Dr Finlay's Casebook

by AJ Cronin

  In this desolate fashion he turned across the common towards Arden House. And then as he entered Park Street he saw an agitated figure hurrying down the road, apparently making for the tennis club. It was Matron Clark, and when she reached him she did not stand on ceremony.

  ‘Have you seen Nurse Angus?’ she demanded straight away. ‘I left her in bed at the hospital, and she’s gone, she’s gone.’

  He considered her flushed, concerned face in real amazement.

  ‘But why not?’ he asked. ‘She had to play the tennis match with me this afternoon. She’s up there now.’

  ‘Oh, Dr Finlay,’ wept the matron, ‘how could she, how could she? After me begging and praying her not to go.’

  ‘What do you mean?’ he cried.

  ‘Don’t you know? Didn’t she tell you? Last night when she was on duty the patient in bed fifteen knocked a bottle of pure carbolic acid over. It went right over Nurse Angus’s hand and gave her a shocking burn, an acid burn. Don’t you understand? Why, this morning she could hardly hold a teacup. And to think she’s gone and played . . .’ And in a perfect frenzy of concern matron rushed off towards the tennis court.

  Turning, Finlay surveyed her retreating form with a horrified expression on his face. So that was it. That was why Peggy had fainted. He saw now the reason of the glove, remembered how she had winced each time her racket had met the ball in that last thrilling match! ‘It’s nothing,’ she had said, ‘only a blister.’

  Because of his behaviour to her at the beginning, because he had questioned her pluck, she had stubbornly refused to tell him. She had played the game with a badly burned hand, a hand that could hardly clasp the racket.

  No doubt she despised him, had set herself thus to humiliate him. He groaned aloud at the very thought. And, all at once, a great tide seemed unlocked within his heart.

  He wanted to turn, to run after the matron towards the tennis club, to aplogise to Peggy Angus, to get down on his knees, to say how sorry he was, to ask pardon humbly. But he did not. How could he? She would not even listen to him now. So he turned instead, and walked slowly towards Arden House, trying to take comfort from the thought that he would see her again, that perhaps, if the chance came he could make amends.

  And through it all there pressed upon him an understanding unfathomable and bitter sweet.

  He knew at last what his feeling was, had been from the first, and always would be, for Peggy Angus.

  Known as Inflammation

  After the final of the Nimmo Cup, as related previously in these chronicles, life went hard for Finlay. He moved in a queer preoccupation, ate poorly, slept worse, and in general offered every evidence of a man suffering from deep and compelling emotion.

  Peggy Angus, following a short spell at her home at Dunhill to allow her injured hand to heel, was back in hospital, quietly efficient, once again on day duty.

  Nothing passed between Finlay and the young nurse but a few brief words exchanged in the ordinary routine of the ward.

  Yet Finlay would have given everything he possessed to break down this barrier of coldness and misunderstanding which had arisen and stood, it seemed, permanently separating them. He knew at last, in his secret heart, that he loved Peggy Angus. And it cast a mortal sadness upon him to feel that now she could never care for him.

  As if to escape his melancholy, he threw himself desperately into his work, and more particularly into study.

  Mark you, the conscientious strain in Finlay, though often overlaid by the natural impetuosity of the man, was strong, and this at all times caused him to try to keep up-to-date in his work. It was not easy, since usually the practice occupied him so fully he had little time to read.

  Nevertheless, he did make an effort to keep in touch with modern research in medicine and surgery. And now more than ever he sought a weary consolation by burning the midnight oil over the recent advances of his profession. Not without result, as shall presently be seen.

  To be dramatic fiction, the drama which ensued ought to have been staged on the grand scale. But it was simply bare reality, and concerned a poor family of foreigners named Pulaski, and in particular the little boy named Paul.

  The Pulaskis were Lithuanians who had come, like many others of their countrymen, to work in the mines of Lanarkshire. But, when the industrial situation became depressed, they drifted to Levenford. The father was fortunate in getting work in a humble capacity as labourer in a shipyard.

