by A. J. Cronin
“I simply must see your sister.” I made the statement with a certain desperation.
He did not answer. Wiping his lips with his floury cuff, he gazed at me with a sorrowing smile.
“You can do it, you know,” I went on. “ I’ll wait here while you go back to the house and tell Jean to step out and meet me.”
Still quiet and pitying, he shook his head.
“Jean’s not at the house. She’s away.”
I stared at him, motionless, while slowly he nodded his head.
“It’s well seen you don’t know Father. She was sent off last night to our Aunt Elizabeth in Bethnal Green. She’s to stay there, studying, for the next four months, until she sits her exam again.” He paused. “And Mrs. Russell, that’s our aunt, has instructions to open all her letters.”
Bethnal Green, a suburb of London, more than three hundred miles away—destination impossible of achievement by the villain Shannon. And no letters, by request! Oh, wise, resourceful Daniel. In fact, a Daniel come to judgement. I sat there, quite still, but my eyes fell wretchedly.
There was a protracted silence from which I was roused by the voice of Luke as, in a sympathetic manner, he inquired:
“Would you like another beer?”
I lifted my bowed head.
“No, thanks, Luke.” At least he meant well. “And that reminds me. You want your bike back.”
“Ah, there’s no hurry.”
“Yes, you must.” I saw he was protesting only for politeness’ sake. “It’s in the lane at the back of your house. I took good care of it. Here’s the key.”
He accepted the ignition key without further demur; then we got up and went out. In the street, after a glance up and down, he shook my hand with a kind of melancholy comradeship. I set out to walk to the station.
The rain was falling more heavily now, running in the gutters, plastering the narrow thoroughfare with mud, making everything grey and miserable.
Oh, God, I thought to myself, in a sudden access of heartache, what am I doing in this dreary and forsaken little town? I want to be in the sunshine, away from this mess, uncertainty, and endless striving. I’d like to be on a dubbeh, floating down the Nile, or on the bright hills of Sorrento, basking above the blue Tyrrhenian Sea. No, damn it, I’d rather be in the fog and grime of Bethnal Green.
But I knew I could not be there.
Chapter Eight
After that, everything fell on me at once … but I will try, calmly, to keep the sequence. I don’t intend to harp on my state of mind. It was like the weather, which continued with incessant rain and blustering equinoctial gales that tore from our trees leaves and twigs not yet dead, strewing a sodden litter upon the drive.
We were now extremely busy in the wards, mostly with diphtheria cases—an epidemic of this disease had developed in the western district of Wintonshire. I’d had this infection myself, a circumstance which, I dare say, gave me a fellow feeling for the children who came in with it. So far, we could boast of a clean sheet, not a single death, and Miss Trudgeon proudly paraded about the place as though she, personally, were responsible. And perhaps she was—her efficiency impressed me more and more, and in my heart I had begun, unwillingly, to admire this conscientious, capable, indomitable little war horse, whose hidden qualities far outweighed her obvious, and less attractive, attributes. But I took care not to tell her so. In my present mood I was sullen and rude to everyone.
Then, on the night of the third of November—this exact and fatal date is inscribed indelibly upon my recollection—I came back with bent head and flagging steps from the pavilion to my quarters and flung myself into a chair.
I hadn’t been there ten minutes before a persistent buzzing struck my ear. It was the telephone on my bedside table, the bell sounding faintly because I had forgotten to throw back the switch before leaving the pavilion. I went into the bedroom and wearily picked up the receiver.
“Hello.”
“Hello. Is that you, Doctor? I’m right glad to have reached you.” Despite the bad connection, the relief in the voice was evident. “This is Duthie, Alex Duthie, at Dreem. Doctor … Robert … you must do something for me.”
Before I could answer he went on:
“It’s our Sim. He’s been sick for a week with diphtheria. And he’s not getting on. I want to bring him over to you at the hospital.”
I did not hesitate an instant. We were already full and Alex, living across the border of the county, had no call upon our resources. Yet I couldn’t dream of refusing him.
