“I think you’ll find that fairly accurate,” he said. “I remember this case particularly, because of all the circumstances.”
“You mean the crash?” I asked.
He hesitated. “Well, yes, there was that. But he and two others were prisoners awaiting court-martial, in a detention ward. Did the patient tell you that?”
I said drily, “No, he didn’t.”
He said, “Well, that’s what they were. There was an armed guard on the door of the ward.”
“He told me that he was on his way home from Algiers,” I said. “It is not helpful when the patient tells you a pack of lies. It just wastes time.”
“Well, that was true enough,” said Hodder. “They were sent back from Algiers. There was a load of four or five of them. This man Turner and two others were wanted for some black-market racket in London, selling Army stores, I think. They were found out when they got drafted to North Africa. Turner was the only one of that lot who came through the crash alive. Then there was a paratrooper up for murder in a London pub. The D.A.J.A.G. sent them all back for trial in England in this Hudson, the one that got shot up and crashed.”
“Nice party,” I said. “How many of them survived the crash?”
He wrinkled his forehead in thought. “Three or four, I think; but they weren’t all my patients. They weren’t all prisoners, either. One couldn’t have been a prisoner—the second pilot—the one who crash-landed the machine. He had a broken thigh; an R.A.F. doctor was treating him. I think he was taken in with the rest of them, and not moved when they put the guard on. I think there were four altogether. There was the pilot, and Turner, and the paratrooper, and the Negro. That’s right. Four.”
“A Negro?” I asked.
He nodded. “There was an American Negro soldier in the ward, who’d cut his throat. He wasn’t one of the party from Algiers. The hospital put him in with them, in the same ward, because he had to be under guard and he was too bad to be moved.”
“What did he want to cut his throat for?”
“I forget—some civil offense or other. The American military police were chasing him. He went into an air-raid shelter and cut his throat. But he didn’t know anatomy.”
I returned to the subject in hand. “I’m taking Mr Turner into hospital for examination,” I said. We stood together for a few minutes longer, discussing what I meant to do with him and talking generally about the case. “I’ll drop you a line later on to let you know what happens,” I said finally. “But I doubt if it will be very satisfactory, from what you tell me.”
“I wouldn’t lose much sleep over that,” said Hodder. “I’ve not got a lot of use for people like Mr John Turner, myself.”
“No,” I said thoughtfully. “They make a lot of trouble and they don’t pay much dividend.”
I did not see Turner again till just before the X rays, and then only for a few moments. I got the photographs and the reports from the pathologist and house surgeon that afternoon, and after my consultations were over for the day I sat down with the photographs at the stereoscope. As Hodder had said, there were three metallic fragments. Two were sizable pieces not far below the dura. It might be possible to get at those if necessary, though there was the gravest danger to the patient in such an operation. The third was very small and much deeper in the cerebrum; it was surrounded by a darker infusion of the negative in the immediate vicinity. It was quite inoperable.
I sat for half an hour studying this thing and trying to think out ways and means of dealing with it. I did not want to be beaten, even in the case of Mr Turner. But presently I put the negatives and the reports back into their envelopes and said quietly to myself, “Well, that’s that.” I stubbed my cigarette out, put on my hat and coat, and went home.
I slept very badly that night. At the age of fifty-eight one does not normally lose sleep over a patient, but I lost sleep over Mr Turner. I wanted to do something for him; wanted to very badly. I had a queer inverted feeling that because this little black-market racketeer was a man of no account, the case called for the very utmost limit of my skill. I put that down with diffidence because it looks absurd on paper, but that’s what kept me awake. I could not sleep for running over in my mind the possible combinations of operative and anaesthetic technique, of palliative operations and of neurological treatment. I got out of bed once and went down to my study to look up some recent German work on intracranial fibrosis. I read German rather slowly, and stayed down there for an hour. Then I went back to bed, and slept a little before dawn.
I saw Turner next morning in his ward at the hospital. I took the X-ray photographs along with me. The sister showed me into his rooms; after a perfunctory examination I sent her away and sat down in the chair beside his bed.
“Well, you’ve got three metal fragments in your head still, Mr Turner,” I said. I pulled out the negatives and showed them to him; they were quite clear without the stereoscope.
“Gosh,” he said. “Is that me? I don’t half look a guy.”
“The prettiest girl doesn’t look any better, taken in this way,” I said. I picked out one of the pictures. “This one is the side view—this shows it best. These white things are the metal pieces. These two high up, there, and that one farther in.”
He was interested. “Where would they be on me, doctor?” He put his hand up to his head. “Somewhere here?”
I laid two fingers on his head. “The first two, here and here. The third one about two inches down, under here.”
I showed him the other views. He looked at them carefully and quite intelligently. “Is this third bit the same stuff as the others, doctor?” he asked presently. “I mean, those two are sort of clear-cut, but this one looks all fuzzy.”
I nodded. “That’s the one that’s giving you your trouble. I should say that that is fibrous matter forming round the piece of steel.”
He glanced at me quickly. “Something that oughtn’t be there?”
“Yes,” I said. “That is my own interpretation of these photographs. To some extent it is supported by the pathological report.”
