Doctor On The Job (2 page)

‘Morning, Solly,’ said Sir Lancelot, passing the St Swithin’s skin specialist in the doorway of the dining-room. ‘I hope you’re encountering no sales resistance among our customers.’

‘Some of my best patients are Arabs,’ Dr Cohen told him.

The medical staff dining-room in the Bertram Bunn Wing was a small, bright apartment on the first floor, overlooking the garden. It was decorated with an allegorical mural depicting Charles Hill of the British Medical Association and Nye Bevan inaugurating the National Health Service in 1948. Both were depicted as Florence Nightingales passing soothingly with their lamps along rows of agonized, frenzied casualties, and nobody could decide if these represented the suffering public or the medical profession. Sir Lancelot always ate with his back to it.

‘Hello, Lancelot, what have you been up to?’ asked Sir Lionel Lychfield, the Dean of St Swithin’s Medical School, looking up from
The Times
as the surgeon sat next to him at one of the square tables.

‘The Sheikh of Shatt al Shufti’s bilateral inguinal hernia. I did his hydroceles for an encore. I was going to leave them as shock absorbers for riding his camel, but of course the fellow hasn’t had a rougher ride than a Rolls-Royce for years. I hope he won’t be cross. At home, he punishes thieves by lopping off their hands. And I suppose other offenders by the removal of similarly appropriate parts. I distinctly didn’t like the look of his two bodyguards lurking outside the operating theatre.’

Sir Lancelot opened the glossy-covered menu. The Bertram Bunn Wing enjoyed the reputation among medical consultants as the best place to eat in London. The food came from the same kitchens as the St Swithin’s National Health patients’, but its own chef toothsomely overcame the challenge of all possible physical states, religious obligations and national or personal tastes. He provided a dozen attractive diets – low calorie, low sodium, high protein, low cholesterol, diabetic, duodenal, vegetarian, kosher, Mohammedan, Cantonese, Pekinese and Indian, as well as his normal
cordon bleu
. This nourishment being heavily subsidized, the dean ate there whenever he could in preference to the St Swithin’s consultants’ mess. He was famous in the hospital for a purse as tight as an oyster with lockjaw.

Sir Lancelot asked the young waitress in a green ward orderly’s smock for some cheese sandwiches and a glass of orange juice. The dean ordered
entrecôte garni
with extra vegetables. ‘The matron’s gone neurotic again, by the way,’ Sir Lancelot told him.

‘I do wish she were a more stable sort of female,’ the dean said testily. He was short and skinny, with a pointed bald head and large round glasses beneath straight, bristly black eyebrows. These became agitated in his frequent storms of exasperation, when they always suggested to Sir Lancelot a pair of hairy caterpillars performing a love-dance. ‘But of course, she
is
highly decorative, as matrons go,’ the dean conceded. ‘And if you’re paying an absolute fortune for your penthouse, you don’t want to be ushered into it by someone with the appearance and attitude of a seaside landlady during a wet August.’

‘She’s threatening to go again. But she won’t. She had exactly the same tantrums last January. You may remember, that was when a newly admitted patient, understandably unfamiliar with such complexities of civilization as air-conditioning controls, lit a fire in the middle of his room by chopping up the furniture. She’s also been on about her nephew, Chipps. I suppose if I have to fail him in surgery again tomorrow, he’s for the boot?’

‘Most definitely. Can’t encourage idleness in the medical school. It doesn’t matter whose nephews they are, even the Minister of Social Services.’

Sir Lionel Lychfield was one of St Swithin’s dozen or so consultant general physicians. But as dean of the medical school, he exercised the power and high-minded severity over its students of Dr Arnold at Rugby. ‘That’s the trouble with the younger generation,’ he went on. ‘Laziness, lack of application, no sense of purpose, complete indifference to their elders, and in fact to all authority whatever. Not all of them, naturally,’ he corrected himself briskly. ‘Some of our young are absolutely first-class. They restore your faith in the coming generation and humanity in general. My youngest daughter Faith, for example –’

‘You told me about your youngest daughter Faith at lunch last week,’ Sir Lancelot interrupted.

‘Young Faith! Barely eighteen years old. Already with the serious intent and the sense of vocation of a budding Florence Nightingale.’ The dean nodded proudly towards the mural. ‘Faith neither smokes nor drinks nor wears jeans, and devotes her life to helping the underprivileged –’

‘So you were saying last week –’

‘Do you know what she’s been doing all this month? Living in this austere hostel under barracklike discipline down in Fulham. On a pittance – I must say, these voluntary service organizations do quite blatantly exploit the good nature of girls like Faith. She gives the full benefit of her sweet and altruistic character to the down-and-outs they collect off the Embankment and similar places. Though I suspect most of them are simply too lazy to do a decent day’s work, and if I had my way would be given a pick and sent down the coalmines.’

