“There’s no question about that, Doctor,” said he, “because I can’t get out, at least I can’t stand properly if I do. My legs seem to have gone on strike and there is something queer about my feet; sort of pins and needles, and a dead kind of feeling, as if they had got a coat of varnish over them.”
“But,” I exclaimed, concealing as well as I could my consternation at this fresh complication, “you haven’t mentioned this to me before.”
“I hadn’t noticed until yesterday,” he replied, “though I have been having cramps in my calves for some days. But the fact is that the pain in my gizzard occupies my attention pretty completely. It may have been coming on before I noticed it. What do you suppose it is?”
To this question I gave no direct answer. For I was not supposing at all. To me the new symptoms conveyed nothing more than fresh and convincing evidence that I was completely out of my depth. Nevertheless, I made a careful examination which established the fact that there was an appreciable loss of sensibility in the feet and some abnormal conditions of the nerves of the legs. Why there should be I had not the foggiest idea, nor did I make any great effort to unravel the mystery; for these new developments brought to a definite decision a half-formed intention that I had been harbouring for the last day or two.
I would seek the advice of some more experienced practitioner. That was necessary as a matter of common honesty, to say nothing of humanity. But I had hesitated to suggest a second opinion since that would not only have involved the frank admission that I was graveled—an impolitic proceeding in the case of a young doctor—but it would have put the expense of the consultant’s fee on the patient; whereas I felt that, since the need for the consultation arose from my own incompetence, the expense should fall upon me.
“What do you think, Doctor, of my going into a nursing home?” he asked, as I resumed my seat by the bed.
I rather caught at the suggestion, for it seemed to make my plan easier to carry out.
“There is something to be said for a nursing home,” I replied. “You would be able to have more constant and skilled attention.”
“That is what I was thinking,” said he; “and I shouldn’t be such a damned nuisance to my wife.”
“Yes,” I agreed, “there’s something in that. I will think about your idea and make a few inquiries; and I will look in again later in the day and let you know the result.”
With this I rose, and having shaken his hand, took my departure, closing the door audibly and descending the stairs with a slightly heavy tread to give notice of my approach to the hall. When I arrived there, however, I found no sign of Mrs. Gannet and the dining room door was shut; and glancing towards the hat-rack on which my hat was awaiting me, I noted another hat upon an adjoining peg and surmised that it possibly accounted for the lady’s non-appearance. I had seen that hat before. It was a somewhat dandified velour hat which I recognized as appertaining to a certain Mr. Boles—the man whom I had met on the stairs at my first visit and had seen once or twice since—a big, swaggering, rather good-looking young man with a noisy, bullying manner and a tendency to undue familiarity. I had disliked him at sight. I resented his familiarity, I suspected his monocle of a merely ornamental function, and I viewed with faint disapproval his relations with Mrs. Gannet—though, to be sure, they were some sort of cousins, as I had understood from Gannet, and he obviously knew all about their friendship.
So it was no affair of mine. But still, the presence of that hat gave me pause. It is awkward to break in on a tete-a-tete. However, my difficulty was solved by Boles himself, who opened the dining room door a short distance, thrust out his head, and surveyed me through his monocle—or perhaps with the less-obstructed eye.
“Thought I heard you sneaking down, Doc,” said he. “How’s the sufferer? Aren’t you coming in to give us the news?”
I should have liked to pull his nose. But a doctor must learn early to control his temper—especially in the case of a man of Boles’s size. As he held the door open, I walked in and made my bow to Mrs. Gannet, who returned my greeting without putting down her needlework. Then I delivered my report, briefly and rather vaguely, and opened the subject of the nursing home. Instantly, Boles began to raise objections.
“Why on earth should he go to a nursing home?” he demanded. “He is comfortable enough here. And think of the expense.”
“It was his own suggestion,” said I, “and I don’t think it a bad one.”
“No,” said Mrs. Gannet. “Not at all. He would get better attention there than I can give him.”
