The Chequer Board (2 page)

I let him put on his clothes, and we sat down again.

“Well, I think you’ll have to come into hospital for a few days, for examination, Mr Turner,” I said. “I want to take some X-ray pictures of your head, and we can do a lumbar puncture for pathological examination at the same time. That’s quite a simple matter.”

He said, “I’m all right, though, doctor?”

“That’s what I’m trying to find out,” I replied. I leaned towards him. “Look, Mr Turner—you know as well as I do that you aren’t quite right at present. So far the symptoms are not serious. There is the slight functional disability of your right hand, lighting the lighter and buttoning your clothes. We’ve just found that your left eye isn’t doing much to help you see; of course, you didn’t notice that. Added to that there are the giddiness and fainting, and the exhausted feeling that you get. There’s some reason for all this, you know. It may be that something under
that wound of yours requires a little attention. You’ll have to come into hospital for a week for observation.”

There was a long pause, “Okeydoke,” he said at last. “If that’s what’s got to happen—well, that’s that. When would it be, doctor?”

“I’ll have to see when I can get a bed,” I said. “You’d like a private ward?”

“How much is that?”

“Six guineas.”

“I suppose so,” he said. “Be nicer if the wife comes to see me.”

I nodded. “I’ll fix it up as soon as I can,” I said. “Probably in about a fortnight. I’ll write to Dr Worth and tell him what I can arrange.”

“I’ll tell him what you said.” He stared down at his hat for a minute, and then looked up. “You’d be able to see splinters and that in the X ray?” he said.

“Were there any splinters left in the wound?” I asked.

He said, “I think there was. I don’t think they got ’em all out. They was too deep in.”

“I see,” I said thoughtfully. “Oh yes, they’ll show all right. If any of them are giving trouble, that may show too.”

“They wouldn’t, after all this time, would they?” he asked.

I got up and pressed the bell on my desk. “I hope not, Mr Turner,” I said. “But that’s what we’ve got to find out.”

He went away, and in the evening I wrote to the War Office about surgeons in the Penzance neighbourhood in September 1943, who might have operated on him after
that crash. In a few days they sent me an answer. At that distance of time they could not identify the surgeon, but they gave me a list of five names of R.A.M.C. officers stationed in the district at that time who were of sufficient seniority to tackle such an operation, any one of whom might have done it.

One of them, Major P. C. Hodder, struck a chord of memory. Percy Hodder had been a medical student in the London Hospital under me in 1934. I remembered him particularly because of his great interest in the brain. He had been a thin, sandy-haired young man. I turned to the Medical Directory and looked him up; he had got his F.R.C.S. in 1938. Percy Hodder was probably my man. He was now practising in Leeds.

I sat down and wrote to him.

Three days later I received an answer.

D
EAR
M
R
H
UGHES
,

I remember the case of Captain Turner very well; I did the operation at Penzance about the time you mention. I doubt if we could locate the X-ray photographs now, and my own case records were destroyed by enemy action in London at the time of the V bombs.

So far as I can remember, I had to leave several splinters in the brain matter as the immediate operative danger to the patient in their removal seemed greater than the risk that they would create trouble later on. I am not, therefore, greatly surprised if trouble has developed.

I shall be in London on Tuesday next, and could look in to see you at your rooms in Harley Street at about five o’clock if that would be convenient for you.

Yours sincerely,            
P. C. H
ODDER

When we met in my consulting room he said at once, “If it’s the Captain Turner I remember, he’s had some years of useful life. I never thought he’d live to make old bones.”

I described the man to him, and his apparent injury.

“That’s him all right,” said Hodder. He thought for a minute. “So far as I remember,” he said slowly, “there were seven or eight metallic splinters or fragments in the cerebrum. I know I left three of them in, as being altogether too deep-seated to be tackled. As it was, the patient very nearly died of shock; we had a great deal of trouble in saving him after the operation. I didn’t think he’d live. After that, I didn’t think he’d recover all his faculties. But he did. I saw him some months later, and he seemed to be completely normal.”

