by Steve Low
On the way to Auckland – to the oral exam – the handwringer had the window seat. Most of the flight he presented me with the back of his head, as he stared earnestly out at the clouds. Periodically he would lean sideways and invite me to observe some landmark drifting by, thousands of feet below. I would peer past the awestruck Canadian, through the double glazing, and pretend to be amazed by the distant mountain chain of the Southern Alps, or the volcanoes of the North Island. In truth I felt like vomiting. The visual spread seemed remote and irrelevant. Tomorrow we would be in the gun. It was do or die. One false move, and with a stroke of the examiner’s pen, someone would be pulped – probably Gerry Davenport. The slack would be punished and deservedly so. It would be retribution from the Gods, for concentrating on Melanie East instead of the core texts. There was also the prospect of striking Nigel as an examiner. Normally this wouldn’t be considered a problem, for the man was known to be quite reasonable. Indeed he often guided the candidate towards success. However I felt I had offended him by backing Boatwood and it would probably be better to not to strike him on this occasion.
“There’s no smoke coming out today,” Handwringer said, almost penetrating the glass in his bid to sight Mt Ruapehu.
I grunted. “The only thing that’s gonna be smoking, is my arse – after the caning tomorrow,”
Handwringer looked across inanely before returning to the vista – immediately
becoming overwhelmed by the looming Lake Taupo. “It’s a giant volcanic crater,” he said. “I think the correct term is caldera, in the geological world.”
“Really,” I said. I longed for a cocoon of silence.
In Auckland, we checked into a plush Newmarket motel. Agitated, I paced amongst the white walls and tubular steel furniture, gazing absently at the etchings. Meanwhile, Handwringer unrolled his pajamas for an early night. As the door closed on my yawning colleague, I set out to revise the whole syllabus in four hours. I took nothing in, but consumed many cups of coffee, thus ending the evening with a wretched stomach.
In the morning the Handwringer came to his senses and showed a few frayed nerve endings. We snapped at each other over the Weet-bix. The ball-cock system failed in the latrine, after it had received many visits by us both. At eight-thirty, two sub-humans jerked their way down Newmarket road. Once again, I was struck by the bizarre juxtaposition of these two hyper-stressed individuals, mingling with all the lucky ones – those who didn’t have an exam that morning. I envied the taxi drivers honking their horns, the shoppers stopping to browse at windows, and the power dressed executives striding confidently towards their places of work.
“Give me an ordinary life,” I said. The Handwringer was too choked up to reply.
At the hospital outpatient department, we were absorbed into the melee of candidates. Boy Wonder grinned amiably in his broadcaster’s jacket. We were placed on stools outside examination booths. I sat astride the stool, my mind a washing machine inside my skull. I gazed at my blanched hands as they writhed about, seemingly independent of central neural control. The bell rang and I bolted through the white door, like a gunshot.
Inside, on a bed, rested an old man with inch thick glasses and wayward grey hair. I introduced myself. There was only a blank stare in return. I asked the silent one what had brought him to hospital. Ah yes, an ambulance. Of course, what a fool I was. That classic time waster. Well at least he can speak. Time for the direct approach. What’s wrong with you? What’s your illness? The grey one suddenly became animated, his face breaking into a toothless grin.
“That’s what you’ve got to find out, isn’t it?”
My heart sank. I looked at his watch. Twenty two minutes to go. Please Gods. Come on you old fart. I haven’t got much time.
“I’m diabetic.” It was spontaneous – unasked for. It saved the day. I pumped the patient for the key points. Cataracts, angina, hypertension, ankle ulcers and an infected toe. Drugs: insulin, hydrochlorothiazide, metoprolol, a nitrate and flucloxacillin. I got up really close and peered into the eyes with an opthalmoscope. I could have wept with joy at the classic retinopathy in the right eye, and the cataract obscuring the left. The painless ulcer was malodorous, but I didn’t notice. It was painless and that was the key. Peripheral neuropathy! I had all the pieces tothe puzzle. The examiners nodded approvingly when I presented my findings. One of them unrolled an ECG for me to examine. It was left bundle branch block.