There followed something like a wrangle between the two, to which I listened impassively, inwardly assessing their respective motives. Obviously the lady favoured the prospect of getting the invalid off her hands, while as to Boles, his opposition was due to mere contrariety; to an instinctive impulse to object to anything that I might propose.
Of course, the lady had her way—and I had intended to have mine in any case. So, when the argument had petered out, I took my leave with a promise to return some time later to report progress.
As I turned away from the house, I rapidly considered the position. I had no further visits to make, so for the present, my time was my own; and as my immediate purpose was to seek the counsel of some more experienced colleague, and as my hospital was the most likely place in which to obtain such counsel, I steered a course for the nearest bus route by which I could travel to its neighbourhood. There, having boarded the appropriate omnibus, I was presently delivered at the end of the quiet street in which St. Margaret’s Hospital is situated.
It seemed but a few months since I had reluctantly shaken from my feet the dust of that admirable institution and its pleasant, friendly medical school, and now, as I turned into the familiar street, I looked about me with a certain wistfulness as I recalled the years of interesting study and companionship that I had spent here as I slowly evolved from a raw freshman to a fully qualified practitioner. And as, approaching the hospital, I observed a tall figure emerge from the gate and advance towards me, the sight brought back to me one of the most engrossing aspects of my life as a student. For the tall man was Dr. John Thorndyke, a lecturer on Medical Jurisprudence, perhaps the most brilliant and the most popular member of the teaching staff.
As we approached, Dr. Thorndyke greeted me with a genial smile and held out his hand.
“I think,” said he, “this is the first time we have met since you fluttered out of the nest.”
“We used to call it the incubator,” I remarked.
“I think ‘nest’ sounds more dignified,” he rejoined. “There is something rather embryonic about an incubator. And how do you like general practice?”
“Oh, well enough,” I replied. “Of course, it isn’t as thrilling as hospital practice—though mine happens, at the moment, to be a bit more full of thrills than I care for.”
“That sounds as if you were having some unpleasant experiences.”
“I am,” said I. “The fact is that I am up a tree. That is why I am here. I am going to the hospital to see if one of the older hands can give me some sort of tip.”
“Very wise of you, Oldfield,” Thorndyke commented. “Would it seem impertinent if I were to ask what sort of tree it is that you are marooned in?”
“Not at all, sir,” I replied, warmly. “It is very kind of you to ask. My difficulty is that I have got a rather serious case, and I am fairly graveled in the matter of diagnosis. It seems to be a pretty acute case of gastro-enteritis, but why the fellow should have got it and why none of my treatment should make any impression on it, I can’t imagine at all.”
Dr. Thorndyke’s kindly interest in an old pupil seemed to sharpen into one more definitely professional.
“The term ‘gastro-enteritis,’” said he, “covers a good many different conditions. Perhaps a detailed description of the symptoms would be a better basis for discussion.”
Thus encouraged, I plunged eagerly into a minute description of poor Gannet’
s symptoms—the abdominal pain, the obstinate and distressing nausea and physical and mental depression—with some account of my futile efforts to relieve them; to all of which Dr. Thorndyke listened with profound attention. When I had finished, he reflected for a few moments and then asked:
“And that is all, is it? Nothing but the abdominal trouble? No neuritic symptoms, for instance?”
“Yes, by Jove, there are!” I exclaimed. “I forgot to mention them. He has severe cramps in his calves and there is quite distinct numbness of the feet with loss of power in the legs; in fact, he is hardly able to stand, at least so he tells me.”
Dr. Thorndyke nodded, and after a short pause, asked:
“And as to the eyes—anything unusual about them?”
“Well,” I replied, “they are rather red and watery, but he put that down to reading in a bad light; and then he seems to have a slight cold in his head.”
“You haven’t said anything about the secretions,” Dr. Thorndyke remarked. “I suppose you made all the routine tests?”
“Oh yes,” I replied, “most carefully. But there was nothing in the least abnormal; no albumen, no sugar, nothing out of the ordinary.”
