“Dr. Mansell, please let me see my son. I can assure you I shan’t fuss or excite him. I know how one should behave in a sickroom; and besides, I understand him far too well.”
Hilary had, when she knew it to be essential, a long reserve of patience, which at other times she did not always trouble to employ. She employed it now. She explained, gently and with detail. At the end, she saw that she had made no headway at all.
“Yes, I quite understand that of course he must be kept quiet, since you say he has concussion. Even we lay people realize that, you know. But you see, that’s the very reason why I must be there. My son and I have been a great deal together; we’re accustomed to one another’s companionship. When he was ill at school I put up at a hotel close by and spent every day with him. The first thing he’ll look for, when he recovers consciousness, will be to see me in the room. Unfortunately, he’s rather highly strung. If he misses me he’ll be terribly worried. You don’t want that to happen; you said so yourself.”
She waited, with confidence, the effect of her words. To Hilary they were in fact conclusive; she abandoned any fleeting thought she had had of giving way. Her feet felt familiar ground. She became inflexibly courteous and calm.
“We should certainly want to avoid that; but I don’t think there’s any fear of it now. Your son recovered consciousness nearly an hour ago. He’s quite passive and lethargic, and content to take everything as it comes, unless he’s stimulated in any way; then he gets pain and sickness and so on. That’s quite usual. It’s vital that he should simply vegetate till he’s past that stage. I’m sure you understand.”
“If he’s conscious,” said Mrs. Fleming sharply, “I’m sure he must have asked for me.” Her voice and her eyes added, all too plainly, that she suspected Hilary of being ready to conceal it.
“Hardly yet. He doesn’t even remember how he came here. He’s had an injection now to make him sleep. Don’t you think, if he were roused and the effects were bad, as they would be, it would only distress you? Please believe I know how you feel, but I’m afraid I must say no visitors, for today.”
“In that case,” said Mrs. Fleming, “I must defer to your judgment, of course.” Hilary moved with her toward the door.
They paused on the threshold. Hilary had felt her thinking as they walked. She waited.
“There’s just one thing that perhaps we should discuss now. Dr. Lowe—you know him, I dare say—is our family doctor. He will be looking after Julian when he’s well enough to come home. I don’t know the etiquette in such things; but I imagine you would like to have him here quite soon, and discuss the case with him. A second opinion, it’s called, isn’t it?”
There was a pause. Hilary held on to herself, coldly and rigidly. The motive was so palpable that she felt contempt for her own sensations. But the half-healed wounds in her self-esteem, scratched raw, made no response to reason.
“Certainly, if you wish.” She recalled Dr. Lowe, who had practiced in the neighborhood for some thirty years; a large. kindly man, radiating fresh air and those homely clichés which the patient can repeat, afterward, with pride to his friends, or the relatives with reverence over the port at the funeral. “I’ll ring up Dr. Lowe,” she said, “and arrange for a consultation. Good afternoon.”
She walked back into the hall. Her cigarettes were in her pocket; she lit one, and saw the flame of the lighter quiver from the shaking of her hand. It was something, she thought, that the Matron had not waited; how sorry she would have been to know what she had missed. From some recess of memory a voice came back to her, casual and cool, the voice of David. “You women have an extraordinary delusion that you should reason with the layman. You over explain. It never works.”
In her car, she grappled seriously with herself. Probably, she thought, this will turn out a perfectly straightforward case who’d recover without any trouble in his own home, with Sarah Gamp to nurse him. Why am I making an event of it, getting my hackles up, behaving as if this average silly woman had raised some major issue in my career? It wouldn’t take David long to tell me. The shrillness of an inferiority complex … When he wakes he’ll be almost normal, and delighted, no doubt, to see Lowe walk in at the door. I shall be well out of a tiresome business.
