Steady Now Doctor (7 page)

Chapter 6

A Dip Into The Well of Pleasure

Andy soon found that he loved being a doctor. The first three months of his House Physician's job were tremendous. He had never worked harder in his life, but he enjoyed it. Nights and weekends were terrible, they were so understaffed. The Path Lab closed at weekends, so the Housemen had to cross-match any blood needed, as well as all their other tasks. Fortunately, as O'Sullivan had forecast, the number of resident staff increased. Two hard-working girls and a lazy lunatic man from St Jane's were the first to join the team. The lunatic man was really a lunatic, he would be half-way through putting a plaster of Paris on say a broken leg, notice it was knocking-off time and just go off and leave it.

They were followed by a sort of united nations, two Indians, one Nigerian, one Irishman, one Lebanese, one Pole and a young Scottish anaesthetist. They all used to gather in Andy's room for nine o'clock cocoa made on the precious gas ring and swap experiences.

The Pole, who had lived in the part of Poland occupied by the Russians in 1939, had been transported by them to a camp in Mongolia for two years. He told them that the Mongolians had not only never heard of Poland or England, they'd never even heard of Russia. Then when Germany invaded Russia, they were transported to the Middle East to join the Polish Army.

They were a happy lot, and O'Sullivan, or one of his contemporaries, always knew where people were if an emergency arose.

Andy suffered with getting too close to his patients, as he did throughout his medical life. He had a thirty-five-year-old man with a stroke, slowly getting better to the delight of his wife who was the maid in some wealthy household. Andy would talk to her every day and to her employers who visited occasionally. The young man was almost ready to go home, when one night he had a pulmonary embolism and died within twenty-four hours.

Andy had to break the news to his wife who was quite hysterical. He was almost as upset as she was, but somehow had not to show it, as well as to comfort her. He felt somehow that it was his fault.

Andy's pay at the time was fifteen pounds a month. A couple of weeks after the death of the young man, he got a thank you letter from the wife with a ten pound note which was probably two months' wages for her.

Andy groaned, “Ten pounds, and a husband who died under my care.”

It took him weeks to come to terms with this particular death, and from then on he was anxious when anybody was recovering, and about to go home, to make a careful examination of their lower legs to see if there was any evidence of a deep vein thrombosis.

Apart from his own work under his own Physician and Registrar, he was called to all ends of the hospital, giving anaesthetic in Casualty, or helping out there with a bit of stitching up. On his first night on duty he was called to an emergency on the Thoracic Surgery Ward, his heart sank, he knew nothing about thoracic surgery. He approached the ward nervously, there were about half a dozen men in beds with drips, tubes, oxygen tents and large blood stained Winchester drainage bottles on the floor. This was today's list and all had either lost a lung or at least half a lung.

He was approached by the efficient-looking male charge nurse who said, “Sorry to bother you doctor, but the suction drainage from number two bed is not functioning.”

“What do you usually do in these cases?” said Andy, at a loss.

“Well, doctor,” said the charge nurse, “often changing the draining bottle does the trick, but we can't do it without a doctor's authority.”

“Please change it,” said Andy, “and I'll keep everything crossed until you've done it.”

It took about five minutes to change the bottle, and to Andy's relief he saw bloody watery fluid draining in the bottle.

“That's fine,” said the charge nurse.

“Thank God,” said Andy, “is there anything else I should do?”

“If you could just put a line in his notes,” replied the charge nurse and added, “I don't think I've seen you before, sir.”

“It's my first night as a doctor,” said Andy grinning.

“Who's houseman are you?” said the charge nurse.

“I am Dr Ramsden's HP,” said Andy.

“Ah well,” said the charge nurse, “you're lucky you have Dr Hudson as your Registrar, he's the best doctor in the hospital, and nice with it.”

Dr David Hudson was a nice, small gentleman who always had a little whimsical smile on his face, particularly on ward rounds when he once had to tell Dr Ramsden that he was holding some electro-cardiogram reading upside down. David Hudson was reading for his membership and with Andy due to resit the medical part of his degree, made a point of specifically teaching Andy every time some appropriate condition came up.

