[2003] LOSS & PORPHYRY the novels  

0071 – Part 8 - Hospitals

Some weeks later, having started my new job, I had decided that the most distinctive feature of hospitals in general was their smell. It was true that it no longer comprised that uniquely pungent mixture of disinfectants cut with traces of ether which had coloured the memories of my childhood. Then hospitals had held unknown, nameless, terrors for me, on the few occasions I had been dragged across their thresholds. When I started this new role, those terrors had still haunted me. But I found that modern disinfectants were now more subtly perfumed. The new anaesthetics had almost no smell at all and were much less inclined to explode.

One of the little known facts I had discovered, since joining this new job, was that explosions in operating theatres had been a not infrequent occurrence in the past. Hospitals were not the oases of safety that patients had been lulled into believing. Just entering one put a visitor at risk, from the infections that lay in the corners, or wafted on the scented air, ready to claim a new host. My mind, as it acquired these facts, was rather like that of a pack-rat. I revelled in storing away such inconsequential trifles of information, knowing full well I was never likely to use them, but attracted to them just for their own, bright and glittering, selves.

Even though hospitals no longer assaulted my nostrils with their presence, apart from the wards where the acrid smell of bedpans would remain for ever, their corridors had a lingering, unmistakable smell of hygiene at work. It included disinfectant and floor polish, as well as the less hygienic, distant, odour of stale food. But, most important, it excluded the homely smells that were to be found in other environments. The smell of normal people, which they carry around with them almost as if to emphasise their individuality, was excluded; as if, by design, the practitioners wanted to depersonalise even the atmosphere.

In my new job, and burdened by my pack-rat mind, I was rapidly becoming a connoisseur of hospitals. There were the modern district hospitals, the legacy of the 1970s Labour government's investment in promoting their cherished cause of the National Health Service; but which were, even then, starting to crumble around the edges, as if to add their own comment on the decline of the politics that had seen their birth. Then there were the old hospitals, the legacy of a confident Victorian belief in their ability to conquer the frontiers of disease just as much as those of the empire. Their staff were as proud of being the guardians of an 'infirmary' as they were of the 'Royal' accolade that was almost invariably included in the name. Both types of hospital featured acres of carefully polished linoleum. In the new hospitals this stretched into the distance. In the older ones it was interrupted by the accretions of generations. Scarce space was fought over with a degree of ferocity which would have frightened many generals, and even parts of the corridors had succumbed to encampments erected by the neighbouring departments exercising their territorial rights; and whose supposedly temporary nature was belied by their architecture which reeked of the generations before, when they had been first erected.

Musing on these thoughts of man's refusal to give up his territorial imperative even in the most unlikely of circumstances, I was negotiating the intricacies that had developed around the pedestrian arteries of one of the most revered of hospitals. The Chiswick Hospital, despite its very pedestrian name, had an academic reputation almost without parallel, even if it was, quite deliberately, relatively unknown outside the medical field. It was a teaching hospital of the first rank. There were, of course, many hospitals that could, and did, proudly claim that they were teaching hospitals, laboriously teaching the undergraduates who were to become the doctors of the future. There were, as I had now realised, far more teaching hospitals then the general public imagined. The proverbial man in the street, as I had previously been, held an image of all undergraduates being crammed into St Bartholomew's, St Thomas's and Guy's. These were, however, just a few that the medical profession themselves, contemptuous of the popular culture, recognised as being truly pre-eminent, and the Chiswick was one of these. Its staff well new its unique reputation within their own profession and, with professional arrogance, didn't care a damn for what the hoi poloi thought.

In fact the main corridor at the Hammersmith had changed remarkably little since Victorian times. The inevitable later accretions had been shoe-horned between the wards that ran off to each side; until the whole space seemed to be solid with buildings. Then they had started building upwards. I knew that the haematology clinic was buried deep in these added layers, somewhere at first floor level. After two false starts, and a number of requests for redirection, I eventually found a staircase hidden off the main corridor which sported a direction sign to the clinic. Even then, the unexpected dog-leg in the corridor, when I reached the first floor, sent me on yet one final false trail. I muttered to myself, as I wove my way between the patients and visitors thronging the corridors: 'The main skill involved in selling to the health service surely must be map-reading! I must spend half my life wandering lost around these mazes!'

At last I realised I had reached my first objective. Ahead stretched what was clearly the narrow corridor of the clinic, off which were the various treatment and consulting rooms. Narrow though the corridor was, the whole of one side was filled by a long line of the institutional, stackable chairs; those so expertly designed for temporary use but which are nearly always put to permanent use - their low cost imposing its price on those forced to endure the lack of comfort. On these chairs sat the queues of patients, waiting for their fate to be decided. By now I knew that the majority of them would have succumbed to one or other of the various forms of leukaemia. Their very presence in the hallowed domains of this clinic meant that the diagnosis would have been confirmed elsewhere, for the Chiswick normally only deigned to handle cases referred by other hospitals, and they would already have the knowledge of their desperate situation gnawing at their insides. They came looking for miracles, as some went to Lourdes. But, even though, this was surely one of the best clinics in the world, the doctors realistically chose to talk of the quality of life, rather than cure; knowing that only a minority would stand any chance of such a cure. It would be as much a function of fate, a spin of the cellular roulette wheel that governed success in this most difficult of medicines, than of their own professional skills.

