CHAPTER 7
Mr Abdul was glad he had changed hospitals now. He had been keen to move away from the area but hadn't known whether he would be ridiculed if he applied for another job, even though it was a few years now since the Eldred Jones episode. Would any reputable hospital employ him? Thanks to his photo appearing in all the newspapers, he was now known as the paediatrician who had not only been unable to treat successfully a lung disease which, once diagnosed, had cleared up overnight, but who had been previously heard to refer to the child patient who carried out his own diagnosis and apparent cure as ‘possibly slightly retarded.’
Fortunately, his new employers had reacted good-humouredly and he had been able to play it down. When they mentioned Eldred at the interview, as he had known they would, it was clear they regarded the incident as a good joke – a joke at Mr Abdul’s expense, of course - but he had laughed along with them and then, modestly, turned the story to his own account.
He didn't say very much, just let it be known by the lift of an eyebrow, a gentle shrug of the shoulders, that professional discretion prevented, of course... ‘But there's always more to a patient's history,’ murmured Mr Abdul, ‘than one is permitted to discuss, least of all with the gutter press. And the patient's family, of course, will not divulge any history of deeper problems ... What can I say?’
The atmosphere changed. No, no, they all assured him: he was not required to say any more. Naturally, they understood. And they themselves, as fellow professionals, had never believed for one minute the ridiculously distorted version of events offered by the popular press. Mr Abdul's silence on the evident psychological problems of his young patient was entirely to his credit... and of course no one would dream of probing any further ...
Since he had become officially employed, a few of his superiors had appeared to change their minds about this, and hinted that - solely among medical colleagues who wouldn't dream of breathing a word - it might be acceptable, and even obligatory, in the interests of medical knowledge, for Mr Abdul to be a little less discreet about his former patient. But Mr Abdul had so far escaped the pressure to confirm that he had been in control of Eldred's case all along, meeting each enquiry with an enigmatic smile, an expressive spreading of his hands, and the words, ‘What can I say?’
By now, his colleagues seemed to be getting the message that what Mr Abdul could say was nothing at all, much as his apologetic air seemed to suggest that he would like to, if only medical ethics permitted. This was gaining him a name for being a good chap, though one rather incapable of discerning when it was quite safe to bend the rules.
Mr Abdul didn't mind being seen as a stickler for the ethical rule-book. Anything was better than being known as the child-expert who had been outsmarted by a five-year old. He still felt a slight sense of unease as he entered the ward at the start of each new day's shift, so it was always a relief to him when work began with a problem he could deal with easily.
Keith Harper was a straightforward case. He was a hospital regular, a 14year old boy, disabled from birth, who looked much younger than his years and could therefore be addressed with the same level of paternalistic kindness that Mr Abdul would use towards any child - any child, perhaps, except Eldred Jones.
‘Now, Keith,’ Mr Abdul greeted him warmly this morning, ‘I see you're back with us once more.’
The small hunched figure in the child-size wheelchair craned his head to peer up at him crookedly. The gaze from his blue eyes was unexpectedly shrewd.
‘I haven't met you before,’ the boy pointed out.
‘Not me personally, no,’ said Mr Abdul. ‘When I said "back with us", I was speaking on behalf of the hospital.’ He felt suddenly foolish.
‘You're the new paediatrician?’ Keith asked. ‘Mr Gannet told me last time that he was leaving.’
‘I am Mr Abdul,’ said Mr Abdul, drawing himself up to full height. This meant the boy had to crane his neck even more to look up at him. Mr Abdul pulled up a chair and sat down.
‘I'm here to discuss your operation with you,’ he said, clearing his throat. ‘I see that you are no stranger to surgery, Keith, having had no less than thirteen operations before.’
‘Fourteen,’ said Keith apologetically. ‘This will be the fifteenth. If I have it done.’
‘If?’ Mr Abdul looked up from Keith's notes. This was a problem within his field. He was notoriously good with children who lost their nerve before surgery. He was a master of reassurance. ‘It's natural,’ he said soothingly, ‘to feel fearful, Keith.’