Noticing that Sir Lancelot was staring dreamily out of the window, the dean turned back to his newspaper, giving it an irritated shake. ‘God knows what the country’s coming to,’ he muttered. ‘Everyone today seems to think he’s entitled to a job for life, doing exactly the same work for steadily rising pay, even if nobody wants in the slightest what he happens to be making. Otherwise, everyone simply comes out on strike, and lives on the benefits the rest of us have to provide under this ghastly “pipsqueak” taxation. It’s a wonder there aren’t still factories making horseshoes and carriage-springs –’

He broke off with a noise like a rusty gate in a gale.

‘What’s the matter?’ asked Sir Lancelot, looking alarmed.

‘They’ve caged our fox.’ Sir Lancelot seemed puzzled. ‘The St Swithin’s shop steward. Or our “SS man”, as I preferred to describe him,’ the dean added grimly. ‘That little twit who represented all the trade unionists at St Swithin’s, ever since they merged into the Amalgamated Confederation of Hospital Employees, ACHE. Read that.’

He indicated the
In brief
column.

MALE NURSE JAILED

Arthur Pince (22), male nurse, was imprisoned for three years at the Old Bailey for indecent exposure and shoplifting. Mr Pince asked for a record number of 82 other charges to be taken into consideration.

‘They said he was the most bent shop steward in Britain,’ exclaimed the dean in anguish. ‘You could have used his vertebral column for a corkscrew.’

‘I know nothing about this man’s activities. All politics bore me, and hospital ones to distraction. From his utterances, I always thought him a seagreen incorruptible Robespierre.’

‘Muddy and loaded with valuable flotsam and jetsam, more likely,’ said the dean with a bitter laugh. ‘These revolutionaries are all the same. Morality and misery for the masses, sybaritism for themselves. Pince was as susceptible to flattery as an infant to chicken-pox. He took bribes – or rather presents in the interests of good employer-staff relationships – with the ease and frequency of bookmakers taking bets on Derby Day. I believe he was also susceptible in the right mood to blackmail.’

‘I play golf with the President of ACHE,’ reflected Sir Lancelot, but the dean was too distracted to hear.

‘I wish the stupid twerp had mentioned his little legal difficulties. I’ve several good friends among the judges. And what’s a touch of indecency, when one can’t walk more than half a mile about London at night without getting one’s face smashed in?’

Sir Lancelot looked puzzled. ‘But if I never had any dealings with this Pince person, I don’t see why any other members of the medical staff should.’

‘You nevertheless enjoyed the benefit. If we hadn’t kept him sweet, he’d have started interfering with the hospital’s private beds.’ The dean embraced his surroundings with a quick glance. ‘That doesn’t seem to worry you?’

‘Not particularly.’

‘But surely you must be in favour of private practice?’ the dean asked impatiently.

Sir Lancelot sat back to meditate on this question. ‘In principle, yes. I think people should be allowed to pay, to avoid dying among people they would not usually be seen dead with. Also to perform their bodily functions in solitude and switch off the television when they feel like it. And doubtless we must condone the snobbery of the Shires, by keeping their daughters from aborting in public beds. It also occurs to me that private beds could richly subsidize the free ones. But raising the standards of the lowest towards the highest, instead of vice versa, would go against the cherished principles of the British people.’

Ignoring the lecture, the dean stared resentfully at the news item. ‘We shan’t have the luck to be landed again in the power of an immature youth who combines sex and kleptomania. Those union bosses knew perfectly well that something fishy was going on at St Swithin’s. They’ll see our members of ACHE elect a really tough egg as the new SS man.’

‘I deplore hospitals becoming a circus for trade union power politics, like every other institution in the country,’ observed Sir Lancelot loftily, as his lunch arrived. ‘But that is a trivial activity, compared with getting the patients on their feet. How unappreciated are the minor miracles of modern science,’ he remarked, holding up his glass. ‘This fresh orange juice is transported in little drums in a state of unrelenting iciness from the steamy groves of Florida,
Dipping through the Tropics by the palmgreen shores
, as Masefield put it, just to satisfy my passing whim in the shadow of St Paul’s Cathedral. Wonderful. Sir Bertram Bunn himself could never have foreseen it.’