He said weakly, “Well, that’s bloody good fun.”
There was a short silence. “Would that be what makes me feel tired, doctor?” he asked at last.
“I think so,” I replied. “It would account for that and for the disability of your right hand. It would account for the fits of giddiness and fainting, and for your eye trouble. In fact, it fits in with most of the symptoms that you’ve got.”
He said, “I suppose this means I’ve got to have another operation.”
I was silent for a moment. “I’m a surgeon, Mr Turner,” I said at last. “I’ve been operating all my life, and mostly on the head. What I have to tell you now is that there are limits to the things that operative technique can achieve. If you have your leg cut off in some accident, the surgeon cannot operate and give you a new, wholesome leg. In the case of the cranium there are similar limits. There are some operations that one does not usually attempt.” I paused, and looked him in the eyes. “I’ve got to tell you, Mr Turner, that I think this is one of them.”
The slight grey on his rather florid face showed that he understood me. “You mean that if you tried to get that bit out, I’d die?” he asked.
I said evenly, “I’ve given this a lot of thought, Mr Turner. I have to tell you that I could not undertake such an operation with any expectation of success.” I paused. “At the same time, you must understand that that’s only my personal opinion, the personal opinion of one man. If you feel you would like to have another surgeon examine you and study these photographs, I should be very pleased to arrange it for you, or to co-operate with anyone you choose. Because one man admits defeat, it doesn’t mean that everybody else does, you know.”
He said, “You’re the best in England on this sort of thing, aren’t you, doctor? That’s what Dr Worth told me.”
“Oh no, I’m not,” I replied. “There are other people here in London just as experienced as
I am. You could see Mostyn Collis, for example.”
He said, “Well, what’s going to happen if you leave it alone, the way it is? Will it get any worse?”
I said, “It doesn’t have to get worse, but it may. I can give you certain palliative treatment that may arrest the lesion. That means it may heal up of itself and give you no further trouble.”
“Does that often happen?”
I shook my head. “Not very often, in my experience. I have known it to occur, though.”
He asked, “How often?”
I thought for a moment, and then I said, “Perhaps one case in ten improves under the sort of palliative treatment that we can apply. Not more, I’m afraid.”
“The other nine get worse?”
I nodded.
He whispered again, “Bloody good fun.”
There was a long silence in the little ward. A fly buzzed on the window pane, the knob at the end of the blind cord tapped on the window, the bright sun streamed in; from below came up the noise of London traffic. I sat by his bedside waiting for him. It’s best to give the patient plenty of time in a case like this. It’s all one can give.
At last he said, “If it goes on getting worse, doctor, what’s it going to mean? What’s it going to be like?”
I knew that was coming, of course. I, too, had had time to think. “You say you first noticed this about six months ago,” I said. “The disability, so far, is not very great. I can’t estimate the actual rate at which it will progress you know.”
He said impatiently, “Yes, but what do you think, doctor? I mean, I’ve had it, haven’t I?”
I said, “I should say that there might be a progressive loss of faculties, Mr Turner. You might be able to carry on your normal life for another six or eight months, but these attacks of fainting will grow more frequent. You ought not to drive a car again. Generally speaking, I think you must expect all the symptoms to increase as time goes on.”
He said quietly, “After that, I’ll die.”
“We’ve all got to do that, Mr Turner,” I replied.
CHAPTER TWO
I WROTE to Dr Worth after I had explained his position to Mr Turner in the hospital. I said,
DEAR DR WORTH,
I have examined Mr John Turner, and I have consulted with Mr Percy Hodder, who as a major in the R.A.M.C. performed the original operation on Mr Turner in 1943. I have considered the pathological report resulting from a lumbar puncture, and the X-ray photographs of the cranium, which I enclose with the radiologist’s report for your information.
You will see that there are three metallic fragments still lodged in the cerebrum; I have indicated with an arrow the one which I consider to be causing trouble. In my opinion, no operation could be undertaken with success to remove this fragment. A lesion in this vicinity is consistent with the apraxia and vertigo from which Mr Turner suffers, and with a marked papilloedema of the left eye which is apparent on examination with the ophthalmoscope.
I have known cases of this sort to remain static for many years and even to improve, but this is not the normal course. I should expect that all symptoms would increase in severity, resulting in death within a year.
I should like to see Mr Turner again in about four months time. In view of the wartime nature of his injury and his general position, I should waive any further fee.
Yours truly,
HENRY T. HUGHES
Mr Turner left the hospital while I was writing this. He went by underground to Piccadilly Circus and put his bag into the cloak room. Then he walked up Shaftesbury Avenue and turned into Dolphin Street, and to the Jolly Huntsman. He went into the saloon bar; it was only about noon and there were few people in the place.
“Morning, Nellie,” he said. “Gimme a pint of bitter.”
The barmaid, a cheerful woman about fifty years old, drew a tankard and wiped the bottom of it with a cloth, and passed it to him across the counter. Mr Turner took it from her, swallowed a quarter of it, and slipped on to a stool. He smacked his lips. “First I’ve had for a week,” he said with satisfaction.
“You don’t say,” said the barmaid mechanically. “Elevenpence. You haven’t been around here lately.”