How good he was became clear when Andy admitted an unconscious man to the ward who had had an epileptic fit. Andy took a careful history from the wife, frequency of fits, et cetera. He learnt that the patient had been investigated at the Neurological Hospital in Queen's Square and they had made a diagnosis of some sort of high brain stem epilepsy. The tablets they had given him were not controlling his fits, which were becoming more frequent and the patient was often violent before a fit then became unconscious, slept for two or three hours, woke up hungry and was then all right until the next fit.

Andy examined the patient and then sent for Dr Hudson.

David Hudson glanced through Andy's notes then asked the wife if she minded answering a few more questions.

“All right,” said the wife, a bit reluctantly, “but they did have a go at me at Queen's Square.”

“When does your husband have his fits?” said David.

“Any time,” said the wife.

“When you said, any time,” said David, “are they for example, more often before a meal, or more often after a meal?”

“Now you mention it,” said the wife, “it's most often just as we are about to have a meal. I can't tell you how many dinners have spoiled.”

“Thank you,” said David. “Now if you would like to go and sit in the Day Room and ask Sister if you can have a cup of tea. If she says she would like to, but Matron won't allow it, tell her Dr Hudson has ordered it.”

“Now, doctor,” said David to Andy, “what do we do now.”

“I have no idea,” said Andy. “Wait until he comes round I expect.”

David said, “Mark this my boy, the golden rule on all unconscious patients. Always do a blood urea, a blood sugar, a lumbar puncture, a blood count, a urine test and a chest X-ray on every patient that is admitted. Often those are the only investigations required. It's surprising what comes up. Have you done a lumbar puncture before?”

“No,” said Andy.

“Well, this will be your first,” said David.

They began by taking some blood samples and sending them to the laboratory, they then prepared the man as if for an operation. He was laid on his side with head tucked down, knees up. His back was swabbed with iodine then draped with sterile towels, just leaving the lower portion of the back uncovered. David and Andy scrubbed-up and put on sterile caps, gowns, masks and gloves. Sister, similarly dressed, was laying out a lumbar puncture tray with a large pair of forceps, picking-out needles and syringes from a dish filled with some antiseptic fluid, then washing them in a dish of sterile water.

Two chairs were drawn up for Andy and David and they sat facing the exposed back.

“Now,” said David, “feel for the third invertebral space.”

Andy prodded with his fingers until he found the appropriate spot between two bony spines. Then from the lumbar puncture tray David passed him a three inch hypodermic needle that had a metal plunger in it and a cap. “Now,” he said, “gently push this needle into the space you've found, if you hit bone, stop, and come out, if suddenly you are aware that the pressure has no resistance, stop.” Andy pushed the needle in tentatively, the skin was tough, it was easier when he got into the softer tissue, then suddenly, no pressure, and he stopped.

“Well you could be first time lucky,” said David, “pull out the plunger and see what happens.”

Andy pulled out the plunger and a clear, colourless fluid began to drip from the base of the needle.

“Quick, specimen bottle,” said David, and a bottle was held under the needle and about ten drops collected.

“Now replace your plunger,” said David, “pull out your needle, dig your thumb into the area you shoved the needle in and rub it about, then put some collodium over the injection site - we don't want him to be leaking.”

“What do we do now?” asked Andy.

“Well,” said David, “what do you think, look at the ward clock, what does that tell you?”

“Oh, it's lunchtime,” said Andy.

“And,” said David, “thereby could hang a tale.”

At lunchtime David went to the Consultants' table and spoke to Dr Ramsden saying he would like him to see a case in the afternoon. When he rejoined Andy, Andy said, “What does Dr Ramsden do in the afternoons?”

“Sleep mainly,” said David, “I didn't want to have to wake him up.”

When they got back to the ward the notes from Queen's Square, electro-encephalograph readings et cetera had come over. As David read them his smile became even more whimsical. Having read them he passed them over to Andy. This coincided with results coming up from the Path Lab which David read, then a broad smile crossed his face. “Great,” he said, “we're right.”