The dean shot him a narrow glance. Everyone at St Swithin’s was saying how Sir Lancelot had mellowed since his wife died. He wondered if it was really softening of the brain.

Sir Lancelot Spratt finished his sandwiches, glanced at his watch and excused himself to the dean. He had to see a new patient.

As he stepped from the escalator which led to the ground floor, he saw that she had already arrived. The pair of brown-coated porters and the girl in the white overall behind the plastic desk were grinning and nudging each other and whispering animatedly, ‘It’s Brenda Bristols, just look.’

Brenda Bristols was not a great actress who could awe her public. She had instead the valuable knack of making everyone feel that one of their girl friends had stepped on to the stage or screen and was fooling about. She was immensely popular. Her
Up Your
–– series of films was apparently unending. And she was unlike so many of her contemporaries, who offstage lounged about in frayed jeans and a crumpled T-shirt, looking as if they had been obliged to extract themselves hurriedly from a blazing bedroom. Brenda Bristols invoked the disciplined traditions of the 1930s, when film stars dressed to colour the drab lives of a depressed world. She had appeared in the Bertram Bunn Wing wearing a scarlet straw hat three feet across, and a long dress of green sequins cut in the front, Sir Lancelot noticed, well below the xiphisternum.

‘Yo ho, Lancelot!’ She waved at him, clutched him and kissed him. ‘This tit of mine’s all right, really?’ she asked anxiously.

‘An entirely benign fibroma, I assure you, my dear,’ he comforted her courteously. ‘A lump of no unpleasant significance whatever. I shall have it out as easily as pulling a plum from a pudding. A couple of days and you’ll be home again, as right as rain.’

‘People keep catching their fingers on it.’ Brenda Bristols looked round the lobby. ‘What a weird place. It looks like a remake of
Up Your Arabian Nights
.’

‘We’re very cosmopolitan here. In the sun-baked villages where these people usually partake of their lunch, they would be equally disturbed by our demanding the paraphernalia of tables, chairs, knives, forks and cruet.’

‘Have you no British patients
at all
?’

‘Regrettably few can afford the prices these days.’

‘What happens if some poor little man gets run over outside the front door?’

‘He’s taken round the corner to the National Health wards of St Swithin’s. They are considerably more comfortable since my days as a house-surgeon, but of course definitely package-tour compared to first class.’ The corner of Sir Lancelot’s eye caught the matron darting from her office by the front entrance. ‘This is the famous Miss Brenda Bristols,’ he introduced her. ‘She’s with us for a day or two. Excision of mammary fibroadenoma. My patient.’

‘Go on, love, I’m more than just your patient,’ said the actress playfully, fluttering eyelashes which the matron thought resembled spiders’ legs. ‘Sir Lancelot and I are old mates, Nurse.’

‘Matron,’ she corrected, in a voice like a snapping icicle.

Brenda Bristols held her gaze for a second. ‘How stupid of me. Of course, you’re obviously far senior to all these young nurses everywhere.’

The matron clicked her fingers towards the white plastic counter. ‘A hospital porter will see you to your room. I have more important duties to perform.’

‘My house-surgeon will shortly be along to examine you, Brenda. Mr Havens – you’ll find him a charming young man.’

‘I go for charming young men. But I thought they went out with the haircut?’

‘There’s colour television, two channels and one in Arabic if you’re interested,’ Sir Lancelot informed her helpfully. ‘And the
pâtisseries
at teatime I understand to be exquisite.’

‘I wasn’t aware that you were even acquainted with this…this comedienne,’ said the matron sharply, as Brenda Bristols was escorted zealously by both porters to the lifts.

‘We have a common interest in the drama. I have become a regular theatregoer since the death of my wife.’

The matron synchronously clasped her hands and pursed her lips. ‘I hope you remember your Hippocratic Oath?’

‘I don’t think I’ve ever read it. It never seems to be written down anywhere, only bits of it carved over medical school doorways.’

‘You should have sent her to one of the other St Swithin’s consultants. Surely you fully realize the danger of a surgeon mixing his professional and personal attentions?’

‘I am past the age when I did not realize it fully,’ he told her severely. ‘And then I always disregarded it, anyway. But I am hardly one of the trendy young practitioners who would wish the General Medical Council so to attenuate our ethical code that any young woman might literally find herself in bed under the doctor.’

