Past Lives (6 page)

Lessing, a thickset middle aged man with a mane of white hair and a goatee beard sat at his microscope with his glasses pushed up on his forehead. The fingertips of his left hand adjusted the fine focus control of the instrument while he made notes on a spiral-bound pad with his right.

‘
What have you got?’ asked Macandrew.

‘
Take a look at these two tissue sections. Tell me if you see a difference.’

Macandrew took Lessing’s place and widened the binocular eyepieces a little before looking down. After a few minutes he said, ‘
Both
are malignant.’ He sounded surprised. He had expected one to be normal.

‘
No difference?’

‘
Stain colour maybe.’

‘
Exactly,’ said Lessing, pleased that Macandrew had picked up on it. ‘The one on the left is Jane Francini’s tumour but the haematoxylin staining is a different colour from the more normal reaction of the other one although, as you say, both are malignant. That’s what caught my attention. The colouring’s unusual and it rang a bell from way back: I think the Francini tumour is a Hartman’s tumour.’

'A what?'

'This is not a big gap in your knowledge,’ said Lessing. ‘It’s only the second I've come across in twenty years. It was named after the first patient to present with it, Mona Hartman. The tumour cells produce some kind of acidic chemical that affects the staining process in the lab. That’s what brought it to mind - that and the fact that some guys over in Europe did some research on it a couple of years ago and I remembered reading about it. How’s the patient doing anyway?’

‘
Not good. I was confident I’d got it all out but the way she’s behaving says there’s something really wrong . . . maybe there were secondaries that didn’t show up on the scan – or I didn’t pick up on them . . .’

Lessing could see that Macandrew was worried. ‘Would it help if I was to have a look at the scans?’ he asked.

‘
I’d be grateful.’

Lessing asked one of his technicians to fetch Jane Francini’s brain scans. Macandrew told her where to find them.

‘
Coffee?’

They went next door to Lessing’s small and cluttered office and he poured coffee from a large flask sitting on a hot plate on top of a filing cabinet. Lessing lit a cigarette.

‘
These things will kill you,’ said Macandrew in a weak attempt at humour when he didn’t feel in the least humorous.

‘
Something’s going to for sure,’ replied Lessing, displaying the philosophy of a long-serving pathologist.

The technician returned with the scans and Lessing clipped them up on a light box. He examined them for a good five minutes – occasionally employing a small magnifying lens - while Macandrew sipped his coffee and watched.

‘
Just the one, as far as I’m concerned,’ announced Lessing.

Macandrew let out his breath in a long slow sigh. ‘Thanks Carl. I didn’t think I’d missed anything but you never know . . .’

‘
I’ll see what I can dig up on Hartman’s tumours,’ said Lessing. ‘I’ll give you a call.’

Macandrew went back upstairs and called Klinsman from his office. Diana French answered. 'I'm sorry, Mac, Saul has gone for the day.'

Macandrew called Klinsman at home but there was no reply and he decided not to leave a message on the answering machine. He thought about contacting Tony Francini personally to tell him the bad news about the tumour but decided against it. There was still a slim chance that Jane might come out of it OK. He would wait until she surfaced from her sedated sleep before saying anything to anyone. He looked at his watch. With the schedule he had written her up for, Jane Francini would be out for another eight hours at least.

Macandrew didn't feel like cooking when he got in. Instead, he fetched a packet meal from the freezer and put it in the microwave. When it emerged, it bore little or no resemblance to the appetising delight depicted on the pack. 'Delicious Cod Steaks in a light wine sauce' had become amorphous yellow goo. He got a Bud Light from the fridge, picked up a fork and settled himself in front of the television to watch the news while he ate. His attention span only lasted as long as the goo. He picked up then channel changer and started hopping through the stations. Nothing could hold his interest. He couldn't get Jane Francini out of his mind.