“Too easy,” the examiner said, ramming a chest Xray into the viewing box.
“Left ventricular enlargement,” I said. “Fluid in the bases. Kerley’s B lines.”
“You’re a winner,” the examiner said, with a smile. “By the way, did you find him easy to talk to?”
A fortuitous train of thought led me through the triumvirate of halting delivery, forgetfulness and poor concentration, linking in the history of alcoholism, with a probable hyperglycaemic attack and thiamine deficiency. “Wernicke-Korsakoff,” I announced and left the room triumphant.
Back out in the foyer, the Handwringer was ashen. His lips trembled as he regaled his story. He had gone into the booth expectantly when the bell rang, to find his patient dead. Rather than commence resuscitation, he had rushed out yelling for this and that and generally not displaying the cool head the examiners might have hoped for.
“Well at least you didn’t have to take a history,” I humoured him. “I’m sure they’ll take into account that you were thrown a bit, by encountering a dead man on the examination bed.”
“I hope so. After my panic attack, the examiners rushed in and we did CPR on the lady. . . for twenty minutes. When it was clearly no go, we left the corpse, and they grilled me about the new thoracic pump theory of CPR. The trouble was I got it mixed up with the chest compression theory. One of the examiners got angry and started thumping the desk.”
“Oh,” I said.
In the afternoon, we gathered on the fifth floor of the medical school. We were to face two half hour oral examinations. These were the big ones. The morning’s skirmish with a patient counted for little. The hard edge of cross examination was about to begin. I slumped in a chair, waiting for the bell. My diaphragm traversed against a tense resistance; the abdominal wall rigid and unyielding. Spherical bubbles of stomach gas, seeking escape, burned my throat.
The shrill of the bell, cut like a knife. I stumbled to the room, limbs stiff. Rigor-mortis before death. I looked up to the examiners – two of them – Benign and Sanguine. Benign commenced, his half lidded eyes blinking repeatedly, as he fixed on the target. It was easy at first. I was hesitant, but covered the ground quite competently. Sanguine did everything but tell me the answers, almost apologising if I fell short of the mark. The bell rang and we all shook hands and smiled, Benign becoming effusive, Sanguine metamorphosing into a real enthusiast.
Back out at the halfway station, I had mixed feelings. They weren’t going to lull me into a false sense of security. Handwringer was looking at his feet and hyperventilating. A flask of chilled water sat untouched between us.
“Who did you have?” I asked. It wasn’t idle curiosity. I would be facing them next.
Handwringer looked up, his eyes dilated and unfocused. “Nigel and Black Jeremy,” he said.
I felt the strangling of my distal gut. Was it possible to feel any worse? Black Jeremy was renowned as an examiner who was inclined to make the candidate squirm,
The ringing of the bell jolted us both. I made a face for Handwringer as we rose. The pasty faced Canadian seemed to look right through me, so removed was he from his physical surroundings. Clumsily he made for his door, like a drugged psychiatric patient with extrapyramidal symptoms. And I, feeling as though I was observing myself from outside my body, plunged through the designated door, and crossed the miles to the desk. Nigel jumped up, his face animated, his greeting effusive. Black Jeremy didn’t bother rising. “Sit down Doctor Davenport,” he said. “Tell me about your favourite ventilator,” he continued, as I struggled with a chair. I commenced my ans
wer, looking into the examiner’s dull black pupils. I couldn’t help but notice the large twisted earlobes, the triple chin, the huge gut upon which he rested his arms. As I described the Siemens Servo C ventilator, I had a brief surge in well-being. I classified it, discussed its power source, described the electronic and pneumatic units, outlined the monitoring functions and evaluated the ventilation modes. The competence of the delineation filled me with temporary solace. Even Black Jeremy seemed beguiled by the flow of words, as I dealt with the application of the ventilator to various patient management scenarios. The first fifteen minutes seemed over, as soon as it had begun. Black Jeremy raised his hairy eyebrows and nodded to me, perhaps indicating that this time, I had thwarted his black heart.