  They lived in impoverished conditions in the Vennel, and there was a brood of children, amongst them Paul, aged eight, who spent most of his spare time playing on the pavement of the squalid slum.

  When Paul fell ill with vomiting and a bad pain in his stomach no one paid much attention to the fact.

  Certainly Mrs Pulaski had no thought of the doctor, for this was an expensive luxury far beyond the means of her humble establishment. But when Paul, dosed with some dark concoction and put to bed, showed no signs of improvement, she held an uneasy colloquy with her husband, the result of which was that Finlay arrived next morning to see the patient.

  He found the little boy in bed with a furred, dry tongue, a flushed face, a high temperature, and severe pain and tenderness low down on the right side of his body. The vomiting had stopped, but, instead of bringing relief, this seemed merely to have aggravated the condition.

  ‘I don’t know what he takes to upset him!’ exclaimed Mrs Pulaski brokenly, with her dark foreign eyes fixed intently on Finlay. ‘Or maybe it’s a chill on the stomach he would have – the inflammation, eh, doctor?’

  As the familiar word fell on Finlay’s ear he remained silent. Inflammation! – the convenient receptacle into which all manner of doubtful and unknown conditions were cast.

  He continued his examination, not satisfied that this case before him was a simple chill or disturbance. Something in the signs and symptoms, in the boy’s attitude, struck him vividly and reminded him of a certain condition which his recent reading had brought before him.

  He said nothing, however. Turning from the bedside, he prescribed a simple remedy and a fluid diet, and indicated to the mother that he would return with Dr Cameron.

  At midday he went over the points of the case with Cameron, making no bones about the fact that he considered the condition serious, and about two o’clock the two doctors walked down the road and arrived at the mean home in the Vennel.

  Cameron made his examination of Paul, who seemed worse, in greater pain than ever, and unable, as his mother related, to retain even the sips of water she had given him.

  Later, in consultation together in the little kitchen, Cameron passed up and down dubiously.

  ‘He’s bad, right enough, the little chap,’ he threw out. ‘It looks to me like inflammation of the bowels. What do you think yourself?’

  There was a silence. Inflammation again, thought Finlay, and he answered slowly—

  ‘I think it’s appendicitis.’

  At the mention of the strange new word which at the beginning of this century was causing open war amongst the pundits, Cameron threw up his head like a startled horse.

  ‘That!’ he said abruptly.

  Finlay nodded slowly, and before the old doctor could intervene he launched into a rapid explanation.

  ‘I’ve been reading Englemann’s treatise and Mitchell’s account of his cases. This boy here has got all the typical symptoms. It’s not just inflammation, I’ll swear it’s this new thing they’re talking about in London, and Paris and Vienna. Appendicitis! Oh, I know it sounds trashy and newfangled to you, but I’m convinced in my very bones it’s a genuine case.’

  Cameron inspected Finlay quietly.

  ‘I don’t think it’s trashy,’ he said slowly. ‘And just because I’m not acquainted with the condition, because maybe I’m a little old-fashioned and behind the times, I don’t propose to deny its existence.’

  There was a silence. Moved by Cameron’s generous attitude Finlay did not speak, and eventually the older man resumed—


  ‘But talking doesn’t help us much. Granted you’re right, what do you propose to do?’

  Finlay started forward eagerly.

  ‘Well, believe me, castor oil and linseed poultices won’t help us here. There’s only one thing to do. Operation!

  Another silence. Cameron stroked his chin reflectively.

  ‘Well,’ he said at length, ‘maybe you’re right But it’s a serious step, man, a gey serious step. I wouldn’t like you to take it on your own responsibility. No, no! Suppose anything happened to the boy? Bless my soul, they’d swear the operation had killed him. You’ll need to have another opinion. I can’t help you here, though I’m with you heart and soul.’

  He paused. ‘Suppose you call in Reid and see what he says?’