He went on to tell me in some detail where he thought the other splinters were. The more I heard of it, the less I liked it. The man was older now, and less able to resist operative shock.

“Not a very good prognosis,” I said at last.

He shook his head. “I wouldn’t like to try to get those out, myself,” he said. “Would you operate, sir, in a case like that?”

I said slowly, “I doubt it. That is, assuming that the present X ray supports your memory of where the pieces are.”

“I think you’ll find that fairly accurate,” he said. “I remember this case particularly, because of all the circumstances.”

“You mean the crash?” I asked.

He hesitated. “Well, yes, there was that. But he and two
others were prisoners awaiting court-martial, in a detention ward. Did the patient tell you that?”

I said drily, “No, he didn’t.”

He said, “Well, that’s what they were. There was an armed guard on the door of the ward.”

“He told me that he was on his way home from Algiers,” I said. “It is not helpful when the patient tells you a pack of lies. It just wastes time.”

“Well, that was true enough,” said Hodder. “They were sent back from Algiers. There was a load of four or five of them. This man Turner and two others were wanted for some black-market racket in London, selling Army stores, I think. They were found out when they got drafted to North Africa. Turner was the only one of that lot who came through the crash alive. Then there was a paratrooper up for murder in a London pub. The D.A.J.A.G. sent them all back for trial in England in this Hudson, the one that got shot up and crashed.”

“Nice party,” I said. “How many of them survived the crash?”

He wrinkled his forehead in thought. “Three or four, I think; but they weren’t all my patients. They weren’t all prisoners, either. One couldn’t have been a prisoner—the second pilot—the one who crash-landed the machine. He had a broken thigh; an R.A.F. doctor was treating him. I think he was taken in with the rest of them, and not moved when they put the guard on. I think there were four altogether. There was the pilot, and Turner, and the paratrooper, and the Negro. That’s right. Four.”

“A Negro?” I asked.

He nodded. “There was an American Negro soldier in
the ward, who’d cut his throat. He wasn’t one of the party from Algiers. The hospital put him in with them, in the same ward, because he had to be under guard and he was too bad to be moved.”

“What did he want to cut his throat for?”

“I forget—some civil offense or other. The American military police were chasing him. He went into an air-raid shelter and cut his throat. But he didn’t know anatomy.”

I returned to the subject in hand. “I’m taking Mr Turner into hospital for examination,” I said. We stood together for a few minutes longer, discussing what I meant to do with him and talking generally about the case. “I’ll drop you a line later on to let you know what happens,” I said finally. “But I doubt if it will be very satisfactory, from what you tell me.”

“I wouldn’t lose much sleep over that,” said Hodder. “I’ve not got a lot of use for people like Mr John Turner, myself.”

“No,” I said thoughtfully. “They make a lot of trouble and they don’t pay much dividend.”

I did not see Turner again till just before the X rays, and then only for a few moments. I got the photographs and the reports from the pathologist and house surgeon that afternoon, and after my consultations were over for the day I sat down with the photographs at the stereoscope. As Hodder had said, there were three metallic fragments. Two were sizable pieces not far below the dura. It might be possible to get at those if necessary, though there was the gravest danger to the patient in such an operation. The third was very small and much deeper in the cerebrum;
it was surrounded by a darker infusion of the negative in the immediate vicinity. It was quite inoperable.

I sat for half an hour studying this thing and trying to think out ways and means of dealing with it. I did not want to be beaten, even in the case of Mr Turner. But presently I put the negatives and the reports back into their envelopes and said quietly to myself, “Well, that’s that.” I stubbed my cigarette out, put on my hat and coat, and went home.

I slept very badly that night. At the age of fifty-eight one does not normally lose sleep over a patient, but I lost sleep over Mr Turner. I wanted to do something for him; wanted to very badly. I had a queer inverted feeling that because this little black-market racketeer was a man of no account, the case called for the very utmost limit of my skill. I put that down with diffidence because it looks absurd on paper, but that’s what kept me awake. I could not sleep for running over in my mind the possible combinations of operative and anaesthetic technique, of palliative operations and of neurological treatment. I got out of bed once and went down to my study to look up some recent German work on intracranial fibrosis. I read German rather slowly, and stayed down there for an hour. Then I went back to bed, and slept a little before dawn.