“All right. Get your doctor to sign a certificate and I’ll send the ambulance over, first thing in the morning.”
“No, no.” His voice came back quickly. “The boy’s right bad, Robert. We have a car at the door, and he’s all wrapped in blankets. I want to fetch him to you now.”
I wasn’t sure that it was correct to make this irregular admission, on short notice. However, because of my deep regard for Alex, I had to take the risk.
“Go ahead then. I’ll expect you in about an hour. See you keep him warm on the way.”
“I will. And thanks, lad … thanks.”
I replaced the receiver and went along the corridor to the matron’s room. Here, however, the lights were out and I was obliged to press the night bell, which summoned Sister Peek. When she arrived I gave her curt instructions to prepare a cot in the side room of Ward B, a comfortable little annex usually reserved for private patients and now the only space remaining unoccupied. Then I sat down to wait.
It was not a long vigil. Shortly before midnight a closed hired car drove up to the front entrance, and as I pushed open the door against the wind and heavy, driving rain, Alex appeared carrying his son, all bundled up in blankets, in his arms. I showed him into the reception-room. His face was white and drawn.
When he had deposited the boy upon the couch, where Sister Peek began to prepare him for examination, Alex wiped his forehead with the back of his hand and stood aside in silence, fixing upon me a look of haggard inquiry.
“Don’t look so worried. When did Sim take ill?”
“The beginning of the week.”
“And he’s had his antitoxin injections?”
“Two lots. But it hasn’t helped him much.” Duthie spoke faster. “It’s deep down in the throat. When we saw that every minute he was getting worse, I just had to bring him over. We have faith in you, Rob. Take a look at him, for pity’s sake.”
“All right. Don’t get excited.”
I turned towards the couch and immediately the reassuring expression which I had assumed for Duthie’s benefit left my face. In fact, as my gaze fell upon the livid child who, with closed eyes and clutching hands, was fighting for every breath, I received a painful shock. Silently, I went on to examine him. The temperature was 103, the pulse so thin as to be almost imperceptible. I did not try to count the respirations. A tough yellow membrane covered the back of the throat and extended viciously into the larynx. The child was clearly in extremis, already almost moribund.
I glanced at Duthie, who, standing mutely by, was trying, with even greater anxiety, to read my face; and although moved by pity, I felt a sharp anger against him for the predicament in which he had placed me.
“You should never have brought him out. He’s desperately ill.”
He swallowed dryly.
“What like’s the matter?”
“Laryngeal diphtheria. The membrane is blocking the windpipe … keeping him from breathing.”
“Can’t anything be done?”
“Tracheotomy … and at once. But we can’t do it here. We’ve no theatre, no facilities. He should have been moved to one of the big city fever hospitals long ago.” I moved across to the telephone. “I’ll ring up the Alexandra now and make arrangements to get him in at once.”
I had begun to dial the emergency number when suddenly the child began to crow, a thin, desperate stridor which rasped and echoed in the room.
Alex pulled at my arm.
> “We’ll never get him to another hospital. God knows it was bad enough coming here. You do what’s necessary yourself.”
“I can’t. It’s a job for an expert.”
“Go on, do it, do it.”
Arrested, I stood staring at him, in a startled and helpless manner, like a fool. As I have explained elsewhere, I had the most limited experience in the practice of medicine, and had never attempted a serious operation in my life. From the clear heights of pure science I had always affected to despise the bustling practitioner who, in a pinch, would tackle anything. Yet there was no denying the dreadful urgency of this case. It was, indeed, a question of minutes—for I now perceived that if I evaded the issue, on the pretext of transferring the case to the Alexandra, the child would never reach that hospital alive. Aware of my own hopeless inadequacy, I groaned inwardly.
“Get Matron up.” I turned to Sister Peek. “And move the patient over to the side room at once.”
Six minutes later we were in the side room, Miss Trudgeon, Sister Peek, and myself, gathered round the plain deal table upon which, in a clean hospital nightdress, lay the gasping form of the unconscious child. Apart from that convulsive breathing there was dead silence in the cramped little room. I had rolled up my sleeves, washed my hands hurriedly in carbolic solution, and now I was in such a mortal funk, I glanced instinctively, incredibly almost, towards the matron for support.