“No,” said Mr Turner. “What’s more, I won’t be around at all after a bit.”
“Going away?” she enquired idly.
“That’s right,” he said. “Going a bloody long way.” He lit a cigarette, fumbling awkwardly with the lighter in his left hand.
“There’s no need to swear about it, anyway,” she said.
Only a man can know the help that barmaids give to men in trouble. “Sorry,” he said. “But you’d swear if you was me. I just come out of hospital. They say I’m due to pass out in a year or so. Kick the bloody bucket.”
She stared at him. “No …”
“Fact,” he said. “I’m telling you what they just told me.’
“But why? You don’t look ill to me.”
“It’s this conk I got on the old napper,” he said moodily. “It’s gone bad on me, after all these years.”
“Lord,” she said. “You got to have an operation, then?”
He shook his head. “There’s bits of shell inside going bad, or something. They can’t operate, they say.”
She said again, “Lord …” and then, uncertainly, “I don’t suppose they really know, Captain Turner. I mean, doctors say all sorts of things. Friend of mine, she thought she was going to have a baby, and the doctor said so too, but she never. They was all wrong. I expect they’re wrong with you. I wouldn’t worry my head about it, long as you feel all right.”
He took a drink of beer. “I don’t feel so good, sometimes,” he said quietly. “They done all sorts of things to me in hospital; I reckon they know, much as anyone can do.”
There was silence.
“What are you going to do, then?” asked the woman gently, at last.
“I dunno—I got to think it out.” He blew a long cloud of smoke. “Got to go home and tell the wife, first thing of all. She don’t know nothing about it, yet.”
“Didn’t they tell her nothing at the hospital?”
“She never come to see me in the hospital,” said Mr Turner briefly. “I was only in a week.” He paused, and then he said, “We don’t get on so well—not like I thought it would be, one time. I don’t reckon this is going to mean much to her, except she’ll have to start and think about a job again.”
“She’ll be terribly upset,” the barmaid said softly. “You see.”
“Maybe,” said Mr Turner thoughtfully. “I dunno.” He swallowed down the remainder of his beer. “Got to see the firm, too, sometime, I suppose.”
“I wouldn’t tell them while you can go on working.” said the barmaid shrewdly. “Some firms turn funny, you know. Ever so mean they can be, sometimes.”
“We get three months’ pay, I think,” said Mr Turner. “Sick pay, I mean. Of course, you don’t get the commission … I don’t know as I want to go on working, though.”
“No?”
“Well, would you? I mean, what’s the sense in going on?”
“Well, I dunno,” said the barmaid. “You got to do something.”
“I dunno what I want to do,” said Mr Turner moodily. “I dunno that I want to go on selling flour right up to the end. I’d sort of like to chuck it up and do something better ’n that, even if there wasn’t any money in it. After all, it’s not for long.”
“You don’t want to chuck up the job and then find you get well again,” said the barmaid practically. “I don’t think any of these doctors really know.”
“You don’t want to pack up at the end and find you done nothing but sell flour all your life, either,” said Mr Turner.
He pushed his tankard to her across the bar. “I must be getting along.”
“Want another?” she enquired.
He shook his head. “I got to go back and have it out with the wife,” he said. “She don’t like beer.” He slid off the stool, and grinn
ed at her. “All be the same in a hundred years,” he said quietly. “That’s what I say.”
He went out into the busy, sunlit street. He had intended to telephone from the nearest box to his firm, Cereal Products Ltd., and possibly to go into the office that afternoon. On the pavement he hesitated, irresolute. He did not want to go into the office; he wanted to think for a little before going back. He bought an evening paper and walked slowly down towards the Circus again, and turned into the Corner House and had a steak and chips with another pint of beer.
By three o’clock he was at Watford, on his way home. He lived in a small detached villa in a row, No. 15 Hyacinth Avenue. It was a fairly pleasant little house, one of many thousands around London, with a small front garden with a cyanotis tree and a larger back one with a lawn and a laburnum tree and rose bushes. He let himself in with his latchkey, and called rather gruffly, “Mollie?” The empty house echoed back at him; he did not call again.
He went out moodily into the garden. The lawn needed cutting, but he did not feel that he could tackle that. In that suburban place of gardens it was pleasant, that warm, sunny afternoon. He did not know a great deal about gardens. His work had made great inroads on his leisure time; so many evenings had to be spent late or entertaining buyers from the provinces that he had never taken seriously to gardening. There was always something more Important to be done, the sheer, insistent business of living that stood before the things he would have liked to do. A jobbing gardener came in one afternoon a week to do the garden for him.
He stood looking at the roses; they were coming into bloom. He stooped down to smell one; it had a fragrance wholly alien to the world he knew. He straightened up, and then stooped down and smelt it again. “Be nice to have a lot o’ them,” he muttered to himself, and his mind travelled to a vision of a rose garden between tall trees without a house in sight, a quiet place with crazy paving and a fountain, a managing director’s garden. And then he thought that he had better make the best of what he’d got, that next year’s roses would not interest him much.
“Takes a bit of getting used to,” he said quietly to himself.