‘I’m sorry, Lancelot,’ she apologized, suddenly meek. ‘You know how upset I am today. I’m not going to resign after all. I’m a dedicated nurse. So I shouldn’t be put out in the slightest if my patients do anything anywhere.’

Sir Lancelot was not able to offer his congratulations on her wise redecision, nor even his commendation of such professional stoicism. At that moment, a small, round, well-scrubbed looking man in a grey business suit and thick-rimmed glasses appeared through the sliding plate-glass doors. ‘Freddie, I am delighted to welcome you in person to the Bertram Bunn Wing,’ Sir Lancelot greeted him.

‘Have I come to the right door?’

‘Not exactly. This is Lord Hopcroft, Matron, Chairman of Hopcroft Hotels,’ Sir Lancelot introduced him. ‘He is said to be responsible for more sleepers than British Rail.’

‘Not these hard times, I’m afraid,’ said Lord Hopcroft with a woebegone look. ‘Some of my more expensive hotels are as quiet as Sleeping Beauty’s palace.’

‘I recommended Lord Hopcroft to come for a routine check-up, now that our quite amazing new diagnostic system is installed.’

‘It won’t take long, will it?’ he asked worriedly. ‘As usual, I’m horribly busy. Can I tell my chauffeur to wait?’

‘By all means. It will take no time at all,’ Sir Lancelot assured him. ‘Everything is completely computerized. I don’t really understand these machines. Do you, Matron?’

‘Thoroughly, Sir Lancelot. I have been on a course.’

‘I gather it sorts out any possible physical defects electronically, in a flash. To my mind, its main advantage is not facing the patient with a series of po-faced doctors asking how much he drinks and why doesn’t he lose weight. It apparently thinks a million times faster than we old-fashioned human surgeons, who need half a day to explore every bodily avenue and be sure we’ve left no gallstone unturned.’

‘I’m certainly a strong advocate of electronic aids to efficiency,’ Lord Hopcroft said firmly. ‘Computers may attract a number of witless jokes, but our modern world could never run without them. In my office, we can tell you instantly the credit rating of millions and millions of British people. And they don’t even know the information has been chalked up,’ he declared proudly. ‘I’ll just nip out, and tell my chauffeur to hang about.’

As Lord Hopcroft stepped out of the sliding doors, two other visitors stepped in. One was a large African, in a bright blue suit and a broad tie with red and yellow lightning flashes on it. He was fat, glistening, many chinned, with an expression of bubbling jollity. His companion looked to Sir Lancelot an Indian, small, thin, threadbare, greyish-complexioned and miserable.

‘The great Sir Lancelot?’ exclaimed the fat man at once, advancing into the lobby and extending a plump hand enthusiastically. ‘It sure is a big pleasure. I bring respected and feeling greetings from our revered President and Minister of Health, the great and glorious Field Marshal himself.’

‘You must be Professor Ding?’ Sir Lancelot remembered. ‘From Shanka?’

‘Correct one hundred per cent, Sir Lancelot,’ the professor returned delightedly. ‘I asked your name at the great St Swithin’s Hospital, and they say to come round here. I’m sure glad to meet you, Sir Lancelot, particularly as we’re in the same line of business.’

‘And your friend –’ Sir Lancelot politely held out his hand.

Professor Ding laughed uproariously for some seconds, tears squeezing from his closed eyes. ‘That sure is the funniest thing what you just said,’ he managed to articulate at last. ‘That is no friend. That is my patient.’

‘I see.’ Sir Lancelot turned to the matron. ‘Professor Ding has come to St Swithin’s under a special international arrangement, to perform the first heart transplant in Shankian history.’

‘I sure am. Our great President and Minister of Health, he mighty proud of the fact. He say, “You go to St Swithin’s, boy, the well known and learned London hospital, they got all the facilities for this sort of stuff, you swap a few hearts just to get the feel of the thing, then you come home and swap hearts right here in Shanka, just to your heart’s content.”’ Professor Ding roared again. ‘Heart’s content! I made a joke. Heart’s content! Get it?’

‘Very droll,’ said Sir Lancelot.

‘All I waiting for now is one of you Britishers have a slight accident with a bus, or maybe a taxi would do, then you haul him into the famous St Swithin’s Hospital, and say, “By Jimminie, he’s a croaker!” Then you hook him up to the wunnerful breathing machine and keep him going off the electric mains till I got time to open up my patient here. And I slip one heart out and slip another one in, easy as changing my shoes.’

‘You’ve had considerable experience of heart surgery in Shanka, I take it?’ Sir Lancelot asked.