She was admirably calm, impersonal, efficient, and, although she had just awakened from sleep and thrown on her uniform at short order, correctly dressed. Even her starched headdress was adjusted so that not a hair seemed out of place. Despite the feud between us, I couldn’t suppress a surge of admiration, and of envy too. She knew her job inside out, and her courage was superb.
“You won’t want an anæsthetic?” she asked me in an undertone.
I shook my head. The state of the breathing simply wouldn’t permit it. In any case the child was too far gone.
“Very good, then,” said Miss Trudgeon, cheerfully. “I’ll take the head and arms. You steady the legs, Sister Peek.”
As she spoke she handed me a lancet from the square of white gauze in the enamel basin and, staunchly setting herself at the head of the table, took a firm grip of Sim’s arms. The night sister, in a wobbly fashion, grasped the boy’s ankles.
Although doubtless it was only for an instant, it seemed to me that I stood there, with the knife in my inept and nerveless hand, for a timeless eternity.
“We’re all ready then, Doctor,” the matron reminded me and, believe it or not, there was again a firm encouragement in her tone.
I took a deep breath, clenched my teeth, and, holding the skin tense, made an incision in the child’s throat. The blood oozed thick and dark, obscuring the wound. I swabbed, again and again, and cut deeper. Sim was unconscious, and felt nothing, I am sure; yet at every touch he writhed and squirmed on the table in a kind of feeble agony. At the same time there came, intermittently, that frightful heave for breath, which convulsed all his body, as though he were a fish, gasping upon a slab. These sudden uncontrollable movements increased my difficulties. I tried to get a retractor into the opening. It went in, but immediately fell out and went clattering to the floor. Then the blood welled thicker, not a bright, spurting stream which I could have controlled, but a slow treacly flow which choked up everything. I couldn’t use the lancet any more. I was too near the great vessels of the neck. One false snick and I would sever the jugular vein. I tried with my forefinger to part the tissues, muddling about in the mess, seeking desperately for the trachea. If I didn’t find it quickly it was all up with Sim. He was almost black in the face now. His efforts to get air, which sucked in all his ribs, and breastbone, till his small white chest was hollow, had a more frantic quality, but were less frequent and more feeble. There were long intervals when he didn’t breathe at all. Already his body had a cold and clammy feel.
The perspiration burst in great beads upon my forehead. I felt so sick I thought I was going to faint. I couldn’t find the windpipe, I simply couldn’t, and the child was almost gone. Oh, God … for Christ’s sake … help me find that trachea.
“No pulse, now, Doctor.” It was a soft, reproachful bleat from Sister Peek who, from time to time, had laid her fingers on the boy’s wrist. But still, at the head of the table, the matron never said a word.
I don’t know what came over me—with the courage of despair I took the lancet and cut deep. Suddenly, as by a kind of magic, there sprang up in the wound, thin, white, and shining, like a silver reed, the object of my blundering, frantic search. My own breast gave a great convulsive heave and, dashing the perspiration from my eyes, I slit the exposed trachea. Instantly, there was a whistling inrush of free air, a blessed draught which filled those choked and suffocating lungs. Once, twice, the starved chest heaved deeply, to its full extent. Again and again, in a kind of ecstasy of relief. Then, slowly, at first, but with increasing force, the moribund child began regularly to breathe. The dusky tinge faded from his skin, the bluish lips slowly turned to red, he ceased to struggle.
Quickly, with trembling fingers, I slipped in the double tracheotomy tube, sutured a few small bleeding points, stitched up the wound and bandaged it so that the narrow metal orifice of the tube protruded. My knees were knocking under me, my heart bumping against my ribs, and the worst of my agitation was that I had to hide it. I stood limply by, damp and dishevelled, with bloodied fingers, while Matron expertly tucked Sim into the side-room cot, with hot bottles round him and his head well-pillowed.
“There now,” Miss Trudgeon remarked at last. “ He ought to do very nicely. You’ll take over this case, Sister, and special on it all night.”