I looked expectantly at Nigel, waiting for the second fifteen minutes to begin. He had his eyes screwed tightly shut, and head bowed. There was a prolonged pause as we waited for the first question. Black Jeremy seemed nonplussed by the delay as well. At last Nigel spoke. “Tell me about plasma cells?”
The question was a surprise. It was peripheral to intensive care medicine. However it could conceivably have been a lead in to something more relevant. Therefore I set about the answer without great concern. “Plasma cells are leukocytes involved with the production of antibodies,” I said. “They are a mature by-product of the B lymphocyte lineage.”
Nigel wanted to hear about plasma cell disorders.
“Disorders?” I said, looking away from the interrogator to gather my thoughts. There were few thoughts to gather up. “Disorders result from overproduction of either the cells or their by-products. Examples of this include multiple myeloma and amyloidosis. These diseases may impact on intensive care services because of their involvement in organ system failure, or through failure of the immune system allowing opportunistic infection.” In my peripheral vision, I could sense Black Jeremy nodding, but Nigel was looking annoyed.
“You haven’t mentioned underproduction. A malignancy of lymphoplasmacytoid cells that secrete Igm – who described that?”
I had no idea. I shook his head.
“Waldenstrom,” Nigel said colourlessly. He cracked his knuckles slowly. “How does it manifest?”
Beads of sweat broke across my brow. I shuffled about in the chair, my eyes dancing about, as if to find shelter. There was none. The walls were unfriendly. There were years of sterility, baked into the surface.
“Overproduction of Igm, effects organ system function and allows acute infection. Other plasma elements may be swamped.”
“May . . . be . . . swamped?” Nigel said. He closed his eyes and held his head in his hands. He reached for a glass of water.
“There may be lytic lesions in bone,” I said, hoping it was similar to multiple myeloma.
Nigel’s face came up, as if to look at me, but the eyelids were down. “Well, like myeloma, the disease involves the bone marrow,” he said. “But unlike myeloma, it does not cause lytic bone lesions.” The eyelids came up. His eyes appeared just like Handwringer’s had, a few minutes before. They appeared to look right through me.
“What I wanted you to describe,” Nigel said, “was the Hyperviscosity Syndrome of Waldenstrom’s Macroglobulinemia.” He gazed at me for a few long seconds. “What are the units of viscosity?” he asked.
“I’m sorry, I don’t know,” I said. My back felt warm and clammy.
Black Jeremy laughed suddenly. His earlobes waved like paddles. “There’s no point apologising to us,” he said, leaning back and placing his hands upon the considerable midriff.
“It’s not a measurement we use clinically,” I said, feeling annoyed.
Nigel ignored the remark. “What is the risk of renal impairment in such a case?”
I realised I was doomed. Nigel was going to flog the question to death.
“Quite high,” I guessed. “The Igm is secreted into the renal tubules, resulting in stasis of tubular flow.”
Nigel almost smiled. “No . . . quite wrong. The molecular weight of Igm is too high for renal secretion . . . What percentage of macroglobulins are cryoglobulins?”
I could barely focus on the question. Nigel was way out of line surely? These ‘facts’ were of no relevance to good intensive care practice. “Fifty,” I said ,my face burning up in resentment.
“Ten,” Nigel said. “What would you see in the optic fundi of such a patient?”
The bell rang. I rose from his chair. Black Jeremy laughed. “Too late, to be saved by the bell,” he said.
Out in the foyer Handwringer waited, his face a lopsided grin. My head was in a spin. The lining of my brain seemed to be smouldering. “Come on,” I said, pointing at the stairwell. We descended the five floors to the street, our voices echoing up and down the shaft.