“I take it,” said Thorndyke, “that it did not occur to you to try Marsh’s test?”
“Marsh’s test!” I repeated, gazing at him in dismay. “Good Lord, no! The idea never entered my thick head. And you think it may actually be a case of arsenic poisoning?”
“It is certainly a possibility,” he replied. “The complex of symptoms that you have described is entirely consistent with arsenic poisoning, and it doesn’t appear to me to be consistent with anything else.”
I was thunderstruck. But yet no sooner was the suggestion made than its obviousness seemed to stare me in the face.
“Of course!” I exclaimed. “It is almost a typical case. And to think that I never spotted it, after attending all your lectures, too! I am a fool. I am not fit to hold a diploma.”
“Nonsense, Oldfield,” said Thorndyke, “you are not exceptional. The general practitioner nearly always misses a case of poisoning. Quite naturally. His daily experience is concerned with disease, and as the effects of a poison simulate disease, he is almost inevitably misled. He has, by habit, acquired an unconscious bias towards what we may call normal illness; whereas an outsider, like myself, coming to the case with an open mind, or even a bias towards the abnormal, is on the lookout for suspicious symptoms. But we mustn’t rush to conclusions. The first thing is to establish the presence or absence of arsenic. That would be a good deal easier if we had him in hospital, but I suppose there would be some difficulty—”
“There would be no difficulty at all, sir,” said I. “He has asked me to arrange for him to go to a nursing home.”
“Has he?” said Thorndyke. “That almost seems a little significant; I mean that there is a slight suggestion of some suspicions on his own part. But what would you like to do? Will you make the test yourself, and carry on, or would you like me to come along with you and have a look at the patient?”
“It would be an enormous relief to me if you would see him, sir,” I replied, “and it is awfully good of you to—”
“Not at all,” said Thorndyke. “The question has to be settled, and settled without delay. In a poisoning case, the time factor may be vital. And if we should bring in a true bill, he should be got out of that house at once. But you understand, Oldfield, that I come as your friend. My visit has no financial implications.”
I was disposed to protest, but he refused to discuss the matter, pointing out that no second opinion had been asked for by the patient. “But,” he added, “we may want some reagents. I had better run back to the hospital and get my research case, which I had left to be called for, and see that it contains all that we are likely to need.”
He turned and retraced his steps to the hospital where he entered the gateway, leaving me to saunter up and down the forecourt. In a few minutes he came out, carrying what looked like a small suitcase covered with green Willesden canvas; as there happened to to be a disengaged taxi at the main entrance, where it had just set down a passenger, Thorndyke chartered it forthwith. When I had given the driver the necessary directions, I followed my senior into the interior of the vehicle and slammed the door.
During the journey Dr. Thorndyke put a few discreet questions respecting the Gannet household, to which I returned correspondingly discreet answers. Indeed, I knew very little about the three persons—or four, including Boles—of whom it consisted and I did not think it proper to eke out my slender knowledge with surmises. Accordingly I kept strictly to the facts actually known to me, leaving him to make his own inferences.
“Do you know who prepares Gannet’s food?” he asked.
“To the best of my belief,” I replied, “Mrs. Gannet does all the cooking. The maid is only a girl. But I am pretty sure that Mrs. Gannet prepares the invalid’s food; in fact, she told me that she did. There isn’t much of it, as you may imagine.”
“What is Gannet’s business or profession?”
“I understand that he is a potter; an artist potter. He seems to specialize in some sort of stoneware. There are one or two pieces of his in the bedroom.”
“And where does he work?”
“He has a studio at the back of the house; quite a big place, I believe, though I haven’t seen it. But it seems to be bigger than he needs, as he lets Boles occupy part of it. I don’t quite know what Boles does, but I fancy it is something in the goldsmithing and enamelling line.”
Here, as the taxi turned from Euston Road into Hampstead Road, Thorndyke glanced out of the window and asked:
“Did I hear you mention Jacob Street to the driver?”