‘It's not fear,’ said Keith. 'I've done it before, fourteen times. I'm just wondering if there's any point in it.’
‘Ah,’ said Mr Abdul. ‘Now there I can help you, Keith, and that's what I'm here to do: to explain to you exactly what this operation is for and what it will do for you. I usually find it helpful to draw a diagram – that's a kind of picture - of your bones. Do you know what a fibula is?’
Keith pressed a knob on the control panel of his electric wheelchair and spun himself round. One shaky hand reached towards a large book on the bed. ‘Would you mind passing me that book?’ Keith asked politely. ‘I can't quite reach it.’
The book was open, Mr Abdul saw, at a complex diagram of the human skeleton showing some of the tissues as well as the structure of the bones. His heart sank. Was this another Eldred, lecturing his doctors from a pilfered medical textbook?
‘I'm not an expert,’ Keith said modestly, ‘but naturally you want to find out as much as possible about your own condition, don't you?’
Mr Abdul did not agree. Patients were, by nature, intended to be passive – appreciative recipients of the hard-earned fruits of medical expertise, not co-workers with their doctors. Amateurs should not be encouraged to meddle in the work of professionals.
He laughed tolerantly, to show that his words could not convey any offence. ‘Sometimes,’ he said, with one eyebrow raised humorously, ‘the patient is the person least equipped to comprehend the detailed analysis of his own malady. We experts may take quite a different view from a lay person.’
Keith's eyes widened. ‘But in the end, the only purpose of an operation is to benefit the patient,’ he said, 'isn't it?’
‘Among other things,’ Mr Abdul conceded, ‘but we professionals have the authority and the responsibility - which of course we don't take lightly - to decide exactly what will benefit the patient and what will not.’ He glanced at his watch discreetly and smiled. Take your time, he conveyed to the child, but not too much time.
The child was not smiling. ‘What other things?’ he asked.
‘I beg your pardon?’ said Mr Abdul.
‘I said the purpose of an operation was to benefit the patient and you said, “Among other things,”’Keith reminded him. ‘What other purpose could there be?’
‘It's imperative, of course, and very natural,’ Mr Abdul assured him, ‘for the patient to think first of his own interests - though as I say, he can only decide in the light of professional guidance in what respects his own interests consist.’ He was becoming ungrammatical, he noted with annoyance, as well as slipping into using the longer words he would normally only use with adults; this boy had somehow influenced him to relinquish his usual tone for addressing sick children and was making him defensive.
He cleared his throat again, rustled his notes and stood up. ‘But there are other factors involved,’ he said, ‘such as the effect on the patient's social environment and relationship with the family, who have to facilitate his attempts to live with his disability ...’ He was doing it again. The child was watching him, with eyes that were strangely unchildlike. Mr Abdul blotted the innocent gaze of fiveyear old Eldred Jones from his memory and continued, ‘... and of course the contribution to medical research and the knowledge we acquire which enables us to offer help in similar cases ...’
‘You mean,’ said Keith, ‘you would ask me to have this operation to further your research or to make my body easier for my parents to
lift and dress - even if I decided it wouldn't make life any easier for myself?’
There was definitely something of Eldred Jones about this case, Mr Abdul felt. He moved backwards a couple of steps.
‘None of us can decide to do something,’ he said, ‘merely on the basis of what suits ourselves, Keith. And, as I say, we are not always in the best position to decide what would most benefit ourselves. I will leave you to think about it, Keith, and I am here for you to discuss your doubts with at any time - I want you to know that. But, as your consultant, I have no doubt that this operation will be in your best interests, and I promise you that I myself will give you the very best of my skill to ensure that your surgery is successful.’
‘It won't make me walk,’ said Keith simply.
‘No,’ said Mr Abdul.
‘Then I don't believe,’ Keith said, ‘that another operation would benefit me.’ A whirring noise from the wheelchair signalled that the child's clawlike hand had selected reverse gear again on the control panel. Mr Abdul found that he had been dismissed from the conversation, as the chair bore the small crippled body away from him.