It was late when she got back, having taken in two or three visits on the way. The sun had gone in; her tension had slackened into flatness: she felt chilled and tired. It cheered her to see firelight through the windows of the square hall where, in the evenings, she often sat with Mrs. Clare. Hilary found her the ideal hostess, landlady, or what you will. She was placid and effortlessly efficient; friendly, but never obtruding; her reserves were profound—in all this while Hilary had not discovered what it was her husband did abroad—but they had the effect of laziness rather than of strain. She was about Hilary’s age; her soft contours and smooth dark hair knotted at the nape gave her a look of ripeness which was a matter of poise rather than of shape. In the minor crises of life, Hilary never failed to find her soothing: she hoped she would be in tonight.
Fatigue making her a little clumsy, she opened the front door with a noisy carelessness which was unlike her, and slapped down her bag and gloves on the table outside the door. The lights were not on yet, but the fire was bright in the big stone fireplace, and it was by this that she saw Mrs. Clare. She was on her knees on the rug, with the fire tongs in her hand; her head and body were turned, in a moment of swift arrested movement, toward the door. Her face was clear in the glow of the flames she had been stirring; lit with a brilliant, incredulous, transforming joy. Hilary paused, suddenly awkward; but next moment Mrs. Clare had seen and recognized her. The unfamiliar face returned, quietly, to familiarity. It was then that Hilary recalled hearing her say once, in her low peaceful voice, “Sometimes he gets back to England at short notice, and just appeals. I never really know.”
There seemed nothing to say, but Mrs. Clare, as was her way, seemed to require nothing. She said that Hilary had come in at just the right moment, for she had been about to make tea. Hilary said it was just what she had been longing for—which, she discovered, was true—and went up to take off her things.
Chapter Four: “IF HE DIES—”
THE PREMATURE BABY WAS DEAD. It had breathed, imperceptibly, through half the night in its oxygen tent, looking, through the transparent cover, like a wax doll in a glass case. In the small hours its heart had failed, and it had died without a movement or a sigh of protest, with no sign at all except a faint blue shadow on the skin.
Hilary went up to the women’s ward and spent a few minutes with the mother. They talked softly, because the beds of the other women were not far away. Like her child, the mother did not protest. She received Hilary’s consolations meekly. Hilary took, for a moment, her thin rough hand, and felt ashamed of the strength and vitality of her own as if she had offered some insulting ostentation. The mother pressed it, timidly and politely.
Hilary went slowly downstairs. Habit made her able to shift such things quickly from the surface of her mind, to confine them in protective formulas. Beneath the surface they still worked inward, coloring her mood. She had only one more patient here to see; the Fleming boy. The X-rays were ready in the Matron’s office; holding them to the light, she saw a faint something which might have been a fine frontal crack. At all events, nothing gross. She had better take one more look at him, before putting in the call to Dr. Lowe. And that, she thought, will be that. She crossed the hall to the single ward, and went in.
Nurse Jones was engaged in giving the patient his midday drink. She had fixed him up quite correctly, high enough to swallow but not high enough to disturb him, and was holding a feeding-cup of Benger’s, taken from a neat little tray with a clean traycloth. She was, Hilary reflected, a conscientious girl. She had not heard the door open, and was coaxing prettily; for all the world, Hilary thought, like a nurse in a film.
“Now come along, Mr. Fleming. Just a teeny drop. You won’t pick up, you know, if you don’t take your dinner
, now will you?”
The Fleming boy seemed inattentive to all this. He was looking past Nurse Jones and across the room toward the door. Hilary smiled at him, and opened her mouth to speak; but checked in her forward step, because his face had undergone no change at all. At this moment, Nurse Jones popped the spout of the feeding-cup into his mouth; he muttered something blurred and indistinguishable, and moved his head away, so that part of the liquid spilled. Nurse Jones said, “Now, please, Mr. Fleming,” and mopped his chin with the diet cloth.
Hilary shut the door behind her, and went up to the bed.
“Julian. How are you?”
She spoke loudly and clearly, almost into his ear. His face was stupid and slack; the loosened jaw took from it even the vacant beauty of a mask.
“Julian.”
His eyes focused for a moment; dimly and fleetingly, the look of personality returned. “I’m—all ri’. Good night,” he said, laboriously, and shut his eyes.
Hilary turned round. Nurse Jones was regarding her with wide-eyed curiosity.
“How long,” said Hilary levelly, “has he been like this?”