  Finlay’s eyes fell. Though he knew Cameron’s suggestion to be a wise one, it was not, to him, a happy one. He was fairly friendly with Dr Reid, a young man like himself, with a fair-sized practice in the Newtown, and a bustling go-ahead manner, which was hearty enough, though perhaps a little jeering at times. Yet Finlay was loth to submit to outside interference. He was an individualist. Nevertheless, he saw the wisdom of Cameron’s advice, and at last he raised his head.

  ‘Right!’ he said. ‘I’ll have Reid in at once.’

  Without delay he called Reid, and while Cameron set out alone on the afternoon round the two younger doctors went into consultation at the Pulaski’s house.

  Reid, deeply gratified by Finlay’s invitation, professed full knowledge of Mitchell’s recent work, and he made it plain in no uncertain fashion that this new condition known as appendicitis was to him an open book.

  ‘I went through the reports of the John Hopkins Hospital only last month,’ he added. ‘You’ve seen them I suppose?’

  ‘No,’ replied Finlay dourly. ‘But I’ve seen this case.’

  Reid said no more for the moment but went on with his thorough examination of the boy. When he had finished he followed Finlay into the other room, lit a cigarette, and, planting his legs apart, blew a long cloud of smoke towards the ceiling. He seemed absorbed in thought, but at last, with a certain diffidence, he spoke.

  ‘Frankly, Finlay,’ said he, ‘I can’t agree with your diagnosis. As I’ve told you, I’m up to this thing. Absolutely, man. But this isn’t it. I don’t look on this as any more than a simple inflammation. The boy’s vomiting has stopped, his temperature has fallen, his mother says he is complaining of less pain.’

  Reid waved his cigarette. ‘I’m sorry, Finlay, to disagree with you, but I’m confident you’re wrong. There’s no appendicitis here. I couldn’t, under the circumstances, become a party to advising operative treatment. Wait and see, my boy, that’s the idea here – a masterly inactivity.’

  And with a friendly little nod, Reid took himself away.

  But Finlay did not leave the house. Somehow he could not. Far from reassured by Reid’s words, he wandered back into the little bedroom where Paul lay, and stared at the passive figure of the boy.

  It was perfectly true, as Reid had said, the vomiting had ceased and the pain was less, but this, in Finlay’s eyes, marked not an improvement but a rapid deterioration in the patient’s condition.

  He took Paul’s hand.

  ‘Does it still hurt you?’ he asked.

  ‘It doesn’t hurt me so much. But I feel awful queer. It’s kind of black in the room.’

  Finlay bit his lip. The pulse, racing under his fingers, coupled with a falling temperature, bore down upon him ominously.

  Here, in this poor and squalid home, he felt himself faced with that awful figure – the dark angel of death. He must do something – he must. Cameron could not help him, Reid had failed him; the decision rested entirely with him.

  For a full five minutes Finlay stood motionless, staring down at the narrow disordered bed. Then across his set face a light spread suddenly.

  He had it! Why hadn’t he thought of it before? He would ring up a certain professor in Glasgow. The professor knew him, remembered him as his house surgeon, would undoubtedly with his unfailing charity, run down and see this humble case. The professor on occasion could demand a hundred guinea fee and a special train to transport him to his lordly patients; but on other occasions he would come obscurely, and for nothing, in the cause of mercy. This was such an occasion, and Finlay was sure of his man.

  Turning, he went into the other room, where Mrs Pulaski stood with a clutter of frightened youngsters clutching at her skirts, and in as few words as possible he explained that Paul would have to go to hospital immediately.

  ‘Hospital!’ echoed the frightened woman. ‘Holy mother! Is he that sick, doctor?’

  ‘Yes,’ said Finlay, ‘and he’ll be worse unless we do something quickly.’

  Sitting down at the table, he took his prescription pad and dashed off a hurried note to Matron Clark at the hospital instructing her to send the ambulance for Paul and prepare for the operation by the professor that evening.

  Then, comforting the weeping mother as best he could, he hurried back to Arden House, where, without delay, he put through a call to Glasgow, and was connected to the professor’s house.

  But here he received a rude shock. The professor had left two days before to spend a fortnight’s vacation in the south of England.