‘Oh, sure. Them slobs out there queuing up for heart operations. Our great Minister of Health, he organize that. Besides, I read all Christiaan Barnard’s book, all the way through.’

‘May I ask what precisely is the diagnosis?’ inquired Sir Lancelot, glancing at the patient, who seemed to have become greyer during the conversation.

‘Diagnosis?’ Professor Ding looked puzzled. ‘Oh, sure…he got the tetrology of Fallot. In fact, the cardiac works.’

‘Fallot’s tetrology is certainly a serious quadruple of congenital cardiac defects,’ observed Sir Lancelot, stroking his beard. ‘But surely, it usually comes to notice immediately at birth? And its unfortunate sufferers seldom reach adult life?’

‘He a case of arrested development, maybe?’ Professor Ding laughed again, slapping his patient hard on the back. ‘Well, we gotta be getting along, take a look round the town, maybe see the famous Marks and Spencers. We gotta get it all in while we can, hey?’ he demanded jovially of his companion. ‘This very minute, some poor Britisher maybe try looking up the underside of them lovely big red buses, then it’s coats off and sleeves up and get stuck in there digging.’ He clapped Sir Lancelot on the shoulder, grabbed his patient by the biceps, and hurried back to the sunlight.

‘The professor seems a jolly fellow,’ Sir Lancelot observed.

‘That patient doesn’t look remotely like one with a Fallot’s tetrology,’ the matron declared.

‘It may be some lesser cardiac defect. All professors tend to exaggerate. I suppose it’s an enormous prestige symbol for Shanka, having its own cardiac transplant. All the smaller countries have been eager getting into the act, including our own. They used to be contented with simply sporting their own national airline.’

‘Which was probably less lethal.’

Sir Lancelot nodded. ‘I can never entirely disagree with the definition of cardiac transplantation as the only operation which kills two patients at once.’

‘Where
is
Shanka?’ asked the matron, frowning.

‘Search me. These African states seem to change names and regimes with bewildering speed. One day we shall wake up to find the Republic of South Africa become New Zululand or some such. The new rulers will pass a law saying “For black, read white”, and I suppose their exclusively black teams will face hostile anti-apartheid demonstrations whenever they appear at Lord’s or Twickenham.’

Lord Hopcroft reappeared with a businesslike step, after instructing his chauffeur to wait. Sir Lancelot apologized that he had a clinic in St Swithin’s itself. ‘Matron will make you quite at home,’ he assured the patient, departing. ‘She and the computer share a certain empathy.’

The matron led Lord Hopcroft across the lobby and through a small door in the corner beside the lifts. Together they walked down a narrow, whitepainted, empty, echoing corridor. The piped music was silent. The air-conditioning was several degrees lower. Lord Hopcroft could not fend off an intrusion of uneasiness.

The corridor ended in a plain door marked CID.

‘What’s this?’ he asked sharply.

‘The Clinical Investigation Department, of course,’ the matron told him, he thought disdainfully.

They entered a small, white room, starkly lit by fluorescent tubes. He noticed they gave her a bluish, corpselike complexion. In the centre stood a transparent plastic capsule, containing a plastic stool and a stand supporting a television screen.

‘That is the diagnostic box,’ the matron indicated. ‘Please do not approach until the red light flashes above the screen. Beneath it you will find three buttons, marked “Yes”, “No”, and “Uncertain”. You answer the questions which appear on the screen by pressing the appropriate one.”

‘But supposing I should make a mistake?’ Lord Hopcroft asked, surprised at the anxiety in his voice. ‘I mean, it would be quite feasible, like misdialling on the telephone.’

‘Please try not to. But all mistakes are automatically rejected, once the computer has created a model of your clinical profile. It will simply order you to return and repeat the test.’

‘But supposing
it
makes a mistake?’

‘The computer does not make mistakes. It is impossible.’

‘Then what happens next?’

‘According to your clinical profile, the computer will tell you to proceed through one of the two doors opposite.’

The patient had not noticed them. They were hardly distinguishable from the white wall, one marked IN the other OUT.

‘“Out” leads directly to the street,’ the matron informed him. “In” leads to the next stage of diagnostic investigation, if thought necessary.’

‘Thought necessary by whom?’

‘By the computer.’

‘But doesn’t Sir Lancelot have a say in things somewhere?’ he asked uneasily.

‘Human agency is unable to interfere with the computer. There is some iced water in the corner. Good afternoon.’