“Yes, that is where Gannet lives. Rather a seedy-looking street. You don’t know it, I suppose?”
“It happens that I do,” he replied. “There are several studios in it, relics of the days when it was a more fashionable neighbourhood. I knew the occupant of one of the studios. But here we are, I think, at our destination.”
As the taxi drew up at the house, we got out and he paid the cabman while I knocked at the door and rang the bell. Almost immediately the door was opened by Mrs. Gannet herself, who looked at me with some surprise and with still more at my companion. I hastened to anticipate questions by a tactful explanation.
“I’ve had a bit of luck, Mrs. Gannet. I met Dr. Thorndyke, one of my teachers at the hospital, and when I mentioned to him that I had a case which was not progressing very satisfactorily, he very kindly offered to come and see the patient and give me the benefit of his great experience.”
“I hope we shall all benefit from Dr. Thorndyke’s kindness,” said Mrs. Gannet, with a smile and a bow to Thorndyke, “and most of all my poor husband. He has been a model of patience, but it has been a weary and painful business for him. You know the way up to his room.”
While we were speaking, the dining room door opened softly and Boles’s head appeared in the space, adorned with the inevitable eyeglass through which he inspected Thorndyke critically and was not, himself, entirely unobserved by the latter. But the mutual inspection was brief, for I immediately led the way up the stairs and was closely followed by my senior.
As we entered the sickroom after a perfunctory knock at the door, the patient raised himself in bed and looked at us in evident surprise. But he asked no question, merely turning to me interrogatively; whereupon I proceeded at once concisely to explain the situation “It is very good of Dr. Thorndyke,” said Gannet, “and I am most grateful and pleased to see him, for I don’t seem to be making much progress. In fact, I seem to be getting worse.”
“You certainly don’t look very flourishing,” said Thorndyke, “and I see that you haven’t taken your arrowroot, or whatever it is.”
“No,” said Gannet, “I tried to take some, but I couldn’t keep it down. Even the barley water doesn’t seem to agree with me, though I am parched with thirst. Mr. Boles gave me a glassful when he bro
ught it up with the arrowroot but I’ve been uncomfortable ever since. Yet you’d think that there couldn’t be much harm in barley water.”
While the patient was speaking, Thorndyke looked at him thoughtfully as if appraising his general appearance, particularly observing the drawn, anxious face and the red and watery eyes. Then he deposited his research case on the table, and remarking that the latter was rather in the way, carried it, with my assistance, away from the bedside over to the window, and in place of it drew up a couple of chairs. Having fetched a writing pad from the research case, he sat down, and without preamble, began a detailed interrogation with reference to the symptoms and course of the illness, writing down the answers in shorthand and noting all the dates. The examination elicited the statement that there had been fluctuations in the severity of the condition, a slight improvement being followed by a sudden relapse. It also transpired that the relapses, on each occasion, had occurred shortly after taking food or a considerable drink. “It seems,” Gannet concluded, dismally, “as if starvation was the only possible way of avoiding pain.”
I had heard all this before, but it was only now, when the significant facts were assembled by Thorndyke’s skilful interrogation, that I could realize their unmistakable meaning. Thus set out they furnished a typical picture of arsenic poisoning. And so with the brief but thorough physical examination. The objective signs might have been taken from a text-book case.
“Well, Doctor,” said Gannet, as Thorndyke stood up and looked down at him gravely, “what do you think of me?”
“I think,” replied Thorndyke, “that you are very seriously ill and that you require the kind of treatment and attention that you cannot possibly get here. You ought to be in a hospital or a nursing home, and you ought to be removed there without delay.”
“I rather suspected that myself,” said Gannet; “in fact, the doctor was considering some such arrangement. I’m quite willing.”
“Then,” said Thorndyke, “if you agree, I can give you a private ward or a cubicle at St. Margaret’s Hospital; and as the matter is urgent, I propose that we take you there at once. Could you bear the journey in a cab?”
The Third R. Austin Freeman Megapack Page 218