Handwringer was astonished at Nigel’s line of questioning. “That’s not fair at all,” he said. “They’re not supposed to hammer one topic like that – especially one so peripheral to the job. They’re supposed to open a new subject, if you are struggling.”
“Nigel was bizarre. He was like a dog with a bone. Anyway he’s blown it for me. I’m out. The writing is on the wall.”
Out on the street, we walked along aimlessly, discussing our own personal misfortunes. We crossed the Grafton bridge, heading roughly for the city centre. “This is where Aucklanders come to commit suicide,” I said. “Right now I might as well join them.” Handwringer didn’t respond. He wanted me to accompany him to view the city art gallery, to help kill the time before we collected our results at six. I opted to wander solo instead. I knew my prospects of success were very slim. I needed to start the grieving process right away. That would not be possible, while partaking in superficial parlance with Handwringer. I ended up in the docklands. The sea, a turquoise and grey slop smacking the undersides of the wharf, had an odour of fish scales, oil and rust. Overhead cranes, derricks and flagpoles split the sky. I leaned against a railing and disconsolately watched the rock and roll of the sea. All that study time wasted. The spectre of failure sat heavily in my gut. I sought refuge in meditating about aspects of life that might have greater meaning than the exam failure. I dwelt on Melanie and how such powerful love appeared to have great meaning. Such a great force must surely be totally relevant. This train of thought wilted as I walked. Melanie and I were estranged and our travails seemed distinctly earthly and basic. Leached of spirit, I meandered up the hills to the hospital. I looked at my watch. Five o’clock. One hour until the results were to be posted. I slid into the resident-doctors’ quarters. I had stayed there once before, during a study course. The corridors were angular, closed in, dimly lit. I knew where I was going – to the showers. I threw everything off onto the floor. I ran the water with searing heat. The brutal rain scorched my back. I flung my head back, sending my scalp to a premature perdition. A stifling humidity infiltrated the cupboard sized room. Insentient, I stood in suspended animation, cushioned from the approaching doom. Just before six I roused, and shut down the steaming water. I stuffed himself into my clothes. Outside a foreboding wind tore at the kerb-side pepper trees. Like a spinnaker, my open jacket propelled me towards the antiseptic building.
On the fifth floor we stood and waited. The confident ones chattered rabidly, impatient for the triumph that was deservedly theirs. The uncertain ones were stricken, hunched over in their own personal agony. Handwringer and I were propped up against a wall, in silent companionship. I could see Boy Wonder amongst the confident group. There was an occasional flash of teeth, as the complacent one entertained another notion of personal success. A door opened and a balding man in faculty robes appeared carrying a sheet of paper. The atmosphere was electric. It was all slow motion for me. Images of the fateful moment, were laid down indelibly in my mind. The list of successful candidates, was taped to a bare white wall. We all rushed forward, craning to see if our candidate numbers were posted. The whoops and shrieks of the vanguard cut the air. Fists were raised in triumph. I arrived at the wall, almost in a fugue state. It only took
a second. There were eight numbers. 256 wasn’t among them. I knew I was going to fail, but even so, the reality of it left me punch drunk. Tears welled without control. I had to get out of that place. I thrust aside the grinning victors, to seek the sanctuary of the stairwell. I clattered down the stairs, two at a time. Outside the darkling sky enclosed me, like a mother’s cloak around a grieving boy. I ran and ran, faraway from the cruel tower block, where the victors would be sipping sweet sherry with their examiners. When I stopped running, my body convulsed and shook, the realisation of failure too much to bear. Head swollen with grief, I stumbled through dark streets, oblivious to the malevolent surroundings. Back in Newmarket, the Saturday night crowds didn’t notice this solitary tragic figure passing amongst them. My slow burning hell, was swallowed up by the human tide – the carefree masses.