As she swung round to go out, she gave me a quick half-glance, neither of approval nor disapproval, as though to say: It was touch and go, but you came out of it better than you deserved. For the first time we understood each other.
Even when Matron had gone I could scarcely bring myself to leave. Sister Peek had drawn up a chair to the cot, with a tray of swabs handy to clear the mucus which occasionally bubbled in the mouth of the tube, and behind her I remained watching the boy, now resting, a good colour in his cheeks. From sheer exhaustion he had begun to drowse, but suddenly, briefly, his eyes opened and, by a strange chance, encountered mine. For an instant he smiled, at least a shadowy suspicion of a smile faintly moved his lips. Then his lids drooped and he was asleep.
Nothing could have so deeply moved me as that tremulous and childish smile. I could have wished no greater reward.
“I’m going now, Sister,” I said in a matter-of-fact tone. “You know what to do?”
“Oh, yes, Doctor.”
Only as I went out did I remember Alex Duthie, still waiting in the reception-room, and at the prospect of ending his suspense I increased my pace, under the bright and singing stars. Yes, he was there, seated stiffly in a hard chair, facing the door, holding his cold and empty pipe, as though he had not stirred since we had left him. When I entered, his attitude became more rigid, then he rose, confronting me in silence, his eyes burning with the question he could not bring himself to utter.
“He’s all right now.”
So set was his expression, he could not immediately relax it. I could see the sinews of his jaw muscles drawn tautly under the skin. Then, all at once, his mouth began to twitch. He said, at last, in a low voice:
“You did it?”
I nodded.
“Now he can breathe. In fact, he’s asleep. When he’s got over his diphtheria, in ten days or so, we’ll take out the tube and the wound will heal up. There’ll hardly even be a scar.”
Duthie took a step forward and seized my hand, wrung it so gratefully, with such fervour and feeling, he made me flinch.
“I’ll never forget what ye’ve done for us this night. Never, never. I told you we had faith in ye, the wife and me.” Mercifully, he relinquished my crushed fingers. “ Can I ring her up? She’s waiting at the farm manager’s house.�
�
A moment later he was in the hall, relating the good news, inarticulately. When he had finished I rejoined him, went out with him to the hired landaulet, beside which the forgotten driver, his cap pulled over his ears, patiently paced up and down.
“All’s well, Joe!” cried Duthie in an uplifted tone. “ The young-un’s ower the worst.”
In his gratitude the good fellow leaned through the window, his voice tense with feeling.
“I’ll be over to-morrow, lad, and bring the missus. And again … from the bottom of my heart … I thank ye.”
When the car had gone I lingered in the cool, windy darkness. Then, as I heard the clock in the vestibule strike one, I made my way rather dizzily to my bedroom. I was so confused I didn’t want to think about anything. I only knew that amidst my disappointments and perplexities there was a queer peace in my heart. I fell asleep almost at once, thinking, of all things, of Sim’s smile.
Chapter Nine
I must have slept for about four hours when I was again aroused, and forcibly, by someone tugging at my arm. I opened my eyes to find the light full on and Sister Peek at my bedside, with a stricken face, exclaiming hysterically in my ear:
“Come at once … at once.”
She almost pulled me from the sheets and, as I struggled into my coat and slippers, I realized, though half awake, that only a catastrophe could have caused this shrinking creature to burst into my room in such a fashion and at such an hour. Indeed, she seemed almost at her wits’ end, and as I set out beside her, half running, towards Ward B, she kept on repeating, like a lesson she had learned, while she scurried along:
“I didn’t do it. I didn’t do it.”
In the dim, warm side room Sim was lying back upon his pillows, propped up as I had left him, very peaceful and quiet. Yet he seemed unnaturally still, and as I knocked the shade off the night-light and peered closer I saw, with a start, that the shining orifice was missing from his bandages, the tube was no longer in his throat. Hastily, I snatched up a pair of forceps and cleared the plug of mucus from the wound, then, taking hold of his slack arms, I began to apply artificial respiration.