“Well, really, till just now he hasn’t been difficult at all. He took his Bovril at ten with hardly any trouble, and since then he’s been sleeping every time I’ve been in to him. I just woke him up for his dinner. I think really he’s a bit sleepy still.”
A bit sleepy!” Hilary felt her voice rising, and forced it down. “I want his pulse chart, please.”
Nurse Jones fished it out from the box that hung on the foot of the bed. The last entry was for ten o’clock.
Hilary took the wrist which lay inertly on the counterpane. His pulse was a bare fifty; his respirations about twelve to the minute, against a norm of twenty. The chart said sixty-two and sixteen.
“This pulse has been falling steadily since eight this morning. Why hasn’t the chart been kept up?”
Over Nurse Jones’s candid face spread a look of relief and virtuous rehabilitation. “Sister said two-hourly would be enough today, as he was so well. It isn’t quite twelve; I was just going to do it.”
“All right, Nurse. I see. Another time, always report if a head injury gets drowsy. Where can I find Matron?”
“I’m afraid she’s serving dinners now, Dr. Mansell.”
“Never mind. Get this ready, will you, and give it straight away.” She wrote on the chart. “Nothing more by mouth, he may not be swallowing.” She crossed the hall and picked up the telephone.
“Give me trunks, please.”
The inevitable delays followed. At last the jar of the picked-up receiver, and a brisk time-pressed voice she knew.
“Mr. Sanderson’s house surgeon speaking.”
“Oh, George, is that you? Hilary Mansell here. … Yes, of course, where else would I be? … Like a duck to water, and what about you? … No? Congratulations, George, well, we could all see it coming. Listen, how are you off for beds? … Yes, I know, but I’ve got to have one. This is a subdural. Acute. … Yes, every indication. I’ll give you the history in a minute. How soon will the theater be free? … Ye-es, I suppose so, just, if it’s no longer. He’s been getting drowsy since ten this morning, the fools didn’t tell me. … Yes, but that’s about all you can say. Do you want to take anything down for the Chief? I’ll be coming in with him myself. … All right—ready? Man, aged 23, thrown while riding about 3 p.m. yesterday. …”
When she had finished, found the Matron, informed and calmed her, she came back to the telephone again. Now, for the first time, she hesitated. The Matron was just disappearing.
“Oh, Matron, before you go—has his mother been to inquire after him today?”
“She rang up this morning. Sister brought me the message. I didn’t commit myself to any improvement, I’m glad to say. Comfortable, I think I said, and condition much the same. That would have been at about nine-thirty, she was coming in this afternoon. … If only I hadn’t spent so long over those dressings this morning. Once the nurses see you do anything slipshod, they get so slack themselves you’ve got no check on them.”
“Don’t worry about it, Matron.” Hilary warmed to her; would she herself, she wondered, have hauled down her flag with so much grace? “They do sometimes slip by in the first stages; we had a few cases as advanced as this, and there was still just time—I hope the mother’s at home.”
“Yes, poor thing. If she doesn’t see him alive again …”
There was no reproach in her voice; but Hilary guessed that, left to herself, she would have let Mrs. Fleming in yesterday, and was remembering it.
“Perhaps she could go with the ambulance, if we kept it just—”
“No,” said Hilary. “The ambulance can’t wait” She took the receiver down.
The bell at the other end seemed to ring for a long time. Hilary imagined the sound filling a sunny morning room, and, out in the garden perhaps, a woman turning and crossing the lawn, in gardening gloves and an old, good hat; she would certainly wear a hat in the garden. … The receiver clicked.
It was Mrs. Fleming. Hilary announced herself, and came to the point quickly. When she had finished there was a silence. It lasted a second or so; to Hilary, the tension seemed endless. Then an even, held-in voice:
“And Dr. Lowe? What does Dr. Lowe say?”
Hilary gripped the edge of the telephone table. At any moment the ambulance would be here. All she could take seriously was that it might have to wait while she wasted time on a maddening side-issue.
“I had intended asking him to come over this afternoon. But in view of this development, I haven’t felt justified in risking the delay. I’m afraid it’s absolutely essential that your son should see a neurosurgeon—a brain specialist—immediately, and go where there are facilities for—”
“Then Dr. Lowe hasn’t seen him at all?”
