special to say. You see that lady with the fair hair? She is from Germany.’

‘I am studying your National Health Service,’ Dr Langenbeck explained to Pip. ‘Which your politicians repeatedly indicate as the envy of all civilized nations.’

‘She is also preserving perfect decorum,’ Sir Lancelot went on, ‘while doubtless squirming with laughter inside, at the spectacle of the idiot way in which this country of ours – well within my memory, ruler of the greatest Empire the modern world has known – is tearing itself to bits less through selfishness, envy and laziness than through a degree of bloody-mindedness which makes Dracula look like a milksop. You should be ashamed of yourself, Chipps. You don’t seem to have one patriotic chromosome in your entire set of genes.’

Pip answered evenly, ‘Patriotism is only the capitalists’ way of getting the workers to die for them suddenly instead of slowly.’

‘I shall ignore that remark. If I did not, I should beat you over the head with the bedpan that nurse is carrying past.’

‘Please, what is a milksop?’ inquired Dr Langenbeck.

‘
Schwächling
.’

‘I find your English jokes sometimes very difficult to follow.’

‘As for Faith, Chipps, you are not fit to share the same street with her, let alone the same shack. What is it?’ Sir Lancelot demanded testily as the browncoated Harold Sapworth pushed past his elbow.

‘Pip, there’s hundreds of blokes from the newspapers outside,’ Harold told him excitedly. ‘Telly vans, radio, the lot. Since you was on the box last night, almost every hospital in the country’s come out in sympathy. They wants you to hold a press conference.’

Pip drew himself up. ‘I have stopped the entire National Health Service,’ he said breathlessly. ‘Well! Fancy that.’ He stared wide-eyed, seeing neither Sir Lancelot nor anyone. ‘Power.’ He opened and closed his fists. ‘The power of television, which is real life to the oppressed poor who struggle with their sordid ones…’ He continued whispering to himself, ‘I, Pip Chipps, addressed them sitting in their own homes… Power, lovely power…’ He jerked back to reality, adding decisively to Faith, ‘Right. I shall hold a press conference forthwith.’ He raised his clenched fist. ‘Workers of the NHS unite! Remember the Three Day Week War. This is yet another but more famous victory.’

Pip strode from the ward, Faith and Harold Sapworth at his heels. A second later, he imagined he was being assassinated.

As Pip had stepped into the corridor, a man hurled himself forward knocking him into the arms of his followers. After a second, Pip judged the assailant to be simply another of his admirers, from the manner in which he was grovelling, embracing Pip’s ankles and his unpolished zipped boots. His adulator appeared a wizened, dusky fellow, wearing a towelling dressing-gown issued by St Swithin’s to patients who for reasons of poverty or emergency arrived ill-equipped.

‘Master, master,’ cried the man at Pip’s feet. ‘Save me, save me.’

‘Something the matter?’ he asked.

‘Master, I know you. Everyone in my ward knows you. Mr Chipps, the most powerful personage in St Swithin’s.’

‘If not the whole country,’ Pip corrected him in a modest voice.

‘You have the power of life and death. My life and death. Please, sir, I implore you.’ His face gazed up tear-stained from the floor. ‘Cardiac transplantation. The operation is not by any manner of means an emergency, is it?’

Pip scratched his chin. ‘Might be difficult to say.’

‘Please, Master, decide that it is not an emergency. Then it cannot be done. At least, it cannot be done this morning. Oh, Master! I am a poor man. But I will sell all my goods in Shanka and make you a lovely present if only you will decide that I am not an emergency. You can take my beautiful daughter as a household slave, what you in England call an
au pair
.’

‘It’s a really difficult diagnosis,’ Pip announced ponderingly. ‘What do you say, Harold? Is a heart transplant an emergency operation or isn’t it?’

‘Real dodgy, that one,’ Harold Sapworth agreed. ‘Could be, or couldn’t. Reckon you’d have to refer it to the executive of ACHE. Maybe even the President. It’s one of them fundamental decisions, like the demarcation rules in the Scottish shipyards.’

‘Exactly.’ Pip nodded. ‘I should like to call in a second opinion,’ he told the grovelling patient. ‘You’ll probably hear within a week or two.’

‘But I must know this minute,’ he objected agonizedly. ‘My surgeon is all ready to operate, he is sterilizing his special knife, the biggest knife I have seen in all my born days, oh my goodness.’

‘And who is your surgeon?’

‘Professor Ding,’ he replied with quivering cheeks.

‘Oh, yes. The one we call the Black Barnard.’

‘He is the black something else, let me tell you,’ the patient said grimly. ‘Moreover, he is my brother-in-law. There is nothing wrong with me, I am as healthy as any astronaut.’ He thumped his chest. ‘But my brother-in-law, he wants to make a meal of my heart, just to get the Order of the White Rhino and a blooming great backhander.’

He started shaking all over as a roar came from the end of the corridor. In green gown and cap, rubber gloves on hands, mask dangling below unsmiling face, Professor Ding came charging upon his patient.

‘What’s the bleeding idea, you escaping from the anaesthetic room, just as I am all tooled up and ready for work?’ he demanded furiously. ‘Walk out on us, hey? With me and my assistants, anaesthetists, nurses, fifty people, all putting themselves out on account of saving your health and life. Some people ain’t got no gratitude,’ he complained, eyes rolling in the direction of Pip. ‘On your feet, Sonny Boy. You and me going back to the operating theatre in double-quick time, carry on the good work, and you’re gonna lie back and enjoy it, get me?’

The patient was on his knees, hands clasped in prayer directed at Pip. Professor Ding seized the nape of his scrawny neck and jerked him erect. ‘I say,’ frowned Pip. ‘What is all this, exactly?’