“What d'you mean?” said Andy.

“His blood and Cerebro Spinal Fluid sugars are nil,” said David. “Has he been taking insulin then?” said Andy.

“No,” said David, “this almost certainly means that he has an islet cell tumour at the tail of the pancreas. This is a benign tumour which over-secretes insulin, thus our friend here blacks out just when his mouth begins to water at the thought of his dinner. This man is no more epileptic than you or I, all he needs is a small operation to remove this little tumour and our friend here will be all right.” They were interrupted by Dr Ramsden. David Hudson had to explain the situation to him as clearly and slowly as he had to Andy. “The proof is in the pudding,” said David, “let's give him some intravenous Dextrose.”

Sister passed him a large syringe of Dextrose solution.

David injected it into a vein.

In five minutes the patient was fully conscious, asking where he was and demanding food.

“Well done, Hudson,” said Dr Ramsden. “I must ring Harry Burgess at Queen's Square and tell him if he wants his patients properly diagnosed he'd better send them over here.”

He disappeared into the Sister's Office, Andy and David could only hear snatches of conversation, it was mainly, “I this,” and, “I that.”

“He's taking all the credit,” said Andy, indignantly, “and he didn't do a thing.”

“Never mind,” said David, “he is a bit dim, but he is the head of our team and, if unlike today, we'd made a mess of something, he would have stood up and taken the flak for us, he's all right.”

For the next forty years of Andy's medical life he always had one eye open for an islet cell tumour and was always testing for it, but he never ever saw another case.

The patient was operated on by Diana Reynolds three days later with David and Andy watching. As expected an islet cell tumour was found and easily removed.

Diana Reynolds had an FRCS and was entitled to call herself ‘Mr'. She was less like a mister than anyone Andy had ever met. She still completely ignored him as they met on their communal stairway, but there was many a night when Andy massaged himself to sleep with some fantasy about her, but so did many other males in the hospital.

Three months just sped by. It was announced by Mr Farrant that there was to be a Hospital Summer Party for medical staff and their wives only. It was a pretty low-key affair. For once there was plenty to eat and more than plenty to drink. Diana Reynolds had come in a yellow clinging dress that made her look as if she was about to burst from it. By eleven everybody was a bit merry and Mr Farrant called a halt to the proceedings.

Diana and Andy happened to leave at the same time. For the first time ever she spoke to him. “Is your gas ring still working?” she asked Andy.

“Yes,” said Andy suddenly alert.

“What can you offer me?” said Diana.

“Cocoa, Ovaltine, tea, coffee,” said Andy.

“I'll have some Ovaltine,” she said.

“Shall I bring it to you?” said Andy.

“No,” she said, “I'll come in with you.”

Andy went ahead of her into his room. When Diana came in she had not only locked the door, but bolted it. Suddenly Andy had the biggest erection of his life. He busied himself with the Ovaltine, hardly daring to turn round. Diana prowled around the room and then said casually, “I want to sit on the floor and I can't in this dress, I'll have to take it off.” There was a rustling of clothes and Andy's erection nearly hit him on the chin. He made the Ovaltine, turned round with a cup in either hand to find Diana lying on the floor naked, apart from a brief pair of pants, her head reclining on the seat of the armchair. “Come and sit here beside me,” she said, patting the floor.

“You know they call you Mouse,” said Diana, as Andy came towards her.

“No,” said Andy, “why do they call me that?”

“Because you are always scuttling about all over the place.”

At that moment Andy had never felt less like a mouse in his life. He handed Diana a cup of Ovaltine then sat down beside her as bidden, hardly being able to believe what was happening.

Diana placed her left hand on Andy's lower abdomen. “My God, who's a big boy,” she said.

“Now,” she said, “rules of engagement. I am a bit pissed, but if ever you blab about what's going to happen I will ruin you and say you tried to rape me.

“Rule number two, no kissing on the mouth. Number three, practicalities, have you any contraceptives?”