Looking down that line of faces, though, I could see no sign of the turmoil that must have lain below the surface. All seemed composed, with that distantly vacant expression which is the accepted pose for all medical waiting rooms. It would only be when they reached home, and were in the arms of their loved ones, that the facade would crumble and the tears would come. Only then could they rail against the blind fate that was so determined to snuff out their existence.

Having achieved my first objective, of reaching the clinic, I now had to find someone in authority who would point me towards the consultant who was my target; who had, perhaps foolishly, crumbled before my telephonic blandishments and had agreed to see me. The corridor was patrolled by a veritable posse of nurses. For a few moments I halted my progress, and attempted to make sense of the hierarchy. Every hospital had its subtle differences in uniform, which distinguished the student nurse from the qualified nurse, from the staff nurse, from the sister. The problem was that each hospital noted these all important nuances of status by totally different devices. For some the hat, ranging from a token cap of lace precariously held on by hair pins through to a fairly close approximation of a vestigial nuns habit, was the arbiter of status. For others the detail on the sleeve, puffed or not, was what the students longed for.

By now I could recognise the sisters. Their dress almost always had the simplicity of command, but it was the authority of their posture as they issued their commands which really gave the secret away. The Japanese might determine their hen-pecking order by the depth of their bow, but the British nursing establishment depended on the straightness of the back. I didn't, however, want to attract their attention; I was still almost as afraid of them as were the patients.

The staff nurses, for whom I was now looking, could, paradoxically, usually be distinguished by the extra ornamentation of their attire; as if they were allowed a last fling of feminine whimsy before they had to settle down to the plain frumpery of being a sister. I eventually decided which of the figures in my field of view matched my expectations, and moved steadfastly towards her. I had already discovered that purposefulness was what was necessary to mark me out as being on the medical staff side of the divide between patient and doctor; and ensured that I commanded attention. Patients were, on the other hand, diffident and subservient. It was almost as if they too had a uniform, in this case only visible to the medical professionals. It was a mystery where they learnt their submissive role, but in any hospital it was immediately obvious to the trained eye just who were the patients.

'Could you tell me which is Bill Howell's clinic please,' my long practised sales skills had now taken over. By using my prospect's first name so confidently, I deliberately gave the impression I was already an acquaintance, if not even a colleague, of the consultant; who, in fact, I had never met. By this device I hoped that the path would be most easily smoother to my meeting; and the technique usually worked superbly well. Thus, buoyed up by my unflappable confidence, I sailed through the normal chaos of the clinic; led by the staff nurse into the treatment clinic at the end of the corridor.

It took me nearly ten minutes, and once more a number of false starts, to find my way through the labyrinth to the laboratory where Bill Howell would now meet me. In the event my delays didn't matter, for my target still hadn't returned.

The environment in the laboratory block was different again from that of the main hospital. It was much more like that of a university. The smell was of unknown chemicals and the hot oil of overheated machinery. It had none of the studied antisepsis that characterised the hospital itself. Instead there was clutter everywhere. It was almost as if its occupants were determined to live up to their own stereotype, that of the absent-minded professor.

Despite his being one of the leading consultants, Bill Howell's office was poky and located in the corner of the main laboratory. Inside, it carried on the almost studied theme of disorder. There were mounds of papers everywhere; on the shelves lining the walls, on top of the filing cabinets and all over the desk. I even had to move a pile of them so that I could sit on the visitor's chair. Waiting for my contact to return, I had plenty of time to study my surroundings; and try to judge the character of the man. The office had a determinedly academic air. The few books were either copies of theses or the proceedings of abstruse conferences. Most of the rest of the clutter comprised copies of journals; but scattered across the desk, apparently at random, were the sets of purple stained microscope slides which were so much the tool of the haematologist - and which so irrevocably determined the fate of their patients. On the pin-board above the desk were photographs and cards from some of the youngest of these patients. I hoped that they had been the successful ones.

I used the time to relax. It was part of my sales style that I was relaxed, but it didn't come naturally; I had to work on it continuously, as any actor works on his performance. In reality I was a bundle of nervous energy in every call. It was a feat of acting worthy of a graduate of RADA to appear so relaxed. It was fortunate that so much of any industrial salesman's time was taken up with waiting for calls. The image of the salesman racing from one call to another was a myth, at least amongst all the salesmen I knew. The longeurs of waiting, in a steamed up car, between the few calls that could be arranged were much more typical than the excitements of the call itself. But I found these periods of inaction almost essential; where I needed to relax before each meeting.

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