At first, he found his preoccupation hard to bear. After all, he wasn't an intern wrestling with his first brush with failure. He was a seasoned surgeon who knew and understood the score. Dealing with life and death was part of the job. He was good at his job but he wasn't a miracle worker. He didn't pretend to be. So why couldn't he come to terms with the Francini case? Maybe it was her husband who was bothering him? Listening to him hadn't been pleasant but then people said all sorts of hurtful things when they were upset and Francini had certainly been that. His wife, as he had put it, was everything to him.

It wasn't Francini’s behaviour, he concluded, it was Jane herself. He had come across patients who had lost their minds before but Jane Francini was different. Something her husband had said kept coming back to him. He said that she looked like Janey . . . but she wasn't.

The more he thought about it, the more convinced Macandrew became that he was right. She just wasn't Jane Francini any more . . .

Macandrew didn't have an operation scheduled for the following day so he permitted himself a couple of large Bourbons. He needed a good night's sleep and the alcohol would help. Normally he would sleep late when he wasn't operating, take a leisurely shower and read the morning paper over breakfast but tomorrow he wanted to get into the Med Centre early. He wanted to be there when Jane Francini came round. Please God she would have recovered but somehow he feared that this was wishful thinking. He tried looking up Hartman's Tumour in his textbooks but failed to find any mention. If Carl Lessing didn’t come up with something, he would take a trip to the Med Centre library.

Jane Francini regained consciousness shortly after six thirty am. For a few brief moments Macandrew thought that things were going to be fine; she appeared relaxed and sleepy and the sounds she made were soft and feminine as she moved her head on the pillow. But as he came closer to listen to what she was saying, he realised that all was not well. Jane was speaking in the little girl voice that she had lapsed into on one occasion yesterday.

'Jane!' whispered Macandrew in her ear. 'Can you hear me?'

'Why are you calling me Jane?' replied Jane, without opening her eyes.

'Because that's your name,' continued Macandrew gently.

'Don't be silly, it’s Emma.'

'Emma who, Jane?’

'Emma Forsyth. Stop calling me Jane! Where's my mother? She said she would take me to town today.'

'Town?'

'To get me a new dress. Daddy’s coming home soon and she wants me to look pretty for him.'

'Where has your father been Emma?'

'Fighting the enemies of the King. He's very brave.'

'The king, Emma?' asked Macandrew. ‘What king?’

'There's only one king, silly,' said Emma. 'He's . . . ' The words froze on Jane Francini's lips and for a moment she appeared to have gone into a trance then slowly she opened her eyes and recoiled when she saw Macandrew leaning over her. She behaved as if she’d never seen him before. Her tone of voice had completely changed too as she let out a torrent of meaningless words.

Macandrew backed away from the bed and a nurse murmured, 'That lady has a problem . . .'

Jane Francini had now surfaced from the sedation she had been under and was clearly a seriously disturbed woman. Macandrew became aware that the nurse was waiting for him to say something. 'I’m going to have a psychiatrist take a look at her.'

'Yes Doctor,' replied the nurse.

'For the record,' said Macandrew without turning round, 'Mrs Francini’s tumour was both malignant and aggressive.’

'Tough break,' said the nurse.

Macandrew returned to his office and picked up some coffee from the machine on the way. He sipped it while he waited for Tony Francini to arrive, half hoping that Saul Klinsman might arrive first but recognising that this wasn't likely. The head of surgery usually arrived late and left early: this was written in the stars. The phone rang.

'I came up with some stuff on Hartman’s tumours,’ said Carl Lessing. ‘Not that it’s very encouraging, I’m afraid. From the few recorded cases I managed to find, the prognosis is bad. None of them ever recovered.’

'Secondary invasion?’

'Strangely enough, no. Removal of the primary tumour seemed to stop the cancer in its tracks. It was more a case of being left with residual brain dysfunction.'

'What level of dysfunction are we talking about here?'

'Euphemism level,' said Lessing. 'They were out of their trees: they were all committed.’

Macandrew closed his eyes and screwed up his face. It sounded as if the clinical picture in Jane Francini’s case was matching up to Lessing's information.