I saw Turner next morning in his ward at the hospital. I took the X-ray photographs along with me. The sister showed me into his rooms; after a perfunctory examination I sent her away and sat down in the chair beside his bed.

“Well, you’ve got three metal fragments in your head
still, Mr Turner,” I said. I pulled out the negatives and showed them to him; they were quite clear without the stereoscope.

“Gosh,” he said. “Is that me? I don’t half look a guy.”

“The prettiest girl doesn’t look any better, taken in this way,” I said. I picked out one of the pictures. “This one is the side view—this shows it best. These white things are the metal pieces. These two high up, there, and that one farther in.”

He was interested. “Where would they be on me, doctor?” He put his hand up to his head. “Somewhere here?”

I laid two fingers on his head. “The first two, here and here. The third one about two inches down, under here.”

I showed him the other views. He looked at them carefully and quite intelligently. “Is this third bit the same stuff as the others, doctor?” he asked presently. “I mean, those two are sort of clear-cut, but this one looks all fuzzy.”

I nodded. “That’s the one that’s giving you your trouble. I should say that that is fibrous matter forming round the piece of steel.”

He glanced at me quickly. “Something that oughtn’t be there?”

“Yes,” I said. “That is my own interpretation of these photographs. To some extent it is supported by the pathological report.”

He said weakly, “Well, that’s bloody good fun.”

There was a short silence. “Would that be what makes me feel tired, doctor?” he asked at last.

“I think so,” I replied. “It would account for that and for the disability of your right hand. It would account for
the fits of giddiness and fainting, and for your eye trouble. In fact, it fits in with most of the symptoms that you’ve got.”

He said, “I suppose this means I’ve got to have another operation.”

I was silent for a moment. “I’m a surgeon, Mr Turner,” I said at last. “I’ve been operating all my life, and mostly on the head. What I have to tell you now is that there are limits to the things that operative technique can achieve. If you have your leg cut off in some accident, the surgeon cannot operate and give you a new, wholesome leg. In the case of the cranium there are similar limits. There are some operations that one does not usually attempt.” I paused, and looked him in the eyes. “I’ve got to tell you, Mr Turner, that I think this is one of them.”

The slight grey on his rather florid face showed that he understood me. “You mean that if you tried to get that bit out, I’d die?” he asked.

I said evenly, “I’ve given this a lot of thought, Mr Turner. I have to tell you that I could not undertake such an operation with any expectation of success.” I paused. “At the same time, you must understand that that’s only my personal opinion, the personal opinion of one man. If you feel you would like to have another surgeon examine you and study these photographs, I should be very pleased to arrange it for you, or to co-operate with anyone you choose. Because one man admits defeat, it doesn’t mean that everybody else does, you know.”

He said, “You’re the best in England on this sort of thing, aren’t you, doctor? That’s what Dr Worth told me.”

“Oh no, I’m not,” I replied. “There are other people
here in London just as experienced as I am. You could see Mostyn Collis, for example.”

He said, “Well, what’s going to happen if you leave it alone, the way it is? Will it get any worse?”

I said, “It doesn’t have to get worse, but it may. I can give you certain palliative treatment that may arrest the lesion. That means it may heal up of itself and give you no further trouble.”

“Does that often happen?”

I shook my head. “Not very often, in my experience. I have known it to occur, though.”

He asked, “How often?”

I thought for a moment, and then I said, “Perhaps one case in ten improves under the sort of palliative treatment that we can apply. Not more, I’m afraid.”

“The other nine get worse?”

I nodded.

He whispered again, “Bloody good fun.”

There was a long silence in the little ward. A fly buzzed on the window pane, the knob at the end of the blind cord tapped on the window, the bright sun streamed in; from below came up the noise of London traffic. I sat by his bedside waiting for him. It’s best to give the patient plenty of time in a case like this. It’s all one can give.