  Completely dismayed, Finlay replaced the receiver, and rested his head in both hands. He knew no other surgeon well enough to ask him to undertake the journey to Levenford and to perform the operation without fee. Caught in a dilemma of his own making, he felt trapped and helpless.

  But time was not standing still, and he could not afford to waste one precious moment. Though he did not know what he was going to do, he was still conscious that he must act – act immediately.

  Rousing himself, he went out of the house and walked rapidly across the Common towards the Cottage Hospital.

  He entered the hospital, and went straight to the matron’s room, but she was not there, and so he turned and made his way into the ward.

  Nurse Angus was in the ward, standing beside the clean white bed in which Paul now lay, and as Finlay entered she looked up and met his eyes, not in her usual impersonal manner, but with a strange intentness.

  ‘He’s very bad,’ she said in a low voice. ‘Temperature subnormal, and the pulse almost imperceptible. He seems to be slipping into coma.’

  With his gaze upon the bed Finlay saw that she was right. He muttered—

  ‘It’s a bad lookout, I’m afraid,’ he paused, then blurted out – ‘The professor can’t come. I can’t get anyone to tackle it. We’ll have to do the best we can without an operation.’

  He did not look at her, but waited instinctively for some cold reply. He knew that now she must despise him more than ever. His heart sank. But to his amazement she did not speak. He lifted his head and found her warm eyes fixed steadily upon him.

  ‘Do you mean that there’s no one to do this operation? And you know that it must be done!’

  He nodded his head dumbly, conscious of her presence, of her disturbing scrutiny. There was a long pause, then she said slowly and distinctively—

  ‘Why don’t you do it yourself?’

  He stared at her, staggered at the suggestion, yet strangely thrilled by it. And, all at once, inspiration flowed to him from the composure in her face. He had never dreamed of tackling the operation himself, for although he knew its technique from reading, he had felt it far beyond him.

  He had operated, of course, in a small way, but a major abdominal operation had stood always as difficult, dangerous, and obscure, something quite outside his power. But now, with this sudden suggestion offered so unexpectedly, his purpose deepened.

  He realised that it was the only thing to do, that he must make the attempt.

  At that moment the matron came waddling up.

  ‘The theatre’s ready,’ she announced officiously. ‘Whenever the professor arrives we are ready to begin.’

  Finlay faced her with real determinat
ion.

  ‘He’s not coming,’ he declared. ‘But for all that, we’ll begin at once. I’m going to do the operation myself.’

  ‘You!’ gasped the matron.

  ‘Exactly,’ said Finlay abruptly.

  ‘But, Dr Finlay—’ protested the matron.

  Finlay did not wait. Before the astounded woman could say more he walked out of the ward and into the little office, where, picking up the telephone again, he rang through to Reid’s house.

  It would have been easier by far for him to have asked Cameron to give the anaesthetic, but now he did not want the easy way. He wanted Reid to be there, since he had disagreed with his diagnosis, to see everything, to witness the best or the worst that he could do.

  Three-quarters of an hour later Finlay stood in the operating theatre ready to begin. The theatre was hot. The sun had been shining through the ground glass windows, and it was full of a hot bubbling and hissing from the small steam steriliser.

  Exactly in the centre of the theatre was the operating table, breathing unevenly under the anaesthetic was Paul.

  At the head of the table, very disturbed and unwilling, sat Dr Reid. He had made it perfectly clear that he came merely to give the anaesthetic and would take no responsibility for the issue.

  Beside her tray of instruments was Nurse Angus – still calm, and impenetrable in her demeanour – while beside the metal cylinder of oxygen, as though she felt that she would soon be obliged to use it, was Matron Clark.

  It was the moment at last. With a quick prayer, Finlay bent over the table and reached out his hand for a lancet.

  He concentrated on the one neat square of Paul’s body surrounded by white towels and coloured a fine bright yellow with iodine. It was inside the square that everything would take place.

  He tried, in the hot room through the daze of his conflicting emotions, to remember everything that he must do.

  Aware above everything of the presence of Nurse Angus, he drew a deep breath.