On the Monday in my hospital mail box – an unaddressed envelope. Absently I ripped it open. There was a single photograph. It was myself and Melanie, caught outside the Governor’s Café. We were close – staring at each other. My hand was reaching out to her face, fingers outstretched. I turned it over. There was no message.
Eleanor was ironing when I got home. I flopped into the beanbag. The turmoil in my life – it all burned deep into my skull like a cavitating soft nose bullet. Eleanor was almost within touching distance, yet I felt totally alone. My gut seemed to involute, as if in intersusseption. My body felt tremulous, but my limbs were still. I looked up at Eleanor. I watched the hot iron race across the pleats. Hot air, bubbled through the distilled water. Steam under pressure, hissed into the room. The years of frustration rose and jammed in my throat. She glanced at me at that moment. What she saw was almost certainly startling. She would no doubt always remember that moment. The look I must have had - the physical declaration of resentment.
“What’s the matter with you?” she asked.
I began to talk and by the end of that speech my marriage was over.
I met Melanie in a pull off area on Queens Road. It was 10pm and dark. We held each other but I knew immediately it too was over. She had been ‘woken up’ by the reality check our philosophical differences had produced. It wasn’t great with Rikki and she’d gotten involved with me as a consequence, but that didn’t make it right. When I told her about the photograph and the aggressive driving of a Volkswagen car she went pale.
“God, I’d better go home and do some fast talking,” she said.
Before we parted she grabbed my lapels. “I know it’s hard for you Gerry,” she said. “But you’re free now. There’s nobody to hold you back now. Don’t be tempted to try and go back to Eleanor – to seek comfort – just because your life is in turmoil. You must move on now that you’ve made the break. You can really live now.”
My mood softened with her words. I could hear that she really cared about me. She asked me where I was going to stay. I intimated with Isobel – but I wasn’t sure of a warm welcome from Junot.
We were both very emotional on parting. I stumbled to my car convulsed with grief and drove away fast. Soon I recollected her words. ‘You can really live now.’
“Yes,” I yelled, and thumped the wheel. “This is really living. I’ve lost the woman I love . . . but apparently . . . I’m really living!” The words died amongst the fabric of the car.
I lay in the spare room of Isobel’s flat. My head spun with orbiting memories. A broken Isobel outside her flat with her arm around my waist - the angry figure of Melanie in my rear vision mirror striding off into the night - the Volkswagen of Rikki East, lining me up on a deserted street - the line of questioning of Nigel Green and his determination to bring me down - the excited voices of the successful examination candidates - the haunted look of Eleanor, as she assimilated the bombshell. I sweated – a dampness in my hair. It soaked down my neck and onto the pillow. With a single kick the duvet flew off. I ripped my T-shirt up over my head. I lay there panting, naked, my skin a swirl of goose-bumps in the sudden freshness.
Half past two, and at last Isobel came. The montage of failures rotated away, through foramena, into unknown recesses of the brain. I was upright in a flash.
“He’s deeply asleep now.” she whispered.
I dressed quickly, closed my case, picked it up and edged quietly out the door. Isobel’s belongings (those that she was taking) were already pre-loaded into the boot of her car. We passed the partially open door behind which Junot lay sleeping. His breathing was slow and regular, aided by the drugs we had bandied around at the end of the evening. Isobel and I had pretended to take the drugs. Isobel placed an envelope on the hall table. It would be a shock for Junot in the morning, but we both knew he wouldn’t have any trouble moving on.
Outside much of the cityscape was invisible. It was black as ink. Across the bay in Ravensbourne a car head-light stabbed at the night. A comrade was out there, cowering below the shrouded cosmos. We didn’t start the motor but slid away down the slope of the street in neutral. At the corner Isobel switched on the headlights and glided around into the next street. The road fell away steeply down towards Andersons Bay. She crash started the motor and the car jerked into life.
BOOK 3
Chapter 1