Francini arrived in the Med Centre a little after seven fifteen to find that his wife had been put under sedation again - Macandrew had written her up for this before leaving her to come upstairs. The nursing staff relayed the message to Francini that he should go straight on up to Macandrew's office.

'How come she's still out?' demanded Francini without any preamble.

'She came round a short time ago,' said Macandrew softly. 'She was very disturbed. I put her under again.'

Francini looked at Macandrew in silence for a moment. At first his expression was questioning, and then it changed to accusation. 'What are you trying to tell me?'

'Sit down Mr Francini.'

'I don't want to fucking sit down,' retorted Francini. 'I want to know what's wrong with my wife!'

'Your wife is a very sick lady, Mr Francini. Her tumour was malignant and it’s a very aggressive kind of cancer. The pathology lab made the diagnosis last night.'

'But you removed the damn thing. You said everything went well.'

'It did from a surgical point of view,' said Macandrew. 'But it so happens that this particular kind of tumour tends to leave patients brain-damaged. We're not sure why. There may be hidden secondaries or damage we can’t see on the scan. There hasn’t been enough research done on it. It’s a very rare type.'

'Damaged?' whispered Francini as if he was scared of the word. 'What the fuck do you mean, damaged?'

'The few similar cases we’ve been able to trace were left very severely confused with regard to cerebral function.'

'You mean Janey is nuts?' asked Francini, suddenly wide-eyed and vulnerable.

'I'd like one of our psychiatrists to see her before we make any kind of formal assessment.'

Francini suddenly buried his head in his hands and started to sob. 'Oh Christ,' he wept. 'What the hell am I gonna do?'

'I'm very sorry,' said Macandrew, suddenly feeling for the man. 'I assure you, we'll do our very best for her.'

Francini suddenly jerked his head up and spat out, 'No you won't! You assholes have done enough to Janey. I'm calling in a real doctor.'

'I'm sorry you feel that way, Mr Francini,' said Macandrew. 'But I don't think you'll find any comfort in a second opinion.'

Francini stifled his reply as the door opened and Saul Klinsman came in. 'I was just telling this guy here that I don't want any of you hicks touching Janey any more. I'm calling in some brains.'

Klinsman shot Macandrew a questioning glance and Macandrew said, 'Mrs Francini's tumour was malignant and aggressive – a Hartman’s tumour. I’ve told Mr Francini that it wouldn’t be right for us to reach any firm conclusions on her condition without his wife being seen by a psychiatrist,' said Macandrew.

'That would be sensible,' agreed Klinsman.

'And I was saying, I don't want you guys touching Janey,' interrupted Francini. 'I'm calling in my own people.'

'That is your prerogative of course,' replied Klinsman, 'but that will probably take a few days if you're going to bring in someone from out of town. Surely it would be in your wife’s best interests if we were to continue caring for her?'

'No!' insisted Francini. 'I don’t want you bastards causing any more damage. She's not to be given anything, especially not the knock-out drops this guy's been using to shut her up.'

Macandrew bit his tongue and said, 'It's important that your wife should not be allowed to get over excited, because of her heart condition. That's why I sedated her.'

''I want her conscious and alert when a real doctor gets here, not acting like some spaced-out zombie!'

'I'll need you to sign something to that effect Mr Francini,' said Klinsman. ‘You could be putting your wife’s life in danger.'

Francini snorted and said, 'Danger? After what you assholes did to her? That's fucking rich!'

Macandrew knew he was in danger of losing his temper. He appreciated that Francini was very upset but the man was pushing things too far. His wife's condition had been fully diagnosed. The tumour had done the damage to her, nothing else. There had been no mistakes, no overlooked secondaries, no incompetence and he was not keeping her sedated to cover up his own blunders. He was doing his level best to keep her stress levels within reasonable bounds. He looked away so that Francini would not see the anger he felt. He was going to keep his temper if it killed him.