“Mrs. Fleming, I’m sorry. I’ve the highest possible opinion of Dr. Lowe. But I’m afraid I must make it clear that this condition is very urgent; one of the most urgent in surgery. If we wait here for a consultation, it may be impossible for Mr. Sanderson to operate in time.”
Another pause; this time so long that Hilary began to wonder whether the woman at the other end had fainted.
At last, slowly and a little jerkily: “Very well, Dr. Mansell. When will the surgeon be here? I should like to see him.”
“I’m afraid it would be useless for Mr. Sanderson to come here, even supposing he could get away. He couldn’t do anything without his own theater and his own staff. In view of the urgency, I’ve sent already for the ambulance to take your son to the Clyde Summers Hospital, where his department is.”
There was a sharp indrawn sound. “To take him away? But that hospital’s in—it’s almost the other side of England. At a moment’s notice like this. It gives me no time to make any decision, to—”
Why, thought Hilary desperately, can’t I say as I’ve said a score of times, “My dear, I know how you feel, but you must trust me”? They always have. But I don’t know how she feels; and she’ll never trust me. There’s no time now for anything but the truth.
“I’m sorry to have to tell you this. But without an immediate operation I don’t think your son has any hope of living through the day. There’s bleeding going on somewhere inside the skull. Until it’s found and stopped, the pressure on the brain will go on increasing. That means that sooner or later, the vital functions, such as breathing, will stop. I should expect that to happen within twelve hours, at most.” (In her own mind, she had given it six.) “You understand?”
“Yes. Yes, I understand.” The voice suddenly changed; it grew febrile and desperate; and yet, it seemed to Hilary, the fear and distrust below it remained the same. “I’ll come just as I am. I’ll get a coat and come straight over, so that I can go with you. I can be there in just over half an hour.”
“I’m terribly sorry.” (Was that the bell of the ambulance, far along the road? She could see herself as this woman must be seeing her, a callous autom
aton. As if the image possessed her, she struggled to feel, and could feel nothing.) “I do so wish we could. But the ambulance is due any moment now. That half-hour might mean everything. A car will get you there almost as soon. Sooner, perhaps.”
“I see,” said the thin voice. Through the open window, Hilary heard the ambulance drive in. “Very well, Dr. Mansell. You leave me no choice. I find it hard to believe that things couldn’t have been managed differently.” The receiver clicked at the other end.
She went into the hall, where the men from the ambulance were bringing in their stretcher. As she went with them, to supervise the lifting, she thought, If he dies, as he well may, and if this woman has local influence, as no doubt she has, I can put my practice up for sale. The sooner the better. But the thought was as unreal to her as a dinner engagement for next week. She could only see the still face on the cotton pillow, darkened and shadowed, since yesterday, with a faint growth of beard that made it look, curiously, more boyish than before; and the unseeing eyes which, as she watched, closed again heavily as if sleep were pressing them down. When the stretcher had been settled on its racks, and she sat down beside him to feel his pulse again, his fingers closed vaguely on hers. It would be as well to know, she said to herself, when the reflex was obliterated. She took the pulse with her other hand.
Chapter Five: Is A Woman Surgeon Still A Woman?
THE ANESTHETIC-ROOM WAS STILL EMPTY. Reaching from the familiar places the mask, cap, and gown, Hilary almost expected to see Sanderson’s head lean out of the men’s changing-room and say, “You’d better scrub up, I think, Miss Mansell. Collett’s tapping a ventricle downstairs.” Familiar smells of warm ether and Dettol wafted in from the anteroom door. A bitter nostalgia filled her. She forgot, for a moment, why she was here, and felt only that she had been a fool to come.
The other door, the door behind her, opened, and the trolley came in.
He lay quite still under the thick scarlet blanket, his face composed. She stood watching him, while the ward nurse who had brought him picked up the band of the blood-pressure gauge and bared his arm to fasten it on. His lips parted in a long, slow, shallow breath. She realized that during all the previous interval he had not breathed at all. About four to the minute, she thought.